Hostile and Litigious Personality Disorders

HOSTILE AND LITIGIOUS PERSONALITY DISORDERS

"The symptoms of anger, exploitativeness, impulsiveness, and self﷓centeredness all suggest the diagnoses of BPD [Borderline Personality Disorder], NPD [Narcissistic Personality Disorder], HPD [Histrionic Personality Disorder], and ASP [Antisocial Personality Disorder]" (p. 6).

". . . . If an adult maintains the complementary positions he or she assumed in childhood, he or she 'recapitulates' early patterns . . . .
"Complementarity can also generate what is known as 'self﷓fulfilling prophecy'"(p. 47).

"The biting dog elicits fearful behavior, but the fearful person also elicits bites" (p. 59).

"Application of the principle of 'antithesis' should help the clinician identify the interpersonal position that is most likely to draw for the opposite of whatever is going on. For example, suppose patient A is engaged in BLAME. The opposite behavior, AFFIRM, would represent a desirable change in the way of being with his wife [her husband, etc.]. The principle of antithesis suggests that the wife should engage in the complement of what she would like him to do. That complement of AFFIRM, is DISCLOSURE. The wife of patient A should try to tell her husband how she feels about what he is doing. She should focus on herself, not him. She should be friendly, and she should avoid enmeshment. This is the position that should have the best chance of helping him listen to her rather than blame her.
". . . . the clinician first should find the opposite of the undesired behavior, and then invoke its complement. . . . Clinicians who teach these ideas to patients can greatly help marriages that are based on good faith, but are disrupted by bad interpersonal habits.
"Unfortunately, the principle of antithesis is effective only with younger children and with relatively normal adults. Normality includes an ability to be flexible and to respond appropriately to the interpersonal context. Individuals with personality disorders are not likely to be able to do this; they are more likely to misperceive and to respond inappropriately to context. . . (p. 63).

"[The 'Shaurette Principle', developed by Glenn Shaurett, M.D.] suggests that the therapist should match the hostile patient in hostile space, and then move stepwise toward the desired goal that may be set by the principle of antithesis" (p. 64).

"The BPD's [Borderline Personality Disorder] perceptiveness and knowledge of unfair rules of interpersonal play make her capable of shredding the therapist's confidence and effectiveness. Her neediness and identification with abusers drive her to ruthless extremes with the therapist. For example, a BPD may detect and appeal to the therapist's need to be seen as a loved and lovable person. She will offer presents, ask to go to dinner, bring a bottle of wine to the session, plead for hugs and kisses, draw the therapist into confessions about his or her personal problems, and so on. If the therapist appropriately refuses to accept these offerings, he or she is called 'uptight, cold, uncaring.' On the other hand, if the therapist accedes to any such gestures, he or she is 'dead meat' at a later point in therapy when the BPD is angry about the inevitable perceived abandonment. After desperately and skillfully pleading with the therapist to allow such intimacies, the BPD is completely capable of switching to the following: 'You violated standard professional ethics when you . . ., and I am going to [see a lawyer/call your wife/tell my husband/kill myself and leave a note explaining why].' It is at this point that a therapist can really 'lose it.'. . .
"Lest this analysis be misunderstood as an example of 'blaming the victim,' let me say this: I firmly believe that 'reality is my best friend.' Telling it as it is offers the only hope for making it better. We therapists are vulnerable human beings. BPDs are victims who have learned the tactics of abuse, and they are willing to use them on caregivers. To the extent that we can embrace the truth, we are in a better position to be truly helpful. Denial, hypocrisy, and power madness only lead to more of the same" (p. 131).

"BPD's often have a high level of interpersonal skill already; the proof is in the way they can disrupt whole health care systems. The problem is (p. 132) that BPD's use their abilities in destructive ways" (p. 133).

"The BPD is addicted to empathy and nurturance, but it is vital that such support be given in the service of good functioning rather than in service of chaos, misery,and regression" (p. 133).

". . . . No matter how lethal the verbal attacks, or how seductive the offers from the BPD, the therapist should hold to the basic terms of the therapy contract. . . . As the therapist maintains boundaries in this way, the BPD is very likely to complain that the therapist is 'cold' and 'uncaring,' and 'doesn't offer enough.' She may seek (and may find) other therapists. . . . The boundary﷓setting therapist can respond to this peaceful termination of the present therapy . . . with a welcome to return if the BPD changes her mind" (p. 134).

"Hospitalization reflects the need for help with containing old patterns. . . . Within a learning model, hospitalization can be viewed by analogy to the water safety instructor who throws the drowning learner a life preserver, asking him or her to grab it. Nobody imagines that the dramatic intervention is a part of learning to swim. It merely preserves the option to take up lessons later on, when the learner is ready to continue" (p. 137).

"The present model also suggests that medications should be viewed as aids in controlling symptoms so that the work of learning about patterns can con﷓ (p. 137) tinue. If seen in that light, medications are less likely to encourage regressive dependence on miracle cures . . ." (p. 138).

". . . . the 'empty﷓tank theory of development . . . asserts that if a child is given enough attention and nurturance, all will be well. . . (p. 226)
"Unfortunately, nurturance given noncontingently after infancy weakens rather than strengthens the child" (p. 227).

". . . the pattern of 'attacking the hand that feeds' is masochistic. It is also sadistic. In persons with this disorder [NEG, Negativistic Personality Disorder or Passive﷓Aggressive Personality Disorder], the subsequent suffering is amplified to condemn the allegedly cruel and negligent caregiver. The goal of provocation and the therapist's angry countertransference were described by Reich (1949):

. . . . In reality it is not a matter of punishment at all, but of placing the analyst or his prototype, the parent, in a bad light, of provoking him into a behavior which would rationally justify the reproach, 'You see how badly you treat me' (pp. 223﷓224)" (p. 268).

"Not surprisingly, NEGs as a group are very likely to fall behind if not to default entirely on paying their therapy bills" (p. 271).

. . . a NEG [similar to the Narcissistic Personality Disorder in expecting and feeling 'entitled' to nurturance and protection] will see any bits of power, hostility, and neglect in a communication as personal abuse. Even if a comment is carefully nested in a benevolent context, the NEG will grasp at the most unfavorable interpretation. . . . These patients are not much fun. The therapist must perform perfectly! NEGs are more likely than others to try to sue the therapist; I could give examples, but fear to do so" (p. 289).

"In paranoid families, grudges are held for a long time" (p. 320).

"The major treatment problem with PAR [Paranoid Personality Disorder] is the creation of a collaborative patient-therapist bond. . . . (p. 332).

"The therapist is well advised to remember how hostile and litigious PARs can become. While always being kind and supportive, the therapist must especially vigilant about not straying from professional, legal, and ethical guidelines.
"One PAR began therapy by insisting on seeing the therapy notes . . . . He then insisted that the therapist take no notes. The therapist refused to comply with the demand that there be no notes, but did reassure the patient about the confidentiality of the file. The therapist also agreed to keep note taking to a minimum, and said that from then on, notes would be taken after rather than during the sessions (p. 335).
". . . . In deteriorated condition, the patient demanded angrily to have the therapy notes. His intent was to demonstrate that the file was inadequate and that he had been exploited. The idea was that money had been paid, but service had not been rendered" (p. 336).

"The PAR needs to know that his or her feeling of vulnerability and fearfulness does not 'prove' that the therapist, spouse, or boss was in fact attacking" (p. 337).

"Some things that are unconscious must become conscious" (p. 391).

Benjamin, Lorna Smith. (1993). Interpersonal Diagnosis and
Treatment of Personality Disorders. New York: The
Gilford Press.

Reich, W. (1949). Character Analysis. (3rd ed.). New
York: Orgone Institute Press.

Replies:

Re:Hostile and Litigious Personality Disorders, by D., 10/19/01 Re:Hostile and Litigious Personality Disorders, by , 10/20/01

| Behavior OnLine Home Page | Disclaimer |

Copyright © 1996-2004 Behavior OnLine, Inc. All rights reserved.