Mayhew-Hite Report        Working with People Who Have Personality Disorders in Mediation

Disclaimer: The following article has been reviewed by the Mayhew-Hite Editor. Articles published in the Mayhew-Hite Report do not undergo the same rigorous accuracy check or editing process as articles published in the print edition of the Ohio State Journal on Dispute Resolution. 

Elizabeth Erin Oehler

I. Introduction

It is essential that mediators expand their knowledge and skillset in order to work productively with a wide range of diverse individuals. Currently, there exists very limited literature and guidance for mediators on how to best interact with people who have personality disorders. The Mayo Clinic defines a personality disorder as “a type of mental disorder in which [someone has] a rigid and unhealthy pattern of thinking, functioning and behaving.”[1] Around 9% of adults, about 22 million people[2], in the United States live with a personality disorder.[3] Of the people living with a personality disorder, many of them do not seek treatment because they are unaware of the presence of their disorder.[4] In fact, a study conducted by the National Institute on Mental Health found that only 39% of those with a personality disorder received treatment for mental health issues or substance abuse within a year’s time of responding to the survey.[5]

Due to the prevalence of personality disorders, most mediators, if they have not already, will find themselves working with someone who has a personality disorder. And, from time to time, every person exhibits “some elements of these character types, particularly when under stress.”[6] This note provides a basic overview of the different groups, or “clusters”, of personality disorders and suggests how a mediator can adjust a mediation session to assist in issues that may arise. Although not fully comprehensive, this note gives a starting point for those mediators who wish to gain knowledge in this area. The bulk of the note is divided into two parts: Part II and Part III. Part II introduces the different clusters of personality disorders and describes, in more detail, a few specific personality disorders. Part III argues that the techniques and methods used in psychotherapy should be applied during mediation sessions and provides several practical ways the mediator can use these methods to enhance the mediation session.

II. Telling a Lot from a Little: Overview of the Signs and Symptoms of the Different Personality Disorder Clusters

“[P]ersonality disorders are characterized by longstanding, inflexible patterns of thinking, feeling and interpersonal relating . . . .”[7] During a session, a mediator may be compelled to play a more specific, implicitly assigned role.[8] The DSM-V classifies personality disorders into three groups or “clusters”: Cluster A, Cluster B, and Cluster C.[9] It is important to remember that there are no clear lines between the varying personality disorders or even between healthy and disordered thinking.[10] While the following information will give a glimpse on how to identify a personality disorder, a true diagnosis should be left to the discretion of a mental health professional.

A. Cluster A Personality Disorders

Cluster A personality disorders are “characterized by odd, eccentric thinking or behavior.”[11] These disorders include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder.[12] For those who suffer from paranoia, they are always skeptical of others and can often become irritable and/or hostile.[13]  Yet, the dominant trait in this cluster of personality disorders is distorted thinking.[14] Distorted thinking can have impact on how a person feels and behaves.[15] For instance, people with paranoid personality disorder tend to misinterpret what other people do or say as an intentional attack on them personally or as a way to either hurt them or take advantage of them.[16] When they make this misinterpretation, people with paranoid personality disorder may become “overly defensive, hostile, or even aggressive.”[17] Mediators may face several obstacles in a session if one of the parties begins to exhibit signs of a Cluster A personality disorder, so it is imperative that the mediator stay cognizant of any potential red flags in order to adjust the mediation accordingly.

Of all the personality disorders, schizotypal personality disorder may be the easiest to identify.[18] Imagine a mediation session between two parties: Kate and Tom. During this session, the mediator notices that Tom has been exhibiting behavior that is both odd and disruptive.[19] For example, Tom has been speaking in overelaborated and metaphorical speech.[20] He has also discussed his superstitions at length and appears to be paranoid about the whole mediation process.[21] During the session, the mediator also has reason to believe Tom is experiencing a perceptual distortion because he keeps complaining about a non-existent flickering light.[22] In addition, Tom has shown inappropriate emotions and responses to some of the topics discussed so far in the mediation.[23] Tom’s behavior and actions exemplify some common types of behavior of someone who lives with schizotypal personality disorder. Therefore, Tom’s actions should put the mediator on notice that adjustments may be necessary to keep the mediation session moving forward.

In the example above, it is easy to comprehend why the symptoms of a Cluster A disorder can have a negative impact on a mediation session. The symptoms may not only seem unusual and concerning to the other people in the room[24], but people “with Schizotypal Personality Disorder sense they are quite different from others and are often aware that other people seem uncomfortable around them.”[25]  Mediation requires the willing engagement of parties in explorations and discussions[26]; thus, the mediator has the responsibility of creating an environment that is conducive for both sides. With the proper tools and understanding, the mediator can take steps to improve the process for all those involved.

B. Cluster B Personality Disorders

“Cluster B personality disorders are characterized by dramatic, overly emotional or unpredictable thinking or behavior.”[27] People who have personality disorders that fall within this cluster “share problems with impulse control and emotional regulation.”[28] Examples of such disorders include: borderline personality disorder, narcissistic personality disorder, histrionic personality disorder, and antisocial personality disorder.[29] These types of personality disorders pose potential problems for the mediation process because the person may not be able to control his or her emotions or gage the true emotions of the other people in the room. Mediators will have to display an extra emotional sensitivity when working with people who may have Cluster B personality disorders.

According to the National Institute of Mental Health, 1.6% of U.S. adults have borderline personality disorder.[30] “Borderline personality disorder (BPD) is characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior.”[31] Consider the following example of a mediation session between Sarah and Grace to see how a Cluster B personality disorder may present itself in a mediation: While in session, the mediator notices that Grace’s stress level continues to increase, causing her mood to shift up and down.[32] Just recently, Grace had an angry outburst over a minor disagreement with Sarah that was a bit jarring.[33] Additionally, Grace’s perception of Sarah appears to be quickly changing from “all good” to “all bad” for no particular reason.[34] Because of her constant shifting of emotions, Grace is struggling with being consistent with her goals and makes radical changes without any advanced warning.[35] Sarah is becoming agitated by the flow of the mediation.

Working with those who have a Cluster B personality disorder can cause challenges to the mediation process because mediation is often “described as a move away from a focus on the right-wrong dichotomy.”[36] Instead, mediation tries to create an environment centered on problem solving.[37]  People living with a Cluster B disorder, especially borderline personality disorder, will often characterize actions as either bad or good and can lose focus on what is actually going on in the moment.[38] Furthermore, a person with a Cluster B personality disorder may become too emotional to have an effective conversation about what he or she really wants from the mediation.[39] This type of conversation is pivotal to the mediation process[40], so it is important for mediators to recognize when emotions are beginning to impede the mediation session.[41] By using the appropriate tools, mediators can adjust the mediation session in such a way that would help get the conversation back on track.

C. Cluster C Personality Disorders

The last cluster of personality disorders, Cluster C, is “characterized by anxious, fearful thinking or behavior.”[42] This cluster includes avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder.[43] When exhibiting avoidant behavior, people with a Cluster C disorder tend to be “shy, inhibited, and very sensitive to rejection and how others look at them.”[44] Conversely, “people with dependent personality disorder will rely completely or almost completely on others to make the decisions and for support.”[45] All of the personality disorders in Cluster C, however, “share a high level of anxiety.”[46] Again, mediators need to be aware and be prepared to change the atmosphere of the mediation session if they believe one of the parties may be suffering from a Cluster C personality disorder. For reference, it should be noted obsessive-compulsive personality disorder is not the same as obsessive-compulsive disorder, which is a type of anxiety disorder.[47]

Take for example a mediation between Bob and Steve. From the very beginning, Bob has been preoccupied with the rules and structure of the mediation.[48] Due to Bob’s preoccupation, the mediator is finding it difficult to have Bob open up and be flexible in his discussion with Steve.[49] The mediator is also having issues with moving the process along because Bob wants to work out each issue before moving onto the next.[50] Additionally, the mediator has noticed that Bob keeps trying to control the session and all of the participations.[51] Bob’s rigidness is preventing an effective mediation, and it is up to the mediator, at that point, to make adjustments.[52]

The symptoms of a Cluster C personality disorder can pose unique obstacles in a mediation setting. “Mediation, by design, is flexible.”[53] Additionally, while certain rules and guidelines exist in a mediation, they are rarely precise or detailed.[54] For people who have a Cluster C disorder, this aspect of mediation can create a very stressful environment that can ultimately cause them to be shy and withdrawn from the process.[55] Moreover, if a person is showing signs of dependency, the neutrality of the mediator may be more difficult to maintain.[56] A person with a Cluster C disorder may look to the mediator as a guide or someone to make decisions for him or her.[57] “Most experts agree that the mediator should maintain a neutral process and provide the parties an equal opportunity to participate in the process.”[58] Therefore, it is essential that the mediator create a comfortable setting in order to have the participation of the person exhibiting signs of a Cluster C Personality Disorder.

III. Implementation of Psychotherapy Techniques to Assist in Mediation

Individuals with personality disorders have “pervasive and long-standing traits that affect their perception” and the way they think about themselves and others.[59] Mental health providers, like psychiatrists and psychologists, use psychotherapy as treatment to assist people who have a mental illness, such as those with personality disorders.[60] Psychotherapy helps the person gain control of his or her life and “respond to challenging situations with healthy coping skills.”[61] Similarly, a mediator must be sensitive to the nuances of varying personalities to keep the mediation from reaching an impasse.[62]  One challenge mental health providers face in working with people who have personality disorders is figuring out which types of responses and behaviors can help those individuals better cope with their symptoms in order to have a more effective session. There are a variety of techniques used in psychotherapy that could easily be utilized by a mediator during the mediation process.[63] Typically, the mental health provider tailors the therapy approach to the particular individual’s situation. [64] Nevertheless, there are a few applicable, broader approaches that mediators can mimic which could potentially be a significant help to the mediation process.

The first and critical element of a mediator’s role is to diagnose, when possible, why the parties are unable to reach a resolution.[65] In making this assessment, the mediator may have reason to believe that one or more of the parties is suffering from a personality disorder. The mediator would then be able to simulate psychotherapy techniques to assist in the mediation process. As with any mediation, effective mediators should implement different tools and techniques depending on the personality of the actors involved.[66]

A. Cluster A Tips: Using Reality Testing and Goal Setting as Substitutes for Cognitive Behavioral Therapy Techniques

With Cluster A disorders, it is important not to directly challenge any delusions or inappropriate thoughts a person may be experiencing.[67] Instead, a better approach is to create a warm and supportive environment.[68] Cognitive behavioral therapy is a form of psychotherapy that has been studied and recognized as useful in helping a person suffering from a Cluster A personality disorder, especially schizotypal personality disorder.[69] Cognitive behavioral therapy “focuses on helping [people] understand how their thoughts and behaviors affect each other.”[70] When a person understands the interaction between his thoughts and behaviors, it is easier for him to not let negative emotions have a significant impact on whatever he is trying to accomplish, something that is particularly important in mediation.[71]

Mediators can use the mediation technique of reality testing to simulate the cognitive behavioral therapy technique of performing a “thought records exercise.”[72] The thought records exercise is “designed to test the validity of thoughts.”[73] When conducting this exercise, the therapist asks the individual to write down evidence for and against a negative thought, and once this is accomplished, “the idea is to come up with several more balanced thoughts.”[74] “Thought records tend to help change beliefs on a logical level.”[75] Similarly, reality testing causes an individual to look objectively at his or her actions and see how those actions are serving or not serving the individual’s interest.[76] To keep from embarrassing the party, it would be best to perform the reality testing technique during a caucus.[77] When implementing a reality test, the mediator should ask questions that will cause the individual “to rethink a position, objective or opinion.”[78] Examples of these types of questions may resemble: “What goal is the other party trying to achieve?”, “Besides making a personal attack, what do you believe are the underlying intentions of the other party?”, and “What are the positives of negotiating with the other party?” By making him or her partake in a version of a thought records exercise, the mediator is giving the person an opportunity to look at the situation objectively without interference of irrational thinking.[79] Settlement discussions may be able to continue once the person has the chance to obtain control over his or her symptoms. Overall, the main point is to guide the person into looking at other perspectives besides just the negative one in order to let him or her achieve more balanced thoughts.

A major theme in cognitive behavior therapy is goal setting, which is also a technique used in mediation.[80] In a therapeutic setting, the therapist will ask the patient to draft a list of goals that he or she wants to achieve from therapy.[81] Then, the therapist works with the patient to create “practical strategies to help fulfill these goals.”[82] A mediator would easily be able to implement this type of practice in a mediation setting due to the fact that goal setting is already a common practice used by mediators.[83] If the mediator senses that an individual with a personality disorder is starting to get frustrated by the process, the mediator may call for a caucus session. While in caucus, the mediator can have the individual he or she suspects of having a personality disorder create and write out personal goals for the mediation.[84]

A caucus would work best in this situation because, as previously mentioned, people with a Cluster A personality disorder may be suffering from paranoia which can cause the them to be skeptical of others and excessively defensive over their own actions.[85] By performing the goals exercise in an individual session, the mediator is granting the person a safe space to create his or her goals.[86] Later, when things become tense or seem to be getting out of hand once again, the mediator should ask the individual to review his or her goals as a reminder of the bigger picture. Hopefully, this technique will keep the process moving forward because the written goals provide yet another objective resource on which the person exhibiting symptoms can rely. Goals also help the person keep perspective of the purpose of the mediation and avoid getting caught up in the emotional aspect of everything else that occurs during the session.

Looking back at the example mediation of Kate and Tom, the mediator, in that situation, could implement one or both of the techniques suggested. Since both techniques require the separation of the parties, the first step the mediator would want to take is to call for a caucus. After the mediator is in private session with Tom, the mediator should request Tom to take a moment and write out his goals for the mediation. It would be beneficial to perform the goals exercise first because a part of the reality test is asking the individual hard questions about his or her goals. When Bob is creating and writing his goals, it is imperative that he not feel pressure from the mediator because the stress has the potential to cause paranoid thinking. The purpose of the caucus and exercise is to calm the situation and get the mediation back to a good place. Suppose that after Bob is done with his goals exercise, he is still experiencing symptoms that could impede the mediation. Then, the mediator may choose to implement the reality testing exercise. This is the time the mediator would want to ask Bob the type of questions previously discussed. These questions will help Bob focus objectively on the reality of the situation, and hopefully, he will be able to maintain this objectivity throughout the rest of the mediation session.

B. Cluster B Tips: Implementation of New and Old Tools

Dialectical behavior therapy has been found to be a helpful form of psychotherapy for people with Cluster B Personality Disorders.[87] “Dialectical behavior therapy (DBT) treatment is a cognitive-behavioral approach that emphasizes the psychosocial aspects of treatment.”[88] The underlying theory of this approach stems from the idea that “some people are prone to react in a more intense and out–of–the–ordinary manner toward certain emotional situations . . . .”[89] Dialectical behavior therapy includes four sets of behavior skills, one of which is mindfulness.[90] “Mindfulness is a state of active, open attention on the present.”[91] It allows a person to observe “thoughts and feelings from a distance, without judging them good or bad.”[92] The use of mindfulness by mediators has already been acknowledged as a way in which a mediator can recognize his or her own biases towards parties in a mediation.[93] Performing mindfulness exercises in mediation allows for the opportunity to realize that a person’s thoughts are not the same thing as that person.”[94] This is important for both people living with a personality disorder and mediators.

With regards to the Cluster B disorders, individuals may have a hard time regulating their emotions and thoughts.[95] Mindfulness is a way in which the individual can step back from the situation and disassociate themselves from the actions of the other participants.[96] In addition, “mindfulness meditation cultivates one’s ability to observe one’s thoughts, and to recognize the emotions that arise from those thoughts,” which can allow the person to have a choice on whether to react instead of exhibiting an instinctual reaction that hurts the mediation process.[97] The most basic practice of mindfulness “involves sitting and using breathing as the focus of the meditation.”[98] For instance, if someone appears to have issues concentrating or staying calm, the mediator could have him or her perform “one minute of mindfulness.”[99] This would be best performed during a caucus because the private session would put the individual into an environment with less distractions. The one minute of mindfulness is an easy exercise to implement.[100] All the mediator would need to do is have the individual focus on his or her normal breathing for one minute while keeping his or her eyes closed during the exercise.[101] The mediator should also instruct the individual to try and prevent his or her thoughts from wandering and focus solely on breathing in and out.[102] Hopefully, by the end of the exercise, the individual will have calmed down and be ready to move forward. However, if the mediator does not feel comfortable suggesting such an exercise, there is still another way the mediator can bring mindfulness into the session.

The mediation tool of reframing can be implemented by the mediator as a way to bring the concept of mindfulness to the mediation session. The main idea behind mindfulness is to focus on “being in the present.”[103] The reframing technique is already used by mediators to set-up fresh frameworks in order to “persuade parties to frame issues in terms not of positions . . . but of interests, needs, and ultimate goals . . . .”[104] By reframing, the mediator changes a statement made by the individual to remove negativity while still keeping the substance of the message.[105] The purpose of such an exercise is to have parties see their conflict in a new light.[106]  The neutral tone produced by the mediator will give the individual with a Cluster B personality disorder a better chance to hear the true issues in dispute[107] rather than an exaggerated[108] version of them.

The use of these techniques can play out in various ways during a mediation. Referencing back to the mediation example with Grace and Sarah, the mediator may choose to use one or both of these techniques once he or she has a suspicion that Grace has a Cluster B personality disorder. Suppose the mediator first tries the reframing technique. This would allow the tensions to decrease and add objectivity to the situation. By doing this, the mediator creates a neutral version of each parties’ goals. When the mediator reframes Sarah’s statements, Grace will be able to see Sarah’s real goals and intentions instead of the frightening alternative her paranoid[109] thinking created. Similarly, Grace will obtain a better view of her objectives by hearing the substance of her statements without the emotional aspect. If reframing is unable to fully solve the impediment, the mediator has the option to call a caucus. During the caucus, the mediator can have Grace perform the one minute of mindfulness before any further discussion begin. This will allow Grace time to calm her emotions and thinking in order to gain more clarity on the situation. Again, the mediator should not feel pressure to perform the one minute of mindfulness exercise if he or she is uncomfortable.

C. Cluster C Tips: Creating a Supportive Environment with Mediation Tools already at Hand

Supportive psychotherapy is a form of psychotherapy that is both flexible and comprehensive.[110] As a result, it is frequently applied to varying kinds of psychopathology, including issues associated with personality disorders.[111] This type of “psychotherapy can be characterized by the use of direct measures to ameliorate symptoms.”[112] A general principle of supportive psychotherapy is to minimize a person’s experience with anxiety and maximize a sense of control.[113]

A clear mandate for therapists using supportive psychotherapy is for them “to be explicit about the tasks and goals: that is, the way in which a therapist and patient will work, providing a clear rationale, and the direction in which they are headed.”[114] For this to be accomplished, therapists are asked to have a “meeting of the minds” with the patient in order to discuss tasks and goals.[115] Mediators already use the technique of establishing clear ground rules for the purposes of creating trust and confidence among the parties involved in the mediation.[116] In mediation, party participation in formulating ground rules can, in itself, be an exercise that builds trust.[117] This tool of mediation is called contracting.[118] “In contracting, the mediators and the parties agree on the structure, the rules, and the goals of the mediation.”[119] Since people with Cluster C personality disorders may experience high levels of anxiety or fearful thinking, mediators can use this same tool to help the mediation session. Although this tool is typically used before the mediation is started, it is always something the mediator has the option of implementing once he or she notices a potential issue with a Cluster C personality disorder. If the discussion seems to be stuck, the mediator can refocus the conversation and have the parties create clear ground rules for the rest of the mediation session. After the rules are created, the mediator could even place them on the wall, so the individual will be able to refer back to them if he or she feels anxiety at some future point in the mediation.

Some other techniques used in supportive therapy include: clarification and encouragement.[120] “Clarification is used extensively in terms of summarizing, paraphrasing, and organizing the patient’s statements without elaboration or inference.”[121] “In the interactive process between the parties, most are unclear, leaving a lot of room for inaccurate interpretation.”[122] In addition, fearful thinking may produce thoughts such as “The mediator does not like me” or “Everyone is against me.”[123] By taking a moment to clarify statements, the mediator can allow the person to take a step back from the anxiety and bad thoughts in order to gain a perspective about what is actually occurring in the situation. Techniques already used by mediators that would work well for clarification purposes are active listening and summarizing. Active listening gives the mediator the skill to listen in a certain manner which “makes it possible to grasp the real messages in what the speaker expresses.”[124] While performing active listening, the mediator lends his or her ears to the individual and tries to keep eye-contact.[125] In addition, the mediator should try to have an attentive posture and make responsive facial expressions.[126] Once the message is received, “[s]ummarizing establishes overall understanding and keeps things on track by listing, synthesizing, and reviewing important information.”[127] “A skillful summary ensures understanding by repeating key information, keeps things on track by reminding people where they are, and makes sure there is clarity before moving on to another point.”[128]

On the other hand, therapist use encouragement in a variety of ways such as praise, reassurance, and empathic comments.[129] Mediators similarly perform work of great sensitivity.[130] Mediation calls “on the mediator to stay closely attuned with the parties both by empathetic engagement and by checking with them to see how they are doing.”[131] In any mediation, mediators will have to confront emotions of the parties because “there is no thought without emotion.”[132] Thus, mediators already try to acknowledge emotions[133], and it is substantively no different when working with someone who may have a personality disorder. A suggested technique already in place is for the mediator to “[t]ry to hit both the nature of the emotion and the strength.”[134] This can be done by saying things such as: “What I am hearing on your part is a great deal of anger;” “This must have been frustrating for you;” “Help me to understand, I am sensing hurt on your part.”[135] These same statements currently being used in mediation are of the same caliber as statements therapist use to show sensitivity in supportive psychotherapy.

All of the listed supportive techniques can be used in conjunction with one another or separately, depending on what is needed in the mediation session. Take for example the use of contracting in the situation with Bob and Steve. The mediator, in this case, believes that Bob may have a Cluster C personality disorder and wants to adjust the mediation session accordingly. By using the contracting technique, the mediator is invoking the “meeting of the minds” technique. To begin with, the mediator can lay out the details of the mediation process, the goals of the mediation process, and what is expected from the parties during mediation. Once this has been expressed, the mediator can have the parties agree to the terms. Bob may feel more at ease with specific, stable rules.[136] Additionally, the mediator may choose to place the agreed upon rules on the wall. Having the rules displayed will hopefully make Bob feel more at ease for the rest of the mediation session. If the “meeting of the minds” technique did not fully help the situation, then the mediator can begin to use tools that simulate clarification and encouragement.

IV. Conclusion

The presence of a personality disorder should not place a hindrance on a mediation session. There are practical, real solutions that mediators can implement in order to make the whole process run effectively. As a way to assist the person exhibiting signs of a personality disorder, the mediator can adapt psychotherapy techniques to the mediation setting. This adaptation can take the form of tools the mediator already has in his or her toolbox, such as caucusing and contracting.  If the mediator needs assistance in helping recognize the presence of a personality disorder, the mediator can create a guide similar to the one already put in use by judges. “The Judges Guide to Mental Illnesses in the Courtroom is a two-page bench card to help judges recognize the signs of possible mental illnesses among individuals in the courtroom and to respond sensitively and productively.”[137] In part, the guide provides judges with information such as a list of the prevalence rates of serious mental illnesses and notes on behaviors the judge may observe that should cause him or her to be concerned that someone may have a mental illness.[138]  A mediator could follow the format and structure of the judge’s guide to create a guide for the identification of personality disorders in a mediation session.

Lastly, the mediators should acknowledge that, in some circumstances, the personality disorder may be too severe to manage.[139] Although this article provides some basic insight into how to work with those individuals who have personality disorders, it is important to remember that complete diagnosis and treatment should be left to medical care professionals. The mediator should be confident in his or her abilities in any mediation session, not just those where an individual with a personality disorder may be present.

[1] Mayo Clinic, Diseases and Conditions: Personality Disorders (2016), http://www.mayoclinic.org/diseases-conditions/personality-disorders/basics/definition/con-20030111.
[2] United States Census Bureau, State & County QuickFacts, http://quickfacts.census.gov/qfd/states/00000.html.
[3] M.F. Lenzenweger et al., National Survey Tracks Prevalence of Personality Disorders in U.S. Population, (National Institute of Mental Health), https://www.nimh.nih.gov/news/science-news/2007/national-survey-tracks-prevalence-of-personality-disorders-in-us-population.shtml.
[4] Diseases and Conditions: Personality Disorders, supra, note 1.
[5] M.F. Lenzenweger er al., supra, note 3.
[6] Elizabeth Wittenberg, Are Your Clients Making You Crazy?, 68-MAR Bench & B. Minn. 20, 21 (2011).
[7] Id.
[8] “It’s helpful to have a template in mind for some of these personalities so you can recognize them, understand a bit about the dynamics of the personality, and know how to work with someone who has it” Id.
[9] Mayo Clinic, Diseases and Conditions: Personality Disorders Symptoms (2016), http://www.mayoclinic.org/diseases-conditions/personality-disorders/basics/symptoms/con-20030111.
[10] Wittenberg, supra note 6.
[11] Diseases and Conditions: Personality Disorders Symptoms, supra note 9.
[12] Id.
[13] UAMS, Three Clusters of Disorders (2016), http://uamshealth.com/news/multimedia/herestoyourhealth/personalitydisorders/threeclustersofdisorders/.
[14] Simone Hoermann, Ph.D., Corinne E. Zupanick, Psyc.D., & Mark Dombeck, Ph.D., DSM-5: The Ten Personality Disorders: Cluster A (2015), https://www.mentalhelp.net/articles/dsm-5-the-ten-personality-disorders-cluster-a/.
[15] MentalHelp.net, Examples of Personality Disorders with Distorted Thinking Patterns (2016), https://www.mentalhelp.net/articles/examples-of-personality-disorders-with-distorted-thinking-patterns/.
[16] Id.
[17] Id.
[18] Although easier to identify, this personality disorder is rare. Hoermann, Zupanick, & Dombeck, supra note 14.
[19] A 2009 study found the prevalence of schizotypal personality disorder in a sample to be 3.9% with a significantly larger number of men having the disorder. Attila J. Pulay, M.D. et al., Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Schizotypal Personality Disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions, 11(2) Prim. Care Companion J. Clin. Psychiatry 53 (2009); See also Right Diagnosis from healthgrades, Statistics about Schizotypal Personality Disorder (2014), http://www.rightdiagnosis.com/s/schizotypal_personality_disorder/stats.htm.
[20] People with Schizotypal Personality Disorder may show the symptoms of “[o]dd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped).” PsychCentral, Schizotypal Personality Disorder Symptoms (2016), http://psychcentral.com/disorders/schizotypal-personality-disorder-symptoms/; People with schizotypal personality disorder can have “[p]eculiar dress, thinking, beliefs, speech or behavior.” Diseases and Conditions: Personality Disorders Symptoms, supra note 9.
[21] Schizotypal Personality Disorder Symptoms, supra note 19.
[22] Id.; With regards to the perceptual distortions, people with schizotypal personality disorder may see flashes of light or shadows that no one else can see. Hoermann, Zupanick, & Dombeck, supra note 14; They could possibly even hear a disembodied voice. Diseases and Conditions: Personality Disorders Symptoms, supra note 9.
[23] People with schizotypal personality disorder may have flat or inappropriate emotions.  In addition, they can have an “indifferent, inappropriate or suspicious response to others.” “Magical thinking” could potentially cause another problem, which is “believing you can influence people and events with your thoughts.” Diseases and Conditions: Personality Disorders Symptoms, supra note 9.
[24] “[P]eople who work or interact closely with those who have these disorders often find themselves responding in uncharacteristic ways or experiencing uncomfortable feelings they don’t usually have.” Wittenberg, supra note 6.
[25] Examples of Personality Disorders with Distorted Thinking Patterns, supra note 15.
[26] “[I]t is the parties who must inform the mediator and the other participants about what it is they really desire, the parties themselves take a very active part in the process.” Kimberlee K. Kovach, Mediation in a Nutshell 59–60 (West Group, 2003).
[27] Diseases and Conditions: Personality Disorders Symptoms, supra note 9.
[28] Simone Hoermann, Ph.D., Corinne E. Zupanick, Psyc.D., & Mark Dombeck, Ph.D., DSM-5: The Ten Personality Disorders: Cluster B (2015), https://www.mentalhelp.net/articles/dsm-5-the-ten-personality-disorders-cluster-b/.
[29] Id.
[30] National Institute of Mental Health, Borderline Personality Disorder (2007), https://www.nimh.nih.gov/health/statistics/prevalence/borderline-personality-disorder.shtml.
[31] Id.
[32] Diseases and Conditions: Personality Disorders Symptoms, supra note 9.
[33]  People with this disorder apply their harsh judgment to themselves and others. Id.
[34] Id. It is important to note that people with Borderline Personality Disorder are generally hard to calm down once they have become upset.
[35] Id.
[36] Kovach, supra note 26, at 58–59.
[37] Id.
[38] Hoermann, Zupanick, & Dombeck, supra note 28.
[39] Kovach, supra note 26, at 58–59.
[40] Id.
[41] Mark D. Bennet & Scott Hughes, The Art of Mediation 76–78 (Anthony J. Bocchino et al. eds., 2nd ed. 2005).
[42] Diseases and Conditions: Personality Disorders Symptoms, supra note 9.
[43] Id.
[44] Three Clusters of Disorders, supra note 13.
[45] Id.
[46] Simone Hoermann, Ph.D., Corinne E. Zupanick, Psyc.D., & Mark Dombeck, Ph.D., DSM-5: The Ten Personality Disorders: Cluster C (2015), https://www.mentalhelp.net/articles/dsm-5-the-ten-personality-disorders-cluster-c/.
[47] Id.
[48] Diseases and Conditions: Personality Disorders Symptoms, supra note 9.
[49] Hoermann, Zupanick, & Dombeck, supra note 50.
[50] Id.
[51] Diseases and Conditions: Personality Disorders Symptoms, supra note 9.
[52] Hoermann, Zupanick, & Dombeck, supra note 46.
[53] Kovach, supra note 26, at 39.
[54] Id.
[55] Three Clusters of Disorders, supra note 13.
[56] Kovach, supra note 26, at 154.
[57] Three Clusters of Disorders, supra note 13.
[58] Kovach, supra note 26, at 154.
[59] Psychotherapy and Personality Disorders, 8 No. 10 Medico-Legal Watch 54 (1999).
[60] Mayo Clinic, Tests and Procedures: Psychotherapy (2016), http://www.mayoclinic.org/tests-procedures/psychotherapy/basics/definition/prc-20013335.
[61] Id.
[62] David A. Hoffman & Richard N. Wolman, The Psychology of Mediation, 14 Cardozo J. Conflict Resol. 759, 761 (2013) (discussing the need for the mediator to adjust to the personalities of the parties and the underlying psychology of the interaction).
[63] Hoermann, Zupanick, & Dombeck, supra, note 46.
[64] Id.
[65] Kovach, supra note 26, at 75.
[66] Amy L. Smith & David R. Smock, Managing a Mediation Process 11 (A. Heather Coyne & Nigel Quinney eds., 2008).
[67] PsychCentral, Schizotypal Personality Disorder Treatment: Psychotherapy, http://psychcentral.com/disorders/schizotypal-personality-disorder-treatment/.
[68] Id.
[69] Roxanne Drygen-Edwards, Schizotypal Personality Disorder: What is The Treatment for Schizotypal Personality Disorder, MedicineNet.com (Aug. 8, 2015), http://www.medicinenet.com/schizotypal_personality_disorder/page4.htm#what_is_the_treatment_for_schizotypal_personality_disorder; see CJ Hopwood, AN Banducci & CW Lejuez, The Effectiveness of Cognitive Behavioral Therapy for Personality Disorders, 33(3) Psychiatric Clinics of North America 657 (2010) (finding that cognitive behavioral therapy is an effective treatment modality for reducing symptoms and enhancing functional outcomes among patients with personality disorders); see also Falk Leichsenring and Eric Leibing, The Effectiveness of Psychodynamic Therapy and Cognitive Behavior Therapy in the Treatment of Personality Disorders: A Meta–Analysis, 160(7) The American Journal of Psychiatry 1223 (2003) (finding evidence that cognitive behavioral therapy is an effective treatment for personality disorders).
[70] Drygen-Edwards, supra note 54.
[71] Kovach, supra note 26, at 58–59.
[72] Alice Boyes, Cognitive Behavioral Therapy Techniques that Work, Psychology today (Dec. 06, 2012), https://www.psychologytoday.com/blog/in-practice/201212/cognitive-behavioral-therapy-techniques-work
[73] Id.
[74] Id. The article provides an example of a student “who gets negative feedback from a supervisor” and jumps to the conclusion that the supervisor thinks the student is useless. In performing the exercise, the student would right information for and against this negative thought. “Evidence against the thought might be things like ‘My supervisor is allowing me to run assessments and give feedback to clients.’ The student could then look at the objective evidence to see that if the supervisor thought the student was worthless, then the supervisor probably wouldn’t have allowed her to give feedback to clients. The student can then come up with a more balanced thought such as “My supervisor will be impressed to see me learning from my mistakes and incorporating her feedback.”
[75] Id.
[76] Bennet & Hughes, supra note 41, at 60.
[77] Id.; Bennett & Hughes, supra note 41, at 33.
[78] Kovach, supra note 26, at 52.
[79] Boyes, supra note 72.
[80] Department of health & Human Services, State Government of Victoria, Australia, Cognitive Behavioral Therapy (2015),  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/cognitive-behaviour-therapy.
[81] Id.
[82] Id.
[83] Kovach, supra note 26, at 42.
[84] Bennett & Hughes, supra note 41, at 60. A couple of important tasks that mediators undertake in a caucus include “ask[ing] for information that has not been revealed in joint session, particularly in sensitive areas,” and “be[ing] transparent about the process and ask[ing] the party how she things the mediation is proceeding.”
[85] Hoermann, Zupanick, & Dombeck, supra, note 14.
[86] Bennett & Hughes, supra note 41, at 61.
[87] See Carla D. Chugani, Michael N. Ghali & Jon Brunner, Effectiveness of Short Term Dialectical Behavior Therapy Skills Training in College Students with Cluster B Personality Disorders, 27(4) Journal of College Student Psychotherapy 323 (2013) (finding dialectical behavior therapy participants had significant improvement in increasing skills use); see also Willem H.J. Martens, Therapy on the Borderline: Effectiveness of Dialectical Behavior Therapy for Patients with Borderline Personality Disorders, 8.4 Annals of the American Phsyotherapy Association 5 (2005) (finding the results of evaluation studies into the efficacy of dialectical behavior therapy for patients with borderline personality disorder promising).
[88] PsychCentral, An Overview of Dialectical Behavior Therapy (2016), http://psychcentral.com/lib/an-overview-of-dialectical-behavior-therapy/.
[89] Id.
[90] What is DBT?, The Linehan Institute, Behavior Tech (2016), http://behavioraltech.org/resources/whatisdbt.cfm.
[91] Psychology Today, Mindfulness: What is Mindfulness? (2016), https://www.psychologytoday.com/basics/mindfulness.
[92] Id.
[93] Evan M. Rock, Mindfulness Mediation, the Cultivation of Awareness, Mediator Neutrality, and the Possibility of Justice, 6 Cardozo J. Conflict Resol. 347, 349 (2005).
[94] Id. at 352.
[95] Diseases and Conditions: Personality Disorders Symptoms, supra note 9.
[96] Mindfulness: What is Mindfulness?, supra note 91.
[97] Rock, supra note 93, at 353.
[98] Id. at 351.
[99] The Guided Mediation Site, Mindfulness Exercises, http://www.the-guided-meditation-site.com/mindfulness-exercises.html.
[100] Id.
[101] Id.
[102] Id.
[103] Thich Nhat Hanh, Five Steps to Mindfulness (2010), http://www.mindful.org/five-steps-to-mindfulness/.
[104] Smith & Smock, supra note 68, at 45.
[105] Kovach, supra note 26, at 29. The author gives the example of an individual complaining about “terrible, loud music.” The mediator reframes this phrasing by stating “the problem with late night music.”
[106] Id. at 46.
[107] Kovach, supra note 26, at 50.
[108] Diseases and Conditions: Personality Disorders Symptoms, supra note 9.
[109] Id.
[110] Arnold Winston, Richard N. Rosenthal & J. Christopher Muran, Supportive Psychotherapy, reprinted in Handbook of Personality Disorders: Theory, Research, and Treatment 344, 345 (W. John Livesley ed., 2001).
[111] Id. at 347.
[112] Id.
[113] Id.
[114] Id. at 348.
[115] Id.
[116] Smith & Smock, supra note 68, at 38.
[117] Id.
[118] Bennett & Hughes, supra note 41, at 33.
[119] Id.
[120] Rock, supra note 93, at 348.
[121] Id.
[122] Hans Boserup, Mediation: Six Ways in Seven Days—Special Part of the Mediation Process 98 (DJOF Publishing, 2007).
[123] Diseases and Conditions: Personality Disorders Symptoms, supra note 9.
[124] Hans Boserup, Mediation: Six Ways in Seven Days, 30 (DJOF Publishing, 2007).
[125] Id. at 35.
[126] Bennet & Hughes, supra note 41, at 90.
[127] Id. at 105.
[128] Id.
[129] Mindfulness Exercises, supra note 99, at 348. The authors provide several examples of the type of statements that therapist use to express encouragement. For particularly difficult situations, the authors note that therapist use empathic comments (e.g. “That must have been really hard for you”). Also, the authors suggest using statements that will “tell the patient something about him- or herself, but not in a disingenuous way (e.g. ‘That took a lot of courage’).”
[130] Bennett & Hughes, supra note 41, at 19.
[131] Id.
[132] Id. at 78.
[133] Id.
[134] Id.
[135] Id.
[136] Diseases and Conditions: Personality Disorders Symptoms, supra note 9.
[137] Justice center, judges’ guide to mental illnesses in the courtroom (Jan. 22, 2012), https://csgjusticecenter.org/courts/publications/judges-guide-to-mental-illnesses-in-the-courtroom/.
[138] Id.
[139] Paul Fisher, Identifying and Managing Difficult, High-Conflict Personality Clients, 26-FEB Prob. & Prop. 56, 61 (2012).