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.