Treating Personality in Routine Clinical Practice: Notes on Destigmatization and The Changeability of Personality

Written by: Katherine "Kayce" Hyde Brott, PhD

The accompanying handout for this article can be found here.

It is well documented that personality disorders are among the most highly stigmatized mental health disorders even among mental health professionals (Commons-Treloar, 2009; Masland et al., 2022; Ociskova et al., 2017). Evidence suggests that this is perpetuated by poor mental health literacy surrounding personality disorders, which thwarts and inhibits effective treatment and engagement. For example, holding the belief that personality is unchangeable or untreatable may deter mental health professionals from providing services or seeking out additional training and make them more likely to see treating personality disorders as part of specialty care and referring out instead of making these services part of their routine practice (Ring & Lawn, 2019). However, personality disorders are relatively common in clinical practice, as about 7% of people globally will meet criteria for a personality disorder in their lifetime (Winsper et al., 2020). Additionally, research suggests that personality is changeable (Hudson & Fraley, 2015; Roberts et al., 2006; Roberts et al., 2017), and people overwhelmingly want to change (Hudson & Roberts; 2014; Robinson et al., 2015). Therefore, needed are improved mental health literacy around personality disorders and interventions for personality disorders that are accessible and easily to learn and implement in routine clinical practice. Below, I will also provide a brief overview of COMPASS, a novel, short-term treatment for targeting personality traits underlying borderline personality disorder.

COMPASS is a modular, personality-based treatment targeting neuroticism, antagonism, and inhibition, which are thought to underlie borderline personality disorder (Sauer-Zavala et al., 2023). This treatment focuses on addressing these traits by emphasizing psychological flexibility and values-centric living as well as teaching clients skills for thinking, being, and doing in managing emotions, relationships, and impulses. COMPASS is particularly innovative in its modular, customizable framework that allows the practitioner to select modules as applicable to the client’s particular personality profile, particularly as borderline personality disorder is highly heterogeneous and individuals with this disorder may not show dysfunction across these three personality domains (Sauer-Zavala et al., 2023; 2024). Additionally, COMPASS is short-term, and research supports its efficacy in 18 weekly, hour-long sessions, which fills a unique need, as other empirically supported treatment for borderline personality disorders require substantial time commitment, sometimes over 30 weeks or more and at times meeting for up to three hours a week for treatment. COMPASS is also steeped in the cognitive-behavioral tradition, which many practitioners are already familiarized as trained in as this is the predominant therapeutic orientation in the mental health field today, making this treatment easy to learn and implement into a busy routine clinical practice. In closing, it is part of a well-rounded practice to be able to address and treat personality factors in psychotherapy, these are factors are in fact changeable, and people want to change, and there exists promising, short-term interventions that are feasible to implement in routine clinical practice.