Relationships and personality disorder

This years Mental Health Awareness week focuses on relationships and connections.

With that in mind, it felt fitting to offer something from the perspective of Personality Disorder, a diagnosis that features difficulty with relationships at its very core. Personality Disorder is something that holds significance to me not only in a professional capacity, but also in my personal life as a user of Personality Disorder Services in the past.

Personality is the tool we use to relate and interact with the world; it serves a purpose and is the functional vehicle we use to get our needs met. I think that’s why it’s so important to consider when thinking about the core of the relational work we carry out in services.

What has helped me towards recovery, has been the learning and understanding of some of the underlying difficulties brought about by early developmental experiences and how some of these can sometimes unhelpfully transfer into adult life. Regardless of whether I am a service user or a professional, these factors still remain the same; I have a personality and I use that personality to relate.

A once integral part of my life and identity that served to shape and inform my behaviours, now feels a lot more externalized; it sits on my back and occasionally reminds me it’s there, but ultimately it’s not ruling my life in the ways it used to. I feel that I have moved beyond diagnosis and my life is significantly different to how it once was; this can be attributed to the ways I have learned to understand my personality and the function it has.

I’m not suggesting it’s easy or it’s something that happens overnight – for me, it took around 13 years and a lot of hard work; I’m pretty sure that in my time as a service user, I projected much anxiety and frustration towards those attempting to assist me at times of difficulty; it something that comes across so often when working with clients and services – the levels of distress, frustration and anxiety this much misunderstood condition can bring.

What sometimes gets missed in the process is that people forget that they too have a personality and that the interplay and clashes between these personalities, can often lie at the root of the problem.

Regardless of a disorder or not, people are in essence a proportion of not only how they view themselves, but what is then fed-back and validated to them. If somebody holds a very fixed and rigid ill view of their own self and continually has that reinforced, as can be the case with labelling and attitudes it’s easy to see how people can become very stuck in their diagnoses.

By presenting a negative held self-view to another, we can then inadvertently have people act towards us based on this negative projection; we call this transference and counter-transference.

What stands out for me sometimes is the language we use around Personality Disorder and how this can impact on a person’s identity; terms such as ‘manipulative’, really grind my gears – it serves no productive or positive function to be labelling people in these ways.

I’ll often challenge by asking people “Last time you asked your friend to the pub and they said no, did you take no for an answer? …or did you use your personality to say something along the lines of ‘oh, go on…you know you want to…we haven’t seen each other in SUCH a long time…’? “.

The fact of the matter is this – we all have a personality, we all use it to get our needs met and in doing so, we could all be described as manipulating others – it all comes down to how good we are at doing it.

An interesting quote on this comes from Diamond and Factor who state:

“Patients who are labelled manipulative are unskilled in dealing with other people and often cause others to feel resentful or angry.

People who are skilled in getting other people to do what they want are described as friendly, convincing, or influential and rarely as manipulative”

What helps in my role, is the understanding that we can be dealing with someone who simply hasn’t learned to use their personality in a helpful way; it’s not personal – they may not know any other way to do this. What’s needed is simply the help and guidance to achieve better outcomes and this comes by first understanding what it is that an individual is attempting to achieve or communicate.

Whilst the theories around personality are too vast and wide ranging to go into in explicit detail here, I would encourage people to look at things such as Carl Roger’s 19 propositions of personality theory, Eric Berne’s theories around ‘transactional analysis’, Heinz Kohut’s Self-Psychology and more recently, Jeffrey Young’s work around Early Maladaptive Schema.

In understanding and accepting the developmental aspects of Personality, we can begin to work collaboratively in addressing these difficulties and finding new ways of functioning to achieve the same need payoffs. In understanding ourselves, we can understand when our own frustrations are getting in the way of achieving positive outcomes.

What drives me the most, is the relational aspect to the work that we do – being able to model and experience healthy and functioning relationships; if we take the disorder out of the equation and look simply as ‘personalities’, an entirely different picture emerges; one that puts us on a much more equal footing and offers a platform for shared understanding. Whilst there is still some way to go in addressing attitudes, I think we are beginning to work a lot more effectively with Personality Disorder since the publication in 2003 of ‘No Longer a Diagnosis of Exclusion’.

In July 2014 the Department of Health and Emergence released a further document called ‘Meeting the Challenge, Making a Difference’ – it’s a available as a .pdf file on the Emergence website – emergenceplus.org.uk and contains some useful guidance for how as practitioners, carers and family members we can begin to relate much better to Personality Disorder.

One thing that aided me in recovery is the patience, understanding and collaborative approach taken by professionals who have worked with me over the years; some were a very small piece in a much larger jigsaw although ultimately, still played their part in showing me new ways to relate; I couldn’t necessarily tell you the roles they did, but I could tell you their names – that was what felt important to me and still does.

I wanted to end the blog with a positive message as it’s something we’re not really used to hearing where personality disorder is concerned; people can and do recover from this condition.

Whilst it can be hard and there may be many frustrations along the way, I will say this about working in the role I do with personality disorder, it often feels like a gift.

By the time I conclude working with a client, one thing is almost assured, I certainly understand myself just that little bit better than I did when I began.