Not too long ago I got a text from a client I’ll call Dave that stopped me in my tracks: “Fuck you, Dr. Lars, you are a complete shit.” But 20 minutes later, another text: “Hey, can we move my appointment? Got a clash.” That push-pull, that blend of rage and reliance, is the essence of working with clients who have personality disorders like Borderline Personality Disorder (BPD), Antisocial Personality Disorder (ASPD), and Psychopathy in the justice system. What I’ve learned is to look beyond the chaos to the person underneath. For therapists, these are familiar battles. For laypeople, it’s a window into a world of raw human struggle. Today, I’m sharing key lessons, infused with schema therapy insights, to help you understand and connect with these clients compassionately yet pragmatically, even when they test your limits.
The Landscape: Personality Disorders in Forensic Contexts
Personality disorders are enduring patterns of thinking, feeling, and behaving that clash with societal norms, causing distress or disruption. They’re like a smartphone with glitchy software—functional but prone to crashes. In the general population, they’re uncommon: BPD affects 1–2%, ASPD 1–4%, and Psychopathy around 1%. In prisons, they’re the norm: BPD hits 20–30%, ASPD 50–70% for men (20–30% for women), and Psychopathy 15–25% (Lowenstein et al., 2016; Hare, 2003). These clients bring emotional storms, manipulative tactics, or chilling detachment to every session, with high stakes—ASPD clients are 7.6 times more likely to be violent, BPD clients 2.6 times (Fazel et al., 2024).
The term “personality disorder” is controversial. Critics argue it stigmatizes, labeling people as “broken” or untreatable. Others debate its validity—ASPD and Psychopathy overlap, and BPD’s symptoms can mirror trauma. Some see PDs as a way to pathologize behavior society dislikes. But here’s the pragmatism: in forensic settings, these frameworks help us predict and manage behaviors that can spiral into harm or disconnection. Dave’s texts weren’t random—they were a window into his pain. Schema therapy offers a compassionate lens to understand why these patterns form, guiding us toward meaningful engagement.
Key Learnings: Understanding and Engaging with Schema Therapy
Schema therapy views PDs as rooted in early maladaptive schemas—deep beliefs formed in childhood—and schema modes, maladaptive coping modes / emotional states that drive behaviour. These concepts reveal why clients act out and how we can respond. Here are three lessons I’ve learned, blending compassion with practical tools for therapists and anyone navigating tough relationships.
Lesson 1: Decode Their Inner World with Schema Therapy
Schema therapy shows how clients’ schemas and modes shape their actions and offending, offering a roadmap for therapy challenges.
BPD: The Emotional Rollercoaster
Schemas: BPD clients often carry Abandonment (“Everyone will leave me”) and Defectiveness (“I’m unlovable”), seeing themselves as bad or vulnerable and others as saviours or threats.
Modes: They switch between Vulnerable Child (needy, scared), Angry Child (lashing out), or Punitive Parent (self-harming).
Link to Offending: Impulsive acts like domestic violence stem from abandonment fears; expressive rule-breaking (e.g., self-harm) signals distress (Working with Offenders with Personality Disorder, n.d.).
Therapy Example: A client arrives beaming: “You’re the best therapist!” But when you set a boundary (e.g., ending a session on time), they erupt: “You don’t care about me!” Later, they call in tears, apologizing and begging not to be “dropped.” This is BPD’s Abandonment schema in action, with the Vulnerable and Angry Child modes clashing.Compassionate
Insight: Their outbursts aren’t personal—they’re rooted in early rejection or trauma, fueling a desperate need for connection.Pragmatic Strategy: Spot cues like clinginess (Vulnerable Child) or rage (Angry Child). Validate their pain—“I hear how hard this feels”—and reinforce boundaries to avoid reinforcing schemas.
ASPD: The Boundary-Tester’s Game
Schemas: ASPD clients often hold Mistrust/Abuse (“Others will hurt me”) and Entitlement (“I deserve what I want”), viewing themselves as strong loners and others as weak or exploitable.
Modes: Detached Protector (avoiding vulnerability) or Bully and Attack (dominating) modes can dominate.
Link to Offending:Broad offending—violence, fraud, some sexual crimes—is driven by impulsivity and substance misuse, amplifying violence risk.
Therapy Example: A client charms you: “You’re sharper than my last therapist.” They dodge questions about their past, saying, “It’s not a big deal.” Mid-session, they test boundaries: “Can you write a report saying I’m fine? It’ll help my case.” Compassionate Insight: Their manipulation isn’t always malicious—it’s a survival tactic in a world they see as hostile, shaped by Mistrust schemas.
Pragmatic Strategy: Watch for charm or evasiveness (Detached Protector). Redirect firmly—“We need to explore the truth to make progress”—and use external structures (e.g., session rules) rather than empathy, which schemas may block.
Psychopathy: The Detached Strategist
Schemas: Psychopathic clients hold Superiority (“I’m better than others”) and Emotional Deprivation (no need for connection), seeing themselves as above rules and others as inferior pawns.
Modes: Predatory Mode (destroying others metaphorically or actually) or Conning Mode (charming for gain) prevails.
Link to Offending: Calculated violence or recidivism, with institutional misbehavior, reflects remorseless goal-pursuit.
Therapy Example: A client is polished: “I’m here because I have to be.” They share a rehearsed story about their offense but show no emotion. When you probe deeper, they deflect with flattery: “You’re good at this—let’s keep it light.” They resist exploring feelings, saying, “That’s pointless.” This is the Conning Mode, driven by Superiority schemas.
Compassionate Insight: Their detachment isn’t cruelty—it’s a schema-driven disconnect from emotions, often from early neglect.
Pragmatic Strategy:Spot superficial charm or flat affect (Conning Mode). Use a businesslike approach—“Let’s focus on your goals for therapy”—and co-work with colleagues to avoid manipulation, as modes resist emotional work.
The controversy? PD labels can feel reductive or stigmatizing, and schemas vary across individuals. Critics argue they pathologize survival strategies or overlap with trauma. But pragmatically, they help us understand why clients like Dave rage or withdraw, guiding us to respond effectively. Schema therapy adds depth, showing how early wounds shape forensic behaviors.
Lesson 2: Build Bridges with Strategic Compassion
Engaging these clients means meeting their modes with tailored responses, fostering trust without being overwhelmed. Schema therapy helps us address the underlying schemas, not just surface behaviors.
For BPD: Validate the Vulnerable Child mode while steeping limits on the Angry Child. A client upset about a session boundary might hear: “I hear how tough this feels—but I am here for you so let’s plan our next session.” This soothes Abandonment schemas while maintaining structure.
For ASPD: Counter the Bully and Attack mode with firmness. A client testing boundaries gets: “I’m here to help, but we follow the session rules.” This respects Mistrust schemas while setting limits.
For Psychopathy: Address the Conning Mode with professionalism. A client dodging emotional work hears: “Let’s focus on what you want from therapy.” Transparency sidesteps Superiority schema games.
These bridges aren’t about fixing clients—they’re about creating space for progress. Therapists, you use similar tactics in schema-focused sessions. Laypeople, think of it as handling someone who flips from warm to hostile—validate, then redirect.
Lesson 3: Protect Your Own Compass
High-risk clients can drain you—BPD’s intensity, ASPD’s manipulation, Psychopathy’s chill. Schema therapy reminds us: their modes can trigger our own schemas, like Subjugation (“I must please them”) or Defectiveness (“I’m failing”). My biggest lesson? Protect your emotional health. Debrief with colleagues, lean on supervision, and remember: you’re not here to save clients, only to show up with clarity and compassion.
For therapists, this means processing countertransference—BPD’s neediness might hit your Subjugation schema. In forensic settings, where clients face incarceration and stigma, your steady presence is enough, even if change is slow.
The Bigger Picture: Compassion Meets Pragmatism
The debate over PDs—stigmatising? reductive?—is real. But in practice, PD frameworks and schema therapy offer a lifeline. Dave’s texts weren’t just chaos—they were his Angry Child mode, rooted in Abandonment. BPD clients aren’t “dramatic”; they’re battling Defectiveness. ASPD clients aren’t “sociopaths”; they’re shielding against Mistrust. Psychopathic clients aren’t “evil”; their Entitlement schema blocks connection. Compassion sees their pain; pragmatism equips us to respond without being swept away.
For therapists, these lessons enhance forensic work—validate BPD’s pain, set ASPD’s limits, navigate Psychopathy’s detachment. In the justice system, where trust is scarce and stakes are high, these strategies uphold dignity while keeping you grounded.
References:
Fazel, S., et al. (2024). Personality disorders, violence, and antisocial behaviour: Updated systematic review and meta-regression analysis. British Journal of Psychiatry.
Lowenstein, J., et al. (2016). A systematic review on the relationship between antisocial, borderline and narcissistic personality disorder diagnostic traits and risk of violence to others. Borderline Personality Disorder and Emotion Dysregulation, 3, 14.
Hare, R. D. (2003). The Hare Psychopathy Checklist-Revised (2nd ed.). Multi-Health Systems.
Young, J. E., et al. (2003). Schema Therapy: A Practitioner’s Guide. Guilford Press.
Working with Offenders with Personality Disorder – A Practitioner’s Guide (n.d.).
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