From the classical point of view, the mere fact that someone is in therapy is supposed to indicate motivation to change. But sometimes people wind up in therapy for other reasons and don’t really want to change at all. When that happens, therapists need another paradigm besides treating all personality dysfunction as a neurotic style of coping.
Recently I accompanied my wife, who is also a psychologist, on a spiritual and philosophical pilgrimage by attending a marvelous Jungian psychology conference. All of the speakers were knowledgeable, gifted, and engaging, their topics most intriguing, and the overall conference experience somewhat magical. And the physical setting for the event was one of the most beautiful I can remember. We had quite the time. There we were: me, my best friend in the world, and over one hundred other “neurotics” (i.e., dreamers, truth-seekers, self-reflectors, and yearning souls — “high-functioning” neurotics, perhaps, but neurotics nonetheless), eager to dream, share, muse, and explore the depth and richness of Carl Jung’s work and legacy. It was a most positive and memorable experience.
Because approximately half of the attendees were mental health professionals of one persuasion or another, and because we therapist types simply cannot avoid “talking shop” at conferences, it was probably inevitable that opportunities would continually present themselves to discuss not only the beauty of some of our old and dear paradigms but also the need for new models of viewing the human condition. By the end of the first week, no fewer than a dozen therapists had expressed similar sentiments during our various conversations, sharing how they found themselves struggling in their endeavors to help some of their clients, and hoping against hope that they might take something away from the conference that would help them understand why they might be failing in their therapeutic efforts.
One therapist seemed particularly distraught about some of her cases. She was a most accomplished woman with many years experience under her belt. But she was beginning to think that there were certain clients that she simply didn’t have the personality attributes or the therapeutic skills to work with. And during some of the sessions, especially given the nature of many of the questions she asked, it was clear that she had one particular case on her mind. Naturally, she couldn’t possibly share all that she might have liked to about the case, but it was clear from the general descriptions she gave that she must have been dealing with a fairly narcissistic client. And we both attended some sessions involving all the traditional explanations for how narcissism develops and how as therapists we’re supposed to deal with it. Some of the presentations on the subject were almost poetic in their beauty and appeared to make so much sense on an intellectual level. Nonetheless, in the end there was no resonance between what the theoretical perspectives presented and this woman’s experience with her client, which really distressed her and invited her to think that she might simply be failing to understand it all.
One of the things that bothered this therapist about her client is that he didn’t seem to “get it” with respect to the harmful repercussions of many of his actions. Still, she knew he must be aware on some level because he could parrot back to her not only many of the things she had reflected to him during counseling sessions but also things that had been reflected to him time and time again by other therapists he had seen. But what bothered her most is that he didn’t appear to have the underlying anxiety, pain and pressure that typically accompanied the folks that sought her services. And he didn’t seem to really want to be better, which perplexed her even more. From the classical point of view, however, the mere fact that he was there in therapy is supposed to mean that he had some unconscious motivation to change, so she figured that she simply must not be creating a sufficiently positive atmosphere for him to grow. But as we got to discussing things, and all the telltale signs began to add up (e.g., the fact he had always been pretty much pressured into therapy by his relationship partners, that he didn’t seem to be compensating for anything with respect to the high regard he had for himself, that he had awareness of what others wanted to see change in him but had little desire to change these things, etc.), it became clear that she was dealing with an impaired character but trying to view and treat his narcissism as a form of neurosis. There are, after all, still many handbooks promoting the notion that all personality dysfunction can and should be viewed as a neurotic style of coping. So I suggested to her that she might at least want to entertain the possibility that perhaps her difficulties with her client had less to do with her failures as a therapist and more to do with the shortcomings of the theory of neurosis and it’s inability to adequately explain all aspects of human functioning. And I invited her to look at how her client might stack up on the set of typical characteristics that distinguish neurotics from disturbed characters. She became quite intrigued and asked if I had written on the subject, and I mentioned she could find these differences outlined in my book Character Disturbance [Amazon-US | Amazon-UK] and also mentioned some places on the web where she could find not only my own material on the subject, but also the material of several others who have delved into the realm of character dysfunction.
A few days later, this woman and several other therapists engaged me in a robust discussion. Many of the comments were the same. All of us appreciated the great beauty and still quite useful benefits of our classic psychological models. They are so tailor-made for us neurotics! And they still have their place. But almost everyone was experiencing a similar state of affairs in their clinical practice: far fewer high-functioning, insight-seeking, neurotics were among their clientele, and they found themselves dealing with many more impaired characters pressured into treatment in one way or another. And with these clients, the ways they had always used to help people grow and change were not proving very successful.
Every time I attend a conference like this (yes, I do still enjoy and benefit from studying the classical paradigms, so actually attend such conferences quite regularly), I only become more reinforced about the mission I’ve had for the last 20 plus years: to acquaint folks (especially helping professionals) with other, fresher perspectives that have proven themselves more appropriate for dealing with the problems of our times. And I regularly get emails or phone calls from therapists who have experienced a renewal of spirit because adopting a new point of view proved to be the key to making a difference in their efforts to help people change. I’ve even heard from therapists overjoyed about the fact that once they adequately dealt with their clients’ character issues using the newer paradigms, they were able to switch back to more traditional modalities to deal with any of their underlying neuroses. Such feedback gives me great comfort.
I know there will always be a place for our wonderful and ageless paradigms. And I think we can appreciate them even more when we accept and respect their limitations. So, while our paradigms necessarily shift to accommodate the phenomena of our times, there’s really no cause for fret or alarm. Our traditional models aren’t going anywhere. Besides, there’s still a lot of us good ol’ fashioned neurotics out there who find them inspiring and helpful to our growth.