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Understanding personality disorders

Personality disorders are patterns of thinking, feeling and behaving that can persist across situations and over time. You might notice these patterns in relationships, at work or when managing emotions and impulses. Rather than a single symptom, personality disorders involve a cluster of traits that affect how you relate to others and how you view yourself. In the UK many people seek help because these patterns create distress, difficulty maintaining relationships or challenges in daily functioning.

How this commonly affects people

When personality traits become rigid and long-standing they can make ordinary stresses feel overwhelming. You may find yourself reacting intensely in certain situations, avoiding closeness, or struggling with trust. Behavioural patterns can lead to repeated conflicts, feelings of emptiness, or a cycle of reassurance-seeking and withdrawal. It is common for people to describe a sense of being misunderstood or stuck, and that patterns learned early in life continue to shape present-day responses.

Signs you might benefit from therapy for personality disorders

You may decide to explore therapy if you recognise persistent patterns that cause distress or keep you from living the life you want. Red flags can include repeated relationship breakdowns, unstable self-image, frequent crises, difficulty regulating anger or emotion, and impulsive actions that you later regret. You might also find that small events trigger outsized reactions, or that you feel chronically lonely despite being around people. If these experiences interfere with work, study or family life, seeking a therapist who understands personality-related difficulties can be a helpful next step.

What to expect in therapy sessions focused on personality disorders

Therapy for personality-related difficulties usually begins with a thorough assessment. During initial sessions you will be able to describe your history, current struggles and what you hope to change. The therapist will ask about relationships, mood patterns, past treatment and any risks such as self-harm. This assessment helps develop a collaborative plan that matches your goals and the therapist's areas of expertise.

Assessment and goal-setting

The early phase is typically exploratory. You will review how the patterns developed and which situations activate them now. The therapist and you will set realistic, measurable goals for therapy. Goals may focus on reducing crisis frequency, improving emotional regulation, building more stable relationships, or developing new coping strategies. It is common to agree on session frequency and to review progress at regular intervals.

Therapy sessions and structure

Sessions tend to be weekly or fortnightly and generally last around 50 to 60 minutes. Over time you will practice skills in-session and apply them between appointments. Therapy can feel demanding because it often asks you to reflect on long-standing habits and try new patterns of relating. You should expect a mix of talking, skill-building exercises and reflection on real-life interactions. Many therapists offer a clear plan for crisis management and will discuss how to access additional support if you are in immediate difficulty.

Common therapeutic approaches used for personality disorders

Several evidence-informed approaches are commonly used in the UK to support people with personality-related difficulties. Dialectical behaviour therapy offers practical skills for emotion regulation, distress tolerance and interpersonal effectiveness, with a strong focus on building balance between acceptance and change. Mentalisation-based therapy focuses on improving your ability to understand your own and others' mental states, which can reduce misunderstandings and impulsive responses. Schema therapy explores deep-rooted life patterns and aims to change long-standing self-defeating coping styles through experiential work and cognitive techniques.

Other therapists use psychodynamic approaches to explore how early relationships shape present-day behaviour, and cognitive-behavioural methods to address unhelpful thoughts and behaviours. Some practitioners combine approaches or use creative and group-based formats when appropriate. When medication is considered, this is usually discussed in collaboration with your GP or a psychiatrist because medication can sometimes help manage specific symptoms while psychotherapy addresses the underlying patterns.

How online therapy works for this specialty

Online therapy has become an accessible option for people seeking support for personality-related difficulties. You can expect to receive care through video calls, telephone sessions or written exchanges, depending on the therapist's offered formats. Video appointments allow for face-to-face interaction while remaining in your chosen environment, which may make it easier to attend regularly. Therapists will discuss how they manage appointments, data protection and how to reach them in a crisis. Many also offer a mix of online and face-to-face work if that suits your needs.

Working remotely can make it simpler to maintain continuity of care when you travel or have a busy schedule. It can also change the dynamic of therapy in helpful ways - for example, you may find it easier to bring examples from your daily life straight into sessions. At the start of online therapy your practitioner will normally agree on practicalities such as session length, technology checks and what to do if a session is interrupted. You should also clarify how emergency situations will be handled and whether local face-to-face support is available if needed.

Tips for choosing the right therapist for personality disorders

When looking for a therapist, consider professional registration and specific experience. Many UK therapists are registered with recognised bodies such as BACP or HCPC, and some hold specialist accreditation through recognised programmes. You may want to prioritise someone who explicitly specialises in personality disorders or the particular pattern you are experiencing. It can help to read practitioner profiles carefully to understand their therapeutic approaches, training and experience with crisis management.

Arrange an initial consultation to get a sense of whether the therapist's style suits you. Ask about the expected length of therapy, how progress is measured and what happens if you need extra support between sessions. Discuss practicalities such as session fees, cancellation policies and whether they offer remote or in-person appointments. Trust your instincts about whether you feel heard and respected - a good match often makes therapy more effective and tolerable when the work becomes challenging.

Finally, consider a joined-up approach to care. If you have a GP, discussing referral options can be helpful, and some people benefit from coordinated support involving psychiatrists, social services or community mental health teams. Remember that seeking help is a step towards understanding and changing patterns that have been hard to shift on your own. With the right therapist and a clear plan you can develop new ways of relating to yourself and others and find more reliable ways of coping with difficult emotions and situations.