Richard Sears – CBT for Cluster B: Proven Strategies for Borderline, Narcissistic, Antisocial & Histrionic Personality Disorders

Outline

What You Need to Know about Cluster B Diagnoses and Approaches

• Key features, diagnostic criteria, and differential diagnosis considerations
  • Borderline Personality Disorder
  • Narcissistic Personality Disorder
  • Antisocial Personality Disorder
  • Histrionic Personality Disorder
• Top indicators of PD not in the DSM-5®
• 5 things you probably never knew about Cluster B personality disorders
• Unique treatment considerations

Behavior – Approach Maladaptive Behavior, Self-Sabotage, Manipulation, and Attention Seeking

• How to shift behaviors that have been conditioned over a lifetime
• Disrupting reinforcement
• 5 things you may be doing that inadvertently reinforce maladaptive behavior and what to do instead
• Practical application of classical and operant conditioning concepts
• Roots of behavioral therapy and why it matters in treatment
  • Psychoeducation: Increase clients’ insight into how their behavior is reinforced
  • Exposure techniques: Build distress tolerance and momentum toward healthier choices
  • Chain analysis: Decrease hopelessness, improve awareness, and identify precipitating factors and choice points
• Case study – Sam, The Man Who Blames Everyone Else

Cognitive – Recognize and Interrupt Unhealthy Thinking Patterns

• Interventions to overcome the experience of negative emotion and negative beliefs about treatment
• Strategies to adapt cognitive techniques for Cluster B personality disorders
  • ABC records
  • Challenging Beliefs Worksheets
  • Socratic dialogue
  • Common cognitive distortions
• Why challenging your client’s thoughts can make things worse and what to do instead
• Case study – Martha, The Woman Who Confused her Thoughts and Memories with Reality

Mindfulness and Acceptance – Breaking Free of Distressing Thoughts, Feelings, and Behaviors

• Cognitive and behavioral mechanisms
  • Increase psychological flexibility
  • Decrease emotional intensity
  • Focus on the bigger picture
• Mistakes with mindfulness – inadvertently encouraging avoidance
• How to adapt mindfulness and acceptance techniques for Cluster B
  • Cognitive defusion: Stepping back from thoughts
  • Acceptance: Letting go of control
  • Mindfulness: Fostering the ability to stay present
  • Observing the self: Developing a bigger sense of who you are
  • Identifying values: Finding the “why”
  • Taking committed action
• Case study – Arthur, The Loving, Self-Centered Father

Clinical Considerations for Working with Personality Disorder Clients

• Crisis management
  • Suicidal ideation/gestures, self-injury
  • Create a clear plan to keep clients safe and avoid personal liability
• What to avoid – documentation considerations and more
• 5 warning signs you need to check your boundaries
• Minimize boundary violations and avoid false reporting to licensure board
• Strategies to recognize and address countertransference
• Top 3 tips for staying present in session
  • Balance boundaries with compassion
  • Model presence with distress, not joining the emotional chaos
  • Internal messages – Not getting sucked in
• Exercise: People that bother me