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File Size: 3468 KB
Print Length: 35 pages
Publisher: The Guilford Press; 3 edition (October 31, 2014)
Publication Date: November 17, 2014
Sold by: Amazon Digital Services LLC
Language: English
ASIN: B00NMKMDK0
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I tend to be drawn to relational theories (psychodynamic), such as Object Relations (OR) and Interpersonal, as a conceptual framework. Yet I practice from a technically integrated approach, drawing variously from all major orientations depending on the client's personality and Stage of Change (Prochaska, 1984, Systems of Psychotherapy: A Transtheoretical Analysis). While relational theories imply cognitive interventions, I felt I ought to read Beck's Cognitive theory of personality as its the seminal work of the cognitive-guru and I try to practice a well-rounded therapy.I personally thought that Beck's approach to Cognitive Therapy (CT) for personality disorders goes back to his psychodynamic roots, having much similarity to OR theory. However, I think Beck's theory is quite distinct from OR theory. While its easy to compare the therapeutic approach between CT and OR, I think the more interesting discussion is the possible integration of theory.There is a wide belief that all psychological functions perpetuate personality disorder, thus therapy must take an integrated approach, intervening on all those functions at the same time. Beck describes this as a cognitive-interpersonal cycle were beliefs lead to interpersonal behavior that reinforce the beliefs. However, Beck's approach to Axis I disorders would challenge the belief and ask the client to behavior differently in interpersonal interactions to either find evidence of their belief or to develop a new belief / change their schema. This would separate the cognitive/intellectual intervention from the behavior and emotional reaction. In order to intervene on all the psychological functions at once, the interpersonal interaction must occur in therapy. The therapist must explore the therapeutic relationship with the client, the cognitions and emotions that shape the client's interpersonal behavior, and the therapist's reaction. This also must be associated with ongoing interpersonal relationships outside of therapy and past events in the clients life. This is quire similar to a transference analysis and interpretation in OR or other psychodynamic therapy (Davanloo's interpersonal triangle between therapy, current relationships outside therapy and past events; Kernberg's Transference-Focused Therapy). Thus Beck's CT approach to personality bears some resemblance to his psychodynamic roots.However, Beck's theory of personality differs from OR theory. Both theories would conceptualize the cognitive processes and belief systems similarly, as well as the interpersonal patterns. Yet Beck believes schemas are at the pith of personality while OR theory believes there are several split-off ego states. Ego states could include a rational, adaptive ego; regressive ego-states fixated via childhood trauma; & ego-states shaped by interactions with key developmental figures such as parents, as well as society in general. Healthy personality is a gestalt or whole of past experiences, yet even healthy individuals can recognize ambivalence between 'parts of their self.' For example, we all say "part of me wants to... while the other part of me feels like I should." This is the parental or societal ego-state battling our wants, wishes or desires. In personality pathology, these ego-states lack integration and are often dichotomize or polarized. Some personalities oscillate between polarized ego states, others remain fixed at one extreme. Oscillation is most evident in Borderline Personality Disorder (BPD). Such an individual might flip rapidly from a regressive child-ego state to a parental-ego state. Their posture will go from slouched or even fetal to authoritarian, their inflection from child-like to parental, their emotional state from regressive to intellectualized, their defense mechanisms from primitive to rationalized, their sense of identity is completely shifted, emotional reactions polarized and labile, resulting in extremes in behavior and unstable relationships. An individual with paranoid personality has a belief that the world and people are malevolent because they have been victimized in the past, thus they enter social interactions in a defensive child-ego state. However, defensive posture is a passive, avoidant position to an underlying aggression. When other people notice this defensive posture / ego-state they too become defensive to protect themselves in case the passive aggression becomes active. When the individual with paranoid personality disorder sees others take on the defensive posture, they switch from a passive, defensive child-ego state to the complimentary ego-state that identifies with the aggressor that victimized them in the past. When the paranoid individual sees the world as aggressive, they are projecting the internalize image of the aggressor onto others. When others respond defensively, they are taking on, or identifying with this role - projective identification. The paranoid individuals follows suite by also identifying with the role of the aggressive and switching ego states: their posture will go from slouched, fetal and defensive to open-shouldered and offensive, their inflection will go from victimized to aggressive, their emotional reaction will go from regressive self-pity to a callous lack of empathy tied to rationalization defense mechanisms. Beck's cognitive schemas, at least in this book, cannot describe these radical shifts in identity, ego-states or 'ways of being' that or quite easily observable in personality pathology. However, OR theory rejects constraining and circumscribed approaches to conceptualizing personality, such as Freud's 'mental apparatus' model of personality. They want to purely conceptualize each client, which can be difficult and tiresome. I believe Beck's schema's can offer a medium that composes the 'stuff' of ego-states, thereby offering a way for OR theorists to conceptualize personality in a more organized manner. Additionally, this integration of the two theory's can explain how schemas can result in immense shifts in personality, identity and ways of being that Beck's theory otherwise cannot explain. Schemas consist of cognitive concepts or nodes that are related to each other to varying degrees (a psychological correlation between concepts). When a set of concepts are highly enough correlated, they create a schema: the physical parts of a dog are related to form a dog-schema. However, concepts are related between various schemas as well: dogs and cats both have wet noses, thus feeling a wet nose sniff your leg ought to equally elicit schemas of cats and dogs for a person who is equally familiar with both animals. Any event will be associated with a handful of cognitive concepts which will 'active' a handful of schemas that shape how we cognitively and emotionally process that event and behave in reaction to that event. In an individual who lacks ego integrity - whose personality consists of multiple split-off ego states - the even will active clusters of schemas associated with various ego states. For example, going back to the individual with paranoid personality disorder, the event of a social interaction elicits a belief that the world and people are malevolent, activating two clusters of schemas. The first cluster constitutes the defensive child-ego-state of the paranoid individual who sees the social interaction through the same lens that they saw the world after being victimized as a child: they regress to that period of their life. The second cluster of schemas constitute the aggressor-ego state, which is latent until the individual sees evidence in the social interaction that seems to provide proof their their belief is true: the the world and people are malevolent. These schemas that constitute the aggressor state include the physical posture (threatening), emotional capacity (or paucity of empathy), and behaviors (aggression) of the aggressor. In this way, ego-states organize a vast, unorganized sea of schemas into 'ways of being' in the world, and schemas define and conceptualize the contents of various ego states. Defining the contents of ego-states is vital to helping the client recognize their ego-states and associate them with their past trauma. This allows therapy to begin working through past trauma. If the client can recognize components (schemas, cognitive processes, etc) of an unhealthy ego-state, they can attempt new, healthier ways of being and begin defining the strong, adaptive components of their self as differentiated from those unhealthy states. Often these clients have the experience of 'being along for the ride:' their health, adaptive self is completely out of control to unhealthy-ego states. This is what Beck would call valence of schemas & dynamic psychology would call cathexis. Defining unhealthy vs adaptive ego states shifts cathexis to adaptive ego states. This process compartmentalizes maladaptive ego-states, yet once the client works through the unresolved emotions, the components, or schemas, of those ego states can be integrated with the adaptive, strong ego into a gestalt, whole, or healthy, integrated personality. A huge range of interventions, particularly experiential, can help with this but is outside of the point of this review.In other words, an integration between psychodynamic (particularly OR) and CT theory offers a much more helpful conceptual framework their either by themselves.
Nice overview of each disorder from a Cognitive perspective. I used it primarily for a lecture on narcissism but will incorporate information on other disorders for other lectures. I found the chapter on NPD clearly written and with some fine suggestions regarding treatment from a Cognitive Therapy point of view,
Older book yet has great information. I also ordered the newer version.
Absolutely what I was looking for! Instrumental learning material for any Psychology, Social Work, or Human Savices student or professional! Beck, et.al coordinated an easy to read masterpiece.
Thanks
Used it for a CEU's
Good book.
This study of thought disorders is an accessible and thorough cover of the material used for treating thought disorders. Great.
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