Personality disorder is a term that covers several different types of mental disorders that cause an unhealthy pattern of thinking, functioning and behaving. Most clients with personality disorders believe that their thought processes are normal, and everyone else is the problem; therefore, many may never seek counseling or therapy and go untreated. Personality disorders may develop from a history of childhood abuse or neglect, negative or traumatic experiences, or dysfunctional family life. Personality disorders are categorized into three clusters according to behavior: Cluster A disorders (Schizoid, Schizotypal) exhibit odd, or eccentric thinking and behavior, Cluster B disorders (Antisocial, Borderline, Narcissistic) exhibit dramatic, unpredictable and overly emotional behaviors, and Cluster C disorders (Obsessive-Compulsive, Avoidant) exhibit anxiety and fear.
The primary features of a personality disorder are self and interpersonal function and specific personality traits. For each disorder, there must be stability in the expression of the personality traits across a consistent period of time and situations. The client’s developmental stage, socioeconomic status or culture do not explain the difficulty in functioning and the impairments are not related to another mental or medical condition or substance use.
Client will develop ability to set realistic goals. Client will identify realistic personal strengths. Client will demonstrate a reduction in violent or manipulative behaviors. Client will demonstrate coping skills for anxiety.
Assess client’s neurological status
Determine if there are other conditions present and get baseline
Observe and identify behaviors and set clear limits with consequences
Helps to set and maintain structure and limits that develop feelings of security and safety
Be consistent when interacting with the client and in routine care
Changes in consistency threaten the structure of care and open up the opportunity for the client to use manipulative behaviors or tactics. Client may be resistant to change, so consistency helps encourage new thought processes.
Approach and interact with a calm, respectful, supportive and stable attitude
Personal insecurities or emotions can cause tension or power struggles with client. Professionalism helps improve client’s treatment and therapy and avoid negative behaviors.
Discuss with the client their plans and goals; help distinguish between positive, realistic goals and unrealistic goals
Help the client regain control of reality and become more focused. Helps the client understand their personal capabilities
Set realistic, short term goals for client and offer recognition for attaining those goals
Helps client realize their abilities and limitations. Encouragement improves self-esteem and cooperation.
Provide realistic feedback and evaluations
Manipulative behavior may ensue without honest, realistic interpretations of behavior or therapy progress and may negatively impact treatment.
Helps discern areas of improvement and areas that still need work
Enforce limits and consequences, and discourage hostile or aggressive behaviors
Helps reinforce structure and discourage inappropriate behaviors. Maintains safety of client and others.
Discuss alternative ideas or ways of thinking
Helps client develop coping skills for emotions or feelings
Monitor and encourage positive social interaction with others in a safe environment
Help clients develop positive social skills and healthy interactions. Offers an opportunity to learn new ways of dealing with social situations.
Teach clients relaxation techniques and deep breathing exercises
Help clients control anxiety and manage situations independently to reduce symptoms.
Provide resources and support for family members
Help family members learn to cope with effects of client’s disorder and develop effective communication skills.
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