Sunday, April 21, 2013

Compass Therapy: The Mind of the Antisocial Personality Disorder


Compass theory employs the term “Rule-breaker” as a significant feature of the antisocial personality disorder mindset because it reflects a willful stand to live outside the boundaries of custom and the rule of law, and because counselees readily understand the term.

Antisocial Rule-breakers are notably resourceful. They learn from life experience that little will be achieved without substantial effort and cunning, and that desired goals must be accomplished by one’s actions.

Thus Rule-breakers overly use the Assertion and Strength compass points of the Self Compass. What happens to the lower quadrants? 

Antisocial Personality Disorder

The Love compass point is warped into a façade of charm that masks the hidden intent to exploit. The Rule-breaker represses feelings of tenderness, for this would give others the edge. 

The avoidance of healthy Weakness keeps them from empathizing with other’s pain or admitting any faults. It is precisely this lack of empathy combined with entitlement that creates a “superego lacunae”—a massive deficiency in social conscience. Thus a Rule-breaker is streetwise, glib, and able to lie convincingly, and is well equipped to exploit people’s weaknesses or trust.

THERAPY for ANTISOCIAL PERSONALITY DISORDER

1. The therapist can offer reflections and interpretations that not only show empathy for Antisocial Rule-breaker counselees, but also help them become aware of the cognitive self-talk that underlies the antisocial pattern:
  • I disdain traditional ideals and hold conventional ethics in contempt.
  • I have no guilt about using and discarding others when I no longer need them.
  • I take pleasure in shrewdness, calculation, and the transgression of social codes.
  • I can wear a mask of helpful civility to hide my true intentions.
  • Openness and caring are signs of weakness. If I run into a kind and attentive psychotherapist, I’ll take him (or her) for a ride.
  • I don’t mind escalating into verbal threats or physical violence if it gets me what I want.
  • I will never be caught. I’m always ahead of the law, the regulatory boards, and the gatekeepers.
  • I think people should have access to all the alcohol and drugs they want.
 
Antisocial Rule-breaker

2. Antisocials typically block a therapist from any transactions that resemble moralizing, yet respect tough-minded challenging that resonates with their strong-willed posture. In a way akin to Reality Therapy, Compass Therapy meets the antisocial at the level of concrete operations, where they are cognitively fixated, and nudges them forward toward abstract thinking.

3. By connecting behavior with its logical consequences, and developing interpersonal perspective that anticipates their behavioral impact on others, counselees learn how to increase non-exploitive exchanges with individuals and institutions in daily life. This growth strategy is very similar to coaching a rebellious teenager into a more proactive life.



Thursday, April 11, 2013

Compass Therapy Drug Addiction Technique


Metaphors are especially needed when counselees lack proficiency in reasoning or verbal fluency

Sergio was a nineteen-year-old former gang member who saw me for a dozen sessions. He was on a year’s probation for getting caught with several bags of methamphetamine in his car. After doing some jail time, the police department had released him to work a residential drug treatment program (Narcotics Anonymous) and get some individual counseling. 

In this sixth session, Sergio was contemplating for the first time enrolling in a community college. Understandably, he had anxiety that all he had learned in gang life would work against him.
 
“One thing I’ve discovered about you, Sergio, is that you are a very resourceful guy.”
“In gang stuff. But I don’t know nothing about college.”
“I see that differently.”
“Like what?”
“Remember the things you shared about getting in tight with the gang, robbing an enemy’s stash, and living off drug sales?”
“Yeah.”
“When you put it all together, I think you had a high learning curve for figuring out how to deal drugs and carry on a successful business.”
“I did pretty good ‘til the cops popped me.”
“So what’s to keep you from that same high learning curve at community college?”
“I can’t sell drugs there. They’d bust my ass in two seconds.”
“Yeah, but think of all the social skills you’ve learned in the past few years. You’ve learned how to hang with people, how to watch out for them, how to be loyal to your friends and customers. College students are human just like you. Your social skills will work there as good as in a gang.”

Community College

“But what about all the bad things I know?”
“So what? The best students bring some life experience with them to college. You’ve survived on the street and that’s valuable experience. Now you’ll just be applying your intelligence to learning math instead of weighing and bagging dope.  I imagine you have good rudimentary math skills.”
I was good at keeping a ledger for what people owed to me.”
“Just change the scene a bit and you’re passing college algebra so you can build a trade instead of rotting in jail.”
“What about reading? I don’t read good.”
“Neither do I. How did you handle it in the gang when you needed to learn how to turn a drug deal?”
“I talked to somebody who was good at it—somebody in the gang longer than me.”
“There you have it. Use that same determination to find a friend or tutoring course on campus to help you do the reading. And don’t forget that Hollywood smile you’ve got. You should use it more often, now that you’re not trying to scare people.”
Sergio smiled.


“So here’s the deal,” I said. “You’re a talented man with a sharp intelligence and considerable social skills. You’ve already proved how successful you are at the formidable challenges of gang life. Only you don’t like the jail time that goes with it. Now you’ve kicked your drug addiction through NA and your Higher Power. The way I see it, God is calling you forward into a whole new future. What’s keeping you from putting your courage and talent into a first semester at the community college?”
“Nothing. I think I’ll go over and check it out.”

Sergio did just that, and after two more months of thinking about it, Sergio entered the community college for the summer term.

For more, read:  

CHRISTIAN COUNSELING THAT REALLY WORKS 

 
Christian Counseling Book

Monday, April 1, 2013

Borderline Personality Disorder Origins


The borderline personality pattern is formed in a family dynamic where frequent boundary incursions and crises make it difficult for the child to establish a reliable identity. Rather, the child experiences confluence with the parent, in which thoughts and feelings are all tangled into knots. It seems impossible to establish where one’s identity begins and another's ends. This amorphous merging prevents the child from successfully developing either attachment or individuation. Lacking sufficient self-boundaries, the child is stuck in an undifferentiated limbo. Communications are taken personally and reacted against, rather than responded to or understood.

Family Chaos

The child interprets these garbled communications as his or her fault or the fault of others. Parents may act out through incessant arguing, drunken fury, physical combativeness, suicide attempts, or incestuous abuse. The child learns to become center-stage in this chaos, discovering how to create a similar chaos in others.

Family members perceive attempts toward autonomy and individuality as betrayal, and punish the child accordingly. With no Self Compass for balance, the child remains dependent upon family members while feeling rage against them for the invasion of one’s personhood. Inner pain that erupts in volatile explosions seems perfectly normal.

CLINICAL LITERATURE

Schneider first employed the term “labile” to accentuate the volatile nature of the borderline pattern. Indeed, this term is more descriptive than “borderline,” capturing the pattern’s predictable inconsistency.

Stern characterized this pattern as a “borderline group of neuroses” exhibiting contradictory traits: narcissistic grandiosity combined with feelings of inferiority, and psychic rigidity combined with inordinate hypersensitivity. Stern coined the term “psychic bleeding” to convey the anxious desperation that drives this unstable pattern. 

Schmidberg viewed the borderline personality as “stable in his instability, whatever ups and downs he has, and often keeps constant his pattern of peculiarity.” More recently, Kernberg has described the pattern as a “mutual dissociation of contradictory ego states.” 

COMPASS THERAPY INTERPRETATION

Borderline Self Compass: Dr. Dan & Kate Montgomery

The self-system of the borderline pattern fluctuates drastically as emotional explosions are interspersed with the boundless need for reassurance. When caught in the grip of anxiety (Weakness compass point) or longing for nurturance (Love compass point), the person seeks assurance in the manner of the Worrier or Pleaser patterns. This sends others an SOS signal that elicits a desire to rescue the borderline patterned person from depression or loneliness. But since one demands assurance that is absolute and comforting that is perfect, these demands can never be met.

Then self-righteous judgment erupts. Furiously accusing others of neglect, disregard, and untrustworthiness, one’s behavior then more closely resembles that of the Arguer and Boaster patterns.
“Just look at this pizza. The crust is thick! You know I like thin crust. Some treat you brought me. You did this just to make me miserable. Well, you succeeded admirably. I’ll never trust you again!”
  • Extreme lability of affect, erratic shifts between neediness and aggression, and a lack of basic trust make the Self Compass highly unstable. 
  • Such instability is accentuated by the ever-present but contradictory feelings of dependent anger and anxious superiority toward others. 

For more read:
Christian Psychology In Action 
and

 
Compass Psychotheology