- Please also see article on “Toxic People” on this web site

Unfortunately it is true that every one of us – even the most saintly – has some character traits that irritate some other people!  The good news is that it’s not always the fault of the person who is perceived to be irritating:  for instance, a “Type A Personality” may benefit from having some traits of more peaceful and joyful people that s/he finds highly annoying because they may not behave rashly enough to suit his/her needs for immediate gratification.  So, the person described as “difficult” may not be as problematic interpersonally as the one who describes him/her in such terms.Traits are considered to be dysfunctional if they interfere significantly with our optimal functioning in our personal life [e.g. causing depression, anxiety, addictions], our social life [e.g. our ability to function effectively socially or in intimate or family relationships], or our work life [e.g. in concentration, or in relationships at work].

Character or personality traits are qualities we all have, in various combinations.  They can be adaptive or functional, like certain life skills:  An accountant needs to be precise in her work, but hopefully not in exact in the way she arranges her flowers every day.  That would be bordering on maladaptive or dysfunctional behaviour, and may be traits or indicative of a fixed and invasive Personality Disorder which generally can affect people around her negatively or lead to arguments or rejection.

Traits are called ego-syntonic if we are proud of them and wish to keep them, despite others not believing we should indulge in them, or despite their interference with our optimal functioning as described above [e.g. "I like being aggressive: it gets me what I want"].  Traits that we ourselves recognise as dysfunctional or negative are termed ego-dystonic [e.g. "I would like to stop being addicted to cocaine because I realise it's harming me and my family"].

Certain clusters of traits appear to occur in set patterns and are always dysfunctional. These clusters are diagnosed only in adults [i.e. people over 20] and are well researched so that reasonably accurate conclusions can be drawn as to their causes and how they affect an individual and his/her life.  We can even predict with reasonable validity when a teenager who displays these clusters is likely to develop them into the fixed patterns of behaviour called Personality Disorders, by the time s/he reaches adulthood.

Although a person must fulfil all the criteria to be diagnosed with a Personality Disorder [and only a professional with clinical certification, like a psychiatrist or a clinical psychologist, may make such diagnoses!], some adults have enough of the traits to make their or others’ lives a misery – hence “difficult people”.

The following PDs [Personality Disorders] are stipulated in the current Diagnostic and Statistical Manual of the Psychiatric Disorders [DSM].  There are also other proposed categories [e.g. Depressive PD] that are being researched and may be added later.

CLUSTER A                                     CLUSTER B                         CLUSTER C

PARANOID PD                                ANTISOCIAL PD                 AVOIDANT PD

SCHIZOID PD                                  BORDERLINE PD                DEPENDENT PD

SCHIZOTYPAL PD                          HISTRIONIC PD                  OBSESSIVE-COMPULSIVE PD

                                                       NARCISSISTIC PD              PD NOS [Not Otherwise Specified]

Personality traits are not chosen as an act of will, and they are not signs of “madness”, though they may make people feel “mad, bad, or sad” if the traits are strong! [with prevalence of the traits notated as ++ or +++].  “Madness” [or psychosis] implies that an individual is frequently and grossly out of touch with reality, and no longer generally able to function effectively in his/her life - personally, socially or occupationally.  Even persons with “text book” PDs, tend to function quite well in some of these areas most of the time, and – except for Antisocial PDs – are usually not hospitalised or institutionalised [eg in forensic settings] – unless there is a specific symptom or threat such as attempted suicide.

Even for certifiable “madness” [psychosis – see below], there is always a Cause or Etiology.  The old psychotherapy cliché “It’s all my mother’s fault” is not as inappropriate as most of us would prefer it to be, especially if we are a parent or a caregiver! But the failure to make an individual feel safe and wanted in the world is often caused by peers, or by other authority figures or caregivers than the mother.  

Defense / Coping mechanisms are the infant’s and the young child’s attempt to ward off perceived terror / anxiety in repeated early situations that suggest to the person that s/he is in danger of abandonment / rejection / annihilation that would end in the destruction of the integrity of the Self.  Such defense mechanisms are not “genetic”, although symptoms could be similar: Being born with brain damage, for instance, may predispose a person to act out violently, similar to someone with Antisocial PD, or to have severe mood swings like someone with Borderline PD;  however, the cluster of symptoms and etiology is what allows us to differentiate between various mental disorders, according to a Differential Diagnosis.

Other disorders now clearly associated with brain damage [eg low brain matter density and resultant enlarged ventricles] include psychotic disorders, like the schizophrenias [typically demonstrating symptoms like auditory hallucinations or various delusions], and these may be aggravated by inadequate parenting. 

“Psychotic / psychosis” implies an inability to stay primarily in objective reality.  We might all like to call our mother-in-law or boss a “Devil”, but when we actually believe her/him to be Beelzebub, horns and tail and pit of sulphur and all, we are diagnosed as “psychotic”.  Psychosis may usually be indicated in any of three categories: 

[1] Not being orientated to Person [who I am], Place [where I am], Time [when is this] or Situation [what is happening]. 

[2] Hallucinations [seeing or hearing or smelling or tasting or feeling things that are not there as if they are, or vice versa, not experiencing them when they are present], or Illusions [experiencing distortions in sensory perceptions, such as “walls bending in on me”]. 

[3] Delusions [fixed beliefs that are not real to objective others, eg "I can fly off the roof", or "There is a snake in my belly and it's eating me up inside"].  Note that such psychotic symptoms are commonly associated with people who do not have a general psychotic illness but who are intoxicated by drugs, and they can also occur in certain cultural milieu such as “mass hysteria” and a “calling to be a spiritual healer”, without indicating a fixed psychotic disorder.

NB: Note that psychiatric disorders are diagnosed according to an Exclusion principle, i.e. first eliminate possible medical causes of symptoms, then possible substance causes, then genetic, etc…   And diagnoses are based on patterns or clusters of symptoms, not on a single symptom.  [This means, Gents, that a woman who is pregnant and has mood swings because her hormones are not balanced, may NOT primarily be diagnosed as "Borderline" because of the one symptom;  it is however possible to be both Borderline PD and pregnant.]

While people with PDs may have certain symptoms that appear delusional [such as the belief "I am the greatest person on earth and therefore deserve special treatment" in Narcissism, or "I am helpless and can't do anything for myself" in Dependent PD] or hallucinatory [such as the body dysmorphia associated with some eating disorders], the person with a PD moves generally in the world of objective reality, with short lapses into unreality [often described as micropsychotic episodes] from which s/he can usually emerge without medication or any overt intervention.

PDs are resistant to therapy:  How can one be expected easily to give up the very habit/s one unconsciously believes are the only defense that wards off one’s annihilation?  For the first part of the 20^th century Freud and his followers generally de-selected people for analysis if they suffered serious deficits such as found in the PDs.  Even in face-to-face psychoanalytic therapy it could take many years of thrice or twice a week therapy for the PD to abate sufficiently for people to live more peacefully with others and themselves.  Speedier results have been reported with modern integrated therapies that include techniques like Hypnosis or EMDR, but the danger of causing collapse if the defenses are too quickly overwhelmed, is significant, and such work should only be attempted by licensed and experienced or supervised clinical psychotherapists.

Remember that PDs are formed after repeated and continuous failures of caregivers to provide a safe, accepting, welcoming, non-intrusive yet stimulating, caring environment, with appropriate freedom and boundaries, over time.  And none of us are taught this art in schools!  We learn our parenting skills from the often inadequate role-modelling by our own parents, early teachers and other caregivers.  And if there is a severe enough failure to provide such a safe and nurturing environment by even one “big person” [such as being emotionally abused by a teacher or sexually molested by a family member], not even the best efforts of relatively good parents may be sufficient to ward off severe defensive traits or even disorders of the personality.

Half a century ago British psychoanalyst Donald W Winnicott coined the phrase “good-enough mother”, which can be extrapolated to good-enough parents, father, nanny, teacher, etc.  Different behaviours are required of good-enough parents in the child’s different developmental stages [for instance, not still breastfeeding the seventeen year old may be a good idea].  An infant psychologically needs a great deal more eye contact and physical holding than a teenager, as another instance.  Modern psychotherapists generally believe that optimal provision of a child’s emotional needs should include unconditional love / positive regard, freedom from intrusion and neglect, and appropriate boundary setting for his/her behaviour, and some add optimal frustration, which stretches his/her resourcefulness without being overwhelming.

When parents / significant others repeatedly fail in one or more of these areas, the child is likely to develop such strong defenses against unconscious fears of being hurt / annihilated / abandoned / rejected, that the formation of a PD defensive structure is likely.

So, generally “difficult” people can become “nicer” people if they get a chance to have these basic developmental needs consistently met at some stage in their life, for instance in therapy.  In interaction it nay be useful to remember that the “difficult” behaviour in any specific moment points to a fear of a perceived threat:  If Alex suddenly becomes bombastic / grandiose/ arrogant, it’s likely that someone has done something [or Alex believes in fantasy  that this has been done!] to make her/him feel small, powerless, disrespected, ignored, diminished, worthless, unheard… [for instance, in ignoring his/her contribution to a discussion].

The answer to the question of how to change his/her defensive behaviour seems obvious:  to acknowledge that s/he is worth some positive regard.  Similarly, if Ashley is acting in an over-controlling manner, it is likely that more structure or safeguards are necessary in the situation/s that evoke the behaviour.  But such “therapeutic” responses are hard to sustain in practice with a “difficult” person, who may often have the effect on others to suggest or make them feel “mad, bad, or sad”!

Some specific examples of various PD’s are discussed in the 2009 monthly Selfgrow newsletter, to which you can subscribe on this web site.  There are also various internet News groups that focus on specific Personality Disorders.

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(Note:  In fact, the name does not do justice to this technique: skin-tapping [tactile] or auditory stimulation on both sides of the body have similar results to eye movements.  Some people use the terms  “Bi-lateral” or “Bio-lateral Stimulation” instead of EMDR.)

Psychoanalyst David Grand calls this phenomenal and highly efficient new form of psychotherapy “Emotional Healing at Warp Speed“.

I was very dubious when I first heard this description but over the past four years of using EMDR an average of three to eight times a week, this flattering description appears to be quite justified!  My colleagues who also have advanced training in EMDR and who use it, frequently, agree.  In some cases, people have been in psychotherapy twice or thrice a week for many years without much alleviation of their suffering; often, after only one or two sessions of EMDR, their whole world can feel more comfortable, more friendly, more accepting, and much much safer.

From the field of Psychoanalysis concerns sometimes are expressed about psychotherapies that appear to work much faster to alleviate distress and specific symptoms: are the changes in the patient real and lasting, or do they just bring temporary relief at the superficial level, with the symptoms soon to be replaced by others?

EMDR is considered the most thoroughly researched form of psychotherapy yet.  Through such modern developments as PET scans, we can actually see how effectively this therapy helps to process traumatic experiences in the brain as the activity of the brain shifts in the course of a single set of eye movements from the right hind brain area to the left and right frontal and temporal lobe areas.  The changes in sensitivity to triggers, in conclusions about self and world and future, in the sense of security and safety of self, and in self-worth, appear to be permanent more than a decade after treatment!

 How does it work?

Traditionally, the therapist sits quite close to the patient and, after a protocol of several questions, asks the patient to open his/her eyes and follow the therapist’s hand which is waved to and fro.  The length of a set of eye movements is determined by different factors such as the patient’s level of distress, a certain length of time felt by some practitioners to be adequate, non-verbal signals from the patient suggesting a readiness for feedback, or indications of stuckness in a thinking-loop, etc.. In some situations practitioners use 24 to 50 movements to left and right each, as the basic set; sometimes the set can run for many minutes.

After each set, the patient is asked to give some feedback, which is written down by the therapist for later connections or reference. 

Certain specific interventions called “Interweaves” that have a specific therapeutic stimulus quality, are sometimes added before the next set of eye movements commences.  Very impressive results are obtained with specialised Hypnotic interweaves [see Maggie Phillips's work in this regard.]

The process continues until all aspects of the presenting problems situation are dealt with, or until a significantly lower level of distress is achieved.  If this does not occur before the end of the therapy session, the patient is helped to access a safe and peaceful, conflict-free image or situation, which helps to contain anxiety and distress until the next session.

It is remarkable that during a session, often a single set of eye movements creates sufficient processing for the patient to feel immediately calmer  in mind and in bodily symptoms of distress.

Some EMDR therapists do not use their arms to facilitate eye movements, but instead make use of machines with lights that flicker to and fro for the same effect.

For persons with lights-sensitive eyes, or blind people, one can also use auditory or tactile stimulation.

How long does it take?

The length of treatment is determined by many factors: for instance, whether the patient has had previous unresolved traumatic experiences, the age and personality of the patient, whether other persons had been hurt or killed, and especially whether there was a single-event trauma, or whether the trauma was of long and ongoing duration (such as physical, emotional, or sexual abuse over time).

Single-event traumata tend to be resolved quite effectively in 2 to 3 double sessions of EMDR, even such horrific for them to as being gang-raped, or being held hostage during a robbery with a limpid mine to one’s head, or being hijacked and shot, or having somebody throw themselves in front of your fast moving car or train…

For persons whose childhood was sufficiently traumatic for them to have developed a so-called Personality Disorder, 6 to12 months of once-a-week sessions can allow similar permanent changes to occur in the personality, as what may be found in three or more years of twice a week, or even thrice a week sessions of some of the psychoanalytically orientated psychotherapies.  It must be noted though, that for such severe problems situations, one can only engage in the acceleration forms of therapy (like EMDR or hypnosis) within a stable therapeutic alliance, and when the patient has sufficient external support for the distress that might need to be managed.  It might take several months, therefore, before one actually introduces the patient to EMDR, and there may be breaks of a week or more between consecutive sessions of EMDR, to facilitate processing and/or stabilisation of the patient.

What does it cost?

For adults it is often necessary to commence with one or two longer sessions of about 100 minutes each.  Medical aids now allow for a double session per day.  Even if the therapist gives a considerable discount for the double session, you may have to pay some extra money out of your own pocket for one or two sessions.  Thereafter, it is sometimes safe to continue with normal 50 minutes or 60 minutes sessions.

 Some therapists are prepared to work at medical aid rates but many psychologist specialists in EMDR are also prepared to offer substantial discounts, e.g. for cash payments.  You may inquire about cost when you make initial telephonic contact.

What are the side effects?

Usually, for about one day after the first session you may find an increase in symptoms (for instance a patient who requires therapy for binge eating, may have the desire to binge even more than usual for a day or so after the first session, before the symptoms tend to be alleviated significantly).  Many people also feel quite tired and drained, or may have a headache after the first session, mainly because they access strong emotions and may even cry quite a lot doing the session.  A restful evening and perhaps some over-the-counter medication for headache tend to alleviate these side effects effectively.

I always advise my patients about what they can expect so that we can choose a time for the first session — and sometimes for subsequent sessions, when their lifestyle can allow them the necessary periods of recovery.

As with any psychotherapy, people might also feel strong emotions like anger towards persons who have injured them — which may be a problem if you are living in the same house, or working in the same office, as these persons.  The therapist can help the patient to be alert for such reactions and to find ways of managing the situation until the emotions are processed.  Fortunately, in EMDR and hypnosis, such processing can occur much faster than in some other psychotherapies.  Irrationally strong emotions tend to abate very quickly during a few sets of eye movements. 

Which problems can be helped with EMDR?

People who have had the opportunity to use the power of EMDR either as patient or as therapist, are in agreement that this is the most powerful form of psychotherapy for disorders like PTSD (Post-Traumatic Stress Disorder), every kind of phobia, loss and grief due to death or illness and even decision-making in the present.  The healing that occurs both at symptom and deeper personality layers seems to be permanent.  Using EMDR even after single-event traumata does more than just restore the patient to previous levels of functioning;  the conclusions about self and world that change during EMDR, tend to generate to many other levels of conscious and unconscious experience, as evidenced by anecdotal report from patients, as well as by observations by clinicians, and friends and family of the patient.

Using EMDR in conjunction with other psychotherapies, such as Psychoanalytic Self Psychology, Client-Centred therapy, Schemata therapy, other forms of cognitive and/or behavioral therapies including group therapy such as Psychodrama, various forms of Hypnosis, body-orientated therapies such as Thought Field Therapy (TFT) and Emotional Freedom Technique [EFT], appears to speed up the process of healing dramatically and facilitate lasting strengthening and cohesion of the self.

I have found EMDR to be a powerful tool in just about every form of distress that clients have brought to my consulting rooms:  anxiety and panic attacks, distress about arguments in the home, depression and mood swings, postnatal depression, decisions about things like changes in careers, whether to stay with or separate from a partner, physical illness of all kinds, recovery after surgery, preparation before surgery or other medical treatment, and all kinds of compulsive disorders including substance abuse, eating disorders and even Trichotillomania (hair-pulling).  I must point out that there is not much literature on the successful use of EMDR in compulsive disorders, and for such disorders I always use it as part of an integrative psychotherapy approach for the specific problem and the specific patient. 

Also note that EMDR is not a magic potion: it is not comfortable to work through and process the problems that have shaped us to the personality, with its specific defensive structures, that presents for treatment.  EMDR sessions are anything but peaceful and calm; the work is painful and tiring for the patient.  But the surgery we sometimes have to undergo for physical healing is also not fun: it can require the anaesthetic to make the pain manageable, as well as considerable recovery time.  Compared to that, EMDR can be defined in terms of “a lot of healing in the long-term is worth a little bit of pain in the short term”.

You can find out more about EMDR in books by, for instance, Dr David Grand or by the originator of this remarkable psychotherapy, Francine Shapiro, or on the website for the EMDR International Association (www.emdria.org).

Clients in the Western Cape who wish to find an advanced practitioner of EMDR close to their home or work, can phone Reinette Steyn at her Milnerton practice
(Tel +27  021  555-4248  Office hrs;  GMT +2)