CC19 Workshop 14 - Use PACT for Working with Personality Disorders - Stan Tatkin, PsyD, LMFT

Description:

This workshop will take the first two introductory seminars and push it working with personality disordered partners. We will move from an attachment model to that of an American object relations/ego psychology to understand the structural and functional differences between insecure attachment and personality disordered individuals and how to work with them in couple therapy.

Educational Objectives:

*Sessions may be edited for content and to preserve confidentiality*

1. List at least five differences between insecure attachment presentations and that of disorders of the self.
2. Describe at least two interventions for working with various personality disorders in couple therapy.
3. Apply at least three strategies for therapist self-regulation.

Outline:

Introduction to Workshop and Participant Background

• Workshop titled "Use PACT for Working with Personality Disorders" with Stan Tatkin at the 2019 Milton H. Erickson Foundation Couples Conference.

• Emphasis on therapist training in personality disorders and understanding different structural types in couple contexts.

Understanding Personality Disorders and Attachment

• Overview of personality disorder spectrum (e.g., borderline) and their movement into psychoneurosis.

• Attachment codes used to describe secure vs. insecure styles (e.g., autonomous, avoidant).

• Couples work preferred for accessing relational dynamics and faster insights.

Deficits and Capacities in Personality Disorders

• Personality disorders marked by real deficits, including theory of mind and self-regulation issues.

• Differences between narcissistic, schizoid, and antisocial types in developmental delays.

• Comparison of American object relations (ego/self-psychology) vs. British approaches.

Therapeutic Approaches and Defenses

• Use of ego consolidation and interpretation to manage primitive defenses (e.g., splitting, projective identification).

• Self-harming and identity diffusion common; understanding defenses is critical to treatment.

Transference, Acting Out, and Countertransference

• Clients with personality disorders test therapists via transference acting out.

• Therapists must maintain a tight, neutral frame and regulate their own emotional reactions.

Case Presentation and Demonstration

• Case of a long-married couple involving anxiety and infidelity.

• Importance of normalizing trauma responses and guiding the partner through forgiveness and repair.

Understanding the Role of the Helper in Healing

• The helper (often the offending partner) must endure blame without leverage, provide scaffolding, and hold firm boundaries to rebuild trust.

The Importance of Pain and Interest

• Pain drives motivation. The helper must maintain a position of strength and consistency to foster behavioral change and relational repair.

Addressing Trauma and Secure Functioning

• Behavioral symptoms may mimic personality disorders but are trauma responses.

• Full transparency required for betrayed partners; they must control the narrative.

The Role of Information and Trust

• The betrayed partner sets the terms for recovery; information must be freely shared.

• Therapist supports this transparency and manages memory-based distortions.

Role-Playing and Emotional Reactions

• Role-playing used to elicit honest emotional expression and uncover deeper dynamics.

• Emphasis on expressing real reactions to facilitate therapeutic progress.

Addressing Trust Issues and Boundaries

• Clear boundaries and trust rebuilding are essential to relational repair.

• Therapist must facilitate effective communication and emotional safety.

Cultural and Gender Dynamics

• Cultural and gender roles influence behavior and communication.

• Therapists must understand and incorporate these into the treatment plan.

Dealing with Domestic Violence

• Safety is the first priority. Domestic violence must be addressed immediately and explicitly.

• Therapist ensures a safe environment and stops treatment if violence is present.

Addressing Mental Health Concerns

• Mental health issues must be identified and treated concurrently with relational work.

• Couples must understand how mental illness affects dynamics and attachment.

Strategies for Therapeutic Intervention

• Various techniques used depending on couple dynamics and pathology.

• Focus on communication, emotional regulation, and building secure functioning.

Discussion on Borderline Personality Disorder and Suicide Risk

• Borderline traits and suicide risk require heightened care and external supports.

• Therapists must be vigilant and involve others when risk is high.

Therapist's Role and Approach in Handling Complex Cases

• Avoid taking statements at face value; look for tells and underlying truths.

• Focus on relationship dynamics, even when individuals have severe character disorders.

Handling Threats and Maintaining Professional Boundaries

• Therapists should not continue with clients who threaten them.

• Professional boundaries are non-negotiable for therapist safety and effectiveness.

Therapist's Use of Anger and Intervention Techniques

• Anger can be used to hold structure, not punish.

• Therapists scaffold reality and promote affect regulation in clients.

Confidentiality and Infidelity in Therapy

• Infidelity must be disclosed early; secrecy damages the relationship structure.

• Therapist encourages honest, direct conversations between partners.

The Role of Personality Disorders in Therapy

• Different disorders require tailored approaches.

• Goal is helping partners with personality disorders become more self-activated and relationally responsible.