In a previous post, I described one category of therapy-interfering beliefs that clients with personality disorders sometimes hold, having to do with their ideas about engaging in treatment. A second category relates to their concerns about experiencing negative emotion. Many Axis II clients are reluctant to allow themselves to feel badly due to their negative predictions. For example, clients may believe:
If I start to feel distressed [in and/or out of session]...
it will get worse and worse.
I'll lose control.
I won't be able to tolerate it.
I'll cry and won't be able to stop.
I'll end up in the hospital.
others [including my therapist] will think less of me.
Or they may ascribe a negative meaning to the experience of negative emotion:
If I get upset, it means...
I'm a basket case.
When clients hold beliefs such as these, they will naturally try to avoid experiencing negative emotion. In session, they may fail to reveal distressing information, change an emotionally-laden subject, or object when the therapist probes too deeply. Outside of session, they may avoid confrontations with others, distract themselves when they feel upset, or use substances to quell their negative emotions.
It is important to conceptualize therapy-interfering behaviors to uncover the associated beliefs. This allows therapists to then help clients test their beliefs. In this case, in addition to cognitive restructuring, imagery work, etc., clients might be encouraged to do behavioral experiments for increasingly longer periods of time (if necessary), to find out what will actually happen if they allow themselves to feel badly. Or therapists may use Socratic questioning to see whether their conclusions about experiencing negative emotions are valid.
Future posts will address two other categories of beliefs Axis II clients often hold, that are related to solving problems and getting better.