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

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Clients with Cluster B Personality Disorders (Borderline, Antisocial, Histrionic, and Narcissistic) can be amongst the most challenging for therapists. Clinicians who are not properly trained can inadvertently make clients worse, and can even put themselves at risk for licensure board complaints. However, when equipped with a deeper understanding of these disorders and the most effective principles and techniques, it can be extremely rewarding to witness the positive ripple effects that occur in these clients and their families.

Join clinical psychologist and author, Dr. Richard Sears for a compassionate yet direct approach for working with these individuals using cutting edge, practical interventions that are grounded in theory.

In this recording you’ll learn:

• How even the most frustrating, maladaptive behaviors get conditioned and reinforced over time (and what to do about it)
• How to recognize and interrupt unhealthy thinking patterns
• Strategies to help free clients of struggles with thoughts, feelings, and unhealthy behaviors
• Interventions to manage stressful sessions and emotional chaos
• How to avoid getting pulled into a client’s “crisis of the week” drama

With solid principles and detailed case examples, Dr. Sears will bring these concepts and methods to life with passion and humor, giving you practical take-aways to use in your very next therapy session!

1. Differentiate diagnostically between the four Cluster B personality disorders to accurately inform the treatment planning process.
2. Manage maladaptive, self-sabotage, manipulation, and negative attention seeking behaviors in clients to improve client level of functioning.
3. Utilize treatment interventions based in cognitive approaches, including ABC records, challenging distortions, and Socratic dialogue for clients diagnosed with personality disorders.
4. Employ mindfulness-based interventions to increase client’s psychological flexibility and decrease emotional intensity.
5. Evaluate and address potential clinical issues including crisis management, countertransference, boundary setting, and self-care to improve clinical outcomes.
6. Distinguish three strategies to improve client engagement and stay present in session.

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