Kayla: Welcome back to the Designer Practice Podcast, and I'm your host, Kayla Das.
In today's episode, Harmony Kwiker, Licensed Professional Counselor and clinical supervisor, we'll discuss how to focus on process over pathology when working with clients who have a personality disorder.
Hi, Harmony. Welcome to the show. I'm so glad to have you here today.
Harmony: Hi, Kayla. Thank you so much for having me.
Kayla: Harmony, before we dive into today's episode, please introduce yourself, where you're from, and tell us a little bit about your own practice journey.
Harmony: I live just outside of Boulder, Colorado, and I have a private practice here. My practice journey has been really expansive actually, when I was a new therapist, I tried so hard to fit into this model of what I thought it meant to be a therapist and I felt very stifled and really ineffective, quite honestly. I was getting in the way of my client's process really by doing what I thought I needed to be doing as opposed to exploring the more dynamic realms of healing and transformation and integration with my clients. And I've been in practice now for almost 18 years.
And I teach at Naropa university and I'm a supervisor now, and I really have shifted to this place of deep trust in the healing process and deep trust in my client's ability to find their way back home to themselves.
Kayla: So, for today's episode, I know it's titled process over pathology. So, what does that really mean?
Harmony: Well, pathology is the study of diagnosis and disease, and psychopathology really originated from this concept of the pathology of cells but apply it to a person's mental state. So, each time we sit with a client, if we think there's something wrong with the clients that we need to fix or change or teach this client how to be different, then we're pathologizing them. We're seeing them as having this disorder that is wrong and that we need to fix or change in order to be effective. And as we know, insurance billing is set up this way to have a diagnosis of something wrong with the client and to show that we're effective and that we can fix or change our client.
In Gestalt therapy, which is what I'm trained in and what I teach it's really a theory of health and not pathology. So, we're not analyzing our clients. We're not pathologizing our clients. We're contacting our clients as they are, and we're supporting them and creating awareness within themselves and with the environment.
In Gestalt, we see all symptoms as co-creative with the environment. And, we're looking at the way a person adapts and adjusts to unmet needs or difficulties within the environment. And we see those adaptive strategies as healthy and wise. It's really about when the original circumstances are no longer present. And those strategies are rigid habits that cause the client distress. That's when a client arrives to therapy, but by staying in process with the client, as opposed to pathologizing them, what we're doing is we're staying present with the client as they are. And we're honoring their innate wisdom, not only beneath the patterns, but also embedded within the patterns. We're honoring those patterns as wise.
Kayla: I love that. So, when we think of process over pathology, specifically with clients who have a personality diagnosis, how can therapists focus on the process.
Harmony: Personality disorders are interesting. I've found over the years that understanding the diagnostic criteria is actually extremely helpful in understanding the internal organization of the client. And so, when a client has a personality disorder, essentially, they are hyper identified with the way in which they've adapted to unmet needs from the past, and it's made its way into their personality. And they believe that their thoughts are truth, that the way to get their need met is by controlling their environment, or controlling the people in their environment in a specific way.
I find that new therapists have a very challenging time working with clients who have a diagnosis of a personality disorder, partly because if we believe as the clinician that our job is to be the relational repair for the client, we end up giving away our internal resources to try to heal the client.
In transpersonal counseling, we still believe that the relationship is paramount to transformation. However, we see that the therapeutic presence is more about being a clear mirror of reflection to support the client's increasing awareness of how they leave a healthy aware state. And so, by understanding the diagnostic criteria of the personality disorder, we can support the client in seeing the water that they're swimming in, so to speak, seeing the way that their mind is creating these narratives that they believe are true, and then supporting the client in differentiating from that personality.
So, it's not about changing the personality in any way. It's about recognizing that that's not who they are, they are more that there is a bigger aspect to themselves and it's in that differentiating that the client can access the part of them that wants to change and that has a different solution for themselves.
Kayla: I love that. You just mentioned the word transpersonal counseling. First of all, what is it? And how can it be helpful when working with clients who have a personality disorder?
Harmony: In transpersonal counseling, we are meeting the client beyond personal identity. So, trans means beyond, and then personal, meaning personal identity. And we, the clinician, aren't engaging from our personality, and we're not engaging with the client's personality. And this is really helpful when working with a client who meets the diagnostic criteria of a personality disorder.
When a client has a personality disorder, the people in their lives are typically frustrated with them or feel disempowered in relationship with them because the individual really believes that the solution to their pain and their distress lies in the people outside of them. This is one of the main elements of a personality disorder. For example, a person who meets the criteria for generalized anxiety disorder, they don't feel good inside. And so, they want to change. But with a personality disorder, the person thinks that everybody else needs to change, and then I'll feel okay.
When we are the clinician and the client wants us to be different to meet their needs, right, this is a moment that can be very delicate in the therapeutic relationship and the therapeutic process. So, when we're working with a client from a transpersonal lens, and that client has a personality disorder, we are wanting them to see with clarity the way that their mind tries to control the people in their lives or see other people as the solution to their pain and their problem. And get space from those thoughts in service of discovering what is beneath that personality pattern that is left unresolved from the past.
So, for example, the way that I see borderline personality disorder is the way that the grief from unmet needs of childhood has made its way into the personality. And so, as we're starting to work with differentiating from those thoughts that people outside of me need to meet my needs so that I feel okay, we're working with the unresolved experience from the past where that young one, that child really did need the people in their lives to come and be a safe attuned presence for them. And that need was never met. And so now, eventually, over time, that client can see how they've been putting that onto the environment to the people in their lives, even though it's not other people's jobs to meet their need.
Kayla: That makes complete sense. So, are there specific strategies, interventions, modalities, I mean we've already talked about transpersonal counseling, but are there other modalities that could be helpful when working with clients who have a personality disorder?
Harmony: I think Gestalt therapy is genius in this. One of the most well-known therapeutic interventions that comes from Gestalt is called the two-chair approach. And what the two-chair approach is doing is taking an internal polarity and externalizing it into the room, into these two chairs. So, in one chair in this example would be the voice of the personality disorder, but we'd have the client’s name that with something less clinical. So maybe the voice of unmet needs or the voice of control or whatever they are working with in that moment. And they would then in the other chair, put what is being rejected or disowned when they cling to the voice of that personality disorder. So, it might be they're disowning grief or fear or something else.
And we would have the client actually go into the phenomenology of those aspects of the polarity. So, phenomenology prioritizes expressing and experiencing over analyzing and talking about. And this can seem a little abstract if you've never experienced it yourself, but in this example, the client would sit in the seat of control, let's just say, the part of their personality disorder that wants to control the people in their lives. And they would speak from it as if they are it.
I think the thing that could be confusing about this is we've worked so hard to get the client to differentiate from the personality disorder, now why are we having them sit in the seat of this? And what I've learned over the many years of being a Gestalt therapist is that the moment a client embodies the phenomenology of an aspect of themselves that they're hyper identified with, they actually gain more mastery over themselves, and they can start to metabolize and mobilize what that part of their mind has been holding on to.
And so, they can feel it in a more somatic, body-based way also, the moment they sit in that seat. And this is an integrative process. So, where they've been split internally, they now start to integrate and find their own way back to their repair. It's really graceful and honoring that it is their work to do to find their way back. We're not inserting our own opinions or ideas of what we think they ought to be.
Kayla: That's a really great way of looking at it. Do you have any additional advice, insights, or tips for listeners when working with clients who have a personality disorder?
Harmony: The main tip that I would have is to be aware of where you're holding space from, because if you are holding space from your personality, it's really common to not like the client's personality disorder. And if you don't like the client's personality disorder, that is an indicator that you are engaging from your personality.
You are the I that doesn't like, as opposed to opening up to awareness-based knowing, and seeing the wholeness of the client and really listening to the wisdom of the way that they've created these habits of their personality. There's so much brilliance and genius that's being held there. And until we can see the threads of that genius, it'll continue to appear as maladaptive, even though it truly is an adaptive way that they've organized their internal world. So just to reiterate, the space from which you create the container from matters so much in the way that this unfolds.
Kayla: Harmony, you have a free course that you'd like to share. Can you tell us a little bit about what it is and how it can help listeners?
Harmony: The free course is called The Most Important Tool for an Awakened Therapist. And in this free course, I share with you the different levels of awareness. that the client moves through as they do this work synergistically with your different levels of awareness as you do this work. And it's really a simple framework to help you understand how to support deep transformation.
Kayla: Great. So, to sign up for Harmony's free course, check out kayladas.com/harmonykwikerfreecourse
Or you can simply scroll down to the show notes and click on the link.
Harmony, thank you so much for joining us on the podcast today to discuss how to focus process over pathology when working with clients who have a personality disorder.
Harmony: Thank you so much, Kayla. It's been such a joy to be here with you.
Kayla: And thank you everyone for tuning in to today's episode, and I hope you join me again soon on the Designer Practice Podcast.
Until next time, bye for now.
