Ep 64 - EMDR: Rethinking Personality Disorders
What if a personality disorder is just a really adaptive way that our brain has responded to the conditions that we grew up in? We know a little bit about personality - we know that there are a few personality traits that are inherited and and these can be either expressed or enhanced or suppressed depending on how we grow up and what we're exposed to in our very early life. and there's been a lot of research around this around the nature or nurture kind of concept and people have applied this to personality in itself but you don't read so much about this being applied in personality disorders. There are around five traits of personality or maybe it would be better to say five traits of temperament that we seem to be born with and these include openness, conscientiousness, extraversion, neuroticism, and agreeableness. Now if we grow up in a happy contented, safe family then we are free to express what our true personality is and some of those personality traits might become really beautiful and warm and lovely things that we are known for in our general life. We are free to express and discover who we really are. but what about personality disorders? so traditionally in medicine personality disorders have been considered as a collection of traits that are fixed and immovable and untreatable. or if they are treatable it's only with many many years of intense psychotherapy that costs hundreds of thousands of dollars to the Client, and needs a very dedicated therapist or psychiatrist to help that person with their personality disorders. The personality disorders that I'm talking about here can be classified as cluster A (the paranoid, schizotypal or schizoid personality disorders), cluster B (the Borderline, antisocial, histrionic and narcissistic personality disorders) or cluster C (which are the Avoidant, Obsessive Compulsive or Dependent personality disorders).
So why am I talking about this in particular today? So just last week I went to a training for treatment of personality disorders using EMDR, run by this incredible pair of therapists Ad de Jongh and Susie Mathison from the Netherlands. I have to say I do fan girl a little bit over these two because they are fabulous, incredible, generous, intelligent people and they do really groundbreaking research in in regards to treating people with very hard to treat conditions like severe PTSD, complex PTSD and now personality disorders using EMDR. They use mainly a combination of EMDR and exposure therapy. They've just released a study that shows that they can treat somebody in their inpatient unit in the Netherlands with five days of intensive therapy that includes four sessions a day - two sessions of exposure therapy and two sessions of EMDR to work on their trauma. Their results are outstanding, with around 73% of the clients improving enough to actually lose their diagnosis of a personality disorder. Another study treating clients with personality disorders in the outpatient setting, with 10 sessions of EMDR over 5 weeks, shows 44% of clients in remission from their personality disorder diagnosis.
Now this is a very exciting thing to do because it reimagines a personality disorder as a response to trauma. so we all know that how we respond to trauma we respond in the very best way that we know how to do. We never want to be damaged by trauma so we respond in ways that a brain can cope, the best we know how at that time. If these events happened to us when we're very small then that response may be helpful at that moment but may not be helpful in the long-term. And it's all about what we learn about ourselves and the world from the trauma. so perhaps with personality disorders we might say that the personality disorder rests on these negative beliefs about ourselves and these affect the way we interact with the world and respond to various challenges and situations. For example in narcissistic personality disorder, the response to the world is affected maybe by a belief of. I am bad. I'm shameful and the response the defence to this very painful belief, is, to assert that I am always right. I'm the best. There is there's nobody better than me. I always get what I want. My needs always come first. So if we can treat the trauma that lies underneath this if we can get underneath these defences then and we treat the trauma that caused the original negative belief about ourselves. I'm worthless, shameful etc then we don't need the defence any more. That's really exciting. So say for example another type of personality disorder may be dependent personality disorder. The beliefs that are portrayed in this personality disorder might be might lie in the control and power realm and they might be something like I'm not important I have no control. I am not effective, I need others to survive, things like that and they may have learnt this very early on. You can imagine what may teach somebody these negative beliefs perhaps a very domineering family that didn't allow that child to exert any control or perhaps a helicopter family who never let that child explore anything for themselves. They always made the decisions for the child. Never let them make any decisions for themselves and so they always grow up feeling helpless and dependent upon somebody else. If we can receive those memories of being helpless or not having control, then the person will be able to be more self actualising, more independent, make better decisions, or make any decisions!
so this is really exciting research and I'm really pleased that I went up to Sydney to do this training even though I had to get up at 4 o'clock in the morning to catch a 6 am flight to get to Sydney from Melbourne and to the training by 9 am so it was a really huge day in lots of ways a huge cause I was very tired and also huge because the concepts that they that Susie and ad are promoting are really exciting and groundbreaking and inspiring.
how has it inspired me exactly? well I've got this renewed commitment to treating the trauma that underlies the discomfort, that underlies the unhappiness, that causes the coping mechanisms or the defences. I've been reflecting on a little bit of case conceptualisation, how I approach these things and I think we always need to hold in mind that we need to get the centre of the distress more quickly, and more effectively. Because the earlier we do this the sooner our clients can release all the distress around their memories. The sooner they can form the adaptive beliefs about themselves and have the peace that they deserve.
If you're a therapist and you'd like to learn more about the case conceptualisation that might be helpful for you and your treatment of personality disorders than first of all if you have the opportunity please go along and do one of Ad de Jongh and Susie Mathison's trainings. Ihave to note here, that this is not a paid ad! I have just personally found their trainings to be really effective in helping me use my skills to the best of my ability. If you're not able to do that or if you want some help in case conceptualising around some of your current clients feel free to reach out to me for consultation.
In other exciting news this week, I've just heard from EMDRAA that they have approved my application to become an Emdr Consultant so that's very exciting for me and I hope to be able to help a lot of therapists to perhaps work with clients with really complex needs to make their therapy the most effective it can be.
If you are a client and you have at some stage being diagnosed with a personality disorder then maybe this podcast has been a little bit helpful to you just reconceptualising that it may be a very adaptive response to a really terrible situation that you faced early on in life and that this adaptation, if it doesn't serve you any more then can certainly be alleviated with good trauma treatment and EMDR may be able to help you with that. A personality disorder diagnosis does not need to last a whole lifetime.
I hope this has been helpful to you, please feel free to reach out to me via my website emdrdoctor.com.au or my email address [email protected] and if you have enjoyed this podcast, please do like, review and subscribe, or leave a comment or a request for a podcast topic, I love to hear from you all, and I will talk to you again next week, in the meantime take good care, bye for now.
