The Dance of Power…Frustrating the DRAMA! Presented by: Josh Smith, LMSW, BCD Co-Owner of The DBT Center of Michigan Owner of The DBT Center of Western Kentucky

Normal Personality vs. Disordered Personality Primary Characteristics of Normal Personality Problem solving process: 1)Problem is defined “operationally” (all the things that lead to this happening) 2)Possible solutions are thought about 3)Solution(s) selected 4)Implement solution 5)Results are evaluated 6)Adjustments are made Process called: Problem Solving Goal of process: Create solutions and adaptations

Normal Personality vs. Disordered Personality Primary Characteristics of Disordered Personality Problem Solving Process 1)Problem is defined “personally” 2)Agreement and disagreement is generated 3)Responses and behaviors are justified 4)Problem remains unaddressed, enhanced or multiple problems occur 5)Identity is validated and gains additional agreement Process called: DRAMA Goals of process: Validate position (identity)

Rescue r Persecutor Victim The Drama Triangle

Primary Traits of DRAMA A)Overt (what they want others see) purpose: – To show you that my behaviors are justifiable, reasonable and understandable B) Covert (what I want to see in myself) purpose: – To validate or verify my own position/identity rather than reach a workable outcome

Primary Traits of DRAMA, cont. C) We enter into the drama triangle through one of the positions and will “switch” to get back to or end up in our “home” (covert) position D) This creates stimulation in order to substantiate their identity (existential position) E) This produces new problems or to intensify current problems

Primary Traits of DRAMA, cont. F) To resist being exposed to intervention or exposed to change G) Designed to propagate itself and to get others to participate in the DRAMA

The severity of a personality disorder is identified by the intensity of the DRAMA 3 degrees of drama 1 st degree: Socially acceptable – Traits 2 nd degree: Socially unacceptable – Breaks social rules – Hides, sneaks, denies or rationalizes – No self-observational capacity 3 rd degree: Life-Threatening – Breaks survival rules

Cluster B Personality Disorders “The Immature Type”

Antisocial Personality Disorder Published in DSM-II (replaced “psychopath”) 1% -3% of general population 3% - 30% of clinical population (obviously higher in forensic settings) Violates agreements which violates society Do not keep commitments/agreements Functional trait: EXPLOITATION **A pervasive pattern of disregard for and violation of the rights of others**

More stats on APD 94% have a history of trouble with employment and jobs 85% have history of some violence 72% have multiple moving violations 67% have severe marital problems 47% have a significant arrest record Psychotherapy outcomes: Only helps when they are able to be made to feel guilty

Drama Pattern of APD Drama entry point: RESCUER or VICTIM Drama switch: RESCUER to PERSECUTOR VICTIM to PERSECUTOR Home position: PERSECUTOR Example: “I’m smart. I didn’t sign the bottom line. He should of known better. He made the mistake and he got what he deserved.”

The Drama Triangle Rescue r Persecutor Victim Deception of trustworthiness (RESCUER) or neediness (VICTIM) Opens the door for exploitation and take advantage of (PERSECUTOR)

Borderline Personality Disorder.4% - 5.5% of general population 10% of outpatient clients 20% of inpatient clients 9 – 11% will die by completed suicide A disorder of the emotion regulation system Functional trait: INTENSE changeability/instability in moods ***A pervasive pattern of instability of mood, affect, impulsivity, interpersonal relationships and self-image***

Drama pattern of BPD Drama entry point: VICTIM or RESCUER Drama switch: VICTIM to PERSECUTOR RESCUER to PERSECUTOR Home position: VICTIM Ex: “I hurt myself because you didn’t return my phone call.”

The Drama Triangle Rescue r Persecutor Victim Feeling attacked and victimized of self (VICTIM) or others (RESCUER) Have the right to get even with or back at (PERSECUTOR)

Histrionic Personality Disorder Most common Cluster B disorder 1.6% - 3.9% of general population 10% - 15% of clinical population No long-term studies Functional trait: EXPRESSIVENESS ***A pervasive pattern of excessive emotionality and attention seeking”

Drama Pattern of HPD Drama entry point: VICTIM Drama switch: VICTIM to PERSECUTOR PERSECUTOR to VICTIM Home position: VICTIM Ex: “Are you kidding me!?!?” “WOW! I don’t believe it!” “I just can’t do that. It’s too much.”

The Drama Triangle Rescue r Persecutor Victim Immature/Childlike neediness (VICTIM) Over-the-top/Excessive demands (PERSECUTOR) Whiny complaints (VICTIM)

Narcissistic Personality Disorder Least common of the Cluster B PDs.4% - 5.5% of the general population 2% - 16% of clinical population “Arrogant, haughty behaviors” are the most reliable diagnostic criteria Deficient in equality and empathy Norway twin study found 77% of traits appear to biological Functional trait: Self-Exaggeration ***A pervasive pattern of grandiosity in behavior or fantasy***

Drama Pattern of NPD Drama entry point: RESCUER Drama switch: RESCUER to PERSECUTOR Home position: PERSECUTOR Ex: “I’m everything and untouchable; you’re nothing.”

The Drama Triangle Rescue r Persecutor Victim Being important and held in high regards (RESCUER) Others are less than and belittled (PERSECUTOR)

Wrap-Up Review Q & A Contact Information: Josh Smith