For all disorders, the CBT therapist starts by educating clients about their diagnosis, helps them set goals, and socializes them to CBT by teaching them essential thinking and behavioral skills. In working with personality disorders, the CBT therapist works to moderate the more extreme aspects of the condition and to increase flexibility in personal life and relationships.
For example, for clients with borderline personality disorder, characterized by an instability of their emotions, goals, identity, relationships, and actions, CBT therapists may focus on helping clients find stability within the storm. Mindfulness meditative practice may help them observe the changes in thoughts and feelings, staying firmly grounded in the present moment. Skills training may help them promote greater stability in their relationships. Schema-focused work may help them address the long-standing, deeply grounded beliefs that guide their actions and sensitize their reactions.
Clients with schizotypal personality disorder, whose eccentricities compromise their ability to form social and close relationships, need to focus on empathy and acceptance of their idiosyncratic style. If they desire and value understanding and acceptance, they can learn to take the initiative be being understanding and accepting of others. And they can examine the beliefs that make this difficult.
For clients with avoidant personality disorder, whose feelings of social ineptitude and fears of ridicule result in social avoidance and inhibition, the focus is on connections. CBT therapists may help them in accepting their sensitive nature, examining the beliefs that hold them back, and acknowledging their courage in pushing through them.
Each of these personality disorders holds a seed that can reflect a positive intent, a positive purpose or drive. CBT therapists work with the client to discover ways to enable that seed to grow.