How do you work with clients with personality disorders?
Many of the clients Dr. Lapite-Garrett works with carry diagnoses of borderline or histrionic personality disorder, diagnoses that are frequently applied to individuals whose emotional intensity and relational patterns are direct expressions of unprocessed trauma rather than fixed character pathology. That clinical reality shapes how this work is approached from the very first session.
Regardless of diagnosis, Dr. Lapite-Garrett meets every client where they are. She recognizes the function of a client's behaviors before she addresses their form, understanding that what looks like dysregulation from the outside is often a highly organized response to a history that demanded it. Clients are not asked to arrive regulated in order to receive quality care. They are not shamed for the full expression of their presentation. They are not turned away because their complexity is inconvenient.
What they receive instead is tender, precise, and clinically rigorous care that holds the whole of them without alarm, without pathologizing, and without the implicit message that they must become more manageable before they deserve to be treated. The only circumstance under which a higher level of care is recommended is when the clinical presentation genuinely requires a more intensive level of support than outpatient individual therapy can safely provide, and even then, that conversation is held with the same dignity and care as every other.
Dr. Esther Lapite-Garrett is a licensed psychologist and the founder of Alafiora, a premium private practice offering depth-oriented, attachment-centered care for individuals navigating complex sexual trauma and the relational patterns that form in its aftermath. The clients Dr. Lapite-Garrett works with include survivors of rape, incest, sex trafficking, intimate partner sexual violence, and childhood sexual abuse. What followed that history is the center of her clinical practice: the love obsession, limerence, compulsive sexual behavior, hypersexuality, and emotional dysregulation that form in the aftermath of sexual harm, and that most generalist approaches were never quite equipped to treat.
Alafiora is one of a small number of practices equipped to work with the full spectrum of how these patterns express themselves in contemporary life, including the migration of erotic and romantic attachment into AI companionship, parasocial bonds, fantasy-based intimacy systems, and the accelerating escalation that occurs when real-world connection no longer feels safe, satisfying, or possible. The clients who carry these presentations arrive having spent considerable financial, emotional, and psychological resources on experiences that brought temporary relief and deepening shame in equal measure.
The clients Dr. Lapite-Garrett works with are not struggling with a lack of insight. They have read the books, tried the prior therapy, and understand their patterns with a clarity that has not been enough to stop them. They wake at 3am with a body that will not settle. They reach for sex or connection not from desire but from the need to feel something, or to feel nothing at all. They love with an intensity that outlasts what the relationship warrants, cycling through obsessive thought long after every rational part of them knows the situation has ended. They make choices in moments of emotional flooding that they do not recognize as their own afterward. They experience behavior escalation, spending elevations, and deepening secrecy. Even still, they find that the pattern repeats, each time carrying a little more shame and a little more distance from the person they understood themselves to be.
What years of prior effort could not move, the work at Alafiora finally does. What changes in our work is structural. The clients who engage fully describe experiencing more than symptom management but a fundamental shift in the organizing patterns that formed them, patterns that prior treatment approaches could not reach.
Alafiora is a private-pay practice offering sessions virtually, in person, and on location across multiple states. The practice maintains a small, intentionally limited caseload to ensure each client receives the full depth of care their history requires. Visit https://www.alafiora.com to learn more or inquire confidentially.
