Richard Niolon, Ph.D.
3/02

Why integrate a personality theory into your work? Well…

This isn't comprehensive by any stretch of the imagination… BUT… it might give you some starting ideas for what to do with a theory to integrate it into your work.

Psychodynamic Theory
This is helpful in explaining how problems interact, and how others can be helpful to the client. Basic ideas include:

Adler's Individual Psychology
This offers some ways to explain pathology without pathologizing. We all begin life with a sense of inferiority and try to develop a sense of superiority

Karen Horney
This model offers some good descriptions of how people cope. Emotional coldness toward children creates basic anxiety, a feeling of being isolated and helpless. Horney offers 10 resulting neurotic strategies in 3 basic trends to cope:

The Compliant Types -- move towards, seek love and protection with a neurotic need:

1) for affection and approval, but can't express wishes and say "No"
2) for a partner who will take over their life
3) to restrict their life within narrow borders, sometimes to avoid rejection

The Aggressive Types -- move against, seek control and prestige with a neurotic need:

4) for power, perhaps for a worthy cause, but it's tied to anxiety and inferiority
5) to exploit others to feel safe… "do unto others before they can do unto you"
6) for recognition and prestige, evaluating all things in terms of their prestige
7) for personal admiration to compensate for self contempt
8) for personal achievement

The Detached Types -- move away, with a neurotic need:

9) for self-sufficiency and independence
10) for perfection

Horney described 7 defenses:

1) blind spots--ignores obvious contradictions and becomes numb to experiences
2) compartmentalization
3) rationalization
4) excessive self control--suppression leads to greater resentment and control
5) arbitrary rightness--doubt is intolerable, and a dogmatic and selfish style develops
6) elusiveness--cannot be pinned down to anything to avoid being wrong
7) cynicism--denies and devalues moral beliefs, projects this and suffers

Object Relations
This model is good for describing how a client's relationships work. OR deals with our internalized representations of others which we use to build a self. Examine a client's understanding of:

1) various feelings
2) conflicting and changing feelings

3) different possible resolutions with understanding of impact to self and others

Cognitive, Behavioral, and Learning Theory
These models explain how a person organizes the information they gather about their world. Here's a few ideas:

Rational Emotive Therapy - Albert Ellis
A Something happens, B We think terrible things ("mustabatory fantasies"), C We get upset
D We reconsider, E We are more rational about matters

This model is nice for explaining life stages and struggles.
Basic Trust Vs. Mistrust -- 1 basic trust with consistent nurturing care and hope, but basic mistrust with abuse or neglect (depression and even paranoia)

Autonomy Vs. Shame -- 2 to 3 autonomy and will, but if too permissive or demanding parents, shame and doubt, with neurotic striving for competency (narcissistic injury, histrionic)

Initiative Vs. Guilt -- 4 to 5 initiative and purpose if supportive home, otherwise guilt and inhibition, with a constricted life (too much purpose and no guilt leads to ruthlessness - ASP)

Industry Vs. Inferiority -- 6 to 12 industry and competence or inferiority and inertia, like in self-efficacy, coping skills, success experiences to shape expectations

Identity Vs. Role Confusion -- 13 to 19 identity and fidelity, "the ability to sustain loyalties freely pledged in spite of the inevitable contradictions." Marcia offers 4 resolutions:

Identity Achievement - commitment and crises, healthy and flexible
Moratorium - crises w/o commitment, may stay in crises and never develop identity
Foreclosure - commitment w/o crises, buy parents'; resists growth, rigid and authoritarian
Identity Diffusion - no commitment or crises, may never develop, pessimistic and bored with unfocused anger

If this fails, identity diffusion; may join cults or hate groups and repudiate values, or the military and show fanaticism… may become psychotic and fragmented

Intimacy Vs. Isolation -- 20 to 24 ability to be close, gaining love. Orlofky offers 6 resolutions:

Intimate - forms relationships
Preintimate - able but scared
Stereotyped - superficially able/doesn't

Pseudointimate - superficially able/does
Isolated - unable and avoids
Merger - enmeshed and sacrifices identity

Failure leads to promiscuity, short mergers, or exclusion (reject relationships)

Generativity Vs. Stagnation -25 to 64 a strong ego identity, creativity, and success leads to generativity and care, failure to stagnation or self-absorption and lack of meaning

Ego Integrity Vs. Despair - 65 to death ego integrity and wisdom or despair and dread of death; maybe false integrity or presumption, or disdain for life

Kohut offers a nice way to explain how someone became the way they are now:

• a child needs 1) accurate mirroring from the parents that the child is good, 2) to idealize the parents and internalize protective and loving objects to sooth and calm, and 3) kinship
• if lacking adequate care and empathy, the child is traumatized and develops a grandiose self with an intense need for admiration and praise
• the parents must allow idealization first and later show how to love yourself with faults, providing optimal frustration to show the child is not all powerful but can still cope
• failure will lead to arrest at a psychosexual stage for fear of re-experiencing rejection
  
  Disturbances to the Self
  Psychosis--protracted damage, few defenses, disorganized, chaotic, constantly threatened self
  Borderline States--self is in chaos, but has some defenses sometimes available
  Schizoid Personality--emotional distance through coldness, protecting from distortion of self
  Paranoid Personality--distance through hostility/suspiciousness, constantly fear exposure
  Narcissistic Personality Disorders--severe damage to self including subtypes:

Understimulated Self--prolonged lack of stimulating responsiveness from parents, experiences self as boring and apathetic, and seeks stimulation to relieve their deadness
Fragmenting Self--received little parental responsiveness, but the parent's empathic failure focused on a single aspect of the child's total self
Overstimulated Self--excessive responsiveness to grandiose and idealizing needs, no optimal frustration, moves into adulthood with a weak separation between the fantasy/reality of the self
Overburdened Self--views the world as hostile and dangerous, responds irrationally because lacked the opportunity as a child to merge with a calm powerful self object

Narcissistic Behavior Disorders--less severe harm, with a tendency toward grandiosity and pretentiousness at times, but self-criticalness and minimization at others.

Mirror-Hungry Personalities--seeks self objects who will provide mirroring
Ideal-Hungry Personalities--seeks idealized partners to make them feel worthwhile
Alter-Ego-Hungry Personalities--seeks others to conform to their beliefs and validate self
Merger-Hungry Personalities--seeks idealized attachment to repair seriously defective self with primitive self-objects and primitive needs
Contact-Shuning Personalities--seeks all encompassing idealized union, but fears rejection

Carl Rogers and Person-Centered Therapy (Kohut-Lite)
This theory is easy to understand and implement. The social self is an organized self based on others' perceptions, while the true self is based upon our actual feelings and experiences. Conditions of worth activate the social self, repress the true self, and produce incongruence. Unconditional positive regard places social and true self in harmony, and congruence results.

Three Conditions are necessary and sufficient for therapeutic change.

• therapist shows unconditional positive regard for the client
• therapist shows empathy for the patient through empathic listening
• patient perceives 1 and 2
  
  Rogers thought that there were six characteristics of a healthy marriage
• difficulties are always present in the partnership but are brought into the open
• communication is more open and more real, with mutual listening
• the partners will come to recognize the value of separateness
• the woman's growing independence is recognized and valued
• role expectations drop away, people choose their own way of behaving
• either partner may form satellite relationships which ultimately enrich the relationship
  
  Rogers argues that the fully functioning person is open to experience, focuses on their experiences in the present, trusts their organism and does what feels right, is creative and lives a richer life, taking challenges, risks, and hurts as they come. They are honest and open, and opposed to highly structured, inflexible bureaucracies. They are indifferent to material comforts and rewards, but have a deep distrust of technology that exploits people and relies on authority.

Maslow and the Hierarchy of Needs
This theory is nice to incorporate systemic, community, and social views. Maslow posited the existence of a biologically based goodness that, if fostered by society, would develop into a drive benefitting man. Needs were arranged in a hierarchy:

self-actualization (being able to reach our potential, facing Deficiency-Cognitions or judgmental, condemning, and black-and-white thinking and developing B-Cognitions, or non-judgmental, validating, and clear thinking. Peak moments define someone capable of clear B-Cognitions. You can still be petty, unreasonable, and uncertain, but you live life in the moment and experience self and world clearly and consistently)

esteem (based both on our own and upon others' views of us)

belonging and love (Deficiency-Love and Being-Love, or love only to meet one's own needs versus love to meet another's needs)

safety (physical safety, stability, law and order - where threatened, panic, emotional distress, and turmoil can result)

physiological (food, clothing, shelter- where threatened, the others can not be addressed)

Family Therapy
Bowenian Family Therapy
This model is good for understanding relationship problems, how they start, and their context in family systems. It understands multi-generational patterns in families and includes culture, ethnicity, religion, and more regarding expressing emotions, dealing with death and life, loyalty to the family… Key ideas:

Structural Therapy
The Structural and Strategic models can help in families, as well as systems like a company, social service agency, and referral source. Minuchin argues that there are good (adaptive and coping) and bad (rigid and stuck) families. You unstick them by getting the family to realign and do something different. Key ideas:

Strategic Therapy
Main concern is with the presenting problem and changing it through different behaviors to break feedback loops; desires for power/love cause dysfunctional patterns to emerge. Key points:

The difference between the schools is sometimes not what they do, but why they do it.

Paradoxical Techniques - highlight the paradox they create but won't name
Resistance Techniques- tell them not to change and engage their resistance
Prescribing the Symptom - tell them keep doing it, but do it more
Reframing
Affect Shocking - like "Dad's going to die within a year if he keeps drinking like this"
Empty Chair Techniques
Session Limits - like 10 and no more
Outpositioning - helpless mom is now fully in charge

Mix and Match is not OK
You are not an expert
Beware of coming across as manipulative using paradoxical techniques

Know research
Be aware of professional boundaries
Consider the system

Three concerns
1) delay between realizing marriage has problems and seeking help is six years
2) relapse - 30-50% of improved couples relapse in two years
3) 55% of couples improved after therapy, only 35% were in the non-distressed range

Dysfunction is marked by:

Fondness and admiration - or the dailyness of positive events. Work on

Help regulate conflict (69% of issues don't get solved, they get managed)

Create Rituals of Connection (marriages end at 5-7 years due to high conflict or 10-12 years due to the loss of intimacy and connection)

Assessment