Why can't people always treat us kindly

Psychiatry, Psychosomatics & Psychotherapy

Psychotherapeutic methods and procedures are of the utmost importance for the treatment of personality disorders. For each disorder there are certain therapy concepts that take the respective circumstances into account. For some personality disorders there are now tailor-made treatment concepts that are very effective. This is particularly the case for borderline disorder, dissocial personality disorder and self-insecure (fearful-avoidant) personality disorder. The decisive factor for therapy is the situation in which the person concerned is at the time of treatment. If the patient is in an (emotional) crisis situation or if there are even suicidal tendencies, the course of therapy will be different from that of a relatively stable patient.

If there are other (mental) illnesses (depression, anxiety disorders, post-traumatic stress disorders), these will also be treated. Depending on the type and severity of the disease, psychotherapeutic as well as drug therapies are possible.

Paranoid personality disorder

Paranoid personalities rarely seek help because they blame their environment as the cause of their problems. They only seek psychotherapy if they get into an emotional crisis that they cannot deal with on their own. The most important therapy goal is to reduce distrust of others and to improve social skills.

The inner assumptions that a paranoid person makes for himself must be broken down in behavioral analyzes and compared with reality. In this way it can be experienced that the other person does not pose a threat in many situations, but is friendly and well-disposed.

Group therapy can be useful to work on the strong desire to withdraw and the lack of interpersonal disputes. In role-playing games, people can learn that they have positive skills, such as a good power of observation, and can use them to solve problems and to understand the other person.

Schizoid personality disorder

Schizoid personalities usually do not feel that they need treatment. Since they do not suffer from the lack of social contact, there is usually no desire to change anything. However, the need to work in a team at work, or depression, anxiety disorders, or psychotic disorders can all lead a schizoid person to seek help.
Psychotherapy can only be successful if it is possible to develop a good relationship with the therapist. Since schizoid people find it difficult to trust other people, building this relationship is crucial and usually takes a long time. The aim of the therapy is to activate the emotional processes and to intensify or even enable social interaction with fellow human beings. In the case of schizoid personalities, individual therapy is preferable to group therapy, as the stable relationship with the therapist is more promising.

Histrionic Personality Disorder

The main goal of psychotherapy for the treatment of histrionic personality disorder is to promote autonomous, authentic interaction with others and to stabilize self-esteem. It should be learned to recognize feelings, to name them, to look at them in a differentiated manner and finally to communicate appropriately. Working with emotional logs, therapy diaries or self-observation sheets is promising.
In the course of therapy, the patient learns how his behavior and appearance are related to his personal life experience. Since histrionic people define themselves very much through others, part of the therapy is learning to regularly perform tasks and activities alone.

Narcissistic Personality Disorder

For narcissistic personalities, a stable relationship with the therapist is extremely important in psychotherapy. Patients often only come into therapy when they are in an existential crisis or have attempted suicide. Since these people are very sensitive to criticism, the therapist must find an appropriate balance between appreciation and critical feedback.

The main goals of therapy are to reduce the excessive self-image, improve the ability to criticize and promote empathy. Group therapy can help to understand other people's point of view in role play and to improve empathy.

Emotionally unstable personality disorder (borderline type)

Specific psychotherapy is the most important and central component of treating borderline disorder. In addition, drug therapy is also possible.
For more detailed information, see the Borderline Disorder article.

Dissocial Personality Disorder

Antisocial personality disorder requires a package of different psychotherapeutic therapy methods in order to be successful (e.g. the Reasoning Rehabilitation Program, R&R program). The aim of the R&R program is to improve self-control, social skills, problem-solving skills, the development of values ​​and the assumption of responsibility for one's own actions and thus of characteristics that are closely related to their deviant and criminal behavior.
Dissocial personalities often do not go into therapy on their own. Rather, it is the requirements of the court, the youth welfare office or the demands of the partner that lead these people to the therapist.

If there are other illnesses such as depression or anxiety disorders in addition to the personality disorder, these must also be treated. If necessary, anti-aggression drugs are used.

Insecure Personality Disorder

The insecure personality disorder is treated with psychotherapy. For a shy, sensitive person, a trusting relationship with the therapist who conveys security is of particular importance. The focus of the treatment is on reducing social anxiety.

At the beginning of the therapy, the patient is informed about his personality and behavioral style. Together we work out how it came about and how the thoughts, feelings and effects are related to one another. In the further course of the therapy, the current behavior is related to the life story of the patient. This enables the patient to understand why certain behaviors have developed. The goal is to break the negative thought loop in which the patient is trapped and "reprogram" beneficial, positive thoughts.

Since insecure patients avoid unpleasant situations, an attempt is made to slowly and gradually expose them to similar, previously analyzed situations. Group therapy has proven to be particularly effective for this, since the group situation in itself already represents a confrontation with the unpleasant situation. Here the patient gradually learns that he is not inferior, but that he has skills and resources.

In addition, relaxation techniques such as progressive muscle relaxation can be useful, which help to control the strong physical restlessness and excitement.

Dependent personality disorder

The dependent personality disorder is treated with psychotherapy. The main goal of therapy is to strengthen the patient's independence and autonomy. To do this, you have to learn to recognize your own wishes and needs and to work towards the outside world. Since the patients adapt easily, the therapist must pay particular attention to the fact that supposed progress due to a great willingness to cooperate also leads to an inner development and does not just represent a renewed adjustment process.

In detailed discussions and analyzes, the influence of current behavior on private and professional relationships is worked out and how people react to them. Group therapy has proven to be particularly effective, as the patient can practice new courses of action and self-confident behavior in a safe environment. Positive experiences lead to the patient's reassurance about the chosen path.

Anankastic (compulsive) personality disorder

Many people with obsessive-compulsive personality disorder get along well in everyday life. They usually only come into therapy when they can no longer calm down due to changes in the environment, as an adjustment is not possible due to the lack of flexibility. This can lead to depression or anxiety disorders. The primary goal of therapy is the development of more emotional orientation, spontaneity and willingness to take risks. This can be achieved with the help of psychotherapy. The clarification and explanation of the positive and negative aspects of extreme conscientiousness help to reflect on previous attitudes to life, to rethink and possibly to develop new perspectives. The therapist tries, together with the patient, to discover that problems can be solved with interpersonal interactions and that adherence to rules and norms is not absolutely necessary. It is important for the patient that the ability to enjoy is also promoted. This is possible with euthymic therapy.