Why personality disorders are difficult to treat: Is there a cure?

• While there isn’t a cure for personality disorders, there are effective treatment methods out there for those who struggle with these conditions, such as therapy.
• These clients can often be described as “change-resistant” as they have a particularly difficult time making changes, even when those changes will benefit them.
• That said, therapists can still help these clients make the necessary changes to live a happier, healthier life, even if it takes some third wave treatment.
• Two staples of third wave treatment are acceptance and gratitude; strategies rooted in acceptance and gratitude help the individual understand and accept pain in their life.
• Furthermore, cognitive defusion and metaphors help those with personality disorders to become more aware of their thoughts and emotions, and therefore, adapt healthier habits.

Personality disorders are rooted in unhealthy thought and behavior patterns. Those with a personality disorder—be it narcissistic, avoidant, or obsessive-compulsive personality disorder—have a markedly difficult time functioning in their day to day. And while there is no cure, per se (there rarely is when it comes to mental illness), there are effective treatments out there for those afflicted.

Judith Belmont, a licensed professional counselor, tackled the topic of treating personality disorders in her book The Therapist’s Ultimate Solution Book. “Personality disorders are hard to treat, as psychological disturbance is woven into the fabric of one’s personality. It provides a backdrop for discrete mental health problems like depression, anxiety, substance abuse, eating disorders, etc.,” she tells us. However, they are not impossible to treat. Belmont helps to explain through her writing in The Therapist’s Ultimate Solution Book just how individuals with personality disorders can learn to cope in therapy.

Helping the Change-Resistant Client

“It is not surprising that clients with personality disorders are the ones who are the most change resistant,” says Belmont. “Since their ‘survival mode’ results quite often from trauma early on, from an unstable or even abusive childhood to traumatic love relationships, clients come to counseling needing support and nonjudgmental validation before they feel the safety net to make changes.” That said, sometimes traditional therapy treatment isn’t enough. And the therapist needs to go a little deeper, to implement additional approaches, which Belmont refers to as the third wave of treatment.

Two staples of this third wave, which prove to help change-resistant clients such as those with personality disorders, are acceptance and mindfulness. “Mindfulness and acceptance strategies help treatment-resistant clients accept the inevitability of some pain in their lives which helps them develop a more objective, mature, and detached, awareness of their difficult emotions and thoughts,” she explains. “Rather than feeling immobilized by these emotions and thoughts and seeing things in absolutes (i.e., ‘I will never get over this’ or “He is bad and I hate him’), our change-resistant clients can be taught ways to be more flexible in their perceptions.”

Implementing the Third Wave of Treatment

As Belmont stated above, practices in this third wave of treatment help the individual to become more aware of their thoughts and emotions. The following two strategies often prove effective in doing so:

1) Cognitive defusion.

• Have you ever heard the saying, “Take what they say with a grain of salt”? Essentially, this means, don’t invest a lot of time, energy, or thought into what he or she says. Well, many of us could benefit from applying that to ourselves; from taking what we think with a grain of salt.

Cognitive defusion is rooted in the notion that we amplify our thoughts and take them way too seriously. We should instead “defuse” ourselves from our harmful thinking patterns. “In the act of cognitive defusion, which is a cornerstone of acceptance strategies, problematic thoughts and emotions are experienced indirectly by an ‘observing head’ that looks at troubling emotions nonjudgmentally rather than looking from them,” Belmont explains. “The phrase ‘don’t believe everything you think’ is an example of a non-judgmental stance.”

2) Metaphors.
“She was an old flame.” This is a common metaphor used to describe a past romantic interest. There are loads of metaphors out there, of which you probably hear or say every single day. But have you ever considered how it might help you to process your emotions?

Belmont says that metaphors are also an effective tool used in the third wave of treatment to help the individual better understand their thoughts and feelings. “For the change-resistant client, metaphors can also significantly unlock emotion and insight where mere talking cannot. Metaphors conjure up images that promote understanding,” she explains.

“Such clients come to therapy seeking a refuge of peace and security, often raw over the unpredictability of others in their lives and driven by the need for predictability and stability,” says Belmont. Fortunately, the third wave of treatment and the strategies listed above can help these individuals find that peace and security.

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