As we enter the New Year, it is common for us to reflect on the past and set goals for the year ahead. While there is nothing inherently wrong with intention setting or making resolutions, these practices can miss the mark in therapy with patients who are struggling with personality disorder (PD). As we work with these patients, it is time to turn away from standard goal-setting, and lean into relationship — that is how we get to the root of the problems our patients are facing.
Focusing on Relationship in Therapy
Patients with personality disorder are operating from a mental state of infancy to toddlerhood, the result of childhood trauma and insecure attachment in those formative years. Goals and milestones do not exist in this state, and the patient’s emotional experience is at the forefront. When therapy is successful and patients activate their true selves, they show us what their goals and milestones are.
The focus on relationship in therapy means that the types of progress we celebrate are grounded in emotional experiences. These are things that can often look small or out of control to the average person, but are significant to patients, such as taking the opportunity to do something productive rather than destructive. For example, for patients who cut, we may reflect that their cuts are not as deep as they previously have been and ask our patients, “Can you see this as progress?” We esteem and celebrate this progress.
How it works
Like so many walking into therapy offices, patients at Nysa Therapy come because they are dealing with anxiety, depression, relationship issues, and other challenges. For patients with personality disorder, the cause of these symptoms is not a lack of communication or social skills — it is that they have arrested development that has resulted in personality impairment. The patient’s true, authentic self did not activate in development, and they are functioning through defenses started in early childhood.
To get to the heart of this issue, Nysa Therapists build secure attachment with patients so that they can activate their true self. Once this true self has activated, they may begin to:
- Stand up to people who dominate them
- Realize what is true and right for them and are able to assert those things in their life
- Identify things they really want to do in relationship, career, and beyond
- Engage in messy behaviors as they attempt to find what they want out of life
As patients identify these strengths in themselves and what’s true in their lives, we nurture and support them. These behaviors may look messy or dangerous, because patients are moving through the stages they missed during development. Rather than attempt to mediate these behaviors or try to stop them (unless these behaviors become lethal), we honor subtle progress as our patients move through these stages. This is a sign that therapy is working.
At Nysa Therapy, we believe in people. Our approach starts with the belief that every person has everything they need within them. Our job is to remove barriers to activating their true selves. This does not come from setting goals or working toward physical accomplishments. It comes from seeing them through their darkest moments.
