The internet is filled with stories of difficult living with «toxic» people and questions about whether they can be changed. Elena Sokolova, Doctor of Psychology, a specialist in personality disorders, shares her opinion.
First of all, let me remind you: do not diagnose relatives. This can only be done by a doctor. The task of a psychotherapist with a clinical and psychoanalytic education is to consider each specific case individually and try to understand what kind of person is in front of him, how his personality is arranged. That is, to make a personal diagnosis.
One thing is obvious: the scale of possible changes strongly depends on the structure of the personality, on the depth of violations. A mature person, even if with some neurotic traits, and a patient with borderline or narcissistic personal organization are completely different people. And their «zone of proximal development» is different. For the most part, we are able to notice flaws in our behavior, realize that something is wrong with us, ask for help, and then readily respond to this help.
But people with borderline and even more so narcissistic organization, as a rule, are not aware of their problems. If they have anything stable, it is instability. And it applies to all spheres of life.
First, they experience great difficulty in managing emotions (they are characterized by violent, difficult to control affects). Secondly, they are extremely unstable in relationships.
On the one hand, they have an incredible craving for close relationships (they are ready to cling to anyone), and on the other hand, they experience an inexplicable fear and desire to run away, to abandon relationships. They are literally woven from poles and extremes. And the third feature is the inability to form a generalized and stable idea of oneself. It is fragmentary. If you ask such a person to define himself, he will say something like: «Mom thinks that I have an ability in the exact sciences.»
But all these violations do not cause them any concern, since they are almost insensitive to feedback. A mature person is able to correct his behavior thanks to the messages of the outside world — in everyday communication and when meeting with different life circumstances. And nothing serves them as a lesson. Others can signal them: you are hurting, it is difficult to be around you, you are harming not only yourself, but also your loved ones. But it seems to them that the problems are not with them, but with others. Hence all the difficulties.
Difficult but possible
Work with such people should be long-term and deep, it implies not only the personal maturity of the psychotherapist, but also his good knowledge of clinical psychology and psychoanalysis. After all, we are talking about rigid character traits that arose long ago, during early infancy. Some violations in the relationship between the infant and the mother serve as a damaging factor. In the conditions of a «disabled environment» an anomalous character is formed. These early developmental disturbances limit the ability to change. Don’t expect quick improvements.
Patients with borderline narcissistic organization resist any kind of influence, it is difficult for them to trust a psychotherapist. Doctors say that they have poor compliance (from English patient compliance), that is, adherence to a particular treatment, the ability to trust a doctor and follow his recommendations. They are very vulnerable and unable to endure frustration. They perceive any new experience as dangerous.
What results can still be achieved in such work? If the therapist has enough patience and knowledge, and the patient sees that they really want to help him, then little by little some islands of relationship are tied up. They become the basis of some improvements in feeling, in behavior. There is no other tool in therapy. Don’t expect big changes. You will have to work slowly, step by step, showing the patient that improvements, however small, are being achieved with each session.
For example, the patient for the first time managed to cope with some kind of destructive impulse, or at least get to the doctor, which was not possible before. And this is the path to healing.
The Path to Healing Change
What advice would you give to the families and friends of people with personality disorders? What about those who are not ready to end the relationship and leave?
If you value your relationship, try not to blame the other for anything, but to carefully consider your interaction, and first of all, turn to yourself, your motives and actions. This is not about blaming the victim. It is important to remember such a psychological defense mechanism as projection — everyone has it. This mechanism causes uncomfortable features of one’s own behavior — one’s selfishness, or aggressiveness, or the need for guardianship — to be projected onto a loved one.
Therefore, when we accuse someone of manipulation, it is worth asking ourselves the question: how do I myself communicate with other people? Do I treat them like a consumer? Maybe I’m only ready for a relationship that boosts my self-esteem or social status? Do I try to understand the other person when it seems to me that he is striking? This change of position, empathy and the gradual rejection of self-centeredness allows us to better understand the other, take his position and feel his discontent and the pain that we may unwittingly inflict on him. And he responded to us.
Only after such inner work is it possible to talk about understanding each other, and not blaming yourself or the other. My position is based not only on many years of practice, but also on serious theoretical research. Claiming to change another person is highly unproductive. The path to healing change in relationships is through self-change.