Vocational Implications of Psychiatric Disabilities: Introduction to Personality Disorders

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Vocational Implications of Psychiatric
DisabilitiesIntroduction to Personality
Disorders

• David R. Strauser, Ph.D., CRC
• University of Illinoisstrauser_at_uiuc.edu

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Work Foundations

• Changing nature of work
• Macro level factors
• How work is performed
• Increased cognitive and interpersonal factors
• Impact on individuals with psychiatric
  disabilities
• Hard to meet the changing demands of work

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Problems with work behavior

• Conflicts with authority
• Problems with co-workers
• Poor work quality
• Inability to modify behavior to meet standards
  and increase productivity
• Inability to create effective boundaries between
  work and non-work issues

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Conceptualizing Problems at Work

• Occupational Adjustments
• Performance Adjustments
• Personal and Social Adjustments
• Work Adjustment

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Occupational Adjustments

• Following work rules
• Relating with co-workers
• Dealing with public
• Using Judgment

• Interacting with Supervisor
• Dealing with work stress
• Functioning independently
• Maintaining attention and concentration

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Performance Adjustments

• Complex Job Instructions
• Detailed Job Instructions
• Simple Job Instructions

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Personal and Social Adjustments

• Maintaining Personal Appearance
• Emotional Stability
• Predictable in Social Situations.
• Demonstrate reliability

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Work Adjustment

• Work 8 hours per day
• Work 5 days per week
• Work without excessive breaks
• Maintain regular attendance

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Personality Disorders

• Definition- an enduring pattern of inner
  experience and behavior that deviates markedly
  from the expectations of an individuals culture,
  (that) is pervasive and inflexible, has an onset
  in adolescence or early childhood, and is stable
  over time, and leads to distress or impairment.

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Four areas of problematic functioning
(Personality Disorders)

• Typically, individuals with personality disorders
  have problems in the following areas
• Expressive acts
• Interpersonal conduct
• Cognitive style
• Regulatory mechanisms

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Cluster A- The Odd Cluster

• Paranoid
• Schizoid
• Schizotypal

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Paranoid Personality Disorder

• What is like-
• Misinterpretation of interpersonal situations
• Hostile and aloof
• Blaming and vindictive
• Overtly rationale
• Litigious

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Paranoid Personality Disorder

• Effect on Work
• Profound interpersonal tensions
• Difficult to supervise
• Difficult to work with
• Workplace danger

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Vocational Strategies

• To optimize success
• Work alone
• Interactions conducted in a direct,
  straightforward manner
• Include in decisions that impact them directly
• To have an emphasis placed on specific tasks
• Emphasis on strengths, abilities, and work well
  done
• Good relationship with the supervisor from the
  rehabilitation professional

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Cluster B-The Dramatic Cluster

• Anti-Social
• Borderline
• Histrionic
• Narcissistic

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Borderline Personality

• What is it like-
• Instability in relationships, sense of self-and
  mood
• Lack of empathy and remorse
• Impulsivity, irresponsibility, unreliability
• Inappropriate expression of anger
• Self-Destructive
• Fear of abandonment, hypersensitivity to rejection

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Borderline Personality

• Effect on Work
• Tense, unstable relationships
• Frequent changes in career and training plans
• Poor stress tolerance
• Workplace danger

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Borderline Personality

• Workplace strategies
• Strong support for vocational strengths
• Flexible scheduling
• Clearly spelled out behavioral expectations
• Firm supervision
• Direct and straightforward approach
• Social support within and outside
• Good communication from provider

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Anti-Social Personality

• What is it like?
• Disregard for rules, norms and laws
• Frequent alcohol and drug use
• Lack of empathy and remorse
• Impulsivity, irresponsibility, and unreliability
• Physical and verbal aggression
• Poor relationships with authority figures

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Antisocial Personality Disorder

• Effect on Work
• Superficial, troubled relationships with
  supervisors and co-workers
• Easily bored, poor judgment
• Danger in the workplace
• Can be charming and persuasive

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Antisocial Personality Disorder

• Vocational Strategies
• Close supervision
• Frequent reminders about limits
• Very little flexibility
• Extended periods of monitoring
• Monitor drug and alcohol use
• Outdoor and fast paced work

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Cluster C- The Anxious Cluster

• Avoidant
• Dependent
• Obsessive-Compulsive

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Passive Aggressive Personality

• What is it like?
• Negative attitudes
• Passive resistance to reasonable demands by
  others
• Excessive complaining about and criticism of
  authority figures

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Passive-Aggressive Personality Disorder

• What is it like at work
• Obstructs efforts of others
• Impedes work completion
• Argumentative with supervisors
• Chronic Complaining

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Passive-Aggressive Personality Disorder

• Vocational Strategies
• Flexible scheduling
• Opportunity to work mostly alone
• If possible, tie compensation to work performance
• Close supervision
• Clear work objectives
• Immediate and consistent consequences

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Intervention Approach

• Working Alliance
• Goals
• Bonds
• Tasks

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Bonds

• 1st step- develop a good structured relationship
  with the consumer
• Value
• Listen
• Respect
• Expectations

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Goals

• Three level of goals
• Immediate
• Short-term
• Long-term
• Must have all three
• Clear to both parties
• Easily measurable
• Easy to understand

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Tasks

• Action steps-brings goals to life
• What is going to be done
• Who is going to do what
• Clear expectations of consumer
• Clear expectations of counselor
• Constant evaluation
• Expect results

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Conclusions

• Summary
• Questions