Counseling the Paranoid Personality Disorder

Treating the paranoid personality disorder involves embracing a paradox: the best therapeutic strategy is to give up the need to help them. 

Why? Because their radar will translate any conscious or unconscious need of yours as a devious attempt to influence them. If you want to help them, they will see this as condescension—that you’re really only interested in taking their money or building your ego at their expense.

In other words, they come in armed to the teeth to defend themselves against dependence upon you or learning anything from you. Fritz Perls called this the bear-trapping game, by which he meant that aggressive-oriented counselees lay out traps that spring into action when you least expect it. 

Springing A Trap

They may cajole you with questions about your qualifications, your personal life, or your intentions for them, then place your words or actions into a distorted context that is aimed at your humiliation. Or they may jump on a phrase you use and put you on the hot seat.

You would not be human if you didn’t feel the occasional sting from these machinations. Yet you can foresee and avoid most traps by:

1. Developing modest expectations for the therapy.
2. Engaging the counselee at a more objective than subjective level.
3. When appropriate, uncovering the structure and function of the paranoid Arguer pattern with calm aplomb. 
4. Equally important is keeping the motivation for every aspect of therapy squarely on the counselee’s shoulders. 

One might wonder why paranoid Arguers are willing to seek therapy, let alone pay for it.

The most common answer is that they are motivated to recruit a mental health professional into agreeing with them that someone in their interpersonal world is stupid, devious, and argumentative because they are not doing what the Arguer wants them to do.

If they can convince you to agree with them that the other person (usually a spouse, child, or work associate) is guilty and they are innocent victims, then they can use your expert opinion as a hammer for battering the other person.

By thoroughly mastering the paranoid mentality, you develop immunity from various paranoid tactics that could otherwise leave you rattled. 

If you know their pattern as well as they experience it from inside themselves, and yet don’t use your knowledge to blame and attack them, they detect that they can’t manipulate you. Their trust and respect

for you as a therapist increases.

Here are a few points to keep in mind:

1. Paranoid Arguers are stubborn and proud of it. 
2. Their views are always right. 
3. Criticize them and they become vindictive. 
4. Threaten them and they become stronger. 
5. Attack them and they make vengeful plans to make your life miserable.

Paranoid Arguer

 

Their thought patterns run along these lines:

• People can’t be trusted because they are devious and will side against you.
• I am honest in saying that my philosophy of life is how things really are.
• I must test those around me to see if they are loyal.
• Other people want to interfere with my freedom, put me down, and discriminate against me. 
• I have never received the good treatment that society owes me.
• If people seem friendly, they’re only trying to manipulate me.
• I need to be constantly on guard against adversaries who want to take advantage of me.
• I am hard-nosed and proud of it.
• People make me angry because they are untrustworthy and exasperating.

For more on techniques for working with the Paranoid Personality Disorder, read:

COMPASS THERAPY:

Christian Psychology in Action

The Self Compass in Counseling and Therapy

Incorporating the Self Compass diagram in a session is simple and intriguing. 

Show a graphic of the Self Compass to your client and say something like: 

“One of the building blocks of your therapy is this compass diagram. Notice that it’s divided into four compass points that are essential to every person. 

“The Love compass point stands for all the love and caring you’ve ever received or given, but its opposite, the Assertion compass point, is just as important. Loving helps you care for others; Assertion lets you express yourself and stand up for your feelings and values. Now I wonder if you might explore how the Love/Assertion polarity relates to you.”

By asking clients to locate and elaborate on their own experiences within the Self Compass, you involve them in assessing and describing their own behavior. Two things happen. 

First, they begin to develop an observing self that will help them reflect on their behavior throughout the therapy. 

Second, they enjoy talking about themselves in compass terms by sharing significant life experiences that relate to a given compass point. This prepares for continued exploration of the relationship between their current functioning and their actualizing growth toward holistic health.

Personality researchers have frequently found that this process of developing "psychological mindedness" is associated with successful treatment outcomes.

By introducing the Self Compass early in therapy, you invite the person to become a motivated collaborator in the therapeutic alliance. Substantial evidence links proactive client participation with beneficial outcomes in therapy. 

Once you have explored the terrain of a client’s reflections on Love and Assertion, you launch the next expedition by saying: 

“The other polarity represents times in life when you’ve felt especially weak or particularly strong. The Weakness compass point equals anxiety, vulnerability, and uncertainty. The Strength compass point describes your experiences of confidence and adequacy. How would you say these two compass points relate to you?”

As vital information from your client’s life history comes forth, you discern how he or she has typically handled the Weakness/Strength polarity. Is he stuck overly exaggerating weakness at the expense of strength? Has she developed a superior attitude to compensate for her fear of showing weakness?

The rapport you build and the insights you gain help form a diagnostic impression of the client’s personality configuration. You may find out that the man who is a confident physics professor at work is a dependent depressive at home. Or the woman who has mastered yoga for relaxation goes to pieces when stressed by her hyperactive three-year-old son.

You and the client are working together like Sherlock Holmes and Watson, searching for relevant clues and deducing growth goals that will help to solve the mystery of why self-help that has eluded them. 

The spirit of mutual curiosity and discovery generated by exploring the Self Compass adds momentum to motivation, self-reflection, and personality integration. These are key ingredients for awakening clients to full engagement in their change process. 

Here’s a glimpse of how such dialogue can work. Let’s say you’ve just heard Nancy’s disclosure about how she sees herself and her significant relationships in terms of the Self Compass. You begin to formulate a treatment strategy with her.

Therapist: “So Nancy, it sounds like you could benefit from more assertion in order to hold your own with your husband. Is that right?”

Nancy: “Yes, he just makes so many choices about furniture, vacations, and where we eat out without getting my input. I don’t think he’s trying to be bossy. But I do need to let him know what I’d like more often.”

Therapist: “One of our goals can be strengthening your use of the assertion compass point. Working on how to diplomatically express yourself instead of not saying anything. Now what about strength and weakness?”

Nancy: “Well, in my nursing work I feel very confident. Everyone treats me with respect. So that’s okay. But where I get shaky inside is with my teenage daughter. She wants so many things! I give in too easily. I think I feel intimidated by her.”

Therapist: “It’s like you feel strong at work but weak in the presence of your daughter, especially when she puts pressure on you to buy her something.”

Nancy: “Exactly. I’ve tried to set boundaries but she just keeps on until I give in.”

Therapist: “Well, we can strengthen your staying power through some role-playing and help you develop more self confidence in her presence.”

Nancy: “That would be great.”

The Self Compass is a user-friendly tool that helps a therapist: 

• develop a diagnosis-to-treatment strategy
• form an estimate of how many sessions may be needed
• generate action techniques for intervention and growth-enhancement
• monitor a counselee’s progress
• determine when therapy is ready for termination

Sharing the Self Compass demystifies therapy and engages clients as dialogue partners in the therapeutic enterprise. People feel excited and empowered when they know they can directly influence their own functioning.

By adding the knowledge coming in future posts to the central model of the Self Compass, you'll become able comprehend a vast amount of clinically sophisticated material in a way that feels intuitive and easy to recall.

Most of all, you will grasp the link different personality rigidities and effective specific treatment strategies needed for guiding your clients toward health and happiness.

Compass Therapy Provides Hope Over the Lifespan

Compass Therapy offers hope for transformative growth  throughout the lifespan.

The Bible affirms this hope by assuring that God has a positive plan for each person’s life, “For I know the plans I have for you,” says the LORD. “They are plans for good and not for disaster, to give you a future and a hope” (Jer 29:11).

Neuropsychology supports this hope by showing clearly that human personality is malleable. The brain can respond to new learning even into old age.

In the therapeutic alliance the counselor and client are not just working to solve presenting problems, but growing together as persons along life’s way. Through the counselor’s behavioral modeling of caring and courage, humility and esteem, the client comes to experience the interpersonal dimension of hope for fulfilling relationships, giving and receiving love, and if the client chooses, loving and trusting God.

This brings us to a diagram that helps inspire counselees with an overview for their lifetime growth in Christ: “The Actualizing Ascent.” Upon showing the diagram to a counselee, you might say, “This represents the human lifespan.”

You explain that the first half of the curve slopes upward, which represents human development the morning of life, from birth to midlife. The tasks of this phase of life include the acquisition of language and culture, education, experimentation with social roles, identity formation, employment, and marriage and

child-rearing if so chosen.

As shown by the curve’s peak, the middle vertical line designates the high noon of midlife, and sometimes precipitates an identity crisis as people shift from the morning to the afternoon of life. While ambition and ego satisfaction characterize the morning of human development, the afternoon of life requires a more interior search for meaning, wholeness, and interpersonal fulfillment.

Carl Jung reported that virtually all of his patients in the second half of life were grappling with religious concerns. Though an individual may get by the first half of life without cultivating actualizing virtues, the lack of development in the second half of life can lead to confusion, frustration and despair.

It’s almost as if God imbues aging with the power to arrest everyone’s attention -- to finally say, “Look. You really are finite and temporal! You’d better grow in me while there is still time, for without me, you will be nothing.” The down-sloped side of the lifespan curve shows the inexorable decline of bodily health and stamina. Wear and tear in the body shows up in wrinkling skin, slowed metabolism, sagging muscles, stiffened joints, vulnerability to disease, and eventually, diminished mental capacities.

For those who refuse to challenge their rigid personality trends during this time, these trends intensify and take a tragic toll. 

Aggressive persons become crankier and more belligerent, ever more paranoid and chronically suspicious. Dependent persons feel more anxiety-ridden and scattered. Withdrawn people shrivel up like leather left out in the sun too long, adapting to marginal levels of subsistence, barely getting by, and isolating from human contact. Controlling people grow obsessively worried about the things they can’t control, raising their blood pressure and shortening their tempers.

The goods news, though, is that people can grow increasingly wise, patient, and mature in the second half of life. This is represented by the upward-sloped dotted curve, you explain, which shows a person’s potential for actualizing psychological and spiritual growth. 

Indeed, Christians are blessed to know that Christ will help them become more whole through anything they face, and will personally welcome them to everlasting life at the moment of death.

Compass Therapy encourages continued growth and development throughout life. You explain to counselees that individuals who begin growing psychologically and spiritually in their thirties, forties, or fifties tend to keep growing in their sixties, seventies, and beyond.

Since the human personality is malleable, exercising the LAWS of personality (Love and Assertion; Weakness and Strength) and the compass virtues (caring and courage; humility and esteem) promote health and fulfillment even into old age.

Perhaps the single most important attitude that Compass Therapy seeks to impart is that change is normal and the need for growth common to all people. Equipped with an actualizing perspective, stagnation is forsaken in favor of the ongoing transformation of one’s personality and relationships, conjoined with a deepening trust in the Holy Spirit’s help and guidance.

When counselees internalize this health model for hope, grace, and transformation, they learn to face the coming years with increased flexibility and resourcefulness.

The Actualizing Ascent Diagram helps counselees see the importance of exchanging rigidity for rhythm, egocentricity for actualizing development, manipulation for authenticity, and personality   idiosyncrasies for compass virtues.

In this way, the invitation of Christ, the witness of the counselor, and the vision of the counselee converge in the pursuit of a life lived gracefully, accruing in wholeness and purpose. Though there are quintessential tough times and challenging adversities, the overall direction is toward an actualizing ascent in Jesus Christ.

Compass Therapy Promotes Direct Action

Not long ago I was in a therapy session with a twenty year old woman (I'll call her Rachel) who was struggling to recover her battered self-esteem from an eight-month relationship with a domineering and misogynistic man. Of course her boyfriend (I'll call him Bill) had his charm. He bought her a few gifts. He made her laugh sometimes. But that hardly compared to how badly he ran her down in his presence.

We began our work with her describing Bill's many ways of verbally abusing her, at the same time trying to convince her that she deserved this treatment. 

Now in the present session I show her the Self Compass diagram, explaining how people need access to the four compass points of Love and Assertion, Weakness and Strength—the LAWS of personality health.

Rachael immediately got it. She said, "I was definitely stuck on the Love compass point, pleasing and placating Bill in every way, always trying to keep the peace, and always wondering why he was so mean and critical. I didn't dare show Assertion or Strength." Likewise, she identified Bill as stuck on the Assertion compass point with relentless aggression. "He always became angry and impatient, especially if I hesitated to do whatever he wanted."

Once we both grasped the relationship dynamics, I offered insights for developing healthy Assertion and Strength in Rachel's personality. But we needed more than insight alone. We needed to exorcise the emotional anxiety from his reign of terror in her life. In the next session, I moved into a Compass Therapy action technique.

"Rachel, our talking so frankly and fully about the emotional wounding you received from Bill is the first step in recovery. But the next step requires action on your part."

"What do I need to do?"

"Just relax where you are sitting and follow my instructions for the next couple of minutes. We're going to go deep in your psyche, where your unconscious has stored hundreds of painful memories—humiliation, false guilt, and fear of displeasing Bill or any other man. We're going to cast these feelings out of you by replacing them with their polar opposite: peace, dignity, and self-love."

Rachel agreed to follow my lead. I guided her into a deep breathing and muscle relaxation sequence, where she tensed and then relaxed muscle groups from the crown of her head to the tips of her toes.

Once she was physically and mentally relaxed, I said, "Now while you continue to melt your muscles and breathe deeply, I'm going to speak to you the way Bill often did, and use the same tone of voice. Your task is to keep relaxing, and come up with new responses that tell him now—based on your newly developing Assertion and Strength—what you wish you had said back then, but were too afraid."

Once she fully understood what we were doing, and did indeed relax, I repeated many of the criticisms that Bill once used, and was pleased to see her standing up to them. She drew from the Strength of our relationship, and trusted the process of Self Compass expressiveness that Bill inhibited. I cheered her on until she actually felt this healthy assertion in her body/mind/spirit.

A session like this isn't an instant fix. But it does have psychological power to generalize into a person's current and future life. And for Rachel it was lifesaving to develop a new sense of peace and self-confidence. She was taking the first steps to learning how to build a self-boundary strong enough to ward off any future encounter with a misogynistic man.

There are twenty-five counseling techniques in one of my books on Compass Therapy. To read the first chapter, 
visit Amazon.com here:

Christian Counseling That Really Works: 

Compass Therapy in Action

Carl Rogers and Dan Montgomery: A Dialogue About Therapy

Carl Rogers stands out as the psychotherapist and theory-builder who emphasized the significance of feelings and emotion in therapy.

To place Rogers in historical perspective, we need only realize that he felt disturbed by the psychoanalytic and behavioral approaches to therapy in his day. These, he believed, minimized the importance of human feelings and overstated the role of the therapist as an authority figure who knew more about a person's problems than the person.

The many films that feature Carl Rogers in counseling reveal his transparency and sensitivity. Clients who worked with him often reported feeling deeply accepted and understood.

Rogers was raised on a farm with rural folk who prized sincerity above all else. He acknowledged that this upbringing influenced his formulation of therapist warmth, congruence, and unconditional positive regard as crucial to successful therapy. Indeed, he argued that these very qualities in the therapist would facilitate client healing, self-trust, and self-direction.

During Roger's prime, I collaborated with my psychological mentor and film-maker Everett Shostrom to produce the famous "Kathy" films, in which Carl Rogers, Arnold Lazarus, and Shostrom each spent an hour counseling the same woman. She later described Carl Rogers as the most friendly and supportive of the three, but stated she hadn't learned much from him.

In the years that followed, however, a number of studies indicated that Client-Centered or Rogerian Therapy was too non-directive for many clients. It seemed to work best for educated and self-motivated clients who could benefit by the therapist reflecting their feelings, apart from any other techniques or directives.

By contrast, in formulating the principles of Compass Therapy, I came to emphasize that therapists need to come across as experts in the field of therapeutic psychology. This does not mean acting in an authoritarian style, but rather taking charge of the course of therapy by  stimulating a client's healing and personality development through action techniques. This might include relevant teaching about lifespan psychology, human sexuality, healthy versus dysfunctional ways to handle emotions, the challenging of irrational ideas, or role-playing problematic situations or behavioral solutions.

I had the opportunity to discuss these ideas with Dr. Rogers. Here is the heart of that conversation.

Dan: "I have long admired the warmth and support you offer clients, how you are with-and-for them no matter what they share."

Carl: "Thank you for saying so. I believe clinical science has shown that this is an essential ingredient to successful therapy. What is your perspective?"

Dan: "I agree on the whole, but wonder whether in light of your lifetime work you still believe that reflection of emotions is the key element of therapy. And specifically, I wonder if there might be a place for a therapist to use diplomatic confrontation, such as teaching a person about personality patterns that are hurting them, or role-playing methods of coping that can carry over into daily life."

Carl: "This is a sensitive subject, because I've always been cautious about a therapist interfering with a client's inner-direction. But I have to say that if I had it all to do again, this time I would grant a place for more active engagement and methods on the therapist's part, while continuing to express empathy and emotional rapport."

Dan: "I like how you put that, and in the model I'm developing this would amount to the therapist using caring and empathy to maintain client rapport, and action techniques to teach new behaviors and stimulate creative coping."

Carl: "I'm a little suspicious of techniques, unless they are well integrated with the therapist's spontaneity and authenticity. I do like the concept, and wish you well in putting together reflection and action in your methodology."

Compass Therapy continues to integrate action methods with rapport-building principles, so that clients remain emotionally secure, as well as occasionally challenged by the therapist to take needed growth-stretches that actualize their goals.

Compass Therapy Tips for Counseling a Dependent Client

Dependent clients transfer their indiscriminate hunger for people’s approval straight into the counseling setting. In terms of the Self Compass, they are stuck on the Love compass point in the Dependent trend, and their chief difficulty is a fear of using the Assertion compass point.

1. Resist being trapped by the niceness, politeness, and attempts at being ideal counselees. It is important to help dependent clients stay in touch with the need for healthy assertion, because they fear anger and confrontation. Watch out for the temptation of feeling flattered when they tell you how wise and wonderful you are. If you get hooked by this unconscious ploy, they will remain as dependent as ever.

 

2. How do you teach dependents about their self-defeating personality pattern without devastating them? You break the news gently by exploring how they first acquired the Dependent trend in childhood and adolescence. You ask them to recall who taught them to care so much about people’s approval. You predict that unless they outgrow the Dependent trend, they will keep feeling guilty about trivial matters, fearful of displeasing others, and depressed when others inevitably take them for granted.

3. Skillfully frustrate their tendency to lean on you. Ask them how they feel about different issues, and wait for them to spell it out. This helps them take responsibility for thoughts and feelings. Ask what they want and how they might accomplish it. This helps them think for themselves. Compliment every movement toward self-direction and emotional self-sufficiency.

4. Become the accepting parent your dependent client never had. Compliment them when they finally admit their anger towards others, disclose secret depression, or show disgust with their overdone niceness. Your acceptance of their negative feelings helps them accept more realistically their Strengths and Weaknesses—without fear. This is how they become more authentic human persons.

Dr. Jim Beck at Denver Seminary says about  

Christian Counseling That Really Works: 

"The 25 techniques alone are worth the price of the book."