Therapy For Clients With Personality Disorders 805349

Therapy For Clients With Personality Disordersindividuals With Persona

Individuals with personality disorders often face significant challenges in altering longstanding patterns of thought, emotion, and behavior that impede their daily functioning and relationships. These enduring patterns are deeply ingrained, making treatment complex for both clinicians and clients. The DSM-5-TR (American Psychiatric Association, 2022) identifies several personality disorders; for this discussion, I will focus on narcissistic personality disorder (NPD), which is characterized by a pervasive pattern of grandiosity, need for admiration, and lack of empathy, beginning by early adulthood and present in various contexts. The DSM-5-TR criteria for NPD include five or more of the following: a grandiose sense of self-importance, preoccupation with fantasies of unlimited success, belief that they are special and unique, requiring excessive admiration, a sense of entitlement, interpersonal exploitiveness, lack of empathy, envy of others or belief that others envy them, and arrogant behaviors or attitudes.

When treating clients with NPD, a suitable therapeutic approach is psychodynamic therapy combined with cognitive-behavioral therapy (CBT). Psychodynamic therapy aims to uncover underlying patterns rooted in early life experiences that feed the client's grandiosity and lack of empathy. CBT can challenge distorted beliefs about self-importance and foster more realistic self-assessment and empathy. I would choose an individual therapy modality because it allows the focus to be tailored specifically to the client's needs while maintaining confidentiality and providing a safe space to explore vulnerable issues often concealed behind narcissistic defenses. This modality is appropriate as it offers the direct intervention needed to address the client's core personality traits and maladaptive patterns, which are central to NPD (American Psychological Association, 2020; Paris, 2015).

Therapeutic Relationship in Psychiatry and Sharing Diagnosis

The therapeutic relationship in psychiatry is a collaborative and trusting alliance between clinician and client, characterized by empathy, respect, and clarity. Establishing a strong therapeutic rapport is essential for effective treatment, especially with clients who may have difficulty trusting or vulnerability due to their personality disorder. Sharing a diagnosis like NPD must be handled delicately to avoid damaging this rapport. Transparency about the diagnosis helps normalize the client's experiences while emphasizing that the diagnosis is a tool for understanding and treatment rather than a judgment (Wheeler, 2020).

When sharing the diagnosis with an individual client, I would approach it with sensitivity, focusing on how the traits associated with NPD impact their life and relationships, thereby fostering insight without stigmatization. For example, I might say, “You might find that some of your behaviors or thoughts, like seeking admiration or believing you're better than others, could be linked to a pattern known as narcissistic personality traits. Understanding this can help us work together to develop healthier ways of relating to yourself and others.”

In a family context, I would discuss the diagnosis by explaining that some behaviors of their loved one may be linked to this personality pattern, emphasizing the importance of understanding rather than blame. For example: “Your family member's need for admiration or difficulty empathizing can be part of a personality pattern. With proper support and understanding, you can help create a more supportive environment.”

In group sessions, I would introduce the diagnosis carefully, framing it as a common pattern that affects many individuals and focusing on shared experiences rather than labels. This approach promotes empathy among group members, encourages mutual understanding, and fosters a supportive environment for change (Symptom Media, 2020; Wheeler, 2020).

Conclusion

Effective treatment of personality disorders like NPD requires a nuanced understanding of the disorder’s core features and a therapeutic approach tailored to these traits. Psychodynamic therapy combined with CBT offers a comprehensive strategy to address underlying vulnerabilities and maladaptive behaviors. Equally important is the manner in which therapists introduce and communicate the diagnosis, ensuring that the therapeutic alliance remains strong and that clients feel understood and supported. Transparent, empathetic communication—adapted to individual, family, or group contexts—helps foster hope for change while maintaining trust and respect.

References

• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing.
• American Psychological Association. (2020). Wheeler, K. (Ed.). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. Springer.
• Paris, J. (2015). Psychotherapies. In A concise guide to personality disorders (pp. 45-67). American Psychological Association.
• Symptom Media. (2020). Antisocial personality disorder ASPD [Video]. YouTube.
• Symptom Media. (2020). Histrionic disorder [Video]. YouTube.
• Symptom Media. (2020). Narcissistic personality disorder [Video]. YouTube.
• Wheeler, K. (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.