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November 2010

Personality Disorders, or Why Is My Client Such a Jerk?

The interpersonal relationship between lawyer and client is colored by the lawyer’s as well as the client’s personality. Clients with personality disorders present a unique challenge. Although not a physical disorder, personality disorders alter the way people interact in the world. Two common personality disorders encountered in the criminal justice system are borderline personality disorder and antisocial personality disorder. To best serve clients diagnosed or expressing traits of either disorder, criminal defense lawyers must develop special skills to communicate effectively.

Coping with everyday stresses and maintaining meaningful interpersonal relationships is dependent upon a healthy personality.1 Personality makes up who we are as individuals; it colors our experiences, feelings, and thoughts, and it determines our perception of the world. Those diagnosed with personality disorders struggle to adapt to new situations and are often unable to form long-lasting personal relationships.2 People with personality disorders are inflexible, allow their personalities to drive their cases, and often end up sabotaging themselves—a precarious situation for both attorney and client involved in the criminal justice system. The presence of a personality disorder in a client may make it difficult for an attorney to feel comfortable and capable of serving the client’s best interest. For attorneys encountering clients with personality disorders, it is important to recognize the intricacies of each particular diagnosis while at the same time emphasizing the importance of creating a professional alliance, much like that between physician and patient.

There is little information aimed at attorneys dealing with this special population. William A. Eddy, an attorney and a psychotherapist, writes in his book, High Conflict Personalities, that “personalities drive conflict.”3 Eddy considers “high conflict personalities” to be Cluster B Personality Disorders in the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV-TR). There are a variety of personality disorders in the DSM-IV-TR, and to explore possible methods for working with every possible personality disorder is beyond the scope of this article. The two types of personality disorders most typically encountered in the criminal justice system are borderline personality disorder and antisocial personality disorder. Eddy goes as far as to argue that the litigation process itself encourages people with particular personality disorders because the structure of the adversarial process rewards conflict and exacerbates certain qualities of personality disorders.4

The DSM-IV-TR categorizes personality disorders as Axis II diagnoses, which identify “underlying personality disorders or maladaptive personality traits,”5 and then groups them together according to common traits shared among them. There are three lettered clusters of personality disorders: A, B, and C. Both antisocial personality disorder and borderline personality disorder are categorized in the DSM-IV-TR as Category B personality disorders, which are characterized as overly emotional or unstable personalities. The diagnostic criteria for a personality disorder require a prevalent history of particular symptoms occurring in the patient before adolescence; namely, one must express traits and symptoms in a non-transitory manner and reflect an “enduring pattern” of recognizable symptoms.6 General symptoms, according to the Mayo Clinic, include “frequent mood swings, stormy relationships, social isolation, angry outbursts, suspicion and mistrust of others, difficulty making friends, a need for instant gratification, poor impulse control, and alcohol or substance abuse.”7

As legal professionals, lawyers are not required to diagnose any client seeking legal assistance. However, it is beneficial to take the following information and use it to perceive “personality patterns” in clients. Being able to recognize, empathize, and understand those with borderline personality disorder and those with antisocial personality disorder will enable an attorney to handle these cases better and minimize potential conflicts between themselves and their clients.8

Borderline Personality Disorder

Borderline personality disorder (BPD) consists of:
deeply ingrained and maladaptive patterns of relating to others, impulsive and unpredictable behavior that is often self-destructive, lack of control of anger, intense mood shifts, identity disturbance and inconsistent self-concept, manipulation of others for short-term gain, and chronic feelings of boredom and emptiness.9

The characteristics listed above make it clear that creating and maintaining productive relationships are especially difficult for people with BPD. Issues of low self-esteem and constant fear of abandonment can lead those with BPD to view certain relationships and other people in highly idealistic terms. When those relationships or others fail them, they experience severe disappointment. Approximately 2 percent of the general population has BPD, and it is more common in women.10 Furthermore, during times of stress, people with BPD may suffer psychotic symptoms, such as hallucinations and other delusions. As a result, people with BPD have a higher tendency to injure themselves, and roughly 10 percent of people with BPD commit suicide.11

An interesting phenomena observed in people with BPD consists of the creation of emotional facts. In Stop Walking on Eggshells, author Paul T. Mason describes that phenomena:

In general, emotionally healthy people base their feelings on facts. If your dad came home drunk every night (fact) you might feel worried or concerned (feeling). If your boss complimented you on a big project (fact) you would feel proud and happy (feeling). People with BPD, however, may do the opposite. When their feelings don’t fit the facts, they may unconsciously revise the facts to fit their feelings. This may be one reason why their perspective of events is so different from yours.12

Case Study: Susan

Susan, a middle-aged female, was referred to the Travis County Mental Health Public Defender’s Office (MHPD) after being charged with criminal trespass. She had a history of self-injury, including throwing herself down the stairs at a homeless shelter when she was told that she may not be able to continue to stay there. Although she claimed to have had no criminal history, it appeared she had several previous arrests. Other agencies working alongside the MHPD described her as a “pathological liar.” Her actions and behaviors in jail even led jail staff to believe that Susan was malingering—i.e., exaggerating about the nature of her symptoms.

Susan claimed to be wheelchair-bound and to suffer paralysis in certain parts of her body due to a car accident that occurred a few years before. She also claimed she was immobile because of new injuries caused by a police officer’s use of a night stick the evening of her criminal trespass charge. However, medical experts reported that Susan was indeed able to care for herself, and that her behavior in jail was an effort to get extra attention. Susan would often take her claim of complete paralysis to the extreme, choosing to lay in her bowel movements rather than move herself to the toilet. Needless to say, she was not popular with the jail staff. When she met with an MHPD social worker, Susan stated that a jail psychiatrist had called her a “disposable human being,” and she reported feeling anxiety and depression given her current circumstances.

In the interview setting, Susan was invested and “quite informative,” although sometimes her premise of genuine cooperation drew skepticism from others. The information she gave about herself was typically unreliable, inaccurate, and sometimes completely unbelievable. She claimed to have a PhD in Psychology, said she worked as a professional musician, and even admitted to lying about having children—because she believed that “people respond to me differently if they think I have kids.” When confronted with her lies, she would reluctantly admit to them and claim that she wanted to stop, but this never proved out.

When asked to recount the facts of her criminal trespass charge, Susan claimed to have fallen and hit her head, which caused her to forget the majority of the charge. She stuck to her story of amnesia so strongly that the evaluating physician considered her failure to remember as approaching incompetence. However, after extended discussion, Susan admitted that she was “terrified of homelessness” and felt safer in jail than in returning to the streets, should her case be dismissed. Susan also threatened to commit suicide if her partner rejected her.

The MHPD was ultimately able to get Susan’s case dismissed and find placement for her in a nursing home. But working with Susan was perhaps one of the more challenging aspects of her fairly simple criminal trespass charge. Her tendency to lie, to provide unreliable information, to alienate people, and to feign injury made productive meetings difficult. Maintaining boundaries between Susan, her case, and the duties of the MHPD was fundamental in providing helpful legal service. Had boundaries not been maintained, there is little doubt that Susan would have lingered on the case load for longer than necessary, given the desire of someone with BPD to remain the center of attention.

Also, it was paramount that the staff at MHPD was able to avoid certain dramas created by Susan. For instance, when Susan claimed that a jail psychiatrist had called her a “disposable human being,” Susan placed the jail psychiatrist in an extreme category, a common occurrence by those with BPD.

Techniques

Susan’s case shows how maintaining boundaries and distancing oneself from the dramas of a person with BPD is useful in maintaining a productive working relationship. Clients with BPD ultimately fear abandonment by those close to them. Ignoring this unique need often results in attorneys having to make lengthy phone calls, faxes, and office visits to constantly reassure a client with BPD. Eddy suggests that attorneys provide “clear reassurances and limits from the beginning of the relationship” to avoid having a client with BPD feel abandoned.13 In addition to these basic tactics, there is growing support among counselors surrounding the effectiveness of a new method called “dialectal behavior therapy” (DBT) for dealing with people with BPD.14
In layman’s terms, DBT is a “comprehensive treatment approach” for helping people overcome their self-destructive behaviors, and it is specifically designed for people with BPD. DBT attempts to teach clients better ways to cope with their intense feelings and regulate their mood swings. DBT is carried out in a caring, sensitive environment where clients engage in individual therapy, a group skills training class, and skills coaching in between sessions.15 DBT is a very intensive therapy mode, and it requires the dedication of a professional counselor, but there are lessons to be gleaned from it that are directly applicable in legal advocacy:

  • Emotional Regulation. An attorney is not a counselor and should not pretend to be one, but attorneys can better their relationships with clients with BPD by remaining consistent in their communications and maintaining a calm, professional demeanor. Attorneys should never respond to a frustrating BP client with anger, or encourage a client’s own worries by becoming frustrated over inevitable legal obstacles.
  • Mindfulness. Attorneys should keep the conversations focused on the issue at hand. Delving into other personal matters of a BPD client may prove to be ineffective and damaging overall to a healthy attorney-client relationship. Also, attorneys should let BPD clients know they believe that each will feel occasionally frustrated and angry during the case. Attorneys should explain that frustration must be overcome and worked through.16
  • Distress Tolerance. One important aspect of DBT is coping skills. Attorneys can help clients with BPD by explaining to the client the nature of obstacles in the legal process as well as possible solutions. Eddy advises attorneys to “validate the person rather than criticizing the behavior, and then focus them on alternative behaviors or the next task in the case” when clients with BPD become self-destructive.17
  • Interpersonal Effectiveness. Attorneys should always treat clients with BPD with respect and patience. Some important skills include listening non-defensively, providing realistic expectations, and avoiding reinforcement of “high idealization” by balancing their praise for you.18

Antisocial Personality Disorder

Texas attorney Roy Minton provided the following definition at a criminal defense seminar: “The definition of an Antisocial Personality Disorder: Someone you have to teach that opening the door for other people is a good thing!” Unsurprisingly, the antisocial personality disorder (APD) has long been considered one of the most untreatable personality disorders.19 People diagnosed as having APD often end up hindering the legal and mental health systems because they continually relapse into mental health treatment services with little positive change.20 Compared to BPD and other disorders, APD appears to have more of a genetic link.21

In addition, APD tends to coexist with substance abuse problems as well, which exaggerate the negative symptoms of APD. The DSM-IV-TR requires that some traits central to APD diagnosis must be apparent in the patient before 15 years of age. However, diagnosis of APD must not be made until the patient is at least 18 years old. The most recognizable trait of APD is a “pervasive pattern of disregard for, and violation of, the rights of others.” A lack of empathy, callous and cynical worldview, contempt for the feelings of others, an arrogant and inflated self-image, impulsive behavior, a history of aggressive or violent behavior, and a frequent lack of concern for themselves are all symptoms of an APD client.

Case Study: Jerry

Jerry, a 30-year-old homeless man, came to the MHPD with a charge of public intoxication. Jerry claimed to have intentionally gotten himself arrested in order to get necessary medical treatment. He had a history of alcohol abuse from an early age. However, when asked if he wanted help with his alcoholism, Jerry refused any treatment and became irritable. Jerry uses alcohol to handle stress, and he is very impulsive. He stated that he “can’t sit still long enough to fill out forms” and displayed manic behaviors. He spoke rapidly and had visited the office visibly intoxicated. In a meeting with an MHPD social worker, Jerry became sexually inappropriate with the social worker and responded blankly when warned. Later, Jerry continued with his inappropriate, disruptive behavior until the social worker terminated the meeting. Jerry claimed that the social worker’s efforts “wasted his time,” and he became very agitated and difficult. Jerry also conveyed an intricate and strange reasoning for his belief in stealing from stores but not people. According to Jerry, stealing from stores should not be considered a crime.

In working with Jerry, the MHPD staff recognized that Jerry was not interested in altering his lifestyle or cooperating with case managers.

Techniques

People like Jerry with antisocial personality disorder traits are usually not receptive to receiving aid from others without somehow benefiting their own ulterior motives. Thus, attorneys working with APD clients need to recognize their inherent selfishness and work around it in order to best serve the clients’ needs without placing themselves in a precarious position.

Eddy writes, “ASPs [antisocial personalities] fear being dominated and therefore they desire to dominate and control others—it gives them a reassuring sense of power in the world.”22 In the case of Jerry, he dominated the relationship with the male social worker by engaging in sexually inappropriate behavior in order to make the social worker unable to run the meeting. Attorneys working with someone with APD should be very strict about not reinforcing manipulative and dominating behaviors, and must be “attentive to protecting themselves, physically and legally.”23 Also, attorneys should possess a healthy level of skepticism when working with people with antisocial personality disorders.

Clients with APD will use deception to reach their own ends regardless of the consequences to others. For instance, Jerry wanted to get arrested in order to get medical attention. This trait is particularly challenging for criminal defense lawyers to deal with, as client contact is the primary means of obtaining information about the case and the client may engage in self-destructive behavior during legal proceedings for short-term gains. Eddy likens clients with APD to small children who often demand instant gratification and cannot cope with any type of obstacle.24 In order to combat the potential for lies, attorneys should try to get corroborating information from other sources to verify their clients’ stories, as well as avoiding doing any favors and enforcing strict consequences for clients with APD.

Finally, clients with APD may be “predatory in their violence, which means it is planned, purposeful, and lacks emotion . . . This characteristic allows little room for negotiation or cooperation.”25 Lawyers should be aware that there is a spectrum of behavior exhibited by those with APD that not only requires care by the lawyer but also a certain level of caution.

Conclusion

The guidelines outlined in this article are in no way a substitute for a physician’s recommendations for a particular client. Rather, these are all tips designed to enhance communication between professionals working with people who have personality disorders. By utilizing patience and dedication to work with clients who may be more challenging than most, lawyers can reduce the frustrations exacerbated by the presence of a personality disorder.

Notes

1. Mental Health America, “Factsheet: Personality Disorders,” Mental Health America, http://www.nmha.org/go/information/get-info/personality-disorders
2. Ante.
3. William A. Eddy, High Conflict Personalities: Understanding and Resolving Their Costly Disputes (William A. Eddy, 2003), 1.
4. Ante, 32.
5. Ante, 13.
6. Frederick Rodgers and Michael Maniacci, eds., Antisocial Personality Disorder: A Practitioner’s Guide to Comparative Treatments (Springer Publishing Co., 2006), 5.
7. Mayo Foundation for Medical Education and Research (MFMER), “Personality Disorders,” Mayo Clinic, http://www.mayoclinic.com/health/personality-disorders/DS00562/DSECTION=symptoms.
8. Eddy, 16.
9. Robert L. Barker, The Social Work Dictionary (NASW Press, 2003), 49.
10. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Publications, 200), 708.
11. National Alliance on Mental Illness, “Borderline Personality Disorder,” NAMI, http://www.nami.org.
12. Eddy, 29.
13. Ante, 52.
14. National Institute of Mental Health, “Borderline Personality Disorder,” NIMH, http://www.nimh.nih.gov/health/publications/borderline-personality-disorder-fact-sheet/index.shtml.
15. Michael Baugh, “What is Dialectic Behavior Therapy?” DBTSF.com, http://www.dbtsf.com/what-is-DBT.htm.
16. Eddy, 54.
17. Ante, 59.
18. Ante, 75.
19. W. John Livesly, Handbook of Personality Disorders (Guilford Press, 2001), 332.
20. Rodgers, 2.
21. Eddy, 120.
22. Ante, 103.
23. Ante, 122.
24. Ante, 115.
25. Ante.

Jeanette Kinard is Director of the Travis County Mental Health Public Defender Office in Austin, Texas. A longtime criminal defense attorney, Jeanette has a bachelor’s degree from the University of Texas at Austin and a law degree from the University of Houston. She is a frequent speaker, statewide, on the topic of the mentally ill in the criminal justice system. She is a member of the State Bar of Texas, Austin Criminal Defense Lawyer’s Association (president, 1994–95 and 2004–5), Texas Criminal Defense Lawyers Association (Board of Directors, 1996–2000), National Criminal Defense Lawyers Association, and the National Legal Aid and Defender Association.

November 2010 Issue

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Features

13 | Proposed Changes to the TCDLA Bylaws
20 | Prairie Dog Photos – By Chuck Lanehart
24 | Personality Disorders, or Why is My Client Such a Jerk? – By Jeanette Kinard
30 | Can Defendants With Retardation Be “Restored” to Competency? – By Melissa L. Shearer
44 | Defendant’s Ex Parte Motion for Expert and Investigative Assistance – By Richard Davis

Columns

8 | President’s Message
10 | Executive Director’s Perspective
12 | Editor’s Comment
14 | Federal Corner
18 | Said & Done

Departments

5 | TCDLA Member Benefits
6 | Staff Directory
7 | CLE Seminars and Events
34 | Significant Decisions Report