Dear Therapist:

I have a question that has been weighing on my mind for a while. I have a relative that is unfortunately unwell. I am not a professional but from what I've read on the subject I think that she has histrionic or borderline personality disorder. She is constantly needy and crying to everyone near her how she's afflicted with (fill in blank) and how she has the worst life. She craves attention and publicly acts like a pity case which is very embarrassing for her family. She wants everyone to do everything for her because "she feels sick." Unfortunately, she drives everyone away with this behavior. No amount of explaining this reality to her changes her actions. She just keeps on pushing people away with her extreme neediness and her critical outbursts which are sometimes mixed with desperate pleas for others to not abandon her in her time of need. Her children and relatives are left feeling both guilty and angry at her. How can someone effectively help another person that lacks both insight and the will to get better?

It also may be relevant to point out that this woman began acting like this to an extreme during her middle age / older years (as kids left home) although signs were already there earlier.

Response:

Unfortunately, we do not have the ability to change others. Even for relatively “simple” issues, when we attempt to effect change in others, we are typically left frustrated and confused. In fact, we often wind up contributing to the problem. Sometimes the reason for this is that we are—at least in part—actually trying to help ourselves.

The wording that you use implies (at least to me) that your concern is largely for those people who need to deal with the relative in question. Although she appears to be hurting the most, the focus seems to be on her children and other relatives.

When dealing with someone who has a difficult personality, over time it becomes easy to view that person as the perpetrator (which in many ways they may well be). This tends to obscure the person’s own needs. It is her actions that seem problematic. These actions, however, do not exist in a vacuum. Clearly, she is unhappy. The amount of pain that she inflicts on others is but a drop in the bucket next to the pain that she must be feeling on a constant basis.

You mentioned that this relative does not have the insight or the will to get better. Of course, I cannot tell you whether she has a personality disorder. For people who do, it can be extremely difficult to help them see that their personality is the problem. After all, this is their personality—how they view themselves, their relationships, and the world. This may be what inhibits her from attaining insight into what others see as her problem.

As far as the will to change is concerned, from your perspective this is something that she lacks. This is likely due to what you view as the problem. Although the common consensus might agree with your view of what the problem is, your relative appears not to. What she does appear to agree with is the fact that she needs help. Perhaps you (or the person best suited to the job) can use this common ground to guide her toward the professional help that she may agree can help her.

People with personality disorders frequently seek therapy on their own. In many cases, they are not looking for help in dealing with their personality issues, but rather focus on issues that others might see as symptoms of the personality disorder. These peripheral issues can range from anxiety and depression to relationship and socialization problems.

Often, once in therapy for these secondary problems personality issues are addressed as well. Sometimes this happens almost immediately; at other times these are only addressed once the identified problems are at least partially resolved. Sometimes, the client begins to recognize their personality issues; at other times these are addressed without specifically identifying them as such.

Your relative may want to work on her problems, but this doesn’t necessarily mean that others in her life agree with her as to what these problems are. If you are able to understand her feelings from her perspective, it will likely become easier to help her.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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