Aug 2023: Exploring Cluster B Diagnoses: An Introductory Guide for Therapists
Introduction:
Cluster B Personality Disorders form an important category within the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), encompassing a range of challenging and complex conditions. As therapists, counselors, and social workers engaged in group clinical supervision, we must familiarize ourselves with these disorders to better understand and support our clients. In this discussion, we will explore the diagnoses included in Cluster B, acknowledge their historical marginalization of women, and recognize the interplay between Cluster B disorders and complex trauma.
Diagnoses within Cluster B:
Cluster B Personality Disorders consist of four primary diagnoses, namely Borderline Personality Disorder (BPD), Narcissistic Personality Disorder (NPD), Antisocial Personality Disorder (ASPD), and Histrionic Personality Disorder (HPD). Each disorder presents unique challenges and characteristics, necessitating distinct therapeutic approaches.
Borderline Personality Disorder (BPD):
Individuals with BPD often struggle with intense emotional days regulation, unstable relationships, identity disturbances, and impulsive behaviors. Therapy typically involves providing a stable therapeutic alliance, teaching emotion regulation skills, and facilitating the development of a coherent sense of self. Individuals with BPD often struggle with chronic feelings of emptiness, intense fear of abandonment, and recurrent self-harming behaviors.
The therapeutic process may involve exploring childhood trauma, validating emotions, and teaching effective interpersonal skills to foster healthier relationships. Developing a strong therapeutic alliance is crucial in working with individuals with BPD, as it helps establish trust and stability in their often tumultuous lives.
2. Narcissistic Personality Disorder (NPD):
NPD is characterized by an inflated sense of self-importance, a constant need for admiration, and a lack of empathy. Therapy fosters self-awareness, explores underlying insecurities, and encourages healthier interpersonal dynamics. Those with NPD frequently exhibit grandiosity, a sense of entitlement, and a deep need for admiration from others.
Therapeutic interventions for NPD often focus on challenging rigid thinking patterns, promoting empathy and self-reflection, and addressing underlying feelings of insecurity and vulnerability. By encouraging individuals with NPD to recognize the impact of their behavior on others, therapy can facilitate the development of more authentic and mutually beneficial relationships.
3. Antisocial Personality Disorder (ASPD):
ASPD is associated with disregarding others' rights, a lack of remorse, and a pattern of exploitative behavior. Working with individuals diagnosed with ASPD often requires addressing their lack of empathy, promoting accountability, and teaching alternative coping strategies. Individuals diagnosed with ASPD typically disregard societal norms, a lack of remorse for their actions, and manipulative tendencies.
Therapeutic work with individuals with ASPD can be challenging, as they may resist treatment or lack motivation to change. Interventions may involve targeting risk factors, such as impulsivity and aggression, and exploring the underlying emotional deficits contributing to their antisocial behaviors. Setting clear boundaries and focusing on personal accountability are important aspects of therapy for ASPD.
4. Histrionic Personality Disorder (HPD):
HPD is characterized by excessive attention-seeking, dramatic behavior, and a need for constant reassurance. Therapy aims to explore underlying insecurities, develop healthy coping mechanisms, and establish more authentic connections. HPD is characterized by an excessive need for attention, dramatic emotional expression, and a tendency to overestimate relationships’ intimacy.
Therapeutic approaches often involve validating their emotions while exploring underlying insecurities, challenging attention-seeking behaviors, and promoting authentic self-expression. Encouraging individuals with HPD to develop a stable sense of self and healthy coping mechanisms can lead to a more fulfilling and balanced life.
Historical Marginalization and Complex Trauma:
Acknowledging the historical marginalization of women within the diagnoses of BPD and HPD is essential. These disorders have been disproportionately assigned to women due to gender bias and cultural stereotypes. Recognizing this historical context allows us to approach the diagnoses more sensitively and avoid perpetuating gender-based assumptions.
Additionally, it is important to consider the overlap between Cluster B Personality Disorders and complex trauma. Many individuals diagnosed with these disorders have experienced significant trauma throughout their lives. Traumatic experiences can contribute to developing maladaptive coping mechanisms and impact personality functioning. Being mindful of the potential interplay between Cluster B disorders and complex trauma enables us to address the root causes and provide more effective treatment.
Conclusion:
Understanding Cluster B Personality Disorders is crucial for therapists, counselors, and social workers in group clinical supervision. By familiarizing ourselves with the diagnoses within Cluster B, acknowledging the historical marginalization of women, and recognizing the connection to complex trauma, we can enhance our ability to support and empower our clients. We can contribute to the growth and well-being of individuals diagnosed with Cluster B Personality Disorders with compassion, empathy, and evidence-based interventions.
To Prepare for Clinical Supervision
Please prepare for our conversation and meeting by watching the following videos:
Podcast episode:
Therapy Chat: Borderline Personality Disorder + Developmental Trauma with Dr. Janina Fisher
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Next Steps
If you're a social worker or counselor in Colorado looking to enhance your trauma-informed practice, we invite you to consider working with Two Rivers Therapy of Colorado. Our experienced team of trauma-informed therapists and supervisors can provide the tools and resources to integrate trauma-informed principles into your work with clients and supervisees.
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Understand how trauma impacts your clients and supervisees
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Address vicarious trauma and burnout
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Integrate trauma-informed principles into your supervision practice
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As trauma-informed practitioners, we believe that trauma-informed care and supervision are essential for promoting healing and empowerment among our clients and supervisees. We are committed to supporting social workers and counselors in Colorado who share this commitment and are looking to enhance their trauma-informed practice.
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Other Services Offered at Two Rivers Therapy
At Two Rivers Therapy, our team of caring and skilled counselors understands you may struggle with multiple mental health struggles. To best support our clients in achieving optimal mental health and well-being, we offer services for those needing anxiety therapy, depression treatment, trauma therapy, therapy for teens, and therapy for the overwhelmed and overworked. To learn more, check out our blog or About Us!
Ann Robinson (she/her) is a trauma therapist and clinical supervisor in Fort Collins, Colorado. When she's not busy helping her clients navigate life's ups and downs, you can find her co-owning Two Rivers Therapy & Consulting. Ann has a knack for working with womxn who exudes enough grit and resilience to make Wonder Woman blush. Her secret weapon? Incorporating humor into therapy sessions because, let's face it, life's too short to take everything so seriously. Ann's got your back if you're ready to cope with lives stressors without burning the candle at both ends.