While core content reflects the deep emotional drivers of personality pathology, surface
content includes the behaviors, symptoms, and presenting concerns that bring clients into
treatment. This session explores how clients with personality disorders often present, with
dramatic, confusing, or contradictory behaviors, and how these external expressions relate to
their internal emotional worlds.

Clinicians frequently encounter intense mood swings, relationship conflicts, self-harm,
dissociation, perfectionism, or control-seeking behaviors. While these are often the focus of
initial sessions or crisis management, they are better understood as coping strategies or
defenses that protect against intolerable emotional states like shame, fear of rejection, or
emotional emptiness.

This session helps clinicians distinguish between the behavior and the need behind the
behavior. We’ll examine how diagnostic criteria, symptom checklists, and even well-meaning treatment plans can become overly focused on managing outward behavior without
addressing the emotional core. When this happens, treatment becomes reactive rather than
transformative.

Through clinical case examples, we’ll explore how to map presenting symptoms back to
emotional themes, using curiosity and clinical empathy to help clients feel understood rather
than pathologized. Participants will also learn to identify when behaviors are adaptive efforts
at regulation and when they signal deeper disorganization or fragmentation of self.

By better understanding surface content as communication, often unspoken and unconscious, clinicians can avoid getting stuck in cycles of symptom-chasing and instead begin to build a
path toward deeper insight and healing.

This session provides the critical link between what clients do and what they feel but may not
yet be able to express.

What You’ll Learn:

1. Differentiate Surface Behaviors from Emotional Drivers:
   Identify and clarify the observable behaviors, symptoms, and presenting problems in clients with personality disorders, distinguishing what is visible in session from the underlying emotional states fueling these patterns.
2. Map Behaviors to Emotional Themes:
   Develop skills to trace presenting symptoms—such as mood swings, self- harm, perfectionism, or dissociation—back to core emotional needs or defenses, using clinical curiosity and empathy.
3. Assess Adaptive vs. Maladaptive Regulation:
   Learn to recognize when client behaviors represent adaptive attempts at emotional regulation versus signs of deeper disorganization or fragmentation of self.
4. Move Beyond Symptom Management:
   Apply strategies to avoid reactive, symptom-focused treatment by understanding surface content as communication, enabling a shift toward interventions that address both behavior and the unmet emotional needs beneath.

Agenda:

10 min – Introduction to Surface Content
Define and distinguish from core content. Introduce the “iceberg” model.

15 min – Case Vignette with Disruptive Behavior
(e.g., impulsivity, substance use, self-harm, aggression)

25 min – Discussion
What behaviors dominate? What do they mask or signal?
How is the behavior reinforced?

25 min – Interventions
How to manage surface content without reinforcing defenses
Grounding, crisis management, behavior chains

15 min – Group Exercise
Translate surface behaviors of a real client into possible core themes.