Many therapists and counselors avoid working with personality disorders like they will transmit the plague to them. Believe me, I understand why. They are some of the most difficult clients you will ever work with, and will challenge your skill, adaptability, and resolve more than once.
In grad school we learn about transference and countertransference, our feelings working with clients, and how we transfer these feelings to them and vice versa. These are things to have a heightened sense of, when working with anyone with a personality disorder.
I’ll stop short of saying I love working with clients with personality disorders. It certainly has its difficult times that make you question your ability to continue to do so, but I will say that I have learned to like it, and here are the reasons why.
I instantly become an “expert” in working with them
I think the reason for this is two-fold; as a Master’s level provider, Ph.D. or PSYD, we always end up in situations where we defer to a Psychiatrist, being both MD’s and having an education in psychology, they are often the go-to when working as a team. However, there are no medications that treat personality disorders. Many clients may suffer from multiple disorders, and may be treated with medications for another disorder parallel to your counseling for the personality disorder, but you ultimately hold the keys to helping them with this particular problem area in their lives.
They often have “burnt their bridges” and lack stability in their lives
This may not seem like a good thing, but the reality is, when you are working with someone in this scenario, they often end up working with you because they have nowhere else to go, no one else to talk to, and leave you with a very clear starting point… establishing insight and some internal locus of control (simply put, taking responsibility for outcomes) into the reason they are where they are, and why they lack stability in their lives. This is almost always your starting point when working with individuals with personality disorders, and in my opinion, is refreshing.
The changes are profound when they happen
I hold firm with my belief that individuals with personality disorders have the greatest potential to succeed at their goals. We tend to look at individuals with personality disorders as having a very poor prognosis due to the fact that they have difficulty maintaining relationships with those trying to help them. But, when you look past that point and have seen people develop an internal locus of control, identify their own behaviors and thought processes as problematic, and put in the hard work necessary, you see what I have seen…. Success, and an amazing life ahead of someone who no one wanted to work with due to their poor prognosis and their difficulty connecting with providers.
Why the positivity on a difficult topic?
I often times work with tough clients. I have seen great things, and big success come from clients that I had officially or unofficially given a poor prognosis. One thing I have learned is that people will amaze you every day if you give them the potential to do so. Some people have profound realizations while you are working with them. I’d like to take the credit, but I am wise enough to realize that sometimes the moment is just right for them. If you work with clients who struggle with personality disorders, make sure you are there to support them when the moment is right because chances are others have already decided they cannot or will not.
