1 Evasion and diversion. Manipulators will give half‐answers that only seem like whole answers unless you think about them for a minute. Be careful not to take things at face value too readily. If it seems that someone is sidestepping or dodging an issue in some way, avoiding a topic, or balking at full disclosure, don't assume that they're simply anxious or being justifiably apprehensive or guarded. They could be being deliberately evasive for manipulative purposes. Press gently, while remaining respectful of boundaries. Deliberate and potentially malicious sidestepping will most likely then reveal itself. Manipulators are also good at redirecting focus to something irrelevant when they suspect you're zeroing in on something. Sometimes you don't even realize they've gotten you off topic until you're well into dealing with issues completely different from those you started to address. It's up to you to keep the focus where it needs to be, no matter what other diversionary paths they might tend to lead you down.

      2 Distortions, inconsistencies, and calculated omissions. There are many ways to lie, and the most effective of these are subtle and covert. Sometimes the most effective way a person can lie (and therefore succeed at manipulating you) is to recite a litany of completely true, verifiable things while deliberately leaving out a key bit of information that would shed an entirely different light on things. Be especially on the lookout for vagueness, especially when it seems to occur at particular times. I once asked a person I suspected had a drinking problem if he'd ever been diagnosed or treated for substance abuse. The response: “They sent me to one of those places where they do the steps and all that and they told me I didn't have a problem and let me go,” was classic in its evasive quality. First, there's the use of the nebulous “they.” And when this vagueness is accompanied by no further clarifying information (a calculated “omission”) it can be a successful manipulation tactic (i.e. “I know what you're going for here, Doc, but really there's nothing there so let's move on to something else, okay?”). But through polite, gentle, yet persistent follow‐up, I eventually learned that the person had indeed been referred for inpatient treatment several times and to a very reputable clinic at that but was discharged for noncompliance each time.

      3 Rationalizations and excuses. Some people have what seems to be an answer for everything. That is, until you reflect on things for a bit. Then, all of a sudden, their “explanations” don't make as much sense. Be mindful when someone is giving their explanations of events or reasons for doing certain things and don't take anything purely at face value. Trust your instincts when things just don't seem to be adding up. Don't be afraid to ask follow‐up questions. Even the most seasoned con artists can dig themselves a pretty deep hole when you follow‐up on answers that on second thought don't really explain anything. Most of us were taught to view a rationalization as something a person unconsciously does to avoid the anxiety and pain associated with feelings of guilt. But artful excuse making can also be a fully conscious and deliberate way to make you think a person didn't do anything wrong or had just cause to do something that might appear wrong. Be leery when someone has too many answers for behaviors you find troubling in some way.

      4 Minimization and magnifying. Earlier I gave the example of the inmate who “scored” drugs highly prone to abuse from an unsuspecting physician. The physician would later tell me how distressed the woman he treated appeared during the clinical interview. Her hands were shaking, her voice quivered, and she appeared to be holding back tears much of the time. And she reported all the things you'd expect for someone who was dealing with a fair degree of anxiety and depression: She couldn't get to sleep, couldn't stay asleep, wasn't eating right, was withdrawn, felt edgy and confused much of the time, and all the joy had gone out of her life. But these symptoms were all highly magnified. The records and reliable collateral information would have indicated that she routinely slept and ate well, was regarded as one of the more jovial, socially gregarious, and active individuals among her peers. And while she magnified any level of distress she might be experiencing for manipulative purposes, she also minimized the nature of other things, especially with regard to her history of substance misuse and other criminal activity. While it was true that she had never been incarcerated before and came in on a “technical” violation of the terms of her probation (she provided this information during her clinical interview), it was not true that she was a relatively minor offender who just happened to make a careless mistake. In fact, this individual had a lengthy history of all sorts of criminal activity for which she had been craftily able to avoid successful prosecution. And authorities were more than pleased that at least her violation of the terms of her probation for the one major charge that “stuck” allowed them to take her off the streets for a bit. With sufficient access to and careful examination of the official record and other reliable collateral data, the physician would have had a much better idea the kind of person he was dealing with. In today's world, with character dysfunction so much more prevalent than in years past, having sufficient historical and reliable collateral information is essential. Armed with such information, you're better able to spot minimization, magnifying, and other tactics when they occur.

      5 Seduction. Manipulators know how to turn on the charm. Sometimes, it's so clearly superficial that an astute person can see through the charade. But the more crafty a manipulator is and the more intent they are on taking advantage of you or putting one over on you, the more careful they are about currying your favor. So sometimes they can appear quite genuine. They hope to endear your trust so that your guard will be down when they start advancing their real agenda. They will promise you things they have no intent on delivering, appeal to or stroke your “ego” to make you think they really like and value you, etc. when all the while their real intention is to eventually take advantage of you in some way. And, if you've allowed yourself to be charmed enough, you won't realize what they're really all about in character until long after you've been exploited.

      6 Shaming and guilting. By and large, physicians are a fairly conscientious lot. It takes more than a fair amount of conscientiousness to excel in one's studies, to endure rigorous training, and to work long hours for rewards that are often quite delayed in coming. Character‐impaired people know this intuitively. And they also know that the best way to manipulate someone is to prey on their level of conscientiousness. Conscientious people want to do the right thing. So, if someone “invites” them to feel guilty about either doing something or failing to do something, or to feel ashamed about something they've done, they're likely to feel particularly motivated to make things right. Shaming and guilting work as manipulation tactics when the intended target of manipulation has a well‐developed conscience rooted in empathy for others. Just try using the same tactics with a character‐impaired individual and see how far you get. Manipulators prey on your good nature, pushing your guilt and shame buttons. Most of the time this is done very subtly. You won't hear a manipulator say something stark and overt like, “I think you're a horrible person,” or call you a horrible doctor. Rather, they'll imply such indirectly. Still, the effect is the same. And the bigger conscience you have, the more susceptible you are to this kind of manipulation.It's important to develop what some clinicians refer to as your “third eye” and “third ear” in your interactions with folks who might be manipulative or otherwise character disturbed. At workshops, I like to advise attendees to take a step back and pay less attention to what the person says and more attention to the kinds of things they're saying, keeping that third ear open for the kinds of tactics described above. The same thing is true for the interpersonal processes taking place in an encounter with them. Sometimes, if you take a step back and look at the process critically with that third eye, you can more readily spot the jockeying for power and advantage that might otherwise slip your notice.