In this episode, the first of a two part series, we learn about what exactly a psychologist is and the differences between a Clinical and a Forensic Psychologist.
Dr. Caroline Logan, who is a Consultant Forensic Clinical Psychologist, talks to us about the meaning of psychological terms such as personality disorders such as narcissistic personality disorder, borderline personality disorder, whether they are the product of nature or nurture and how those affected behave.
Dr. Caroline Logan is a Consultant Forensic Clinical Psychologist. For nearly 30 years, she has worked as a researcher and honorary senior lecturer at the Universities of Liverpool and Manchester in the UK, as a lead clinician in secure forensic mental health services in the north of England and Norway, and as a consultant/contractor with law enforcement services in the UK and elsewhere. Dr Logan has ongoing clinical and research interests in personality disorder (including psychopathy), risk, violent extremism, and forensic clinical interviewing, and she has a special interest in gender issues in the range of offending behaviour. She has published five books and over 70 articles on these subjects, including Violent Extremism: A Handbook of Risk Assessment and Management [uclpress.co.uk], co-edited with Randy Borum and Paul Gill, published in November 2023, and a second edition of Managing Clinical Risk: A Guide to Effective Practice [routledge.com], co-edited with Lorraine Johnstone, published in December 2023.
https://www.linkedin.com/in/caroline-logan-31656b9a/
In this episode, the first of a two part series, we learn about what exactly a psychologist is and the differences between a Clinical and a Forensic Psychologist.
Dr. Caroline Logan, who is a Consultant Forensic Clinical Psychologist, talks to us about the meaning of psychological terms such as personality disorders such as narcissistic personality disorder, borderline personality disorder, whether they are the product of nature or nurture and how those affected behave.
Dr. Caroline Logan is a Consultant Forensic Clinical Psychologist. For nearly 30 years, she has worked as a researcher and honorary senior lecturer at the Universities of Liverpool and Manchester in the UK, as a lead clinician in secure forensic mental health services in the north of England and Norway, and as a consultant/contractor with law enforcement services in the UK and elsewhere. Dr Logan has ongoing clinical and research interests in personality disorder (including psychopathy), risk, violent extremism, and forensic clinical interviewing, and she has a special interest in gender issues in the range of offending behaviour. She has published five books and over 70 articles on these subjects, including Violent Extremism: A Handbook of Risk Assessment and Management [uclpress.co.uk], co-edited with Randy Borum and Paul Gill, published in November 2023, and a second edition of Managing Clinical Risk: A Guide to Effective Practice [routledge.com], co-edited with Lorraine Johnstone, published in December 2023.
https://www.linkedin.com/in/caroline-logan-31656b9a/
Welcome to the Diffuse podcast with host Philip Grindel, CEO and founder of Diffuse, a global threat and intelligence consultancy that blends psychology and intelligence to mitigate threats and risks to prominent people and brands.
Speaker 2:Hello everyone and welcome back to the Diffuse podcast. Now, I know I say this probably every time I do a podcast, but this one's going to be really, really important and interesting. I think what I find every day is I open the newspapers and there's someone talking about somebody being a narcissist or a psychopath or a sociopath and all these other various things, and I wonder whether we actually understand what those terms really mean. And I would probably gamble that a lot of the journalists don't really understand what those terms really mean, and that's why today's guest, dr Caroline Logan, is going to be so interesting.
Speaker 2:I met Caroline a few weeks ago in Paris and, bizarrely, we ended up going for a drink and with a whole grand gang of us and I was probably the only non-psychologist there and we had the most fascinating conversation, which is what motivated me to do this podcast around.
Speaker 2:Well, what do these things actually mean and how do we know if someone's this or that or what have you, and does it matter if they're this, that or whatever? So Caroline has got. I'm not going to read her buyout because it's so long. I'd probably probably spend the whole, not because it's full of fluff, because it's full of incredible achievements, but I'd probably spend most of the podcast reading out her qualifications and her resume. Suffice to say that she's one of the most qualified and experienced in her field and you know it was so fascinating sitting in a room full of psychologists and watching how they deferred to Caroline as the expert, and I know she's going to be humbled by that. But that was an interesting observation by me to look at what was going on in that, in reading the room, so to speak. So, without further ado, caroline, welcome. Thank you for volunteering to do this.
Speaker 2:Thank you for asking me um, so I guess the stuff down after that one. No, no, no, no, don't listen it. I know you know it's all true, you're just too humble to admit it, but but I think I think where the good place to start is. You know, psychology is a, is a is a field of such fascination for all of us.
Speaker 2:Many of us think we're amateur psychologists in terms of oh, I've been in the police 30 years so I can read people, and actually statistical evidence suggests I can read people no better than the average person. Or when you're going into interviews, you can't tell whether someone's lying or not lying any better than the average person. You might have some instincts, but whether you're actually any good at it or not is a matter of opinion. But we're all fascinated by psychologists. Over the last 20, 30 years, the kind of field of personal development and personal psychology seems to have exploded. So we all think we've got some understanding of each other and, more importantly, ourselves at some point. But I'm not convinced we really all understand some of the deeper meanings of the mind and of how humans behave, and of course, that's your expertise. So how did you get into, how did you become a psychologist and why did you become a psychologist?
Speaker 3:That's such a good question and there's so much to say in response. I think. In brief, however, because I really want to get onto the meat of what we should talk about, I definitely became a psychologist because of my personal background. I came from a family where there was quite a lot of psychological problems in a number of its members, quite a lot of psychological problems in a number of its members, and understanding those problems became integral, I think, to my getting along in life and surviving. Really, my father had very severe mental health problems and I spent quite a lot of time mental health problems and I spent quite a lot of time accompanying him to the local psychiatric hospital where he went for care. So from a very young age I was involved in mental health services as a as a you know a family member, a young carer and it, and I think that attunement from an early age meant that I was destined really to do a lot more of it. So for me there was never any choice about what I would do. I was never going to be an engineer or a lawyer or lawyers work very well with people but I think I was always going to be somebody who spent time talking to people well, ideally getting them to talk to me, because I think the biggest gift of any of us is to shut up and listen. Um, and I think that's what I've spent many years training to do is to talk less in order to create the opportunity for more information, to understand people better. Anyway, so I did an undergraduate degree in psychology that was in Glasgow and then I worked in a very low-grade post as an assistant psychologist. It's not a low-grade post In the grand scheme of psychology work. It's uh, you've got a graduate degree but you're not yet qualified to practice. So it's a kind of lowish post. But it's an invaluable post to get the credentials, to get the experience to enable you to then do a postgraduate qualification that specializes you in the practice of psychology. So for me, that was.
Speaker 3:My second degree was in clinical psychology. I was at glasgow university. I then diversified because I'm, um, I'm really interested in research. I really, if I, if I want to understand something, I like to go to the nth degree to try to do so. So I often did a doctorate, research doctorate, and then in I did a couple of postgraduate sorry, postdoctoral research fellowships and that took me to Liverpool University and there I also qualified as a forensic psychologist.
Speaker 3:Now, great question you asked about how can we determine people's credentials to be able to say that they are the things they say? Unfortunately, for the time being, the word psychologist is not a protected title. So anybody can call themselves a psychologist and indeed lots of people talk about themselves as amateur psychologists and that's perfectly fine. But to put themselves in a legal setting or a setting where evidence could officer or an employment specialist, whatever, I can't stop somebody from calling themselves a psychologist. But if they are a specialist psychologist, like a clinical psychologist or a forensic psychologist, that will be. They have to be registered with the Health and Care Professions Council as an applied psychologist so you can look them up. So if somebody calls themselves a forensic psychologist, you can just Google HCPC and UK, because this is only UK relevant but there will be similar schemes in other countries. You can check whether they are registered with the local organization, the national organization that sets the standards for practice.
Speaker 3:So if you look me up in the hcpc you'll see I'm registered both as a clinical psychologist and as a forensic psychologist and that should give you some reassurance that you're speaking to somebody who's got whose peers and academic institutions have said, yes, you've got the knowledge and, um, you can call yourself this thing.
Speaker 3:That's one part of it, but then the other part of it is the experience. So there's a difference between me and somebody who's just registered as a clinical or forensic psychologist and that's unfortunately no, it's not unfortunate, but 13 years of post-qualification practice. So I have cut my teeth in a variety of different mental health and criminal justice services and perhaps more for me than for others because of my research background, I have put a lot of what I've done into writing so you can check my papers that have published the articles, the book chapters and indeed the books, books. So that gives people a little reassurance. Not everybody does that. Lots of people are pure practitioners and are amazing, amazingly experienced. As a consequence, I'm just somebody that like to write things down, so I have more of a public profile than perhaps some of my more deserving colleagues have. So does that?
Speaker 2:yeah, I mean I guess where. The other question then is okay, so if you so, what qualifies you to be a member of the british psychological society? Then what does, what does that mean? Oh, right.
Speaker 3:oh, what british psychological society? Goodness me, I'm going to be cold out here. It's been around for decades, probably I would have said since the 50s. I should know that, but I can't remember. And up until 2005 or 2006, I wouldn't have been able to get a job as a psychologist unless I was chartered with the British Psychological Society.
Speaker 3:The Health and Care Professions Council became the registration organisation at around that time, became the registration organisation at around that time and it came to be that you know for a while well, I still do, but for a while lots of us had chartership with the British Psychological Society and registration with the Health and Care Professions Council. Currently, an employer like the NHS or the Prisons and Probation Service will in the UK will only employ you if you have that registration or you're working towards registration. The British Psychological Society has become a special interest group, but not something that's required in order to demonstrate that you have the credentials of a forensic psychologist or a clinical psychologist or an occupational psychologist. The BPS covers lots of different psychological specialities. The Health and Care Professions Council is really about those who work directly with other people in, or have the basis for doing that in a caring capacity.
Speaker 2:And what's the difference there between a clinical and a forensic psychologist?
Speaker 3:Yeah, great. So my training in clinical psychology took me all the way through mental health problems. So I did years of training in what is a mental health problem, the different ways in which mental health problems can impact on a person, how they develop, where they've come from and, most importantly, as a clinician, what we can do about it. So I trained in understanding mental health problems and in their treatment. So a developmental perspective, so that perspective of the past through to the present and into the future, is really important.
Speaker 3:In forensic psychology the focus is very similar. They overlap like two circles in the Venn diagram, overlapping circles in the Venn diagram. We have many things in common our wish to understand people, where they've come from, from, how they've come to be where they're at now and where they're heading. But the focus of a forensic psychologist is going to clearly be on matters to do with the courts. Right, it's going to be to do with people whose backgrounds and experience take them into um contact with other people that results in harm, of whatever kind, which means they come before get arrested, they come before the courts and they're prosecuted. So my forensic psychology colleagues in the UK, the Prison and Probation Services are the largest employer of forensic psychologists they are, and also trainees they are largely involved with understanding criminal behavior right and they will take.
Speaker 3:They've got training in mental. The kind of mental health problems that can be influential, like personality problems, which we'll come on to talk about the irrelevance in people's decision making leads to harmful behaviour but also the kind of mental health problems substance misuse, psychotic disorders which, in combination, along with early trauma, can result in reckless behaviour that leads to rule-breaking and law-breaking.
Speaker 2:And is there a difference between mental health problems and mental illness?
Speaker 3:That's another great question. Now, mental health problems is a term that would be used very broadly. So I can have a phobia about spiders and that could legitimately be called a mental health problem, especially if that meant that, you know, I had a family member getting married in Australia and I decided I couldn't go because I couldn't run the risk. Maybe outside the big cities I couldn't run the risk of encountering one of those what are they? Funnel spiders or any other such gruesome, beautiful, amazing piece of nature. So that would be a mental health problem. In the scheme of things, it's a fairly minor one and probably a fairly simple one, actually a fairly simple one to remedy. And then we could look at something like a psychotic disorder, which is a family of disorders, probably the most common amongst which is paranoid schizophrenia. It's a type of psychotic disorder and that's a devastating condition. The World Health Organization rated schizophrenia as probably the most disabling sorry, as the most disabling, probably about it as the most disabling condition in terms of its impact on all parts of a person's life and prospects. So we might use the term mental health problem to cover the full range from paranoid schizophrenia other sorts of really severe disorders like bipolar disorder, severe depression, some of the neurodevelopmental disorders that can come with severe complications. So that would be a type of mental health problem, as would our most simple phobias. And there's loads and loads in the middle and there are a couple of systems that we can, volumes that we can refer to the Diagnostic and Statistical Manual, which is published by the American Psychiatric Association, and the World Health Organization's International Classification of Diseases. These two volumes, which cover the whole practice internationally, list all the different conditions that there are, and that's a volume of mental health problems in the full range. We tend to use the term mental illness for the the most severe end.
Speaker 3:So if I describe somebody as mentally ill, I would generally be saying that they've got a disorder of such severity that either well, that occasionally they lose touch with reality and that's what we might say about somebody who's psychotic or they've got paranoid schizophrenia, and then they are in an acute phase they can't quite trust, or they can't trust at all what they hear because they're hearing things that other people can't hear.
Speaker 3:Auditory hallucinations are the most common form of hallucination a person might have, but it also means they can't always believe what they've come to believe, that they are safe, that the person that shares a bed with them is actually their wife or husband of 30 years, as opposed to a doppelganger who has been replaced because of something. Perhaps the big organisations like the CIA, the FBI, the security services they tend to get evoked or even the church. These big, powerful organisations are often evoked in people's delusional beliefs. I'm being followed or they're listening to me. The television is often, or mobile phones are often the means by which people feel that they are communicated with by these powerful forces that they can't quite control, and they can come to believe that they have to do the things that they're instructed to do by these voices. They believe that they hear and are genuine.
Speaker 2:It's genuinely the voice of god and is that where gang stalking fits in, in terms of these people feeling that, through these delusions, that they are being tracked by state or some other wider body?
Speaker 3:Yes, that would generally be the case.
Speaker 3:I mean one might want to check that out, because that old adage just because you're paranoid doesn't mean to say people aren't out to get you I work a lot with people who are in prison and you would be daft not to be paranoid in prison because you need to look out for your own safety, your own safety. There are various ways that we can test the the incredibility of people's delusional beliefs. There are sort of structured means that we can measure them, because we've got a bit of a sliding scale there. Some things are clearly delusional, clearly not correct.
Speaker 3:That somebody you've never met is in love with you not correct. That somebody you've never met is in love with you that is incredible. But what if you had bumped into a person and maybe locked eyes with them and maybe there was a little bit of a connection there? But then you went off and thought there is a connection between us and maybe inflated that? That could be, rather than a delusional belief, it could be an overvalued idea, something that you've maybe inflated, and maybe when you think about when you've been in your teenage years and you've got a crush on someone and you reciprocate that feeling, it gets little bit of a you know you want to believe it yeah, so there's a little bit.
Speaker 2:Pardon my dog's barking there it looks very well that'll be the postman that comes every single day, but anyway, um. So I mean, where do we start then? Because we've got a selection of terms that you know are used every day, I think, mindful of what's going on in the world of politics and all that and we certainly had a fascinating chat about this let's start with narcissism. What is narcissism? If you are narcissistic, what does that actually mean?
Speaker 3:That's it, you've got me. You're asking me a question about probably my favorite subject in the whole world, so you better watch the clock because I could go on at this at some length. And I, just so you know, I, from the very start of my training in psychology, my undergraduate degree, I looked at personality, and then my clinical degree, the research I did then, I also looked at personality. My, my doctorate was also on personality and then my postdoctoral research fellowships were in personality disorder and the, the link between personality problems and risk. And my clinical practice, since the ending of my second postdoc, which was early noughties, has all been, almost all been with people with personality problems. So this is a. This has been my professional background, and narcissism and its pathological forms has been probably front and centre.
Speaker 3:Because the question you need to follow up with is well, what's the difference between pathological narcissism and psychopathy? But we'll come back to that. What's narcissism, right? Well, narcissism is a form of personality, it's a personality trait. We might say it's a personality trait, we might say it's a strand of personality. It's associated with self-regard. So we all need to be a little bit narcissistic. Okay, if I had, when we were in the pub, if I had, just, apropos of nothing, reached across the table and poked you in the eye, you would have quite rightly said how dare you? How dare you do that?
Speaker 2:Or something similar, or something similar.
Speaker 3:That would have been a wrong thing for me to have done. It might be physical harm. I could have said something really rude or something very critical of you. It was completely unjustified and you should absolutely have been uh, not accepted that and that's your a normal, healthy level of narcissism, saying I am, I am worthy of respect. Okay, if you had said, oh gosh, I wonder what I did to deserve that, because I must have deserved it, that would be a bad thing.
Speaker 3:And I've worked a lot in services in criminal justice services, prisons, secure hospitals, where I've worked with people who have been like that, who simply have no capacity to stop people from harming them. They have been victimised, often from a very young age, and just assume that a victimised state is the natural state for them, because they lack even a basic level of self-respect and self-regard, so they've got no barriers, so they get together with people who hurt them continuously. So it is important and healthy for people to be a little bit narcissistic, but it's on a dimension and people can be a little bit more narcissistic than most and some people can be narcissistic to the point that it's a problem and that's where we would start to think about pathological narcissism or narcissistic personality disorder, where a person's got more than a sneaky suspicion that they're better than other people and they actually go out there and act in a way that undermines others. They don't just, they are people who might show off in a way that can be a bit irritating. I mean, we've probably all met people who are a little bit you know, they've got lots of. They brag a lot in a way that can be a little bit boring. That's kind of you know, that's okay, that's fairly harmless.
Speaker 3:But if the way in which they self aggrandize is at the cost of other people, so they put other people down in order to feel better about themselves, they might say something like see you, see you, you're a, you're a really low level person. See me, I'm a much higher, higher level person. So that's that's where it starts to become more problematic, where I'm putting you down in order to feel better, and often when there's an audience. So, and in my pathologically narcissistic state, I might think those people are looking at me and thinking, oh my gosh, I want, I wish I could be like that person. The assumption is that by making these sorts of statements, I'm putting myself in a position where I'm admired. I'm not just looking for attention, I'm looking for admiring attention.
Speaker 3:Is there a difference then between narcissism and vanity? Well, they certainly overlap. Lots of us can be a little bit vain. Um, I, I, I have spent moments in front of the mirror this morning because I'm thinking you know what I've? I've brushed my teeth because you know I'm going to confront somebody online and I want to be respectable. So that's vanity.
Speaker 3:But where you've got a person who cannot pass a reflective surface without looking at themselves in the mirror, then you're starting to worry. For me. I might think well, that's a curious little piece of information. There could be very good reasons for that. It could be quite insecure. So one would never take one piece of information like hogging the mirror and make an assumption that means you're pathologically narcissistic. It just means that's an interesting piece of information. I might be curious enough to look for other pieces of information that suggest a self-centeredness, as in I am the center of my world and I've made an assumption that I'm the center of yours as well, even though I've only just met you, even though we've not even met. So vanity can be a component part.
Speaker 3:But we can see vanity in lots of very balanced, healthy individuals. In pathologically narcissistic people we will see vanity in spades, in absolute spades. So even once we get to pathologically narcissistic, even then we've got grades of severity. So one could have a boss who's mildly personality disorder narcissistic personality disorder, like a mild form of it which just means that they are a bit of a nightmare to be around. They're always talking about themselves, they hog the conversation, they put other people down. But you know they're good at their jobs, they can work. They don't hurt people, they're just a bit irritating. They can claim the credit for things that other people have done. That can lead to complaints in a work setting.
Speaker 2:Sounds like a politician to me.
Speaker 3:I'm saying nothing. Can I just say that?
Speaker 2:in the private conversation. I didn't mean a politician. I mean politicians genuinely that they kind of claim the credit for everything and you know it's always about them rather than others.
Speaker 3:I wouldn't like to generalise, because I think I've met and followed some politicians, that I have huge amounts of respect for yeah, I agree. I wouldn't like to generalise, but we could name those on one hand couldn't we? I think that what you've got to be. However, when you think about people who are public facing, they have to have a lot of self-confidence, don't they?
Speaker 2:But the interesting thing is how genuine is that and I have a belief in you, yeah, how how genuine is that? Yeah, but how genuine is that in terms of is it based on fact or is it based on covering an insecurity?
Speaker 3:yeah, that's a, that's great. And and that's where a superficial look at them on the television, for example, is not going to answer that question, um, and even like a documentary going into them in more detail wouldn't necessarily answer that question. The best way unfortunately for everybody else apart from me and people like me is the best way to figure that out is to sit down with them and uh and let them talk and apply. You know, I say I've done lots of work on personalities.
Speaker 3:I've got lots of sort of frameworks of personality in my mind which help me make sense of what people tell me, because we are like a species of storytellers and we make sense of ourselves and we make sense of the world and we make sense of other people by the stories that we tell of them, that they tell of us, that we tell of each other. So my job, the job of all my wonderful colleagues, is to evoke those stories and it's through the stories that we can start to see how people are put together, whether they're put together well or whether in fact they're not put together so well at all. They're a bit of a, to coin a Scottish phrase, they're a bit of a shugly hoose, so they're not very stable, or whether, in fact, the foundations are secure and you've got a castle built on rock.
Speaker 2:So can a narcissistic. As in a pathological narcissistic person can they be dangerous yes, they can be, and that's the severity thing.
Speaker 3:Um, even there might be people quite severely narcissistic, severely narcissistic or extremely narcissistic. They can function somewhat, but they are much more likely to have trouble. So, if I believed that I was the only great person in the world, if I walked into a room, assuming that everybody else admires me and wants to be like me and is prepared to give me money to do that, I'm thinking I deserve this. I truly am a force for good and these people should be grateful to be around me. So, yes, I'll just charge you whatever it is and you can sit at my feet, blah, blah. Then you've got extortion, you've got fraud, which is deeply problematic. You've got the potential to influence people who are vulnerable to certain sorts of messages. So you can have an online or even online presence and you look at cult leaders, for example, and you might see some of these traits in those individuals who put themselves on a higher plane and expect and reinforce and demand, sometimes with menaces, the devotion of others, including the financial handing over the money. We can see. I see pathological narcissism in quite a lot of the people that I have worked with that have assessed in my job. So, for example, we may see pathological narcissism in people who commit serious sexual offences like rape. So what we might see is a person who thinks they are the big cheese, super big cheese, and they are with another person who thinks they're the big cheese, super big cheese, and they are with another person who does not act as they expect and they have a sort of frustrated entitlement. So I have taken you out, I have shown you a good time, I have whatever.
Speaker 3:I you know, if I was the pathologically narcissistic person, I feel I might feel entitled to take something from you which could be intimacy, whether you like it or not. Because I'm old, because I don't see you as a three-dimensional person worthy of respect, I see you as an object for my pleasure. That's when we get to the extreme levels of pathological narcissism. We have those highly dysfunctional relationships, attachments towards other people which enable, permit these, really can permit these really harmful acts to take place. So a person might force themselves on another person, on a victim, and feel perfectly all right about it. They've taken what is in their minds, they're due. So in that sort of situation, a person has been victimized directly as a consequence of the personality problems experienced by the perpetrator and what happens then?
Speaker 2:when you challenge or confront those people in so much as you're saying to them you're not the big chief, you're not the person you think you are and you're challenging their self-perspective.
Speaker 3:That's a good question and I would do that. I do do that, but I have to be clear about the reasons why I'm seeing that person. If I'm seeing a person for therapy because I want to shift some element of their element of how they express them, their personalities, maybe less value, and saying, see you, um, you're you, you're not a big choose, what that's going to do is make the person feel injured. We might refer to that as an narcissistic injury which generates narcissistic rage in a sort of a cyclical way to humiliate that person is to invite them to then dominate me to prove.
Speaker 3:You're wrong to prove you're wrong, yeah, because I've around. So if I think I'm a big cheese and, um, you come along and say, caroline, you're, you're nothing, you know, you're just. Uh, this other that, um, you're, you're in prison, you're in prison, you're whatever, you're no big cheese at all, I will feel humiliated. As a pathologically narcissistic individual, I will do anything to avoid humiliation, guilt, embarrassment, these emotions which most of us feel sometimes and live with. It's unpleasant.
Speaker 3:We'll try and make amends, but for a pathologically narcissistic person, what you will tend to do is get an overwhelming um rejection of rage in order to protect that super vulnerable part of them. They cannot accept that. So you'll see them hit right back in a way that's proportionate and scale and nature to the injury they've perceived. So if I've said, if something, if I said to a person, uh, you're not, you're not a big cheese and what's to that effect, they'll probably come back to me and see see you, you dirty little woman, you're a, you're a, you're a troll up, you're, uh, you know, and really me down, much more so than me saying you know, you're not as big as you think you are. They might absolutely come after me and they can come after me to my face. They could come after me physically in intimidating, aggressive or even violent gestures, or they could go to the ACPC, for example, and say see her, she's no good, she's unprofessional, and make a formal reputational complaint.
Speaker 2:So sort of malicious complaints and malicious allegations, is that kind of one of? Their work methods.
Speaker 3:Definitely it could be one. I mean, and this is why the organisations like the HCPC in the UK are very good at saying, okay, well, let's look at both sides, let's look at contemporaneous records that were made by both sides and let's test this out, because it is definitely the case that people in positions of trust abuse some hopefully a very small number of people in positions of trust abuse people in their care clients. So it's for an independent body like the HCPC to determine the maliciousness or otherwise. But I could have been unprofessional yeah, you could have done something that was way over the mark.
Speaker 3:I could have humiliated, literally humiliated that person so that somebody is you know you're stopping in the conversation might have thought whoa steady on yeah that's whoa. That's unnecessary, so the person has got a right to complain. Sure. But if it was a professionally inspired comment about a person, what if you're not the big cheese? You think you?
Speaker 3:are, and I'd like to think I'm reasonably thoughtful about these things. I don't like triggering people's rage. I'd prefer to try and understand where it comes from and come alongside it with alternative ways of protecting themselves and unacceptable feelings, which does take a little time. It's not a quick fix. So I would like to think I don't generally do these sort of humiliating type things, but I think it's entirely the right of the person to stay steady on.
Speaker 2:To defend themselves. That was a net yeah. So in terms of the spectrum, then if that's a correct word of personality disorders, when you hear the term borderline personality disorder, does that mean they're on the cusp or is it because it infers that? Is that what it means? Because it infers that?
Speaker 3:Is that what it means? Borderline personality disorder is a very controversial personality presentation. In the American system, the American Psychiatric Association system, which I mentioned earlier called the Diagnostic and Statistical Manual, it's called borderline. In the European sorry, in the World Health Organization system, which tends to be used in Europe and the rest of the world, it would be referred to as emotionally unstable personality disorder, with or without impulsivity. So we can use borderline emotionally unstable generally to mean similar things.
Speaker 3:If you're a professional person professional person, although borderline is maybe something that's got a more common usage a bit like narcissistic, which means, just as you were saying earlier on, that these terms can then take on a meaning of their own.
Speaker 3:They can be used in ways which are more fuzzy than I might use them. I might use them to mean something really quite specific. I might use them to mean something really quite specific. So borderline is a pattern of personality characteristics, or characteristics thought to come from the essence of the individual, which are associated with the presentation of instability.
Speaker 3:So the behaviour might be unplanned, the mood can change quite quickly, the attitude towards relationships can change quite quickly and rapidly and the ways in which, for many people who are not, who have not got that label, they may change more slowly.
Speaker 3:We might change like a big tanker in the sea, a little bit slowly, and this is a very severe event, whereas people who might have this label professional label, borderline personality disorder can change pretty quickly and that's a horrible way to live if you just felt like the sand under your feet was constantly shifting and changing and not knowing what kind of mood you're going to be in in a day-to-day basis, not knowing really how well to manage your mood and what we can, sometimes, by no stretch of the imagination, always.
Speaker 3:We can sometimes see people turning to medications prescribed, or indeed not prescribed, and alcohol as ways of trying to manage emotional swings quite understandably, but often what that then does is just compound the original problem, make it worse and worse, because then you've got drug and alcohol problems, maybe financial problems arising from that. So we can often see, by the time I see some people with this borderline presentation, there's a sort of tangled nest of difficulties a person might have. Most of those difficulties are going to play out in relationships with other people, including with me as a therapist or psychologist.
Speaker 3:So borderline, the term does suggest that a person's perhaps on the cusp of being more disordered, but that's more of a historical. The term was developed. The term was developed. The term was used first used to describe this condition associated with instability and impulsivity.
Speaker 3:Um, maybe, oh gosh, I'd have to check but probably about 80 or so years ago, and it meant something different then from what it means now, because we've done a lot more research, but what it does tend to be associated with and these we can drill down all the personality types to essentially problems in two areas problems with a person's sense of self and problems with a person's way of relating to other people. Now, if you think of yourself, you might think well, what does that mean? Well, if I were to ask you a question, how would you describe yourself? And we might have a chat about it? I would synthesise from what you said your sense of self. I would synthesise its nature. Are you an outgoing person or a bit more shy? Are you a person prone to worrying about things or are you actually deadly back? Are you somebody who's got a really fertile imagination and can weep over amazing music, or you know, in a modern art gallery, or you walk into a gallery and think, jesus, how much did they pay for that pile of bricks? You are you the kind of person just generally gets on with other people, or are you a little bit antagonistic? Are you a very disciplined, careful person, meticulous, or are you a little bit slapdash? So I would be able to synthesise the nature of you from what you would tell me in response and the stories. I might then encourage you to tell me who first described you as that thing you've just described yourself as. Give me an example of what that was like. So I'll get, I'll have a chat about it and I'll synthesize the nature of you. But also what I'll try to do is determine, um, the, the coherence of that sense of you.
Speaker 3:I would imagine from just recent chats, philip, that you've got quite a strong sense of self. You are the same every time I meet you Not very often, but you're the same person. You speak in the same way, you relate in the same way, You're not easily offended. You're not same person. You speak in the same way, you relate in the same way, you're not easily offended, you're not easily distracted, you don't dominate. So I've got a sense of you already, building slowly over time, and I've got a sense that the sense I'm getting of you is built on quite strong foundations. These may have come from your early upbringing or they may have been acquired by you, or both. Indeed, through a strong identification with, for example, being a police officer, being in you know, other areas of professional practice in your life, these, these identities become very important to us. So what? My identity as a psychologist is fundamental to me. If you took away my ability to practice as a psychologist then it would be. I'm not sure what I'd do. So when we talk about borderline, oh sorry.
Speaker 3:And just to come back to self and the way a person sees themselves impacts how they relate to other people. So if a person's got a strong foundation, a strong sense of themselves, what they say about themselves it marries up really well with what other people say about them. Then they can go into any situation, know how they're going to react pretty much most situations. Obviously there will be curveballs occasionally, but you know pretty much what to expect of yourself, what other people can expect of you, and that provides security In that personality presentation called Borderline.
Speaker 3:That sense of self tends to be on a sugary ground. It's not securely founded. I might ask a person how would you describe yourself? And they say don't know. And even when you probe it, they actually don't know. They don't know the words to say don't know what they're like. And that's for me it's genuinely it's difficult to hear somebody say that, because then if you don't know who you are, if you're not sure who you are, then you're not sure how you're going to react in different situations. You're not sure what you want, so you might try lots of different things and waste time and money.
Speaker 2:And is that insecurity? Is that the same thing?
Speaker 3:Well, it certainly relates to it. They've got an incoherent, not well-constructed sense of self. There may be walls missing, there may be parts of them that are just not functioning very well, which means that relationships then become an absolute minefield and distressing potentially, because they might get involved with somebody who likes them rather than they like the other way around. Most of us we spend time with people we like, who, coincidentally, tend to like us too, but for somebody with a borderline presentation, it can be difficult to know whether they like that person, because they're not sure how to read the other person.
Speaker 3:Now, that can have a variety of different origins. It can be about them having been raised in a situation um, a caregiving situation from a young age, where their parenting, caregiving was inconsistent. They were maybe given contradictory messages One day you're mummy's wee princess or prince, next day you're a little shit, and so they're like what the hell? They are told words, or indeed not told words, about their emotions. So you know what it's like when you're little kids, and from a from smallest age, your tone of voice, your physical comfort that comes with that tone of voice, is consistent, ever present, reliably present. As they become little, people become more verbal, observant and verbal. They can detect the tone of those emotions. Attach the emotions to the words that are consistently used to describe them happy, sad so that they then acquire the words and the words have a reliable meaning, so that when they are older and they say I am happy, when they're older and they say I'm hungry, when they're older, they say I'm angry. That's precisely what they are, what they are.
Speaker 3:But for people with disrupted early upbringings or upbringings, but people who are maybe not in the best position to coach them in these things, which might happen for a variety of different reasons they don't acquire that internal dialogue, so that when I come along and say how would you describe yourself? I don't know.
Speaker 2:Because it's inconsistent.
Speaker 3:Or they might say bloody blah.
Speaker 2:Yeah.
Speaker 3:And it doesn't marry up with what they like. Yeah, because they've just said things that they think I might want to hear.
Speaker 2:And so I guess the question then is is that all nurture or is some of that nature? You know, in terms of the subject matter that we've talked about so far, is it nature or is it nurture? It's their kind of defining question, isn't it so? I mean, some people may be, I guess, born with problematic or misfiring brains or the synapses haven't connected properly, etc. But the vast majority of us are born with the same kind of functions. Is it their nature that creates these personality challenges in us?
Speaker 3:yeah, that's a huge question and is, exactly, as you say, the defining question really of our, of our, any of us who refer to ourselves as a psychologist, amateur or otherwise, um, concentrate on, um, I'm going to be a really annoying psychologist and say, well, it's a bit of both um any anybody.
Speaker 3:Um, it's a little thing. I usually wouldn't do training and talks or something. I would say this and it always. It tickles me the response I say to an audience of people, those of you with more than one child how soon did you realise that your second child was completely different from your first child? And usually people laugh and the responses are often either from the women while I was carrying them, oh, wow.
Speaker 3:Because of how squirmy they were in the second, third trimester More often than not within weeks, if not even days Depends, and the key ways in which they might be different from their siblings is in terms of the things I mentioned earlier about how prone they are to worrying about things. So some children are very laid back even from a very early age and some are much more anxious, need more comfort, more cuddling, a little bit more. They need to be reassured that you're not too far away, how sociable they are. Is this a child who's really happy to go to any sort of party and can just you know, it's really quite spontaneous and just won't pile in there to a little kiddie's party and just get playing with the other kids? Or are they the kind that sort of want to go with mum, want mum to stay there for a few minutes or even go to the party with a friend so they're not there alone? Uh, from the very start they're fine once they get there, but they might have had some anticipatory anxiety. So that's social anxiety and how open they are to new things, you trying new things, and then that sort of um agreeableness, how well they kind of get on with other kids or are they a little bit more of a loner, a little bit more independent, emotionally independent? And then how sort of disciplined are they? Or can they be? So often, from you know, in the early day months into the early years, we can see those differences. So it's clear, and the research evidence is clear, that we are born with propensities to be certain kinds of people, and the big five personality dimensions neuroticism, extroversion, openness, agreeableness and conscientiousness are ones that we, the field, feels that there are biological markers of that we see behavioral evidence of from a very early age. Okay, so we're all born, we're not blank slates. We're all born with a little bit of this and that which then nature, as soon as we're born, nature kicks in. Sorry, nurture kicks in, I beg your pardon, nurture kicks in and shapes it. Now, good enough.
Speaker 3:Parenting we're not talking about excellent parenting and you know I can't imagine anybody. Um, well, I'd love to think people could deliver that, but I think most of most people just do well enough and that's good enough. Most of the time you're there for your kids, you're there, you know, you're consistent and that's enough. Kids manage and they do pretty well out of that. But sometimes that parenting goes askew, or that caregiving goes askew for whatever reason. There can be a whole host of reasons and the messaging is inconsistent and the the that those parental figures are um only occasionally there or present emotionally in the room and um that that the person's ability to manage themselves then becomes poorer.
Speaker 3:So let's say somebody's quite a little child's born, quite two little children, separate families are born quite neurotic, high in that tendency to worry about things. Good enough, parenting will help that child over the years to feel that it's okay to be worried about things. They'll model their parental figure, might model being worried about something and then just dealing with it. And then they might show the child how to deal with being worried about things so going to the party, picking up a friend on the way so they don't miss out on the party, they get to the party and they have a great time. So they know that anxiety and worry about things can be overcome and maybe teach them how to make lists and things so they're nice and organised.
Speaker 3:So one parental figure might help that anxious, dispositionally anxious child to deal with it. And another situation caregiving situation where that caregiving is more haphazard, more intermittent, harder for the child to understand that tendency towards being anxious might simply never be really trained and disciplined and managed so that young person may grow up thinking I can't control this unless I do more drastic things like act up in school or steal something or, um, you know, do something that hurts me, um, and so we can see we've got the same characteristics or traits, but nurture makes the difference in how they're expressed. Okay, that makes sense. So part of my job when I'm working in a therapeutic capacity is to look at how people have learned to express themselves and see what we can do to maybe loosen the ties of some of that early learning.
Speaker 2:So there seems to be an increased popularity over the last few years with personality tests and psychometric tests and all these other things, and separating us into colours as an example is a kind of popular one, and it's one that we did in the police. It started years ago, obviously, with Myers-Briggs and all that sort of stuff. What's your kind of perspective, from from your expertise, on the validity of these tests? And I appreciate they're all different, but but in general terms, if I just sit down and take a test, how accurate is that likely to be?
Speaker 3:yeah, great question. There are actually several different ways that we can assess people's personality Self-report questionnaires like Mars, briggs and lots of the questionnaires that are available out there. These are probably the most common ones. They're generally quite cheap. They're generally quite diminished, don't take very long maybe take 20 minutes or so. There's some much longer ones, but they generally don't take very long. Maybe take 20 minutes or so. There's some much longer ones, but they generally don't take very long.
Speaker 3:An algorithm can give you a readout on yourself and it can be quite fun to do and, especially if you like, myers-briggs works. You know, like how do we put people together like pieces of a jigsaw to create a bigger picture that functions. That works fine, but there are alternatives and I'll tell you why there are alternatives in a moment, but I'll explain what they are. I an alternative I use a lot is, uh, what we would refer to as a semi-structured clinical interview, so that's like a scaffolded interview that I'll use with somebody, so they won't be filling out a piece of paper, ticking boxes in a piece of paper. Instead, we'll be having a conversation like this, but I'll have a piece of paper. Instead, we'll be having a conversation like this, but I'll have a kind of framework, probably in front of me in the form of a book, so that I don't miss out anything that's important, and I'll go through that and try to draw you out with questions, and try to draw your answers with probes to get a sense of both the nature and the severity, if there are problematic characteristics, of what these are, and also to differentiate them from other conditions, because if somebody is, let's say, depressed, I don't want to mistake that for pessimism, for example. So we've got various rules and things, juristics or or guidance that we want to rule out some of these things like paranoia. I don't want to attribute your paranoia related to your paranoid schizophrenia, to paranoia as a personality characteristic. So we've got various things that we need to sort out first before I would then do this interview, and interviews are generally regarded as the gold standard in personality assessment. I'll come back to the reason why momentarily just to say that the other options are for me to interview other people about you again with this sort of structure, and I could do that in a self-report format or I could do it in an interview. And then there's these um, I think they're quite fun um projective tests. So you've heard of the roshash inkblots or the thematic perception test, where a person is given ambiguous stimuli, either like an inkblot or a photograph that's unclear, and you're invited to tell us the person's invited to tell a story, and I pull out strands of the story as an indicator of what's underneath in your personality. We don't tend to use that so much in in the uk. The projective techniques are used quite a lot in scandinavia, in North America and in other places. So here mostly, what happens here?
Speaker 3:Probably mostly self-report questionnaires and specialists like myself would do the interviews. The problem with the questionnaires is two things. One, people can lie and it tends to be in these questionnaires. That's pretty obvious what the right answer is, the one that presents you in a good light. So people will tend to because they don't want to. It happens to me if you're doing an employment interview in an assessment centre for a job, there's no way you're going to say, oh, I'm a horrible little person. I think horribly of my colleagues. You know I'll speak about the behind your back. You're not going to say these sorts of things. Was that which is a problem? Which is why in my practice I might use the self-report questionnaire, but I would also use an interview yeah and I'm also speak to other people, so I tend to triangulate my assessments.
Speaker 3:So they're really thorough. But the other thing is people might simply not have insight into themselves. Look, I can give you just really quickly. Are we okay for time?
Speaker 3:yep just a really quick little anecdote. I worked with a person in a in a secure hospital once he's no longer with us, but he was a fascinating gentleman and who was very happy to talk to me, which I felt very grateful for because he gave me great insights both into his nature and also into the nature of people like him, and people like him are people with very severe levels of pathological narcissism. He was a person who'd committed a sexual offence that was directly related to his pathological narcissism was a person who had committed a sexual offense that was directly related to his pathological narcissism revenge for sexual attacks on women he felt had slighted him.
Speaker 3:So I went to him and this was just touching on what you said earlier on about confronting somebody. I'd reached the point where I did have to do a confrontation because he was trying to. He was applying, through Toibino to go to conditions of lower security in this forensic care system and I had to say, look, I'm worried about this application because there's a couple of things that are wrong or a couple of things that are not in your favor. One is that you haven't engaged in treatment specifically to do with the offenses that you committed and the other is the difficulty you've got acknowledging that other people have a problem with you. I put it better than that, but basically is that you know there's still a lot of personality problems and there there have been interventions available to you here that you could have used to try to address that. But you're a blanket denial of the behaviour and of the personality problem and I was very careful the way I told him this, because there's nothing to be gained by annoying him. He was a bit on this and it was because there's nothing to be gained by, you know, by annoying him and he was a big lad. I certainly didn't want him to hit, I didn't think he would, but nonetheless I was thoughtful. I didn't want to get his back up, so he didn't hear what I was going to say.
Speaker 3:Anyway, he started to cry. Now, that's not something I'm proud of and it's not something that happens very often and to be honest, I was a little bit startled. I hadn't expected him. He's a very sort of hyper masculine man, so crying for him was something that I thought was oh. My immediate thought was oh shit, he's going to feel humiliated about this and he might take that out on me. And I thought then he's not going to hear me what I saying and I really want to erode some of this self-belief. He's got in his innocence and in his perfection. So we carried on talking. He didn't get aggressive at all and anyway talked a little bit more. And when I left the ward I said to the nurse in charge look, this is what's happened. Can you keep an eye on him? I didn't think he would hurt himself, but it wasn't inconceivable that he might have gone out and had a shout at somebody else. And anyway, nothing untoward happened and a lovely person, kept a good eye on him, supported him afterwards, they had a cup of tea afterwards and they had a chat about it.
Speaker 3:Anyway, I was on the ward a couple of days later and the the person the patient said indicated to me from across the room I want a word with you. So I went up to him and said do you want to talk now? He said yes, come with me. In that quite um, quite dominant way of talking he had asserted himself he was back on top, in a sense. Fortunately, the same nurse in charge was on and watching. So he indicated he would keep a wee eye on things.
Speaker 3:And the patient led me into the room and indicated for me to sit down and then leaned over the table, put his hands on the table and sort of leaned over the table towards me and said and I am paraphrasing, it was a while ago but I have not forgotten what he said he said this isn't easy for me to say, but I want to apologise for upsetting you the other day. And I said tell me what you remember about our conversation. And what he recalled was me feeding back and I had the paper copy of the report in front of me, feeding back my report and crying. He has a in front of me reading back my report and crying. He has a distinct memory of me crying, of me feeling pressurised to say things that I didn't want to say about him and getting upset about that, and he wanted to know that. He understood the position I was in and he forgave me for that. Now, my understanding of that was that he was stuck between a rock and a hard place. He likes me. He hated what I was saying, so he had to reconcile the two, and he reconciled the two by telling himself, and acting accordingly, that I had been made to say these things by other forces, the other forces being like the authorities, and that's how he made sense of it in his head.
Speaker 3:Now, that's a fairly clear-cut example. We can all do that in tiny little ways where we maybe shift our recollection of events to make ourselves feel a little better about, maybe, something that happened or was said. In tiny little ways, where we maybe, you know, shift our recollection of events to make ourselves feel a little better about, you know, maybe something that happened or was said in tiny little ways. But if we're working with people who've got more severe personality problems, we can see these distortions happening all the time, so self-report questionnaires won't pick those up or will in fact only reflect the distortions, so we can't rely on them. They're not necessarily reliable indicators, which is why I always use another form of assessment in addition to self-report, if I suspect and is it also?
Speaker 2:there's an issue must be around context. So you mentioned the word paranoia earlier on. Excuse me, somebody might be feeling paranoid at a specific time because there's a specific set of events going on in their life and therefore that sense of paranoia may not be their baseline. It's just that's how they're feeling right now because of something external.
Speaker 3:Absolutely. We will differentiate between state and treat. A self-report questionnaire is much more likely to pick up your state. A self-report questionnaire is much more likely to pick up your state. So if you've had a horrible journey into work and you're in the middle of a difficult, you're moving house and whatever you know you've got, the kids are having exams and that's your family members are driving your potty and I sit down and say fill in this questionnaire. That's going to tell me how you feel. I'm going to get it both bottoms, quite rightly. But if I caught you in a day you know you've just come back from your holiday, you're, somebody else is looking after your inbox no crisis that come on while you were on holiday and you're still on your day four after your holiday and you're still in that floaty mood, I'm gonna give you my questionnaire.
Speaker 3:Okay, I'll get the floatiness yeah, yeah, yeah so self-report questionnaires can really pick up on that state trait sorry, the state that will be impacted by state. A clinical interview will allow me the opportunity to see that, because invariably that clinical interview will be conducted in more than one session. I like to spin things out, so I like to see people several times, if I possibly can um, so that I can get a sense of how they change over time. And especially if so, I quite often interview people on um video links, or prisoners on video link, which allows me then to see them about five, six, seven times and stuff will be going on in their lives in the prison and so forth, and I get to see them with different contexts, different stuff going on, and I get to see what the continuity is. So context does matter, it colours.
Speaker 2:So, caroline, so far we've talked, you know, a range of subjects around personality disorders and and the personality, how it grows, how it can be managed, how it develops, etc. Um, and that's been, for me, just fascinating. It's got my mind working and, you know, I think perhaps maybe many other people might be doing the same, but I'm kind of self-reflecting on my own life and my own upbringing, my own you know, personality weaknesses or vulnerabilities that I've experienced over the years, et cetera. We're going to kind of close this particular session now because I know what we are going to do is then move on for next month's session to what some people might think are the more dangerous aspects in terms of, you know, psychopathy and functional psychopathy.
Speaker 2:You know how do CEOs who are psychopaths, or these high functioning psychopaths that we keep hearing about I've got a book somewhere saying psychopath in suits you know how do they function, as opposed to the guy that goes out and commits mass murder or something so fantastic talking to you for phase one those of you listening stand by, because phase two will come in a month's time and it'll be even as interesting as, or even more interesting, because we're moving on to a really interesting area that I think those of us that sometimes are working in the areas of risk, we hear these terms, we don't understand them and you know, I've got a couple of examples where I can talk about, where I know that Caroline will clarify whether that was right or wrong. So thank you for now and we'll move on to phase two.
Speaker 1:Thank you for listening to the Diffuse podcast with host Philip Rendell, CEO and founder of Diffuse. Please rate, review and subscribe on your favorite podcasting platforms.