Treatment Success For The Paranoid Personality Disorder

Understanding the mind, heart, and spirit of the Paranoid Arguer personality disorder lies at the center of treatment success for the Christian counselor.

Paul had this to say about the Paranoid Arguer pattern:
“When you follow your own wrong inclinations your lives will produce these evil results...hatred and fighting, jealousy and anger, constant effort to get the best for yourself, complaints and criticisms, the feeling that everyone else is wrong” (Gal 5:19-20 TLB).

To the Paranoid Arguer, God is only wrathful, quick to anger, and slow to forgive. In what is surely a self-statement, the Arguer hears God saying, “I mete out punishment to those with whom I disagree. I make a point of disparaging alternative views. I issue ultimatums to those not in my will. After all, ‘Vengeance is mine,’ says the Lord.” 

Paranoid Arguer

But the apostle John replies: “Whoever says, ‘I am in the light,’ while hating a brother or sister, is still in the darkness” (1 Jn 2:9).

Arguers’ independence isolates them from social feedback, so they hear only the marbles rolling around in their own heads. Nothing else is relevant; nothing else matters. Over time their thoughts can take the form of delusions in which they are captains of fate struggling against formidable forces, a theme strengthened by selectively interpreting most stimuli to fit this internal scenario.

Their highest ongoing priority is to maintain freedom in a world of their own making—a mentality that shares much in common with schizoid, schizotypal, and schizophrenic ideation. On the other hand, they share with the histrionic pattern ideas of reference whereby they interpret insignificant or innocuous events in ways that suit their dictates and confirm their suspicions.

WHY?

Compass Therapy suggests this explanation for paranoid Arguers’ stubbornness and vainglorious pride: they have desensitized themselves to the Love compass point as a defense against caring, and to the Weakness compass point, where hurt, shame, and self-doubt are barred from consciousness.
The decommissioning of Love and Weakness reduces their interpersonal connection with humanity to a defensive vigilance against perceived threats. The short-term gain is a remarkable lack of intrapsychic conflict achieved through an aggressive reflex-arc that utilizes the mid and lower brain stem—what I call the “reptile brain”—to create a psychology of hate, suspicion, and retribution. The neocortical functions are recruited to verify these assumptions by sifting for evidence to build a case that other people have ulterior motives.

In every vocation paranoid Arguers vent their malevolence on those under their control. They train underlings to walk on eggshells to reinforce their power over others, criticizing them over nothing as a form of stimulation. And, of course, there is not the slightest remorse for dressing someone down because “if he (or she) had done the right thing, I wouldn’t have had to blow my stack.”

Paranoid Personality Disorder

HEALING TREATMENT
Understanding the above features helps the Christian counselor selectively empathize with the pain the counselee has known in life, while at the same time feeding back a certain amount of truth serum about the toxic effects of the paranoid Arguer pattern. While taking care to speak in a diplomatic and non-inflammatory way, you nevertheless remain firm about how pattern recognition can serve the counselee’s self-interest better than the paranoid pattern itself.
You identify with their pride, yet suggest that a realistic integration of both strengths and weaknesses will increase their capability to understand motivation. You temporarily align with their grudges against others, while suggesting that this narrowed perceptual field creates a vulnerability all its own. You compliment their no-nonsense realism, while delicately pointing out that the reason they are in marital therapy (or some other difficulty) is related to a general lack of empathy and caring.
Over time you construct the mental possibility that the world might be a friendlier place than they assume, and that other people could find them interesting and attractive if they’d quit baring their fangs. Many paranoids are genuinely surprised to learn that there are people in the world who want to like and love them, but have never been given the chance.

As a Christian counselor, suggest to a Christian counselee that they consider learning to:

1. Talk with you about painful times during childhood or current situations that are aggravating.
2. Speak from the heart.
3. Confess their sins.
4. Pray for a deeper trust in God’s love.
5. Immediately distrust their knee-jerk angry reactions and practice replacing these with the deliberate cultivation of patience.
6. Offer quick apologies after any lapses into the old inflammatory behavior, seeking to make peace, not war.
7. Experience the grace of forgiving and being forgiven.
8. Give others the benefit of the doubt.
9. Discover the pleasure of becoming a more caring person.
10. Pray to “put away…all bitterness and wrath and anger and wrangling and slander, together with all malice, and be kind to one another, tenderhearted, forgiving one another, as God in Christ has forgiven you” (Eph 4:31-32).

Forgiving others as Christ has forgiven you

For more, read: 

COMPASS THERAPY: Christian Psychology In Action

Counselees as Heroes in Therapy

Human beings have an existential need for visibility; that is, recognition and validation that they are special and their lives matter. When counselees feel stuck in problems they can’t find their way through, it takes a toll on self-esteem. Compass Therapy seeks to strengthen their self-image, promoting redemptive hope by viewing them as uniquely heroic in their efforts to overcome difficulty.

Miguel was seeing me for help in solving a relationship problem. He had been dating the same woman for five years, yet she was still holding him at arms length whenever he mentioned marriage. In the first two sessions I had learned that Miguel had experienced a fairly tempestuous adolescence, including a good amount of fighting, cussing, and delinquency. He and Monica attended the same church, but this didn’t stop his old behaviors from sabotaging his efforts at emotional intimacy. 

Now in the third session, Miguel says, “I just don’t get it. Monica knows I love her. Why won’t she marry me?”

 

“I wonder if it has something to do with the way you respond to her in conversations?”

“Well, she does say that I cut her off and don’t understand her feelings. But it’s boring when she gets emotionally worked up. I really don’t want to hear about it.” 

“So from your view she's always asking for more emotion that you're willing to give?” (This is an emotional reflection designed to make sure Miguel feels that I empathize with his frustration, before expanding this thought to help mend his mind). 

“Exactly. She drives me crazy that way!”

“I think I have a hypothesis about what’s going on. Would you like to hear it?”

(I’m now signaling to Miguel that we are changing to another part of his human nature—his mind—and I’m doing so respectfully by asking his permission).

“Sure.”

“Well, from what you told me in our first session about the pretty aggressive crowd you grew up with, and from your identifying with the Arguer and Boaster personality patterns when you read the Self Compass book, I think we can say that you might be showing hostility and rudeness to her a lot more than you’ve realized.”

Miguel laughs. “She’d agree with that. But verbal sparring comes naturally to me. That’s how I make my living in sales. I always have an answer before someone asks the question, and I totally control the conversation. Isn’t that a good thing?”

“It’s a communication style that may work in business, but not if your goal is man/woman love.”

“Why?”

“How about putting on your thinking cap and telling me?”

Miguel offers a sheepish grin. “Because I don’t pay attention to what she’s saying?”

“And even more significantly, perhaps because you’re not emotionally connected to her while she’s speaking.”

Miguel sits back and sighs. “But I pride myself on being a good communicator. All my friends say I can talk my way out of anything.”

“I think this is the crux of the difficulty. In that fast crowd you grew up around, was it considered a strength to outsmart people with comebacks and put-downs?”

“Yeah. I always came out on top, too.”

(Now I administer more truth serum, knowing that if he receives it, I can move toward framing him as a hero of his life’s narrative).

“So as long as the conversations were focused on verbal sparring and had a competitive edge, you were the best of the best. But when you developed a man/woman relationship headed for marriage, everything stalled. Is that right?”

Miguel takes another deep breath, his eyes glazing over in thought. “I never thought of it like that before. I’ve always thought this whole problem was Monica’s fault for not being tough enough to handle how I talk to her.”

“I wonder if you’re on the verge of seeing that perhaps your aggressive speech has inflicted her with a lot of emotional wounds; that maybe she’s tried to tell you this but you turned a deaf ear.”

Miguel tears up. “She’s used that exact word—wounded. I never knew what she meant.”

“What are you feeling right now?”

Miguel wipes away a tear. “I feel sorry for being hard on her. Sorry, too, for never understanding her.”

(I wait for a few moments as he stares into space, sensing that his mind is assimilating a new theory about his past behavior, and perhaps finding fresh resolve to make attitudinal changes).

“I’m experiencing admiration for you, Miguel, because many individuals who have dished out harsh treatment to a partner aren’t willing to acknowledge it. But here you’re not only admitting your aggressive communication style, but also feeling empathy for how it’s impacted Monica.”

“I love her, Dr. Dan. I really do.” (His voice quavers with the emotion behind his declaration).

“I feel the sincerity of your love. But it seems like your aggression has the potential to destroy that love, at least on Monica’s part. Would you give me permission to point out when I observe traces of this aggressive trend in sessions, so you can become more aware of it?”

“Absolutely. It’s so second nature I don’t know how to change it. But I don’t want to hurt Monica any more.”

“Because?”

“Because I want her to love and trust me.”

(I want to deepen the cognitive memory trace of his statement and all it conveys).

“Please say this again, even firmer.”

His eyes tear slightly once more. “I want Monica to trust me because I start listening to her feelings.”

(Now I can place a new frame around Miguel’s life narrative, a frame that encompasses the growth he seeks).

“So may we describe you as a man who has finally come to face his combative ways? Who wants to transform his history as a tough-talking teenager into an adult capable of love and respect for the woman he hopes to marry?”

“That’s exactly right.”

“How would you say this to Monica?

“I guess I would say, ‘Hey Babe, I’m really sorry for bad-mouthing you so much. I know it’s not right. I want to treat you a lot better.”

“That’s a solid beginning, Miguel. That’s how an aggressive guy can become a hero of love.”

It is very worthwhile to build a warm human bond where curiosity and fascination enliven the counseling process, inviting counselees to join in the adventure of human growth.

Pastoral Counseling Using Compass Therapy for Brief Situational Support

In the Compass Therapy approach to pastoral counseling, brief situational support consists of one to three sessions aimed at strengthening counselees in life situations that have temporarily thrown them off course.

Let’s say a woman comes to you feeling stunned and confused because her husband died that weekend. Relatives are arriving from out-of-town to assist with the funeral. She tells you through tears that she doesn’t know how to act around them. Then she bites her lip, as though apologetic for her show of emotion.

Grief

“Andrea,” you say, “it’s okay to let your feelings come out here. Let yourself breathe and say whatever comes to you.” Here you are defining the counseling encounter as a safe place to contact emotions and let them pass through her. You are showing that while you are in charge of the session, she is free to express herself spontaneously. You are also implying trust in her, that as she discharges emotions and catches up with her thoughts, she will find a way through this situation.

After looking pensive for a minute, during which you relax your body and respectfully await her next communication, she takes a deep breath and says, “Should I be brave and make everyone comfortable? Or should I just cry when I feel how much I miss Brad?”

You explore this and find that her heart is aching terribly over the loss of her husband. She can barely even conceive of life without him. Yet she needs a way to behave in the midst of her many relatives.

“It’s like you are torn between concentrating on your feelings of loss and trying to watch after your visitors. Is that right?” Asking if your interpretation is on track lets counselees focus even more clearly on what they are experiencing. If they agree with you they will automatically move forward. If they disagree, they will add the nuance of thought or feeling that provides greater detail.

“Exactly,” she says. “I’m trying to make sure people have enough to eat and somewhere to sleep, and then suddenly I feel like I’ve been hit in the chest with a two-by-four.”

Now you want to expand the emotion behind the chest metaphor so that she can literally get the pressure off her chest.

“This deep emotion about Brad…what name would you give it?”

Her eyes grow distant, as though lost in thought. Then her shoulders slump and she sighs from her depths. “I feel…lost. Like there’s no ‘me’ inside me. Like I have tunnel vision and feel numb all over.”

Tunnel Vision

“This is perfectly understandable, Andrea. You are in shock. And your body is temporarily shutting down in order to protect you until you have time to sort things out.”

She tears up, a good sign that you’ve said the right thing, for her expression is no longer simply blank, but rather conveys the relief of expressing a core feeling and being understood. Aware that the session time is nearly over, you offer a tentative suggestion.

“Do you suppose it might work this week to go ahead and say when you’re feeling overwhelmed, so that you’re taking care of yourself as well as interacting with your relatives?”

Closing her eyes, she nods. “Yes, I think that’s what I need to do.”

Notice in this counseling transaction the sense of forward movement, even to the point of offering a creative plan. Counselees need more than having their feelings accepted; they need ideas to consider, perspectives to try on for size, tentative plans that steer them in a productive direction. In brief situational support the coaching dimension of pastoral counseling provides these elements.

You close the session with prayer, inviting Andrea to come back if she needs further support.

Other situations appropriate for brief situational support might include talking with a college student who is so homesick he’s considering dropping out of school; brainstorming with a counselee who has lost his job and feels submerged in a whirlpool of failure feelings; or comforting a woman who confides that she’s gone through the motions of religion for years without ever feeling close to God.

Brief situational support occurs most often within the faith community and reflects the heart-pulse of pastoral counseling and coaching. When parishioners speak transparently to a pastor, a church becomes a home. Pastoral counseling in this context helps to stabilize, nurture, guide, inspire, and lend a helping hand. The mere availability of pastoral counseling helps people feel the presence of a safety net underneath them, as the Psalmist recognized when he wrote: “Underneath are the everlasting arms.”

Long before I embarked on my counseling career I had a single session with a gifted pastoral counselor. I described how awkward I felt around people and how my way of emotionally blurting things out often backfired.

“So it seems like your impulsive style of speaking works against you more than you’d like,” he said.

“Yes,” I replied, amazed at the warmth that his eyes conveyed. “And I’m afraid that not even God can change me.”

He folded his hands together and looked thoughtful. Then he exhaled slowly and said, “Dan, I think the Lord is giving me a visual picture about you. If I understand it correctly, I see you as a boulder in a river filled with rapids. While you may seem rugged right now, in due time the Holy Spirit is going to rub off and polish your rough edges. I believe that someday you’re going to become a rock of support who helps other people know that God loves them.”

That visual metaphor has traveled with me these forty years. I hope I’ve become a source of God’s love to others as much as that pastoral counselor was for me.

Contemporary models that can strengthen your capability for providing brief situational support are found in books like: Strategies in Brief Pastoral Counseling, by Howard Stone (2001); Counseling: How to Counsel Biblically, by John MacArthur (2005); and Christian Counseling: An Introduction (2007), by H. Newton Malony and David Augsburger.

For more about the Compass Therapy approach to pastoral counseling, read:

Pastoral Counseling and Coaching: Compass Therapy in Churches

Pastoral Psychotherapy Using Compass Therapy

Long-term pastoral psychotherapy generally requires ten sessions to a year or more. While some exposure to clinical pastoral training is recommended for all pastoral counselors, long-term pastoral psychotherapy in particular needs formal academic and supervisory training in the field of counseling.

If brief situational counseling is like taking a car in for lubrication, oil change, and tire rotation, then longer term pastoral psychotherapy is like rebuilding the car’s engine. This requires the thorough integration of a Christian personality theory with a well-established counseling theory, and supervision of your initial counseling experience.

You want enough knowledge about personality disorders to treat counselees with narcissistic, compulsive, paranoid, antisocial, histrionic, dependent, avoidant, schizoid, and borderline personality patterns.

You want enough knowledge of biochemical disorders such as chronic depression, bipolar disorder, and attention-deficit disorder to discern when a referral for medical evaluation is indicated.

You want an understanding of the role of the unconscious in the generation of psychopathology and the therapeutic transformation of personality.

And you will undergo a course of therapeutic treatment yourself, a standard requirement for advanced degrees in counseling, so that your own personality patterns do not negatively impact the counseling process.

The reason for this extensive psychological preparation is simply that you don’t want the counselee to become worse off for seeing you! And this is what can happen when a counselee’s repressed emotions, irrational thoughts, conflicted values, and pent-up pain enter the counseling arena.

You can take them too far too fast, or make a seemingly innocuous remark that sets in motion rash decisions, suicidal urges, destructive aggression, or the collapse of a fragile sense of self. Nor do you want to become emotionally enmeshed with your counselee, so that you both topple off the nearest cliff.

Think of it like this: if your counselee needs you as a guide to ascend Mount Everest, you want to have safely guided many people up that mountain so that you know the territory.

That said, pastoral psychotherapy contributes profoundly to the present and future wellbeing of people that it serves, for it can transform barriers to wholeness, creating a positive behavioral legacy that will bless generations of people to come. You just have to know that you are called to this vocation and that you have acquired the expertise to deliver on its challenges.

I suggest that if you have a passion for counseling, you set about developing your capability in all three types of pastoral counseling—brief (1-3 sessions), short-term (four to nine sessions), and long-term (ten sessions to a year)—so that you can exercise wisdom and creativity in meeting a wide range of counselee needs, enjoying the freedom and fulfillment this brings you.

For more theory and techniques to enhance

pastoral psychotherapy and pastoral psychology, read:

Compass Therapy: Christian Psychology In Action