Neurosis vs. Character Disorder: Contrasting Needs in Therapy

Whereas neurotics need and value insight in therapy, disordered characters are already keenly aware of their attitudes and behaviors that cause problems. They already see, they just disagree.

Another important difference between neurotics and disordered characters concerns what they need and benefit most from in any kind of therapy or counseling experience. Because they are struggling with inadequacies, insecurities, and emotional conflicts, and because the roots of these problems are most often unconscious, neurotics both need and benefit from positive regard, supportive guidance, and most especially, insight. They tend to appreciate it when their counselors interpret the “dynamics” of their circumstances and shed “new light” on their situation. Further, because the ways they had been trying to cope with their issues were inadequate and making them feel badly, they both need and value the help they derive from the therapeutic experience.

Disordered characters, on the other hand, are already keenly aware of the kinds of the attitudes they hold as well as the behaviors they typically display that cause problems. There isn’t one thing anyone can say or bring to their attention that they haven’t heard a thousand times before from a variety of sources and in a variety of circumstances. In many of my workshops, I introduce the trite little saying: “They already see; they simply disagree.” They’re often aware of what someone else wants to tell them about their conduct before they say it. They’ll often retort: “I know, I know” when someone begins to offer advice. But they’re just not disturbed enough by their way of doing things — or they’ve been successful enough getting their way by doing those things — that they don’t want to consider changing their modus operandi.

What disturbed characters need within the context of any relationship (whether it be a therapeutic relationship with a counselor or any other relationship) is not so much insight but rather benign yet firm confrontation, limit-setting, and most especially, correction. I like to speak of what they need most in a therapeutic setting as “corrective emotional and behavioral experience.” By this I mean that they need to experience a situation in which someone will artfully challenge their dysfunctional beliefs, destructive attitudes, and distorted ways of thinking, stymie their typical attempts at manipulation and impression management, set limits on their maladaptive behavior, and structure the terms of engagement in a manner that prompts them to try out alternative, more pro-social ways of relating. They can then be reinforced for their willingness to try out new, more constructive ways of behaving.

There are many more significant differences between neurotics and disordered characters that I’ll be posting on in the coming weeks.

There have been some very interesting and timely questions and comments regarding the material I’ve been posting regarding character disorders. In my next post, I’ll be responding to some of these and attempting to clarify some key issues on this intriguing topic.

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