Again, the problem itself has sabotaged the treatment of the problem. In addition to giving insight into the nature of their defenses, a potential method of treatment for these patients is to encourage them to tolerate activities they can do without a partner. However, patients still need to use the therapeutic relationship as a transitional object that can help them move out of bad relationships and/or to help them avoid getting into future bad relationships.
Conclusion
While some patients exhibit only one of the major traits exampled above, some patients may have a mix of the different styles. I have purposely avoided the use of diagnoses here in order to keep the focus on the interpersonal mechanisms involved rather than a label. Everybody has some amount of one style or another, no matter how subtle. The examples above are also not an exhaustive list of potential life strategies. In addition, this paper is mainly a description using personality styles and does not discuss situations complicated by depression or other psychiatric illnesses.
One can see how the problem itself can sometimes sabotage its own treatment. It takes a considerable amount of courage to admit that one's personality style needs changing, so it is natural that one will have resistance to this endeavor. This is the challenge that faces the psychotherapist and the patient in the sessions. Many patients do, of course, get better without sabotaging their therapy.
If the therapist can gain the trust of the patient and effectively explain the way therapy can work and the pitfalls involved, then progress can be made. It is often not easy for the therapist to articulate this process; and if the patient is relatively mature and uses rationalization and other intellectual defenses (as in the examples above) that "hide" the more underlying defense, these patterns can be subtle and not evident to the therapist until it is too late.
Dr. Berger is in private practice and consults with pharmaceutical companies in Tokyo.
Further Reading
MacKinnon RA, Michels R (1971), The Psychiatric Interview in Clinical Practice. New York: W.B. Saunders Company.
