THERAPY FOR CLIENTS WITH PERSONALITY DISORDERS

Individuals with personality disorders often find it difficult to overcome the enduring patterns of thought and behavior that they have thus far experienced and functioned with in daily life. Even when patients are aware that personality-related issues are causing significant distress and functional impairment and are open to counseling, treatment can be challenging for both the patient and the therapist. For this Assignment, you examine specific personality disorders and consider therapeutic approaches you might use with clients.(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)

To prepare:

·       Review this week’s Learning Resources and reflect on the insights they provide about treating clients with personality disorders.

·       Select one of the personality disorders from the DSM-5-TR (e.g., paranoid, antisocial, narcissistic). Then, select a therapy modality (individual, family, or group) that you might use to treat a client with the disorder you selected.(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)

Succinctly, in 1–2 pages, address the following:

·       Briefly describe the personality disorder you selected, including the DSM-5-TR diagnostic criteria.

·       Explain a therapeutic approach and a modality you might use to treat a client presenting with this disorder. Explain why you selected the approach and modality, justifying their appropriateness.(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)

·       Next, briefly explain what a therapeutic relationship is in psychiatry. Explain how you would share your diagnosis of this disorder with the client in order to avoid damaging the therapeutic relationship. Compare the differences in how you would share your diagnosis with an individual, a family, and in a group session.(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)

Support your response with specific examples from this week’s Learning Resources and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)

·       Symptom Media. (2020). Antisocial personality disorder ASPD online CNE CEU courses for nursesLinks to an external site.[Video]. YouTube. https://www.youtube.com/watch?v=ewBFri65Quw

·       Symptom Media. (2020). Histrionic disorder NP mental health continuing educationLinks to an external site.[Video]. YouTube. https://www.youtube.com/watch?v=GJVRGofeV-w

·       Symptom Media. (2020). Narcissistic personality disorder online LPN CE credit CEU unit classesLinks to an external site.[Video]. YouTube. https://www.youtube.com/watch?v=knfVjj3P9es

Rubric

NRNP_6645_Week10_Assignment_Rubric

NRNP_6645_Week10_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning OutcomeSuccinctly, in 1–2 pages, address the following: • Briefly describe the personality disorder you selected, including the DSM-5-TR diagnostic criteria.

15 to >13.0 pts

Excellent 90%–100%

The response includes an accurate and concise description of the personality disorder, including the DSM-5-TR diagnostic criteria.(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)

13 to >11.0 pts

Good 80%–89%

The response includes an accurate description of the personality disorder, including the DSM-5-TR diagnostic criteria.

11 to >10.0 pts

Fair 70%–79%

The response includes a somewhat vague or inaccurate description of the personality disorder, including the DSM-5-TR diagnostic criteria.(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)

10 to >0 pts

Poor 0%–69%

The response includes a vague or inaccurate description of the personality disorder, including the DSM-5-TR diagnostic criteria.

15 pts

This criterion is linked to a Learning Outcome• Explain a therapeutic approach and a modality you might use to treat a client presenting with this disorder. Explain why you selected the approach and modality, justifying their appropriateness.

25 to >22.0 pts

Excellent 90%–100%

The response includes an accurate and concise explanation of both a therapeutic approach and a modality that could be used to treat a client presenting with this disorder…. The response includes a concise explanation of why the approach and modality were selected, with strong justification for why they are appropriate for the disorder.(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)

22 to >19.0 pts

Good 80%–89%

The response includes an accurate explanation of both a therapeutic approach and a modality that could be used to treat a client presenting with this disorder…. The response includes an explanation of why the approach and modality were selected, with adequate justification for why they are appropriate for the disorder.

19 to >17.0 pts

Fair 70%–79%

The response includes a somewhat vague or inaccurate explanation of both a therapeutic approach and a modality that could be used to treat a client presenting with this disorder…. The response includes a vague or inaccurate explanation of why the approach and modality were selected, with a somewhat vague or inaccurate justification for why they are appropriate for the disorder.(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)

17 to >0 pts

Poor 0%–69%

The response includes a vague or inaccurate explanation of a therapeutic approach and a modality that could be used to treat a client presenting with this disorder. Or, response is missing…. The response includes a vague or inaccurate explanation of why the approach and modality were selected, with poor justification for why they are appropriate for the disorder. Or, response is missing.

25 pts

This criterion is linked to a Learning Outcome• Briefly explain what a therapeutic relationship is in psychiatry. Explain how you would share your diagnosis of this disorder with the client in order to avoid damaging the therapeutic relationship. Compare the differences in how you would share your diagnosis with an individual, a family, and in a group session.(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)

30 to >26.0 pts

Excellent 90%–100%

The response includes an accurate and concise explanation of the therapeutic relationship in psychiatry…. The response clearly and concisely explains an approach for sharing the disorder diagnosis to avoid damaging the therapeutic relationship, and how this approach would be similar or different in individual, family, and group sessions.

26 to >23.0 pts

Good 80%–89%

The response includes an accurate explanation of the therapeutic relationship in psychiatry…. The response adequately explains an approach for sharing the disorder diagnosis to avoid damaging the therapeutic relationship, and how this approach would be similar or different in individual, family, and group sessions.(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)

23 to >20.0 pts

Fair 70%–79%

The response includes a somewhat vague or incomplete explanation of the therapeutic relationship in psychiatry…. The response provides a somewhat vague or incomplete explanation of an approach for sharing the disorder diagnosis to avoid damaging the therapeutic relationship, and how this approach would be similar or different in individual, family, and group sessions.(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)

20 to >0 pts

Poor 0%–69%

The response includes a vague and inaccurate explanation of the therapeutic relationship in psychiatry. Or, response is missing…. The response provides a vague or incomplete explanation of an approach for sharing the disorder diagnosis to avoid damaging the therapeutic relationship, and how this approach would be similar or different in individual, family, and group sessions. Or, response is missing.

30 pts

This criterion is linked to a Learning Outcome·   Support your approach with specific examples from this week’s media and at least three peer-reviewed, evidence-based sources. PDFs are attached.(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)

15 to >13.0 pts

Excellent 90%–100%

The response is supported by specific examples from this week’s media and at least three peer-reviewed, evidence-based sources from the literature that provide strong support for the rationale provided. PDFs are attached.

13 to >11.0 pts

Good 80%–89%

The response is supported by examples from this week’s media and three peer-reviewed, evidence-based sources from the literature that provide appropriate support for the rationale provided. PDFs are attached.(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)

11 to >10.0 pts

Fair 70%–79%

The response is supported by examples from this week’s media and two or three peer-reviewed, evidence-based sources from the literature. Examples and resources selected may provide only weak support for the rationale provided. PDFs may not be attached.(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)

10 to >0 pts

Poor 0%–69%

The response is supported by vague or inaccurate examples from the week’s media and/or evidence from the literature, or is missing.

15 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)

5 to >4.0 pts

Excellent 90%–100%

Paragraphs and sentences follow writing standards for flow, continuity, and clarity…. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineates all required criteria.

4 to >3.5 pts

Good 80%–89%

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time…. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)

3.5 to >3.0 pts

Fair 70%–79%

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time…. Purpose, introduction, and conclusion of the assignment are vague or off topic.

3 to >0 pts

Poor 0%–69%

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time…. No purpose statement, introduction, or conclusion were provided.(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)

5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)

5 to >4.0 pts

Excellent 90%–100%

Uses correct grammar, spelling, and punctuation with no errors.

4 to >3.5 pts

Good 80%–89%

Contains 1 or 2 grammar, spelling, and punctuation errors.

3.5 to >3.0 pts

Fair 70%–79%

Contains 3 or 4 grammar, spelling, and punctuation errors.

3 to >0 pts

Poor 0%–69%

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows the correct APA format for the title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.

5 to >4.0 pts

Excellent 90%–100%

Uses the correct APA format with no errors.

4 to >3.5 pts

Good 80%–89%

Contains 1 or 2 APA format errors.

3.5 to >3.0 pts

Fair 70%–79%

Contains 3 or 4 APA format errors.

3 to >0 pts

Poor 0%–69%

Contains many (≥ 5) APA format errors.

5 pts

Total Points: 100

PreviousNext

Therapy for Clients with Personality Disorders Comprehensive Nursing Essay

Antisocial personality disorder (ASPD) is among the least understood personality disorders, significantly overlapping with other mental health problems such as psychopathy. Contemporary estimates provide the prevalence of ASPD ranging from 1 to 4% amongst the general population, making it one of the most prevalent personality disorders in the United States (Fisher et al., 2021). The predicting aspect of the first diagnosis of conduct disorder should be before the age of 15; hence childhood psychopathology related to ASPD is rarely evaluated. The disorder significantly causes impairment, disrupting thought and behavioral patterns, and is linked to violent and criminal behavior. More men (6%) than women (2%) within the general population are likely to be diagnosed with ASPD (Fisher et al., 2021). The paper aims to describe ASPD, including DSM-5 TR criteria for diagnosing ASPD, treatment, and the importance of therapeutic relationships in psychiatry.(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)

Antisocial Personality Disorder – Description

Personality disorders are categorized into clusters, and ASPD belongs to Cluster B, characterized by individuals displaying dramatic, emotional, and unpredictable relationships and interactions with other people. Individuals with ASPD experience dysfunctional thought processes aligned with social exploitation, delinquency, and criminal behavior due to their lack of remorse for their actions and behaviors (Fisher et al., 2021). ASPD patients violate laws and rules and disregard other people’s rights, making them more susceptible to criminal and legal indictments. In addition, such individuals experience problems sustaining employment and are involved in deception, manipulation for selfish and individual gains, and the inability to establish stable relationships. Genetic and environmental factors are integral in ASPD development, with studies showing varying heritability estimations, ranging from 38-69% (Fisher et al., 2021). Adverse childhood experiences such as sexual and physical abuse and neglect coupled with childhood psychopathology are environmental factors attributed to the development of ASPD. Family dynamics and peer influence can also lead to ASPD because they influence a wide range of behaviors present in antisocial personality disorder. (Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)

ASPD DSM-5-TR Diagnostic Criteria

The DMS-5 criteria for ASPD provide that for a diagnosis to be established, the individual must (Fisher et al., 2021):
1. Display a prevalent pattern of disregard for and violations of other people’s rights, beginning at least at age 15, indicated by at least three of these features: (Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)
a. Nonconformance to social norms regarding lawful and accepted behaviors, including actions that prompt arrest.
b. Deception, using a false identity, repeated lying, and conning others for individual benefit.
c. Planning failure or impulsivity
d. Aggressive behavior and easy irritability involving physical fights or assaults in most cases.
e. Reckless behavior and disregard for other people’s safety.
f. Pervasive irresponsibility, difficulty sustaining employment and consistent work behavior, or honoring monetary obligations
g. Indifference, irrationality(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay), and lack of remorse for being hurt, mistreated, or stolen from other people
2. Be at least 18 years(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)
3. Have evidence of conduct disorder diagnosed before 15 years.
4. Antisocial behavior should not occur exclusively during schizophrenia or bipolar disorder.

Treatment

Patients with antisocial personality disorder demonstrate a persistent disregard for other people’s rights, safety, and lawful behavior. These individuals have problems socializing; therefore, delivering psychotherapy treatment in group or family formats can be challenging, making individual therapy the most appropriate treatment modality (Fisher et al., 2021). The individual approach involves a practitioner working one-on-one with a client in a safe, caring, and confidential setting. Individual therapy allows clients to assess their thought patterns, feelings, beliefs, behaviors, and other aspects of life perceived as problematic to understand themselves better, develop personal objectives, and strive towards the desired change.(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)
The patient receives maximum attention from the practitioner in individual therapy, which is critical in building trust and helping the client change thinking patterns associated with antisocial behavior. Practitioners can adopt cognitive behavioral therapy (CBT) during individual therapy sessions, considered the most effective psychotherapy and the first option for ASPD patients (Sargın et al., 2018). The treatment modality aims to identify and eradicate negative thought patterns and maladaptive dysfunctional thoughts to help patients determine how their behavior and action impact others. CBT helps ASPD patients develop trust in other individuals and enhance emotional regulation and social interactions (Sargın et al., 2018).
A therapist can invite patients to a behavioral experiment to interact with others and assess their feelings. Patients and therapists work closely on challenges like persistent disregard for other people’s rights, safety, and lawful behavior and can adopt social skills training to help enhance their social interactions. Social skills training is critical for social skills improvement, which is limited in people with ASPD (Sargın et al., 2018). It can be delivered individually, combining mediated instruction and interventions targeting specific social skills (Turner et al., 2018). The practitioner can involve family members to help maintain social skills at home and reinforce interactions with family members and peers.(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)

Therapeutic Relationship in Psychiatry

Description

A therapeutic relationship describes the relationship between a practitioner and a client that can effect beneficial change in the patient. The therapeutic relationship (RT) is perceived as the basis of mental health practice, vital to the successful and effective psychological treatment of mental health issues (Bolsinger et al., 2020). There is a statistical significance in the relationship between therapeutic relationships and treatment outcomes, with a positive therapeutic relationship leading to better treatment outcomes regarding clinical improvement, hospital stay, readmission and re-hospitalization rate, and client satisfaction (Totura et al., 2018). Conversely, negative therapeutic relationships are linked to poor patient and clinical outcomes, increasing the risk of secondary effects such as increased irritability, aggressiveness, and violence.
How to share ASPD Diagnosis with a Patient(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)
Practitioners should pay close attention when communicating with ASPD patients and sharing information about their condition, including diagnosis, since the nature of communication can develop or break trust. I would communicate openly, avoid arguments, adopt simple directions, ensure adequate personal space, and eradicate any triggers when sharing diagnostic results with an ASPD patient. Open, honest, and clear communication is fundamental in developing and maintaining trust with the patient and ensuring the continuity of the therapeutic relationship. In addition, I would be open about my point of view concerning the problematic thinking patterns and behavior to help reassure the patient and give them a new or different perspective about their condition and why changing their thinking patterns and behavior would help improve their quality of life.(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)
The Differences in how to share a diagnosis with an Individual, a Family, and in a Group Session
Sharing the diagnosis with an individual is easier because the patient feels safe, and the individual approach is confidential. I would openly communicate when sharing an ASPD diagnosis with an individual, providing my perspectives about the patient’s condition and the need for change. Nonetheless, I would remain respectful of the patient’s beliefs, offering clarifications about my perceptions to help the patient develop a new perspective on their condition. Individuals with ASPD tend to be distrustful, lack remorse for being hurt or hurting others, and disregard lawful behavior and other people’s rights and safety. Therefore, it can be challenging to share their diagnostic results in family or group settings (Fisher et al., 2021).
When sharing diagnostic results in a family or group format, the first step is to build trust and a non-judgmental attitude among members to make the patient feel safe. I would create rules about respecting each other and maintaining confidential information in a group setting. I would communicate respectfully and honestly, offer clarifications when communicating diagnostic results in family and group settings, and provide equal opportunity for everyone to offer feedback and personal space to share opinions about the diagnosis.(Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)

Conclusion

An antisocial personality disorder is marked by dysfunctional thoughts and behavior patterns that include pervasive disregard for other people’s rights and safety, lawful behavior, deception, or continuous lies for personal gains. ASPD significantly impacts the quality of life, exposing individuals to legal and criminal indictments and bruised relationships with other people. The disorder is not common in clinical environments because patients face challenges seeking professional help independently. Offering cognitive behavioral therapy in an individual format is a more appropriate treatment modality, considering the persistent antisocial behavior and dysfunctional thought patterns indicated by ASPD patients. Therapeutic relationships are integral in addressing ASPD, helping the practitioner develop and maintain trust in a safe, respectful, and confidential environment. (Therapy for Clients with Personality Disorders Comprehensive Nursing Essay)

 
References

Bolsinger, J., Jaeger, M., Hoff, P., & Theodoridou, A. (2020). Challenges and Opportunities in Building and Maintaining a Good Therapeutic Relationship in Acute Psychiatric Settings: A Narrative Review. Frontiers in psychiatry, 10, 965. https://doi.org/10.3389/fpsyt.2019.00965
Fisher, K. A., Hany, M., & Doerr, C. (2021). Antisocial Personality Disorder (Nursing).
Sargın, A. E., Özdel, K., & Türkçapar, M. H. (2018). Cognitive-behavioral theory and treatment of antisocial personality disorder. In Psychopathy-New Updates on an Old Phenomenon. IntechOpen.
Totura, C. M. W., Fields, S. A., & Karver, M. S. (2018). The role of the therapeutic relationship in psychopharmacological treatment outcomes: a meta-analytic review. Psychiatric Services, 69(1), 41-47. https://doi.org/10.1176/appi.ps.201700114
Turner, D. T., McGlanaghy, E., Cuijpers, P., van der Gaag, M., Karyotaki, E., & MacBeth, A. (2018). A Meta-Analysis of Social Skills Training and Related Interventions for Psychosis. Schizophrenia Bulletin, 44(3), 475–491. https://doi.org/10.1093/schbul/sbx146