Psychotherapy

I just thought it would be a good idea to post some of the recent research on the effectiveness of psychoanalytical therapy. The dates are when the stories hit my Google Reader.

First, an article defining Psychotherapy:

What Is Psychotherapy? What Are The Benefits Of Psychotherapy?
http://www.medicalnewstoday.com/articles/156433.php
Jul 4, 2009
Psychotherapy is commonly used for psychological problems that have had a number of years to accumulate. It only works if a trusting relationship can be built up between the client and the psychotherapist (in psychology "client" can mean "patient"). Treatment can continue for several months, and even years. Psychotherapy may be practiced on a one-to-one basis, or in pairs, and even in groups. Generally, sessions occur about once a week and last one hour.

Some of the types of psychotherapy are: Behavior therapy; Cognitive therapy; Family therapy; Interpersonal therapy; Group therapy; and Psychodynamic therapy. If you take a college class (or two) on counselling theories, you probably will use Gerald Corey's texts, which also covers: Adlerian; Existential; Person-centered; Gestalt; Reality; Feminist; and Post-modern. There is some overlap in the two lists and some of the categories, but I like Corey's stuff because he's good at making the approaches easier to understand. For the curious, I share a study aid I made for myself, using his work: Counseling Theories Comparison Spreadsheet.

Now some research articles. I'll keep the number down for you and I'll send you to professional summaries of the research, so you don't have to worry about reading the highly academic stuff. Don't worry, the articles have the actual research publications citated. It would be nice to have direct links, but there's that subscription thing to consider.

According To New Study, Psychodynamic Psychotherapy Brings Lasting Benefits
http://www.medicalnewstoday.com/articles/177110.php
Jan 26, 2010
The eight meta-analyses, representing the best available scientific evidence on psychodynamic therapy, all showed substantial treatment benefits, according to Shedler. Effect sizes were impressive even for personality disorders - deeply ingrained maladaptive traits that are notoriously difficult to treat, he said. "The consistent trend toward larger effect sizes at follow-up suggests that psychodynamic psychotherapy sets in motion psychological processes that lead to ongoing change, even after therapy has ended," Shedler said. "In contrast, the benefits of other 'empirically supported' therapies tend to diminish over time for the most common conditions, like depression and generalized anxiety."

Can Therapy Really Change Your Brain?
http://psychcentral.com/blog/archives/2009/11/25/can-therapy-really-change-your-brain/
Nov 25, 2009
In the “Clinician’s Digest” section of the November/December 2009 issue of Psychotherapy Networker, Garry Cooper discusses a study led by psychiatrist Jakob Koch of Christian-Albrechts University in Kiel, Germany suggesting that “effective psychotherapy with depressed clients is associated with changes at the brain’s cellular level,” increasing the production of a key brain protein that assists in creating neural pathways. In this study they used Interpersonal Psychotherapy (IPT) which looks through the lens of both cognitive and interpersonal issues. It would be interesting to know how other theoretical orientations would fare.

Psychodynamic Therapy vs CBT Smackdown for Anxiety
http://psychcentral.com/blog/archives/2009/08/09/psychodynamic-therapy-vs-cbt-smackdown-for-anxiety/
Aug 10, 2009
This study demonstrates that psychodynamic psychotherapy is an effective alternative for the treatment of generalized anxiety disorder, when compared to the more commonly-used CBT. The researchers encourage more studies like this one, and I couldn’t agree more. It’s a timely reminder of the value of the different types of psychotherapies available, not just the kind that might be in vogue at the moment.

Psychodynamic Psychotherapy Gets Some Research Respect
http://psychcentral.com/blog/archives/2008/10/01/psychodynamic-psychotherapy-gets-some-research-respect/
Oct 1, 2008
.... This meta-analysis shows that, contrary to many clinicians’ opinions, psychodynamic psychotherapy can be an effective modality, especially in cases of chronic depression or anxiety, or personality disorders such as borderline personality disorder. It cannot say whether it’s better than other long-term psychotherapies (virtually all psychotherapy techniques and approaches can be used for years, although many are focused on short-term symptom relief and change). And the analysis says nothing to the placebo effect of just being with another human being for a year or more.

Aesthetic versus Psychological Placement of Art Elements

One thing I have found while working with art is that it is the actual doing of art that is the most therapuetic part of therapy art. Yes, art can be used to diagnose things like schizophrenia and possible sexual abuse; but that is not therapy, that is diagnostics and should only be done by someone who has training in doing it.

There are several reason for this, but one of the major mistakes I've seen made by people, who attempt to do this because they think they can know people better than the person themselves, is that they don't understand that not all elements in a work of art are there for psychological reasons. I once questioned the reason why art therapists are required to take studio art classes, because I found that my art professors had a tendency to insist on certain elements in their student's work. This outside control may make good art, but not good therapy. I understood the need for learning how to do the art, in order to help the client use the materials, but I often felt at odds with my profs. I finally accepted the fact that my art professors were only doing their job and teaching us aesthetics.

Even though an art professor can encourage a student to do something of personal meaning to them, they still will introduce elements into the student's work. Take a look at this lithograph I made last year.


Sing a Song of Sixpence by ~mamaslyth on deviantART

Now, there is a lot of personal symbolism in the piece. I am the first to admit that. However, while discussing this piece with a counseling professional without art therapy training, he asked me about the symbolism of the floor tiles. I said in a rather reactive fashion that the floor tiles had no real significance, though I then added some possible symbolism for it. My reaction was emotional because I didn't make the decision to put the checker board tiles in the picture. It was my lithography professor's idea. My reaction was from a neurotic need of mine to not take credit for another person's ideas. This tends to be a very big deal to me, hence the knee-jerk response.

My lithography prof had me introduce the tiles because I had too much white space for a good print. Even though I could come up with possible symbolic reasons for the checkerboard, none of them had any real connection to the actual meaning of the print, itself. I chose to copy the element in other prints in the series because part of the assignment was to make the series coherent and repeating elements is a quick and dirty way of doing that. Had the counseling professional had the same exposure to art education that I had, he would have not put much significance to an element added there to improve my grade in a class.

If you want more proof that checkerboards really aren't that significant to me, feel free to check out some of my other art. You will see that, outside to the American Mutt series, I rarely use checkerboarding in it.


More art

Another major mistake, one most frequently made by lay people (and some professionals, I'm not going to let them off the hook, either) is not understanding that the most important meaning of a symbolic element is what it means to the artist. In my understanding, there are at least three levels of symbolism: the personal, the cultural, and the archetypical. As someone who has written poetry since the age of seven, I have had the cultural and archetypical meanings applied to my work by strangers with really amusing results at times. Because of this, I always make a face when someone wants me to proof read poems.

My favorite example of the differences between levels of symbolism is the color yellow. Archetypical, yellow represents things like the Sun, warmth, joy, intellect and a host of other things with are common among most humans that live on this planet. An example of cultural difference is how yellow can mean cowardly to one culture and divine in another culture. We can also have subcultural meanings. Take the sports fan - depending on what team they cheer for, yellow can be either a good thing or a bad thing. Then there is the personal level. For me, personally, yellow is a color I usually avoid wearing because it emphasizes the yellow tones in my skin, making me look like I'm sick. For a friend of mine, yellow is one of her favorite colors because when she was a kid, she used to hide among her grandmother's yellow rose bushes when she needed peace and quiet. For her, yellow means peace and security. For another friend, yellow is a terrifying color that can trigger flashbacks because it was a color that had ritualistic importance to her abuser.

Of the three of us, I am the most likely to use yellow for aesthetic reasons in a work of art. In fact, the way I found out about their personal meanings for yellow was because, several years ago, I used yellow as a major element on a webpage and they shared their reactions to it. I almost changed the element for the second friend, but we agreed that it was my webpage and I needed to go with what I felt would work. I did, however, avoided using yellow on certain pages for her.

I am willing to admit that 80 to 90% of the time, you can get really close using the cultural and archetypical results. It's that other 10 to 20% that's going to mess you up. That's not really a problem if you are reading something for your own benefit - you should find your own meanings in art and literature. Just don't attribute it to the artist or author!!! In fact, by taking responsibility for your interpretations - that it is truly yours and not another's - you will actually gain a better understanding of yourself and your world, in my experience. Besides, that 10 to 20% lets you, the audience, become part of the work.

In regards to personal therapy, though, this is a bad thing. It is better for a therapist to avoid putting too much of themselves into a client's piece of work. The idea is to let the client have their voice and express their thoughts and feelings - not to echo the therapist's philosophical systems. Some connection needs to be made between the therapist and the piece, but a good art therapist can say "This is how I view the piece and this is how the client views it." And once the client has made their view known, the therapist can share their view to show that they also have been touched by the work, as well as offer possible alternate ways to look at it. If any of the alternate views strikes a chord with the artist/client, then the therapist has a better understanding of what is going on than when no chord is struck.

Anyway, the point is personal symbolism will trump the other symbolic meanings of an art element. If you don't know the personal symbolism behind the elements, or how the elements were chosen, then chances are you will be wandering in the wrong direction, while attributing meaning to a piece of art. In the strict audience sense, that's fine. In a therapuetic sense, it's not.

Private and public artistic exploration

I firmly believe that art is an effective means of personal exploration. Even if we do not gain great insight or find personal significance in doing artwork, our minds gain visual and kinetic experiences that help to fine tune our mental processes. I touch on this concept briefly my last post. The following film clip shows some representational examples of artists who explored their medium.


Warning: there is profanity in this clip. You probably don't have to watch it to understand my next points, so feel free to skip it if you wish.

The way I see it, the artists did gain a lot from the creation of their art. Their personal exploration probably did help them to reach a better understanding of their world. However, I do side with the established painter cohersed into juding that art show. It was the actual process and not the finished work that created that transformation, so the art itself said nothing because the context had passed.

All art is useful, but not all art is communicable. There is a difference between the act of making art and the finished work. Cultural art is something that should speak to observer. If it does not, then the conversation that should happen between masterpiece and observer is missing, and there is no enlightenment nor increased understanding.

Personal art needs only to speak to the artist. Under the right circumstances, a single line on a piece of paper can open the gate to passion, clarity, and wisdom--but it will only speak to that artist. It is the artist's conversation with the universe. Such a piece of work should rightly be treasured by the artist, but not necessarily enshrined for the rest of humanity. That would be telling people that this line has now been done, there is no need for more. Instead, the line should stay with the artist's heart and she should encourage others to find their own lines, to unlock their own passions and wisdom.

Which type of art is more valid? The very question itself is blasphemy in my opinion. Without cultural art, we lose our soul as a society. Without personal art, we can lose our very minds.

I must take a step back from my philosophical gushing and point out that even personal art needs to be shared to fulfill its purpose. In art therapy, this is known as "witnessing". Witnessing is when the artist shows the work to a supportive person, who lets the artist tell them what it means to them personally. There is no critique, no suggestions, just an act of listening to the sound of one person's soul being reveal.

At the same time, there is much to be gained by playing around with the art of others, as long as the original works are left physically untouched. It provides an interaction between the artwork and the audience, making the original piece more meaning ladened and important as the conversation continues. The following talk, though mostly meant to be humorous, is a prime example of entering into conversations with well-known artworks.



Granted, the conversations can become turbulent in some cases, but once you develop a personal relationship with a piece of work, it becomes alive and part of your mental fabric. Your brain now has a larger visual vocabulary to work with.

Here are a few sites online that will let you have your own conversation with art. Enjoy the process!





Shockwave needed.

art therapy in prison

Creating Safer Prisons Through Art
By Amanda Doerr

Originally written April 24, 2007

The first questions many people have in regards to art in prison are probably along the lines of: “Why should we make life easier for these convicts?” “They’ve broken laws and now we’re going to let them play?” “Why should our taxes go for such a program, when there is so many other things we could fund?”

The best answer to these questions comes from Ed Howe, the activities manager at the State Correctional Institution Pittsburgh, who says "[Art] also keeps us safe. If prisoners have idle time, they find their own recreation." (Menees, 2001) This is not a good idea by any stretch of the imagination. If some of these people had healthy outlets for their boredom, they would not be incarcerated in the first place. They are in prison because they are unable to function in a conventional social environment. (Gussak, 1997, p 1) Case in point, convict Jeremy Pinson spent his time in prison planning revenge and writing threatening letters because he didn't have anything else to do, adding more and more time to his own prison sentence with each threat he mailed. (M. G. Preisz, Oklahoma City University Forensic Psychology lecture, April 17, 2007) This is not an isolated incident. The Commission on Safety and Abuse in America's Prisons also found in their research that "few conditions compromise safety more than idleness." (The Commission on Safety and Abuse in America’s Prisons. [CSAAP], 2006, p 14)

Art's effect on violence

Can art actually affect the level of violence? According to the 1983 California's Brewster Study, inmates participating in AIC [Arts In Corrections] at two state prisons had fewer disciplinary problems. (Menees) In one institution, the reduction of disciplinary reports written was 80%. (Gussak, p xix) How much violence could art reduce nationwide? Unfortunately, not enough data about non-lethal violence is available to properly assess the costs of violence to the prison system. Some facilities keep no record at all of the assaults within their walls. (CSAAP, p 15)

Art can help in several ways. Crafts often build self-control within inmates, even those uncomfortable with drawing and painting. (Hall, 1997, p 32 and Milligan, 1997, p 181) Creating expressive art can help an inmate avoid a confrontation by giving him a way to work out his anger. (Hall, p 33) If the means are available and conditions favorable, aggression can be channeled through the creation of physically demanding three-dimensional objects. (Ronaldson, 1997, p 179) Releasing emotion can be problematic in a prison environment, for it can either be considered threatening or a sign of weakness to both guards and other inmates. Inmates who engage in art making are less disruptive, having less of a reason to act out. (Hall, p 39) This was true whether the art was created in an art class or in isolation in a cell. (Taylor, 1997, p 200)

Art also works with mentally ill inmates. Board Certified Art Therapist, David Gussak, one of the editors of Drawing Time: Art Therapy in Prisons and Other Institutional Settings, has "seen examples of nearly every DSM IV diagnosis" while working with prison populations. (Gussak, p xv) The sad reality is that there are still people being sent to high security prisons, who pose no threat to the populace, simply because they are mentally ill. (CSAAP, p 16) Art is a powerful tool for dealing with depressive symptoms while incarcerated, though not as much anxiety symptoms, possibly because heighten states of anxiety are needed for survival in prison. Still, art helps the mentally ill inmate cope better with his situation. (Woodall, 1997, p 116)

Making art safely

There are no total guarantees in life, not even with art. Safety must still be maintained. Scissors, long pencils and paintbrushes can be weapons in the hands of a determined inmate. Clay can be used to make a key or disable a lock. For these reasons, many normal art making supplies are not allowed inside many prisons. (Ursprung, 1997, p 18) Even common art solvents such as turpentine can be forbidden because of the potential risk they can pose. (Menees) Art therapists and facilitators in prisons have discovered many alternative sources of art supplies, often through the ingenuity of those under their care. Found art is common, but other art media might include: foil potato chip bags, socks, hair, nuts, Kool-aid and M&M candies as pigments, magazines, cigarette wrappers and a mixture of toilet paper and soap, which when "mixed with water and combined in the right consistency" becomes a modeling paste that can easily be painted. (Ursprung, p 19 & 21) One inmate grew his hair for five months in order to make his own paintbrushes. (Dobnick, 2006) Through much of the literature on this subject, the need to create in a hostile environment is commented on again and again. (Ursprung, p 17)

And on their own, therapists and facilitators come up with ways around the restrictions. While making masks is usually prohibited because they might aid in an escape, Gussak's solution was to have the inmates make masks with paper plates that couldn't possibly resemble a real face, thereby allowing him to still use a very powerful art therapy technique. (Gussak, p 69) He also taught the inmates to create Plaster of Paris three dimensional works that not only could be accounted for after the session (thus satisfying the fear that it would be used on keys and locks), but also created an art experience in which inmates had no expectations of seeing a recognizable form in, eliminating feelings of inadequacy based on their art skills in most of those participating. (Gussak, p 63)

Even when normal art supplies aren't used for dangerous purposes, care must be taken so they won't be stolen. Art supplies are a valuable commodity in the prison black market because they are means to earn goods and services from other inmates. Portraits, handmade stationary, posters, and decorative objects are often purchased as gifts for loved ones on the outside and for personal use. (Hall, p 36 & 37)

Art and guards

The relationship between guard and inmate depends on a great many variables, not the least of which is the managing culture of the prison they are in. Because of their duties, prison guards and other staff can and do affect how art is created in their institutions. They can't stop it completely, but they can help or impede its creation.

Positive staff involvement can bring about significant results in a prison arts program. It can even generate inmate sympathy towards the correctional officers, as evidenced by an inmate at Folsom State Prison, who said that even the guards didn't need any more negative publicity. Even as far back as 1930s, the connection between the guard and the guarded can be shown, when "a convict named Ralph Pekor painted 'The Last Supper' in the prison chapel . . . The warden loved the fresco until he realized the convict had painted him as Jesus, the inmates on condemned row as the disciples, and, for good measure, tucked himself in underneath the table." (Menees)

Jung once said "The meeting of two personalities is like the contact of two chemical substances. If there is any reaction, both are transformed." Whether this transformation is a positive or negative one depends on the correctional staff more than the prisoners, since they, by their position, hold most of the cards. In a positive manner, staff may become involved through helping in the display artwork in shows that help breakdown the stereotypes of incarcerated people. (Ursprung, p 15) In addition, prison staff may buy inmate artwork, allowing their own prejudices to be dispelled through the admiration of the creative works and giving the inmates a means for purchasing more art supplies. (Ursprung, p 21) The effects of this transformation can be far reaching, even across generations. A Sing Sing guard who encouraged and helped an inmate artist to sell works which allowed the artist to send money to his family even in his incarcerated state, was survived by his daughter, who even now tries to find the descendents of this prisoner so she can give them some of his artwork. On her living room wall is a portrait of her mother, done by the same artist and it is obvious from her interview that she, too, has respect for those her father used to guard. (NYCHS, 2007)

However, not all prisons have a culture that is conducive to positive staff involvement. In those, it is advisable to not have guards in the actual art room, since it may inhibit the inmates. (Hall, p 28) In some correctional institutions, officers may be so paranoid that they feel threatened by the images and either react with alarm or belittlement towards the inmates' creative expressions, further dehumanizing them. Even with paranoid reactions from prison staff, art therapy specifically can help inmates by its ability to allow an inmate to work out issues on a nonverbal level, beneath the radar of those who might otherwise be threatened by inmate expressions. However, this requires the art therapist to allow the staff to continue to see the art as benign and simplistic. (Gussak, p 60 & 61)

Based on the results of the positive staff interactions in several institutions, it seems possible that by carefully involving the prison staff in the display of a public exhibition of prisoner art, a highly strained and possibly abusive atmosphere could be affected in a beneficial way for both staff and inmates. It would have to be done in a manner which would not create resentment on either side and require a great deal of patience on the part of the person managing these events. Such an individual would do well to read Gussak's chapter "The Ultimate Hidden Weapon: Art therapy and the compromise option." in Drawing Time: Art Therapy in Prisons and Other Institutional Settings for advice on how to survive in the destructive dyadic relationship between staff and inmates that exists in some prisons. Changing the atmosphere of an institution does not happen overnight. It takes a lot of work and diplomacy.

A possible theme for an inmate art show that would be relatively benign, yet still beneficial to the inmate artists, the staff and the community, would be to have inmates create images of local historical interest. An elderly inmate at a Pennsylvanian correctional facility decided on his own to do such works, which were then put on display in a local mall. His works not only gave him a reason to research the history of the town, but gave other seniors outside of the prison something to talk about and engage their mental processes with. (Wisker, 1997, p 236) We talk about criminals paying their debt to society, what better way to do this than to educate people through their art, while grounding them in the very community most of them will eventually be released into?

This would, of course, be only the start of the art journey for an institution which has no positive art program history to draw from. It is hoped that eventually in these institutions, art could be done in a freer fashion, allowing both sides to benefit from it. As the Commission on Safety and Abuse in America’s Prisons states, "We must create safe and productive conditions of confinement not only because it is the right thing to do, but because it influences the safety, health, and prosperity of us all." (CSAAP, p 2)

Resources

The Commission on Safety and Abuse in America’s Prisons. (2006, June). Confronting Confinement. Retrieved April 21, 2007 from http://www.prisoncommission.org/pdfs/Confronting_Confinement.pdf

Dobnick, V. (2006, December 10). In prison, art supplies are likely to be coffee, candy. Associated Press. Retrieved April 18, 2007 from http://findarticles.com/p/articles/mi_qn4188/is_20061210/ai_n16902944

Gussak, David E. (1997). A Brief History. In D. E. Gussak & E. Virshup (Eds.), Drawing Time: Art Therapy in Prisons and Other Institutional Settings (pp. xv - xx). Chicago, Illinois: Magnolia Street Publishers.

Gussak, David E. (1997). Breaking Through Barriers: Advantages of art therapy in prison. In D. E. Gussak & E. Virshup (Eds.), Drawing Time: Art Therapy in Prisons and Other Institutional Settings (pp. 1 - 12). Chicago, Illinois: Magnolia Street Publishers.

Gussak, David E. (1997). The Ultimate Hidden Weapon: Art therapy and the compromise option. In D. E. Gussak & E. Virshup (Eds.), Drawing Time: Art Therapy in Prisons and Other Institutional Settings (pp. 59 - 74). Chicago, Illinois: Magnolia Street Publishers.

Hall, Nancy (1997). Creativity and Incarceration: The purpose of art in prison culture. In D. E. Gussak & E. Virshup (Eds.), Drawing Time: Art Therapy in Prisons and Other Institutional Settings (pp. 25 - 42). Chicago, Illinois: Magnolia Street Publishers.

Menees, Tim, (2001, September 30). If not art, then what? Pittsburgh Post Gazette. Retrieved April 7, 2007 from http://www.post-gazette.com/ae/20010930artprison0930fnp2.asp

Milligan, Nancy (1997). A Barbed Wire Garden: Art therapy in a maximum security prison for adolescents. In D. E. Gussak & E. Virshup (Eds.), Drawing Time: Art Therapy in Prisons and Other Institutional Settings (pp. 175 - 186). Chicago, Illinois: Magnolia Street Publishers.

NYCHS [New York Correctional History Society]. Fine Art Behind Bars. Retrieved April 19, 2007 from http://www.correctionhistory.org/html/chronicl/state/singsing/finearts/fineartsbehindbars.html

Ronaldson, Claudia (1997). The Lucky Ones: Probationary students in a special education school. In D. E. Gussak & E. Virshup (Eds.), Drawing Time: Art Therapy in Prisons and Other Institutional Settings (pp. 167 - 174). Chicago, Illinois: Magnolia Street Publishers.

Taylor, Marcia (1997). Growing Old the Hard Way: Art therapy as an intervention in gerontology and criminology. In D. E. Gussak & E. Virshup (Eds.), Drawing Time: Art Therapy in Prisons and Other Institutional Settings (pp. 197 - 209). Chicago, Illinois: Magnolia Street Publishers.

Wisker, Carol (1997). What One Museum Does for Prison Art. In D. E. Gussak & E. Virshup (Eds.), Drawing Time: Art Therapy in Prisons and Other Institutional Settings (pp. 231 - 239). Chicago, Illinois: Magnolia Street Publishers.

Woodall, J., Diamond, P. & Howe, A. H. (1997). Art Therapy in a Managed Care Environment. In D. E. Gussak & E. Virshup (Eds.), Drawing Time: Art Therapy in Prisons and Other Institutional Settings (pp. 99 - 126). Chicago, Illinois: Magnolia Street Publishers.

Ursprung, Will A. (1997). Insider Art: The creative ingenuity of of the incarcerated artist. In D. E. Gussak & E. Virshup (Eds.), Drawing Time: Art Therapy in Prisons and Other Institutional Settings (pp. 13 - 24). Chicago, Illinois: Magnolia Street Publishers.

Electroshock Therapy

This TED talk is about one surgeon's personal experience with electroshock therapy. Please be advise that foul language is used, but it's only like four or five times.



For the record, electroshock therapy is for very severe depression. If you take only ONE thing away from this video, let it be that people can return from the depths of non-function and psychological pain. That they can regain their abilities again.

If you need more proof, I present Dr. Jill Bolte Taylor:



Her progress is better laid out in her book, My Stroke of Insight. Quoting my capstone paper again: "Five years after Dr. Taylor's stroke, she was able to do division and other simple mathematical problems. Two years after that, she was teaching Gross Anatomy again. As of 2006, she was a consulting neuroanatomist at the Midwest Proton Radiotherapy Institute, helping stroke survivors neurologically rehabilitate themselves. (Taylor, 2006)"

Never underestmate a person's ability to recover and function.


Taylor, J. B. (2006). My stroke of insight: a brain scientist's personal journal. New York : Viking.

Narcissistic Personality Disorder: Illness or Character Flaw?

I've seen a lot of posts on the Narcissist Personality Disorder on my Google Reader recently. However, I've notice that most of them are not going off of recent research. The information in this paper is two years old. It is not the final format, but all the material is here.

Narcissistic Personality Disorder: Illness or Character Flaw?

Written by Amanda D. Barncord Doerr

CHAPTER 1. INTRODUCTION

Initial shock

Walking out of a therapist's office after being told that their loved one is exhibiting the symptoms of a Narcissistic Personality Disorder (NPD), a person is forced to consider the implications of this diagnosis. There is confusion about how this diagnosis affects their view of their loved one, whether the NPD should be pitied or scorned. There is curiosity about the disorder itself and the affect, if any, it would have on the self view of the one diagnosed. And then there are worries about what the diagnosis means to the therapist treating the loved one and what is the prevailing thought on the Narcissistic Personality Disorder among mental health professionals.

Two views

In the literature available to the general public, there can be found two very diverse views of the Narcissistic Personality Disorder. The more accessible sources appear to portray the disorder as a character flaw or a label for difficult people. Popular author and psychiatrist, M. Scott Peck (1983) said in his book People of the Lie: The Hope for Healing Human Evil that evil people could appropriately be classified as a variant of the narcissistic personality disorder. On a website that approaches the disorder from a layperson's perspective, Joanna Ashmun (2004) points out that in the clinical literature NPD is usually discussed as a "character disorder".

On the other hand, the inclusion of Narcissistic Personality Disorder into the DSM, would strongly suggest to many people that it is an illness. Indeed many online "psychology" sites call it just that. Though to some laypeople it is more likely to suggest that the psychology field is trying to explain away a set of character flaws by suggesting that the "sufferer" is not responsible for their actions. Of course, the laypeople who cling to this notion of irresponsibility in the mental health field rarely believe in the need to view the sets of behavior that comprise an NPD in an objective and scientific manner.

Self-proclaimed NPD sufferer and author of Malignant Self Love : Narcissism Revisited, Sam Vaknin (1997) confuses the matter further with his views on whether or not narcissistic personality disorder sufferers can help themselves on his website. He first convinces the reader that a narcissist cannot help themselves and then goes on to show that the essential ingredients to remission is for the narcissist to be humble and take responsibility for his own actions.

Professional questions

All of this leads to the following questions. What is the professional view of the Narcissistic Personality Disorder? What data supports this view? Does treating NPD as a illness give any relief to the life impairment caused by it? What are the alternatives for narcissistic personality disorder sufferer and those who must interact with them?

CHAPTER 2. DIAGNOSIS

Background and history

Narcissism may be one of the most commonly recognised character flaws. The word itself comes from the Greek myth of Narcissus, a young man who fell in love with his own image in a pool and then was turned into a daffodil by the gods for punishment for his hubris. Ellis and Nacke first introduced the term into psychiatry at the end of the 1800s, but it took Freud and Rank in the 1910s to describe the disorder. Reich an Horney expanded on the concept some in the 1930s. Then for about 40 years the issue laid practically dormant until the 1970s, when Kohut and Kernberg connected the developmental processes of self to the formation of pathological narcissism. It was their work that introduced the Narcissistic Personality Disorder (NPD) into the DSM. (Rivas, 2001)

Symptomology

According to the research of Dimaggio, Semerari, Falcone, Nicolò, Carcione, & Procacci (2002, December), NPDs often display vague sensations of emptiness, boredom and emotional anesthesia. Their emotional state is not available to their consciousness. This cognitive deficit is a form of alexithymia. Alexithymia is the inability to link the physical response to words, fantasies, and feelings to the expression thereof. An example is when an NPD shows facial expressions of annoyance, but when asked about the annoyance, they will deny feeling anything and may even start looking confused when the questioner continues to probe the matter. This lack of self-awareness makes self-reflection very difficult for the NPD. To compensate, they rely on having a rigid set of values to help make decisions and judgments. However, unable to recognise the internal signals that guide most people when there is conflict between their beliefs and actions, NPDs will often act in counterproductive ways.

One side effect of the value system reliance is that NPDs usually display two main states of mind; admiration and contempt. The overt admiration state involves disdainful grandiosity, fantasies of wealth, power, physical attractiveness, and invulnerability. The covert contempt state involves an out-of-place sensitiveness, a sense of inferiority, insignificance and fragility, and a search for glory. It is usually during the therapeutic process that other states, such as anger, envy, fear and confusion are displayed.

The rigid value system also creates many interpersonal problems when compounded with other aspects of the disorder, such as a sense on entitlement and a haughty demeanor. Unable to reflect upon their own actions, NPDs also lack the ability to emphasize with others, seeing them instead as "self-objects". This deficit in object relations has been recognised in NPDs since the works of Kohut and Kernberg. When speaking to others, NPDs tend to be rhetorical, vague and evasive in their speech, with an egocentric view of reality. It has been noted that while NPDs transmit nonverbal signals, they do not receive them. And while they may not be able to reflect on their feelings, they can use them as an engine for social action.

Despite the NPD's belief that they should only associate with other special people, they are threatened by "kindred spirits" and will treat anyone who may be their equal as competition, instead of as a compatriot. The fragile self-esteem of the NPD does not allow for true peers. Nor does it allow for narcissistic damage in the form of insult or loss of esteem. Robert Simon (2002) noted that the actions caused by such damage resembled PTSD, without the flashbacks. This would include the outbursts of anger and other antisocial acts associated with narcissistic rage.

According to Phebe Cramer (1999), NPDs are more likely than other personality disorders to seduce their environment to meet their needs. When this fails, they will fall back on rationalization as a defense, resorting to fantasy and complete denial when that fails.

DSM criteria

For a patient to be diagnosed with having a narcissistic personality disorder, five of the following nine criteria must be met: a grandiose sense of self; a preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love; the belief that the patient is special and can only be understood by other special people; a need for excessive admiration; a strong sense of entitlement; a pattern of taking advantage of other people to met their own needs; a lack of empathy; a sense of envy towards others or the belief that others envy them; arrogant behavior. (APA, 2000)

Prevalence

According to the American Psychiatric Association (2000), the prevalence of NPD is less than 1% of the general population and 2 to 16% in the clinical population. In 1999, Rivas (2001) pointed out that the Narcissistic Personality Disorder was removed from the tenth revision of the International Statistical Classification of Diseases and Related Health Problems, leading some researchers to believe that maybe NPD was a cultural disorder, specifically an American one. However, studies supported by by the National Project of Mental Health of the Istituto Superiore di Sanità, Rome, Italy (Dimaggio et al, 2002), have since given a great deal of insight into this disorder.

CHAPTER 3. VALIDITY

Character disorder

It is not without good reason that researchers like Joanna Berg (1990) and others refer to NPD as a "character disorder". Some of the more noted aspects of this disorder is a high sensitivity to criticism, grandiosity, a sense of entitlement, a lack of empathy, envy and a need for excessive praise. All of these are considered character flaws in Western civilization. In fact, if we were to compare the traditional seven deadly sins with the criteria for NPD, we would be easily be able to match three - envy, pride and greed to the DSM-IV's list. Add narcissist rage to match with wrath, and we have over half the deadly sins. Compare the diagnostic criteria with any established religious code and one might begin to wonder why the NPD is seeing a therapist instead of a religious advisor. After all, Cramer (1999) said that the NPD does have a remnant of a moral conscience. Why is a deficiency of morals being addressed in in a manual for mental disorders in the first place?

The answer is quite simple. These people have behavioral problems that need to be treated and most of them do not have the ability to acknowledge their own faults. But still, it is interesting to note that Links & Stockwell (2002) found that some pathological narcissism can be cured through real life accomplishments. If able to achieve a major real life accomplishment, a NPD can be helped to reflect on their success. Once this reflection occurs, the NPD often ends up with a more realistic view of themselves and no longer needs to hold on to the fantasies of success, wealth and power they had been previously clinging to.

Another example of a successful treatment of NPD comes from Nicolò, Carcione, Semerari & Dimaggio (2007). It requires the therapist to time when they are caring towards the NPD to coincide when the NPD is willing to accept the idea that it is okay to be flawed. Then the therapist's help is seen as an enrichment, instead of an insinuation that the NPD is fatally flawed. In the case study given, the female NPD patient found acceptance for being helped through her own childhood memories of helping elderly strangers in a public restroom.

The two ways listed in this paper of affecting NPD in a positive way does reflect the adage that for a NPD to be cured, they must first learn humility. Then, as Sam Vaknin (1997) said, they must take responsibility for their actions. One cannot miss the fact that humility and responsibility are considered positive character traits in this culture, calling to mind the question again, should character flaws be grouped with mental disorders?

Cognitive deficits

But is NPD really a set of behaviors caused by a lack of moral fiber? Or the results of cognitive defects? The evidence of alexithymia, the inability to reflect on their own actions, not being able to receive conversational cues, and the disturbances in object relations all suggest that there is something going on inside the mind of the NPD that has nothing to do with moral turpitude. Stevens et al (1984) reported that NPDs felt a great deal of discomfort while experiencing considerable excitement. And what of Simon's finding that narcissistic damage resembled PTSD in many ways? Perhaps the problem isn't the character, but the cognition of the sufferer.

Kohut and Kernberg both believed that NPD was a product of developmental problems (Stevens et al, 1984). In Kohut's self-psychology theory, the NPD is created through a deficit of parental mirroring or parental rejection at the infancy stage. Unable to develop a bond with their primary caregiver, the NPD holds on to the idealization of their own ability to affect their environment, until they can develop a bond with the therapist, which allows them to learn the developmental skills denied them as children. In Kernberg's theory of pathological narcissism, the same lack of parental warmth causes the creation of a grandiose self, which is unable to care for anyone else. For years, these two theories were referenced almost exclusively in NPD studies.

A proposed integrated narcissism model set forth by Dimaggio et al (2002) has through research and study, outlined a complex set of cognitive processes and the means by which the disorder perpetuates itself. While Kohut and Kernberg's work are still at the model's foundation, the model focuses more on the immediate meta-cognitive defect of the NPD instead of the developmental processes that created it. Since therapists rarely deal with the NPD at the time of their developmental disruption, this model is probably far more useful in treating those in practice.

Traits versus contextual

Hummelen and Rokx (2007) discussed that one problem with personality disorders is that people display consistent personality traits on an inconsistent basis, depending on the context these traits occur in based on many variables. Therefore, it is possible that an individual could display non-pathological traits in the therapist's office, while displaying very pathological behaviors with neighbors who are not available for interviews. Likewise, an individual may display previously unknown pathological traits in an office due to abnormal fears and stress of meeting with a "shrink", much like a person whose blood pressure rises whenever he is examined by a physician.

Relying on the DSM

Hummelen and Rokx also criticized the syndromal approach of the DSM, with its highly ambiguous definitions based on often unobservable behaviors. Such definitions lead to generalizations and the expectation that certain behavior will always be present. There is almost no consideration of the context of the behavior. After all, a world class soccer player would legitimately be able to say he is the best in his field and be used to entitled treatment from others, but unless the person treating him followed the sport, they might doubt the patient's claims.

The DSM (APA, 2000) itself admits that the Cluster B personality disorders resemble each other. NPD can also resemble the obsessive-compulsive personality disorder, the schizotypal personality disorder, the paranoid personality disorder, and manic or hypomanic episodes. Using the DSM alone for identifying this disorder is an exercise in eliminating other possibilities.

Using the MMPI and MCMI

Chatham, Tibbals, & Harrington (1993) state in their study that NPDs only show a significant difference on the hypomanic scale using the MMPI. This means that MMPI could not differentiate between a NPD and a legitimately talented person experiencing a mild case of mania. The MCMI was even less clear, scoring the NPD high not only on the hypomanic scale, but also the histrionic, narcissistic, and antisocial scales too. Chatham et al concluded that more data was needed for diagnosing NPD than was provided by these tests.

Using the Rorschach Inkblot test

Surprisingly, one of the tests that has consistently been able to designate NPDs from other disorders has been the Rorschach Inkblot test. Harshly criticized in the 1990s, Ganellen (2001) and others have successfully defended the test, stating that it is just as accurate as the MMPI in overall use, as long as it was used for the purposes it was originally intended for - a diagnostic test based on perception alone, with little attention paid to the projections. Weiner (1996) gives four examples of successful applications for the Rorschach: differentiating personality variables; measuring developmental changes in children and adolescents; monitoring improvement during psychotherapy; and identifying experienced distress in war veterans with PTSD. There is also evidence in at least 48 studies that the Rorschach can detect cognitive complexity, reality testing, general psychological stress, disordered or psychotic thinking, and disturbances in object relations. Published longitudinal studies have shown that the Rorschach variables were steady over time.

The disturbances in object relations is of particular interest in regards to the NPD. Both Kohut and Kernberg were object relations theorists and their theories of pathological narcissism depended in disruptions in the development of self and object relations. In Kohut theory, NPDs had arrested development. In Kernberg's theory, they were created through a developmental aberration. (Stevens, Pfost & Skelley, 1984) Therefore, it stands to reason that the Rorschach test would be a better instrument to detect pathological narcissism. In studies done by Hilsenroth, Fowler, Padawer and Handler (1997), the four variables usually elevated in NPDs are reflection responses, personalized responses, idealized responses and the egocentric index. Of these four, two - reflection and idealized responses, were found to be empirically comparable to the DSM-IV diagnostic criteria.

In an earlier study by Hilsenroth, Hibbard, Nash & Handler (1993), borderline and narcissistic personality disorders showed several differences using the Rorschach. Ironically, borderline personality disorders (BPDs) tend to show higher grandiosity than NPDs, while NPDs were more egocentric. BPDs were also more aggressive and used more primitive emotional defense mechanisms than other PDs. This might explain the findings of Hummelen & Rokx (2007), where neuro-imaging scans show BPD patients to consistently have a smaller and hyper-reactive amygdala.

While the Rorschach can be defended as a diagnostic tool, it is still open to misuse in clinical settings. As Weiner (1996) pointed out, it was never meant to be used for everything, nor was it meant to be used by those not thoroughly trained in evaluating it. One hopes that now the ability to diagnose NPDs through object relations has been proven that a less subjective test can be devised for it.

CHAPTER 4. CONCLUSION

Based on studies using the Rorschach test, other psychometric instruments and documented case studies, the current prevailing professional view of the narcissistic personality disorder would be that it a deficit of meta-cognition, probably caused by a disruption of self-development in infancy. While it is not treated with medication, approaching NPD as a disorder is very important because it easier to be less emotionally hurt by the sufferer's actions. This emotional distance is necessary when dealing with NPDs, since it allows one some control over how they are seen by the NPD. To get anywhere with an NPD requires the individual to be seen as admirable.

Cognitive therapy is the only course so far that has shown any success in treating NPDs. Confronting a NPD and calling them to repentance is pointless in most cases. The narcissistic defence system is far too sophisticated to be dismantled by such tactics. At best, the NPD will retreat into a depressive state and cycle through emptiness and fear until they latch onto their grandiose self and return to their pathology when the immediate threat of shame is past. A more successful approach is to guide the NPD to a point of real achievement, in either the present or the past, and help them to realize that not being powerful all the time is nothing to be ashamed of.

It is very easy to see how a lay person would question the diagnosis of NPD as a mental disorder, based on the literature and websites available to them. Upon seeing the criteria for NPD, many would understandably declare its sufferers as difficult people who should just straighten up their acts. However, as we look closer at the studies of NPD, it becomes apparent that the narcissist is suffering from a cognitive defect, which uses a rigid value system as a coping mechanism. Because of this coping mechanism, NPDs will have character flaws, but the treatment of the disorder is not in the flaws, but in the cognitive deficits. In his confusing way, Sam Vaknin is correct about his disorder. It is something that the NPD suffer cannot completely control, however, through humility and responsibility they can overcome their cognitive deficits. In a way, it is not much different than a bipolar patient who must manage their symptoms. The jury is still out as to whether NPD can be completely cured. It is tricky enough just to get the patient into the therapist office in the first place.

REFERENCES

American Psychiatric Association. (2000) Diagnostic and statistical manual of mental disorders, (4th ed.), Text revision. Washington D.C.

Ashmun, J. M. (2004). Narcissistic Personality Disorder (NPD) : DSM-IV Diagnostic Criteria. Retrieved September 02, 2007, from http://www.halcyon.com/jmashmun/npd/dsm-iv.html#npd

Berg, J. (1990, December). Differentiating ego functions of borderline and narcissistic personalities. Journal of Personality Assessment, 55(3), 537-548. Retrieved September 5, 2007, from PsycINFO database.

Chatham, P., Tibbals, C., & Harrington, M. (1993, April). The MMPI and the MCMI in the evaluation of narcissism in a clinical sample. Journal of Personality Assessment, 60(2), 239-251. Retrieved September 5, 2007, from PsycINFO database.

Cramer, P. (1999, June). Personality, personality disorders, and defense mechanisms. Journal of Personality, 67(3), 535-554. Retrieved September 5, 2007, from PsycINFO database.

Dimaggio, G., Semerari, A., Falcone, M., Nicolò, G., Carcione, A., & Procacci, M. (2002, December). Metacognition, states of mind, cognitive biases, and interpersonal cycles: Proposal for an integrated narcissism model. Journal of Psychotherapy Integration, 12(4), 421-451. Retrieved September 5, 2007, from PsycARTICLES database.

Ganellen, R. (2001, August). Weighing Evidence for the Rorschach's Validity: A Response to Wood et al. (1999). Journal of Personality Assessment, 77(1), 1-15. Retrieved September 22, 2007, from Academic Search Premier database.

Hilsenroth, M., Fowler, J., Padawer, J., & Handler, L. (1997, June). Narcissism in the Rorschach revisited: Some reflections on empirical data. Psychological Assessment, 9(2), 113-121. Retrieved September 5, 2007, from PsycARTICLES database.

Hilsenroth, M., Hibbard, S., Nash, M., & Handler, L. (1993, April). A Rorschach study of narcissism, defense, and aggression in borderline, narcissistic, and Cluster C personality disorders. Journal of Personality Assessment, 60(2), 346-361. Retrieved September 5, 2007, from PsycINFO database.

Hummelen, J., & Rokx, T. (2007, December). Individual-context interaction as a guide in the treatment of personality disorders. Bulletin of the Menninger Clinic, 71(1), 42-55. Retrieved September 9, 2007, from PsycINFO database.

Illness. (n.d.). The American Heritage® Dictionary of the English Language, Fourth Edition. Retrieved September 02, 2007, from Answers.com Web site: http://www.answers.com/topic/illness

Links, P., & Stockwell, M. (2002). The role of couple therapy in the treatment of narcissistic personality disorder. American Journal of Psychotherapy, 56 (4), 522-538. Retrieved September 5, 2007, from PsycINFO database.

Nicolò, G., Carcione, A., Semerari, A., & Dimaggio, G. (2007, February). Reaching the covert, fragile side of patients: The case of narcissistic personality disorder. Journal of Clinical Psychology, 63(2), 141-152. Retrieved September 5, 2007, from Academic Search Premier database.

Peck, M. S. (1983). People of the lie: the hope for healing human evil. New York: Simon & Schuster.

Rivas, L. (2001, January). Controversial issues in the diagnosis of narcissistic personality disorder: A review of the literature. Journal of Mental Health Counseling, 23(1), 22-35. Retrieved September 5, 2007, from PsycINFO database.

Simon, R. (2002, January). Distinguishing trauma-associated narcissistic symptoms from posttraumatic stress disorder: A diagnostic challenge. Harvard Review of Psychiatry, 10(1), 28-36. Retrieved September 5, 2007, from PsycINFO database.

Stevens, M., Pfost, K., & Skelly, R. (1984, March). Understanding and counseling narcissistic clients. Personnel & Guidance Journal, 62(7), 383-387. Retrieved September 5, 2007, from PsycINFO database.

Vaknin, S. (1997). Can the narcissist help himself? Retrieved on September 02, 2007, from http://samvak.tripod.com/narcissismselfhelp.html

Weiner, I. (1996, June). Some observations on the validity of the Rorschach Inkblot Method. Psychological Assessment, 8(2), 206-213. Retrieved September 22, 2007, from PsycARTICLES database.

white paper - successful interventions

White Paper - Addictions

Amanda Doerr

KEYS TO A SUCCESSFUL INTERVENTION

When many lay people talk about having an intervention with someone about their behavior, they tend to bring up scenes of verbally abusive behavior that is expressly prohibited by the ethical guidelines of the APA. Obviously there must be something wrong with this idea of ambushing a person with their bad behavior and beating them over the head with their flaws. Such behavior sounds more destructive than therapeutic. And indeed, described that way it is, this model of intervention sounds far more satisfying to the participants than useful to the recipient.

But then why do we have interventions and confrontations still in use? The answer is that professional interventions have developed a great deal since the Synanon program and its "attack therapy" as developed by Chuck Dederich in 1958 (Polcin, 2003). At that time, it was believed that the release of emotional energy would release tension and break down denial, thereby allowing a more honest discussion about the addiction and the behavior that resulted from it. The goal at the end was to reaffirm the confronted person's importance to the group. However, many criticized this technique as a replication of the abuse many of these clients experienced in their past. The same criticism could be applied to the early therapeutic communities that use humiliation and punishment to change the addict's behavior. Faced with the alienation by the respected mental health professionals, some therapeutic communities began to use group feedback methods in the 1970s and 1980s. This moved the focus from "breaking down the denial" to confronting the dysfunctional behaviors caused by the addiction. Other factors that brought about this transformation in methodology were: the increasing number of dual-diagnoses of addiction and mental illness, the desire to be allied with 12-step programs, and the research showing that addictions were fueled by core emotional issues.

While there are still disagreements as to what one means by "confrontation", some researchers and program directors prefer to define it, more or less, as "someone being approached, in a realistic but not punitive way, that 'bad things' might happen if they don't make changes in regards to their addiction" (Polcin et al, 2006). Personal attacks are discouraged, as well as other forms of disruptive confrontation. Perhaps the term "therapeutic confrontation" should be used more often to distinguished from the more hostile versions of confrontation, such as the "beat them into submission" type.

Studies show that successful interventions usually generate gratitude and good feelings towards the confronters by the confronted (Polcin, 2006). Given the all too human reaction to be offended when someone tells us we're wrong, how is this created in a confrontation?

One element is the relationship of confronters to the client. The closer the relationship, the more successful the confrontation because the information given is seen as more valid (Malis & Roloff, 2007). Among not so close peers, a great deal of face work has to be done to create enough of a valid bond for their views to be considered. In fact, that bond often has to be there before a peer will even consider confronting someone with their addiction. With therapists, this would be the creation of a therapeutic alliance. While some practitioners claim that this is not necessary, research shows that is does help and never hurts. A study by Miller, Brown, Simpson, Handmaker, Bien, Luckie, Montgomery, Hester, and Tonigan found that there was a strong positive correlation between supportive and empathic approaches and positive outcomes (Polcin, 2003).

To up the odds of an effective confrontation, many current professional intervention programs first educate those of the confrontation team how to phrase their concerns in "a realistic but not punitive way". Alanon facilitation and Johnson Institute interventions are ways that this is done (Polcin, 2003). While the Johnson Invention has high relapse rates, it has a higher rate of getting clients into treatment and still retains clients (Loneck et al, 1996). A more effective training program for the family and friends of a client is the Community Reinforcement and Family Training (CRAFT) program, which teaches behavioral change skills. According to Bob Poznanovich, CEO of Addiction Intervention Resources, they go even further and assess the situation of the family (Conan, 2008). In fact, Poznanovich claims that they work more with the family than with the addict, because family can often enable addictive behavior without realizing it. He calls it a "family illness" and points out that many people are given bad advice about how to deal with addiction, such as it is just a matter of will power or that there is nothing that can be done.

Another important element is the timing of the confrontation (Polcin, 2003). Light to moderate drinkers gain less from interventions than problem drinkers, probably because the concerns seem less valid. However, light to moderate drinkers do respond favorably to the more empathic therapies. Addicts with major cognitive impairment from the drug they're taking, respond better after a period of detox. Addicts already in being treated in a facility benefit more from a therapeutic confrontation after they have been there long enough to emotionally stabilize. Otherwise, they will flee or regress in response to the confrontation. In many programs, the client is educated about the positive role confrontation can play in their recovery. This preparation not only makes the confrontation less traumatic, but also puts the client in a mindset prepared to make the most of the information given to them during the confrontation.

It should be noted that some addicts, because of comorbid conditions, may not be good candidates for intervention. One cannot expect a paranoid or antisocial personality disorder to respond favorably to confrontations. Nor can one expect someone with diminished cognition to fully comprehend what they are being confronted with.

The most important element is the focus of the confrontation. According to a study by Polcin, Galloway, and Greenfield (2006), when the message was on the behaviors and potential problems, clients consistently said that they were more likely to have a positive experience with confrontations. Remarkably, the more frequent the confrontations, the more individuals involved, and the more sources involved, the more positive was the views of the confrontations. Thinking distortions can also be addressed as part of the confrontation.

An element of choice also makes an intervention more successful (Conan, 2008). When the addict is allowed the choice of whether to get better or suffer from their own behavior, and then chooses to get better, they are more committed to the change. Even if the addict chooses not to change at first, some will change their minds later as the "bad things" they had been warned about happen to them.

A skilled counselor should be directing the therapeutic confrontation, in case emotions run too high or a deep issue is triggered (Polcin, 2003). The counselor should be able to switch from a confrontive stance to a clinical exploration of the issues exposed. A far cry from the "beat them until they see the errors of their ways." Modern interventions are more about support for reducing dysfunctional behaviors, than they are about making the recipient admit that they are an addict.

In summary, a successful intervention requires: a trusting and supportive relationship between the client and the intervening group; focusing on the dysfunctional behaviors and possible bad outcomes from the addiction; the client and interveners to be prepared to make the most of the situation; and a facilitator to handle any problems. Education for the family, friends, and client increases the chances that the intervention will be more effective as does the number of confronters and interventions. While old fashion interventions might make for great television drama, forcing the client to admit that they are an addict or otherwise personally attacking them, is more likely to impede than to help the situation.

Resources

Conan, N. (2008). Addicted Loved Ones: When to Intervene?. Talk of the Nation (NPR), Retrieved April 17, 2009, from Newspaper Source database.

Loneck B; Garrett JA; et al (1996). The Johnson Intervention and relapse during outpatient treatment. American Journal of Drug and Alcohol Abuse, 22(3):363-375. Retrieved April 17, 2009, from Academic Search Premier database.

Malis, R., & Roloff, M. (2007, January). The effect of legitimacy and intimacy on peer interventions into alcohol abuse. Western Journal of Communication, 71(1), 49-68. Retrieved April 17, 2009, doi:10.1080/10570310701199186

Polcin, D. (2003, January 15). Rethinking Confrontation in Alcohol and Drug Treatment: Consideration of the Clinical Context. Substance Use & Misuse, 38(2), 165. Retrieved April 20, 2009, from Academic Search Premier database.

Polcin, D., Galloway, G., & Greenfield, T. (2006, February). Measuring Confrontation During Recovery From Addiction. Substance Use & Misuse, 41(3), 369-392. Retrieved April 20, 2009, doi:10.1080/10826080500409118

being a fully functional person

Being a Fully Functional Person

Here is where the two books I am reading intersect in purpose. In Rituals of Healing: Using Imagery for Health and Wellness, the idea is to increase one's physical functionality. In On Becoming a Person, the idea is to increase one's mental and emotional functionality. So far, with the help of the first book, I have created a breathing routine, or ritual, which has helped me a lot with lower my stress and tension, as well as with my asthma problems (though it doesn't completely rid me of them). I still have yet to work on something for the chronic pain, which is a revelation in itself, since I had the underlying belief that taking care of the stress and lessening the fatigue would reduce the pain. So sometime this week, I will have to rethink my chronic pain.

Ever since my late twenties, I had often expressed the desire to be a fully function human being. But looking back, I'm not sure I really knew what I meant by that, outside of the wish to feel compentent and secure--and the ability to keep up on housework. And yet nothing I did seemed to be enough. Instead of feeling more human, I found myself feeling less and less human. Carl Rogers, based on his observation of his clients, defined being fully functional as "being the self one truly is". This means to accept that there are some things I am good at and some things that I am not good at. I have always understood to a point that I had to play with my strengths, and have even had some success with it.

However, looking over my past efforts, I approached them more as a problem in engineering, than a progression towards personhood. Instead of being more efficient, I might have been more successful if I questioned the "shoulds" more, fought the facades being placed on me in an effort to please and meeting the expectations of others. That might to make it easier to follow my own direction, with all the complexity that is me. That doesn't mean that I can ignore the expectation of others completely, but I can certainly be more picky as to which expectations I accept and those I don't.

Life is not a steady state. Years ago, I wrote the following mission statement for myself: "Everything deserves respect and an opportunity to develop itself to its fullest potential, including me. This can be achieved most effectively when the forces of our lives are in balance. Imbalance causes stress and a system in stress must compensate for that stress. This is the way of nature, whether it occurs in an ecosystem or a test tube or someone's life. My body and mind are ecosystems in themselves and need to be kept in balance. This balance is not a steady state, but a fluid, living thing that requires adjustments from time to time."

Becoming a Person

Becoming a Person

A summary by A. Doerr over Chapters 5, 6 & 7

 

[Yes, I am a few weeks late with this.  I have been reading the material, but not writing on it.  I will hopefully correct this oversight during the next few weeks.]

 

What does it mean to become a person?  Aren't we already a person because of our humanity?  While this makes sense logically, intuitively, most of us know that this isn't true.  For what every reason, many of us have experienced blocks to feeling that we are actually people and deserve to be considered as such.  The idea of taking "quiet pleasure in being" ourselves is a foreign and almost blasphemous concept, one often confused with pride and boastfulness.  Yet, there is a difference between the loudness of boasting and the quietness of acceptance--to accept that we have just as much right to exist as anything else in this universe.

 

According to Carl Rogers, the inner most core of a person is basically socialized, forward moving, rational and realistic.  But to get there, people must accept that they are human organisms, with the realistic ability to control themselves and socialize.  To quote Rogers, "There is no beast in man.  There is only man in man."  And when humans are less than fully human--when they deny various aspects of their experience--then there is reason to fear their behavior.  Such people cannot make adequate judgments because they have contorted their own data.

 

So, what are the traits of a fully emerged person, according to Carl Rogers?  First, an openness to experience.  This doesn't necessarily means to seek out new experiences, as it does to actually be open to what we are currently experiencing and seeing it without preconceived notions.  To take the situation as it is, without distorting it.  Second, trust in one's self.  To believe that we are capable to make correct choices and behave in a satisfying manner in a situation.  Third, to evaluate ourselves using an internal standard than to constantly compare ourselves to others.  This includes accepting responsibility for our actions.  Finally, to be willing to accept that we are always a work in progress and never a finished product.  We constantly flow with life and its events.  We don't jump from plateau to plateau.

 

To be able to achieve these traits, we have to move from being remote to our feelings to being able to accept them, even in ambiguity, as we feel them. We accept new experiences within their own existence, without imposing the structure of the past onto them.  We reconsider our mental constructs.  We are not threatened by other possibilities.

 

I personally believe that by lessening our frustrations created by incompatible self-perceptions, we lessen the stress that needs to be released and are more able to release it in a controlled manner that have it corrosively seep out our seams or blows up in our faces.