Part II

TYPES OF
CHARACTER
ORGANIZATION

INTRODUCTION TO PART II

Each chapter in this section covers a major character type. I have chosen these types on the basis of the frequency with which they are encountered clinically and on the basis of my own clinical familiarity and confidence working with them. As I noted in the Preface, some personalities that I do not cover in this section are depicted in the Psychodynamic Diagnostic Manual (PDM Task Force, 2006).

Order of presentation is arbitrary, but overall, I have started with the least object related and ended with individuals who tend to strike therapists as powerful in their attachment, even though their specific attachment style may be problematic. With each personality I consider (1) drive, affect, and temperament; (2) adaptive and defensive ego functions; (3) early relational patterns that contribute to the development of the personality, become internalized, and repeat in later relationships; (4) experiences of the self, including conscious and unconscious ways one sees oneself, along with the ways one seeks self-esteem; (5) transference and countertransference outcomes of internal representations of self, others, and self–other patterns of interaction; (6) implications for treatment; and (7) considerations of differential diagnosis.

RATIONALE FOR CHAPTER ORGANIZATION

The first four categories I have taken from Pine (1990), who has summarized drive, ego, object relational, and self aspects of individual psychology as follows:

Broadly speaking, under these four terms I am referring, respectively, to the domains of (a) drives, urges, wishes; (b) defense, adaptation, reality testing, and defects in the development of each; (c) relationships to significant others as experienced and as carried in memory; with whatever attendant distortions such experiences and memories may entail; and (d) subjective experience of self in relation to such phenomena as boundaries, esteem, authenticity, and agency. (p. 13)

Like Pine, I see these four perspectives as implicit in the psychoanalytic tradition and as useful for sorting out different aspects of psychological complexity.

I have added affect to Pine’s first domain (cf. Isaacs, 1990; Kernberg, 1976; Spezzano, 1993; Tomkins, 1962, 1963, 1991, 1992). Because Freud subsumed emotion under drive (see Solms & Nersessian, 1999), a focus on affect per se has been slow to come to analytic theorizing. In a 2000 survey, however, Blagys and Hilsenroth found that psychodynamic clinicians consider work with affects to be definitional of their orientation. Analysts have long noted the therapeutic superiority of emotional over intellectual insight (see J. G. Allen, 1980); more recently, many theorists have put affect at the center of human psychology and the clinical process (e.g., Chodorow, 1999; Fosha, 2000, 2005; Maroda, 2010; D. Shapiro, 2002).

There have been countless scientific studies attesting to the powerful operation of unconscious affects (see Westen, 1999). Research during the last two decades into early experience and brain function (e.g., Damasio, 1994; Lichtenberg, 1989; Panksepp, 1999; Solms & Bucci, 2000) supports the need to differentiate and comprehend these implicit feelings if we are to understand personality differences. Rainer Krause’s work (e.g., Anstadt et al., 1997) suggests that we all have a characteristic facial affect pattern—an emotional “fractal,” or type and sequence of affective expression that is our unique emotional signature. It has thus become clear that stable personality differences include distinctive affect configurations.

I have also included temperament with drive and affect. The significance Freud attached to innate individual differences in areas like direction and strength of drive look prescient in the light of contemporary genetic and neuroscientific findings and in the aftermath of decades of scholarship about temperament (Kagan, 1994). Because therapy orients itself to what is modifiable, a clinician may tend not to think much about inborn “givens,” but what is hardwired is still valuable to understand. Appreciating someone’s constitutional endowment contributes to reasonable goals and allows us to help a client accept and make new adaptations to what cannot be changed.

The next two topics under each type are intended to illuminate the interpersonal style of someone with that psychology and to suggest components of effective therapy with such a person. I discuss countertransference issues for both diagnostic and therapeutic reasons. Our emotional reactions contain important diagnostic information—often the only clues (especially in more disturbed patients) for differentiating between two character types with contrasting therapeutic requirements. In addition, countertransference information may prepare us for what we are going to feel working with any client; we can then improve our chances of handling our feelings effectively. I have included in these sections some ideas about passing what control–mastery theorists would regard as characteristic “tests” of patients with different types of personality (Weiss, 1993).

Finally, I have included a differential diagnosis section to alert readers to possible alternatives to what may seem an evident personality organization, especially when such differentiations have important therapeutic consequences. It can be disastrous, for example, to misunderstand a hysterical woman as fundamentally narcissistic, or a narcissistic man as essentially obsessive, or a person with pervasive dissociation as schizophrenic. And yet all of these mistakes are made all the time because the DSM checklist approach to diagnosis lends itself to such errors.

CHARACTER, CHARACTER PATHOLOGY, AND SITUATIONAL FACTORS

The following descriptions include both disturbed and healthy versions of each character type. Everyone has regularities of experiencing and coping that constitute a personality. In most of us, it is not “disordered.” We all have features of several personality styles no matter which tendencies are paramount in us. Many people who do not fit neatly into one category are adequately described as a combination of two types of organization (e.g., paranoid–schizoid, depressive–masochistic). Assessment of someone’s character structure, even in the absence of a personality disorder, gives the therapist an idea of what will be assimilable by the client and what style of relatedness will catalyze the therapist’s efforts to help. Even though no one’s psychology corresponds point for point to a textbook description, most of us can be located in a general area that gives a clinician some orientation toward how to be therapeutic.

Dynamics are not pathology. It is reasonable to infer character pathology or personality disorder only when a person’s patterns are so stereotypical that they prevent psychological growth and adaptation. An obsessive man organizes his life around thinking, finding self-esteem in creative acts of thought such as scholarship, logical analysis, detailed planning, and judicious decision making. A pathologically obsessive one ruminates unproductively, accomplishing no objective, realizing no ambition, hating himself for going in circles. A depressive woman finds satisfaction in taking care of others; a pathologically depressive one cannot take care of herself.

In addition to distinguishing between personality and personality disorder, it is important to distinguish between character and responsivity. Certain situations elicit aspects of anyone’s personality that may be latent under other circumstances: losses bring out one’s depressive side; battles for control breed obsessive ruminations; sexual exploitation evokes hysteria. The therapist should be careful to weigh the relative impact of situational factors and characterological ones. People who are in ongoing, unrelentingly stressful situations may look character disordered by external criteria, but their patterns may be more situational than internal. For example, employees or students in “paranoiagenic” institutional surroundings may seem to have stable traits that meet the DSM criteria for paranoid personality disorder, and yet those traits may disappear when they leave the setting and are no longer feeling humiliated, helpless, and unsafe (cf. Kernberg’s [1986, 2006] observations about paranoiagenesis in psychoanalytic institutes).

A Chinese student who was seeing one of my colleagues had numerous narcissistic preoccupations: She was acutely sensitive to how she was perceived, spent considerable energy on maintaining her self-esteem, suffered envy of American students to whom everything seemed to come easily, and worried constantly about whether she “fit in.” The genuine warmth with which she related to her therapist, however, and the affection in his countertransference, belied a conclusion that she had an essentially narcissistic personality. The stresses of adapting to a new community had exacerbated the latent concerns about acceptability, identity, and self-esteem with which anyone would struggle if culturally displaced. In addition to illustrating a caveat about confusing personality with reactivity, this example points to the critical value of subjective data.

LIMITS ON PERSONALITY CHANGE

Clinical experience suggests that although personality can be substantially modified by therapy, it cannot be transformed (the drive-theory homily for this observation was “You can change the economics but not the dynamics”). That is, a therapist can help a depressive client to be less destructively and intransigently depressive but cannot change that client into a hysterical or schizoid character. People maintain their “inner working models” (Fonagy, 2001): core internal scripts, conflicts, expectations, affects, and defenses. Yet with new experience and insight they may vastly expand their sense of agency and realistic self-esteem. The increased sense of freedom comes from mastery and choice in behavior that previously was automatic; the self-acceptance comes from understanding how they got their particular combination of tendencies. Whether or not a therapy contract includes an agreement to try to modify character, an appreciation of it may facilitate psychotherapy.

I have wanted this book to be comprehensive, but not so much so that it would weigh down the reader’s book bag, expense account, or fortitude. This section gives in-depth descriptions of psychopathic, narcissistic, schizoid, paranoid, depressive, hypomanic, masochistic, obsessive, compulsive, hysterical, and dissociative personalities. As I noted previously, there are many other themes around which personality can be organized, but these are the configurations I know best. It is my impression that most of the personality types I have omitted are seen more commonly as melodic variations than as symphonic themes. For example, while people whose character is fundamentally and centrally sadistic are not unknown, they rarely come voluntarily to therapy. We are more likely to see sadism as part of another clinical picture, such as psychopathy or dissociation. Some people are passive–aggressive at the level of character, but more commonly, passive–aggressive tendencies are ancillary to other dynamics, including dependent, obsessive–compulsive, paranoid, and masochistic trends.