1. Personality Disorders

2. Characteristics common to all PDs An enduring pattern… An enduring pattern… Inflexible and pervasive Inflexible and pervasive Significant distress or impairment Significant distress or impairment Stable and long lasting pattern Stable and long lasting pattern Not better accounted for… Not better accounted for… Not due to… Not due to…

3. ASPD 1. Review the sx 2. Common thinking errors…TIP-pg 368

4. “Key Issues” 1. Countertransference & Transference 2. Counselor Well-being 3. Resistance 4. Contracting

5. Guidelines in treating people with ASPD Accuracy of information provided by the client is questionable. Accuracy of information provided by the client is questionable. Clients will be motivated by how they will benefit from tx, not how others will. Clients will be motivated by how they will benefit from tx, not how others will. Clients often attempt to manipulate you, often through use of criticism or flattery. Clients often attempt to manipulate you, often through use of criticism or flattery. Clients will use intimidation, make overt or implied threats. Clients will use intimidation, make overt or implied threats. Avoid getting hooked in emotionally or allying too personally with the cx. Avoid getting hooked in emotionally or allying too personally with the cx. Role of control and “saving face” is significant influence on cx’s bx. Role of control and “saving face” is significant influence on cx’s bx.

6. Counseling Tips-pg 367 Corral Corral Confront Confront Consequences Consequences

7. BPD 1. Review sx 2. Sexual abuse-70% of inpatient cx. 3. Key Issues-pg. 355 http://www.youtube.com/watch?v=B3t8s2JvV Hg&feature=related http://www.youtube.com/watch?v=B3t8s2JvV Hg&feature=related http://www.youtube.com/watch?v=B3t8s2JvV Hg&feature=related http://www.youtube.com/watch?v=B3t8s2JvV Hg&feature=related http://www.youtube.com/watch?v=q7VFgEwn mdk&feature=related http://www.youtube.com/watch?v=q7VFgEwn mdk&feature=related http://www.youtube.com/watch?v=q7VFgEwn mdk&feature=related http://www.youtube.com/watch?v=q7VFgEwn mdk&feature=related

8. Self-mutilation What purpose does it serve? (source: Understanding and Treating BPD. Gunderson and Hoffman) 1. Affect regulation 2. Distraction-the act and associated rituals 3. Self punishment 4. Proof of emotional distress 5. Exertion of control 6. Alleviation of numbness/depersonalization (grounding) 7. Venting of anger 8. Chemical solution-higher level of opioids

9. Crisis Survival Skills – Marsha Linehan How is a crisis defined according to Linehan? What are the two choices a person has in a crisis? What are two skills a person can use when she/he can’t solve the problem? Examples of these skills?

10. An example-Emotion Regulation as a tool to reduce self-mutilation Emotion regulation defined: acknowledging and experiencing emotions, while preventing emotions from dictating one’s reactions. Emotion regulation defined: acknowledging and experiencing emotions, while preventing emotions from dictating one’s reactions. “Grounding” is one response that is helpful. (pg. 413-414) “Grounding” is one response that is helpful. (pg. 413-414)

11. Basic Training-relevant concepts 1. Names of emotions 2. Nature of emotions 3. Physical sensation associated with emotion 4. Origin of emotions 5. Limits of emotions 6. Options for responding to emotions

12. Skills training 1. Review cx’s knowledge of basic concepts. 2. Review the goal. 3. Demonstrate the skill 4. Have the cx practice the skill 5. Give feedback, answer questions, ask questions. 6. Practice again

13. Practice 1. Assign homework to create opportunities for practice 2. Plan for practicing it in natural situations 3. Follow up with discussion, problem solving, clarification, etc.