Axis II. It's one of the most complicated Axes for clinicians to treat. Primarily because the prognosis for individuals who fall under this Axis is only fair at best. Aside from Mental Retardation, Axis II also holds the diagnoses of Personality Disorders.
Personality is ultimately the determining factor for how we will live our lives. It is directly related to how we think, make decisions and take action. An individual with a Personality Disorder develops traits which are maladaptive and inflexible and ultimately lead to behaviors which cause discomfort, distress and impair an individual's ability to function in society in a manner that reflects stability, security and sound judgement.
There are approximately 11 recognized Personality Disorders. The DSMIV-TR provides the following information regarding Personality Disorders:
"General diagnostic criteria is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture. This pattern is manifested in two (or more) of the following areas: cognition (i.e., ways of perceiving and interpreting self, other people, and events); affectivity (i.e., the range, intensity, lability, and inappropriateness of emotional response); interpersonal functioning; and impulse control. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. The individual's pattern is stable of long duration and its onset can be traced back at least to adolescence or early adulthood."
Now, the booming question most clinician's will ask regarding individuals with Personality Disorders is "How do I manage them and their destructive behaviors?"
According to the High Conflict Institute there are 12 tips for managing individuals with high conflict personalities. 5 Do's and 7 Dont's:
Part I: Understanding High Conflict People
Tip #1: Don’t Take Their Personal Attacks Personally
Tip #2: Don’t Give Them Negative Feedback
Tip #3: Don’t Bend Boundaries With Borderlines
Tip #4: Don’t Diss the Narcissists
Tip #5: Don’t Get Hooked by Histrionics
Tip #6: Don’t Get Conned by Antisocials
Tip #7: Don’t Be a Negative Advocate
Part II: Managing High Conflict People
Tip #8: Connect Using Your E.A.R.
Tip #9: Analyze Your Realistic Options
Tip #10: Respond Quickly to Misinformation
Tip #11: Set Limits on Misbehavior
Tip #12: Choose Your Battles
If you would like more information regarding managing individuals with Personality Disorders and those with High Conflict Personalities you might want to consider reading the following book IT'S ALL YOUR FAULT! 12 TIPS FOR MANAGING PEOPLE WHO BLAME OTHERS FOR EVERYTHING.
Sunday, November 22, 2009
Tuesday, May 5, 2009
Anger & How to Manage It!!
Anger is one of the most intense human emotions we will ever experience. It's intensity varies and results in behavioral symptoms varying from fits of rage to sulking and pouting. Anger, like beauty is usually in the "eye of the beholder." What infuriates some may go unnoticed by others.
So what exactly is the purpose of anger? Does it serve a reason within the realm of human emotion? The answer is absolutely! The purpose of anger is to alert us that something is 'wrong' and that there is an issue which needs to be addressed. The longer we abstain from addressing the issue, the more the anger has a potential to build and fester within us.
It is o.k. to be angry, even furious. It is the behavioral actions which follow the anger that may or may not be o.k. Some actions carry severe consequences which can extend farther into the future the we ever intended. And seriously, do angry outbursts with severe consequences address the issue which made us angry in the first place? Most of the time these types of reactions only serve to perpetuate the intensity of the anger, do not address the problem at hand and often incur some type of consequence. Thus, the dance of anger begins. It goes something like this: Event occurs, we get angry, we react,consequences of our reactions.
There are numerous ways to react to events which make us angry.
Some of them include: ignoring, biting our tounges, reacting with silence, physical aggression, smart remarks, screaming, yelling, cursing, leaving the situation, and the list goes on and on. This is not to say that each of these actions are appropriate and address the issue to solve whatever the 'problem' may be. Part of the reason we behave this way is because we often blame people for our anger and ignore the patterns which lead us to becoming angry in the first place.
Patterns can include feelings of neglect, abandonement, abuse, being taken advantage of and a slue of other issues which can arouse anger towards someone else.
Consider the following example:
Susan has been working for her current employer, an attorney, for nearly three years. She'd like to find another job, but so far, she is "stuck" with where she is now. Susan claims her boss is demanding and blames her for things that are not even her fault. Once she prepared several documents to be filed with the courts, however, her boss never got around to signing them so they could not be filed. He then proceeded to yell and blamed Susan for not "keeping up" with the business of the law office. Susan then apologizes and assures the attorney it will not happen again.
Do you see what is happening in this example? Susan's anger towards her boss no doubt comes from the manner in which she reacts to the pattern that has been established. Susan reacts by 'biting her tongue.' Her anger most likely stems from being disrespected, taken advantage of, and assuming responsibility for her bosses mistakes. Susan's reaction to these feelings is to say nothing about it and 'tell the boss what he wants to hear.'
Therefore, instead of blaming the pattern of poor communication between Susan and her boss, Susan's anger is directed towards the individual (in this case her boss). As time progresses, this anger may build and Susan may eventually do something which creates problematic consequences.
The source of anger should always be considered. While it seems that individuals are to blame for becoming angry, explore the situation further to determine what pattern exists to the anger and then how to change the pattern not the person.
So what exactly is the purpose of anger? Does it serve a reason within the realm of human emotion? The answer is absolutely! The purpose of anger is to alert us that something is 'wrong' and that there is an issue which needs to be addressed. The longer we abstain from addressing the issue, the more the anger has a potential to build and fester within us.
It is o.k. to be angry, even furious. It is the behavioral actions which follow the anger that may or may not be o.k. Some actions carry severe consequences which can extend farther into the future the we ever intended. And seriously, do angry outbursts with severe consequences address the issue which made us angry in the first place? Most of the time these types of reactions only serve to perpetuate the intensity of the anger, do not address the problem at hand and often incur some type of consequence. Thus, the dance of anger begins. It goes something like this: Event occurs, we get angry, we react,consequences of our reactions.
There are numerous ways to react to events which make us angry.
Some of them include: ignoring, biting our tounges, reacting with silence, physical aggression, smart remarks, screaming, yelling, cursing, leaving the situation, and the list goes on and on. This is not to say that each of these actions are appropriate and address the issue to solve whatever the 'problem' may be. Part of the reason we behave this way is because we often blame people for our anger and ignore the patterns which lead us to becoming angry in the first place.
Patterns can include feelings of neglect, abandonement, abuse, being taken advantage of and a slue of other issues which can arouse anger towards someone else.
Consider the following example:
Susan has been working for her current employer, an attorney, for nearly three years. She'd like to find another job, but so far, she is "stuck" with where she is now. Susan claims her boss is demanding and blames her for things that are not even her fault. Once she prepared several documents to be filed with the courts, however, her boss never got around to signing them so they could not be filed. He then proceeded to yell and blamed Susan for not "keeping up" with the business of the law office. Susan then apologizes and assures the attorney it will not happen again.
Do you see what is happening in this example? Susan's anger towards her boss no doubt comes from the manner in which she reacts to the pattern that has been established. Susan reacts by 'biting her tongue.' Her anger most likely stems from being disrespected, taken advantage of, and assuming responsibility for her bosses mistakes. Susan's reaction to these feelings is to say nothing about it and 'tell the boss what he wants to hear.'
Therefore, instead of blaming the pattern of poor communication between Susan and her boss, Susan's anger is directed towards the individual (in this case her boss). As time progresses, this anger may build and Susan may eventually do something which creates problematic consequences.
The source of anger should always be considered. While it seems that individuals are to blame for becoming angry, explore the situation further to determine what pattern exists to the anger and then how to change the pattern not the person.
Monday, April 20, 2009
Acceptance & Commitment Therapy: What Is It?
ACT differs from traditional cognitive behavioral therapy (CBT) in that rather than trying to teach people to better control their thoughts, feelings, sensations, memories and other private events, ACT teaches them to "just notice", accept, and embrace their private events, especially previously unwanted ones. ACT helps the individual get in contact with a transcendent sense of self known as "self-as-context" — the you that is always there observing and experiencing and yet distinct from one's thoughts, feelings, sensations, and memories. ACT aims to help the individual clarify their personal values and to take action on them, bringing more vitality and meaning to their life in the process, increasing their psychological flexibility[3].
While Western psychology has typically operated under the "healthy normality" assumption which states that by their nature, humans are psychologically healthy, ACT assumes, rather, that psychological processes of a normal human mind are often destructive.[4] The core conception of ACT is that psychological suffering is usually caused by experiential avoidance, cognitive entanglement, and resulting psychological rigidity that leads to a failure to take needed behavioral steps in accord with core values. As a simple way to summarize the model, you can say that ACT views the core of many problems to be due to the acronym, FEAR:
Fusion with your thoughts
Evaluation of experience
Avoidance of your experience
Reason giving for your behaviour
And the healthy alternative is to ACT:
Accept your reactions and be present
Choose a valued direction
Take action
6 Core Principles of ACT
ACT commonly employs six core principles to help clients develop psychological flexibility[4]:
1. Cognitive defusion: Learning to perceive thoughts, images, emotions, and memories as what they are, not what they appear to be.
2. Acceptance: Allowing them to come and go without struggling with them.
3. Contact with the present moment: Awareness to the here and now experience with openness, interest, and receptiveness.
4. Observing the self: Accessing a transcendent sense of self, a continuity of consciousness which is changing.
5. Values: Discovering what is most important to one's true self. [5]
6. Committed action: Setting goals according to values and carrying them out responsibly.
Developed within a coherent theoretical and philosophical framework, Acceptance and Commitment Therapy (ACT) is a unique empirically based psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility.
Psychological flexibility means contacting the present moment fully as a conscious human being, and based on what the situation affords, changing or persisting in behavior in the service of chosen values.
ACT illuminates the ways that language entangles clients into futile attempts to wage war against their own inner lives. Through metaphor, paradox, and experiential exercises clients learn how to make healthy contact with thoughts, feelings, memories, and physical sensations that have been feared and avoided. Clients gain the skills to recontextualize and accept these private events, develop greater clarity about personal values, and commit to needed behavior change.
While Western psychology has typically operated under the "healthy normality" assumption which states that by their nature, humans are psychologically healthy, ACT assumes, rather, that psychological processes of a normal human mind are often destructive.[4] The core conception of ACT is that psychological suffering is usually caused by experiential avoidance, cognitive entanglement, and resulting psychological rigidity that leads to a failure to take needed behavioral steps in accord with core values. As a simple way to summarize the model, you can say that ACT views the core of many problems to be due to the acronym, FEAR:
Fusion with your thoughts
Evaluation of experience
Avoidance of your experience
Reason giving for your behaviour
And the healthy alternative is to ACT:
Accept your reactions and be present
Choose a valued direction
Take action
6 Core Principles of ACT
ACT commonly employs six core principles to help clients develop psychological flexibility[4]:
1. Cognitive defusion: Learning to perceive thoughts, images, emotions, and memories as what they are, not what they appear to be.
2. Acceptance: Allowing them to come and go without struggling with them.
3. Contact with the present moment: Awareness to the here and now experience with openness, interest, and receptiveness.
4. Observing the self: Accessing a transcendent sense of self, a continuity of consciousness which is changing.
5. Values: Discovering what is most important to one's true self. [5]
6. Committed action: Setting goals according to values and carrying them out responsibly.
Developed within a coherent theoretical and philosophical framework, Acceptance and Commitment Therapy (ACT) is a unique empirically based psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility.
Psychological flexibility means contacting the present moment fully as a conscious human being, and based on what the situation affords, changing or persisting in behavior in the service of chosen values.
ACT illuminates the ways that language entangles clients into futile attempts to wage war against their own inner lives. Through metaphor, paradox, and experiential exercises clients learn how to make healthy contact with thoughts, feelings, memories, and physical sensations that have been feared and avoided. Clients gain the skills to recontextualize and accept these private events, develop greater clarity about personal values, and commit to needed behavior change.
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