Assessing Emotional Temperament

As we noted in Chapter 1, we have identified seven hypothesized dimensions of emotional temperament, drawn from the scientific literature and from our own clinical observations:

We conceptualize temperament as a set of points on these dimensions. Temperament influences the coping styles individuals adopt to handle their schemas.

There are several reasons to assess temperament. First, temperament is inborn and will always be a significant part of how the patient responds to the environment. Although each temperament poses some drawbacks, it also presents some benefits. Each person’s temperament has advantages and disadvantages. Patients can learn to accept and appreciate their natures and still overcome their problems. Knowledge of one’s temperament can be illuminating. People do not choose their temperaments. They do not generally choose to feel emotional, aggressive, or shy. It is neither good nor bad; it is just the way they are. For example, recognizing their intensely emotional natures can often help patients with BPD build self-esteem. They can see that they are not “bad” for having intense feelings, even if their intensity was problematic for their parents. Rather, it is their nature to be passionate human beings. Patients can also learn strategies for modulating their temperaments and can learn to behave in appropriate ways in spite of their emotional makeup.

We should note that we do not yet have adequate assessment measures to determine with certainty someone’s innate temperament. The best we can do is to make an educated guess by obtaining a detailed history. For clinical purposes, however, it does not matter whether a patient’s lifelong mood state is innate or a result of early life experiences. If it has been a part of them for most of their lives, it is usually extremely resistant to change through psychotherapy and thus can be addressed as though it were innate.

The therapist begins to conceptualize the patient’s temperament by asking a series of questions related to affective states. Some patients can identify their baseline or prevailing moods. The therapist asks questions such as, “What do your family members say you were like (emotionally and interpersonally) as a child?”; “Are you generally a high energy or a low energy person?”; “What is your general outlook on life? Are you generally optimistic or pessimistic?”; “How do you usually feel when you’re alone?”; “How often do you cry?”; “How often do you lose your temper?”; “Do you worry a lot?”

Lifelong traits are likely to be temperamental. Thus, for each of these questions, the therapist asks whether this has always been true for the patient or has been true only for certain periods in the patient’s life. The more consistent and long-term the feelings are and the earlier they began, the more likely it is that they are part of the patient’s innate temperament rather than a response to life events.

In addition to interviewing the patient, the therapist observes the patient’s emotional reactions in therapy sessions and asks about emotional reactions in the patient’s outside life. Finally, the therapist considers what it feels like to be with the patient in the sessions. The affective tone of the meetings can reveal a great deal about the patient’s temperament.