Personality Disorders: A Personality Disorders: A Cognitive Behavioral Cognitive Behavioral Therapy Perspective Therapy Perspective

Greg Meyer, LCSW CBIS

Aaron Beck 1960Aaron Beck 1960

Thoughts influence feelingsThoughts influence feelings

Event Thoughts Feelings Actions Results

Levels of CognitionLevels of Cognition

Automatic Thoughts

Conditional Assumptions

Core Beliefs

Core beliefsCore beliefs

Feel like facts Feel like facts Beliefs about self, others, the worldBeliefs about self, others, the world Acts like a filter or lens which we Acts like a filter or lens which we

appraise situationsappraise situations Axis 1 beliefs are less consciousAxis 1 beliefs are less conscious Axis 2 readily apparent Axis 2 readily apparent

Piaget coined the term “Schema” Piaget coined the term “Schema” meaning ‘structures that integrate meaning ‘structures that integrate meaning into events’meaning into events’

Beck: cognitive structures that Beck: cognitive structures that organize experience and behaviororganize experience and behavior

Landau and Goldfried: a mental Landau and Goldfried: a mental filter that guides the processing of filter that guides the processing of informationinformation

Core beliefs/Schemas Core beliefs/Schemas about selfabout self

HelplessHelpless UnlovableUnlovable Unworthy/WorthlessUnworthy/Worthless FailureFailure Undeserving Undeserving IncompetentIncompetent Toxic (more with Axis 2)Toxic (more with Axis 2)

Core beliefs/Schemas Core beliefs/Schemas about Othersabout Others

Pt with challenging problems often perceive Pt with challenging problems often perceive others in a rigid, over generalized, others in a rigid, over generalized, dichotomous way and generally don’t see dichotomous way and generally don’t see that others are complex human beings who that others are complex human beings who demonstrate traits to a greater or lesser demonstrate traits to a greater or lesser degree 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

Core beliefs/Schemas Core beliefs/Schemas about the Worldabout the World

Pt’s with dysfunctional beliefs may Pt’s with dysfunctional beliefs may believe that they cannot get what believe that they cannot get what hey want from life because of the hey want from life because of the obstacles their world presentsobstacles their world presents

The world is dangerousThe world is dangerous The world is unpredictable The world is unpredictable The world is unfair and unfriendlyThe world is unfair and unfriendly

Why patients believe their Why patients believe their core beliefs so strongly?core beliefs so strongly?

Pt continually selectively focuses Pt continually selectively focuses on data that confirms his/her on data that confirms his/her negative viewsnegative views

Pt discounts data contrary to Pt discounts data contrary to his/her belief his/her belief

Pt fails to recognize contrary dataPt fails to recognize contrary data

Behavioral StrategiesBehavioral Strategies

Core BeliefCore Belief Coping strategiesCoping strategies

““I am I am inadequate”inadequate”

Rely on others to try to Rely on others to try to overachieveoverachieve

““I am I am nothing”nothing”

Withdraw, avoid intimacy, Withdraw, avoid intimacy, be dramatic, or act entitledbe dramatic, or act entitled

““I am I am vulnerable”vulnerable”

Act strong, dominate, or Act strong, dominate, or avoid any possibility of avoid any possibility of being hurtbeing hurt

Conditional AssumptionsConditional Assumptions Attitudes/RulesAttitudes/Rules Believe that if one uses their coping strategy Believe that if one uses their coping strategy

they would be okay- but if they don’t their they would be okay- but if they don’t their core beliefs will become evident or come core beliefs will become evident or come truetrue

E.g. Core Belief “I am vulnerable” E.g. Core Belief “I am vulnerable” Assumption “If I let my guard down, I’ll get Assumption “If I let my guard down, I’ll get

hurt.”hurt.” Core belief “I am bad” Assumption “ If I Core belief “I am bad” Assumption “ If I

blame it means I’m okay” or “If I make a blame it means I’m okay” or “If I make a mistake, I’m bad”mistake, I’m bad”

Situations that trigger Situations that trigger automaticautomatic thoughtsthoughts

Discrete eventsDiscrete events Distressing thoughtsDistressing thoughts MemoriesMemories ImagesImages EmotionsEmotions BehaviorsBehaviors Physiological sensationsPhysiological sensations Mental sensationsMental sensations

Cognitive Conceptualization DiagramCognitive Conceptualization Diagram

Core Belief: I am helpless

Condition assumptions: “If I avoid challenges, I’ll be okay”“If I try to do difficult things, I won’t be able to

Automatic 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 with staff not meeting his/her needs

Behavior: stays on room, avoids contact with staff

Coping Strategies: avoids doing tasks that she perceives to beDifficult, avoids situations which she might be asked to do something she feels

incapable to do

Emotion: Hopeless

Meaning of A.T.: “I’m helpless”

Personality DisordersPersonality Disorders DSM-IV: an enduring pattern of inner experience DSM-IV: an enduring pattern of inner experience

and behavior that deviates markedly from the and behavior that deviates markedly from the expectations of the individuals culture, is expectations of the individuals culture, is pervasive and inflexible, has an onset in pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over adolescence or early adulthood, is stable over time, and leads to distress or impairment.time, and leads to distress or impairment.

Characterized by having a relatively small set of Characterized by having a relatively small set of behavioral strategies that they use across behavioral strategies that they use across situations and across time, even when the situations and across time, even when the strategies are clearly dysfunctionalstrategies are clearly dysfunctional

It is important to view strategies as more or less It is important to view strategies as more or less adaptive vs good or bad. adaptive vs good or bad.

Histrionic Personality DisorderHistrionic Personality Disorder

Beliefs about Self: Beliefs about Self: “I am nothing” “I am nothing” activated when others are inattentive or disapproving, “ activated when others are inattentive or disapproving, “ I am wonderful” activated when others display a I am wonderful” activated when others display a positive reaction towards the patient.positive reaction towards the patient.

Conditional Assumptions: Conditional Assumptions: “If I “If I entertain others, they’ll like me (but if I don’t, they’ll entertain others, they’ll like me (but if I don’t, they’ll ignore me), “If I’m dramatic, I’ll get my needs me (but if ignore me), “If I’m dramatic, I’ll get my needs me (but if I’m not, I won’t get what I need from other people)I’m not, I won’t get what I need from other people)

Overdeveloped Coping Overdeveloped Coping strategies: strategies: Being overly dramatic, dressing, acting, Being overly dramatic, dressing, acting, speaking seductively, entertaining others, seeking adulation.speaking seductively, entertaining others, seeking adulation.

Histrionic Personality DisorderHistrionic Personality Disorder

Underdeveloped Coping Strategies: Underdeveloped Coping Strategies: Being quiet, submissive, blending in with others, holding Being quiet, submissive, blending in with others, holding reasonable standards for others’ behavior towards the patient, reasonable standards for others’ behavior towards the patient, valuing acting within normal limits.valuing acting within normal limits.

Therapy-InterferingTherapy-Interfering Beliefs: Beliefs: “If I entertain “If I entertain my therapist, she will like me”, “If I dramatize my problems, my therapist, she will like me”, “If I dramatize my problems, my therapist will want to help me”, “If I act ‘normally’ in my therapist will want to help me”, “If I act ‘normally’ in treatment, I’ll be average and boring”treatment, I’ll be average and boring”

Therapy-Interfering Behaviors: Therapy-Interfering Behaviors: Creating a dramatic appearance, speaking entertainingly, Creating a dramatic appearance, speaking entertainingly, acting seductively, soliciting adulation, avoiding homework acting seductively, soliciting adulation, avoiding homework assignments that lead the patient to feel ordinary.assignments that lead the patient to feel ordinary.

Obsessive-Compulsive Obsessive-Compulsive Personality DisorderPersonality Disorder

Beliefs about Self: Beliefs about Self: “I am vulnerable to bad things “I am vulnerable to bad things happening”, “I am responsible for preventing harm”, happening”, “I am responsible for preventing harm”,

Beliefs about Others: Beliefs about Others: “Other people weak, “Other people weak, irresponsible, careless”irresponsible, careless”

Conditional Assumptions: Conditional Assumptions: “If I take responsibility “If I take responsibility for everything, I’ll be okay (but if I depend on others , they’ll let me for everything, I’ll be okay (but if I depend on others , they’ll let me down), “If I create and maintain order for myself and others and do down), “If I create and maintain order for myself and others and do everything perfectly, my world will be okay (but if I don’t, everything everything perfectly, my world will be okay (but if I don’t, everything will fall apart)”.will fall apart)”.

Overdeveloped Coping Strategies: Overdeveloped Coping Strategies: Rigidly Rigidly controlling self and others, creating unreasonable expectations, controlling self and others, creating unreasonable expectations, assuming too much responsibility, striving for perfectionassuming too much responsibility, striving for perfection

Obsessive-Compulsive Obsessive-Compulsive Personality DisorderPersonality Disorder

Underdeveloped Coping Strategies: Underdeveloped Coping Strategies: Delegating authority, developing flexible expectations, exercising Delegating authority, developing flexible expectations, exercising control only when appropriate, tolerating uncertainty, acting control only when appropriate, tolerating uncertainty, acting spontaneously and impulsively, seeking fun and pleasurable activities.spontaneously and impulsively, seeking fun and pleasurable activities.

Therapy-Interfering Beliefs: Therapy-Interfering Beliefs: “If I don’t correct my “If I don’t correct my therapist and tell her exactly what she needs to know, she will not be therapist and tell her exactly what she needs to know, she will not be able to help me.”,”If I don’t do my therapy assignments perfectly, able to help me.”,”If I don’t do my therapy assignments perfectly, therapy won’t work.”,”If I lower my expectations for myself and others, therapy won’t work.”,”If I lower my expectations for myself and others, bad things will happen”bad things will happen”

Therapy-Interfering Behaviors: Therapy-Interfering Behaviors: Trying to Trying to control session, trying to impart perfectly correct information, being control session, trying to impart perfectly correct information, being hypervigilant for therapist’s lack of understanding, spending excessive hypervigilant for therapist’s lack of understanding, spending excessive time and care on homework, resisting assignments to be spontaneous time and care on homework, resisting assignments to be spontaneous and delegate responsibility.and delegate responsibility.

Passive-Aggressive Passive-Aggressive Personality DisorderPersonality Disorder

Beliefs about Self: Beliefs about Self: “I am vulnerable to be “I am vulnerable to be controlled by others.”,”I am misunderstood and controlled by others.”,”I am misunderstood and unappreciated.”unappreciated.”

Beliefs about Others: Beliefs about Others: “Other people are “Other people are strong, intrusive, demanding”,”They have unreasonable strong, intrusive, demanding”,”They have unreasonable expectations of me”,”They should leave me alone”expectations of me”,”They should leave me alone”

Conditional Assumptions: Conditional Assumptions: “If others control “If others control me, it means I’m weak.”,”If I exert indirect control (e.g. by me, it means I’m weak.”,”If I exert indirect control (e.g. by agreeing outwardly but not following through), others will be agreeing outwardly but not following through), others will be unable to control me (but if I assert myself directly, it won’t unable to control me (but if I assert myself directly, it won’t work).work).

Passive-Aggressive Passive-Aggressive Personality DisorderPersonality Disorder

Overdeveloped Coping Strategies: Overdeveloped Coping Strategies: Pretending Pretending to cooperate, avoiding asserting, confrontation, and direct refusal, to cooperate, avoiding asserting, confrontation, and direct refusal, resisting others’ control passively, resisting taking on responsibility, resisting others’ control passively, resisting taking on responsibility, resisting fulfilling others expectations. resisting fulfilling others expectations.

Underdeveloped Coping Strategies: Underdeveloped Coping Strategies: Cooperating, assuming reasonable responsibility for self and others, Cooperating, assuming reasonable responsibility for self and others, doing straightforward interpersonal problem solving.doing straightforward interpersonal problem solving.

Therapy-Interfering Beliefs:Therapy-Interfering Beliefs: “If I do what my therapist “If I do what my therapist asks, it means she’s in control and I’m weak”,”If I assert myself directly asks, it means she’s in control and I’m weak”,”If I assert myself directly with my therapist, she’ll exert more control”,”If I improve through with my therapist, she’ll exert more control”,”If I improve through therapy, other people will expect too much from me.”therapy, other people will expect too much from me.”

Therapy-Interfering Behaviors: Therapy-Interfering Behaviors: Collaboratively Collaboratively setting homework assignments but failing to follow through, setting homework assignments but failing to follow through, remaining passive during problem solving, outwardly agreeing remaining passive during problem solving, outwardly agreeing with what therapist says but privately disagreeing.with what therapist says but privately disagreeing.

Borderline Personality Borderline Personality DisorderDisorder

Beliefs about Self: Beliefs about Self: “I am bad, worthless”,”I am “I am bad, worthless”,”I am unlovable, defective”,”I am helpless, out of control”,”I am unlovable, defective”,”I am helpless, out of control”,”I am incompetent”,”I am weak and vulnerable”,”I am a victim”incompetent”,”I am weak and vulnerable”,”I am a victim”

Beliefs about Others: Beliefs about Others: “ Others are strong”,”Others are “ Others are strong”,”Others are potentially hurtful”,”Others are superior”,”Others will reject and potentially hurtful”,”Others are superior”,”Others will reject and abandon me”abandon me”

Conditional Assumptions: Conditional Assumptions: “”If I avoid challenges, I’ll “”If I avoid challenges, I’ll be okay(but if I take on challenges, I’ll fail),”If I depend on others, I’ll be okay(but if I take on challenges, I’ll fail),”If I depend on others, I’ll be okay (but if II don’t, I won’t survive”,”If I do everything others want, be okay (but if II don’t, I won’t survive”,”If I do everything others want, they may stay with me for the time being (but if I displease them, they may stay with me for the time being (but if I displease them, they’ll abandon me sooner),”If I am hypervigilant for harm from other they’ll abandon me sooner),”If I am hypervigilant for harm from other people, I can protect myself(but if not,I’ll get hurt)”,”If I punish others people, I can protect myself(but if not,I’ll get hurt)”,”If I punish others when I’m upset, I can feel more powerful and perhaps control their when I’m upset, I can feel more powerful and perhaps control their future behavior (but if I don’t, I’ll feel weak and they may hurt me future behavior (but if I don’t, I’ll feel weak and they may hurt me again)”,”If I cut off my negative emotions, I’ll be okay (but if I don’t, I’ll again)”,”If I cut off my negative emotions, I’ll be okay (but if I don’t, I’ll fall apart”.fall apart”.

Borderline Personality Borderline Personality DisorderDisorder

Overdeveloped Coping Strategies: Overdeveloped Coping Strategies: Mistrusting Mistrusting others, blaming others, avoiding challenges, depending on others, overly others, blaming others, avoiding challenges, depending on others, overly subjugating self or dominating others, avoiding negative emotions, self subjugating self or dominating others, avoiding negative emotions, self harming when emotions are intenseharming when emotions are intense

Underdeveloped Coping Strategies: Underdeveloped Coping Strategies: Balancing Balancing one’s needs against another’s, looking for nonmalignant explanations for one’s needs against another’s, looking for nonmalignant explanations for others’ behavior, trusting others, calming self down, solving interpersonal others’ behavior, trusting others, calming self down, solving interpersonal problems, persisting in difficult activitiesproblems, persisting in difficult activities

Therapy-Interfering Beliefs: Therapy-Interfering Beliefs: “I can get better and survive “I can get better and survive only if I completely depend on my therapist”,”If II trust my therapist, she’ll only if I completely depend on my therapist”,”If II trust my therapist, she’ll end up rejecting and abandoning me, so I might as well reject her first”,”If I end up rejecting and abandoning me, so I might as well reject her first”,”If I focus on solving problems, it won’t work and I'll end up feeling worse”.focus on solving problems, it won’t work and I'll end up feeling worse”.

Therapy-Interfering Behaviors:Therapy-Interfering Behaviors: Disparaging the Disparaging the therapist, overly relying on the therapist to feel better, making too therapist, overly relying on the therapist to feel better, making too many crisis calls between sessions, demanding entitlements from many crisis calls between sessions, demanding entitlements from the therapist.the therapist.

Dependent Personality Dependent Personality DisorderDisorder

Beliefs about Self: Beliefs about Self: “I am incompetent.”,”I am “I am incompetent.”,”I am weak.”,”I need others to survive”weak.”,”I need others to survive”

Beliefs about Others: Beliefs about Others: “ Others are strong and “ Others are strong and capable”capable”

Conditional Assumptions: Conditional Assumptions: “If I depend on “If I depend on others, I’ll be okay (but if I depend on myself-make decisions, others, I’ll be okay (but if I depend on myself-make decisions, try to solve problems- I’ll fail” “If I subjugate myself to others, try to solve problems- I’ll fail” “If I subjugate myself to others, they’ll take care of me (but if I upset them, they won’t”they’ll take care of me (but if I upset them, they won’t”

Dependent Personality Dependent Personality DisorderDisorder

Overdeveloped Coping Strategies: Overdeveloped Coping Strategies: Relying Relying on others, avoiding making decisions, avoiding solving problems on others, avoiding making decisions, avoiding solving problems independently, trying to keep others happy, subjugating self to others, independently, trying to keep others happy, subjugating self to others, being meek and submissive.being meek and submissive.

Underdeveloped Coping Strategies: Underdeveloped Coping Strategies: Solving Solving problems 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 “If I try to use my skills independently, I’ll fail”,”If I practice assertion, I’ll alienate skills independently, I’ll fail”,”If I practice assertion, I’ll alienate others”,”If I terminate therapy, I won’t be able to handle life”.others”,”If I terminate therapy, I won’t be able to handle life”.

Therapy-Interfering Behaviors:Therapy-Interfering Behaviors:Looking to the Looking to the therapist to solve the patients problems and make decisions for therapist to solve the patients problems and make decisions for him/her, trying too hard to please the therapist, resisting homework him/her, trying too hard to please the therapist, resisting homework assignments involving assertionassignments involving assertion

Avoidant Personality Avoidant Personality DisorderDisorder

Beliefs about Self: Beliefs about Self: “I am unlovable, “I am unlovable, unacceptable, defective, bad”,”I’m vulnerable to negative unacceptable, defective, bad”,”I’m vulnerable to negative emotions”emotions”

Beliefs about Others: Beliefs about Others: “ Others are superior, “ Others are superior, potentially critical, and rejecting”potentially critical, and rejecting”

Conditional Assumptions: Conditional Assumptions: “ If I pretend I’m “ If I pretend I’m okay, others may accept me ( but if I show my real self, they okay, others may accept me ( but if I show my real self, they will reject me)”,”If I please others all the time, I’ll be okay ( but will reject 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 if I upset them, they’ll hurt me)”,” If I (cognitively and behaviorally) avoid, I’ll be okay ( but if I allow myself to feel behaviorally) avoid, I’ll be okay ( but if I allow myself to feel negative emotions, I’ll fall apart)”.negative emotions, I’ll fall apart)”.

Avoidant Personality Avoidant Personality DisorderDisorder

Overdeveloped Coping Strategies: Overdeveloped Coping Strategies: Avoiding social Avoiding social situations, 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: Approaching Approaching others, trusting others’ positive motives, acting naturally around others, others, trusting others’ positive motives, acting naturally around others, seeking intimacy, thinking about upsetting situations and problemsseeking intimacy, thinking about upsetting situations and problems

Therapy-Interfering Beliefs: Therapy-Interfering Beliefs: “If I trust my therapist’s “If I trust my therapist’s apparent care and compassion, I’’ get hurt”,”If I focus on problems in apparent care and compassion, I’’ get hurt”,”If I focus on problems in therapy, I’ll feel too overwhelmed”,”If I reveal negative parts of my history therapy, I’ll feel too overwhelmed”,”If I reveal negative parts of my history and current experience, my therapist will judge me negatively”,” If I try to and current experience, my therapist will judge me negatively”,” If I try to work toward achieving interpersonal goals, I’ll be rejected”,”If I assert myself work toward achieving interpersonal goals, I’ll be rejected”,”If I assert myself reasonably, people won’t like me”reasonably, people won’t like me”

Therapy-Interfering Behaviors:Therapy-Interfering Behaviors:Putting on a false Putting on a false front to therapist, avoiding revealing self, changing the subject when front to therapist, avoiding revealing self, changing the subject when feeling distressed in the session, resisting homework assignments feeling distressed in the session, resisting homework assignments that could lead to distressthat could lead to distress

Paranoid Personality Paranoid Personality DisorderDisorder

Beliefs about Self: Beliefs about Self: “I am weak and vulnerable “I am weak and vulnerable (and must be on guard and/or take preemptive aggressive (and must be on guard and/or take preemptive aggressive actions”actions”

Beliefs about Others: Beliefs about Others: “ Other people will hurt “ Other people will hurt me”me”

Conditional Assumptions: Conditional Assumptions: “”If I’m “”If I’m hypervigilant, I can pick up signs of [interpersonal] danger hypervigilant, I can pick up signs of [interpersonal] danger (but if I’m not on guard, I won’t see them).” “If I assume (but if I’m not on guard, I won’t see them).” “If I assume others are untrustworthy, I’ll be able to protect myself (but if I others are untrustworthy, I’ll be able to protect myself (but if I trust others, they’ll hurt me)trust others, they’ll hurt me)

Paranoid Personality Paranoid Personality DisorderDisorder

Overdeveloped Coping Strategies: Overdeveloped Coping Strategies: Being Being hypervigilant 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 “If I trust my therapist, she’ll hurt me”,”If I’m not on my guard, I’ll be harmed”.therapist, she’ll hurt me”,”If I’m not on my guard, I’ll be harmed”.

Therapy-Interfering Behaviors:Therapy-Interfering Behaviors:Rejecting Rejecting signs of caring from the therapist, rejecting alternative explanations signs of caring from the therapist, rejecting alternative explanations for others’ behavior, resisting homework assignments to be more for others’ behavior, resisting homework assignments to be more intimate with others.intimate with others.

Antisocial Personality Antisocial Personality DisorderDisorder

Beliefs about Self: Beliefs about Self: “ I am a potential victim (so “ I am a potential victim (so my only viable alternative is to be a victimizer)”, “’Normal my only viable alternative is to be a victimizer)”, “’Normal “rules don’t apply to me”“rules don’t apply to me”

Beliefs about Others: Beliefs about Others: “ Other will try to “ Other will try to control, manipulate, or take advantage of me”, “Others are control, manipulate, or take advantage of me”, “Others are there for me to exploit.”there for me to exploit.”

Conditional Assumptions: Conditional Assumptions: “ If I manipulate “ If I manipulate or attack others first, I’ll be on top (but if I don’t, they could or attack others first, I’ll be on top (but if I don’t, they could squash me).”,” If I act hostile and strong, I can do what I want squash me).”,” If I act hostile and strong, I can do what I want (but if I don’t, others will try to control me”.(but if I don’t, others will try to control me”.

Antisocial Personality Antisocial Personality DisorderDisorder

Overdeveloped Coping Strategies: Overdeveloped Coping Strategies: Lying, manipulating or taking advantage of others, threatening Lying, manipulating or taking advantage of others, threatening or attacking others, resisting others’ control, acting impulsively.or attacking others, resisting others’ control, acting impulsively.

Underdeveloped Coping Strategies: Underdeveloped Coping Strategies: Cooperating with others, following societal rules, thinking about Cooperating with others, following societal rules, thinking about consequencesconsequences

Therapy-Interfering Beliefs: Therapy-Interfering Beliefs: “If I dominate “If I dominate my therapist, she won’t be able to control me”,”If I comply with my therapist, she won’t be able to control me”,”If I comply with my therapist, it will mean she is strong and I am weak”,” If I tell my 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 the truth, she will impose negative consequences”,”If I engage in

treatment, I won’t be able to do what I want”treatment, I won’t be able to do what I want” Therapy-Interfering Behaviors: Therapy-Interfering Behaviors: Trying to

intimidate the therapist, lying to the therapist, trying to manipulate the therapist, engaging only superficially, if at all.

Schizotypal Personality Schizotypal Personality DisorderDisorder

Beliefs about Self: Beliefs about Self: “I am different”, “I have “I am different”, “I have special powers”, “I am vulnerable”special powers”, “I am vulnerable”

Beliefs about Others: Beliefs about Others: “ Others won’t “ Others won’t understand me”,”Others will reject me”,”Others will hurt me”.understand me”,”Others will reject me”,”Others will hurt me”.

Conditional Assumptions: Conditional Assumptions: “If I pursue “If I pursue ‘unusual’ interest such as the occult, I’ll be different in a ‘unusual’ 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 special way (but if I don’t, I’ll just be different in a defective way)”,”If I’m hypervigilant for harm, I can protect my self from way)”,”If I’m hypervigilant for harm, I can protect my self from others (but if I’m not, I’ll get hurt”,”If I distance myself from others (but if I’m not, I’ll get hurt”,”If I distance myself from others, I’ll be okay (but if I get close to people, they will hurt others, I’ll be okay (but if I get close to people, they will hurt me).”me).”

Schizotypal Personality Schizotypal Personality DisorderDisorder

Overdeveloped Coping Strategies: Overdeveloped Coping Strategies: Pursuing Pursuing eccentric interests, being suspicious of others, distancing self eccentric interests, being suspicious of others, distancing self

from othersfrom others Underdeveloped Coping Strategies: Underdeveloped Coping Strategies:

Trusting others, seeking out interactions with others, seeking Trusting others, seeking out interactions with others, seeking rational explanations for unusual experiences. rational explanations for unusual experiences.

Therapy-Interfering Beliefs: Therapy-Interfering Beliefs: “If I trust my “If I trust my therapist, she’ll hurt me”,”If my ‘sixth-sense’ tells me therapist, she’ll hurt me”,”If my ‘sixth-sense’ tells me something is true, it must be true”,”something is true, it must be true”,”

Therapy-Interfering Behaviors: Therapy-Interfering Behaviors: Resisting Resisting alternative explanations of events, avoiding fully revealing self alternative explanations of events, avoiding fully revealing self to the therapist, looking for signs of harm from the therapistto the therapist, looking for signs of harm from the therapist

Schizoid Personality Schizoid Personality DisorderDisorder

Beliefs about Self: Beliefs about Self: “I am different, defective; I “I am different, defective; I don’t fit in”don’t fit in”

Beliefs about Others: Beliefs about Others: “ Other’s don’t like “ Other’s don’t like me”,”Others are intrusive”me”,”Others are intrusive”

Conditional Assumptions: Conditional Assumptions: “If I keep to “If I keep to myself, others won’t bother me (but if I engage with them, myself, others won’t bother me (but if I engage with them, they’ll find me lacking)”,”If I avoid relationships, I’ll be okay they’ll find me lacking)”,”If I avoid relationships, I’ll be okay (but if I get involved with others, they’ll be too intrusive).”(but if I get involved with others, they’ll be too intrusive).”

Schizoid Personality Schizoid Personality DisorderDisorder

Overdeveloped Coping Strategies: Overdeveloped Coping Strategies: Avoiding contact with others, shunning intimacy, engaging in Avoiding contact with others, shunning intimacy, engaging in

solitary pursuitssolitary 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 therapist displays caring and empathy, I’ll feel too uncomfortable”,”If I 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.set goals, I’ll have to change my [isolated] life and I’ll feel worse.

Therapy-Interfering Behaviors: Therapy-Interfering Behaviors: Speaking Speaking little, avoiding self-disclosure, avoiding setting goals to improve little, avoiding self-disclosure, avoiding setting goals to improve patient's life, resisting homework assignments involving patient's life, resisting homework assignments involving interpersonal contact.interpersonal contact.

Narcissistic Personality Narcissistic Personality DisorderDisorder

Beliefs about Self: Beliefs about Self: “I am inferior, nothing, a piece “I am inferior, nothing, a piece of garbage” (activated when perceiving that others are of garbage” (activated when perceiving that others are disregarding or critical of the patient).(also, “I am superior” disregarding or critical of the patient).(also, “I am superior” [activated when receiving special treatment or accolades from [activated when receiving special treatment or accolades from others].)others].)

Beliefs about Others: Beliefs about Others: “ Others are superior, “ Others are superior, hurtful demeaning” (also, “Others are inferior” [activated when hurtful demeaning” (also, “Others are inferior” [activated when perceiving others as less successful than the patient].)perceiving others as less successful than the patient].)

Conditional Assumptions: Conditional Assumptions: “ If I act in a “ If I act in a superior way, I can feel better about myself (but if I don’t, I’ll feel superior way, I can feel better about myself (but if I don’t, I’ll feel painfully inferior)”,”If people treat me in special ways, it shows painfully inferior)”,”If people treat me in special ways, it shows that I am superior (but if they don’t, I should punish them)”,”If I that I am superior (but if they don’t, I should punish them)”,”If I control others/put them down, I can feel superior to them (but if I control others/put them down, I can feel superior to them (but if I don’t, they’ll put me down and make me feel inferior).”don’t, they’ll put me down and make me feel inferior).”

Narcissistic Personality Narcissistic Personality DisorderDisorder

Overdeveloped Coping Strategies: Overdeveloped Coping Strategies: Demanding special treatment Demanding special treatment from others, being hypervigilant for shabby (or “normal”) treatment from others, punishing from others, being hypervigilant for shabby (or “normal”) treatment from others, punishing others when feeling slighted, diminished, dysphoric, criticizing, putting people down, trying to others when feeling slighted, diminished, dysphoric, criticizing, putting people down, trying to compete 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 others toward Cooperating with others toward

achieving a common goal, working diligently step by step to achieve personal goals, tolerating achieving a common goal, working diligently step by step to achieve personal goals, tolerating inconveniences, frustration, lack of recognitioninconveniences, frustration, lack of recognition

Therapy-Interfering Beliefs: Therapy-Interfering Beliefs: “If I am not vigilant, my therapist will put “If I am not vigilant, my therapist will put me down”,”If I don’t impress her with my superiority, my therapist will think I’m me down”,”If I don’t impress her with my superiority, my therapist will think I’m inferior”,”If I don’t punish my therapist for making me feel small, she’ll make me do inferior”,”If I don’t punish my therapist for making me feel small, she’ll make me do it 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 therapist demanding 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 to homework assignments the therapist suggests.homework assignments the therapist suggests.