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Struggling with the Same old Patterns? Change is possible.

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Personality disorders often show up in someone’s life not as sudden problems, but as patterns they’ve carried for as long as they can remember, in terms of the ways they feel, react, or relate that feel almost built-in. Some individuals move through the world with a sense of distance or mistrust (Cluster A), others with emotions that rise quickly and intensely (Cluster B), and some with a constant pull toward worry or self-doubt (Cluster C). But whichever cluster a person fits into, they or the people around them might feel something isn’t quite right. They might notice moments at work where they freeze, shut down, or react more strongly than they intended. They might find themselves in relationships that become confusing or overwhelming, or they may look in the mirror and feel that their relationship with themself is the hardest one to manage. Of course, none of these means personality disorder directly. Many people go through periods of feeling stuck, confused, or patterned in their reactions. However, if you’ve noticed strict, long-standing patterns that continue to shape how you think, feel, and relate, and if these patterns seem nonfunctional, you might be looking for options to escape from this loop. Maybe you tried to read self-help books, or had long conversations with friends or family, sought guidance from someone older and wiser, or turned to yoga and meditation when everything feels anxiety-driven. And if you’ve tried all of this, you still feel like you will keep these patterns forever, or even if you haven’t tried anything yet, but started searching for what to do next, one of the first options you’ll come across is therapy. And that brings us here. Starting therapy, and perhaps even moving forward with a “personality disorder” frame in mind, can feel like stepping into unfamiliar territory. In this therapy sketch, we’ll explore what that process actually looks like, what it means to begin, how therapy unfolds over time, and how change becomes possible. 

What Are Personality Disorders?

Personality disorders are long-lasting patterns of thoughts, emotions, and behaviors that usually begin in the teenage years or early adulthood. These patterns often continue for years and can influence many areas of life because they affect the way a person thinks, feels, and relates to others. These areas might include relationships, work, family interactions, and the person’s relationship with oneself. Personality disorders sometimes make it more complicated for individuals to feel understood or to understand others. They might not know why they are feeling the way they think or behaving the way they do. Explaining what they’re experiencing to others might feel impossible, as others might see it as their norm. However, when they are repeating the same strict pattern all the time and experience frustrations frequently in multiple domains of their life, it is possible to experience overlapping symptoms of depression, anxiety, and different kinds of mood disorders over time. And that might lead individuals to seek help in the first place. 

How are Personality Disorders Treated?

And this is where treatment comes into play. It is common for individuals to seek therapy for any other problem they are experiencing. That might be related to problems in romantic relationships or relationships overall; they might feel depressed or feel anxious all the time. The strict patterns unfold after an assessment process.  Overall, the therapy process focuses on understanding what they are experiencing and shows them different ways to cope. There are many therapy modalities specifically used for managing personality disorders. But the important thing is that it brings together different approaches to help people understand themselves, manage difficult emotions, and build healthier relationships.

Therapy Modalities:

Overall, therapy focuses on helping individuals understand what they are experiencing and offering different ways to cope with emotions, behaviors, and relational dynamics that feel keep repeating or are too frustrating. Through therapy, people learn to notice their emotional patterns, make new choices, and develop healthier ways of communicating. There are several therapeutic modalities specifically designed to support people who struggle with long-standing personality patterns. This may take place in individual sessions, group therapy, or sometimes family sessions.

  • Cognitive-Behavioral Therapy (CBT): CBT helps individuals notice the automatic thoughts and patterns that have shaped their lives for years. Someone may realize they constantly expect rejection or assume others are unsafe, without fully knowing where these beliefs came from. Normally, CBT was developed for depression originally. But mental health professionals realized that the usual short-term CBT specifically developed for depression wasn’t enough when someone had patterns that had been with them for years, maybe even since childhood. CBT has been adapted over time and transformed into something that focuses especially on these patterns and core beliefs shaped by early experiences, and the ways these patterns show up in relationships. This relationship includes the one with the therapist. Because these beliefs are more rigid, the therapy moves more slowly and focuses on real-time relational moments with the therapist to help individuals build new emotional and behavioral responses (Beck et al., 2015).
  • Dialectical Behavioral Therapy (DBT): DBT was developed by Marsha Linehan, and it was designed specifically for individuals struggling with borderline personality disorder. One of the core ideas behind DBT is that you can accept yourself as you are and still work toward change. To do that, DBT developed skill-building tools such as mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. These skills help individuals slow down emotional reactions, manage crises without harming themselves, and build more stable relationships (Linehan, 1993).
  • Psychodynamic Therapy: Psychodynamic therapy is one of the oldest therapy approaches, and it works a bit like slowly uncovering the story behind your patterns. The idea is that early relationships and unspoken feelings still shape how you react today, even if you’re not fully aware of it. In sessions, these old patterns often show up in the way you relate to the therapist. This is called transference, and it gives both of you a chance to understand what’s happening beneath the surface. As you explore these moments together, you begin to see why certain emotions feel so strong or why the same relationship struggles repeat. Over time, this understanding creates space for new ways of responding, helping you build relationships that feel safer, clearer, and more stable (Kernberg, 1984).

The Therapist Role

A therapist is one of the most essential parts of the healing process when working with repetitive, standing patterns. They support the person emotionally, help them make sense of their symptoms, and create a treatment plan that fits their life. The progress of therapy and the way it depends greatly on how well the specialist understands the person and how strong their working relationship becomes.

Yes, techniques and modalities and the way therapists use them are really important; however,  the connection between the therapist and person is super important when working with these patterns. Because the relationships and real-time interactions inside the therapy room act almost like a living example of the person’s old patterns, someone who expects rejection might pull away, someone who fears being misunderstood might over-explain, and someone who craves closeness might become overly attached. These moments show up naturally in the therapy relationship, and instead of repeating the old cycle, the therapist helps the person understand what’s happening right there, in the moment. So this real-time experience in therapy becomes a kind of “practice space”. In this space, the person can try new ways to feel safe, express needs, set boundaries, or stay present. In addition to that, a supportive, understanding relationship encourages the client to keep engaged, talk openly, and feel safe while exploring difficult emotions (Kernberg, 1984; Bateman & Fonagy, 2016). 

Challenges During Therapy

Research shows that staying consistent in therapy can be challenging, and dropout is relatively common (De Salve et al., 2025). The challenges are as follows:

  • Working for change for a long time and staying committed to therapy: For example, a person may feel motivated at the beginning, but after several months, they might start thinking “Nothing is changing fast enough” and consider skipping sessions, even though slow, steady work is exactly what long-standing patterns require.
  • Overlapping symptoms: Someone may come to therapy for anxiety, but soon notice that they also feel depressed, struggle in relationships, and have difficulty regulating emotions. These overlapping symptoms can make it hard to understand where to begin or what the “main” problem is for both the person themselves and the therapist.
  • Resistance to change old patterns: A person may intellectually understand a new skill or thought pattern, but still react in the old familiar way simply because the old behavior feels safer, even if it no longer works.
  • Drawbacks: While therapy for personality-related patterns can be beneficial, it also has limitations. Progress is often gradual, emotional discomfort may rise before things improve, and individuals may experience moments of frustration or doubt. Therapy requires time, patience, and a willingness to explore difficult emotions, and not every strategy will work the same for every person.

But that does not mean it is impossible to change old repetitive personality patterns. The keys are:

  • Staying Consistent With Treatment: Showing up regularly to therapy and following recommendations. These challenges are normal but can affect how smoothly the treatment progresses.
  • The Role of Family and Social Support: Family and close friends can make a big difference. When they understand the person’s struggles, they can offer support, patience, and encouragement. Helping loved ones learn about personality disorders often strengthens the whole treatment journey (Livesley, 2003).
  • Long-Term Support and Planning: Long-term treatment focuses on helping the person build habits and skills that support more functional patterns. This includes learning how to notice early signs of emotional difficulty, developing healthier ways of coping, and receiving ongoing support (Livesley, 2003).

Takeaways

  • The therapy for personality disorders aims to improve quality of life, strengthen relationships, and help individuals understand themselves more fully. 
  • The modalities used for repetitive long-standing personality patterns include CBT, DBT, and Psychodynamic therapy. 
  • The therapist’s guidance and the support of loved ones play a significant role in this process.

References:

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  • Beck, A. T., Freeman, A., Davis, D. D., & Associates. (2015). Cognitive therapy of personality disorders (3rd ed.). Guilford Press.
  • De Salve, F., Rossi, C., Gioacchini, E., Messina, I., & Oasi, O. (2025). Dropout in psychotherapy for personality disorders: A systematic review of predictors. Clinical Psychology & Psychotherapy, 32(3), e70080. https://doi.org/10.1002/cpp.70080
  • Gunderson, J. G., & Links, P. S. (2014). Borderline personality disorder: A clinical guide (3rd ed.). American Psychiatric Publishing.
  • Kernberg, O. F. (1984). Severe personality disorders: Psychotherapeutic strategies. Yale University Press.
  • Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
  • Livesley, W. J. (2003). Practical management of personality disorder. Guilford Press.
  • Town, J. M., Abbass, A., Stride, C., & Bernier, D. (2017). Short-term psychodynamic psychotherapy for personality disorders: A meta-analysis. Psychiatry Research, 256, 266–278.