Working with The Brilliant Skeptic or Paranoid Adaptation

A while ago I was thinking about specific challenges that can come up in our work with couples – ones that may require us to go “off script” and take a more nuanced approach to therapy. In particular, I’ve been thinking about cases where at least one partner is entrenched in one personality adaptation. So I wrote a blog post about the work of Paul Ware, MD, and Vann Joines, PhD, in defining six specific personality adaptations and the 3-door model that allows us to connect with clients according to their personality adaptation type. With this awareness we want to start connecting with clients through their open door. Here’s a review of the three doors:
  1. The open door is the place where a client feels strong and ready to meet us right now.
  2. The target door is where substantial change comes from and where the client will benefit most from changing after we’ve gained their trust.
  3. The trap door is the repetitive go nowhere path. This is comfortable for the client but inhibits substantial progress.
For a more detailed explanation of the personality adaptation types and doors read the original blog post. Using the 3-door Model with a Paranoid Adaptation, the “Brilliant Skeptic” Let’s consider how this framework can be useful with a particular couple – one in which a partner exhibits a paranoid personality. This client will present as highly reactive and prickly. These clients have high levels of mistrust and will frequently bring up breaches of trust, either real or imagined. Old injuries are rarely resolved. And this client may have a significant history of trauma. When working with a client who exhibits paranoid features, it can be extremely challenging to establish a good, solid alliance. Making contact isn’t easy and it can be hard to sustain. With this personality adaptation, the place where connection needs to happen is throughthinking. The client fears trusting you. They want to know that your thinking is strong – as good as, or better than theirs. It is easy to get trapped in trying to change the client’s behavior – behavior that seems so outrageous you may be tempted to focus on it first. This is the trap door. These clients don’t give up their protective defenses easily and especially won’t peek out if they are unsure of your strong, careful leadership. The target door for substantial change is in the realm of feeling and emotion. It’s going to come when your client experiences a change in their feeling that the world is out to get them, that their partner is sneaky with them – or that you are out to blame them. The best chance I have found for making an initial connection with this type of client is going slowly in requesting change from them. Defining what is wrong clearly and educating them about the developmental stages can be reassuring. Next I find it helps when they see you challenge their partner first. Asking the other to change first helps relax a partner with a paranoid adaptation. This means you shift the focus away from the sense that he or she is going to be identified as the problem patient, or the one to blame. When your client sees you take seriously the contribution of the other by challenging their partner in a good way, you create a tiny crack where they may begin to trust that they’ll be okay working with you. Now I’d like to hear from you. Have you fallen through trap doors of your own? Please share your thoughts and experiences in the comments section. We have a resource that’s especially helpful with one other type of personality adaptation type. ClickBreakthroughs with the Passive Aggressive Spouse for more information or to order this 90-minute audio and transcript of the audio to study and review, plus links to two additional valuable resources.

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Nic Beets
Nic Beets

Really fits for me, Ellyn. It can be really hard to not push for behaviour change when the behaviour is outrageous – so reassuring to know that it’s not “colluding” but just being tactical


Hi Ellyn,
Thanks for this timely content. Do you have any ideas for how to navigate a paranoid personality, exactly as you mention above, but in a family business situation, where the paranoid person refuses to seek counselling? The crack in the door in that case is not accessible. I would truly value any advise you can offer. Thank you,

Marine Green
Marine Green

Hi Ellyn,
I have a couple like this. Wife struggles greatly with obsessive paranoid thoughts about husband. Your discussed approach was spot on. She built trust with me very slowly by focusing initially more on her husband’s contribution. Now we’re able to name the obsessive thinking and tame it with mindfulness and self compassion until she is ready for trauma work. Thanks again.

Karen Saeger
Karen Saeger

The frightening moment for me with such a couple, both foreign nationals living in the US, was many years ago. I had decided to build that trust by meeting with each individually. The husband, a huge intimidating man, brilliant in his field, responded to my question, “ Is there anything you would like to discuss in our conversation today that has been on your mind?”

He looked at me with those cold blue eyes, silently stood up, walked over to my window, then leaned out, looking slowly up and down the driveway outside my ground floor office. I can see him now – as if in slow motion – as closed the and locked the window. He seemed to be looking for someone eavesdropping. Or making sure no one could hear me call for help? Now Was i Should I tell him I felt vulnerable, trapped? Head for the door? He averted his eyes as he turned back . I had my answer.

He sat down and said, “ I have reasons to believe my wife stopped loving me long ago.” I had earned his trust. Then I had to find a path forward. His warm appealing wife had told me in her own session that she was deep into an affair since moving to Berkeley. I held two secrets. His paranoia was, at least in part, systemic.

Lori Zornado
Lori Zornado

Hello Ellyn, can you say more about how to prepare the spouse in the couple with a more paranoid skeptic type to be “going first” or for what might feel to them to be the same kind of pressure they get from their spouse? They are usually the ones coming in exhausted and beaten down from discouraging interactions and are desperate for change with their partner. Is that something I prepare them for? Or is it best just to go with interventions starting with the less paranoid spouse? Thank you.

Dr. Ellyn Bader

Dr. Ellyn Bader is Co-Founder & Director of The Couples Institute and creator of The Developmental Model of Couples Therapy. Ellyn is widely recognized as an expert in couples therapy, and since 2006 she has led innovative online training programs for therapists. Professionals from around the world connect with her through internet, conference calls and blog discussions to study couples therapy. Ellyn’s first book, "In Quest of the Mythical Mate," won the Clark Vincent Award by the California Association of Marriage & Family Therapists for its outstanding contribution to the field of marital therapy and is now in its 18th printing. She has been featured on over 50 radio and television programs including "The Today Show" and "CBS Early Morning News," and she has been quoted in many publications including "The New York Times," "The Oprah Magazine" and "Cosmopolitan."

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