PATTAYA, Thailand (UCAN) -- Father Lawrence Pinto, executive secretary of the Office of Clergy of the Federation of Asian Bishops' Conferences (FABC-OC), has a doctorate in psychology and works as a counselor in Mangalore, India.

During a seminar organized by FABC-OC, "Caring for Priests - Especially For Those with Difficulties," Father Pinto presented two papers Aug. 29-30 that elaborate dynamics affecting the life and ministry of priests. One focused on psychological and personality problems, the other on tensions and anxieties.

The seminar was held Aug. 27-Sept. 1 at Redemptorist Center in Pattaya, 150 kilometers southeast of Bangkok.

The full text of Father Pinto's paper on priests with psychological and personality problems follows:

CARING FOR PRIESTS - WITH PSYCHOLOGICAL AND PERSONALITY PROBLEMSINTERFERING WITH THEIR PRIESTLY LIFE AND MINISTRYI. Introduction

Pope John Paul II (1987) stated in one of his speeches to the Bishops of the United States, that "the physical and emotional health of priests is an important factor in the overall human and priestly well-being, and it is necessary to provide for these." To substantiate the Pope's statement, Coleman and Sellars (2001) asserted that at some level, all priests are broken, hurting, and alone. It is part of their human condition. When a priest's spirituality weakens, he becomes fragile and ripe for a host of personal difficulties. If his life and ministry are shattered, he is still a priest, but he is a hurting priest who needs rediscovery of his wholeness and holiness. He is in need of strong support to keep his fragile priesthood from breaking. When a priest's life and ministry are shattered, all priests in a sense share in his brokenness. For this reason especially, a fragile priest needs to rediscover his wholeness and holiness, by listening to, and learning from, other priests.

Often priests neglect their physical health and have a carefree attitude to their emotional health. Intellectual and other work/activity is highly revered, often causing imbalanced lives and leading to inappropriate behaviors that trouble the individual and are troublesome to the faith community (Jennings, 1992). Priests find themselves with serious psychological and spiritual problems. One must believe that God has a special solicitude for priests and religious in distress. They have served God and the people for many years and assisted many in need; now it is time for them to receive help. Issues of identity in priesthood often are responsible for many of the problems priests face in their priestly life.

1. Human Identity of Priests

Clearly, healthy affective (emotional) development is fundamental for the formation of an integrated spirituality and effective relational functioning in the ministry. Those priests who have, for whatever reasons, been unable to work through these developmental tasks place themselves in much greater risk for serious interpersonal difficulties in their ministerial and communal lives. It is important to note that the earlier a developmental arrest occurs, the more serious is the pathological acting-out. That is, those priests who are caught in conflicts revolving around dependency and authority are at a far greater risk of engaging in destructive personal and interpersonal dynamics than those, for example, who are struggling with intimacy issues.

Priests who have achieved adequate resolution of dependency conflicts exhibit the capacity to trust themselves, and to place trust in others. They come across as comfortably self-reliant, yet at the same time able to rely on, and entrust themselves on others. They have a well-developed sense of physical and psychic interpersonal boundaries. Respect for others' privacy and need for personal solitude, as well as the capability to engage in interdependent activity with peers characterize the priest who engages in transparent interdependence and friendship.

Individuals, who have conflicts in the areas of dependency, interpersonal boundaries and interdependent activities, form relationships based on need. Such dysfunctional relationships are fraught with codependent neediness. Individuals with codependent (without well-formed self-identity) neediness cannot survive a relationship if the other person in the relationship is a person of wholesome identity (who possesses a well-formed identity). It must be noted that relationships of codependency are plagued by intense jealousy and enmeshment (overdependence).

There are priests who possess an overly well-developed self-identity and are fiercely autonomous persons. Priests with codependency lack the capacity to trust others, and are suspicious and highly guarded. They tend to be alienated loners who, because of the terror of being hurt by broken relationships, live isolated, have emotionally frozen existences (Markham & Repka, 1997). In both the overly dependent and the overly independent person, insecurity and pervasive feelings of inadequacy reside at the core of their character structure. Therefore the goal of all healthy adult interaction is the achievement of interdependence based on openness, honesty, inclusivity, and mutuality. They are able to tolerate independence in the other as well as separation from the other, the mature adult manifests appropriate self-reliance and comfort with inner authority.

Mature priests exhibit a sense of inner authority. They are able to exercise good personal and social judgment as they engage in decision making and the management of conflict in communal and ministerial situations. They are able to manage strong sexual feelings and aggressive impulses in themselves, and in others, in ways that are responsible and respectful. Because they have attained a sense of comfort with their own authority, they are comfortable in the presence of others who are strong, confident, and exude personal power. Thus they do not feel intimidated by authority figures, neither do they involve in oppositional activity, nor do they become persons of hostility or antagonism towards people in authority.

Persons conflicted in this area of development utilize manipulation and devaluation as means of control. Because of their strong need to subordinate others, these individuals use intimidation, threats, criticism, and angry outbursts in their interactions with others, whom they perceive to be powerful. Both aggressive and passive-aggressive behavior characterize such people, who feel that they are out of control. Frequently, they are described as characterologically rigid -- lacking in flexibility and unwilling to bend. Their interpersonal relationships and their spirituality are characterized by external compliance with duty and obligation, while their inner world is filled with rebellion and critical judgment. Defiant and oppositional, they must devalue others in order to make themselves feel powerful and in control (Markham & Repka, 1997).

2. Spiritual Identity of Priests

These words are often echoed in some places as a kind of Mantra in the Catholic Church: "There is no difference between the priest and everyone else." With such a statement, often it is not surprising that some priests speak of a crisis of identity. Indeed, if the priest is no different, then it must follow that he has no unique identity. There are many signs that such struggle with identity has been occurring in the presbyterate. Many a young priest clamors "I can stand more work; what I can't stand is this ambivalence about who I am." This is a stunning revelation which appears to be a common experience of many young priests.

Another sign of this struggle with priestly identity is a recent trend among some newly ordained priests. A significant percentage of younger priests appear to have a strong connection with external signs of priesthood. For example, some wear cassocks, clerical dress, and other such external signs all the time, even call one another with a formal address "Father" even though they are friends. One possible interpretation is that an insistence on external signs of the priesthood may be a reaction to the lack of an inner sense of identity among some priests -- a largely unconscious expression of the need to discover an accurate perception of who the priest is (Rossetti, 2005). While the use of external signs of priesthood may facilitate this process, such signs will not be fully effective unless priests, and the laity, are able to complement these external signs with an inner appropriation of a unique priestly identity.

3. Significance of Self-Identity in Priests

Persons who have achieved an adequate sense of identity convey a sense of comfort with themselves and with their sexual identity and adequacy. Identity is solidified as persons grow in comfortable recognition of having internalized aspects of each parent -- and thus they are able to recognize how their own separate ego identity helps them form a healthy self-image and social interactions. Priests with a solid sense of self are able to establish deep friendships with others. They exhibit the capacity to commit to the mission rather than becoming overly preoccupied with themselves.

When conflicts around identity enter the sexual realm, preoccupation with sexual and aggressive impulses and sexual identity-confusion surface. Consumed with trying to "find themselves," these persons spend inordinate amounts of time in self-absorbed scrutiny focused around fundamental issues pertaining to being male or female (Markham & Repka, 1997). These individuals also tend to form intense, somewhat intrusive relationships with peers in an effort to discover who they are.

Anticlericalism following Clericalism Weakening Priest's Identity

If the priesthood currently suffers from identity confusion in the minds of both priests and the laity, the first step in addressing this confusion is to investigate its genesis. Two possible causes quickly surface. First, we are in a period of anticlericalism, in which the charism of the priesthood is being downplayed. It is a known fact that this anticlericalism was preceded by a period of clericalism (the priest was holier or had a better chance to achieve sanctity than the laity). The idea that priests were "better" led to erroneous assumptions-for example, that priests were immune to psychological problems and impervious to mundane human struggles. It did not occur to many people that priests could suffer from depression, anxiety, and the more distressing kinds of sexual problems.

Today the danger is to go to the other extreme -- to posit that priests are psychologically inferior and defective compared with the laity, who lead a more balanced life. The suggestion today is not only that a celibate, male Roman Catholic priesthood is not a higher calling, but also that is defective and abnormal. In such a climate, it is not hard to understand how a disparaging of the priesthood, and a concomitant weakening of priestly identity, would occur.

Lay Ministry Masks Priestly Identity

All the faithful are called to share in the work of Jesus. As a result, there has been a necessary blossoming of lay ministries and an increasing involvement of the laity in the work of the church. This is grace for all the people of God. However, as we have consciously emphasized the priesthood of all the faithful and their rightful place in continuing the work of Jesus, we have unwittingly de-emphasized the ordained priesthood. Some priests are floundering with understanding their rightful roles, with so much of their previous work now being done by the laity. Confusion about priesthood is as prevalent among the laity as it is among priests.

The church today almost seems to be a church of six sacraments, not seven. The six sacraments preached and taught, but the uniqueness, clarity, and efficacy of the sacrament of Orders are rarely mentioned (Statnick, 2001). We must remember that this necessary development of the lay ministry ought not to take place at the expense of the ordained priesthood. The two need to coexist and be interrelated; but they are integral to the life of the Church. The two priesthoods -- the priesthood of the faithful and the ordained priesthood -- are not different merely in degree. It is not that one has a bit more priesthood than the other. Rather, they are different in kind. Both share in the priesthood of Jesus, but they do so in different ways, and they have different identities. They are not the same.

In summary, priestly identify hinges on some key theological principles that are made operative in a local church:

All the ordained and laity share the same life and ministry of disciples through initiation into the saving mystery of Christ in Baptism, Confirmation, and the Eucharist.

As disciples, we each have a unique and personal relationship with Christ, which calls for respect for each individual, and we all share a communion of life and ministry, which calls for responsibility and accountability to the church and its mission.

Ordained disciples are repositioned in the church communion to stand before it as public witnesses of discipleship and of Christ's headship for the sake of the salvation of all. This is the basis of their leadership and authority.

Such witness is sacramentally designated. It is fully effective when its sacramental character is realized through the full and active participation of all disciples in the saving mystery of communion, through acknowledging and cooperating with the incarnate nature of God's grace, and through the formal relationships ordination creates among and between the church's orders and the whole communion of disciples (Statnick, 2001).

The Challenges Confronting Priests in the Third Millennium

Priesthood is difficult. Ironically, we might actually have more vocations to the priesthood if our young people realized how challenging the life really is. Many generous young people want to commit themselves to a life that stretches them and one that, in the end, means something. Young people want a life of meaning and challenge. Priesthood, when lived with integrity, is such a life (Rossetti, 2005). The demands on a priest's time and energy are relentless and, at times, overwhelming. Most priests struggle under their workloads. People make unrealistic demands on priests. In fact, ministry has become a bottomless pit. But the bottomless pit has become even more foreboding with the declining numbers of priests to cope with ministerial work. Our priests need to learn to say "no" when they are exhausted-this is a form of asceticism we must endure: feeling our limits.

Another asceticism of the priest in ministry is the loneliness of uniqueness. While priests share in the same humanity of the people he serves, yet their being priests, sets them apart. The priest is their spiritual leader. He is both one of them and always slightly separate. Living among people makes our celibate witness and our commitment to God all the more visible to the people of God. Given our sex-obsessed, materialistic and self-oriented culture (of some of our Asian countries) this witness of dedication and sexual self-discipline is desperately needed. The celibate priest witnesses to the immediate presence of God and to a celibate form of loving which is a rich source of grace for both the community and for himself (Rossetti, 2005). But it is difficult.

The priest has to be a sign of contradiction in the midst of self-oriented, materialistic and a sex-obsessed world. He is to be in the world but not of the world. Imbued with the spirit and grace of the gospels, the priest lives among the people yet he is not so filled with secular values as to become salt gone flat (cf. Mt.5:13). This being in the world but not of the world is one of the great challenges of the diocesan priest or any priest ministering among the people. If a priest purchases every electronic gadget, buys the best of everything, and lives a privileged life, he becomes more akin to a comfortable bachelor. We ought to step back regularly and observe our lives, sometimes with a help of a spiritual director or priest support group, to discern if the manner of our living is an outward witness to the gospels.

Because of the challenges and difficulties a priest faces, a danger will be to fall into extended periods of self-pity. It must be noted that feelings of self-pity are often the doorway to behaviors that are incongruous with any Christian life, particularly that of priesthood. Sometimes, priests tend to justify their scandalous and sinful behavior with the thought that "I deserve it because of what I have given up," or I need it to continue this difficult ministry."

Everyone knows that Priesthood is particularly difficult. Jesus promised us that it would be so. If we are truly followers of his, he promised, "My cup you will indeed drink" (Mt. 20:23). Make no mistake about it, the more closely we follow Christ, the more we participate in his suffering and death. Jesus insisted, "Whoever wishes to come after me, must take up his cross, and follow me" (Mt.16:24).

II. Priests have Difficulties - Shame in Accepting Psychological Care

We know that some priests are depressed. But it is to be noted that they are no more likely to be depressed than any one else. Overall, the impression is that psychopathology, that is, serious psychological problems do indeed manifest themselves in the priesthood, but probably at no higher rate than the general population. While people intellectually recognize that priests are human beings and thus have human problems, they still have difficulty in accepting the reality.

Most people expect that a priest's moral conduct should be better than others. Priests have the highest expectations of their own conduct and they are the most crestfallen when they do not measure up to their own high expectations, especially when that person happens to be oneself. While most people feel ashamed when they need psychological care, priests feel doubly ashamed. (Rossetti, 2005). It is a major issue to confront in the beginning of psychological therapy. It is no surprise that priests are unlikely to seek psychological help on their own accord. Given the shame they feel and also given that they view themselves as caregivers, not caregetters, they are unlikely to ask for help, though some do.

They have to learn a whole new way of practicing humility. This is not the humility of the priest washing the people's feet during Holy Thursday liturgy. It is the humility of taking off your shoes and allowing someone else to wash your feet. This takes its own kind of humility. It is good for us priests to learn to be grateful for receiving help.

III. Typical Problems Manifested by Priests

While priests can and do suffer from just about every human problem, there is a common list of significant problems that surface with some regularity. These are some typical problems or typical reasons why a priest will be referred for psychological assistance. This list, in no particular order, includes such problems as: alcohol and drug abuse, depression, a variety of kinds of sexual acting-out, cyber-sex, anxiety, compulsive eating, mismanagement of money, and several kinds of personality problems including narcissism and dependent personalities.

A. Alcoholism and drug-abuse

A few priests, but not many, are drug abusers. Sustained use actually changes brain chemistry. It is a terrible addiction to overcome. At all cost it must be avoided. More priests are alcohol abusers. Most priest alcoholics are not "falling down drunks," rather they are functional alcoholics who use alcohol as a way of dealing with a whole host of problems. While it seems that some alcoholics have simply inherited an alcoholism gene through family transmission, many use alcohol as a way of dealing with inner anxiety and/or depression, inner conflicts (such as sexual desires that they dislike) or with external conflicts, anger and disappointment. These priests need to learn how to face such problems without resorting to alcohol. Depression in alcoholics is not uncommon. For example, the alcoholic may try to medicate depression with alcohol and conversely alcohol can eventually worsen an underlying depression. Alcohol and depression are a nasty combination.

B. Depression

There are many kinds of depression. Some priests suffer from major depressions and may go through an intense period of depression in which they find it difficult to function. Many who suffer dysthymia (mild depression) tend to spiritualize their condition, thinking that this dour (grim) mood is a sign of their sanctity. It is true that those who suffer from psychological illnesses, if they bear them in faith, can become holy through their long suffering. However, we need to tell them that their depression is treatable. We must convince them that "it is not sin to be happy" that is, an abiding sense of joy is a sign of the indwelling of the Holy Spirit. More on this topic will be discussed when we deal with anxiety disorders.

C. Boundaries in the Lives of Priests

Relationships are the basic elements of ministry. How awesome the reality: through relationships, the Paschal Mystery is realized and celebrated. Priests are expressly committed to engage in relationships through Presbyterian life (community of diocesan priests) and they have been a tremendous gift to the Church and to our world so plagued by isolationism and individualism. Persons called to the life of Priesthood are often innate nurturers. They are aware that a certain amount of intimacy is important in order for healing to occur. Sexuality and spirituality are viewed as friends (Markham & Repka, 1997). When asked what characterizes healthy relationships in ministry, a well-meaning priest will often mention mutual respect, trust, care, empathy, and intimacy. These qualities mediate the presence of God. They also imply that one has a healthy understanding of the value of boundaries, essential to appropriate ministerial conduction. Respecting boundaries is an act of love.

1. Boundaries Required of Priests (Ministers)

Boundaries are defined as limits that delineate time, place and person. Boundaries exist across a continuum, ranging from chaotic to rigid. Boundaries that are fuzzy, unclear, confusing, and chaotic tend to work against healthy human exchange, so do boundaries that are too rigid, indifferent, remote or insensitive. Neither end of the continuum is conducive to holistic ministerial relating. Ideally, boundaries between individuals exist without rigidity, are flexible, and are always open to a spirit of dialogue.

Healthy priests maintain clear, flexible boundaries and clarity of purpose. Ministerial relationships have as their purpose sharing with and meeting the needs of parishioners, clients, students, directees and people in formation, to name a few. By contrast, personal relationships are those whose purpose is to meet the personal needs of the parties involved.

2. Crossing of Boundaries by Priests

Boundaries are crossed in three major ways: through touch, through sexualized behavior, and through the power of role. When a priest touches a person to whom he is ministering, the priest must be aware of both the motivation of the touch (e.g. compassing, caring) and how the touch might be perceived by the recipient. This is especially critical at times when the other is vulnerable.

Second, it is important not to sexualize behavior. It is true that humans are sexual by nature, but it is crucial to ministerial interaction that the priest does not communicate sexual interest or sexual content. Sexualized behavior, in and of itself, is neither right nor wrong, neither ethical nor unethical. For a priest who makes a public profession of celibate vow, however, there is an obligation to strive to be faithful to that profession. Beyond the commitment through vows (or promises) the ethical status of sexualized behavior derives from the balance of power in the ministerial relationship. Sexualized behavior on the part of a priest is always abusive to the recipient of help.

Finally, the third way boundaries are crossed has to do with the role of the priest as a minister. It is important to be aware of the power differential between those who minister and those who are served. Boundary violations by priests are often nonsexual. Sometimes, well-meaning priests, recognizing only a sense of personal powerlessness, are na?ve about how much power they have in relationship with those they serve, simply by virtue of their ministerial role.

3. The Emotionally Vulnerable People-Facilitate Crossing of Boundaries

As ministers, we possess a certain built-in power in relation to the recipients of our care. Clients often unconsciously give over their power to ministers of their church. Many people, particularly emotionally vulnerable persons, entrust themselves to the care and concern of priests. Who are the emotionally vulnerable?

a. Children, who are always victims of their particular circumstances. Obviously, children are physically smaller, socially less mature, and emotionally more underdeveloped than the adults around them. They deserve care and protection. A sensitive priest who understands the needs of children must be aware of his boundaries as he serves these children.

b. Adults and children who are isolated and feel abandoned. Such people often count on clergy to listen to them and pray with them-and they must be able to count on priests to know and set boundaries.

c. Adults who lack coping skills -- people often come to priests in pain, weakness, or when they are overwrought and overwhelmed with the activities of life. A hug at a time when someone feels a total loss of self-esteem may be intended as compassion by the caregiver but may mean something different to the recipient in pain.

d. Adults and children burdened by poverty and oppression -- some people have little financial security and must entrust their children and themselves to caretakers, including ministers. They come for help in need and in crisis. It is exceedingly important that priests do not cross boundaries, take advantage of the needs of those in their care, or exploit them in any way.

e. Students of all Ages -- Teachers are in a very influential position with students, no matter what the age. Many priests are gifted with such qualities as warmth, attentiveness, and compassion - all of which are important in a teacher. But what happens when a priest engages in a social relationship with a student outside the school and then must be the bearer of the bad news that the student is not passing in class?

f. Persons in initial formation -- the formator who befriends the novice or a seminarian as a peer confuses the formation process. Most tragic are those situations in which a formator engages in romantic or sexualized behavior with the person in formation. Rationalizations that "this is a relationship between two adults" are both inappropriate and self-serving (Markham & Repka, 1997). While it is important to continue to respect values of equality and collaboration and to move beyond top-down-models of relating, the imbalance of power between the recipient of help and the minister is significant and must be respected.

4. Suggestions for Preventing Harm by Boundary-Crossing

A self-assessment is in order for any priest in active ministry. It is important that every priest takes stock regarding how he exercises the role of a pastor or a cleric by considering the following: What are the effects of his power on those with whom he interacts? In what areas might the priest be more vulnerable in violating boundaries? Can the priest identify his own emotional and sexual needs and meet them appropriately? Are his personal friendships and intimate relationships appropriate (respectful of public commitment, not dual relationships, not exploitative)? Is he willing to discuss personal sexual history with a spiritual director or a counselor? Doing so can open new doors. The most effective way to prevent misconduct in ministry is to nurture healthy relationships with colleagues (priest companions), with others, and with God, as well as to pay heed to mind-body-spirit connections. Priests with intimate friendships outside the ministerial arena generally find it easier to maintain professional boundaries.

Asking the following questions can help one to be honest with oneself about friendships: Do I have friends who are peers, or are they all much older or much younger? Do I have to be secretive about relationships? If so, why? (Some psychologists hold that we are as dysfunctional as the number of secrets we keep). If I cannot seem to form or sustain friendships, what am I doing about it? It is essential for a priest to be open and honest about his relationships.

Another important preventive measure is taking good care of the self. If a priest is not in touch with his own feelings, for example, then that priest will not be able to recognize feelings in someone else. Feelings provide information when things are going awry, and at the same time they are necessary for connection. Those assuming a ministerial role in relation to a parishioner must be alert as to how their affective behavior is perceived by others, and they must also be sensitive to seductive behavior in others. Maintaining a professional role, consulting with a priest-companion, and/or requesting for supervision are all means by which the situation can be handled.

Losses of self-esteem, an unwanted transfer, good friendships, family-members, health, reputation, or even financial status-create vulnerable moments in a priest's life. Additionally, a mature priest is comfortable with his sexuality and alert to how affective behavior is perceived by others. Unfortunately, some less mature priests prefer not to address sexual reactions. They ignore sexuality altogether and assume that keeping such feelings repressed make celibacy easier. Actually, repression make ministry more dangerous.

Finally, the healthy management of daily living - eating healthfully, exercising regularly, remaining faithful to prayer, taking time for fun and friendships - provides the foundation for a rich and meaningful ministry. Given the reality that every human person experiences times of struggle and inner conflict, priests who are self-reflective and insightful about their own inner lives and open to seeking assistance when conflicts emerge are well positioned to be helpful to others.

D. Sexual Misconduct in the Clergy

We are all aware of problems with priests acting out sexually. These are the stories that hit the front page. It is big news when a celibate priest is caught in some sexual behavior, particularly, if the act is illegal. The sensational aspect of such a story is too hot for the media to ignore. Such stories have strong shock value, and they are subtly titillating to the reader.

As a result, a disproportionate amount of media attention is focused on priests engaged in sexual misconduct with the resulting impression that priests are uniquely dysfunctional. We need to take media news about priest-sexual misconduct with a pinch of salt-because this news is often exaggerated.

Sexual misconduct among Catholic priests is scandalous. Even a single case causes untold harm to the victims and their families, to the church, and to the priest himself. But there is no data to support the idea that Catholic priests have any more sexual difficulties than other adult men. Nevertheless, we do not expect them to be better, and we are shocked when they are not, particularly if their problem is sexual.

One person who is very upset by the problem and is full of shame, as previously noted, is the priest himself. Many priests will enter treatment feeling like "walking shame." They will say things like: "There is no hope for me," or "Everything I have done is a lie," or "If people really knew me, they would know that I am not a fraud." This despair, self-denigration, and pervasive shame are part of their disorders and need to be addressed in the healing process.

Eventually the priest needs to realize that he is a good person, created in God's image, and has done many good deeds as a priest. However, he has a serious problem that has harmed others and it needs to be addressed directly, for the good of all, including himself. Some want to brand them as bad and not like us. They want to brand them for their infidelity and place them in a separate category, like the unclean lepers of Israel who were isolated from society and walked ringing a bell, shouting "Unclean, unclean!" This is psychologically dangerous. The more we isolate and stigmatize such people, the more are they likely to act out their problems. They are safest when they are treated, given some sort of productive work, and are supervised. They ought to be kept away from areas of temptation (Children and Women).

E. Personality Problems in Priests

More than a few priests who are referred to psychological treatment suffer from personality problems, that is, a chronic, long-term, maladaptive way of relating to others. This results in dysfunctional interpersonal relationships. Typically, such priests have interpersonal problems wherever they go. They simply have a dysfunctional way of relating to others and no matter what milieu they are placed in, they carry the problem with them. The essential feature of a Personality Disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture (DSM-IV.TR, 2005). An inherent difficulty is that the person does not see the disorder himself. Someone with a personality disorder lives within the distorted perception of others and self and, thus cannot "see" the problem. The person may be aware of the conflicts and problems that surface because of the disorder, but he will ascribe the problems to others. The individual will blame the people, another priest, the bishop, or anyone else, but he will not point to himself.

F. Types of Personality Disorders/Problems Commonly Found among the Clergy

There are seven most common personality disorders that are found among priests. They are: 1. The Borderline Personality, 2. The Dependent Personality, 3. The Narcissistic Personality, 4. The Obsessive-Compulsive Personality, 5. The Paranoid Personality, 6. The Passive-aggressive Personality and 7. Psychopathic Personality (Anti-social Personality Disorder).

1. Borderline Personality Disorder

Borderline Personality is a pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity (DSM-IV.TR, 2005). Appearing emotionally stable at one moment, the borderline personality can suddenly become intensely angry, depressed, anxious or questioning in regard to identity, goals, and values. Impulsive, unpredictable, and intense verbal outbursts and threats, as well as physical displays of temper or self-damaging acts, including suicide attempts and self-mutilation, are characteristic of this personality. Borderline personalities have an intense fear of being alone, because when they are alone they feel incredibly empty and worthless. They can be clinging, dependent, and demanding that others should meet all their unmet needs.

Most of the borderline personalities come from the unstable and abusive families. These personalities grow in the families where they have suffered traumas in their childhood. These individuals can form intense attachments and become very demanding on others in relationships. To defend against any threats to these relationships, the borderline personality uses a variety of psychological defenses. One of these is "splitting". Because they have difficulty tolerating both negative and positive feelings simultaneously for the same person, these individuals see others as all good or all bad (Sperry, 1991). Not surprisingly, those deemed bad become targets for many of the borderline person's emotional outbursts.

Overwhelming personal charm is another common defense of the borderline personality, who may be too generous, always available, overly complementary, or prone to lavishing others with gifts, time and praise. How does this personality develop? The borderline individual often has a history of childhood abuse and trauma; the mother is often absent, neglectful, or in other ways emotionally unavailable or unpredictable. As a result, the child does not develop a secure sense of the mother as a good and caring figure. For the borderline individual, good and bad feelings have not been integrated. Subsequently, rage remains unmitigated by love, and in the face of emotional turmoil other people are perceived as either all good or all bad.

Borderline personality tends to feel, "I don't know who I am or where I'm going" and so also has identity problems involving self, gender, career, and basic values. Thus, borderline personalities have difficulty maintaining constancy in their spiritual lives. Often, they see God as all good and themselves as all bad. Therefore, they cannot easily handle the feelings they have toward God. Borderline personalities frequently use spiritual discipline in a self-centered fashion. Prayer becomes a tool for obtaining the Lord's attention. Furthermore, the borderline personality's spiritual perception is often dependent on social experience: human rejection makes it difficult to tolerate a relationship with the Lord (Sperry, 1991). Thus, the community or confreres must demonstrate human love consistently, yet within clear limits, so that the borderline individual has a framework for experiencing divine love.

2. The Dependent Personality Disorder

Dependent Personality Disorder is a pattern of submissive and clinging behavior related to an excessive need to be taken care of (DSM-IV.TR, 2005). Individuals with dependent personality styles have a pervasive need to cling to stronger personalities who are allowed to make a wide range of decisions for them. The dependent personalities can be na?ve, show little initiative, and appear to be superficially affable and good-natured. Often, they seem to be just a little too sweet and nice to be real. They fear isolation and being alone. Thus they hold on to their superiors and peers. If they are rejected by their peers or superiors, they may experience periods of clinical depression and anxiety. These episodes of depression are usually precipitated by a real loss or abandonment, such as the death of a parent or a closely related sibling or friend.

Psychologically, these individuals grow up viewing themselves as self-degrading, inept, and self-doubting: "I am nice but inadequate." Their worldview is "Others are here to take care of me because I can't do so myself." Their basic life-strategy is to be, "Cling to and rely on others at all costs." Because of these views, dependent personalities seldom develop effective skills of assertive communication, negotiation, and problem-solving.

These individuals come from families where parental overprotection was common and the parental injunction was, "you can't do anything by yourself; you need our help." Not surprisingly, they expect similar care and protection as adults. They latch on to a forceful figure and mindlessly follow his directives.

Dependent persons tend to view God as all powerful and almighty, and themselves as insignificant beings totally at God's mercy. When their prayers are not answered they think God is not there for them. Because of inability to assume responsibility they seek out religious councilors repeatedly and constantly look for reassurance.

3. The Narcissistic Personality Disorder

The narcissistic personality disorder is a pattern of grandiosity, need for admiration and lack of empathy (DSM-IV.TR, 2005). The narcissist is the person whose major focus is himself. He needs adulation, flattery, and support from others. He cannot handle criticism. He is often charming and kind, until he is crossed. Then his inner rage, long buried within, comes out in a torrent. The narcissist believes he is special and expects special treatment, as well as feels entitled to have attention (Rossetti, 2005). He lacks empathy for others and tends to use others for his own self-indulgence. That is, they think they can do as they please in pursuing their goals of self-gratification in the name of the Lord. They can exploit other people's financial means, sexuality, social position, or anything else in order to fulfill their infallible claim.

The narcissistic priest often has a following of individuals who is his special "clique." God is not exempted from exploitation by narcissistic individuals, who tend to view God as being at their beck and call, and they seek to control Him. Individuals with narcissistic personalities may have intense mystical leanings that pull them in the direction of mystical experiences, including occult. They neglect prayer as praise, self-examination, forgiveness, and thanksgiving.

4. The Obsessive-Compulsive Personality Disorder

Obsessive-Compulsive Personality disorder is a pattern of preoccupation with orderliness, perfectionism and control (DSM-IV.TR, 2005). They are also preoccupied with rules and duties. They are unable to express warmth and caring except in limited situations. They are highly oriented toward a life-style characterized by productivity and efficiency, and are temperamentally and emotionally insensitive to others. Obsessive individuals have a tendency to be perfectionists, which shows in their over attention to details, rules, and schedules (Sperry, 1991). Not surprisingly, they are often workaholics. Interpersonally, they are often polite and loyal, although somewhat rigid and stuffy in their dealings with others.

As children, obsessive-compulsive individuals tended to have parental training that taught them to be good and overly responsible in all areas of their life. Their parental injunction tended to be, "You must do, and be better, to be worthwhile." Psychologically, they tend to believe, "I am responsible if something goes wrong, so I have to be reliable, competent, and righteous." Typically, their worldview is, "Life is unpredictable and expects too much of me." Their life strategy becomes "Therefore, be in control, right, and proper at all times." They typically imagine God as a taskmaster, judge, or police officer. Often their prayer tends to focus on their faults, failings, and need for forgiveness. Their tendency of scrupulosity may be manifested in the reporting of tiny fractions of rules and inappropriate behaviors to a pastor or leader of a prayer community. Obsessive-compulsives see themselves as self-appointed guardians of the mores and morals of others.

They often feel they are the worst sinner, or they feel they have sinned against the Holy Spirit and therefore cannot be forgiven. As a result they may become agitated and depressed and refuse all measures of reassurance and comfort. In such instances they are beyond rational persuasion, may be clinically depressed, and may even experience suicidal thoughts. Competent and compassionate pastoral care of such individuals must include psychological referral.

5. The Paranoid Personality Disorder

Paranoid Personality disorder is a pattern of distrust and suspiciousness such that others' motives are interpreted as malevolent (DSM-IV.TR, 2005). Paranoid individuals are typically suspicious, resentful, and hostile. They tend to respond with anger to anything that even approaches ridicule, deception, depreciation, or betrayal. As a result they are chronically tense and vigilant (Sperry, 1991). They tend to be slow to warm up to others and tend to avoid the expression of feelings and intimacy.

Paranoid individuals tend to have had at least one parent who thought of them as special yet treated them with harshness, over-control, rigidity, and over-evaluation. Furthermore, the parental injunction under which they were raised was "You are special and different-but be careful." They tend to believe, "I am special and different and I'm alone because I'm better than others." Their worldview tends to be, "Life is unfair, unpredictable, and demanding. It can sneak up and harm you when you least expect it." Their life strategy becomes, "Be wary, trust no one, counter-attack, and excuse yourself from failure by blaming others."

Their religious bearing reflects this sense of wariness. God is likely to be imaged as a police officer or judge. The paranoid style tends to be most common among men. Paranoid individuals can be successful leaders in competitive fields (e.g., business, management). They impress others with their rapier wit and quickness to point out others' errors, particularly regarding "heresy" in community teachings (Sperry, 1991). Most paranoid leaders succeed in dividing the community of the parish or the religious community or presbyterium.

6. The Passive-Aggressive Personality Disorder

Passive-aggressive individuals follow a strategy of negativism, defiance, and provocation and are unable to make their minds as to whether to adhere to the demands of others or to resist their demands (Sperry, 1991). Consequently, their behavior is characterized by both passivity and aggressiveness.

Some priests are passive-aggressive, that is, they seem agreeable on the outside, but subtly undermine others, especially leaders. They appear to be obedient, but there is a pervasive pattern of passive resistance, and negativism. Such individuals often feel cheated, unappreciated, and misunderstood. They chronically complain to others. They are the bane of every bishop (Rossetti, 2005). They constantly struggle with the dilemma of whether to submit or assert themselves. Passive-aggressives resolve this dilemma by expressing resistance indirectly through procrastination, stubbornness, inefficiency, and forgetfulness.

Passive-aggressive individuals were most likely exposed to a parenting style notable for its inconsistency. Because of this inconsistency they did not develop enough confidence and emotional stability to accurately assess what was expected of them. At times these individuals experience severe and harsh discipline for a particular infraction, while on other occasions they receive little or no discipline. Consequently, they tend to believe, "I am competent but not really competent." Their life strategy becomes, "It's easier to vacillate, temporize, oppose, and anticipate disappointment and betrayal rather than to make a commitment" (Sperry, 1991).

In priestly life, they give an impression of being committed and cooperative individuals, when in fact they sabotage the progress of the diocese or community. They are ambivalent about commitment and they engage in negative cooperation, meaning that what they agree to do never seem to get completed or their performance leaves much to be desired. They tend to hold harsh and unloving images of God, and their pessimistic spiritual outlook mirrors the rest of their rather unhappy, unproductive lives. Unfortunately, religious structures have unwittingly fostered passive-aggressiveness by emphasizing control, avoidance of conflict, and suppression and denial of anger.

Psychotherapy and spiritual direction can transform disordered patterns into healthy styles of personality. The biblical correlate of the personality-disordered is the individual with a "hardened heart." The more rigid and disordered people are, the more they adopt rigid conceptual categories and ideologies, and "need" simple answers to complex problems and issues. They also adopt rigid behavior patterns, particularly compulsive behaviors. Finally, it appears that the passive-aggressive personality is the most prevalent within religious settings.

7. Psychopathic Personality Disorder

It is characterized by a persistent pattern of distorted ways of thinking, feeling, and acting that can lead to disregard for and violations of the rights of others. The disorder is sometimes called anti-social because of the individual's proclivity to subtly or flagrantly attack social convention. There are basically three types of psychopaths: (1) the personable, superficially charming individual who "cons" others but usually avoids imprisonment; (2) the belligerent, antagonistic individual who openly flouts social convention and the law and is to be imprisoned; and (3) the malignant narcissistic personality (Sperry, 1998).

Superficial charm, lack of empathy, and an inflated self-appraisal or self-centeredness characterize psychopathic ministers. These individuals view themselves as important persons and they expect-and directly or indirectly demand-others to treat them as such. While personable psychopaths spend much of their time trying to win the adulation and admiration of others by flattery and efforts to be pleasing, they are often oblivious to the feelings of others because of their limited capacity for empathy.

These people have little awareness of the distress they cause others by their deceptive and manipulative behavior, and are incapable of an intimate relationship. Psychopathic ministers seldom allow themselves to experience hurt feelings, because they believe that showing hurt and anger are signs of being weak and of being controlled by someone else. Instead of getting angry, they focus on getting even. Usually, they manifest their vindictiveness in a socially sophisticated manner. And because they do not experience guilt feelings, they can take immense pleasure in strategizing retribution (Sperry, 1998).

Failing to trust others is another core feature of psychopathic individuals. They never learned how to trust their family, so they cannot trust others. Many come from dysfunctional families in which one or both parents displayed psychopathic patterns or traits, or were addicted to alcohol or drugs, or were emotionally, physically, or sexually abusive (Sperry, 1998). Typically, psychopathic ministers are convinced that they must be on guard against others who will attempt to use and manipulate them. Regardless what others may do for them, the psychopath believes that personal gain is the only basis on which others act. Consequently, they have difficulty understanding the concepts of charity and self-sacrifice.

Psychopathic ministers also have underdeveloped consciences. While they are aware of right and wrong, they do not believe that any moral code is applicable to their lives. The notion of sin is difficult for them to fathom, since they believe that accomplishing their own purposes has more meaning than sinning. Psychopaths are adept at manipulating and exploiting others. One way of controlling others is through deception and deceit. Personable psychopaths usually appear so poised and gracious that their honesty and sincerity are seldom questioned by others, at least, initially.

Psychopaths are adept at recognizing and pursuing the trappings of power and prestige associated with high status and the upper-class lifestyle. They are ingratiating, cooperative, and seemingly unselfish as they move up the ladder of power structure. When they have achieved their position of privilege, they then focus their time, energy, and attention on accumulating the associated trappings of power (Sperry, 1998). These include discretionary funds, expensive cars, lavish living accommodations, and sexual favors.

The essential spiritual issue with psychopathic ministers is their ingrained tendency to focus on power, status, and control in their relationships. Their self-serving thinking goes something like this: because they must be in control of a given situation or relationship, God cannot really be in control; therefore, they must be God. Graciousness, cheerfulness, and charm usually provide them the measure of control and power they seek. If they fail in these strategies, they have recourse to coercion and mean-spirited behavior to achieve the necessary competitive edge or interpersonal leverage they believe is necessary (Sperry, 1998). They subordinate religion and spirituality to their personal need to control.

Faith plays a rather limited role in the daily lives of psychopathic ministers. These ministers exploit religion for their own purposes. For them, religion and spiritual pursuits provide venues for acquiring power, money or interpersonal advantage. There is little depth to the spirituality of these individuals. They tend to relate to God in the same superficial and pragmatic way they relate to others. Prayer tends to be viewed as a means of informing God of their personal needs and wants (Sperry, 1998). When their prayers are not "answered" to their satisfaction, they are likely to react with anger and resentment, and either stop praying or displace their anger on others.

IV. Therapeutic-Healing Measures for Psychological and Personality Problems

1. Personality Disorders -- Difficult Problems to be Treated

Personality disorders/problems are hard to treat psychologically and tend to be long-lasting. Typically, the goal of therapy is to contain not cure. Such individuals may respond to treatment if they are willing to try or are motivated to undergo therapy. Most priests with personality problems can learn to function adequately but need supervision and clear limits. If they cross the limits and act inappropriately, they need to be reprimanded and disciplined.

However, priests with personality disorders should not be placed in positions of significant authority. They are not usually able to be pastors. We must approach priests with personality disorders with such questions: "If you find yourself having chronic interpersonal problem and you are willing to face the issues courageously, then considerable help and healing is available." The power of the Gospel is unlimited; we only need to cooperate with it. But the priest with a personality disorder needs to be willing to listen to others and to take into his heart what is said (Rossetti, 2005). He cannot be a slave to his own "self-will run riot." Trust in the perception of others is the key to making changes in one's life.

2. Issues Underlying the Manifested Problems of Priests

These typical priest-problems, such as substance abuse, depression, a variety of sexual acting-out, anxiety, mismanagement of money, and several kinds of personality disorders, are only observable symptoms. That is, they are the external symptoms of underlying issues that need to be addressed. These underlying issues have given rise to the manifested problems in the first place, have increased their severity, or at a minimum, have sustained their existence. If the underlying issues are addressed, these symptomatic problems will either disappear altogether or become much more manageable. Two of these underlying issues are anger and lack of peer relationships. Their much buried anger is the fuel that keeps alive many of these problems (Rossetti, 2005). Cut off the fuel supply and the dysfunction will disappear. Heal the anger and the bitter priest can become a man of communion and peace.

Tied to the anger are isolation and a lack of peer relationships. Many of our priests have hundreds of acquaintances but no real friends. As noted earlier, the priest may know many people but the relationships are superficial. He does not share his inner self and, as a result, others know little about him. There is no one to hear the hurt in his life and the disappointments. There is no one to support him when he feels low. It is true that he is celibate. But, unfortunately, he is more than celibate. He is alone. Celibacy cannot live well without real friends.

There are other underlying issues that give rise to the personality problems of priests. Many carry a variety of unhealed hurts and traumas from childhood. Some grew up in alcoholic homes or were sexually or physically abused. Others grew up not feeling accepted or worthwhile. Some came from broken homes and became caretakers for their younger siblings or sick parents/divorced mothers. More than a few have not come to terms with their sexual feelings and associate much guilt and shame with them. Some priests are so dysfunctional because they went through terrible traumas.

Nevertheless, such childhood traumas can be healed. Through prayer, the sacraments, and psychotherapy, if needed, such traumas can be largely put to rest. While healing processes do not take the past away, they help the individual to live a life in peace, and no longer tormented by the past. The past loses its power to make us miserable and control our lives. Closely connected to childhood traumas is the common underlying issue of a negative self-image. The fact is, when our self-perception is damaged, there are all sorts of problems that surface such as scrupulosity, depression, anxiety, self-mutilation, and eating disorders (Rossetti, 2005). While each of these is a complex phenomenon, a damaged self-image fuels psychopathology.

Some therapists suggest that repeating positive statements (Self-Monitoring Technique) about self over and over again especially when negative thoughts arise in one's mind will help a person with low esteem to increase self-esteem or better his self-image. The above technique is helpful to make him love and accept himself, and to be accepted by others, and God. Realizing that we are loved just as we are facilitates incredible healing. To accept the idea that God loves us in spite of our lowliness is the most of all therapies.

Finally, another underlying issue of priests' problems is a fractured or nonexistent spiritual life. It is said, "Spirituality is the first thing to go and the last thing to return." It is a known fact that some priests have stopped living any meaningful spiritual life. Celibacy makes no sense without a vibrant relationship to God. Priesthood is empty without daily opening ourselves up to God's powerful presence. There is little hope for a priest's mental health if he does not pray (Rossetti, 2005). Spirituality is good for us on all levels, including the physical and the psychological. And a quick ticket to a dysfunctional life for a priest is to stop praying.

What happens is that the priest, who has stopped living any meaningful spiritual life, is caught up in a superficial spiritual life. He speaks eloquently using theological and spiritual phrases that he has read and heard, but they will not have any personal substance (Rossetti, 2005). Often, the spirituality of priests in difficulty is excessively intellectualized and rationalized. They know the right words, but they ring hollow in their own lives.

3. Psychological Measures/Procedures to Help Priests with Personality Problems

Most people with Personality problems do not like to undergo any psychological therapy. This means that they have to give up defense mechanisms, because these defenses help them keep away anxiety and depression. The use of defenses is required to maintain mental balance and health, however, an over-dose of defense mechanisms may cause psychological problems. This is why a therapist has to be careful, while suggesting to the client the ways of abandoning his defenses, otherwise, therapeutic relationship may be broken. A person with a personality problem may use several defenses. Each defense mechanism is discussed in the context of the healing process of personality disorders.

a. Fantasy

Many persons, especially eccentric, lonely, frightened persons who are often labeled as schizoid personalities, make extensive use of the defense mechanism of fantasy. They seek solace and satisfaction within themselves by creating an imaginary life, especially imaginary friends, within their minds (DSM-IV, 2005). They need to be understood as persons who are afraid of real intimacy. A therapist should maintain a quiet, reassuring, and considerable interest in them without insisting on reciprocal response. Recognition of their fear of closeness and respect for their eccentric ways are useful.

b. Dissociation

The second defense, dissociation or neurotic denial, consists in replacing unpleasant emotions with pleasant ones. Frequent users of dissociation are often seen as dramatizing and as emotionally shallow; they may be labeled histrionic personalities (DSM-IV, 2005). Their behavior resembles stunts of anxious adolescents who, to erase anxiety, carelessly expose themselves to exciting dangers. The therapist needs to be careful in not confronting them with their vulnerabilities and defects; this will make them still more defensive. In a less threatening way but in an empathetic manner, the client may be led to speak about his emotional issues which may have made him "forget" his unpleasant emotional issues.

c. Isolation

It is the characteristic of the orderly, controlled person, often labeled a compulsive personality, who, unlike the histrionic personality, remembers the truth in fine detail but without any feeling. In a crisis, there may be an intensification of self-restraint, over-formal social behavior, and obstinacy. These clients need to hear from the therapist precise, systematic and rational explanations. They value efficiency, cleanliness, and punctuality as much as they do the clinician's affective (emotional) responsiveness.

d. Projection

In this defense mechanism, a person attributes his own unacknowledged feelings to others. Excessive fault-finding and sensitivity to criticism may seem to be prejudiced, hypervigilant injustice-collecting, but should not be met by defensiveness and argument. Strict honesty, concern for client's rights, and maintaining the same formal, concerned distance as with a client of fantasy are helpful. Confrontation by the therapist may terminate therapy, instead the therapist should ask if they can agree to disagree (DSM-IV, 2005).

The therapist may also acknowledge and give the paranoid clients full credit to their feelings and for their perceptions. Further, the therapist neither disputes the client's complaints nor reinforces them, but acknowledges that the world the paranoid describes can be imagined. The therapeutic procedure can bring about a talk about real motives and feelings, even though they are misattributed to someone else, and begin to cement all alliance with the client. By empathizing with the client's position, instead of confronting him, the therapist allows the client to get around to talking about his own feared impulses to harm someone.

e. Hypochondriasis

This is a defense usually found among borderline, dependent, or passive-aggressive clients. Often the hypochondriac's complaint that others do not provide help conceals bereavement, loneliness, or unacceptable aggressive impulses. The first step is self-reproach followed by unrelievable complaints of pain, somatic illness, or by the repetition of insoluble life dilemmas. The mechanism of hypochondriasis helps a client to punish others covertly by his own pain and discomfort. By concealing the real unmet wishes for dependency, the hypochondriac complaints allow the client to feel perpetually justified in an angry reproach of others.

The therapist must not in any way try to meet the client's demands, he should follow three rules. First, state that the hypochondriac's pain is as severe as the therapist has ever seen. This simple statement may make the client minimize his pain. Second, try to meet the client's dependency needs rather than attend to his specific complaint. For example, if he complains of stomach pain, suggest to him to take complete bed rest, go on a diet and undergo complete medical examination (DSM-IV, 2005). Third, instead of retaliating against the helplessness, the hypochondriac engenders, ask "Why is this client so angry?" A careful social history may provide the answer.

f. Splitting

This is a typical mechanism used by clients with borderline personality. In splitting, clients try to divide their past and present caregivers into good people and bad people. For example, in an in-patient setting, some staff members are idealized and others uniformly disparaged. The effect of that defensive behavior in a hospital ward can be highly disruptive; it ultimately provokes the staff to turn against the client. Splitting is best mastered if the staff members anticipate the process, discuss it in staff meetings, and gently confront the client with the fact that no one is all good or all bad.

g. Passive-aggression

This defense mechanism is commonly seen in clients with borderline and passive-aggressive personality disorders, who turn anger against the self. It is often described as "Masochism." It includes failure, procrastinations, silly or provocative behavior, and self-demeaning clowning, as well as, more frankly self-destructive behavior. Some of them, when in severe anger may indulge in wrist-cutting.

Passive aggression is best dealt with by trying to get the clients to ventilate their anger. It is not wise to isolate them if they act out their anger in hostile behaviors. Some of them obtain pleasure and relief from anxiety by repeatedly cutting themselves. They need to be dealt with gently by saying: "I wonder if there is some other way you could make yourself feel better. Can you put what you are feeling into words?" Sometimes long-suffering, self-sacrificing clients are able to cooperate in a therapeutic procedure out of a readiness to add to the burden that they already carry, rather than for the benefits that accrue to themselves.

Recovery may be usefully presented to the client as a special additional task. In every interaction with self-defeating clients, it is important to avoid humiliating comments about foolish, inexplicable behavior. If stubborn passive-aggressive clients are reluctant to help themselves, it is sometimes useful to take time out (DSM-IV, 2005). After a short time-out, the therapist, too, is able to continue the relationship in a less angry and covertly sadistic manner.

h. Acting Out

This is another common defense mechanism displayed by people with personality disorders. The mechanism represents the direct expression through action of an unconscious wish or conflict to avoid being conscious of either the idea or the affect (emotion) that accompanies it. Tantrums, apparently motiveless assaults, child abuse, and pleasure-less promiscuity are common examples. Because the behavior occurs outside the reflective awareness, acting out often appears to the observer to be unaccompanied by guilt. This acting-out behavior needs to be controlled as quickly as possible-prolonging it is equally frightening to the client, and also to the helping personnel. Once the acting-out is stopped, it is possible to access the conflict behind this defense of acting-out. The therapist must realize that the client has (1) lost control; (2) whatever therapist says will probably be misinterpreted; and (3) getting the client's attention is of paramount importance (DSM-IV, 2005). The client needs to be confronted with his conflict to make him realize that he must deal with it, rather than act out on it.

4. Obstacles in the Process of Therapy

There are some stereotyped behaviors, such as, narcissism, dependency, and no-win relationships, which are repetitive behaviors that hinder a client seeking help.

a. Narcissism

When threatened, many clients with personality disorders see themselves as powerful and all important. To the observer, that behavior may be labeled vanity, grandiosity, entitlement, or narcissism. It may lead clients to be unusually critical of the therapist. The therapist may be seen to be superior by the client, in that situation, the therapist must reassure the clients that they are persons in their own right, and offer them consultation with some expertise if that seem appropriate, and explain to them that therapy may be beneficial to him if he chooses to go through with it.

b. Dependency

Though dependency exists in people with personality disorders, but it is often denied. Dependency is often manifested first by a sense of entitlement and then by resentment when unreasonable wants are not met. Pessimism, self-doubt and immaturity are common, and they lead to a dependent, demanding relationship, which become issues of ridicule behind the client's back by helping persons. The best ways of helping a dependent personality is by observing three rules: 1. For self-protection the therapist must set realistic limits, for example, "I can see you today only for 15 minutes", may be tomorrow, I will give you 30 minutes." 2. The therapist should never present limits as if they were an expression of impatience and punitiveness. There should never seem to be a withdrawal of interest or consideration, nothing should be taken away from clients without something else being given. 3. At the same time the limits are set, caregivers should convey their readiness to care for the client as completely as is reasonable.

c. No-win relationships

A no-win situation is one in which two people take positions that neither will modify. Without compromise or changes in behavior, both parties must lose what they otherwise could gain if they reached a fair agreement. The person with a personality disorder frequently seeks out relationships that offer a promise of something for nothing. In choosing people from whom the client feels entitled to take, there is the risk of recreating past cheats and defeating interactions. Consequently, those with personality disorders seem perennially entangled in troublesome relationships in which there is neither satisfaction nor escape.

d. Counter-transference

People with personality disorders are most annoying; their self-defeating behavior provokes compensatory self-defeating patterns in others. Often, the client directs angry, demanding, or wounding statements toward the therapist, more often than not centered on some real, if minor, limitation or vulnerability in the therapist. A host of natural reactions ensues. The therapist must learn to feel safe in experiencing those reactions and yet must be trained not to act on them. Getting angry with the client, feeling on the defensive, denying the truth, wishing to control the client and losing one's concentration are common reactions in even the most experienced therapist.

In long-term psychotherapy of such clients, over-involvement is all too common. Kernberg (1975) has pointed out four danger signs: (1) reappearance of abandoned immature character traits in the therapist during interaction with the client; (2) emotional withdrawal from the client by the therapist manifested by a devil-may-care attitude about how the client fares; (3) a similar lapse into total dedication to the client that promises unrealistic rescue; and (4) the development of hypervigilant (paranoid) attitudes toward the client, with fantasies of being attacked. If the client is suicidal, the therapist may go beyond his role to be overconcerned about the client's life. This may interfere with their professional relationship.

e. What the Therapist Should Not Do

1. The therapist should not listen to stock, repetitious complaints-looking away, or closing the eyes are useful, nonverbal clues to emphasize the point the client is once again wasting time with repetitive complaints. If the client returns to something emotionally relevant, the therapist must show visible interest.

2. The therapist must not feel put down if ridiculed by the client, nor try to outwit the client, rather try to understand him.

3. The therapist must not try to insist on a contract for treatment.

4. The therapist must not encourage dependency.

5. If the client repeats often the same behaviors, the therapist may help him realize the futility of it by saying "How long are you going to let this happen to you?" "Do you like it"? "Or do you want to learn how to change it?"

6. In the early part of the treatment, interpretations must be avoided. Psychoactive drugs must be avoided at any cost.

7. The therapist must not be a "Formal Officer" type of a person, rather more informal/natural in dealing with the client so that a personality disorder trusts the therapist. Normally, these types of clients are sensitive, and are affected by slight changes in the facial expression of the therapist.

8. The therapist should never lie or offer a conflicting nonverbal message.

9. The therapist should not give psychoactive drugs unless there is a specific indication. Obviously, if a personality disorder is compounded by a major depressive disorder, panic disorder, a treatable organic illness, or a psychotic episode, psychoactive drugs are in order.

f. What the Therapist Should Do

1. The therapist should focus on the client's behavior and not on the explanation of that behavior.

2. The therapist should establish a stance of collaboration and sharing to accomplish the professional consultation model of doing something with the patient, rather than the surgical model of doing something to the client.

3. The therapist should remember that the behavior of personality disordered clients, like the behavior of adolescents, seems at times mindless, irrational, and incurable and that next week it is unlikely to respond to any good advice. Like adolescents, however, with a little help, personality disordered people often outgrow their difficulties.

4. The therapist should confront, rather than interpret, the defenses of clients with personality disorders but only in a setting where support, especially peer support, is available.

5. The therapist should set limits and provide structure. The structuring helps clients to reflect on what they are reacting to and what they want for themselves. Limits, however, always produce anxiety and depression; the therapist must be willing to listen to and bear those affects (emotions) when they appear.

6. The therapist should encourage group support. For example, a group of priest-friends or a circle of friends he enjoys. Often, it is the presence of social support which distinguishes limits from punishment; the latter is useless in mitigating personality disorders.

7. The therapist should allow the client to help others. Limiting a personality disordered person to a client-role alone may not bring much help to the client. His self-esteem will be enhanced by allowing appropriate client helpfulness to others who are more needy.

8. The therapist should inquire and help the client to think through the consequences of actual or intended actions. Clarification and interpretation may be more useful to neurotics, but for personality disordered persons they may benefit from their own self-help and reflecting on their own behaviors how they negatively affect their lives.

V. Prevention of Personality Problems in Clergy

I am often invited by Bishops to speak to their priests about self-awareness or helping them live a healthy life. I am more than happy to do this and I think it is important. It shows a real commitment on the part of priests and the bishop to help the priests live lives of integrity and wholeness.

However, I must tell you that priests already know that they are not supposed to become alcoholics, or embezzle money, or have illegal sexual relations or view pornography on the internet. As noted earlier, when priests are beset with unaddressed childhood trauma, when they are isolated and angry, when they have a damaged self-image and their spiritual lives are empty, they are not far from a personal melt-down. The manner in which these underlying problems will finally be manifested depends upon the predispositions of each priest, but they will manifest themselves in very negative ways.

How do we solve this issue? The solution is both individual and collective. Individually, such persons need to enter a personal helping relationship, perhaps more than one. Some believe that spiritual direction is sufficient. As times, it is. However, it is just as likely that the priest who excessively intellectualizes his spiritual life will try to use spiritual direction as just another defense against truly facing his problems. I have known more than one priest who conned the bishop into not requesting him to go into psychological/counseling help by saying that spiritual direction would address his sexual compulsiveness. It is little surprise that it rarely does. Spiritual direction is very important, but it is not appropriate for the treatment of major psychological problems. Thus, priests in difficulty will want to find assistance on a variety of levels -- spiritual, psychological, and perhaps physical.

But the solution is a collective one as well. The more we foster presbyterates and dioceses that are places of true communion, the more healing and life-giving they will be. Healthy presbyterates, promoting mutual support and a positive unity, will bolster the well-being of individual priests. Making time and space plus devoting resources to clergy meetings, priestly days of reflection, monthly recollection with some specialized person speaking to priests, special group therapeutic retreats for smaller groups, training spiritual directors for priests, sabbaticals, and priest-support groups, are all time and money well-spent. Bishops and clergy-leaders (directors) would do well to foster the health of their entire presbyterates, in addition to their all too consuming work with a few priests in difficulty (Rossetti, 2005). Wellness is both a collective and individual reality.

VI. Concluding Remarks

Underneath the aforementioned problems is an even deeper substratum of human challenges. I have some experience in dealing with priests and religious women. As they struggled to find healing and life, I observed a basic level human struggle that seems common to all people. Indeed, their healing journey is only a microcosm of essential human challenges.

These are some of the ultimate challenges of life. They describe the attributes of the next life, which bring to their fullness the choices we have made. We rise to the heaven of peace, gratitude, intimacy, and hope; or we find ourselves in the hell of violence, conflict, anger, isolation and despair. No one can make us choose one or the other. We are not determinists but rejoice in the gift of human freedom. We do not need to be full of hope; we only need a glimmer. We do not need to be perfectly grateful or to be perfectly at peace; we only need to have a sliver of God's peace in our heart and to form the words on our lips "Thank you, God" in order to be saved (Rossetti, 2005).

REFERENCES

1. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), Arlington, VA, 2004.

2. Coleman, G.D. & Sellars, C.J. Group Ministry to Broken Priests, Human Development, Vol.22, No.2. Summer, 2001.

3. Dlugos, R. F. New Program for Healthier Clergy, Human Development, Vol.23, No.2. Summer, 2002.

4. Jennings, D. E. Ministering to Ministers, Human Development, Vol. 13, No.2, summer, 2002.

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END

(Accompanying photos available at here)