Writings from Christine

Safeguards for Therapists Working with Anti-Social Personality Disorders

by Christine Hammond on October 12, 2017

Some of the most stimulating therapy sessions are from clients who have Anti-Social Personality Disorder. There is never a dull moment. Their stories are fascinating and fabricated, their perception is unnerving and improbable, and their behavior is eccentric and luring. But with them comes the unpredictability of the next session and the likelihood that not much progress will be made.

1. When possible, obtain psychological testing confirming the type of personality disorder. The co-morbidity rate is high on personality dysfunctions. This is the reason the DSM-V is considered an alternative definition. Knowing a person is above average on the Anti-social or Paranoid scale is of particular importance for safety reasons.
2. What do they want from therapy? Hint: It is not about healing. Rather, they want an egocentric benefit from the experience. Some common reasons are manipulation of a family member, perpetuating fraudulent legal action, or sustaining deceptiveness at work. Therapists become a cover and can unintentionally lend credibility to the latest fabrication.
3. Set unspoken, basic, and personal goals for the sessions such as gaining trust. Do not over-reach; this only causes frustration for the therapist, not the client. They require a consistent unwavering message over a long period of time. Slow and steady is the best moto.
4. Ask for a signed release to speak with family members. Not immediately, as that will push them away. Instead, ask for it after a couple of sessions. Most likely, the family members need the most assistance which is a wonderful point to make to the client. They will not be upset that their therapist believes their family needs more help than them.
5. Take notes on everything, especially the stories. If possible, collect emails or text notes to keep the stories straight. Lying, exaggerating, and gaslighting come naturally to them. So any evidence can help recall the events more accurately. This is for the therapist’s clarity, not the client.
6. Expect to be lied to on a regular basis even about small and insignificant matters. While the goal of therapy is to have them trust the therapist, the therapist should not trust the client. Instead, take inventory of all propaganda and try to put a date on the events in the notes. This small effort will be useful later when stories aren’t consistent. Don’t be surprised by that, is part of the dysfunction.
7. Do no harm. This is not about harm to the client; rather it is about whom the client might harm. Even a seasoned therapist might teach realization of abuse tactics as a way to heal from trauma. This population absorbs such information and alters it to damage others. They might say they want to heal but what is really desired are more methods of abuse.
8. Listen, ask questions, and offer no advice. This is the best safeguard of all, silence. When advice is solicited, therapists should reframe their questions or ask for more clarity instead of answering. It is important to avoid any attempts to trap a therapist into an opinion that could be manipulatively used later.
9. Emotional detachment is essential. Do not allow emotions of empathy to cloud judgment. This is a common method of scheming designed to gain sympathy and vulnerability. They are notoriously good at reading the emotions of others and twisting them for some personal gain. Remaining detached is self-protection.
10. Don’t take intimidating personally. Some will make bold, threatening statements just to see how a therapist responds. Have some responses preplanned to prevent getting caught off guard. A therapist should expect hostile behavior at some point during the therapeutic process. This is a normal expectation of this population and a strong indicator of a personality disorder.
11. Have limits already been established? Therapists can fire clients. Knowing this boundary prior to an event is preferable. For instance, if a client violates the law such as secretly recording sessions without permission, have a standard already set. This is not for the safety of the client, but the therapist.
12. Be careful about disclosing personal information. Any and all personal information can be used as emotional blackmail in the future. Most clients will insist on some disclosure to share trust. Remember what was discussed and avoid any attempts to supplement the information at another session. Keep a safe distance.
13. Be safe by having a co-worker on alert. A therapist should notify someone that a client has a personality disorder and may be unstable. This can be done tactfully without revealing any confidence. If needed, have a secret code that indicates trouble. Hopefully, this will never be used but is good to have.
14. Talk to another therapist. Working with them can be frustrating. Don’t do this alone as two minds are better than one. This is especially true if the other therapist is well versed in personality disorders.

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