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

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Faculty

Richard Sears, PsyD, PhD, MBA, ABPP Related seminars and products: 9

Director

Center for Clinical Mindfulness and Meditation

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Richard Sears, PsyD, PhD, MBA, ABPP, is a licensed psychologist in Cincinnati, Ohio, board certified in clinical psychology by the American Board of Professional Psychology (ABPP), runs a private psychology and consultation practice, and is the Director of the Center for Clinical Mindfulness & Meditation. He is also clinical assistant professor at Wright State University School of Professional Psychology, clinical/research faculty at the UC Center for Integrative Health and Wellness, volunteer professor of Psychiatry & Behavioral Neurosciences at the UC College of Medicine, and a research/psychologist contractor with the Cincinnati VA Medical Center.

His most recent books include: Cognitive Behavioral Therapy & Mindfulness Toolbox (PESI, 2017); Mindfulness: Living Through Challenges and Enriching Your Life in this Moment (Wiley-Blackwell, 2014); Perspectives on Spirituality and Religion in Psychotherapy (PR Press, 2014); Building Competence in Mindfulness-Based Cognitive Therapy (Routledge, 2015); and Mindfulness-Based Cognitive Therapy for PTSD (Wiley-Blackwell, 2016). Dr. Sears is lead author of Mindfulness in Clinical Practice (PR Press, 2011) and Consultation Skills for Mental Health Professionals (Wiley, 2005).

Dr. Sears is a fifth-degree black belt in Ninjutsu, and once served as a personal protection agent for the Dalai Lama with his teacher, Stephen K. Hayes. He has studied the Eastern Wisdom traditions for over 30 years, receiving ordination in three traditions, and has been given transmission as a Zen master.

Speaker Disclosures:

Financial: Richard Sears holds faculty appointments at the University of Cincinnati. He receives a speaking honorarium from PESI, Inc.

Non-financial:  Richard Sears is a diplomate of the American Board of Professional Psychology and is a fellow of the Academy of the American Board of Clinical Psychology.

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Objectives

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 behaviours 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.

Outline

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

Behaviour – Approach Maladaptive Behavior, Self-Sabotage, Manipulation, and Attention Seeking

• How to shift behaviours that have been conditioned over a lifetime
• Disrupting reinforcement
• 5 things you may be doing that inadvertently reinforce maladaptive behaviour and what to do instead
• Practical application of classical and operant conditioning concepts
• Roots of behavioural therapy and why it matters in treatment
  • Psychoeducation: Increase clients’ insight into how their behaviour 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 Behaviours

• Cognitive and behavioural 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

Target Audience

• Counselors
• Social Workers
• Psychiatrists
• Psychologists
• Psychotherapists
• Therapists
• Addiction Counselors
• Marriage and Family Therapists
• Case Managers
• Nurses
• Other Mental Health Professionals

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