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Therapy for Clients With Personality Disorders

Therapy for Clients With Personality Disorders

Personality disorders are mental health illnesses characterized by distressing, maladaptive, chronic, and pervasive patterns of cognition, mood, and behavior. Persons with these disorders experience a distorted perception of reality. The fifth edition of the Diagnostic and Statistical Manual (DSM-V) outlines the criteria for identifying these disorders. Per the criterion, ten personality disorders, grouped in three clusters, are elucidated. They include schizotypal, paranoid, schizoid, narcissistic, antisocial, histrionic, borderline, obsessive-compulsive, avoidant, and dependant. This paper details the therapeutic approaches for antisocial personality disorder.

Antisocial Personality Disorder

Antisocial personality disorder (ASPD) is one of the most common personality disorders. It has been implicated in the legal corridors as it has become synonymous with acts of crime. ASPD is a mental health illness characterized by dysfunctional thought processes focusing on social irresponsibility. Exploitative, criminal, and delinquent behaviors with no remorse are features of this disorder that predispose its sufferers to various legal parameters (Wong, 2023). Individuals with this disorder often demonstrate a profound disregard for other people’s rights within society, with subsequent violations of the same. Common findings in persons with this disorder include but are not limited to deception, failure to conform with regulations, inability to maintain stable relationships, and incapacity to sustain employment.

DSM-V outlines the criteria for diagnosing ASPD. Per this diagnostic criterion, ASPD is one of the four disorders in cluster-B personality disorders. Persons with this disorder are often dramatic and emotional and demonstrate unpredictable social interactions. DSM-V also details specific features associated with ASPD. A positive diagnosis of ASPD is made in the presence of a pervasive pattern of violation of or disregard of other people’s rights for persons aged 15 years and above. This may be demonstrated by at least three manifestations of repeated deception, manipulation for self benefits, acts of impulsivity, disregard for personal safety and the safety of others, failure to conform to the social norms on expected and lawful conduct, and utter lack of remorse or guilt upon executing some of these actions.

Therapeutic Approach and Modality

The therapeutic approach utilized in the management of ASPD and other personality disorders utilizes psychopharmacological approaches based on symptom severity. Pharmacological approaches are often targeted at treating co-occurring conditions that may be potentiating ASPD manifestations. First-line pharmacological options available, in this respect, are the second-generation anti-psychotic medications such as risperidone and quetiapine. Second and third-line options available are selective serotonin reuptake inhibitors such as sertraline and fluoxetine and mood stabilizers such as lithium and carbamazepine. Anticonvulsants such as oxcarbazepine are utilizable in the management of impulsivity apparent in these disorders.

Psychotherapeutic approaches are the mainstay therapeutic modality for persons with ASPD and other personality disorders. Cognitive behavioral therapy (CBT) is a psychotherapeutic technique valuable in the management of ASPD (De Wit-De Visser et al., 2023). This technique involves helping a person with this disorder to learn to identify maladaptive thought processes and behaviors that predispose them to their perceived behavior. In this regard, therapists work to guide their clients into learning to change maladaptive and problematic thought processes.

The psychopharmacological therapeutic approach maintains effectiveness in the comprehensive management of ASPD. Their combined use is superior to either modality used solely in severe cases. Notwithstanding, these techniques often do not result in a cure, and their effectiveness is questionable. The severity of potential harm attributed to this disorder, coupled with the destabilization of the social norm that persons with these disorders present, often warrants intricate considerations for therapy. These modalities are thus valuable in managing ASPD.

Therapeutic Relationship in Psychiatry

Therapeutic relationships are postulated as a measure of the mutual engagement between the therapist and their clients. A therapeutic relationship is integral in all clinical interactions. Central to therapeutic relationships is the ability of therapists to foster effective communication with their clients, create a good rapport with them, cultivate an environment of empathy and understanding, and encourage shared decision-making and empathy (Marzilli et al., 2021). When sharing the diagnosis with the client, the therapists must use simple, open, and empathetic language. To eliminate self-stigma, close family members can be included when sharing the diagnosis or being notified earlier. Sharing diagnosis information differs when information is being shared with individuals, families, and in group sessions. When an individual is involved, straight communication may be necessary. This is also similar to when the family is involved. In families, explaining the diagnosis to other family members and the implications of the diagnosis to them may be necessary. Nevertheless, when dealing with a group, disclosing the diagnosis may sometimes trigger stigma. Differences in opinions and responses may also be apparent. The therapist has a role in ensuring that each member maintains knowledge of the disorder to lessen stigmatization.


Antisocial personality disorder remains a problematic personality disorder. Therapeutic approaches utilize psychopharmacological approaches. As evident above, this approach is valuable due to the complexities in the manifestations of the disorder. The literature forming the theoretical background of the paper is scholarly. This is because they are peer-reviewed and meet the criteria of relevance and purpose in mental healthcare. This is demonstrated by their ability to address aspects of mental healthcare and their success in addressing gaps in care.


De Wit-De Visser, B., Rijckmans, M., Vermunt, J. K., & van Dam, A. (2023). Pathways to antisocial behavior: A framework to improve diagnostics and tailor therapeutic interventions. Frontiers in Psychology14. 

Marzilli, E., Cerniglia, L., & Cimino, S. (2021). Antisocial personality problems in emerging adulthood: The role of family functioning, impulsivity, and empathy. Brain Sciences11(6), 687.

Wong, R. S.-Y. (2023). Psychopathology of antisocial personality disorder: From the structural, functional and biochemical perspectives. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery59(1).


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Therapy for Clients With Personality Disorders

Therapy for Clients With Personality Disorders

Briefly describe antisocial personality disorder, 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.
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 a group session.
Support your response with specific examples from this week’s Learning Resources( YouTube. 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.

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