What is psychotherapy? Getting into the dark side of personality.
This month in my mental health blogs I intend to deal with the darker side of personality, exploring the unseen and dealing with the underlying personality traits many of use in a rather flippant manner, such as perfectionism, paranoia, narcissism, madness and so on.
Over the weekend I had the real pleasure of having coffee with my close friend Tara who is qualifying soon in psychotherapy. What a joy it is to see someone filled with enthusiasm about this much adored profession, and one in which I see in my TV role as deeply misunderstood by TV researchers and producers. Many psychotherapists are not Chartered psychologists, and come from a variety of backgrounds. Some clinical or health psychologists in UK also gain professional qualifications in the art of psychotherapy .Psychotherapists here in the UK are regulated by their professional body BACP, The British Association of Counselling and Psychotherapy. Chartered Psychologist’s who are regulated by our own professional body, the British Psychological Society. The popularity of psychotherapy in UK is influenced by American culture with its emphasis on individual and family therapy. Many UK BACP Counsellor’s also qualified in psychotherapy.
A psychologist can help you work through such problems. Through psychotherapy, psychologists and or BACP counsellors help people of all ages live happier, healthier and more productive lives. Very often personality and individual differences are at the root cause of many psychological issues.
In psychotherapy, psychologists apply scientifically validated procedures to help people develop healthier, more effective habits. There are several approaches to psychotherapy including cognitive-behavioural, interpersonal and other kinds of talk therapy that help individuals work through their problems.
Psychotherapy is a collaborative treatment based on the relationship between an individual and a psychologist. Grounded in dialogue, it provides a supportive environment that allows you to talk openly with someone who’s objective, neutral and non judgmental. You and your psychologist or psychotherapist will work together to identify and change the thought and behaviour patterns that are keeping you from feeling your best By the time you’re done, you will not only have solved the problem that brought you in, but you will have learned new skills so you can better cope with whatever challenges arise in the future.
When should you consider psychotherapy?
Because of the many misconceptions about psychotherapy, you may be reluctant to try it out. Even if you know the realities instead of the myths, you may feel nervous about trying it yourself.
Overcoming that nervousness is worth it. That’s because any time your quality of life isn’t what you want it to be, psychotherapy can help.
Some people seek psychotherapy because they have felt depressed, anxious or angry for a long time. Others may want help for a chronic illness that is interfering with their emotional or physical well-being. Still others may have short-term problems they need help navigating. They may be going through a divorce, facing an empty nest, feeling overwhelmed by a new job or grieving a family member’s death, for example.
Signs that you could benefit from therapy include:
What are the different kinds of psychotherapy?
There are many different approaches to psychotherapy. Psychologists generally draw on one or more of these. Each theoretical perspective acts as a roadmap to help the psychologist understand their clients and their problems and develop solutions. Often personality types and traits interact with your environmental experiences, such as loss of a job, bereavement, divorce, traumatic events are the root cause of many problems individuals face in our society.
The kind of treatment you receive will depend on a variety of factors: current psychological research, your psychologist’s theoretical orientation and what works best for your situation.
Your psychologist’s theoretical perspective will affect what goes on in his or her office. Psychologists who use cognitive-behavioural therapy, for example, have a practical approach to treatment. Your psychologist might ask you to tackle certain tasks designed to help you develop more effective coping skills. This approach often involves homework assignments. Your psychologist might ask you to gather more information, such as logging your reactions to a particular situation as they occur. Or your psychologist might want you to practice new skills between sessions, such as asking someone with an elevator phobia to practice pushing elevator buttons. You might also have reading assignments so you can learn more about a particular topic.
In contrast, psychoanalytic and humanistic approaches typically focus more on talking than doing. You might spend your sessions discussing your early experiences to help you and your psychologist better understand the root causes of your current problems.
Your psychologist may combine elements from several styles of psychotherapy. In fact, most therapists don’t tie themselves to any one approach. Instead, they blend elements from different approaches and tailor their treatment according to each client’s needs.
The main thing to know is whether your psychologist has expertise in the area you need help with and whether your psychologist feels he or she can help you.
The Dark world of Personality: Depressivity & Anhedonia
In this series of my weekly blogs I want to inform you the public about specific aspects of personality not normally discussed but which may help you understand your mental health more clearly. Modern clinical psychiatry conceptualizes depressions as a disorder primarily characterized as the presence of markedly depressed mood and /or anhedonia., which is a diminished interest or pleasure in nearly all of your activities. My clients often speak of a loss of interest in sex,sport, driving, meeting friends, and even holidays here or abroad. As such, the term, depression can be used to refer to either a profound sadness or to describe a manifestation of a clinical syndrome.The dual definition causes a paradoxical relationship between depression and anhedonia, as anhedonia is simultaneously interchangeable with depression, a feature of depression and also a distinct entity from depression. Many of my ex psychology students were never made aware of this complexity but which is crucial to their clinical careers, as only in very recent years has it surfaced and has become salient in GP consultations with patients So When does one have ether depression or anhedonia? Is this something the psychologist or psychotherapists might be interested in exploring?
I don’t want to bore you in this blog with all of the historical background, suffice it to say that the scientific literature on both often can be seen to merge. Let’s look first at depressivity
This is the recognition of a depressive personality style can be traced back to Hippocrates and later Galen attributed as a lack of black bile as the main cause of melancholia. More than a millennium later, European psychopathologists noted in the 19th and 20th centuries that patients with mood disorders as well as their relatives, showed pre morbid personalities that seemed to be attenuated versions of their illness.Emil Kraeplin ( 1921) identified a constellation of personality traits characteristic of a “ depressive temperament” joyless ,despondent, insecure, guilt prone, ruminative, indecisive, anxious quiet and shy. He claimed that these traits emerge as a by product of the disappointments and difficulties in living and continue to wax and wane over time . At their extreme the traits can be perpetually morbid.
The French psychologist Ribot (1897) coined the term anhedonia to shift attention away from the only negative emotional states commonly associated with depression, to describe the pleasure related deficits. Since then, anhedonia has taken on a distinct role in understanding schizophrenia and substance abuse disorders.in addition to mood disorders.The DSM beginning with the then 3rd edition, broadened Ribot’s definition incorporating a loss of interest and included it as a core symptom of depression.
Its interesting to note that Myerson (1944) historically described a personality style characterized by a persistent state of anhedonia, that is crystallized by early childhood through a combination of genetic and environmental experiences. He termed this the constitutional anhedonic personality Patients or clients with this were seen to be pessismistic, withdrawn, chronically fatigued, lack both a desire and drive for pleasure. They devote themselves to significantly and sometimes exclusively work related activities. He argued that these symptoms were related to low grade chronic depressive illness. Later I noted the use of the term Hypohedonic individuals, who were unable to buffer the effects of negative affect, putting them at increased risk of clinical depression.
Empirically, anhedonic traits in an individuals personality have been linked to a risk of developing depression and they are consistent with clinical models of the relationship between anhedonic temperament and MDD ( major depressive disorder). Psychological research studies using longitudinal methodologies,over the past decade have shown that observed anhedonic behaviour in early adolescents predicted onset of depression in later life. Neuroimaging studies have found functional and structural abnormalities associated with MDD in individuals with trait anhedonia. Harvey et al ( 2007) found that individual differences in trait anhedonia were associated with caudate and ventral striatum volumes in brain functioning.
Depressive Personality Disorder
A core and contemporary criticism of clinical psychiatry’s conceptualization of depression is a disorder characterized by depressed mood and /or anhedonia is that it is treated as a monolithic construct despite evidence that suggesting that anhedonia and depressivity are associated with distinct psychobiological systems (Craver 2006). However, todays clinical admissions show evidence that the majority of depressed individuals exhibit both a depressed mood and anhedonia.The scholarly work in contemporary clinical research studies focuses on depressive and anhedonic temperament. This relationship is helpful to our understanding the development of anhedonia temperament and depressive disorders Its unlikely that these traits actually reflect the basic temperamental processes that originate in early childhood. The reason is that their defining features include a number of developmentally complex cognitive and interpersonal characteristics.
Temperament, Depressivity and Anhedonia.
You have heard of this term pretty frequently as it’s a household name. We speak of one having a temperamental personality or a bad temperament. So what exactly is temperament? It refers to early emerging stable and heritable differences in emotional reactivity and regulation. It is also thought to be influence the development and serve as the underpinnings of later personality. Like personality, temperament is a dynamic construct that even in the first few years of life can change as a function of development and is influenced by environmental experiences. Psychotherapists and psychologists need to understand that two of the most studied and best dimensions of temperament and personality are PE positive emotionality and NE negative emotionality. These broadband dimensions are included as core features of almost all hierarchical models of personality. The Big Five personality traits are Neuroticism, Extraversion, Conscientiousness ,Agreeableness ,and Openess.These can be further reduced to the Big Three which are; PE NE and the constraint CN referred to as Effortful Control in child developmental literature versus disinhibition. PE and NE are similar to Extraversion and Neuroticism respectively.CN includes aspects of both Conscientiousness and Agreeableness such as self control conformity and harm avoidance.
Adaptive and Maladaptive features of Depressivity and Anhedonia.
In their more extreme manifestations, depressive and anhedonic personalities are associated with higher levels of co morbidity suicidality suicide attempts,poorer social functioning and higher levels of unemployment. However, depressivity and anhedonia are not necessarily or exclusively pathological.They can in fact be adaptive for many reasons. We can see this in patients who are highly artistic , creative, poetic in speech and flamboyant. Qualities such as those that come with depressive personality can give rise to talents. A comedian like the openly depressive Woody Allen spots things that others can’t see and he sculptures them into humour
In terms of future research into understanding personality disorders, we need to examine the dynamic and interactive relationship between basic temperament traits over the course of their development.because they can influence the risk for depressive disorders. Theories are only theories at the end of the day. Whats more important, is to know what are the most important research questions to ask and replace the full stops by question marks.