Less rigorous forms of therapy such as couples therapy, marriage therapy or family counseling are extremely common. Visits to a therapist’s office are the most common form of treatment that anyone who suffers from a personality disorder will see. Techniques vary across the board as does the efficacy of treatment.
Many forms of couple’s therapy come under criticism for being ineffective and prone to manipulation by the personality-disordered individual. Therapists who treat personality-disordered patients as merely having communication difficulties, needing validation without acknowledgement of the underlying mental illness or confrontation of the abusive behavior are generally ineffective.
Many psychotherapists assume a validating advisory role rather than an assertive or intervening role with their clients, which can be counter-productive when addressing a relationship between a non-personality-disordered individual and a personality-disordered individual. It can easily be manipulated by the person with the personality disorder into a means of controlling the non-personality-disordered individual.
A common scenario is where the therapist offers both disputing parties validation of their feelings - which can be misrepresented by the personality-disordered individual as an endorsement of their position or support of their abusive behavior. This is usually followed by a suggestion from the therapist that both parties make some sort of compromise, meet in the middle somewhere. This approach makes perfect sense when both parties are rational, reasonable individuals who just have competing interests.
However, in the typical PD-Non-PD relationship, both parties are not rational, logical individuals. What usually happens is that the non-personality-disordered individual yields ground (while increasing their level of resentment) while the personality-disordered individual makes a verbal commitment to yielding ground which is not followed through on or maintained over a significant period of time.
The result can be a short-term appearance of progress, which is very gratifying for the therapist, with a long-term return to the old roles when the deal is broken. This increases disillusionment for the non-personality-disordered individual and an overall increase in resentment. They have yielded ground on something that was important to them and lost one of their bargaining chips because the personality-disordered individual has gone to therapy and can thus argue that this proves that they are “working on it”. Even worse, some of the confessions of their feelings made in therapy can be turned into weapons which are subsequently used against them.
It can also be frustrating and confusing for a non-personality-disordered individual in couples or family therapy with a personality-disordered individual to witness a therapist validating a personality-disordered individual’s dissociative memories. Sometimes the non-personality-disordered individual is characterized as stubborn for refusing to validate or agree to memories, beliefs or events that the non-personality-disordered individual knows or believes to be exaggerated, distorted or false. The non-personality-disordered individual is cornered into a defensive posture, afraid that the therapist will believe the unflattering stories about them and afraid that the personality-disordered individual will use the validation as encouragement to fabricate more. Once this happens, therapy sessions can easily descend into a he-said-she-said type of bickering back and forth with no resolution - other than the payment of the therapist’s fee at the end of the hour.
Both Seeing the Same Therapist Separately
Once it becomes clear that progress is not being made in joint therapy, it is common for therapists to advise couples to replace the joint sessions with individual sessions alternating between the two parties. This is generally more effective than joint sessions together as it allows the therapist to address each of the parties as individuals. However, there are 3 fundamental conflicts of interest that prevail:
- Conflict of interest for the therapist. The therapist normally wants to validate both parties. This is very difficult when the parties are alternately contradicting one another. You are spending good money but instead of just listening to you and giving you good advice, your therapist is sitting there worrying about how his/her actions or statements might come back to haunt them via the other party.
- Conflict of interest for you. Instead of working on yourself, you are spending your money and a valuable portion of your time thinking about the relationship between the therapist and the other party. You may be tempted to begin competing with your significant other for the therapist's approval and validation.
- Conflict of interest for the person who has the personality disorder. Instead of working on themselves, they may begin to compete with you for the therapist’s validation and approval. They may also be tempted to try to “send a message” to their non-personality-disordered partner via the therapist.
Triangles are not a great setup. For this reason it makes more sense for people to see separate therapists.
As long as the therapist maintains a validating posture towards the PDI and avoids any sort of accountability for their behavior the therapy is unlikely to accomplish much more than an emotional back-rub. Most therapists deliberately keep their sessions at that level as it is less strenuous for them and breeds less conflict in the office. Many therapists are afraid of how their client will react if they adopt a more assertive role.