Cognitive therapy

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  • Avoiding contact with others
  • Cognitive therapy

    1. 1. Personality Disorders: APersonality Disorders: ACognitive Behavioral TherapyCognitive Behavioral TherapyPerspectivePerspectiveGreg Meyer, LCSW CBIS
    2. 2. Aaron Beck 1960Aaron Beck 1960 Thoughts influence feelingsThoughts influence feelingsEvent Thoughts Feelings Actions Results
    3. 3. Levels of CognitionLevels of CognitionAutomaticThoughtsConditional AssumptionsCore Beliefs
    4. 4. Core beliefsCore beliefs Feel like factsFeel like facts Beliefs about self, others, the worldBeliefs about self, others, the world Acts like a filter or lens which weActs like a filter or lens which weappraise situationsappraise situations Axis 1 beliefs are less consciousAxis 1 beliefs are less conscious Axis 2 readily apparentAxis 2 readily apparent
    5. 5.  Piaget coined the term “Schema”Piaget coined the term “Schema”meaning ‘structures that integratemeaning ‘structures that integratemeaning into events’meaning into events’ Beck: cognitive structures that organizeBeck: cognitive structures that organizeexperience and behaviorexperience and behavior Landau and Goldfried: a mental filterLandau and Goldfried: a mental filterthat guides the processing ofthat guides the processing ofinformationinformation
    6. 6. Core beliefs/Schemas aboutCore beliefs/Schemas aboutselfself HelplessHelpless UnlovableUnlovable Unworthy/WorthlessUnworthy/Worthless FailureFailure UndeservingUndeserving IncompetentIncompetent Toxic (more with Axis 2)Toxic (more with Axis 2)
    7. 7. Core beliefs/Schemas aboutCore beliefs/Schemas aboutOthersOthers Pt with challenging problems often perceivePt with challenging problems often perceiveothers in a rigid, over generalized,others in a rigid, over generalized,dichotomous way and generally don’t see thatdichotomous way and generally don’t see thatothers are complex human beings whoothers are complex human beings whodemonstrate traits to a greater or lesserdemonstrate traits to a greater or lesserdegree in various situations.degree in various situations. Others are superior to meOthers are superior to me Others are inferior to meOthers are inferior to me Others are untrustworthyOthers are untrustworthy Others are nurturing/necessaryOthers are nurturing/necessary Others are incompetentOthers are incompetent
    8. 8. Core beliefs/Schemas aboutCore beliefs/Schemas aboutthe Worldthe World Pt’s with dysfunctional beliefs mayPt’s with dysfunctional beliefs maybelieve that they cannot get what heybelieve that they cannot get what heywant from life because of the obstacleswant from life because of the obstaclestheir world presentstheir world presents The world is dangerousThe world is dangerous The world is unpredictableThe world is unpredictable The world is unfair and unfriendlyThe world is unfair and unfriendly
    9. 9. Why patients believe theirWhy patients believe theircore beliefs so strongly?core beliefs so strongly? Pt continually selectively focuses onPt continually selectively focuses ondata that confirms his/her negativedata that confirms his/her negativeviewsviews Pt discounts data contrary to his/herPt discounts data contrary to his/herbeliefbelief Pt fails to recognize contrary dataPt fails to recognize contrary data
    10. 10. Behavioral StrategiesBehavioral StrategiesCore BeliefCore Belief Coping strategiesCoping strategies““I amI aminadequate”inadequate”Rely on others to try toRely on others to try tooverachieveoverachieve““I am nothing”I am nothing” Withdraw, avoid intimacy, beWithdraw, avoid intimacy, bedramatic, or act entitleddramatic, or act entitled““I amI amvulnerable”vulnerable”Act strong, dominate, or avoidAct strong, dominate, or avoidany possibility of being hurtany possibility of being hurt
    11. 11. Conditional AssumptionsConditional Assumptions Attitudes/RulesAttitudes/Rules Believe that if one uses their coping strategyBelieve that if one uses their coping strategythey would be okay- but if they don’t theirthey would be okay- but if they don’t theircore beliefs will become evident or come truecore beliefs will become evident or come true E.g. Core Belief “I am vulnerable”E.g. Core Belief “I am vulnerable”Assumption “If I let my guard down, I’ll get hurt.”Assumption “If I let my guard down, I’ll get hurt.” Core belief “I am bad” Assumption “ If I blameCore belief “I am bad” Assumption “ If I blameit means I’m okay” or “If I make a mistake, I’mit means I’m okay” or “If I make a mistake, I’mbad”bad”
    12. 12. Situations that triggerSituations that trigger automaticautomatic thoughtsthoughts Discrete eventsDiscrete events Distressing thoughtsDistressing thoughts MemoriesMemories ImagesImages EmotionsEmotions BehaviorsBehaviors Physiological sensationsPhysiological sensations Mental sensationsMental sensations
    13. 13. Cognitive Conceptualization DiagramCognitive Conceptualization DiagramCore Belief: I am helplessCondition assumptions: “If I avoid challenges, I’ll be okay”“If I try to do difficult things, I won’t be able toAutomatic thoughts: “What’s the use. No one will believe me anyway.Nothing is going to change”Situation: Thinks about talking to social worker to address issues withstaff not meeting his/her needsBehavior: stays on room, avoids contact with staffCoping Strategies: avoids doing tasks that she perceives to beDifficult, avoids situations which she might be asked to do something she feelsincapable to doEmotion: HopelessMeaning of A.T.: “I’m helpless”
    14. 14. Personality DisordersPersonality Disorders DSM-IV: an enduring pattern of inner experience andDSM-IV: an enduring pattern of inner experience andbehavior that deviates markedly from thebehavior that deviates markedly from theexpectations of the individuals culture, is pervasiveexpectations of the individuals culture, is pervasiveand inflexible, has an onset in adolescence or earlyand inflexible, has an onset in adolescence or earlyadulthood, is stable over time, and leads to distressadulthood, is stable over time, and leads to distressor impairment.or impairment. Characterized by having a relatively small set ofCharacterized by having a relatively small set ofbehavioral strategies that they use across situationsbehavioral strategies that they use across situationsand across time, even when the strategies are clearlyand across time, even when the strategies are clearlydysfunctionaldysfunctional It is important to view strategies as more or lessIt is important to view strategies as more or lessadaptive vs good or bad.adaptive vs good or bad.
    15. 15. Histrionic Personality DisorderHistrionic Personality Disorder Beliefs about Self:Beliefs about Self: “I am nothing” activated when“I am nothing” activated whenothers are inattentive or disapproving, “ I am wonderful”others are inattentive or disapproving, “ I am wonderful”activated when others display a positive reaction towards theactivated when others display a positive reaction towards thepatient.patient. Conditional Assumptions:Conditional Assumptions: “If I entertain“If I entertainothers, they’ll like me (but if I don’t, they’ll ignore me), “If I’mothers, they’ll like me (but if I don’t, they’ll ignore me), “If I’mdramatic, I’ll get my needs me (but if I’m not, I won’t get what Idramatic, I’ll get my needs me (but if I’m not, I won’t get what Ineed from other people)need from other people) Overdeveloped Coping strategies:Overdeveloped Coping strategies:Being overly dramatic, dressing, acting, speaking seductively,Being overly dramatic, dressing, acting, speaking seductively,entertaining others, seeking adulation.entertaining others, seeking adulation.
    16. 16. Histrionic Personality DisorderHistrionic Personality Disorder Underdeveloped Coping Strategies:Underdeveloped Coping Strategies: BeingBeingquiet, submissive, blending in with others, holding reasonablequiet, submissive, blending in with others, holding reasonablestandards for others’ behavior towards the patient, valuing acting withinstandards for others’ behavior towards the patient, valuing acting withinnormal limits.normal limits. Therapy-InterferingTherapy-Interfering Beliefs:Beliefs: “If I entertain my“If I entertain mytherapist, she will like me”, “If I dramatize my problems, my therapisttherapist, she will like me”, “If I dramatize my problems, my therapistwill want to help me”, “If I act ‘normally’ in treatment, I’ll be average andwill want to help me”, “If I act ‘normally’ in treatment, I’ll be average andboring”boring” Therapy-Interfering Behaviors:Therapy-Interfering Behaviors: Creating aCreating adramatic appearance, speaking entertainingly, acting seductively,dramatic appearance, speaking entertainingly, acting seductively,soliciting adulation, avoiding homework assignments that lead thesoliciting adulation, avoiding homework assignments that lead thepatient to feel ordinary.patient to feel ordinary.
    17. 17. Obsessive-Compulsive PersonalityObsessive-Compulsive PersonalityDisorderDisorder Beliefs about Self:Beliefs about Self: “I am vulnerable to bad things happening”, “I“I am vulnerable to bad things happening”, “Iam responsible for preventing harm”,am responsible for preventing harm”, Beliefs about Others:Beliefs about Others: “Other people weak, irresponsible,“Other people weak, irresponsible,careless”careless” Conditional Assumptions:Conditional Assumptions: “If I take responsibility for“If I take responsibility foreverything, I’ll be okay (but if I depend on others , they’ll let me down), “If Ieverything, I’ll be okay (but if I depend on others , they’ll let me down), “If Icreate and maintain order for myself and others and do everything perfectly, mycreate and maintain order for myself and others and do everything perfectly, myworld will be okay (but if I don’t, everything will fall apart)”.world will be okay (but if I don’t, everything will fall apart)”. Overdeveloped Coping Strategies:Overdeveloped Coping Strategies: Rigidly controllingRigidly controllingself and others, creating unreasonable expectations, assuming too muchself and others, creating unreasonable expectations, assuming too muchresponsibility, striving for perfectionresponsibility, striving for perfection
    18. 18. Obsessive-Compulsive PersonalityObsessive-Compulsive PersonalityDisorderDisorder Underdeveloped Coping Strategies:Underdeveloped Coping Strategies: DelegatingDelegatingauthority, developing flexible expectations, exercising control only whenauthority, developing flexible expectations, exercising control only whenappropriate, tolerating uncertainty, acting spontaneously and impulsively,appropriate, tolerating uncertainty, acting spontaneously and impulsively,seeking fun and pleasurable activities.seeking fun and pleasurable activities. Therapy-Interfering Beliefs:Therapy-Interfering Beliefs: “If I don’t correct my therapist“If I don’t correct my therapistand tell her exactly what she needs to know, she will not be able to help me.”,”If Iand tell her exactly what she needs to know, she will not be able to help me.”,”If Idon’t do my therapy assignments perfectly, therapy won’t work.”,”If I lower mydon’t do my therapy assignments perfectly, therapy won’t work.”,”If I lower myexpectations for myself and others, bad things will happen”expectations for myself and others, bad things will happen” Therapy-Interfering Behaviors:Therapy-Interfering Behaviors: Trying to control session,Trying to control session,trying to impart perfectly correct information, being hypervigilant for therapist’strying to impart perfectly correct information, being hypervigilant for therapist’slack of understanding, spending excessive time and care on homework,lack of understanding, spending excessive time and care on homework,resisting assignments to be spontaneous and delegate responsibility.resisting assignments to be spontaneous and delegate responsibility.
    19. 19. Passive-AggressivePassive-AggressivePersonality DisorderPersonality Disorder Beliefs about Self:Beliefs about Self: “I am vulnerable to be controlled by“I am vulnerable to be controlled byothers.”,”I am misunderstood and unappreciated.”others.”,”I am misunderstood and unappreciated.” Beliefs about Others:Beliefs about Others: “Other people are strong,“Other people are strong,intrusive, demanding”,”They have unreasonable expectations ofintrusive, demanding”,”They have unreasonable expectations ofme”,”They should leave me alone”me”,”They should leave me alone” Conditional Assumptions:Conditional Assumptions: “If others control me, it“If others control me, itmeans I’m weak.”,”If I exert indirect control (e.g. by agreeing outwardlymeans I’m weak.”,”If I exert indirect control (e.g. by agreeing outwardlybut not following through), others will be unable to control me (but if Ibut not following through), others will be unable to control me (but if Iassert myself directly, it won’t work).assert myself directly, it won’t work).
    20. 20. Passive-AggressivePassive-AggressivePersonality DisorderPersonality Disorder Overdeveloped Coping Strategies:Overdeveloped Coping Strategies: Pretending toPretending tocooperate, avoiding asserting, confrontation, and direct refusal, resisting others’cooperate, avoiding asserting, confrontation, and direct refusal, resisting others’control passively, resisting taking on responsibility, resisting fulfilling otherscontrol passively, resisting taking on responsibility, resisting fulfilling othersexpectations.expectations. Underdeveloped Coping Strategies:Underdeveloped Coping Strategies: Cooperating,Cooperating,assuming reasonable responsibility for self and others, doing straightforwardassuming reasonable responsibility for self and others, doing straightforwardinterpersonal problem solving.interpersonal problem solving. Therapy-Interfering Beliefs:Therapy-Interfering Beliefs: “If I do what my therapist asks,“If I do what my therapist asks,it means she’s in control and I’m weak”,”If I assert myself directly with myit means she’s in control and I’m weak”,”If I assert myself directly with mytherapist, she’ll exert more control”,”If I improve through therapy, other peopletherapist, she’ll exert more control”,”If I improve through therapy, other peoplewill expect too much from me.”will expect too much from me.” Therapy-Interfering Behaviors:Therapy-Interfering Behaviors: Collaboratively settingCollaboratively settinghomework assignments but failing to follow through, remaining passivehomework assignments but failing to follow through, remaining passiveduring problem solving, outwardly agreeing with what therapist says butduring problem solving, outwardly agreeing with what therapist says butprivately disagreeing.privately disagreeing.
    21. 21. Borderline PersonalityBorderline PersonalityDisorderDisorder Beliefs about Self:Beliefs about Self: “I am bad, worthless”,”I am unlovable,“I am bad, worthless”,”I am unlovable,defective”,”I am helpless, out of control”,”I am incompetent”,”I am weak anddefective”,”I am helpless, out of control”,”I am incompetent”,”I am weak andvulnerable”,”I am a victim”vulnerable”,”I am a victim” Beliefs about Others:Beliefs about Others: “ Others are strong”,”Others are potentially“ Others are strong”,”Others are potentiallyhurtful”,”Others are superior”,”Others will reject and abandon me”hurtful”,”Others are superior”,”Others will reject and abandon me” Conditional Assumptions:Conditional Assumptions: “”If I avoid challenges, I’ll be“”If I avoid challenges, I’ll beokay(but if I take on challenges, I’ll fail),”If I depend on others, I’ll be okay (but ifokay(but if I take on challenges, I’ll fail),”If I depend on others, I’ll be okay (but ifII don’t, I won’t survive”,”If I do everything others want, they may stay with me forII don’t, I won’t survive”,”If I do everything others want, they may stay with me forthe time being (but if I displease them, they’ll abandon me sooner),”If I amthe time being (but if I displease them, they’ll abandon me sooner),”If I amhypervigilant for harm from other people, I can protect myself(but if not,I’ll gethypervigilant for harm from other people, I can protect myself(but if not,I’ll gethurt)”,”If I punish others when I’m upset, I can feel more powerful and perhapshurt)”,”If I punish others when I’m upset, I can feel more powerful and perhapscontrol their future behavior (but if I don’t, I’ll feel weak and they may hurt mecontrol their future behavior (but if I don’t, I’ll feel weak and they may hurt meagain)”,”If I cut off my negative emotions, I’ll be okay (but if I don’t, I’ll fall apart”.again)”,”If I cut off my negative emotions, I’ll be okay (but if I don’t, I’ll fall apart”.
    22. 22. Borderline PersonalityBorderline PersonalityDisorderDisorder Overdeveloped Coping Strategies:Overdeveloped Coping Strategies: MistrustingMistrustingothers, blaming others, avoiding challenges, depending on others, overlyothers, blaming others, avoiding challenges, depending on others, overlysubjugating self or dominating others, avoiding negative emotions, self harmingsubjugating self or dominating others, avoiding negative emotions, self harmingwhen emotions are intensewhen emotions are intense Underdeveloped Coping Strategies:Underdeveloped Coping Strategies: Balancing one’sBalancing one’sneeds against another’s, looking for nonmalignant explanations for others’needs against another’s, looking for nonmalignant explanations for others’behavior, trusting others, calming self down, solving interpersonal problems,behavior, trusting others, calming self down, solving interpersonal problems,persisting in difficult activitiespersisting in difficult activities Therapy-Interfering Beliefs:Therapy-Interfering Beliefs: “I can get better and survive“I can get better and surviveonly if I completely depend on my therapist”,”If II trust my therapist, she’ll end uponly if I completely depend on my therapist”,”If II trust my therapist, she’ll end uprejecting and abandoning me, so I might as well reject her first”,”If I focus onrejecting and abandoning me, so I might as well reject her first”,”If I focus onsolving problems, it won’t work and Ill end up feeling worse”.solving problems, it won’t work and Ill end up feeling worse”. Therapy-Interfering Behaviors:Therapy-Interfering Behaviors: Disparaging theDisparaging thetherapist, overly relying on the therapist to feel better, making too manytherapist, overly relying on the therapist to feel better, making too manycrisis calls between sessions, demanding entitlements from thecrisis calls between sessions, demanding entitlements from thetherapist.therapist.
    23. 23. Dependent PersonalityDependent PersonalityDisorderDisorder Beliefs about Self:Beliefs about Self: “I am incompetent.”,”I am weak.”,”I“I am incompetent.”,”I am weak.”,”Ineed others to survive”need others to survive” Beliefs about Others:Beliefs about Others: “ Others are strong and capable”“ Others are strong and capable” Conditional Assumptions:Conditional Assumptions: “If I depend on others, I’ll“If I depend on others, I’llbe okay (but if I depend on myself-make decisions, try to solvebe okay (but if I depend on myself-make decisions, try to solveproblems- I’ll fail” “If I subjugate myself to others, they’ll take care of meproblems- I’ll fail” “If I subjugate myself to others, they’ll take care of me(but if I upset them, they won’t”(but if I upset them, they won’t”
    24. 24. Dependent PersonalityDependent PersonalityDisorderDisorder Overdeveloped Coping Strategies:Overdeveloped Coping Strategies: Relying on others,Relying on others,avoiding making decisions, avoiding solving problems independently, trying toavoiding making decisions, avoiding solving problems independently, trying tokeep others happy, subjugating self to others, being meek and submissive.keep others happy, subjugating self to others, being meek and submissive. Underdeveloped Coping Strategies:Underdeveloped Coping Strategies: SolvingSolvingproblems independently, making decision, asserting self with othersproblems independently, making decision, asserting self with others Therapy-Interfering Beliefs:Therapy-Interfering Beliefs: “If I try to use my skills“If I try to use my skillsindependently, I’ll fail”,”If I practice assertion, I’ll alienate others”,”If I terminateindependently, I’ll fail”,”If I practice assertion, I’ll alienate others”,”If I terminatetherapy, I won’t be able to handle life”.therapy, I won’t be able to handle life”. Therapy-Interfering Behaviors:Therapy-Interfering Behaviors:Looking to the therapist toLooking to the therapist tosolve the patients problems and make decisions for him/her, trying too hard tosolve the patients problems and make decisions for him/her, trying too hard toplease the therapist, resisting homework assignments involving assertionplease the therapist, resisting homework assignments involving assertion
    25. 25. Avoidant Personality DisorderAvoidant Personality Disorder Beliefs about Self:Beliefs about Self: “I am unlovable, unacceptable,“I am unlovable, unacceptable,defective, bad”,”I’m vulnerable to negative emotions”defective, bad”,”I’m vulnerable to negative emotions” Beliefs about Others:Beliefs about Others: “ Others are superior, potentially“ Others are superior, potentiallycritical, and rejecting”critical, and rejecting” Conditional Assumptions:Conditional Assumptions: “ If I pretend I’m okay,“ If I pretend I’m okay,others may accept me ( but if I show my real self, they will rejectothers may accept me ( but if I show my real self, they will rejectme)”,”If I please others all the time, I’ll be okay ( but if I upset them,me)”,”If I please others all the time, I’ll be okay ( but if I upset them,they’ll hurt me)”,” If I (cognitively and behaviorally) avoid, I’ll be okaythey’ll hurt me)”,” If I (cognitively and behaviorally) avoid, I’ll be okay( but if I allow myself to feel negative emotions, I’ll fall apart)”.( but if I allow myself to feel negative emotions, I’ll fall apart)”.
    26. 26. Avoidant Personality DisorderAvoidant Personality Disorder Overdeveloped Coping Strategies:Overdeveloped Coping Strategies: Avoiding socialAvoiding socialsituations, avoiding calling attention to self, avoiding revealing self to others,situations, avoiding calling attention to self, avoiding revealing self to others,distrusting others, avoiding experiencing negative emotionsdistrusting others, avoiding experiencing negative emotions Underdeveloped Coping Strategies:Underdeveloped Coping Strategies: ApproachingApproachingothers, trusting others’ positive motives, acting naturally around others, seekingothers, trusting others’ positive motives, acting naturally around others, seekingintimacy, thinking about upsetting situations and problemsintimacy, thinking about upsetting situations and problems Therapy-Interfering Beliefs:Therapy-Interfering Beliefs: “If I trust my therapist’s“If I trust my therapist’sapparent care and compassion, I’’ get hurt”,”If I focus on problems in therapy, I’llapparent care and compassion, I’’ get hurt”,”If I focus on problems in therapy, I’llfeel too overwhelmed”,”If I reveal negative parts of my history and currentfeel too overwhelmed”,”If I reveal negative parts of my history and currentexperience, my therapist will judge me negatively”,” If I try to work towardexperience, my therapist will judge me negatively”,” If I try to work towardachieving interpersonal goals, I’ll be rejected”,”If I assert myself reasonably,achieving interpersonal goals, I’ll be rejected”,”If I assert myself reasonably,people won’t like me”people won’t like me” Therapy-Interfering Behaviors:Therapy-Interfering Behaviors:Putting on a false frontPutting on a false frontto therapist, avoiding revealing self, changing the subject when feelingto therapist, avoiding revealing self, changing the subject when feelingdistressed in the session, resisting homework assignments that coulddistressed in the session, resisting homework assignments that couldlead to distresslead to distress
    27. 27. Paranoid Personality DisorderParanoid Personality Disorder Beliefs about Self:Beliefs about Self: “I am weak and vulnerable (and must“I am weak and vulnerable (and mustbe on guard and/or take preemptive aggressive actions”be on guard and/or take preemptive aggressive actions” Beliefs about Others:Beliefs about Others: “ Other people will hurt me”“ Other people will hurt me” Conditional Assumptions:Conditional Assumptions: “”If I’m hypervigilant, I“”If I’m hypervigilant, Ican pick up signs of [interpersonal] danger (but if I’m not on guard, Ican pick up signs of [interpersonal] danger (but if I’m not on guard, Iwon’t see them).” “If I assume others are untrustworthy, I’ll be able towon’t see them).” “If I assume others are untrustworthy, I’ll be able toprotect myself (but if I trust others, they’ll hurt me)protect myself (but if I trust others, they’ll hurt me)
    28. 28. Paranoid Personality DisorderParanoid Personality Disorder Overdeveloped Coping Strategies:Overdeveloped Coping Strategies: BeingBeinghypervigilant for harm, trusting no none, assuming hidden motives,hypervigilant for harm, trusting no none, assuming hidden motives,expecting to be manipulated, taken advantage of, diminishedexpecting to be manipulated, taken advantage of, diminished Underdeveloped Coping Strategies:Underdeveloped Coping Strategies:Trusting others, relaxing, cooperating, assuming good attentionsTrusting others, relaxing, cooperating, assuming good attentions Therapy-Interfering Beliefs:Therapy-Interfering Beliefs: “If I trust my therapist,“If I trust my therapist,she’ll hurt me”,”If I’m not on my guard, I’ll be harmed”.she’ll hurt me”,”If I’m not on my guard, I’ll be harmed”. Therapy-Interfering Behaviors:Therapy-Interfering Behaviors:Rejecting signsRejecting signsof caring from the therapist, rejecting alternative explanations for others’of caring from the therapist, rejecting alternative explanations for others’behavior, resisting homework assignments to be more intimate withbehavior, resisting homework assignments to be more intimate withothers.others.
    29. 29. Antisocial PersonalityAntisocial PersonalityDisorderDisorder Beliefs about Self:Beliefs about Self: “ I am a potential victim (so my only“ I am a potential victim (so my onlyviable alternative is to be a victimizer)”, “’Normal “rules don’t apply toviable alternative is to be a victimizer)”, “’Normal “rules don’t apply tome”me” Beliefs about Others:Beliefs about Others: “ Other will try to control,“ Other will try to control,manipulate, or take advantage of me”, “Others are there for me tomanipulate, or take advantage of me”, “Others are there for me toexploit.”exploit.” Conditional Assumptions:Conditional Assumptions: “ If I manipulate or attack“ If I manipulate or attackothers first, I’ll be on top (but if I don’t, they could squash me).”,” If I actothers first, I’ll be on top (but if I don’t, they could squash me).”,” If I acthostile and strong, I can do what I want (but if I don’t, others will try tohostile and strong, I can do what I want (but if I don’t, others will try tocontrol me”.control me”.
    30. 30. Antisocial PersonalityAntisocial PersonalityDisorderDisorder Overdeveloped Coping Strategies:Overdeveloped Coping Strategies: Lying,Lying,manipulating or taking advantage of others, threatening or attackingmanipulating or taking advantage of others, threatening or attackingothers, resisting others’ control, acting impulsively.others, resisting others’ control, acting impulsively. Underdeveloped Coping Strategies:Underdeveloped Coping Strategies:Cooperating with others, following societal rules, thinking aboutCooperating with others, following societal rules, thinking aboutconsequencesconsequences Therapy-Interfering Beliefs:Therapy-Interfering Beliefs: “If I dominate my“If I dominate mytherapist, she won’t be able to control me”,”If I comply with mytherapist, she won’t be able to control me”,”If I comply with mytherapist, it will mean she is strong and I am weak”,” If I tell the truth,therapist, it will mean she is strong and I am weak”,” If I tell the truth,she will impose negative consequences”,”If I engage in treatment, Ishe will impose negative consequences”,”If I engage in treatment, Iwon’t be able to do what I want”won’t be able to do what I want” Therapy-Interfering Behaviors:Therapy-Interfering Behaviors: Trying tointimidate the therapist, lying to the therapist, trying to manipulate thetherapist, engaging only superficially, if at all.
    31. 31. Schizotypal PersonalitySchizotypal PersonalityDisorderDisorder Beliefs about Self:Beliefs about Self: “I am different”, “I have special“I am different”, “I have specialpowers”, “I am vulnerable”powers”, “I am vulnerable” Beliefs about Others:Beliefs about Others: “ Others won’t understand“ Others won’t understandme”,”Others will reject me”,”Others will hurt me”.me”,”Others will reject me”,”Others will hurt me”. Conditional Assumptions:Conditional Assumptions: “If I pursue ‘unusual’“If I pursue ‘unusual’interest such as the occult, I’ll be different in a special way (but if I don’t,interest such as the occult, I’ll be different in a special way (but if I don’t,I’ll just be different in a defective way)”,”If I’m hypervigilant for harm, II’ll just be different in a defective way)”,”If I’m hypervigilant for harm, Ican protect my self from others (but if I’m not, I’ll get hurt”,”If I distancecan protect my self from others (but if I’m not, I’ll get hurt”,”If I distancemyself from others, I’ll be okay (but if I get close to people, they will hurtmyself from others, I’ll be okay (but if I get close to people, they will hurtme).”me).”
    32. 32. Schizotypal PersonalitySchizotypal PersonalityDisorderDisorder Overdeveloped Coping Strategies:Overdeveloped Coping Strategies: PursuingPursuingeccentric interests, being suspicious of others, distancing self fromeccentric interests, being suspicious of others, distancing self fromothersothers Underdeveloped Coping Strategies:Underdeveloped Coping Strategies: TrustingTrustingothers, seeking out interactions with others, seeking rationalothers, seeking out interactions with others, seeking rationalexplanations for unusual experiences.explanations for unusual experiences. Therapy-Interfering Beliefs:Therapy-Interfering Beliefs: “If I trust my therapist, she’ll“If I trust my therapist, she’llhurt me”,”If my ‘sixth-sense’ tells me something is true, it must behurt me”,”If my ‘sixth-sense’ tells me something is true, it must betrue”,”true”,” Therapy-Interfering Behaviors:Therapy-Interfering Behaviors: Resisting alternativeResisting alternativeexplanations of events, avoiding fully revealing self to the therapist,explanations of events, avoiding fully revealing self to the therapist,looking for signs of harm from the therapistlooking for signs of harm from the therapist
    33. 33. Schizoid Personality DisorderSchizoid Personality Disorder Beliefs about Self:Beliefs about Self: “I am different, defective; I don’t fit in”“I am different, defective; I don’t fit in” Beliefs about Others:Beliefs about Others: “ Other’s don’t like me”,”Others“ Other’s don’t like me”,”Othersare intrusive”are intrusive” Conditional Assumptions:Conditional Assumptions: “If I keep to myself,“If I keep to myself,others won’t bother me (but if I engage with them, they’ll find meothers won’t bother me (but if I engage with them, they’ll find melacking)”,”If I avoid relationships, I’ll be okay (but if I get involved withlacking)”,”If I avoid relationships, I’ll be okay (but if I get involved withothers, they’ll be too intrusive).”others, they’ll be too intrusive).”
    34. 34. Schizoid Personality DisorderSchizoid Personality Disorder Overdeveloped Coping Strategies:Overdeveloped Coping Strategies: AvoidingAvoidingcontact with others, shunning intimacy, engaging in solitary pursuitscontact with others, shunning intimacy, engaging in solitary pursuits Underdeveloped Coping Strategies:Underdeveloped Coping Strategies:Possessing ordinary social skills, trusting othersPossessing ordinary social skills, trusting others Therapy-Interfering Beliefs:Therapy-Interfering Beliefs: “If my therapist“If my therapistdisplays caring and empathy, I’ll feel too uncomfortable”,”If I set goals,displays caring and empathy, I’ll feel too uncomfortable”,”If I set goals,I’ll have to change my [isolated] life and I’ll feel worse.I’ll have to change my [isolated] life and I’ll feel worse. Therapy-Interfering Behaviors:Therapy-Interfering Behaviors: Speaking little,Speaking little,avoiding self-disclosure, avoiding setting goals to improve patients life,avoiding self-disclosure, avoiding setting goals to improve patients life,resisting homework assignments involving interpersonal contact.resisting homework assignments involving interpersonal contact.
    35. 35. Narcissistic PersonalityNarcissistic PersonalityDisorderDisorder Beliefs about Self:Beliefs about Self: “I am inferior, nothing, a piece of“I am inferior, nothing, a piece ofgarbage” (activated when perceiving that others are disregarding orgarbage” (activated when perceiving that others are disregarding orcritical of the patient).(also, “I am superior” [activated when receivingcritical of the patient).(also, “I am superior” [activated when receivingspecial treatment or accolades from others].)special treatment or accolades from others].) Beliefs about Others:Beliefs about Others: “ Others are superior, hurtful“ Others are superior, hurtfuldemeaning” (also, “Others are inferior” [activated when perceivingdemeaning” (also, “Others are inferior” [activated when perceivingothers as less successful than the patient].)others as less successful than the patient].) Conditional Assumptions:Conditional Assumptions: “ If I act in a superior“ If I act in a superiorway, I can feel better about myself (but if I don’t, I’ll feel painfullyway, I can feel better about myself (but if I don’t, I’ll feel painfullyinferior)”,”If people treat me in special ways, it shows that I am superiorinferior)”,”If people treat me in special ways, it shows that I am superior(but if they don’t, I should punish them)”,”If I control others/put them(but if they don’t, I should punish them)”,”If I control others/put themdown, I can feel superior to them (but if I don’t, they’ll put me down anddown, I can feel superior to them (but if I don’t, they’ll put me down andmake me feel inferior).”make me feel inferior).”
    36. 36. Narcissistic PersonalityNarcissistic PersonalityDisorderDisorder Overdeveloped Coping Strategies:Overdeveloped Coping Strategies: Demanding special treatmentDemanding special treatmentfrom others, being hypervigilant for shabby (or “normal”) treatment from others, punishingfrom others, being hypervigilant for shabby (or “normal”) treatment from others, punishingothers when feeling slighted, diminished, dysphoric, criticizing, putting people down, trying toothers when feeling slighted, diminished, dysphoric, criticizing, putting people down, trying tocompete with and control them, trying to impress people with material possessions,compete with and control them, trying to impress people with material possessions,accomplishments and intimacy with high-status people.accomplishments and intimacy with high-status people. Underdeveloped Coping Strategies:Underdeveloped Coping Strategies: Cooperating with othersCooperating with otherstoward achieving a common goal, working diligently step by step to achieve personal goals,toward achieving a common goal, working diligently step by step to achieve personal goals,tolerating inconveniences, frustration, lack of recognitiontolerating inconveniences, frustration, lack of recognition Therapy-Interfering Beliefs:Therapy-Interfering Beliefs: “If I am not vigilant, my therapist will“If I am not vigilant, my therapist willput me down”,”If I don’t impress her with my superiority, my therapist will think I’mput me down”,”If I don’t impress her with my superiority, my therapist will think I’minferior”,”If I don’t punish my therapist for making me feel small, she’ll make me doinferior”,”If I don’t punish my therapist for making me feel small, she’ll make me doit again and again”,”If I don’t push hard, I won’t be treated in a special way”.it again and again”,”If I don’t push hard, I won’t be treated in a special way”. Therapy-Interfering Behaviors:Therapy-Interfering Behaviors: Trying to impress the therapist,Trying to impress the therapist,demanding entitlements, treating the therapist as inferior, punishing the therapistdemanding entitlements, treating the therapist as inferior, punishing the therapist(through criticism, snide remarks) when feeling slighted, resisting agreeing to(through criticism, snide remarks) when feeling slighted, resisting agreeing tohomework assignments the therapist suggests.homework assignments the therapist suggests.

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