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THE SELF AND WELLNESS IN PSYCHOTHERAPY

August 2nd, 2009 by Robert DePaolo | Posted in Psychotherapy | No Comments » | 2,282 views | Send article | Print this Article |


In the past several decades the so-called medical model initially espoused by Freud, Jung and others has been called into question (Holt 1986), (Wax, 1986), (Eysenck, 1986). Modern thinking (at least in some circles) holds that psychopathology cannot be classified as a “disease,” nor treated in the same systemic way that a physician might treat a medical disorder; for example by considering not only specific symptoms but overall body homeostasis vis a vis the influence of one organ system upon another. Among the more focal concerns of modern therapists are maladaptive thoughts (schemes) and behaviors that are typically addressed in strict deterministic fashion, e.g…. change the schemes and behaviors and the client is in effect, cured.

In streamlining the counseling process, practitioners of behavioral and cognitive methods have in many instances obtained positive results (Clark & Fairbum 1997) (Grant & Cash 1995) (Rosen, Reiter et al 1995). Just how those results pertain to the highly functional, and arguably non systemic nature of their method is another question. As Just & Varma (2007) have suggested it is difficult to conceive of the mind as being other than systemic. Mayer (2005) has offered a similarly systemic view of the personality. The fact that we use defenses, whereby compensations and adjustments serve to counteract anxiety, depression and other discomforting mood states shows that overall stability is indeed an important aspect of the personality. Consequently, one might expect that in systemic terms, behaviors and schemata would interact with one another in a dynamic way, eventually settling in on stable attitudinal and response systems rather than merely being engaged in functional interactions vis a vis the social environment.

With that in mind it is interesting to note that of late, comparatively little attention has been paid to the Systemic Self; the mechanism that guides mind and body through development, perceptions, adaptations, flexibility and overall stasis. In that context, it seems reasonable to suppose that a focus on the Self in counseling (rather than just behaviors or schemata)  could serve to re-establish stasis, improve resilience, creativity, self actualization and the pursuit of wellness through a process of self expansion. Similar opinions were put forth in the past by Rogers (1984) and Maslow  (1971).

Functions of the Self

The Self is hard to define empirically, as are concepts like thought, cognition and personality. Yet its functions and adaptive advantage are obvious. As Allen &Armour-Thomas (1993) and Bouffard and Bouchard (1989) demonstrated, the Self provides a

means by which the person, fully aware of what he “is” or purports to be, can aspire to goals and process feedback signaling a match between expectations and the attainment of goals. According to the Rogerian premise, the Self is also an information/ resolution provider, reducing the conflict and uncertainty in life by creating anchor points based on skills, traits, associations and distinctions, thereby potentially precluding anxiety and depression. It is also an intellectual gauge, enabling us to determine whether something makes sense, is normal or is credible. All such intellectual processes provide stress-reducing benefits.

The Self is a broader phenomenon than Freud’s concept of the Ego, in that it incorporates all aspects of not only the personality, but also of one’s knowledge base, attitudinal and emotional predispositions and levels of competence. The fact that the Self has such breadth suggests that it is a potentially crucial catalyst of either normalcy (wellness) or psychopathology.

Given the vast, regulatory influence of the Self, it seems reasonable to assume a therapy format that focuses on defining and labeling its parameters, propping it up, expanding it and insulating it against the assault of incongruous inputs might produce resistance to psychopathology – through a kind of psycho-immunization …or wellness process.

Although a Self-oriented counseling format would extend beyond behavioral and cognitive methods, it would not exclude them from the diagnostic and therapeutic process. Those elements would be part of the treatment focus as well. Yet while in cognitive-behavior therapy the counselor typically narrows his analysis down to the logic, or lack thereof, of the client’s thought patterns and behaviors, ie. whether or not they work and/or coincide with the client’s needs and intentions, a Self-oriented method would involve a more comprehensive format, in which the client comes to know himself thoroughly, not just in terms of beliefs and motives but also in terms of his capacity to expand his self-definition and psychological resources. In the process this would improve his resistance to duress. In that sense it would combine  pathology-resolving counseling methods with a wellness-inducing didactic component.  More specifically, diagnosis and therapy would be primarily geared toward teaching the client how to understand, then orchestrate his self system for purposes of maximizing wellness and minimizing conflict and pathology

The question is: how would such a process work, both for the counselor and for the client interested in improving his or her own psycho-immunity and general quality of life?

Theoreticians in the past, such as Rogers, (1961) Sullivan (1953) and Adler (1956) addressed this issue in great detail.  While their theories differed in many respects, they all proposed that some sort of self-expansion was the key to positive adjustment. With apologies for oversimplifying their concepts, the main thesis behind each theory was that a constricted self system, rigid and narrowly defined, with  its “eggs in too few baskets – so to speak would more likely encounter threats and contradictions, thus leading to more frequent episodes of anxiety and depression. For example; viewing oneself as just an intellectual or just an athlete, then failing either in the classroom or on the playing field would create not only conflict but a self-systemic vacuum. Adaptation would be difficult in such circumstances.

On the other hand a more flexible Self would provide greater freedom of movement and more effective resolution capacities, making it easier to adapt with respect to the ever-changing interface between outside inputs and one’s identity, abilities and attitudinal dispositions. That kind of Self would tend to be more resilient and less prone to the development of psychopathologies (Shafran & Mansell 2001), (Steinberg 1991)) It would also provide for the psyche what phagocytes provide for the body, a protective mechanism for dealing with foreign, incongruous inputs.

It might also lead to a slightly different terminology. For example it is now commonplace to refer to elements such as self esteem, self image and self concept; the premise of each being that positive self regard is a key to psychological resilience. Given the inevitable flow of affirmations and contradictions to one’s sense of self in daily life, it might be more clinically precise to say that self-elasticity is the true measuring stick of psychological resilience.

Wellness is not synonymous with the notion of an expansive Self. It does however come into play with respect to the development of a life style that fosters self-expansion. At face value that suggests a person who creates and adheres to a life style of change, experimentation, appropriate risk taking and creative outlets would be less prone to psychopathology.

On the other hand, if the Self is systemic, then it must have parameters beyond which experience becomes ego-dystonic and potentially pathogenic. That means that while it can deviate from “dead center”  and expand to some degree, it must remain attached to a tether of stability.

In that context, the practitioner of Self-based therapy would not simply teach clients to expand the Self. He would first spend time describing the client’s Self in terms of its growth potentials to see how expansive the client could become before experiencing emotional repercussions. In other words, the sessions would involve a self-study component, during which the client discovers, for example, the proportionate needs for individuation vs. affiliation,  creativity vs. conformity and dependence on others vs. the need for self-actualization. Once those parameters and proportions were established (obviously in the context of ego-syntonic social realities) counseling could proceed to a growth/ creativity/ expansion phase.

Since the Self is so thoroughly integrated into all of our functions, counseling themes  might be complex, but the overall therapy process need not be lengthy. That is because the didactic (self knowledge) phase would be followed by support sessions designed around in vivo risk taking and creative endeavors by the client. Those need not take place

in an office, nor on a weekly basis. Most important is that the knowledge gained about the Self, and the competencies and emotional freedom gained from parameter-friendly adventurousness and flexible self-definition would comprise life long skills and adaptive breadth for the client, and in effect comprise a potentially life-enhancing wellness program.

With regard to how this might play out in diagnostic terms, there are a number of tests with self-report components. The M.M.P.I  Reynolds Adolescent Depression Scale, Behavior Assessment Scales and Edwards Personal Preference Record all include self evaluative indices, However these are not necessarily designed to address the rigidity-flexibility continuum. Nor do they gauge the parameters of Self. In that sense, new, or at least recombinant instruments might have to be designed to determine factors such as behavioral/cognitive latitude, potential for self expansion and anxiety proneness as a function of risk taking, cognitive restructuring and enhanced achievement. All of these components can be found in many test instruments – albeit in bits and pieces. More cohesive instruments, focusing squarely on self expansion potential might be needed to diagnose, treat and conduct research based on this model.

REFERENCES

Adler, A. (1956)  The Individual Psychology of Alfred Adler: A Systems Presentation in Selection in his Writing. Basic Books

Allen, BA & Armour-Thomas, E (1993) Construct of Metacognition, Journal of Psychology 127 (2)  203-207

Bouffard-Bouchard, T. (1989)  Influence of Self-efficacy on Performance in a Cognitive Task. Journal of Social Psychology, 130 (3)  353-363.

Clark, D, &C.G. Fairbum (1997)  Science and Practice of Cognitive Behavior Therapy. Oxford University Press

Eysenck, H.J.  (1986)  Failure of Treatment – Failure of Theory?  Behavioral and Brain Science (9) 236

Grant, J.R. and Cash T.F. (1995)  Cognitive Behavior Body Languge; The Comparative Efficacy of Group and Modest-Contact Treatments. Behavior Therapy  (26) 69-84

Holt, R.R. (1986) Some Reflection on Testing Psychoanalytic hypotheses. Behavioral and Brain Science, (9) 242- 244

Just, M. & S. Varma (2007)  Neuroscientists  Propose New Theory of Brain Flexibility. Science Daily. Nov. 18.

Maslow, A. (1971)  The Farther Reaches of Human Nature; Self Actualization and Beyond. New York, Penguin Books, p. 41

Mayer, J. (2005) Personality: A Systems Approach. Allyn Bacon

Rogers, C (1961)  On Becoming a Person; A Therapist’s View of Psychyotherapy. Boston, Houghton Mifflin.

Rogers, C.R & R. Sanford  (1984) Client-centered Psychotherapy. In Kaplan, H.T. & Sadock, B  (eds) Comprehensive Textbook of Psychiatry/IV Baltimore, Williams &Wilkins pp. 1374-1388

Rosen, J.C. J. Reiter & P.Orosan (1995)  Cognitive Behavior Body Image Therapy for Body- Dysmorphic Disorder. Journal of Consulting and Clinical Psychology  (63)  263-269.

Shafran, R & W. Mansell (2001) Perfectionism and Psychopathology: A Review of Research and Treatment. Clinical Psychology Review 21 (6)  879-906.

Steinberg, . (1991) The Spectrum of Depersonalization: Assessment and Treatment. In Tasman, A & Goldfinger, S (eds) Review of Psychiatry. Vol. 10 American Psychiatric Press Washington DC 223-247.

Sullivan, H.S. (1953) A Conception of Modern Psychiatry. W. Norton Books

Wax, M.L. (1986)  Psychoanalysis: Conventional Wisdom, Self Knowledge or Inexact Science?  Behavioral and Brain Science (9)  264-265.

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By Robert DePaolo
MS Clinical Psychology
Licensed School Psychologist
Licensed Clinical Mental Health Counselor

603 485 7566
robertde [at] surfglobal [dot] net

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