Gregory Lester – Personality Disorders: The Challenges of the Hidden Agenda

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Gregory Lester – Personality Disorders: The Challenges of the Hidden Agenda

The client whose problems meet the DSM-5® criteria for a Personality Disorder can be the most difficult client in your caseload to treat. They may require more time in therapy, more energy and involvement on your part, experience a greater number of life crises, and create more upset with their family, work, and social systems than virtually any other diagnostic group.

Often being “sent” for therapy rather than choosing therapy, their motivation for change may be limited and their personality disorder is likely-co-morbid with other exacerbating disorders.

Watch Gregory W. Lester, PhD, and take home an integrated approach for working with these challenging clients.

Take home:

• Evidence-based skills for successful treatment
• Techniques to assess and treat comorbid personality
• A framework for treatment planning
• Skills to assist the client toward greater coping and adaptation

1. Categorize the essential characteristics of each of the personality disorders in DSM-5® for clinical assessment.
2. Determine the “hidden agendas” of each of the personality disorders as they relate to case conceptualization.
3. Describe how transference and countertransference can affect clinical management and treatment outcomes.
4. Explain the boundary violation traps inherent in each of the personality disorder relationships as it relates to clinical treatment.
5. Utilize tools to assess treatability and prognosis early on in the therapy.
6. Evaluate the efficacy of various treatment methods for personality disorders including DBT and CBT.
7. Manage client’s suicidality, self-injurious behavior and violence with clinical strategies.

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Learn the DSM-5® Personality Disorder System

• What is personality, where does it come from and where does it go?
• Attachment-the lifelong problem
• Personality pathology: genes vs. family vs. friends vs. fate
• Personality disorders
• Spectrum or category
• Discrete or complex
• Bump in the road or end of the line
• Why can’t we all just get along?

”It’s All About Me.” The Challenge of the Hidden Agenda

• The core of the personality disorder: The unchanging agenda
• A review of the DSM-5® personality disorders and their agendas:
  • Criteria changes:
    • Schizotypal
    • Narcissistic
    • Antisocial (and Psychopaths!)
    • Borderline
    • Avoidant
    • Obsessive-Compulsive
    • Trait Specified (PDTS) What is that?
    • General Criteria for Personality Disorders
    • Levels of Personality Functioning
    • Personality Trait Domains

Actually, It’s All About You

• Transference & Countertransference
• What does transference and countertransference look like in our work?
• Boundary crossings and boundary violations
• How to tell when you are headed for disaster and how to intervene

What Works and What Doesn’t With Personality Disorders

• Polypharmacy and the borderline client
• DBT, CBT and all the rest-which therapy for whom? What’s the evidence and what’s the truth
• Generic, but incredibly useful, therapy strategies for each disorder
• Are some disorders hopeless?

Nobody Gets Hurt: Violence, Suicide & Manipulation

• Self-injurious behavior
• The frustration of recurrent suicidal behavior
• Suicide risk assessment
• Keeping yourself safe

Limitations of Research and Potential Risks