Learn to Deal with Mentally-Ill Clients

mentally-ill-clients

Lawyer and psychotherapist Elizabeth Wittenberg starts her article, “Are Your Clients Making You Crazy? How to Avoid Drama with Maddening Clients,” with this eye-opening quotation:

Statistically, over 9 percent of American adults have a diagnosable personality disorder … .

In other words, it is not your imagination; some of your clients really are mentally ill. In fact, depending on the kind of law you practice, the percentage of your potential client base with a diagnosable personality disorder is probably substantially higher than the average.

Personality Disorders

A personality disorder, according to Wittenberg, is an “enduring pattern[] of behavior and subjective experience that affect[s] a person’s thinking, feeling, relationships, and impulsiveness.” And, she says, “Often the affected person sees these patterns as perfectly reasonable and appropriate despite their dramatic, negative impact on her daily life and the lives of those around her.”

People with personality disorders have “limited life scripts” and usually behave in “fixed, unyielding ways” that often force people around them to play implicitly-assigned roles like caretaker or bad guy. In other words, personality disorders have a sort of ripple effect on those around the person with the disorder — clients with personality disorders can make you feel disordered, too.

Common Personality Disorders

Here are a few common personality disorders you might see in your practice:

Disclaimer: I am not a psychologist; everything in this post is based on Wittenberg’s article, which you should definitely read.

Narcissistic Personality Disorder

Narcissistic personality disorder is a condition in which people have an excessive sense of self-importance, an extreme preoccupation with themselves, and lack of empathy for others. (from NIH.gov; also, see Wikipedia)

Wittenberg says clients with NPD are often cooperative and engaged, at first, but they will start blaming others and lashing out if unexpected problems arise. She says it is very difficult for clients with NPD to take responsibility for anything, or even to admit they played a role in their problems. And they don’t like to be called on it. Clients with NPD may storm out of your office if you point out the role they played in creating their problems.

Narcissism often conceals extremely low self esteem, which narcissistic individuals conceal beneath a self-important shell, reinforced by affirmation and acclaim from people they admire. Wittenberg recommends helping narcissistic clients maintain their self-esteem by treating them with utmost courtesy and respect. Go along with their desire to see you as worthy and high-status. Let them think of you as “the best,” but be careful not to appear to compete with your client. As exceptional as your client wants to think you are, you must come in second to him. Suppress your irritation at your client’s bragging and witticisms; narcissistic clients need your endorsement, and they will probably settle down and stop begging for it if you stroke their ego a little bit.

Where things get especially difficult with a client is in settlement, particularly in criminal matters, where the client may have to acknowledge some responsibility. You must convey to the client that you are on her side, and explain why it is necessary to accept some responsibility while preserving as much self-esteem as possible.

Do not fell into the trap of getting demoralized while working with a narcissistic client, who will never recognize the quality of your work. Satisfy yourself that your work is up to par, and do not get preoccupied if your client does not recognize it.

Antisocial Personality Disorder

Antisocial personality disorder is a mental health condition in which a person has a long-term pattern of manipulating, exploiting, or violating the rights of others. This behavior is often criminal. (from NIH.gov; also, see Wikipedia)

According to Wittenberg, “[p]eople with Antisocial Personality Disorder or features of this disorder often come into contact with the legal system. That’s because a key marker of this disorder is ‘failure to conform to social norms with respect to lawful behaviors … .” That does not necessarily mean criminal behaviors, but people with ASPD have an “overriding motivation to pull something over on others,” and take pleasure in consciously manipulating people. You are as likely to find them at the head of a corporation as in the back of a police cruiser. They are reckless, lack remorse, and are highly impulsive. They either rationalize the harm they do to others, or don’t care.

People with ASPD need to control others and to feel powerful. Like narcissistic clients, they may brag and deny responsibility for their problems, but they will do it in different ways. A client with ASPD is more likely to brag about illegal activities and characterize illegal activity as something everyone else does, too. They also lie a lot.

Put this together, and clients with ASPD can be dangerous to work with. Wittenberg says “[t]he most important thing … when working with antisocial clients is … to maintain safety.” Schedule meetings when other people will be around. Adopt a firm and direct approach so you are seen as strong, not weak. Be rigid when it comes to expectations, billing, and other aspects of the representation. (Antisocial clients are a good reason not to be lenient with payment plans, or not to accept them at all. They will take pleasure in skipping out on your bill.)

In order to forge a relationship with an antisocial client, you have to play to her need to control. Make yourself useful to her by showing her you can help her get what she wants if she works with you. In discussing the legal matter, focus on consequences, not legality or morality.

Antisocial clients will tell you only what they think you need to know, and usually omit details in their narratives. You must elicit detail without challenging your client, which could send him into a rage.

You will probably feel uncomfortable with antisocial clients, and possibly contemptuous of them. You may even be afraid of them.

If you find yourself working with antisocial clients, do not allow yourself to be intimidated or cheated. Be skeptical of everything you hear (a good quality for a lawyer, anyway), be safe when meeting with your client, and protect yourself financially with adequate retainers.

Borderline Personality Disorder

Borderline personality disorder (BPD) is a mental health condition in which a person has long-term patterns of unstable or turbulent emotions. These inner experiences often result in impulsive actions and chaotic relationships with other people. (from NIH.gov; also, see Wikipedia)

People with BPD are, in a word, unstable. They may even be suicidal, and often engage in other self-destructive behavior. “Clients with [BPD] … can be lots of fun to work with, until suddenly they’re not” says Wittenberg. The trouble is, you may not get any clues that a client has a borderline personality until it emerges later in the representation. In fact, in the beginning, she may be the perfect client — up until something happens to upset her idealized form of your representation.

In legal matters, BPD may introduce intense, inappropriate anger. Clients with BPD may fly off the handle and abruptly terminate relationships — including your representation. Threats of ethics complaints and malpractice lawsuits inevitably follow, when a borderline client terminates your relationship in anger.

Clarity, consistency, and structure will help avoid this result. Regular status calls or emails are especially important to borderline clients, and you should be prompt in returning communications, even if it’s just to acknowledge that you will follow up.

Representing a borderline client can be a roller coaster ride. Resist the ups and downs by staying calm and level. Borderline clients challenge you to reject them. If you stay the course, you will be able to do the work you were hired to do.

You Cannot Avoid Clients with Personality Disorders

Dealing with clients with personality disorders sounds like a lot of trouble, and you may be tempted to resolve never to represent such clients. But, discrimination laws aside, personality disorders may not be clear at the outset of the representation, for one thing. For another, if a tenth (or more) of your potential client base has a personality disorder, chances are good you will end up dealing with a disordered client sooner rather than later, anyway.

If you understand your clients’ personality disorders just well enough to work with their needs, you can still be an effective advocate while making your clients happy.

This was originally published on March 6, 2013. It was revised and republished on February 19, 2014.

Featured image: “Dementia brain problem medical and health care concept symbol ” from Shutterstock.

Lawyering Skills, Our Picks, Practice Management

, , , ,

  • http://www.benchbar.com Judson Haverkamp

    Mr. Glover appears not to have done very careful research, at least not sufficient to support his disparaging comments about Bench & Bar of Minnesota. Ms. Wittenberg’s article is and has been available on our website at http://mnbenchbar.com/2011/03/are-your-clients-making-you-crazy/ since it was first published and is easily discoverable by simply entering the title in a Google search. I’d expect better.

    • http://lawyerist.com/author/samglover/ Sam Glover

      Wow, you are right. I didn’t realize I was looking at a 2-year-old issue of B&B. Well, it has aged well.

      Anyway, my bad. Post updated.

      • static

        Uh oh. Now Mr. Glover won’t win an award and will probably have to sit in one of those back tables with the really lame drunk lawyers at the gala fundraising dinner instead of at a front table with the really cool people like Judson Haverkamp (which is too good a name to make up).

    • Will Geer

      The phrase, “Lighten up, Francis”, comes to mind.

  • http://www.ponerologynews.com/ PonerologyNews

    Great to see this topic being discussed in legal circles. It’s so important and comes into play on all sides of the legal system. The game really changes when a personality disorder is involved as opposed to when it isn’t, so it’s really crucial for there to be awareness. Thanks for sharing.

    • chastity

      Oh yes, you are told by attorney you have something wrong with you just to find a reason your case lost. LOL. Do you think an attorney would ever in their life admit while practicing they have been diagnosed with a disorder if asked ? Yeah right. WOW discrimination .

  • http://lostreef.blogspot.com/ Virgil T. Morant

    Narcissistic Personality Disorder … ?
    Antisocial … ?
    Borderline … ?

    When I tell people I don’t specialize, I mean I don’t limit my counsel to one mental illness. I represent all personality disorders. (That last remark can of course be taken two ways, as well it should.)

  • chastity

    I think its the scamming attorneys who give false hope to clients cases then later on after a significant lose, act like they never did !

  • Vana

    Nice that you talk about this. But the photo and the negative implications of “crazy” are insulting for those who deal with mental illness. Not to mention colleges who are always making jokes about their “crazy” clients. If the ones who work for making justice do not respect those who look for us to feel that justice is a bit real, even when they are “annoying”, how could we stand up for ending discrimination and other forms of oppression?

    • http://samglover.net/ Sam Glover

      Well, I guess I hadn’t considered that, but you are probably right. I don’t think the word crazy is always insulting to the mentally ill (“I’m crazy about my wife” seems okay to me), but I have to concede that it seems pretty insulting when used to describe mental illness.

      I’m sorry for my oversight. I’ve eliminated the word crazy from the post, and I have updated it with a new title and photo.

      Thank you for bringing this to my attention.

      • Vana

        Thanks for your reply. The content of the article was and is good. I understand you were using the common sense meaning of the word “crazy” without giving it a second thought. The problem was the title and the photo, which you changed. Great thing that this was useful to think more about the way we talk about clients with issues. Unfortunately many of my friends keep using words like “crazy” when disclose their “funny anecdotes” by Facebook and other social media. I hope more and more attorneys and people who work with clients start to think more about mental illness before to complain against those “weird” clients. Cheers.

      • TylerBenting

        I like the approach of the article. It’s for lawyers that deal with clients. This article isn’t written for PhDers that academically/clinically work in mental health. I’m fairly certain some of my friends in those fields would be appalled to read this article. I’m fairly certain I’d be appalled to read something someone wrote on the topic of law. *shrug* Can’t please everyone; if you walk in the middle of the road, you’re gonna get hit coming and going.

  • http://samglover.net/ Sam Glover

    I don’t think I suggested that attorneys should try to avoid mentally ill clients. What I pointed out was that they couldn’t, even if they tried.

    However, I don’t think it’s wrong to use the word deal in this context. First, because we “deal” with all our clients, mentally ill or not. I don’t attach any negative connotations to that word when I use it in that context. Second, because mentally ill clients may need their lawyers to use some additional tools in order to provide competent representation.

    As for diagnosis, lawyers are obviously not mental health professionals. Still, they frequently deal with mentally ill clients, and can probably recognize those clients, even if they cannot identify the precise disorder. It’s better to have some tools to better represent those clients, even if it is not a perfect situation.

  • R. Dernister

    I note that psychopathology and explosive personality disorder are rather common among attorneys.

  • D.

    It is an important issue that demands a sensitive discussion. I work withing the legal system where the lawyer cannot refuse the client – state legal aid is provided by the lawyers with private practices that are disignated by courts for the clients in need and later the states pays them for the legal assistance. Every lawyer that has qualifications to act in court is included in this system, you cannot not take those cases. There is a certain amount of clients that you have within it that indeed have some problems, diagnosed or not diagnosed. Some fo them are mainly focused on conducting court cases and suing whoever they want. It does not mean they do not have the right to legal counsel or right to go to the court with their cases. Very often though, the psychiatric disorder makes it difficult to communicate or for the lawyer and the client to find a common ground for discussion, even with all sensitivity shown.

    For example, one of my clients, with diagnosed mental illness (but with full legal capability) has a history of more than 100 court cases filed by him at court within last year. Most of them have no legal basis. The other client (just 11 cases currently in court…), with personality disorder, sues every lawyer that has represented him and every judge in his cases. I do believe they deserve legal help, but those are different cases than the cases of other clients, it is undeniable. And treating them differently does not mean they are discriminated – most oftne those cases demand more time and more work. They demand extra sensivity, often extra communication skills (how to see a hint of a legal problem in a long story describing ongoing plot of the world to destroy them) and often excessive additional documentation (in case I will be the one they sue – that can happen), not to mention the cliens expectations to “win everything”. It is a topic not addressed within the education process for lawyers, at least in my country, but I find it necessary (for the sake of both lawyers and clients).

  • Cindy

    While I have sympathy for the mentally ill and the stigma attached to the word “crazy”, I think the point of this article was really to help lawyers understand why their clients are sometimes overly emotional and irrational. It would have been helpful to also address common stress reactions because many lawyers are representing clients during some of the worst times of their lives, e.g., being arrested and charged with crimes, divorce and other family matters, upon the death of a loved one, because of an employment termination,bankruptcy, foreclosure, etc. Even lawyers who work in the corporate world have stressed clients who are desperate to make a quota, make a deal, impress their boss, etc. People may exhibit some of the behaviors described in the disorders only because of the situation they have hired their lawyer for – but perhaps they are in those situations due to their disorders.

    • Marc Lichtenberg

      Here, here. Many clients may exhibit peculiarities, but associating a personality disorder and preceding with the attorney/client relationship is not conducive to good law. These disorders can be psychopathic (and although there are psychopaths) a disoriented, frightened client who is reacting to usually unfamiliar, confusing circumstances need to be cut a little slack. BTW, if after giving all due deference counsel does see a client with such a disorder I recommend only taking the case by order of the court

  • Julie Gilbert

    Since there are four distinct sub-types of BPD (Borderline Personality Disorder), essentially making them separate disorders, you are advising in your missive about 6 disorders, rather than 3. Cheers! lol

  • http://www.Liberty-Lawyer.com Thomas Gallagher

    I have noticed that Personality Disorders are common. They are not classified as “major mental illness” in DSM-IV R — something less than “major.” People can function in life with them. I read that they’ve been dropped from DSM-V, though I do not have a copy of DSM-V yet. I have used DSM-IV R to help “diagnose” the accuser in criminal cases, often to great and useful effect.