Eric G. Mart, Ph.D., ABPP  |  June 29, 2013

Persons diagnosed with personality disorders are a diverse group, and while individual differences are important, diagnostic classifications can be helpful in understanding a particular client’s general ways of relating to others and viewing the world. I receive many inquiries from attorneys about how to approach persons with borderline personality disorder, since they can be difficult to interview.

Personality disorders are long-standing maladaptive patterns of thinking, feeling and relating that cause significant distress to the sufferer. Persons with these disorders can also often create problems for those close to them or those working with them, and individuals with borderline personality disorder (BPD) can be particularly challenging. The following description of BPD is adapted from the Handbook of Diagnosis and Treatment of DSM-IV-TR Personality Disorders by Len Sperry, M.D., Ph.D. (2003):

• Behavioral Style: Resentful, impulsive, and prone to acting out
• Interpersonal Style: Paradoxical; alternately idealizing and devaluing, rejecting and clinging, sensitive to rejection, fears of abandonment
• Cognitive Style: Inflexible, rigid, and grandiose; failure to learn from experience
• Feeling Style: Labile in mood and emotion
• Self Concept: Identity problems that can affect the view of loyalties, career, values, and gender

Obviously, these characteristics can make it difficult for mental health professionals and lawyers alike to effectively interview individuals with BDP. Rapport is difficult to establish and even more difficult to maintain. Dr. Sperry suggests that these clients will create problems in the interview because of their emotionality, ambivalence, and moodiness. He suggests several approaches that may be helpful in these situations. Problems with rapport are best dealt with by addressing apparent problems as they occur in an empathic way. This can be accomplished by directing the discussion, staying on track, and firmly redirecting diversions and outbursts. Continuing to process this underlying ambivalence and instability not only helps keep the interview progressing, it also will aid in the development of trust and rapport as the client feels that his or her concerns are being heard. In addition, Dr. Sperry also recommends the use of open-ended questions as opposed to more specific and closed queries. Such an approach will probably not solve all problems, but it will help to minimize the disruption of the interview.

References

Sperry, Len. Handbook Of Diagnosis and Treatment of DSM-IV-TR Personality Disorders. 2nd Ed. New York: Brunner-Routledge; 2003.