The clinical (illness model) of personality typology #Freud in the therapeutic setting

It was great to get back to term time lectures again last night even if it was not great to be back in the London climate.  I left Valencia (see above) on Monday when it was 37 degrees.  Last night’s lecture was on Freud.    I will be discussing Freud’s ideas later in the week but I wanted to continue my theme of applying personality typology to the therapeutic environment.

In the psychotherapeutic community we owe a great debt to Freud who was primarily concerned with exploring the personal unconscious. The clinical model has its origins in Freud and covers four types: schizoid, obsessional, depressive and hysterical.

Schizoid

In this model this type is described as introverted.  They are more likely to be avoidant in relationships and are fixated on oral development.  This type often fails to turn up for therapy. The defining feature is the distance between the conscious personality and the
feelings function.  There is very little sense of self and there is a fear of intimacy with this type. The schizoid likes to be alone and is not very good with manifestation.

The approach in therapy is to understand that fantasy is the way into feeling for
this type.  Patience is therefore needed in the therapeutic environment, as perhaps it is needed with all clients, but especially so here.  It is perhaps an over generalisation that this type is represented by ‘air’ in the elements model but it can feel like it when you are sitting and listening to a client who speaks non stop in an avoidant manner. With a contracted client, I would slowly try to ground them by getting them to relax and get in touch with their feelings. A number of transpersonal techniques could eventually be employed
when it is safe such as the pebble exercise, meditation, creative imagination
and deep breathing.

Obsessional

 The obsessional type is also described as introverted. The issue with this type is
control, therefore, this type is less likely to turn up for therapy. The feelings are not shown.  They are there, just that they are not shown. This type is associated with the “stiff upper lip”.  Obsessive compulsive disorder (OCD) can be a presenting issue which is about mastering, a form of control.  In Freudian terms, it emanates from a potty
training issue and a form of distortion which took place around 6-18 months
leading to a fixation.

Attempts at control and people pleasing leads to resentments with this type. Spiritual
experience can threaten them.   This type is more likely to become tyrants, controlling
their world through their will and ultimately leading to isolation.

An approach in therapy would be to investigate what is happening in dreams as obsessives
play out sabotage.  The real work in therapy is to uncover what is really going on.
No less with this type. How can the true feelings be revealed? I would seek to explore the source of the resentments and the need for controlling behaviour. The key is to get behind the primary behaviours to uncover what is really going on.

Depression

Depression can be endogenous, reactive and bi-polar (previously called manic). This type in this model is extroverted as the feelings are shown.  There are lots of water qualities. They are more likely to turn up for therapy because of their extraversion inclinations.

Endogenous depression is not a type of depression rather it is biological depression. The defining characteristics are helplessness and hopelessness. What is behind this is an internalised sense of not feeling good enough.  They seek out scripts that are self-deprecating as they are seeking to have their poor self image reflected back to them. 

The manifestations of low self-esteem usually bring them into therapy.  Unlike schizoids, there is a sense of self, but it is lacking or weak.

Reactive depression specifies that depression comes from some event or some stress occurring. For example, problems in a relationship, bereavement, loss of a loved one, changing job or anything that directly affects one’s life.  Other people can sense the
vulnerability of depressives and can seek to exploit their victim status. This is a major liability in dealing with life’s problems since in the workplace there are invariably bullies lurking to pick up on any vulnerability.

Depressives are water types in the elements model as there is distortion.  The water is stagnant.  Bi-polar (formerly termed manic) depression is the toughest to live with and requires medication for chemical rebalancing. Bi-polar clients can be as high as a kite and can be very sexual, or spendaholics. But then there is a crash.  It is about extremes with this type. If they are challenged they can be very defended.  Lithium is the usual
prescribed medication.

The approach in therapy is to be aware of boundaries which are very important for depressed  clients.  CBT interventions such as “to do lists” can be very useful. They need
accurate mirroring and reassurance and require an acknowledgement of their
accomplishments.  It can be safer to access anger (fire) through creativity, in the form of gestalt therapy or working with images. Fire is the expressed form of the water element as the depressed feelings can be akin to stagnant water.

I find the description of this type in this typology limiting in that I believe we are all a bit depressed, to a greater or lesser degree.  How, for example, can you distinguish between sadness of true feelings, perhaps in response to a harsh event, and the sadness brought about by depression?   Perhaps it is best to think in terms of extreme distortion with this type.   We might all be a bit depressed at times but the issue is when the depressed feelings become our defining quality.

Hysterical

Like depressives, hysterics are more likely to turn up for therapy because of the extraversion in these types.  They are extrovert because the feelings are
being displayed (symbolically) and they are demanding attention. In Freud’s day,
the hysterical type was seen as classically female. Hysterical types seek
attention by whatever means. They are invariably still raging at a parent.  They need attention but the right kind.  These are the type that will commit suicide
by accident. The suicide attempt is really a cry for help, for attention, but it
went too far.

There is always a drama going on with them.  Hysterical types are prone to sexually provocative behaviour or to sexualizing non-sexual relationships. However, they may not really want a sexual relationship; rather, their seductive behaviour often masks their wish to be dependent and protected. They have a tendency to “make mountains out of mole hills.”  The proverb rings true: ”Empty vessels make most noise.”

The strategy with this client is to try to find what is really going on and therefore one needs compassion.  They can be hard to like as they seem to be sabotaging themselves.  They are like a hurt child running the show and are distorted earth types.  They look
fiery, but it’s more like an earthquake or a volcano. The presenting issues
with these clients can entail bad physical conditions. Physical holding can be
a positive reassurance, such as a hand on back, a hug, or a holding hand.

Critique of clinical model

Freud has contributed a great deal to our profession but the psychoanalyst tends to have
the role of the wise initiate who ‘knows’ and disagreement would be seen
usually as a defence or a manifestation of pathology. This is at odds with the
transpersonal school, which most certainly does not ‘know’ but finds creativity
in holding and exploring the mystery.  The clinical model can be useful when seeing extreme, distorted types.  It is an illness model and the conflict is the need to conform to society. I would contend that the need to conform to society is less of an issue nowadays.

There are wide differences of opinion within the transpersonal community
as to the appropriateness of doing transpersonal work with psychotic
individuals. Jung, Wilber, and Grof and Grof  have argued that transpersonally oriented therapies are not appropriate for psychotic individuals.  Lukoff and others, however,  suggest that transpersonal psychotherapy may be particularly appropriate for psychotic disorders, even serious ones. In general, initial evaluation should include not only the usual elements of a psychiatric history, but also an assessment of the patient’s spiritual experiences, developmental level, premorbid functioning,  and interest in exploring the symptoms.

More on Freud soon…..

Related posts

The relevance of personality types in psychotherapy

The important aspect of assessing the relevance of personality types in psychotherapy is that the various typologies are merely a map to guide the therapist when seeing clients since nothing is set in stone. I believe that the purpose of therapy is to uncover the true feelings of the client.  

If our patients are of a similar “type” to us, it can be easier to understand and empathise with them. They will be comfortable following our language and working with the scripts and choices that we make therapeutically. However, what happens if our patients have some different preferences to us? Perhaps they have to really stretch themselves to follow our words and ideas? Maybe as a therapist I am finding it really difficult to “click” as I may find it difficult to understand exactly what they are saying, feeling or doing. An understanding of personality types is therefore useful in the therapeutic environment. The therapist carries a basic tool-kit of essential skills such as emphatic and listening skills; knowledge of typologies can also be a useful guide when thinking about how we communicate with our clients and how we build rapport.  Personality models are a way of understanding the clients but they can be limiting if we judge and put people “in boxes”.  Defences within the client are there for a reason and they need to be broken down very gently.

Psychotherapy is the cornerstone of most treatments and usually must continue for more than a year to change a person’s maladaptive behaviour or interpersonal patterns.  The Clinical model can be useful when dealing with extreme distortion.  The Jungian model can be useful for assessing how one operates in the world, how we interact in organisations.  Essentially any system of typology is no more than a gross indicator of what people have in common and the differences between them. Jung’s model is no exception. It is distinguished solely by its parameters— the two attitudes and the four functions. What it does not and cannot show, nor does it perhaps pretend to, is the uniqueness of the individual.

Both Jung and Clinical (illness) models are based on conflicts and oppositions in the psyche.  In the illness model, pathological symptoms emerge from conflict in society.  Freud thought that we needed to conform and fit in with the expectations in society.  Nowadays, we believe that we fit in with ourselves.   The assumption in the elements model is that we carry all elements in ourselves and we adapt and repress others but we can potentially get in touch with all of them. Through the transformation of alchemy in the elements model, we discover harmony in the relationships between all parts.

Ultimately true healing does not happen in the head. It occurs through feeling toned realisations in response to a lived experience. That is why the analytic process, when pursued on an intellectual level, and that includes most self-analysis, is sterile. As we come to understand and appreciate transpersonal experiences and process, we can evaluate other cultures better and learn from their accumulated centuries of transpersonal wisdom. We can, in effect, reclaim what has been called “the Great Tradition,” the sum total of humankind’s cross-cultural religious and philosophical wisdom so that we may better serve our patients.

Resources http://www.personalitypage.com/high-level.html

High-Level Description of the Sixteen Personality Types

 



ISTJ

Serious and quiet, interested in security and peaceful living. Extremely thorough, responsible, and dependable. Well-developed powers of concentration. Usually interested in supporting and promoting traditions and establishments. Well-organized and hard working, they work steadily towards identified goals. They can usually accomplish any task once they have set their mind to it.

Click here for a detailed description of ISTJ.

ISTP

Quiet and reserved, interested in how and why things work. Excellent skills with mechanical things. Risk-takers who they live for the moment. Usually interested in and talented at extreme sports. Uncomplicated in their desires. Loyal to their peers and to their internal value systems, but not overly concerned with respecting laws and rules if they get in the way of getting something done. Detached and analytical, they excel at finding solutions to practical problems.

Click here for a detailed description of ISTP.

ISFJ

Quiet, kind, and conscientious. Can be depended on to follow through. Usually puts the needs of others above their own needs. Stable and practical, they value security and traditions. Well-developed sense of space and function. Rich inner world of observations about people. Extremely perceptive of other’s feelings. Interested in serving others.

Click here for a detailed description of ISFJ.

ISFP

Quiet, serious, sensitive and kind. Do not like conflict, and not likely to do things which may generate conflict. Loyal and faithful. Extremely well-developed senses, and aesthetic appreciation for beauty. Not interested in leading or controlling others. Flexible and open-minded. Likely to be original and creative. Enjoy the present moment.

Click here for a detailed description of ISFP.

INFJ

Quietly forceful, original, and sensitive. Tend to stick to things until they are done. Extremely intuitive about people, and concerned for their feelings. Well-developed value systems which they strictly adhere to. Well-respected for their perserverence in doing the right thing. Likely to be individualistic, rather than leading or following.

Click here for a detailed description of INFJ.

INFP

Quiet, reflective, and idealistic. Interested in serving humanity. Well-developed value system, which they strive to live in accordance with. Extremely loyal. Adaptable and laid-back unless a strongly-held value is threatened. Usually talented writers. Mentally quick, and able to see possibilities. Interested in understanding and helping people.

Click here for a detailed description of INFP.

INTJ

Independent, original, analytical, and determined. Have an exceptional ability to turn theories into solid plans of action. Highly value knowledge, competence, and structure. Driven to derive meaning from their visions. Long-range thinkers. Have very high standards for their performance, and the performance of others. Natural leaders, but will follow if they trust existing leaders.

Click here for a detailed description of INTJ.

INTP

Logical, original, creative thinkers. Can become very excited about theories and ideas. Exceptionally capable and driven to turn theories into clear understandings. Highly value knowledge, competence and logic. Quiet and reserved, hard to get to know well. Individualistic, having no interest in leading or following others.

Click here for a detailed description of INTP.

ESTP

Friendly, adaptable, action-oriented. “Doers” who are focused on immediate results. Living in the here-and-now, they’re risk-takers who live fast-paced lifestyles. Impatient with long explanations. Extremely loyal to their peers, but not usually respectful of laws and rules if they get in the way of getting things done. Great people skills.

Click here for a detailed description of ESTP.

ESTJ

Practical, traditional, and organized. Likely to be athletic. Not interested in theory or abstraction unless they see the practical application. Have clear visions of the way things should be. Loyal and hard-working. Like to be in charge. Exceptionally capable in organizing and running activities. “Good citizens” who value security and peaceful living.

Click here for a detailed description of ESTJ.

ESFP

People-oriented and fun-loving, they make things more fun for others by their enjoyment. Living for the moment, they love new experiences. They dislike theory and impersonal analysis. Interested in serving others. Likely to be the center of attention in social situations. Well-developed common sense and practical ability.

Click here for a detailed description of ESFP.

ESFJ

Warm-hearted, popular, and conscientious. Tend to put the needs of others over their own needs. Feel strong sense of responsibility and duty. Value traditions and security. Interested in serving others. Need positive reinforcement to feel good about themselves. Well-developed sense of space and function.

Click here for a detailed description of ESFJ.

ENFP

Enthusiastic, idealistic, and creative. Able to do almost anything that interests them. Great people skills. Need to live life in accordance with their inner values. Excited by new ideas, but bored with details. Open-minded and flexible, with a broad range of interests and abilities.

Click here for a detailed description of ENFP.

ENFJ

Popular and sensitive, with outstanding people skills. Externally focused, with real concern for how others think and feel. Usually dislike being alone. They see everything from the human angle, and dislike impersonal analysis. Very effective at managing people issues, and leading group discussions. Interested in serving others, and probably place the needs of others over their own needs.

Click here for a detailed description of ENFJ.

ENTP

Creative, resourceful, and intellectually quick. Good at a broad range of things. Enjoy debating issues, and may be into “one-up-manship”. They get very excited about new ideas and projects, but may neglect the more routine aspects of life. Generally outspoken and assertive. They enjoy people and are stimulating company. Excellent ability to understand concepts and apply logic to find solutions.

Click here for a detailed description of ENTP.

ENTJ

Assertive and outspoken – they are driven to lead. Excellent ability to understand difficult organizational problems and create solid solutions. Intelligent and well-informed, they usually excel at public speaking. They value knowledge and competence, and usually have little patience with inefficiency or disorganization.

Click here for a detailed description of ENTJ.