MIAMI UNIVERSITY The Graduate School
Certificate for Approving the Dissertation
We hereby approve the dissertation of
Valerie A. Domenici
Candidate for the Degree
Doctor of Philosophy
______Larry M. Leitner, Ph.D. Director
______Roger M. Knudson, Ph.D. Reader
______William B. Stiles, Ph.D. Reader
______Paul V. Anderson, Ph.D. Graduate School Representative ABSTRACT
EXPERIENTIAL PERSONAL CONSTRUCT PSYCHOLOGY AND DEPRESSION: A QUALITATIVE STUDY
Valerie A. Domenici
Experiential personal construct psychology (EPCP) proposes that psychological difficulties can be understood in terms of the ways people typically engage in and retreat from interpersonal relationships. In addition, these processes may be complicated by structural arrests – the freezing of meaning making processes at early levels of development. EPCP has been shown to be useful in conceptualizing various clinical problems; however, the implications of the theory for understanding one common psychological problem – depression – have yet to be systematically elaborated. The introduction of this paper outlines the potential connections between one particular diagnostic construction – self-other constancy – and symptoms of chronic, recurrent depression. People who experience a structural arrest at the level of self-other constancy struggle to integrate different aspects of both self and other people into awareness at any one time. For example, they may lose experiential awareness of particular aspects of the self when they become aware of other, apparently contradictory aspects of themselves. The aim of this study was to examine the usefulness of the EPCP diagnostic system (and the concept of self- other constancy in particular) for understanding recurrent depression. The following qualitative study used fixed role interventions as an empirical tool to explore the proposed relationship between self-other constancy issues and recurrent depression. Two participants were asked to enact the role of a specially prepared character who approached life from a position of greater self-other constancy. Thus, through the fixed-role interventions, the participants actively struggled with those issues that the theory proposes are related to feelings of depression. Successful attempts to portray the fixed-role characters coincided with a lessening of depressive symptoms, while unsuccessful attempts were associated with maintenance or exacerbation of distress. The experience of validation appeared to have a beneficial effect on symptoms independent of improvements in self-other constancy. The implications of these experimental results for furthering EPCP theory and refining the proposed conceptualization of recurrent depression are discussed in detail. Suggestions for future research are offered. EXPERIENTIAL PERSONAL CONSTRUCT PSYCHOLOGY AND DEPRESSION: A QUALITATIVE STUDY
A DISSERTATION
Submitted to the faculty of
Miami University in partial
fulfillment of the requirements
for the degree of
Doctor of Philosophy
Department of Psychology
by
Valerie A. Domenici
Miami University
Oxford, Ohio
2007
Dissertation Director: Larry M. Leitner, Ph.D.
Table of Contents
Introduction…………………………………………………………………………….……….....1 Experiential Personal Construct Psychology: Theoretical Foundations………...... 1 Experiential Personal Construct Psychology: Diagnosis…………………………..…...... 2 Personal Construct Psychology and Depression: Empirical Research…………...... 7 Self-other Constancy: An EPCP Conceptualization of Depression……………………....9 Summary………………………………………………………………………..………..18 Methods………………………………………………………………………………………...... 21 Participants………………………………………………………………………………21 Procedure: Pre-intervention assessment……………………………………………...... 25 Procedure: Intervention Planning………………………………………..…………...…27 Procedure: Intervention……………………………………………………………..…...30 Procedure: Post-Intervention assessment……………………………………………...... 33 Data Analysis……………………………………………………………………….…....34 Results “Alan”………………………………………………………………………………...…37 Pre-intervention assessment……………………………………………………...... 37 Fixed Role Sessions...... 53 Post-intervention assessment and feedback………………………………………...…....83 Results “Lauren”……………………………………………………………..………………..…88 Pre-intervention assessment………………………………………………………..…....88 Fixed Role Sessions...... 103 Post-intervention assessment and feedback………………………………………..…..125 Discussion………………………………………………………………………………...…….132 Alan and Lauren: An integration of results………………………………………..…...133 Complicating factors…………………………………………………………….….….142 Theory – forward progress……………………………………………………...... 145 Theory – unanswered questions……………………………………………………..…149 Intervention………………………………………………………………………..…...152 References………….…………………………………………………………….…………..…156 Appendix A………………………………………………………………………...... 159 Appendix B……………………………………………………………………….………….....161 Appendix C……………………………………………………………………….………...…..163 Appendix D……………………………………………………………………….………….....166 Appendix E…………………………………………………………………………………...... 169 Appendix F……………………………………………………………………………...... 170
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ACKNOWLEDGMENTS
This project was made possible by the hard work of so many people. Many thanks to the members of the Fall 2005 Practicum in Experiential Personal Construct Psychology, who assisted in the analysis of the self-characterization sketches. Thanks also to Brendon Smith, who saved me a great deal of time by spending untold hours transcribing audio recordings of the study interventions. I am especially grateful to those fellow graduate students who contributed their time to the data analysis – Nahree Doh, Darren Del Castillo, and Anthony Pavlo. These three people were instrumental in opening my eyes to the richness of the data and in advancing my understanding of both EPCP and depression. I must also credit Jill Thomas for enthusiastically agreeing to read this paper at the last minute and offering her encouragement prior to my defense. Finally, I extend my sincerest gratitude to Larry Leitner for teaching me everything I know about EPCP and most of what I know about being a clinician. His unwavering support has kept me going when I have doubted myself – I cannot imagine being the person I am today without the benefit of his guidance throughout the past seven years.
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Experiential Personal Construct Psychology and Depression: A Qualitative Study Experiential personal construct psychology, or EPCP (Leitner, 1988), proposes that psychological difficulties can be understood in terms of interpersonal processes. EPCP has been shown to be useful in conceptualizing various problems, including anger (Thomas & Leitner, 2006) and psychotic symptomatology (Leitner & Celentana, 1997). However, the implications of the theory for understanding one common psychological problem – depression – have yet to be systematically elaborated. This paper begins by outlining a potential EPCP conceptualization for depression. To provide a context for this conceptualization, I first review the theoretical underpinnings of EPCP and its diagnostic system, as well as previous research on depression within personal construct psychology in general. Using two illustrative case examples, I then examine how various symptoms of depression can be understood in terms of struggles with “self-other constancy” (Leitner, Faidley, & Celentana, 2000). Finally, I describe a qualitative research study that used fixed-role (Kelly, 1955) interventions to empirically explore the theorized relationship between depression and self-other constancy issues. Experiential Personal Construct Psychology: Theoretical Foundations Experiential Personal Construct Psychology is an elaboration of Kelly’s sociality corollary, which proposes that social interactions are made possible by our ability to “construe the construction processes of another” (Kelly, 1955). Essentially, Kelly states that, to have meaningful interpersonal relationships, we must be able to experientially grasp how others construe their worlds through their own eyes. Others (e.g., Leitner, 1988; Leitner & Faidley, 1995; Leitner, Faidley & Celentana, 2000) have extended Kelly’s work by elaborating on the struggles inherent in construing others and engaging in meaningful interpersonal relationships, termed ROLE relationships. EPCP proposes that all people are engaged in a struggle to negotiate a balance between engaging in terrifying, yet meaningful interpersonal relationships versus retreating into the emptiness and safety of a life without these connections. Engaging in true ROLE relationships requires revealing the most deeply personal and vital aspects of oneself to another. In doing so, people risk experiencing the “awfulness” of profound invalidation and injury, as well as the “awefulness” of profound validation and connection with others (Leitner & Faidley, 1995). A
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life without ROLE relationships offers some measure of protection and safety from invalidation and injury, at the price of an impoverished and lonely existence. In this theory, psychological symptoms are viewed as signals that a person is having difficulty negotiating this struggle in a satisfactory way (Leitner et al., 2000). For example, excessive retreating from ROLE relationships often is experienced as emptiness, meaninglessness, and guilt, as well as such classic psychological symptoms as anxiety and depression. Thus, diagnosis within EPCP involves describing the various different ways that a person typically approaches and retreats from ROLE relationships. Experiential Personal Construct Psychology: Diagnosis Leitner, Faidley, & Celentana (2000) developed a system of diagnostic constructs to assist clinicians in conceptualizing a wide variety of psychological problems within EPCP. This system is divided into three axes, all describing different aspects of impaired ROLE relating. A full EPCP diagnostic evaluation describes a person’s struggles and strengths on all three axes independently. However, when problems are present on Axis I, they are considered primary. Effective psychological interventions will target issues on axis one prior to addressing any derivative (e.g., symptom based) concerns. Axis I: Structural arrest. While all people struggle to develop true ROLE relationships, some have more troubles than others. People who tend to struggle the most are those who have experienced a structural arrest. “Structural arrest” (Leitner et al., 2000) is a term used to describe the freezing of meaning-making processes at early levels of psychological development. This section will explain some of the fundamental concepts underlying the theory of structural arrests, as well as describe some common psychological problems linked to such arrests. Kelly wrote that all people are actively engaged in the process of making meaning of their worlds. People construe their experiences in terms of themes over time, and anticipate that future events will conform to these themes. These constructions form the basis for psychological life and our ability to navigate the world. When events we are faced with match our anticipations, we experience validation of our construing and feel confident using those meanings to anticipate further experience and remain stable and secure in our worlds. We can psychologically survive invalidations of our ways of understanding the world to the extent that we are able to adapt our construing to make sense of new experiences. Invalidation demands
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that we reconstrue our experience and alter our predictions, or we will find ourselves ill- equipped to engage life in a meaningful way. However, some constructs are so central and vital that we may find it difficult or impossible to reconstrue when invalidated. These constructs -- termed core constructs -- are the foundation on which we build a meaningful existence in the world and establish relationships with others. When people are confronted with events that they construe as so overwhelmingly threatening to core meanings as to be intolerable, these experiences are called traumas. Events are not traumatic because of their essential nature, but because the individual “can tolerate no structure within which the idea would have meaning” (Kelly, 1955, p. 473). That is, people experience trauma when every conceivable way of interpreting a situation is too threatening to actually adopt. Traumas are those things that prove to be devastating to the basic foundations of psychological life. While typical DSM-type definitions of trauma, which include experiencing threats to or witnessing threats to bodily integrity are also likely to be traumatic in Kellian terms, the constructivist definition allows for an interplay between the capacity of the meaning-making system to subsume certain events in tolerable ways and the characteristics of the event itself in determining traumatic impact. For example, someone who typically construes the world in a very concrete or limited way is more likely to be traumatized than someone with more complex construing – even when faced with the same event. For the person who experiences trauma, the most essential task is to minimize threats to core construing and preserve the basic functions of the meaning-making process. One important way of accomplishing this is through the use of what Kelly (1955) termed “suspension.” Suspension involves relegating certain experiences to a lower level of awareness, where the experience remains essentially unconstrued, unsupported within a system of meanings, and may be forgotten. Forgetting takes place when events remain unstructured, and remembering happens when a structure is created that would support the experience in a tolerable way. The process of suspension may leave one with a feeling of generalized anxiety, which Kelly defined as the awareness that certain aspects of one’s experience fall outside the range of one’s construct system. Traumatic response is, to a certain extent, developmentally influenced. Many events are likely to be more traumatizing for children than for adults for two reasons. First, childhood
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construing is relatively simplistic (Bannister & Agnew, 1976; Barratt, 1977; Klion & Leitner, 1985). For example, young children use a limited number of constructs, and apply them more rigidly than do most adults (Applebee, 1970). As a result, they are more likely to find themselves unable to construe the events they encounter. This is one reason many parents choose to shelter their children from things that are likely to frighten them (e.g., television violence). Second, children are relatively dependent on a few specific people (e.g., parents or caretakers) for physical and psychological survival. Problems in these relationships have greater implications for children than they do for adults, who usually have a wider variety of people on whom they depend. Thus, any threat to a relationship with a trusted caretaker is likely to be experienced as intolerable, and therefore traumatizing. Leitner et al. (2000) elaborated on Kelly’s suspension concept in their theory of “structural arrest.” Just as certain events may be suspended because their implications are intolerable, entire parts of meaning-making process associated with the trauma (e.g., those designed for construing interpersonal relationships) may freeze in their current level of development, remaining essentially unchanged as the person grows chronologically older. Literally, the structure of the meaning-making system is arrested at its current level of development. This happens both because the person cannot move on to a new stage before mastering a previous one, and because moving on to a new stage would require the development of abilities that would require that the trauma be construed in intolerable ways. Structural arrest can occur at any of three different developmental levels that all people progress through as they grow older (Leitner et al., 2000). The first, termed “self vs. other,” is a stage where people learn to distinguish between me and not me. People arrested at this stage experience numerous problems and may not be able to live outside of structured supervised settings. These problems may include treating others as objects (as they are not experienced as beings that have thoughts and feelings of their own) or experiencing self and other as completely self-contained physical bodies, with no understanding of the ways that people psychologically intertwine with the experience of empathy. Psychotic symptoms consistent with this stage may include delusions of having one’s thoughts stolen or broadcast for others to hear (because others being aware of one’s own thoughts and feelings is not understood as being a result of empathy). Hallucinatory experiences also can result from attributing one’s own thoughts to an external voice, which reflects confusion of self and other.
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Those struggling with the second stage, “self-other permanence,” have difficulty retaining an experiential awareness of both self and other. They may experience others as ceasing to exist when they are not physically present, or be unable to evoke the memory of another when alone. This experience is linked to problems with self-soothing and frantic attempts to prevent being alone (hence midnight phone calls to therapists). Difficulty maintaining an identity separate from that displayed (or expected) by others also suggests problems with self-permanence. This is because people who have not achieved self-other permanence are extremely vulnerable to sweeping changes in self-concept that psychodynamic writers (e.g., McWilliams, 1994) have described as an obliteration of the self. For example, psychotic delusions of being turned to stone, shattered by the gaze of another, or killed reflect the experience of the loss of a permanent self at the hands of others (Laing, 1990). Conversely, preserving one’s own self and identity may mean annihilating that of the other (e.g., delusions of having killed or petrified others). Essentially, self and other are experienced as existentially incompatible. Those struggling with the third stage, termed “self-other constancy,” have difficulty integrating different aspects of both self and other people into awareness at any one time. Those struggling in this area will typically lose experiential awareness of particular aspects of the self when they become aware of other, apparently contradictory aspects of themselves. Thus, people without a sense of self-constancy may experience a complete and devastating loss of self-esteem when faced with any minor challenge to their self worth. Confusions about identity occur due to an inability to maintain a consistent sense of self as different thoughts and emotions arise. A similar process occurs when evaluating others. For example, if someone cannot experience another’s temporary state of anger, annoyance, or disinterest without losing awareness of the ways the other has also been kind, patient, and attentive, that person will experience interpersonal relationships as fraught with the danger of betrayal and abandonment. It is important to note that development is a gradual process, and that people do not instantaneously adopt a new way of construing the world. There are transitional periods between stages where a person may have a tenuous grasp on the new way of understanding, but still lack mastery of it. Just as children who are learning to walk continue to fall for a period of time, people transitioning from one stage to the next use their new understandings of the world with varied consistency. If a person experiences trauma during one of these transitional times, their
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process of meaning making also may be frozen in a transitional state. During periods of relative calm, they may retain the ability to construe the world in more advanced ways. When under great stress, however, they may experience the world in terms of the earlier constructions, thus appearing more seriously disturbed. Axis II: Interpersonal Components. The second axis describes an important paradox in the process of ROLE relating – we limit our engagement in true ROLE relationships to the extent that we approach them solely to reduce feelings of emptiness. While feelings of emptiness are signs that we have excessively retreated from ROLE relationships, we only can re-establish these relationships out of a true caring and investment in others. Interpersonal patterns in which significant others are used as a means to reducing emptiness are linked to various kinds of struggles within EPCP. For example, people who have “undispersed dependencies” (i.e., rely on very few others to meet all needs), “excessively dispersed dependencies” (i.e., allow most people access to their core), or who avoid dependencies altogether (i.e., view dependencies as inadequacy and weakness) all view others as objects to affirm the self rather than as people to be appreciated in their own right. In addition, people may limit intimacy in their lives by physically or psychologically distancing themselves from others. People who physically distance themselves from others use geographical separation as a means to limit the depth of their relationships. They may not seek to overcome practical obstacles to in-person contact (e.g., the car is always out of gas) or may cultivate relationships that preclude that possibility of face-to-face meetings (e.g., only interacts with others on-line). People who psychologically distance themselves from others may do so by viewing others as objects to meet some need or fulfill some specific role. Instead of appreciating the complexity of the other’s needs, feelings, and desires, they may see only the particular function that person serves in their own lives. Axis III: Experiential components. The third axis describes nine essential aspects of construing the meaning-making processes of others. These components, essentially different aspects of empathic relating, describe specific ways that people can directly facilitate or retreat from interpersonal relationships (Leitner et al., 2000). The nine components are discrimination (the ability to construe differences between people and evaluate the impact of those differences on the potential for a ROLE relationship), flexibility (the ability to apply different constructions to different relationships, and to simultaneously hold one’s own meanings and those of another
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in awareness), creativity (the ability to create new ways of seeing self and other as relationships evolve), responsibility (the willingness to examine one’s own meanings and their implications for others), openness (the willingness to reconstrue when invalidated), commitment (the willingness to validate another’s meanings over time), courage (the ability to act in spite of fear), forgiveness (the process of reconstruing self and other so that major invalidations do not hinder one from developing future ROLE relationships), and reverence (the experience of awe that results from the awareness that one is affirming another’s core meanings). Struggles with the experiential components typically manifest in one of two ways – either through an excessive application of the principle or a deficient one. For example, a person may over-discriminate by construing the differences between self and other as so large that most relationships seem exceedingly dangerous. Alternatively, a person may under-discriminate by construing the differences between self and other as so minor that all people seem likely candidates for an intimate relationship. It is also possible for people to struggle with opposite manifestations of the same experiential component in different circumstances (e.g., to alternatively over and under-discriminate). Again, where axis one issues are present, any concurrent axis three issues are considered secondary to the structural arrest. Using the diagnostic system. This diagnostic system was designed to be comprehensive. That is, it can be used to conceptualize a wide variety of interpersonal problems and provide an explanation for all kinds presenting symptomatology. However, the implications of this theory for understanding depression in particular have yet to be elaborated systematically. Several questions still need to be answered. For example, which parts of this diagnostic system are especially useful for understanding depressive symptomatology? What aspects of depression does this system fail to account for? How could this system grow or change to better account for the phenomenon of depression? The first step in answering these questions is to take a look at what empirical research in Personal Construct Psychology has revealed about the nature of construing in depression. Personal Construct Psychology and Depression: Empirical Research Kelly (1955) originally linked depression to a constriction of the perceptual field designed to minimize the threats of disorganizing experiences. In other words, when faced with events that are confusing or uninterpretable, people may choose to limit their awareness to those few things they are able to understand adequately. People constricting their perceptual fields
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maintain order and structure in their worlds by “selectively [refusing] to construe persons or events having disruptive implications for the construct system” (Neimeyer, 1984, p. 136). Coherent meaning is achieved, but at the cost of limited applicability. Kelly interpreted the characteristic social withdrawal of depression as part of this constrictive process. Several research studies, now somewhat dated, provided some initial support for the connection between depression and constriction (Landfield, 1976; Osgood & Walker, 1959). Since that time, PCP researchers have turned toward examining polarized construing and negative self-appraisals. Various researchers have linked depression with polarized construing (Neimeyer, 1984; Neimeyer, Klein, Gurman, & Griest, 1983; Neuringer, 1961, 1967; Neuringer & Lettieri, 1971). “Polarized construing” refers to a pattern of interpreting events in terms of the extreme poles of constructs. To state one common example, people who interpret events as either black or white display more polarized construing than those who interpret events in terms of shades of grey. This effect is not due simply to the tendency of depressed people to construe themselves in negative terms. Even when the effects of negative self-construing are controlled for, depressed people still show a tendency toward polarized construing (Neimeyer et al., 1983). In contrast to stereotypical portrayals of depressed people as biased toward purely negative appraisals of self, research within PCP has shown that depression is more accurately characterized by inconsistent evaluations of the self (Pierce, Sewell, & Cromwell, 1992; Space, Dingemans, & Cromwell, 1983). In these studies, depressed people construed themselves in both negative and positive terms in a somewhat inconsistent manner. Space and colleagues proposed that this inconsistency in self-construing can be understood in terms of excessive amounts of “slot rattling” – changing suddenly from one pole of a construct to another (Kelly, 1955) over time. Cyclothymic mood swings and emotional lability are the likely results of abrupt changes in ways of construing self and others. They also proposed that consistently negative self- construing is characteristic of only the most severely depressed. Finally, several studies have shown that depressed people see themselves as different from other people and as interpersonally isolated (Rowe, 1978; Space and Cromwell, 1980). Lack of identification with others and perceived alienation increase with symptom severity (Space & Cromwell, 1980), and are associated with actual limitations in the quantity and quality of interpersonal relationships (Neimeyer, 1984).
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In summary, Kelly (1955) originally proposed linking depression with a tendency to constrict awareness to minimize the effects of disorganizing experiences. Subsequent research has linked depression with polarized construing, inconsistent evaluations of the self, and interpersonal isolation. All of these findings suggest that a focus on self-other constancy would be essential to any EPCP conceptualization of depression. Constancy problems are characterized by a constriction of awareness, polarized construing, inconsistent evaluations of the self and others, and severe problems in ROLE relationships leading to interpersonal isolation. For example, when a person is unable to integrate different aspects of self and other into unified wholes, they constrict their awareness to those narrow portions of experience they can effectively construe in an organized manner. When awareness is limited, constructions tend to be monolithic, stereotyped, and polarized. When that narrowed awareness shifts to a different aspect of experience, constructions of that experience change significantly. Thus, small changes in the experience of self and other can result in radically inconsistent evaluations of both. The next section of this paper is dedicated to discussing these ideas in more detail, and systematically elaborating the ways in which self-other constancy issues can be linked to depression. Self-other Constancy: An EPCP Conceptualization of Depression In order to most effectively examine how the self-other constancy concept can be used to understand depression, I have chosen to provide two case examples from my own prior clinical work. (All case material has been falsified to assure anonymity.) You will notice that both case descriptions involve chronic, recurrent depression with moderate to severe levels of symptomatology. I intend to limit my discussion to this particular manifestation of depression, rather than attempt to develop a conceptualization for all kinds of depression at all levels of severity. While previous research suggests that self-other constancy may be a useful concept for understanding “depression” in general, EPCP theory would propose that this concept is most likely to be useful when conceptualizing cases like the ones I describe below. Case example 1. Mandy, 34, had felt depressed since early adolescence. She reported that she had unattainably high expectations for herself and, as a result, felt consistently inadequate. Mandy felt an enormous sense of guilt for engaging in a number of common imperfections, such as indulging in an extra dessert after dinner, sleeping in, or expending less than her best effort on projects at work. Of particular concern to Mandy was her tendency to “want” things (e.g., a shiny new car or fashionable clothes). While she never allowed herself to
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have these things, the simple act of wanting them was experienced as crossing over “the line” that separated the “good” people from the “bad.” Mandy believed that she couldn’t punish herself enough to make up for breaking one of the cardinal moral rules: “though shalt not covet.” She fantasized about suicide regularly, convinced that she didn’t deserve to live. Case example 2. Chris, 25, had also felt depressed since early adolescence. He abused over-the-counter and prescription medications with increasing frequency over time, and had been expelled from his high school due to behavioral problems (refusing to do assignments, fighting with peers, speaking disrespectfully to teachers, breaking rules). Chris made several suicide attempts by drug overdose in his early twenties, and was arrested several times for petty theft and drug possession. Chris was court-ordered for treatment after he assaulted his live-in girlfriend. At intake, Chris reported to his therapist that his girlfriend had “cheated” on him by spending time socializing with a male coworker outside of the office during her lunch break. The co-worker, who had “broken the code” by stealing his girlfriend, was intended to be the target of an assault as well. Chris, who reported that violence was the only way to make himself feel better, admitted that his girlfriend’s betrayal was a tremendous blow to his self-esteem because it meant that he was a terrible person. According to Chris, “bad things only happen to bad people.” Violence was the only way he could make sure that no one ever tried to hurt him again, and to prove to others that he wasn’t a “loser.” All or none construing. All-or-none construing is one example of what is known as “slot rattling” (Kelly, 1955, p.128). Slot rattling is a term used to describe a sudden shift from one pole of a construct to another. However, not all slot-rattling should be considered diagnostic of self-other constancy problems. Slot change along a single construct – especially if it does not carry profound implications for other constructs – is relatively common and benign. On the other hand, global slot change along multiple constructs at once – combined with a loss of awareness that the abandoned poles were ever applicable – indicates a constancy problem. Thus, constancy problems frequently manifest as a tendency to understand both self and others in all or nothing terms. Instead of “shades of grey,” people who have not established self-other constancy see either black or white. Mandy, for example, was able to articulate a relatively obvious metaphor for struggles with all or none construing: “crossing the line” between good and bad. For her, the “line” was starkly painted, and it separated the people who were all good, loving, caring, and considerate, from the people who were all bad, hateful, selfish, and inconsiderate.
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Any thought, feeling, or action that could be construed as negative within her moral universe was enough to place her squarely in the “bad” category. There was no evaluation of the extent to which her actions over the course of time added up to mostly good or mostly bad. For her, one small misstep essentially eliminated all of the good in her, leaving her feeling like a horrible person. For those without a sense of self-other constancy, evaluations of self and other are made only on the basis of what is occurring in the moment. Characteristics apparently inconsistent with thought, feelings, or behaviors occurring right now are not accessible to awareness. Thus, the person experiencing constancy problems may appear to forget the ways in which they have been “good” during those times when they are being “bad” and vice versa. Though Mandy usually felt guilty and critical of herself when behaving in a lazy or selfish way, she also felt morally superior to others when she did act within the confines of her strict definition of goodness, losing experiential awareness of the “sinfulness” she saw in herself at other times. Similarly, Chris alternated between the “utterly worthless and contemptible victim” and the “righteous innocent victim” roles when injured by others. Both Mandy and Chris experienced self and others with caricatured simplicity: extremes of good vs. bad, right vs. wrong, victim vs. aggressor, and saint vs. sinner. It is only when people are able to integrate experiences over time that such simplified evaluations of self and other become more complex. The implications of constancy problems in the experience of mania should be obvious here. Manic depression is perhaps the most classic presentation of constancy issues. Mania can be described as a state where one is unable to access the negative, the dark, and the pessimistic, while depression can be described as a state where one is unable to access the positive, the light, and the optimistic. Why then would people with an arrest at the level of self-other constancy not all demonstrate manic as well as depressive tendencies? Speaking from a psychodynamic perspective, McWilliams (1994) has noted that people prone to manic depression tend to fall toward the psychotic end of the “psychotic-borderline-neurotic” continuum of personality development, while unipolar depressives can be found throughout the continuum. Thus, from a psychodynamic perspective, manic depression is often considered more primitive than unipolar depression. If we view the establishment of self-other constancy as a developmental process, rather than an instantaneous all-or nothing accomplishment (Leitner et al., 2000), we allow for the
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possibility that different symptomatology reflects different degrees of progress along this developmental continuum. For example, both Mandy and Chris would feel happy (but not manic) if they won the lottery. They would retain awareness of the other times they had not won the lottery, and would predict that they probably would not win it again. If John wins the lottery, believes this was the result of his extraordinary magical abilities, and proceeds to buy thousands of dollars of lottery tickets convinced of future success, then he has not yet developed the same degree of self-constancy that Mandy and Chris have. All three might be equally prone to an all- or-nothing construction of a negative event. Only John will do so when faced with both positive and negative experiences. Thus, those who present solely with symptoms of unipolar depression can be seen as having progressed further than those with manic depressive symptomatology in the developmental progression leading up to full self-other constancy. Identity confusion and guilt. Constancy problems also are implicated in the experiences of severe guilt and identity confusion. These two problems are grouped together here because they are both related to what Kelly termed “core role” (Kelly, 1955 p. 502) -- those aspects of us that are most central to who we are. A brief description of the development of core role constructs will help to illustrate why identity confusion and guilt can be natural consequences of developmental arrests at this level. Within personal construct theory, identity is conceptualized as a hierarchy of constructs, from core to peripheral. Core constructs are used to define the most important and fundamental aspects of who we are, while peripheral constructs are used to understand our more ancillary and incidental characteristics. For example, male vs. female is typically a core construct, while has a hangnail vs. doesn’t have a hangnail tends to be peripheral. Usually, we locate ourselves at a relatively stable and secure place along the dimensions that make up our core constructs, and very little will shake us loose. When we are speaking of core constructs, we say things like, “this is just who I am, and I cannot be otherwise.” We experience much distress when this core role is invalidated. On the other hand, where we locate ourselves on our more peripheral constructs changes more frequently, and is reflected in momentary variations in behavior, thoughts, and feelings. When we speak of peripheral constructs, we say things like, “I could do this or I could do that, it doesn’t make much difference to me.” We experience very little distress when these roles are invalidated, as we can easily reconstrue ourselves as different along these dimensions.
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For those with a firmly established sense of self-constancy, changes along peripheral construct dimensions have very few implications for core construing. In other words, they are able to retain a secure sense of self despite their minor quirks. However, for those without self- constancy those same quirks have profound implications for core construing. A shift on a single peripheral construct can result in radical shifts along core constructs. For example, Mandy found that shifting along her peripheral doesn’t want a shiny new car vs. wants a shiny new car construct caused drastic changes along her core selfless vs. selfish construct. Because Mandy had a strong desire to see herself as selfless, wanting a shiny new car represented a very painful invalidation of her core role, which she experienced as profound guilt. When changes along a single peripheral construct have the power to influence core construing, one’s core is always in danger of being invalidated. One is left with the experience of rattling back and forth between extremes, unable to settle on a singular, unified view of one’s identity. Mandy, for example, found herself hurtling back and forth between self-as-sinner and self-as-saint identities. When asked to reflect on who she was as a whole, she felt chaotic and confused, unable to come to a satisfying answer. Had she experienced herself as constant, she might have said, “there are ways in which I am a sinner and ways in which I am a saint, but generally I fall somewhere in between.” Instead, she found herself saying, “I don’t know who I am.” Similarly, Chris alternately experienced himself as powerful winner and powerless loser. When asked to describe the kind of person he was overall, Chris could not answer, unable to think of a single adjective to describe his own personality. Though sweeping changes in core construing are typically experienced as identity confusion, it would be a mistake to assume that constancy issues imply a complete absence of a core role, or preferred identity. People with self-constancy issues may not be able to say exactly who they are, but they usually have at least a vague awareness of who they would like to be. (Having firmly established self-permanence, they no longer rely on others to establish these preferences for them.) Consequently, they feel guilt, defined within Personal Construct Theory as “dislodgement from core role” (Kelly, 1955, p. 502). In other words, guilt is an acknowledgment that I have stepped outside of the boundaries that define what is most central and important about me as a person. While all people experience guilt when they become dislodged from their core role, those who have not established self-other constancy are especially vulnerable to extreme and pervasive guilt feelings. This is because deviations from the preferred
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poles of even peripheral constructs are experienced as deviations from core role as well. Thus, for the person without self-constancy, dislodgement from any role, regardless of its status in the hierarchy of constructs, is likely to arouse intense guilt because it has implications for their core role. In addition, deviations from core role are experienced as absolute. That is, those without self-other constancy cannot attenuate the impact of core role deviations with an awareness of the other ways in which they do not deviate from that role. For example, part of Mandy’s core role was that of a hard-working and industrious worker. This role, however, would be completely invalidated whenever she felt tired or unmotivated at work for a short period of time. Instead of understanding these times as necessary periods of rest that hardworking and industrious workers need to maintain that role, she instead felt incredibly guilty for being “lazy” and “ungrateful” for the opportunity to have a rewarding career. Internalizing vs. Externalizing. For those with self-other constancy problems, hurtful actions by others tend to be interpreted in terms of the worthlessness of the self (sometimes called internalization) and/or the intentional malevolence of others (sometimes called externalization). Without the ability to construe self and other as complicated beings consisting of both strengths and weaknesses, interpersonal injuries are understood unidimensionally, as indicating fundamental badness of either self or other. Without a sense of constancy, your injuring me must mean that either 1) I deserved it because of my complete and fundamental badness, or 2) you have engaged in an unjustified and mean-spirited attack on me because of your complete and fundamental absence of human compassion. To understand an injury in any other way requires the ability to reconcile bad (e.g., I feel hurt) with good (e.g., I am worthy of love/I am still loved). Mandy, for example, tended to understand relational injuries as reflections on her alone. If she was feeling unloved or rejected by others, it was because she did not deserve to be treated any better. Chris, on the other hand, tended to understand similar situations as reflections on the character of others. He experienced relational injuries as unprovoked, indicative solely of the other’s wish to harm him. Without self-other constancy, neither Mandy nor Chris could understand hurtful actions by others in terms of the complicated web of factors involving all of the various aspects of both self and other simultaneously. Constancy problems also can generalize from the people involved in a particular interaction to the world in general. Chris, for example, frequently approached the world as if it
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were entirely populated with people who were “out to get” him simply because they liked being hurtful. (Further exacerbations of this kind of construing can be seen in cases of paranoid psychosis.) Such exaggerated statements as “everyone has always hurt me and always will” or “nobody can be trusted” are natural outgrowths of an inability to maintain experiential awareness of the more trustworthy and caring side of others who cause us pain. Without this ability, others are seen as capricious and unpredictable, their inevitable deviations tremendously dangerous in their power to destroy all that is good in the world. Compensatory mechanisms. Because their world is perceived as so chaotic and unstable, people with self-other constancy problems often will try to develop compensatory mechanisms that bring a measure of consistency to their affective experience. The main function of these compensatory mechanisms is to establish an artificial sense of self-other constancy where there is none. For example, when she first began therapy, Mandy reported a tendency toward “perfectionism.” As she explored what it would be like for her if she were not perfect, Mandy discovered that she was frantically attempting to avoid the devastating loss of self-worth she experienced when she deviated slightly from her ideals. For her, mistakes implied a complete lack of moral integrity. Generally, any psychological symptom may be serving as a compensatory mechanism if it protects a person from the kinds of experiences that are likely to threaten a tenuous sense of self (i.e., core role). Asking the person to imagine what life would be like without the symptom can be a useful way to determine whether it is being used for this purpose. (For a more complete explanation of this process, see Ecker & Hulley’s, 2000, discussion of “symptom deprivation”). Some symptoms of depression itself can be used in this way as well. For example, such vegetative symptoms as lack of motivation, procrastination, apathy, and feeling stuck in a rut can reflect the terror of actively engaging a world that constantly threatens to invalidate one’s core role. Vegetative symptoms can help to artificially establish a temporary state of constancy by necessitating a retreat from the dangers of actively engaging one’s world. While in some ways this represents a creative attempt at self-healing (Bohart & Tallman, 1999), it also carries risks of its own, including interpersonal isolation and persistently low mood. People struggling with constancy issues also tend to develop compensatory mechanisms to reestablish equilibrium when their sense of self-worth (or the benign nature of others) is shattered. The internalizing-externalizing construct is useful here. Internalizers, like Mandy,
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tend to bring stability to their lives by making efforts to be better – to commit less of the offenses that they believe destroy all that is good in them. They work hard to be good to combat the feelings that arise from experiencing the self as fundamentally unacceptable (Rowe, 2003). These efforts are usually less than satisfying, as nothing short of perfection will truly prevent them from being confronted with the underlying constancy problem. Externalizers, like Chris, try to achieve that same stability by forcing those around them to behave in ways that do not threaten them. For example, Chris’s continual threats of violence toward others can be seen as his way of trying to prevent others from invalidating his very tenuous sense of his own core role. Assaulting others who insulted him or otherwise rejected him was not only his way of replacing his feelings of utter worthlessness with ones of strength and power, but also a way to prevent a continuation of the kinds of threats to his core role that he was not able to tolerate. However, using violence to eliminate threats to his self-image typically was unsuccessful – others tended to respond in a hostile manner to such attacks on their own cores. Relational disconnections. EPCP rests on the theoretical premise that an absence of meaningful interpersonal relationships is fundamental to symptomatic distress of all kinds. However, problems in ROLE relationships can be infinitely more complicated than a simple withdrawal of one person from others. In this section, I will examine some of the processes by which constancy struggles lead to the kinds of interpersonal problems that are likely to exacerbate depressed mood. I return to Chris, who tended to respond to minor empathic failures, interpersonal slights or censure from authority figures with intense anger and accusations that others wished to do him harm. Typically, people do not react positively to having their behavior interpreted in terms of globally malevolent or hateful character traits. For example, many of the people Chris interacted with reacted punitively to what they saw as his inability to accept responsibility for his own misbehavior. Chris, who could not accept such responsibility without losing all sense of self- worth, continued to interpret punitive actions by others in terms of their badness, creating a vicious cycle of miscommunication. Meaningful connections with others require that one be open to seeing all of the different aspects of those others on a regular basis. Because people with constancy problems cannot integrate the varying behavior of others over time, they experience their relationships as chaotic, tumultuous, and filled with experiences of betrayal. These experiences can prompt a withdrawal
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from authentic interaction with others (e.g., through physical withdrawal and psychological distancing) (Leitner et al., 2000). In addition, it often is distressing for others when their friend or family member is unable to see them in their entirety. Consequently, those others also feel misunderstood and injured. These injuries may prompt others to withdraw to protect themselves from further invalidation. For example, many of Chris’s family members refused to allow him to live with them after his girlfriend asked him to move out. While it is relatively obvious why the absence of other-constancy would lead to relational disconnections, experiencing the self as inconstant can be just as disruptive, though in subtler ways. For example, when someone loses all awareness of positive aspects of the self, they can become impervious to the attempts of significant others to express caring and love. Being unable to understand why others would find one valuable is a significant obstacle to understanding those others and experiencing deep and meaningful connections with them. Mandy, for example, often experienced the love of others as superficial because she knew that one who truly understood her would not love her. She physically withdrew from friends (she did not deserve their attention, after all), and she committed herself to a relationship with a man she did not love (why would someone she actually loved return her affections anyway?). Others, who often experienced her withdrawal as disinterest, made few efforts to include her in activities, which Mandy then experienced as confirmation of her own worthlessness. Suicide. Kelly (1955) originally described two kinds of situations in which a person may become suicidal: when “events appear to invest his or her construction with inexorable validity, or alternatively, threaten its utter collapse” (Neimeyer, 1984, p. 134). The first, termed the “depressive suicide,” results from an anticipation of the future as utterly predictable, and therefore without hope. The second, termed the “anxious suicide,” occurs in response to construct disorganization and is designed to forestall the imminent destruction of the construct system. Kelly’s conceptualization provides a useful structure for understanding why suicidal ideation might be associated with self-other constancy problems (Landfield, 1976). As described previously, people with self-other constancy problems will construe themselves and others in all-or-nothing terms across a variety of different constructs simultaneously. They constrict their awareness to a very specific range of experiences until the world appears to be uniform and monolithic. Just as they are unable to use a wide variety of different memories to moderate their experience of the present, they are also unable to use those
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memories to moderate their anticipations of the future. In other words, they can imagine the future only in terms of their highly polarized understanding of the present. Therefore, the future may appear devoid of hope. For example, both Mandy and Chris had moments when they experienced themselves as entirely “bad” –they had always been “bad” and would always be “bad.” During these moments, the only futures they could imagine for themselves were filled with interpersonal rejection and self-loathing. Understandably, they both considered the “depressive suicide” a viable alternative to living such a life. While all-or-nothing construing may leave one vulnerable to the “depressive suicide,” the identity confusion and guilt associated with constancy problems leave one vulnerable to the “anxious suicide.” When people continually experience themselves as deviating from their core role, and consequently have difficulty establishing a solid sense of self, they experience the world as chaotic. Suicide can be an act that allows a person to salvage the remnants of a core in the midst of serious disorganization. Rowe (2003, p. 59) sums up this dilemma nicely: “Suicide is not about letting go and dying. It is about deciding to preserve the sense of being a person by killing the body . . . it is about saving yourself.” In other words, when people anticipate an imminent loss of their core role, suicide may be the means by which they preserve that role. For example, Mandy considered suicide whenever she felt guilty for not living up to her core self-as- saint role. The “selfless” nature of her potential suicide, which she assumed would save others from her sinfulness, can be seen as an attempt to reaffirm her “saint” role. Summary Experiential Personal Construct Psychology (Leitner, 1988) provides a theoretical basis for conceptualizing a wide variety of psychological struggles in interpersonal terms. However, the implications of the theory for understanding depression have yet to be elaborated systematically. In the preceding discussion, I proposed that a variety of typical depressive symptoms can be understood in terms of problems with self-other constancy – the ability to integrate one’s experiences of self and other into unified wholes. Of course, the cases that I have described in this introduction both involved recurrent, chronic depression—and it is on this specific problem that I will focus my study. There may be other, more useful ways of understanding single episodes of depression, adjustment disorders, bereavement, or postpartum mood disturbances within the EPCP system. Thus, when I use the term “depression” in this study, I am referring to forms of affective instability that persist over time and begin at a fairly
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young age. Theoretically speaking, symptoms linked to developmental arrest should manifest earlier, last longer, and be more severe than symptoms linked to other issues (Leitner et al., 2000). While depression can be understood in terms of a variety of EPCP diagnostic issues, it is only in more chronic cases that struggles around self-other constancy are likely to be at play. Though recurrent depressive symptomatology easily can be theoretically linked to self- other constancy problems, this potential link had not, until this point, been explored empirically. The project I will describe next was an empirical exploration of the EPCP conceptualization of depression I have just outlined. In designing this study, I had one major goal: I wanted to give people experiencing depression the opportunity to directly contribute to the examination and development of the EPCP model. However, I thought that describing the theoretical model and asking people if it fit for them would pull for excessively theoretical and abstract responses from participants. I wanted something more experientially near – something that would allow participants hands-on experience with the theory. Thus, in this study, I asked people experiencing depression to directly experiment with approaching life in a way that EPCP proposes will alleviate symptoms of depression. Later in this paper, I use the experientially rich information that these experiments produced to evaluate the usefulness of the theory. The following study used “fixed role” (Kelly, 1955, 1973) interventions as an empirical tool to explore the relationship between self-other constancy issues and depression. A fixed role intervention is essentially a game of make-believe. A person is asked to experiment with a particular way of approaching life by enacting the role of a specially prepared character. Fixed- role interventions have been used successfully to reduce depression (Bonarius, 1970; Viney 1981), social anxiety (Beail & Parker, 1991), sibling problems (Green, 1997), sexually deviant behavior (Horley, 2005), public speaking anxiety (Karst & Trexler, 1970), and simple phobias (Lira, Nay, McCullough, & Etkin, 1975). Through fixed-role interventions, participants were asked to struggle with those issues that EPCP theory proposes are related to feelings of depression. The goal was not to prove that fixed-role therapy is an effective intervention for depression, but rather for the process to yield information that will be useful in furthering EPCP theory. For example, if self-other constancy is a useful concept for understanding depressive symptomatology, then successful attempts to portray a character with a solid sense of self-other constancy should result in a lessening of depressive symptoms. The results of the following experiments revealed the strengths and weaknesses of this particular theoretical approach. In the
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discussion section, I examine the implications of these experimental results for furthering EPCP theory and refining the theory of depression I have proposed here.
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Method Participants Two participants were used in this study. They were recruited though the placement of fliers in various locations throughout Oxford, including the Psychology Clinic, businesses in town, and on the project’s web site (see Appendix A). In addition, I recruited students enrolled in PSY 111 through the Experimetrix web site, offering class credit for participation. The fliers detailed several criteria for participation in the study. First, participants had to identify as currently depressed, though they did not need to have (or qualify for) an official diagnosis of Major Depressive Disorder. Second, they had to report that symptoms of depression had been present to some degree since at least adolescence (ages 12- 17), and had lasted 2 years or longer. Though the choice of these specific ages was somewhat arbitrary, I included this criterion to ensure that all of the participants (especially college age ones) would present with recurrent, chronic depression. Third, participants could not be concurrently undergoing psychotherapy or any other psychosocial treatment program for depression. I included this criterion so that participants would be able to 1) focus solely on the tasks assigned to them in this study, and 2) clearly evaluate the impact of the study intervention. Fourth, participants must not have started treatment with any psychiatric medication within the last month. Those who had been taking medications for longer than one month had to be willing to postpone any further dosage alterations and/or medication changes (additions, substitutions, and discontinuations) during the course of their participation. Since most medications are known to achieve their effects within one month (Gorman, 1997), this final criterion ensured that any psychological changes that occurred over the course of the study could not be attributed to pharmacological effects. I interviewed five people who identified themselves as potential participants for this study. Four of these five people met the criteria for the study outlined above. (The fifth did not present with depressive symptoms at the time of the initial interview, and was therefore not enrolled in the remainder of the study.) The remaining four participants gave their informed consent prior to participation (see Appendix B) and completed the entire study. In the following section, I will share the results from two of the four study participants. These two participants had the most extensive histories of depression in terms of both chronicity and severity of symptomatology. Both had previous treatment histories and an established diagnosis of Major Depressive Disorder. They also had very different demographic profiles (e.g., age, race, gender,
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SES, occupation), which can test the wide applicability of the theory. While all four participants met study criteria, I believe that these two provide the clearest and most useful exploration of EPCP diagnostic issues in persistent depression. At the same time, because self-other constancy was the predominant diagnostic construct for all four, these two cases can be considered representative of the whole group. I will describe “Alan” and “Lauren” extensively in the next (Results) section, but will provide a short description of the remaining participants here. “Caitlyn” was a college sophomore who had been experiencing symptoms of depression and anxiety since her freshman year of high school. She felt isolated from and frightened of others, and reported feeling that she wasn’t “good enough” in academic, physical and social realms. Small mistakes (e.g., a hair out of place, a B on a test) were devastating to her self esteem. Despite maintaining an A average, there were times she felt she wasn’t accomplishing enough, and therefore did not deserve to live. She punished herself by restricting her food intake, hoping to slowly starve herself to death. Overall, Caitlyn’s struggles with self-constancy manifested as an extremely low tolerance for personal flaws and mistakes. Her compensatory mechanisms included perfectionism and a strict adherence to routine and order. In her relationships with others, she became easily “aggravated” or “annoyed” with small behaviors (e.g., tapping a pencil on a desk) that interfered with efforts to establish order around her. Caitlyn’s sense of connection to others often was destroyed by whatever “annoying” idiosyncrasies they were displaying in the moment (i.e., other-constancy). Related interpersonal struggles included a tendency to blame herself for everything (responsibility), fear and avoid people that she was not already familiar with (over-discrimination), and avoid activities where she might not be immediately successful (courage). Objective measures indicated that Caitlyn was “moderately” depressed (a score of 27 on the BDI-II). Even more significant were highly elevated (SCL-90R) scores on measures of interpersonal sensitivity, obsessive compulsive behavior, anxiety, and phobic behavior. Over the course of the study intervention, Caitlyn was asked to take on the role of “Erin Moore” (see Appendix C). Erin was designed to help Caitlyn experiment with valuing small quirks and idiosyncrasies in herself and others. Erin, for example, used “her own eccentricities as a way of letting other people know they can relax and be themselves around her.” Thus, Erin’s flaws were a means of connecting with others, rather than a reason for self-punishment or social isolation. Mistakes were also a necessary part of being “a well rounded person,” instead of
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something that worthwhile people avoid. Despite her general hesitance to try new things, Caitlyn proved to be a quite active participant and eagerly experimented with taking on Erin’s character. She seemed to intuitively grasp the essence of the character early on. Not only could she imagine how Erin would react in a certain situation, but she could also articulate why that was the case. As the experiment went on, Caitlyn found herself becoming more relaxed with others, and discovered that others were more likely to open up to her in response to these changes. She experienced a brief increase in symptoms after receiving a poor test grade, when she struggled to maintain Erin’s accepting attitude toward mistakes. However, once she was able to get back into character, she again felt better. Caitlyn was probably the most successful of the four participants. She exhibited significant improvements in self-other constancy, and her symptoms decreased dramatically. During her final interview, when the concepts behind Erin’s character were explained to her, Caitlyn reported that the idea of having “two sides” that she needs to “bring together” was a “really helpful” idea for her. While she “didn’t really think of [herself] like that before” she could “see how it fits into everything.” Although Caitlyn’s case would have been fascinating to discuss in more detail in this paper, I ultimately decided that many aspects of her case fell outside of the intended scope of this paper. While she did exhibit the depressive symptomatology this study was designed to explore, she had additional problems (e.g., social anxiety, OCD, eating problems) that were not a focus of the original study design. “Tara” was a college freshman who first started feeling depressed around the sixth grade. She seemed to have alternately high and low opinions of herself. At times, small stressors would make her feel worthless as a person. At other times, she seemed preoccupied with why others were not acknowledging her many accomplishments. Overall, self-constancy problems manifested as strikingly opposing views of self that were both accompanied by depressed mood. Tara’s compensatory mechanisms were usually of the vegetative variety. She withdrew from others and experienced a general lack of motivation (which she termed “laziness” and a preference for “instant gratification”) in an attempt to feign indifference to personal success and/or interpersonal validation. Tara tended to go through “phases” in her relationships with others where she would alternately “love” and “hate” them, depending on how they were treating her in the moment (other-constancy). Because she desperately wanted to be liked, she felt awkward and uncertain around others. She would either withdraw in fearful silence or desperately act in whatever way she thought would gain approval (alternately displaying
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struggles with over and under-discrimination). Tara usually attributed her problems getting close to others to these “annoying social skills.” Tara was also engaged in a significant struggle with her parents around her career choice. She construed her choices quite rigidly in terms of being “wealthy and miserable” or “poverty-stricken and happy” (i.e., creativity). Objective measures indicated that Tara was “severely” depressed (a score of 32 on the BDI-II), though she indicated that she was actually having a “pretty good” week when she filled out the questionnaire. Over the course of the study intervention, Tara was asked to take on the role of “Audrey” (see Appendix D). Audrey was designed to help Tara experiment with patiently letting others get to know and value the real her (as opposed to anxiously seeking their instantaneous approval). Because Audrey was interested in “wearing well over time,” she could tolerate temporary disinterest or disapproval from others. Audrey also embodied the philosophy of being “good enough.” This characteristic was designed to bridge Tara’s desire to be the “best” with the apathy that followed her inability to succeed in this endeavor. There were aspects of the Audrey character that Tara was able to understand and apply quite successfully. In particular, Tara used the idea of “wearing well over time” to allow herself to be shy and reserved in social situations if she chose to be. Her efforts to make friends became less desperate and she found that others started reacting more positively to her as a result. At the same time, Tara had a great deal of difficulty understanding what it meant to be “good enough,” and tended to equate it with being “mediocre.” She felt the only way to increase motivation and decrease depression was to trust that in the future, “I can accomplish greatness . . . and I’ll get acknowledgement.” Her motivation, however, remained consistently low throughout the experiments and levels of depressive symptomatology decreased only slightly. Tara’s problems with motivation extended to her participation in this project as well. When she experimented in taking on Audrey’s role, it was usually because an easy opportunity had presented itself to her, rather than her actively seeking to experiment with a new approach to life. There were several experiments that she did not do, or could not describe how “Audrey’s” approach differed from how she would have normally approached the situation. Tara did report that the feedback letter she received “sort of” made sense and felt “pretty close” to being accurate. Her ambivalence seemed to be the result of difficulty understanding some of the concepts (extensive explanation was required) as well as a reluctance to ascribe meaning to her symptoms in general (“sometimes I don’t think it’s caused by anything”). Although Tara’s clinical interview did provide good initial examples of both self-
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other constancy problems and depression, I chose not to focus on her case due to her less-than- optimal participation in the fixed-role experiments. Greater participation was needed in order to fully explore the potential relationship between her symptoms and self-other constancy issues. In the future, research could explore whether more severe levels of depression (and/or vegetative symptoms in particular) are generally associated with lower willingness to engage in fixed-role experimentation. Procedure: Pre-intervention assessment Clinical Interview. I began by interviewing participants using a semi-structured clinical interview. The following interview protocol (see Appendix E) was designed to provide enough flexibility to allow natural process dynamics to unfold between the participant and myself, as well as enough structure to obtain necessary information. The objective of the clinical interview was to obtain 1) a description of any current and past depressive symptomatology and 2) an interpersonal/ social history. Though I will describe the process of obtaining these two histories separately, it was the relationship between the two that was the main focus of this project. Thus, the actual interviews did not necessarily follow the particular sequence described below. I began each interview by asking the participant to describe the kinds of symptoms he/she had been experiencing. Some questions that guided this portion of the interview included: “When did you first start feeling depressed?” “What kinds of things did you notice about yourself at that time?” “What kinds of things were you feeling and thinking about?” “What, if any, changes have you noticed in your experience of depression since that time?” “What kinds of experiences are bothering you most right now?” The interviews began with these more open- ended questions to avoid leading the participants into any particular topics. However, if participants did not address one or more of the “depressive” symptoms described in the introduction portion of this proposal, I asked about them directly: “Some people who feel depressed report that they feel guilty or bad about themselves, confused about who they are, and/or suicidal – have you experienced any of these things?” Participants who responded in the affirmative to any of these direct questions were asked to provide examples or descriptions of these symptoms and the kinds of situations in which they typically appeared. The second purpose of the interview was to explore the participant’s interpersonal/relational history. Some questions that guided this portion of the interview included: “You mentioned that you were most/least depressed at X time. Can you describe
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some of the relationships in your life at that time?” “How did you feel about yourself and the other person over the course of those relationships?” “Can you give examples of some of the ups and downs of those relationships?” “How did you respond to these ups and downs?” “How would you describe the relationships in your life right now?” “Have you noticed any patterns in those relationships?” “When you feel hurt by someone, how do you typically deal with that injury?” “What are your major struggles and strengths in relationships with others today?” Self-Characterization Sketch. The self-characterization sketch, originally described by Kelly (1955), is a clinical tool designed to assess how clients structure their worlds, as well as themselves in relation to it. Instead of assessing where clients fit within a clinician’s construct system, the self-characterization is designed to reveal how clients structure their own construct systems. The instructions for this task are simple: “I want you to write a character sketch of (participant’s name), just as if he/she were the principal character in a play. Write it as it might be written by a friend who knew him/her very intimately and very sympathetically, perhaps better then anyone ever really could know him/her. Be sure to write it in the third person. For example, start out by saying, ‘(participant’s name) is . . .” (Kelly, 1955, p. 323). Kelly worded these instructions carefully so that the resulting sketches would point to how clients “[structure] a world in relation to which [they] must maintain [themselves] in some kind of role.” The purpose of including the self-characterization sketch in this study was two-fold: to provide additional information with which to make a diagnostic evaluation, and to set the stage for the fixed-role experiment to follow. Beck Depression Inventory-Second Edition. The BDI-II is a 21-item self-report questionnaire that assesses the extent of depressive symptomatology. The BDI-II has been established as a reliable and valid assessment measure (Beck, Steer, & Brown, 1996). For the purposes of the assessment phase of this study, the BDI functioned primarily as a confirmation of the participant’s eligibility. Any score above the “minimal” range (i.e., a total score of 14 or above) indicated an acceptable study participant. (The participant who was eliminated fell below this cutoff.) I used the “suicidal ideation” and “hopelessness” items on this scale to screen for suicidal potential (as suggested by Beck and colleagues) so that I could immediately refer participants for more appropriate services if suicide risk appeared to be high. None of the remaining four participants had high scores (e.g., 2’s or 3’s) on either of these items. Secondarily, I used answers to individual items on this measure as a source of qualitative data
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with which to make diagnostic hypotheses. For example, answers to several items on this questionnaire can be suggestive of constancy problems, including, “I feel I am a total failure as a person,” “I feel guilty all of the time,” and “I feel utterly worthless.” Symptom Checklist-90 Revised. The SCL-90R consists of 90 questions that measure somatization, obsessive-compulsive behavior, depression, anxiety, interpersonal sensitivity, hostility, phobic anxiety, paranoid ideation, and psychoticism. Numerous studies have demonstrated its validity and reliability (Derogatis, 1994). The SCL-90R was included here to screen for problems that fall outside the range of traditional depressive symptomatology. I used answers to individual items on this measure as a source of qualitative data with which to make diagnostic hypotheses. For example, answers to several items on this questionnaire can indicate awareness of problems in ROLE relationships, including, “feeling lonely even when you are with people,” and “never feeling close to another person.” Procedure: Intervention Planning Analysis of self-characterization. In this study, I analyzed self-characterization sketches with the help of ten graduate students enrolled in an Experiential Personal Construct Psychotherapy practicum. The purpose of soliciting the help of the class was to generate as many ideas as possible about the meaning of each participant’s statements. Approaching the sketches from multiple perspectives served to provide greater variety and depth to the analysis. In addition, I operated under the assumption that class members’ reactions to each participant would, to some extent, parallel those of the people in that participant’s life. Thus, the class member’s reactions, feelings and thoughts illuminated some of the interpersonal processes participants were likely to encounter on a daily basis. The process that the class followed in its analysis was guided by Kelly’s (1955) original outline, as well as by more recently published guidelines for construct interpretation (Faidley & Leitner, 1993). As an orientation, the class was asked to read Kelly’s (1955) book chapter entitled “The Analysis of Self-Characterization” (p. 319-359) and Faidley and Leitner’s (1993) book chapter entitled “Personal Constructs and Hypothesis Formation” (p. 57-70). They were asked to come up with an answer to two questions: What is this client trying to say? and How can we understand what this client is saying in terms of Experiential Personal Construct Theory? The class discussion was inspired by the following guidelines but did not follow them in any structured way.
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Kelly’s (1955) approach to the analysis of self-characterization includes five major goals: 1) to adopt the credulous approach (i.e., assume that the client’s words represent important personal truths), 2) to examine any major themes or topics with the goal of identifying typical interpersonal patterns or ways of making sense of life experiences, 3) to examine the content of construing by identifying any explicitly stated or implied contrasts (i.e., bipolar constructs), and 4) to examine the process of construing by noting the ways in which topics and themes are introduced, described, abandoned, omitted, or sequenced. The purposes of this project required a fifth and overarching goal: to examine the ways in which the content or process of the participants’ construing may be facilitating or hindering the development of ROLE relationships. Faidley and Leitner’s (1993) approach to construct interpretation included fifteen guidelines that were used to help achieve the goals described above. Ten guidelines were the most pertinent to the purposes of this project. First, the class “[assumed] that the poles of a construct represent, to some degree, contrasting aspects of a person’s dimensions of meaning” (p. 61). The class used those things that the participant considered “opposites” to help clarify the meaning that various terms and/or events held for him/her. Second, they assumed that “certain parameters of the person’s behavior can be encompassed by the poles of his elicited dimensions” (p. 62). In other words, the class attempted to predict possible behavioral changes that might accompany shifts along the participant’s construct poles. Third, they “[observed] the simplicity and abstractness of the person’s interpersonal construing” (p. 62). The class speculated about the degree of sophistication with which the participant was able to interpret the behavior of self and others. Fourth, they observed the extent to which the participant described “social interaction” (p. 63). The class made note of any references to the presence/absence of relational contacts, as well as the implied quality of those relationships. Fifth, they “[observed] the overuse of a construct dimension” (p.63). In doing so, the class remained alert for signs of a particularly important conflict, value, or issue. Sixth, they observed any “language and contrast that [seemed] strange, peculiar, and obscure” (p.64). They speculated about the extent to which the participant’s constructs were common/idiosyncratic enough to facilitate/hinder interpersonal communication. Seventh, they looked for whether “the person used at least one construct dimension that implies openness to experience at one pole and closedness to experience at the other” (p. 65). The class used these observations to assess the capacity of the participant to understand the process of change and to evaluate any potential roadblocks to change. Eighth,
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they looked for any evidence that the participant used “constructs more appropriate for persons who are either older or younger than himself” (p. 65). For example, since the use of physical (tall/short) and social role (mother/father) constructs is characteristic of small children (Barratt 1977), the class considered the possibility of developmental arrest when these types of constructs predominated. Ninth, they “[noted] descriptive modifiers that [were] either extreme or moderating” (p. 66). The class speculated about the possible meaning of excessive use of these words (e.g., never, always, all, none, perfectly, very, etc.), which could include developmental arrest. Tenth, they each “[imagined] that the subject’s personal construct dimensions [were their] own” (p. 67). In other words, the class tried to imagine what the world might be like when approached from each participant’s particular perspective. EPCP Diagnosis. I used information gained from the class’s analysis of self- characterization and the clinical interview to arrive at a conceptualization of the participant’s presenting problems within the EPCP diagnostic system. This conceptualization drew from all three EPCP diagnostic axes (see figure). Diagnostic Axes of Human Meaning Making Developmental- Interpersonal Experiential Structural issues components components Self vs. other Undispersed Dependency Discrimination Self-other permanence Excessively dispersed dependencies Flexibility Self-other constancy Dependency avoidance Creativity (Attachments) Physically distancing self Responsibility Psychologically distancing self Openness Commitment Courage Forgiveness Reverence Table reproduced from Leitner, Faidley, & Celentana (2000). Participants were not given a DSM-IV diagnosis, as qualifying for a particular diagnosis (e.g., Major Depressive Disorder) was irrelevant to the purposes of this project. The purpose of constructing an EPCP diagnosis was to guide the creation of the fixed-role sketch, described below. Creation of Fixed Role Sketch. Fixed-role sketches consist of a description of a character who has an approach to life that differs in significant ways from the approach a person typically uses in his/her life. Kelly (1955) outlined several criteria for the creation of fixed role characters. The new approach must sharply contrast with the old one, without employing the perceived
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opposite to the initial approach. The fixed role character (FRC) must be designed specifically to set a developmental process in motion (as opposed to instantly creating a new state) by suggesting a way out of the more confining constructs contained in the original characterization. The role must include testable hypotheses for participants. That is, it must specify an approach that will meet with validation (or invalidation) of some kind. Most importantly, the role must provide a basis for a new way of interacting with other people, including specific ways that the character attempts to understand the construction processes of others. The FRC must be presented as different, though not necessarily better, than the character the participant originally described. The FRC is given a name of its own to signify that it is a completely different person, and not a perfected version of the participant. The FRC must have strengths and weaknesses, and above all, be someone that participants could imagine actually meeting and wanting to get to know. Larry M. Leitner, Ph.D., and I created each fixed role character together. We created them with the philosophy that the participant’s approach to life was not incorrect, bad or wrong, but rather, serving a purpose that had to be respected. Each fixed role sketch was specifically designed so that the character struggled with issues similar to that of the participant, yet had a different way of dealing with or approaching those struggles. For example, because both participants struggled with self-other constancy, they received sketches describing a person who had a more fully developed sense of constancy. We tried to anticipate the particular problems both participants were likely to face during the course of the experiment, and build ways of dealing with those problems into the sketch itself. Each alternative approach suggested in the sketch was based on one or more diagnostic hypothesis. In other words, the FRC approached life and interpersonal relationships in a way that EPCP theory suggested would alleviate symptomatology for that participant. Procedure: Intervention Fixed Role Experiment. “Fixed role therapy” (Kelly, 1955) was originally designed as an experiment that college students could conduct while they were waiting to be assigned a regular clinic therapist. Later, Kelly suggested that it could be used as a brief interruption to an ongoing therapy that had become stalled. In either case, fixed-role therapy was never intended to be a substitute for traditional psychotherapy. Hence, this study was not designed to provide empirical support for the efficacy of fixed-role therapy, or to suggest that other interventions for depressive
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symptomatology are ineffective. Simply, fixed-role experiments were used here to explore the usefulness of the EPCP theoretical model for understanding depression, and to allow depressed persons to contribute in a systematic way to the refinement of the model. In this study, participants conducted fixed-role experiments in collaboration with myself. Larry M. Leitner, Ph.D, supervised the interventions. I began the fixed-role interventions by introducing their purpose: “Based on what you told me in your interview, and what you wrote in your self-characterization sketch, I have developed some guesses about the sorts of struggles you are having that might be leading you to feel depressed. In order to see if these guesses are right, and to get to know you better, we are going to do some experiments. These experiments involve acting out the part of a character that has an approach to life that may be like yours in some ways, and different from yours in others.” I then presented the fixed-role sketch to the participant and elicited any reactions to it: “Is this a person you would like to get to know? Does this person seem like someone who might actually exist?” If the FRC had not seemed credible or complete, the sketch would have been immediately modified based on feedback from the participant. Neither of the participants challenged the realism or likeability of the characters. I then explained: “I want you to play the role of (FRC’s name) for a period of two weeks. We are going to send (participant’s name) on a vacation, and let (FRC’s name) take over until then.” I gave participants some general instructions about how to do this (see Appendix F). I asked them not to 1) play the part of the FRC in any situation in which it might be dangerous to do so, or 2) tell others that he/she was attempting to play the part of a FRC. I explained the second rule this way: “In this exercise, part of what you are doing is conducting experiments to see how others react to (FRC’s name). If they know that you are enacting a role, we won’t be able to find out what their natural responses to (FRC’s name) would have been, and we will lose some valuable information.” In addition, I asked participants to read the FRC sketch to themselves several times a day. During the first session, I asked participants to try out the FRC while I enacted the part of a teacher, boss, or supervisor. When they were uncertain how the FRC might respond to a particular situation, I briefly enacted the part of the FRC to provide a model. Once participants expressed confidence in being able to play the part of the FRC in this situation, they were assigned the task of enacting the role with an actual authority figure before the next session
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(format of sessions suggested by Epting, 1987). Sessions were scheduled approximately two to three days apart, to allow enough time for the participant to complete his/her assigned enactment. In each subsequent session, participants were encouraged to reflect on the experience of the previous enactment. I explored any difficulties in getting into role or maintaining it in particular situations with them. Once the previous session’s homework assignment has been discussed, I introduced the next experiment. In order, I asked each participant to play the part of the FRC with 1) a boss, teacher, or supervisor, 2) a friend 3) with a spouse, lover, or significant other (or, their best friend if these are not available), 4) a parent (or, someone who plays the role of a parent), and 5) something of religious/spiritual significance (or, some ultimate value or ideal). Some creative brainstorming was required to determine which people in the participant’s life met these criteria. Practice sessions lasted only as long as it took to accomplish the assigned goals: processing the previous experiment and rehearsing the next one. They were scheduled three times a week for the length of two weeks (following the initial assessment period). Participant journal. I asked participants to keep a journal reflecting their experiences conducting the fixed-role exercises. I asked them to write about their initial feelings about the FRC (e.g., “If you met this person on the street, what would you think of him/her?” “How would you approach him/her?” “If you were this person, how would you feel about yourself?” “How is this person similar or different from you?”) and about their experiences trying to enact the new role (e.g., “What was it like to act the part of the FRC?” “Which characteristics were difficult/easy to enact?”). Finally, I asked them to evaluate the results of the experiment (e.g., “How did others react to the FRC?” “What was it like to see their reactions?” “How did you feel about yourself while in the role of the FRC?” “Were there any characteristics of the FRC that you would/would not like to have as a part of your own character?” “What is different/the same about your life now as compared to the beginning of this experiment?”) The participants varied in their eagerness to keep a journal during their participation. Lauren wrote a few sentences about each interaction with encouragement, while Alan kept extensive logs of thoughts and feelings throughout the experiment.
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Procedure: Post-Intervention assessment Interview. The purpose of the post-intervention interview was to give participants the opportunity to reflect on the experience of the fixed-role exercise in terms of its effect on symptomatology, interpersonal relationships, and their internal experiencing of the world. As one of the purposes of this project was to give people experiencing depression the opportunity to contribute to the development of the EPCP diagnostic system, I asked participants to evaluate the ways in which their FRC did/did not embody traits that shed some light on their experience of depression. For example, I asked: “What aspects of this character’s approach to living made you feel more hopeful (about life, relationships, your future)?” “What was missing from this character’s approach that might have helped you feel more hopeful about these things?” “What aspects of this character left you feeling more/less connected with others?” “What could have been included in this character sketch that might have led to greater feelings of connection with others?” “What aspects of this character’s approach left you feeling less/more depressed or sad?” “If you were to adopt this character’s approach to life, which aspects of your experience of depression would be left unresolved?” BDI-II, SCL-90R. Participants completed the BDI-II and SCL-90R again at the conclusion of the fixed-role exercise. Because this study design included too few participants to make a quantitative analysis of pre-post intervention symptomatic change possible, these measures were used as supplementary qualitative data. Feedback to participants. I met with participants one final time, about a week after they completed their fixed-role experiments. During this interview, I described to them the initial diagnostic hypotheses that went into creating the FRC for them, as well as any additional diagnostic hypotheses that had been generated during or after the experimentation phase. They had the opportunity to ask any questions they had about the purpose of the intervention in general or about their participation in particular. (No deception was used.) I then gave participants a written summary of the various issues that I thought were contributing to their experiences of depression. I chose not to use EPCP diagnostic terminology in these summaries in an effort to make them reader-friendly and easily understandable. In addition to providing participants with feedback, I solicited any feedback the participants wanted to give about the summary I had given them. I asked each participant the following questions: “To what extent does this description feel right/wrong to you?” “What
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would you add to it?” “What would you take away?” “In reading it, how hopeful do you feel about the possibility of change for you?” Participant responses to these questions were used to further the data analysis described below. Data Analysis The purpose of this project was to explore the potential connection between depressive symptomatology and self-other constancy issues. While the extent of depressive symptomatology can be measured quantitatively with instruments such as the BDI-II and SCL- 90R, self-other constancy issues do not lend themselves to this kind of mathematical analysis. Thus, the main focus of this data analysis was a qualitative exploration of the relationship between constancy issues and mood symptoms throughout the course of the fixed-role intervention. The data analyzed included all written material generated by the participants themselves (e.g., self-characterization sketches, diary entries), all audiotaped verbal discourse of the class that conducted the analysis of the self-characterizations, and all transcribed verbal material generated in the interviewer-participant interactions (e.g., assessment interviews, fixed- role intervention sessions). The first phase of qualitative analysis was conducted during the course of the EPCP practicum class (hereafter referred to as “the class”), immediately following the first two interviews with each participant but prior to beginning the actual fixed-role experiments. As described above, this phase consisted of making initial diagnostic hypotheses, which were then used to create the individual FRCs. In the results section, I will use each participant’s own words (from the interviews and self-characterization sketch) to illustrate how each initial diagnostic impression was constructed. This phase served as an initial test of the hypothesis that participant’s struggles could be understood in terms of problems with self-other constancy. Where participants presented with issues that could be understood in terms of other diagnostic constructs (e.g., under axis two or three) within the EPCP system, these are noted. However, I proceeded under the assumption that these issues were secondary to the structural arrest. The second phase of qualitative analysis occurred following the completion of the fixed- role experiments. A small group graduate students who were familiar with EPCP (hereafter referred to as “the data analysis group,” or just “the group”) reviewed all of the available written material for each participant (transcripts of interviews and fixed role sessions, self- characterization sketch, and journal). I then met with the group to facilitate an examination of the
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interplay between self-other constancy issues and depression throughout the course of the interventions. The purpose of conducting this phase of the analysis with the help of a small group was to provide alternative perspectives on diagnostic issues. As I created this project, and conducted the fixed role interventions, it was extremely useful to have outside opinions with which to challenge some of my own assumptions. The main goal of this second phase was to explore each participant’s evolving relationship with the fixed-role character. One of the major assumptions of this project was that through portraying the FRC, the participant was experimenting with ways of being that would improve self-other constancy and interpersonal functioning. Thus, in exploring the participant’s relationship to the FRC, we could directly observe his or her struggles with constancy issues over time. To begin, we looked for the answers to several questions, including, “How is this participant viewing the FRC?” and “What obstacles stand in the way of this participant fully embodying this character?” We used the answers to these questions to explore the kinds of difficulties participants encountered when they attempted to approach the world from the position of someone with a more fully established sense of self-other constancy. In addition to examining struggles around portraying the FRC, we asked questions throughout the course of the exercise about the participants’ reactions to the various outcomes of the fixed-role experiments. In line with the main focus of the project, these questions were designed to explore any connections between constancy issues and the experience of depression. The main question guiding this portion of the analysis was: “To what extent were successful portrayals of the FRC related to reductions in depressive symptomatology or increases in feelings of connectedness with others?” To answer this question, we addressed several others, including: “How successfully were participants able to enact the part of the FRC?” “How did they experience the enactment and its results?” and “How did participants feel during and after their enactments with regard to depressive symptomatology?” While examining the fixed role experiments themselves, participant’s verbal reports were used as a qualitative gauge of their level of distress and symptomatology (since quantitative measures were only obtained on the first and last day of participation). Ultimately, we evaluated the outcome of the entire intervention in terms of both depressive symptomatology and constancy issues (as well as changes that fell outside of the realm of either depression or constancy altogether.) Information for this portion of the analysis
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was taken from each participant’s final interview, as well as from any journal entries addressing changes each felt he/she had made as a result of the intervention. Major questions guiding this portion of the analysis included: “What symptomatic changes, if any, did the participant report?” “What changes, if any, have been made toward establishing a greater sense of self-other constancy?” “What aspects of the participant’s experience suggest that changes in issues other than self-other constancy have occurred?” Finally, I made an attempt to integrate the findings from the separate participants into a cohesive whole (see discussion section). This final portion of the analysis assessed the strengths and limitations of the EPCP diagnostic system for understanding the phenomenon of depression. Several questions were addressed: “To what extent was self-other constancy a useful construct for understanding the processes underlying depression for these participants?” “To what extent did EPCP in general provide useful constructs for understanding depression?” “To what extent did an intervention based specifically on these diagnostic constructs prove useful therapeutically?” In general, this portion of the analysis was designed to result in suggestions for theoretical change within EPCP and/or evidence for the fertility and usefulness of the existing theory.
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Results – “Alan”
Interview 1. Alan, the first participant in the project, responded almost immediately to the advertisement for this project after it was posted. He expressed his eagerness to learn more about himself and help contribute to a professional understanding of depression, and started writing an essay describing himself before he was even provided with the instructions. In meeting Alan for the first time, he presented as a man with a fairly distinguished air to him and an eagerness to discuss his life experiences in detail. His mood seemed normal, and his energy level relatively high for someone who is depressed. Introductions and formalities seemed unnecessary to him – Alan jumped right into the interview without direction or question from me. He immediately pulled a stack of newspaper articles and other documents from his pack, pointed to his name prominently displayed on each, and stated: “This is who I am. This is really me. This is my work.” He explained that he was a lawyer, gave the specific number of cases he had won, and described the kinds of settlements and awards he had negotiated for his clients. After discussing his various professional accomplishments, he briefly mentioned several different topics of concern to him in a disorganized, disjointed manner that was difficult to follow. I tried to guide the interview as little as possible, asking questions mainly to clarify points and focus the discussion. The following is a summation of some of the major events and issues that Alan described as being important in his life. Alan remembers first experiencing symptoms of depression at the age of eight. Throughout his childhood, he witnessed domestic violence between his parents and experienced physical and emotional abuse from them as well. He recounted his father beating him to the point of unconsciousness, threatening to kill him, and making insulting and degrading comments about Alan to him and to other family members. Alan remembers crying, feeling guilty, and feeling like he was being persecuted. When asked how he dealt with the abuse as a child, Alan explained that he accepted that he was responsible for the abuse as a way to avoid thinking about what the abuse meant about his parents: “I felt like, ‘ok, I was bad,’ and I wouldn’t go any deeper than that . . . Surely this was some fluke of circumstance and it won’t happen again . . . I just accept this and hope, and hope turned into belief out of self-defense, that they didn’t mean it.” Later, around the age of twelve, Alan remembers starting to think “analytically” about what was happening to him, placing less blame on himself, and construing his father’s actions as a form of
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self-hatred: “There’s something really bad here. There are patterns here. And uh, my father is beating me, but he’s not really beating me. He’s beating himself. He has been treated this way.” When asked to describe his current impressions of the kind of man his late father was, Alan responded quickly: “vile, evil . . . and hateful.” Alan did not experience any relief in his feelings of depression following the change in his construction of his father’s behavior at the age of twelve. Around that time, he remembers becoming an “instant introvert,” fearful of other children at school because his father had told him that they likely would reject him. With this experience, Alan commenced what he now sees as a life-long struggle to prove to others that he is a worthwhile human being by accomplishing impressive things. For example, he pointed out how he had started off our interview by trying to prove to me that he really was a successful lawyer: “Look at me holding these things out. My papers and stuff. Yes, I’m proud of them, but its kind of a defensive move . . . I feel a real need to prove myself. Look, I really did this stuff. It’s kind of like talking to my family, but the world at large, and saying ‘No, I’m not useless’.” Alan described various other accomplishments, finally admitting that despite having a very impressive resume “it all feels worthless when I think about my family because they all have the wrong idea.” Alan believes that because he has not experienced his family’s acknowledgement of his accomplishments, he feels compelled to prove his worth to others in order to feel good about himself. Alan identified certain patterns that are associated with a worsening of his symptoms. First, he experiences more symptoms of depression when he is low on money. This particular pattern seemed to be associated with his desire for validation from his family: “[making money] is proof to my dead father that no, I’m not lazy . . .” When he has more money, Alan feels he has the evidence he needs to justify his worth to others, and his mood improves. Second, during the times when his mood is particularly low, Alan finds that small things make huge differences in the way he feels about himself: “somebody cuts me off in traffic and it hangs with me the entire day. I start feeling really down, bad about myself.” Third, Alan finds that he tends to want to “rescue people” who are “screwing themselves up” because he feels responsible for helping them. While his depression seems to ebb and flow with the relative success of these rescue missions, he does experience some resentment for feeling forced to take on this role (which contributes to feeling more depressed). Fourth, Alan feels worse during those times when he is not romantically involved with someone. He finds that having a romantic partner helps him feel
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that he is physically attractive to others: “. . . when I get lonely I feel like I need to be with someone. Have some attention to validate myself … to feel like I’m not repulsive.” When he is feeling particularly down, he finds himself assuming that other people find him especially physically unappealing, particularly when something negative happens and the reasons for it are unclear (e.g., someone is rude to him, he is not offered the work he was looking for). Beck Depression Investory/SCL-90R. Alan completed the BDI-II at his first interview and scored 25 (moderate depression). He endorsed his highest score (3) in the areas of sleep problems (“I sleep most of the day.”) He also indicated serious problems (2’s) in the areas of pessimism (“I do not expect things to work out for me”), past failure (“As I look back, I see a lot of failures”), loss of pleasure (“I get very little pleasure from the things I used to enjoy”), agitation (“I am so restless or agitated that its hard to stay still”), and loss of interest (“I have lost most of my interest in other people or things”). Alan reported some symptoms that appeared to be less severe, including sadness, guilt, punishment feelings, self-dislike, self-criticalness, crying, indecisiveness, worthlessness, loss of energy, loss of appetite, concentration problems, and fatigue. He denied experiencing suicidal thoughts, irritability, and loss of interest in sex. (When asked during his interview to rate how intense his subjective experience of depression was currently, Alan rated it an 8 on a 10 point scale.) Alan also completed the SCL-90R at his first interview. His responses showed elevated levels of all symptoms, including somatic symptoms (t=81), obsessive compulsive behavior (t=81), interpersonal sensitivity (t=81), depression (t=81), anxiety (t=70), hostility (t=65), phobic behavior (t=69), paranoia (t=68), and psychoticism (t=75). Alan reported that he was “extremely” bothered by the following symptoms during the previous week: “feeling critical of others, trouble remembering things, worried about sloppiness or carelessness, feelings of being trapped or caught, blaming yourself for things, pains in the lower back, feeling blocked in getting things done, feeling lonely, worrying too much about things, your feelings being easily hurt, trouble falling asleep, having to check and double check what you do, difficulty making decisions, feeling hopeless about the future, feeling tense or keyed up, sleep that is restless or disturbed, and others not giving you the proper credit for you achievements.” He also reported that he experiences the following “quite a bit”: “headaches, repeated unpleasant thoughts that won’t leave your mind, feeling easily annoyed or irritated, poor appetite, feeling shy or uneasy with the opposite sex, feeling blue, feeling others do not understand you or are unsympathetic,
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feeling people are unfriendly or dislike you, feeling inferior to others, soreness of your muscles, you mind going blank, numbness or tingling in parts of you body, trouble concentrating, feeling weak in parts of your body, awakening in the early morning, feeling lonely even when you are with people, and feelings of worthlessness.” Interview 2. Alan started out his second interview with “a little bit of show and tell,” sharing various pictures of him at a younger age and magazine/newspaper articles that had been written about him. He reported that he was sharing these because he was “of the opinion that if you want to know someone, it’s good to know what they looked like in the past.” Based on what he had shared in his first interview, I wondered if this was Alan’s way of countering his feeling of being unattractive and unimpressive in the present. We spent the second interview discussing various interpersonal patterns and issues that have played out throughout his life. Alan described developing “xenophilia” early in his childhood, always choosing to befriend people who were older, younger, of a different race, or from a different town than he was. He speculated that he did this because, “I didn’t like myself and it had extended to people in my peer group.” Also, they were people who were different from his family. Alan’s attraction to people who are different than him has continued to this day. For example, the last several women he has dated were, “exotic,” different from him or his family in some way. When asked about his current interpersonal relationships, Alan quickly named the owners of at least four well known businesses, as well as a variety of people who work at various stores in the town where he lives. At the same time he reported that “Most of them don’t know my name or what I do . . . these aren’t people I can catch at home . . . I haven’t been by to see [name] . . . I fall out of touch . . . I don’t follow up on things.” While he was able to name a few people he stays “in touch” with, all of them lived out of state and their contacts seemed to be few and far between. I had the impression that I was the only person Alan had talked to in a long time, and that the only regular social contact he received was limited to conversations with check-out clerks while paying for groceries. Next, I asked Alan to describe how he deals with feeling injured in a relationship and how he responds when he feels that someone has hurt him. Alan’s initial response pointed to a tendency to blame himself, internalize responsibility for interpersonal injuries: “I keep it inside me, and wonder about it . . . What did I do? First, that’s my natural reaction. Anything happens around me, a part of me is always saying, did I do something? . . . Can I repair this, can I fix it?”
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Later, however, he described his natural response as more of a shutting down, a confused bewilderment followed by intense anger at the other person: “It feels unreal and I detach myself from it. So that’s how I first deal with it. Then the anger comes and I think I can’t let this go because I might do something I might regret . . . hurting somebody.” He described the feeling as “hanging fire,” as if something wants him to go ahead and do something hurtful. Alan also described other problems with anger, which he believes stem from abusive childhood experiences for which he had no recourse: “my family is a slow burn kind of anger. I have a real problem with people getting away with stuff.” Occasionally, he finds that he will manufacture a situation where he will have an excuse for accusing somebody of intentionally insulting or harming him in some way. For example, he described accusing an abrupt store clerk of discriminating against him for having a crooked nose: “I looked her right in the face and said ‘are you treating me like shit because of this?!’ Totally irrational. But that’s what I felt like. It was because I was feeling really bad. And depressed people do this. They engineer things.” Alan described how he has seen other people doing similar kinds of things, displacing anger from some injury they have experienced onto an innocent bystander. He sees this behavior as having a punishing purpose: “depressed people want not only amends. They want the guilty person to suffer.” Without directly saying so, Alan gave the impression that he felt his family had not suffered nearly enough for the kinds of abuses they had perpetrated on him. Because he has not received sufficient validation of his anger from them, he occasionally finds other outlets that can be inappropriate. Self characterization sketch. Alan submitted several versions of his self-characterization sketch. The first version was fairly short. It included a physical description of him followed by an exposition of various accomplishments he had achieved throughout his life as well as the abuses he suffered at the hands of family. The second sketch, sixteen single spaced pages long, included more details on these topics as well as a narrative of the dialogue that occurred during a fight between him and his girlfriend several years ago. After writing this sketch, Alan decided that “I get emotional and my writing goes to hell” and wrote a third version of the sketch that he felt was “sequentially better.” Due to time concerns, I decided to give the class an abbreviated version of Alan’s sketch. I also chose to use the second version, as I thought the less edited version would give a more accurate picture of Alan’s thinking while under stress. I chose to give the class those parts of Alan’s sketch where he described himself, as opposed to other people or
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events. In this abridged version (presented below), I have falsified or deleted certain information to assure anonymity. “The basic inventory of Alan is straightforward. He is a 42 year-old Asian-American male, 5 feet 9 inches tall and of average build. The curves and planes of his face bear witness to his Japanese heritage. In addition to English, he speaks Japanese fluently, and can converse haltingly in Hindi and Arabic. He cannot sing, but plays the drums. At various times during his life, he was involved in yoga, shorin-ryu karate, SCUBA diving, and classic automobiles. He is an accomplished model builder, enjoys being onstage (speaking before groups, or playing with a band – the latter something he has not done in many years). He has other interests, but hasn’t been able to enjoy them for several years. There are five circumstances in his life that cause Alan major concern. He feels that these amplify his depression, erode his health, and prevent him from progressing with life. In no particular order of importance, they are: 1) Alan feels emotionally strangled by a relationship he wants to leave, and by a family of alcoholics who have endlessly abused him and reviled his accomplishments. 2) Five years after the fact, he has renewed feelings of regret, sadness, and fondness over the departure of the second true love of his life. He suspects these feelings are the result of a longing for a new romantic relationship. 3) He feels helpless before his nephew’s alcoholism, and for too many years allowed it to interfere with his work and personal life, and to drain his time, financial, and emotional resources. 4) He is frustrated, anxious, and frankly devastated over lack of money. He wants to live on his own, to travel again, and do so many other things – some of which are commonplace to most people. But he can barely afford to buy the prescription drugs he requires and cover his share of household expenses (he shares a rented house). And the money problems of course interfere with his ability to earn money. 5) Finally, Alan has a physical disability that is also a liability. There exists treatment for this problem, but he cannot afford it. He was denied help by social service agencies, despite the fact that he has been living in near-penury for several years, has no savings, no credit, and owns no property. This is a source of deep resentment and anger for him, particularly as the disability has locked him out of income opportunities. Mistreatment at the hands of his family, along with natural curiosity, pressed Alan to become a Xenophile. He has always sought the company of people different from him, and has found this aspect of his life to be largely positive. The only negative aspect of his Xenophilia is
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that his family has always been “suspicious” of him because he has friendships with people of different races and nationalities, with gays, and friendships with women that don’t involve sex. This has led to name-calling and other stupidity. It is worth noting here that Alan avoids feeling, thinking, or acting like a victim; this is vital in his battle against regressing into earlier, more crippling states of depression. All of which is not to say that he doesn’t feel pain and despair. Enough history. Let us examine just who Alan might be. We’ll begin with who he thinks he is, after which we’ll have a look at him through other eyes. Alan defines himself largely by the only constant in his life since [year]; his legal career. He left his last job in [year] to practice law fulltime, and has never looked back. Depending on how you count them, the case he is currently working on will be either his 41st or 48th victory. His professional work includes criminal and civil litigation, consultation with businesses and government agencies, teaching law classes, and research on history of law and legal precedents. (Having presented this demi-biography, we must add that Alan would here wish to belay the oft asked question, “But have you ever won a big case?” by saying, “Yes, you can find evidence of my successes at [website], in newspapers around the country, and in several books (at least those titles currently in print). Each case was heard by “real” judges, such as [4 well known courts/judges] and the like.”) That parenthetical paragraph serves as an exemplification of how important work is to this man’s identity. Alan is asked that question more often than one might imagine, and when he hears it he feels diminished that someone would think he was bragging about winning dozens of small claims cases in daytime TV courts. It is obvious that he has pride of accomplishment in his work, but, perversely, he derives little satisfaction from what he has done, for reasons that will become apparent. (Oh – and in addition to his time in court, Alan has written something over a thousand legal opinions and articles in law journals and textbooks. Scores of successful custody and divorce mediations round out his work.) Getting back to the question of why Alan defines himself by his work, one may wonder whether this is all there is too him. Not at all; in addition to accomplishments already mentioned: He has saved 8 lives by direct action, and prevented one suicide. He once played in rock groups (garage bands). In [years] he owned his own business, concurrent with working fulltime. He has won professional awards, been a scout leader, a volunteer, investigator,
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researcher, inventor, teacher, and has filled other roles, including that of substitute parent. He’s handy with tools and electricity, and before striking out on his own he worked in factories and was a field service technician for electronic equipment. He has built patios, decks, room additions to homes, etc. He is particularly pleased with the fact that he occasionally conducts investigations into credit card theft and online stalking for local police departments. He has also trained FBI, U.S. Customs, and similar agencies in tracking stalkers, pedophiles, and other online malefactors. While the pay is not grand, he feels that the experience is. Alan was a frequent guest on regional television and radio programs in [years]. He has been a guest of honor at several large legal conventions, as well as a featured speaker at conferences. He will speak to any audience for any reason. In addition, Alan has taught credit and non-credit courses at the University of [names ten schools]. There’s more, but you get the picture. Alan is an independent overachiever who wishes he could win the approval of his father, mother, and/or their surrogates among his extended family – a hopeless goal. Given that he has such a wide range of accomplishments, one would expect his self- image to extend beyond his work. But since the turn of the century he has felt that there is nothing else by which he can take measure of himself. And he can at least exercise some measure of control in this part of his life. He realizes there is liability in identifying so closely with his work. It makes him emotionally vulnerable to negative changes in his professional life. When a case is lost or dismissed, or he is shorted on his commission, he often feels as if it were an attack, or a rejection of him personally. Worse, because his income is tied directly to his work success, when he is low on money he begins to doubt his self-worth – not simply the value of his work, but his personal worth as a human being. This has often made it difficult for him to work, and exacerbated his depression, which results in less income (less production), which results in increasing depression, which results in less income … ad nauseum. He believes that a romantic relationship is a necessary component in life, and knows from experience that, if he had a relationship, he would have another dimension of identity, a
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better feeling of security, and likely be more productive. He would also have someone to talk with. (His really good friends live far away, as does his family.) His current relationship was a mistake, and has been nothing more than a platonic friendship for some time. (Alan is heterosexual, though he doesn’t find polite approaches from homosexual men offensive; it’s just not his thing. Apropos of that, he has several comfortable acquaintanceships with both lesbian and gay folks. This is relevant because it is a part and parcel of his Xenophilia.). His partner is intelligent enough, but cannot communicate at a level of sharing feelings. Alan feels that this relationship is holding him down, while at the same time provides some financial benefits. At the same time, he feels that his income would have been higher these past few years, had he been in a solid relationship. Truth be told, he feels that he would easily handle his other problems if he could resolve his finances and find someone to share life with. How do others view Alan? A majority of his friends are women, all of whom say that he is sensual, caring, gentle, sensitive, and a good listener. They also say that he makes them laugh and they feel comfortable with him – at least one says she is more comfortable with him than with her female friends. (His therapist made a good point of reinforcing that he is a good listener; she also told him that an outstanding element in his life was a remarkable ability to bounce back, from anything.) Several women police officers (and other women, for that matter) have confided in him some very volatile personal information, saying that they know they can trust him. He has never betrayed their trust. Male friends say things like, “This is the most intelligent guy I know,” and “someone I trust.” A few say “He can't seem to get away from bad luck.” Most like for him to tell them stories, to relate the numerous funny or horrendous experiences he has had. A few also wish that he would not take bad luck so personally. People with whom he has been in conflict refer to him as a “persistent, hardheaded bastard.” The drunks in his family refer to him as “arrogant,” “mentally ill,” a “fag,” and by a variety of invectives. As for people who have been closer to him, the woman to whom he was engaged from [date] through [date] frequently told him that he was “… the kindest, most caring, and self- sacrificing man I know.” The woman he was seeing after that categorized him as a “risk-taker,” which she respected (maybe because she wasn’t), and found his accomplishments intimidating.
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His partner referred to him as, “the most intense man I know.” He has twice been called “A good dad,” by people outside his family, which brought tears to his eyes. Analysis of self-characterization. Students enrolled in a practicum in EPCP assisted in the analysis of Alan’s self-characterization sketch. Their overriding impression of the sketch was that it had a resume-like quality, listing accomplishment after accomplishment in a way that suggested an extravagant view of the self and a need for admiration. They felt that many of his sentences could easily have ended with “Alan jumps over tall buildings in a single bound.” The class at times seemed so distracted by the listing of accomplishments that they had a hard time identifying deeper and more complex aspects of Alan’s personality. One class member initially remarked, “I know what he’s done, but not much else.” Alan himself addresses this potential concern at one point: “Getting back to the question of why Alan defines himself by his work, one may wonder whether this is all there is too him. Not at all; in addition to accomplishments already mentioned . . .” The paragraph following this sentence, however, provided an additional list of roles (“volunteer, investigator, researcher”), skills (“handy with tools and electricity”), and magnanimous activities (saved 8 lives by direct action and prevented one suicide) that again suggested to the class that Alan equates things he does or achieves with who he is as a human being. At the same time, the class identified an undercurrent of self-loathing that they believed was intimately linked to Alan’s choice to present himself in terms of superman-like images. For example, Alan briefly admits at one point that “he derives little satisfaction from what he has done.” Interestingly, he sandwiches this statement in between an explanation of how angry he becomes at anybody who doubts the authenticity of his accomplishments and another list of fantastic resume items: “Oh – and in addition to his time in court, Alan has written something over a thousand legal opinions . . .” The class saw Alan as engaging in a frantic search for validation from others in order to forestall personal feelings of worthlessness. Alan described this in terms of the “liability” he sees “in identifying so closely with his work.” Criticize his work, his accomplishments, and “he begins to doubt his self-worth – not simply the value of his work, but his personal worth as a human being.” One class member remarked that Alan’s sketch could be summed up in one desperate proclamation (“I AM A GOOD PERSON!”) that overshadows a hidden qualification (“but only if you tell me so”).
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The class at one point turned to considering the likely interpersonal consequences of Alan’s search for admiration from others. They wondered if perhaps Alan found it difficult to trust that others could care for him “warts and all.” They saw how this fear could easily lead to Alan presenting himself in terms of an “extravagant” resume. They also recognized that they felt pushed away and distant, struggling with little success to meaningfully connect with the character that Alan had presented. While they found his accomplishments admirable, they doubted that others would find admiration a sufficient foundation for a relationship. One class member challenged, “How well do you know the people you admire?” Paradoxically, it seemed that Alan’s chosen method of connecting with people was likely to also hold them at a distance. The class also wondered about how Alan might tend to view other people, based on his assumption that they will not be able to care for him if they know about his flaws. If he has to be so perfect all the time, how might he respond to other people’s “warts?” The class identified several different possibilities. First, they suspected that there was a part of Alan that yearned for the feeling of accomplishment associated with “saving” someone from their own faults. For example, they noted that Alan’s depression had been worsened by unsuccessful attempts to intervene in his nephew’s addiction: “He feels helpless before his nephew’s alcoholism, and for too many years allowed it to interfere with his work and personal life, and to drain his time, financial, and emotional resources.” The class wondered if Alan’s inability to accept his own faults made it difficult to accept those of his nephew. Second, they suspected that Alan might find it difficult to empathize with the inevitable failings of others, leading to righteous indignation and, at times, furious rage. For example, they noticed how Alan experiences ambiguously negative events in his legal career as personal affronts: “When a case is lost or dismissed, or he is shorted on his commission, he often feels as if it were an attack . . .” For Alan, mistakes, carelessness, and accidents are experienced as if they are malicious attempts to harm him. As it is very difficult to understand and forgive purposeful maliciousness, they class suspected that Alan might find it difficult to salvage and rebuild relationships marred by these incidents. EPCP Diagnosis. Many of the things that Alan conveyed in his clinical interviews and self-characterization sketch suggested that he struggles with self constancy issues (Axis I). For example, he appeared to swing back and forth between experiencing himself as completely worthless on one hand, and as wildly successful and accomplished on the other. The former
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swing was something that Alan was able to report directly: “it all feels worthless.” The latter swing was most easily inferred from his choice to begin both his interviews with a “show and tell” of his work and to provide an extensive list accomplishments in his self-characterization sketch. While Alan most often experienced himself as wholly negative, he seemed to regularly present himself to others as extremely positive. Alan also demonstrated a struggle with other-constancy issues as well. For example, his tendency to perceive negative life events in terms of personal attacks (“When a case is lost or dismissed, or he is shorted on his commission, he often feels as if it were an attack or a rejection of him personally”) indicated a pattern of very quickly losing touch with the more caring and positive aspects of others. Part of seeing others in all of their complexity involves being able to acknowledge that there could be a variety of reasons for their behavior. In other words, if Alan can see nothing but the fact that others have hurt him, he may be limited to an interpretation of their actions as willful and malicious. He may not be able to understand their actions in terms of, for example, an accidental oversight, preoccupation, or lack of knowledge or skill. Such alternative explanations require the ability to see others as simultaneously good and bad. Alan appeared to have trouble with this at times, assuming attack when a more complex understanding of the people involved would have resulted in a variety of possible interpretations of the situations. Alan’s report that he will occasionally “engineer” conflicts with others seemed to be another intriguing manifestation of other-constancy problems. In describing himself as “totally irrational” when inappropriately accusing someone of some personal attack, he suggested that his response was based on an exaggerated interpretation of one behavior as opposed to a complex understanding of the person. In other words, he became “irrational” because he was unable to come to any other conclusion than that he was being purposefully rejected and humiliated. Experiencing others in these ways appeared to be positively related to the severity of Alan’s depression. Alan also appeared to be struggling with issues of interpersonal attachment, common for people with structural arrests. “Attachment” difficulties are problematic ways of responding to fear and insecurity in relationships (Leitner et al., 2000). Alan, for example, tends to deal with fears of being rejected or humiliated by becoming enraged whenever someone does not meet his needs or acts in an unfriendly manner toward him. His anger can become so intense (e.g.,
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“hanging fire”) that he wants to hurt someone or exact revenge to right a perceived wrong. This interpersonal style, captured by the attitude “If I am on my guard and am powerful enough, you will not betray me” (Leitner et al., 2000, p. 183) is one way of coping with constancy problems. Because of the devastating emotional impact that even small relational failures carry for Alan, he feels he must force others to behave in ways that do not threaten him. Alan’s anger at people “getting away with things,” his attempts to save people from their own problematic behaviors, and even his focus on his professional achievements can be seen as ways that Alan makes himself powerful in the eyes of others. By putting himself in a superior position, he tries to make himself less vulnerable to relational injuries. However, others are likely to be frightened by the intensity of Alan’s anger or alienated by (what appears to be) a holier-than-thou attitude. Thus, while his approach is designed to decrease the probability that he will be hurt in a relationship, it may in many cases increase it. Interpersonally (Axis II), Alan’s struggles with loneliness suggested that he may physically distance himself from others in subtle ways. For example, his statement that many of his friends “aren’t people I can catch at home” pointed toward a tendency to use the busy lives of others as an excuse not to call on them. In addition, the fact that “his really good friends live far away” also raised concerns that Alan uses physical distance as a way of limiting the depth of his personal relationships. In other words, Alan may develop relationships with distant people because they are virtually guaranteed to be limited in their potential for depth of connection. Experientially (Axis III), Alan’s reports of extreme guilt and anger indicate that he likely struggles with responsibility. His first description of what happens when he feels injured in a relationship (“what did I do?”) might suggest a tendency toward taking on full responsibility for conflicts, ignoring the contribution of others. This absorption of personal responsibility also can be inferred from the drop in self esteem that he experiences when someone simply “cuts [him] off in traffic.” At times, however, Alan places all responsibility for the state of his life on other people or things. He can not get a job because he has a crooked nose (“the disability has locked him out of income opportunities).” He is not productive in his career because his partner is uncommunicative (“he feels that he would easily handle his other problems if he could . . . find someone to share life with”) and because he does not have any money (“money problems of course interfere with his ability to earn money”). He is depressed because his family is abusive (“Alan feels emotionally strangled . . . by a family of alcoholics who have endlessly abused him
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and reviled his accomplishments”). While these assertions are not false, they avoid the question of what things Alan does to sabotage his employment opportunities, productivity, and mental health. I thought that it was also possible that Alan had trouble with discrimination in interpersonal relationships. Because I could not find specific statements Alan had made to illustrate this particular problem, I ventured this as an initial hypothesis for later verification. However, there were a few observations that led me to this suspicion. For example, Alan’s choice to begin his initial interview with me without introduction, preamble, or questions about me or the research project struck me as unusual. Assuming that most people need some time to develop a sense of rapport with others before sharing deeply personal aspects of their lives with them, I wondered if Alan’s approach to the interview pointed toward a problem with under- discrimination. In other words, I wondered if Alan tended to share a large volume of relatively personal information with people very quickly, perhaps before assessing the other’s capacity to validate his perspective. I was hesitant about this interpretation, given that the expectation of confidentiality in a research setting generally implies a certain level of safety not inherent in other situations. However, I was also struck by the contrast between the sheer number of people that Alan referred to in his self characterization sketch and his obvious loneliness and social isolation. I wondered if this contrast indicated a pattern of single meetings (or few and far between) filled with rapid, intense exchanges of very personal information. Third, Alan appeared to be struggling with issues of forgiveness (i.e., “reconstruing self and other so that major invalidations are not allowed to hinder the development of future ROLE relationships” (Leitner et al., 2000)). For example, Alan feels that he has to constantly prove his worth to others because, despite his best efforts, his family has never been able to recognize that worth. Today, Alan approaches the world as if it is comprised mainly of people who will ridicule and scorn him. In response to anticipated rejection, he has developed “defensive moves,” like showing others newspaper articles about him and insisting “that’s really me!” Thus, he also becomes angry with people who are not interested in or impressed by his accomplishments. In sum, Alan expects his current relationships to both repeat the injustices of the past and to repair them. A related issue for Alan is struggles around reverence. For example, Alan reports that he is unable to revere himself unless certain people in his life agree to do so as well. No matter how many cases he wins, “it all feels worthless when [he thinks] about [his] family.”
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The following table shows the three axes of the EPCP diagnostic system, with the areas Alan appeared to be having difficulty highlighted in bold print. Diagnostic Axes of Human Meaning Making Developmental- Interpersonal Experiential Structural issues components components Self vs. other Undispersed Dependency Discrimination Self-other permanence Excessively dispersed dependencies Flexibility Self-other constancy Dependency avoidance Creativity (Attachments) Physically distancing self Responsibility Psychologically distancing self Openness Commitment Courage Forgiveness Reverence Table reproduced from Leitner, Faidley, & Celentana (2000). Creation of Fixed Role sketch. While there were many potential issues that could have been incorporated into the fixed role character, I focused on the ones that seemed most essential to Alan’s current psychological distress. Self-other constancy seemed the best area to target, as the other issues appeared to be results of this developmental problem (Leitner et al., 2000). Keeping in mind that Alan struggled with swinging back and forth between his own underdog and superman characters, I strove to create a character that would incorporate both of these, but have strategies for balancing each with the other. The character needed to be complex, able to simultaneously acknowledge pride in his accomplishments as well as feelings of vulnerability and doubt. Because I suspected that Alan feared that others might react negatively to his more vulnerable side, I wanted him to experiment with sharing this side of himself with others. However, I wanted the character to balance out these fears by maintaining an awareness of the courage such openness requires. Thus, he could experience something positive when sharing something negative about himself. He also would be able to challenge any assumptions he had about being automatically rejected for being anything other than superman. At the same time, I did not want him to feel compelled to share the more vulnerable sides of himself indiscriminately, as the people in his life would undoubtedly differ in their capacity to validate the various sides of him. The first paragraph of the fixed role sketch addressed these issues: Robert Harvey is a man who is more complex than he first appears. He has accomplished a lot in his life, feels proud of those accomplishments, and enjoys it when other people look up to him and admire what he has done. However, there is also a side of him that
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feels small and vulnerable. Robert is sometimes uncertain how others will react to this side of him and is tempted to hide it from them. At the same time, he knows that true courage exists in allowing himself to be vulnerable around others. Whenever possible, Robert tries to give others the chance to get to know the real him – he considers this the honorable thing to do. But Robert is not naïve. He saves his courage for those who can see the beauty in the more sensitive sides of him. Though Robert was designed to be a man who could integrate the different aspects of Alan’s personality, I wanted him to struggle with the same swings. For example, I wanted Robert to be consciously aware of and able to incorporate a superman character of his own. I wanted Alan to experiment with noticing his use of this character and explore its purpose and usefulness. I suggested my own theory – that superman functions to protect Alan from rejection – as an initial hypothesis for Alan to start with. I also wanted Robert to have a failsafe, a way to notice when his superman character was no longer achieving his purpose. I decided to suggest a feeling of loneliness as a potential signal that using this character was no longer useful for Robert. I wanted Robert to keep his own watch on Superman, and to experiment with using him more flexibly in his life. The second paragraph of the fixed role sketch addressed these issues: When Robert suspects that he is with someone who cannot appreciate his weaknesses as well as his strengths (or when he is feeling particularly small), he likes to pretend he is someone amazingly fantastic, and he calls this character Superman. Superman is admired by all for the sheer number of his accomplishments, which include rescuing damsels in distress. But Robert knows something about Superman that other people don’t know: it’s lonely at the top. When he’s flying above the city, all the other people look very small. And the smaller they get, the less joy Superman derives from his many accomplishments. So Robert keeps a close watch on Superman, coaxing him back down to the ground to live among the ordinary mortals when he no longer needs his superhero status. In addition to dealing with potential self constancy issues, this sketch had to incorporate suggestions for understanding others in a more constant way. Since Alan had a tendency to lose touch with the more sensitive and caring aspects of others, especially in ambiguous situations, I wanted Robert to be a person who takes his time in getting to know people. In stepping back and always assuming that others are more complex than they first appear, Robert might be able to
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balance out Alan’s quick, instinctual responses. The essence of the next paragraph in the fixed role sketch was that Robert had a careful, critical eye that would notice nuances in others and incorporate them into a whole picture of those people. Robert Harvey is invested in having many close, personal relationships. He listens carefully to others, trying to understand what it might be like to be them. Robert tries not to be swayed by his first impressions, knowing that it takes time to see people in all their complexity. He isn’t satisfied that he truly knows people until he can understand their joys and sorrows, strengths and weaknesses. Knowing that anyone who tries to engage in intimate relationships with others is ultimately vulnerable to being hurt in the process, I wanted the Robert character to include an approach to dealing with these injuries. Alan’s approach to interpersonal conflicts included a tendency to fully internalize or externalize responsibility, leaving him swinging between overly burdensome guilt and furious rage. As an alternative to these extremes, Robert’s approach was to evenhandedly contemplate the role of all of the people involved in any conflict. I decided to describe his approach as curious contemplation in order to convey a slow, questioning response that postponed judgments and conclusions until he was able to consider the various available interpretations of the situation. Since I wanted Alan to know when it would be most important to use this portion of Robert’s character, I decided to make Robert a person who interprets feelings of intense guilt and anger as opportunities to turn to this alternative approach. Robert’s investment in developing close personal relationships leaves him vulnerable to hurting and being hurt by others. When he experiences problems in a relationship, he purposefully cultivates an attitude of curious contemplation. He does not jump to conclusions about blame and responsibility, but instead takes his time evaluating the role both he and the other person are playing in the conflict. Of course, like all people, Robert struggles at times to integrate all of this complexity. So he watches closely for signs that he could be swinging too far one way or the other. For example, Robert views intense feelings of guilt or anger as valuable opportunities to reevaluate his approach to his relationships. Fixed Role Session 1. During this session, I introduced Alan to the character he was to play over the next two weeks. He agreed that Robert sounded like a real person, and was someone he would be interested in getting to know. His first impression of Robert was that he
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was “more me than not.” Alan immediately identified his own need for a superman character, a characteristic that Robert also had. While he admitted that he could not “identify with no longer needing that,” he described a recent “epiphany” he had that “maybe women are attracted to me by more than just the fact that I’m a lawyer – that being the superhero status.” In other words, Alan already had been playing with the idea that his accomplishments didn’t completely explain the affection others held for him. However, he was not yet comfortable enough with the idea to experiment with it in real life. He thought he might have trouble portraying that part of Robert’s character that coaxes superman back down to the ground when he does not need him any longer. On the other hand, he did not think he would have any trouble portraying the parts of Robert that bring about the need for superman: “the bits about being vulnerable or weakness or feeling small, yeah. That’s me.” Alan also quickly honed in on Robert’s tendency to hold back on “first impressions,” as he felt that quick judgments of others were something he struggled with: “I’m aware that the first impressions are there and if I don’t work on it really hard, they stay.” He turned immediately to describing how other people do this to him. He shared that when he has a bad day, he often notices people making snap judgments of him based on his appearance. Noting Alan’s description of this happening on a “bad day,” I was immediately reminded of my hypothesis that Alan assumes rejection and insult in situations where it is not intended, especially when under stress. I suggested as much to Alan: “so your first impression of them is that they’re making a first impression of you.” Alan, laughing, sounded amused at the idea. I let him know that, as Robert, he should be aware that his “first impressions” of others may come in the form of assumptions about how they are viewing him. Alan turned to considering that part of Robert’s character that “cultivates an attitude of curious contemplation.” He thought this would be difficult for him to enact because of his own self-identified tendency to internalize responsibility for interpersonal problems: “course that’s not me. I immediately think about blame and I think of myself first. What have I done?” He connected this tendency to his experience of being unfairly blamed by his parents for various things as a child. While he was intrigued by the idea of reevaluating his approach to relationships in response to feelings of anger and guilt, he was not sure to what extent he did this already: “I honestly, off the top of my head, don’t know if I do that or not. Probably not cause I get caught up in the anger, the hurt.” In other words, Alan acknowledged that he finds it difficult to stand
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back and look at his initial emotional reactions to take the time to consider what they might mean. Fittingly, he did not identify so closely with these parts of Robert’s character, and thought he might struggle with portraying them. In reading over the beginning of this session, the data analysis group felt that Alan’s responses to the fixed role character provided some support for the initial diagnostic hypotheses. He did identify with the extremes of self-image (weak and vulnerable vs. impressive and admirable) that we had linked to self constancy problems, as well as the difficulty with “first impressions” that we had linked to other constancy problems. In addition, he identified a tendency toward self-blame that we saw as part of a larger struggle with responsibility. Interestingly, he did not comment on the flip side of the responsibility issue (our hypothesis that he also struggles with externalizing blame). Though he was able to identify a tendency toward sticking with negative “first impressions” of other people, he immediately altered the focus of the discussion to how others make snap judgments of him. Thus, the way Alan talked about the issue suggested that he was prone to externalization; however, it appeared that Alan saw himself mainly as an internalizer. Following our exploration of his initial reactions to Robert, Alan and I turned our conversation toward planning his first fixed role experiment. Typically, the first role enactment is with some kind of authority figure, boss, or supervisor. Alan identified the editor of a legal journal, Steve, who he was likely to have contact with over the next several days. Alan had never met Steve in person, but had regular contact with him over e-mail. He described Steve as “short in verbiage” and as someone who “comes out with his first reactions and doesn’t think about how he says things.” Alan described having struggled with feeling hurt by something Steve had written in the past, and “[snapping] back at him” in return. Later, after Steve had stated that “I wasn’t criticizing you. I just wanted to know [some information],” Alan looked back over what the editor had actually written and realized he had misinterpreted the message: “Oh, he was just asking me why I thought such and such was a good idea.” Alan’s description of this interchange hinted at self-other constancy issues. For Alan, the slightest hint of hesitation or questioning from the editor felt like a loss of all support from him (“does he think I’m stupid?”), which was followed by a loss of his own self-confidence and a “defensive” retaliation in the interests self- protection. I suggested to Alan that this interchange was a good example of the kinds of “first impressions” that the Robert character would approach in a different way.
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In planning what the experimental interaction with Steve might look like, I asked Alan to describe the kinds of things that might come up in their next communication. Alan planned to approach Steve with an idea for a new article that he expected the editor might be reluctant to endorse. He planned to overcome the expected resistance to the idea with a good sales pitch. I began thinking about aspects of Robert’s character that might be applicable to this situation, and asked Alan if he thought that this might be a situation in which Robert would bring out his superman character. Alan agreed that it was: “And one thing I do going in – and this is bringing out the superman role . . . is I talk about, uh, numbers, the kind of cases, the kind of settlements, I’ve won . . . I’m showing off. But I try to establish myself as someone with a breadth of experience and uh competency in what I'm doing.” The superman approach sounded like a good idea in this situation, given that discussing doubts, insecurities, and personal weaknesses is not likely to be well received when trying to sell oneself as a good professional investment. Alan also described how he found that selling himself as a good investment involved “getting into [the editor’s] world as much as possible.” He typically tries to talk about the legal business a bit, just to give the editor a sense that he knows about what is involved and so that the editor will feel “more comfortable talking with me as a contributor because I’m talking their business.” I thought this approach was consistent with Robert’s character, as he actively tries to see things from other people’s perspectives. I asked Alan if there was anything else Robert might be able to do to get to know Steve better as a person. Alan replied that he does not typically get to know “a lot about the personal lives” of his editors until he has worked with them a while, but that he could find a way to do so with Steve without appearing unprofessional. I thought having more information about Steve as a person might help Alan put some of the editor’s “short verbiage” in some sort of context, tempering some of Alan’s more painful interpretations. In addition, I suggested to Alan that since Robert is invested in meaningful interpersonal relationships, he might want to reciprocate by sharing something about himself with Steve. Alan felt very comfortable doing this: “Oh, I could do that. I love to talk about myself . . . I love being the center of attention.” However, he immediately identified a tendency of his to “be obnoxious and just talk about I do this and I do that and just grab what anyone says and make it mine.” He considered the fixed role sketch and decided that he did not think Robert would do that. I countered that Robert might indeed do that – when he’s in the superman role – but that he would also moderate his approach based on how that role was affecting his relationships. Alan mused
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that the only time he had been able to moderate this tendency was when he was in a romantic relationship, and able to “let my feelings and my fears and hurt and pain and anger out.” Assuming that expressing these kinds of feelings would not be appropriate with Steve, I turned the discussion toward how Alan might come down from his superman role after his conversation with the editor. Alan shared that his current approach after conversations like these was to “completely get away from the whole business thing” by going for a drive or working on another project. He tries not to “invest all of [himself] in one project. That way, if there’s a delay, a failure, or a rejection, less of [him] is tromped on by that.” At first, Alan’s approach sounded like a good way to maintain a sense of self constancy, and consequently something Robert might do as well. At the same time, I wondered if Alan might be tempted to completely divorce himself from an area where he felt particularly vulnerable because of self-constancy issues. As a compromise, I suggested to Alan that Robert would spend some time after the communication with Steve curiously contemplating both the things that went well and the things that did not – without letting himself become consumed by either one. Alan identified that this approach would “parallel being analytical or contemplative about interpersonal relationships.” Concerned that the word “analytical” could indicate that Alan was viewing Robert as someone who distanced himself from emotions through intellectualizing, I explained that, “Robert doesn’t have to be analytical in a logical or emotionless way. Robert has the emotions. He’s just curious about them and doesn’t let one particular one take over. He can be both proud and hopeful and that the same time fearing that the project won’t work out. And he lets them both balance out each other instead of running from one.” Alan thought he could do this, though he would have to “constantly remind [himself] of it.” Overall, Alan felt that the Robert character incorporated enough of his natural responses to make the experiment feasible: “It’s not jarringly different. It’s good. I had some different expectations. This is good. I thought it might be too many opposites. Intentionally too many opposites of me. But there’s so much of me in here that it’s going to make it possible for me to weave more of myself in.” Alan stated that he related to Robert, and that he felt he had identified the parallels between his own weaknesses and the parts of Robert that he might have difficulty portraying. He was particularly interested in exploring the part of him that needed the “superhero status,” and felt that he was starting to “see a hint behind the curtain” of the ways in which having superhero status did not equate to having a great life. He described several people that he
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would like to feel close to but does not, adding that “I don’t have [close relationships] and I want them. The few people I’m close to are far away. People who can see the weak side of me and the hurting side of me, and anger and the flaws, those people aren’t around.” In other words, Alan was beginning wonder if the way he typically chose to connect with others (i.e., by impressing them with various accomplishments) was resulting in a lack of interpersonal intimacy. He knew that his closest relationships were with people he was able to interact with in a more integrated and complex way, though it seemed noteworthy these people happened to be “far away.” The group suspected that physical distance provided Alan a felt sense of safety that allowed him to experiment with more authentic relating. However, it seemed likely that Alan construed the distance as accidental, rather than as a choice he made to protect himself from possible invalidation. Already, Alan described feeling a change in his mood and a lessening in his self- consciousness: “I feel I’ve got in communication with you beyond ‘does she think I look goofy or something?’ and I’ve been able to present my credentials. Now since we’ve started these sessions, I feel less awkward about my appearance. I’ve been able to flirt with women a couple of times.” The group felt it was important to note that Alan’s mood started improving prior to experimenting with the fixed role character. Therefore, it did not seem likely that the change was related to improvement in constancy-related struggles. Because Alan connected his improved mood to the chance to present his “credentials,” they suspected that the interpersonal validation he received during his interviews was responsible instead. Alan typically compensated for constancy problems by focusing on his accomplishments. As long as others validate those accomplishments, his tenuous grasp on self-constancy is not challenged, and his mood remains stable. The group predicted that Alan’s mood would become more depressed if someone were to challenge his perception of himself as accomplished and/or intelligent. Thus, the important test of this theory would be whether Alan was able to sustain his mood improvements in the face of invalidation in the course of the upcoming experiments. Fixed Role Session 2. When Alan came back for this session, he reported that Steve had been out of the office for the past few days, but that he had tried approaching several other professional contacts as Robert. Several days before, Alan had received an e-mail asking him if he had received a recent request for revisions of a textbook chapter he was working on. He was able to identify his initial emotional response as “they’re pissed at me for being late” and
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“they’re putting the pressure on me.” The group could see ways in which Alan’s choice to interpret information gathering as anger in this situation could reflect struggles with other- constancy. While “they” could have been feeling angry and impatient, “they” also could have had a variety of other motivations for sending the email. Because Alan had a global and monolithic understanding of “them,” he could see only one possible explanation for their behavior. Communication that seemed vaguely questioning was therefore automatic evidence of anger and disappointment as well. At this point, however, Alan started thinking about how Robert’s character might respond to this situation. He took on Robert’s attitude of “curious contemplation” and started to recognize that his interpretation of the email was based in feelings of guilt for delaying the project. He then interpreted these feelings as a signal that he needed to reevaluate his approach to the situation. As Robert, Alan decided to “set aside any feelings of guilt as irrelevant to the project and realize I myself had set that aside in favor of other projects I had going.” Essentially, Robert was able to take a step back and remember that he did have legitimate reasons for not responding sooner. The group saw this approach as reflective of better self-constancy. Although Alan felt guilty, and it was possible that someone else was feeling angry with him, he was nevertheless able experience his choice as acceptable and reasonable. In addition, it appeared that Alan was able to recognize that he was projecting his own feelings onto someone else, which pointed to improved responsibility. Following his efforts to reconstrue his own actions, Alan returned to trying to understand those of the editors. He realized that his initial “defensive” response was based on an assumption that “they didn’t like the work I did.” As Robert, however, he looked over the requested revisions again and decided that this was not actually the case. In examining his own guilt and defensiveness, Robert decided that “no, this is irrelevant, set it aside, and just make a really good job of it.” When asked how he felt after dealing with the situation in this way, Alan reported that he felt, “calm, definitely calm. Smooth, definitely.” Part of this calm feeling was related to being able to step away from worry about the quality of his work long enough to “look at [it] and know it’s good.” Because Alan used the word “irrelevant” several times throughout this session to describe Robert’s feelings of guilt and worry, I wondered if those feelings were temporarily suppressed or actually transformed by the process of taking a second look at them. I asked Alan about this
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possibility, who replied, “no, once I set it aside, it did transmute. It did change. Now I don’t feel like . . . I would go back and double guess myself.” Thus, in this situation, Alan appeared to be using the term “irrelevant” in the spirit of reconstruing his feelings, rather than ignoring them. However, the group decided to remain watchful for situations where Alan might portray Robert as an intellectual with an emotionless focus on productivity. In addition to the textbook revision interchange, Alan had dealt with another lawyer who had not contacted him for several weeks after discussing the possibility of working together on a project. Alan had been feeling angry about this delay, and thought about how his typical response to a situation like this might be a hostile statement like, “You know, Mark, it’s like this every time we get involved in a project. It’s been like this since four years ago.” Alan, who decided that this kind of response was “not in the persona,” figured that Robert would think of Mark as a “regular guy,” who did not need someone to “bug him and point out the fact that he’s taking a long time.” Instead, Robert wrote a short e-mail saying “Hi Mark. How are the various projects we discussed going?” I thought that Alan’s switch to thinking of Mark as a “regular guy” was an indication that he had considered alternative interpretations for the delay. While Alan’s instinctual angry response pointed toward globally negative evaluation of Mark (“it’s like this every time”), the response that he made as Robert conveyed an empathy for Mark as a flawed human being who ultimately gets his job done. Interestingly, in writing his email to Mark, Alan also started exploring an implication of Robert’s character that I had not considered when I had written the sketch. Alan brought up that, as Robert, he was trying to think about how other people perceive the things that he says. In doing so, he identified a tendency to engage in a rambling conversational style, providing too much information, and obscuring his main message. Thinking about what this might be like on the receiving end, Alan speculated that “the lengthier a message you send somebody, the more likely they are to miss salient points in it.” He experimented with this idea by sending a brief email to another professional contact that he was angry with for delaying their project: “I just wrote, ‘What do you want to do next?’ New paragraph. ‘I have a short list of options to suggest.’” For Alan, this particular approach was an “extension of not thinking of the guilt or anything else” while in the role of Robert. In other words, Alan started to connect his tendency to “get into these long convoluted sentences with sub clauses and semicolons” with a need to compensate for feelings of guilt. Because Robert was someone who dealt with guilt in a different
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way, he found himself able to tighten up his conversations, getting to his point without undue diversions. Next, Alan and I turned to planning the next experiment, approaching a friend as Robert. Alan struggled to figure out who he might be able to see because most of the people he called friends were “out of town people.” He also started thinking about his superman role, and felt uncertain about being able to approach a friend without it. Though his recent “epiphany” suggested that women might be attracted to him for something other than his work, he feared experimenting with this possibility: “Well, there’s a way to do that, but maybe I don’t want to.” Alan thought that the only way he might be able to approach someone without the superman character was to choose someone “who’s not really an intellectual type person.” He figured that to somebody like this, “the work might not mean anything.” To me, it seemed like a good idea for Alan to experiment with stepping out of the superman role with someone that he knew was not likely to be impressed by it anyway. While ultimately I wanted Alan to evaluate the appropriateness of the superman role in a wider variety of situations, I thought this was a relatively safe place to start. Alan and I talked about his description of a friend who had once shared something personal about himself and cried. Alan agreed with my suggestion that he had felt complimented by his friend choosing to share that moment with him, and was intrigued when I suggested that others might feel complimented when he chooses to do the same with them. Alan wondered if “maybe I’m not letting enough of myself out to other people to be the Robert character. Maybe that’s why I feel distanced from them.” This statement echoed my feeling that Alan’s own superman character distanced himself from others by avoiding sharing truly intimate and personal aspects of himself with them. Turning back to planning the upcoming experiment, I suggested that Robert would want to find out something important about somebody else and share something important about himself as well. I made this suggestion to remind Alan that Robert would be looking to get beyond lists of accomplishments to create a meaningful connection with another person. Alan immediately identified that he would need to moderate this particular approach as well: “It’s not necessarily that I crave that kind of intimacy all the time but its got to be there somewhere.” I agreed, suggesting that Robert would avoid both the “intimacy overload” and the “intimacy vacuum.” Alan could see that each was likely to come with consequences for him: “Yeah, a
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vacuum of it is bad and the overload is probably when I know too much about somebody’s problems and want to fix them.” I thought that Alan’s observation indicated an awareness of the importance of personal boundaries, and anticipated that this would help him temper the suspected tendency toward both over and under discrimination. Toward the end of this session, Alan asked the question: “do we assume Robert’s depressed?” (Since this is the very question this project was designed to answer, in retrospect I would have responded, “Let’s find out through these experiments.” Instead I told him vaguely, “Robert’s a complicated guy who has all sorts of feelings.”) Exploring the question further, Alan seemed to be asking what Robert would do when faced with Alan’s reluctance to leave the house. Thinking of the next experiment, I suggested that Robert would “do whatever would increase the possibility of having a meaningful connection with another person.” Because I suspected that Alan used physical distance to limit intimacy in his relationships, I suggested that face to face contact would be more intimate than a phone call, which would be more intimate than an e-mail. I hoped that Alan would choose to experiment with a face to face contact, but left that decision up to him and his comfort level. Fixed Role Session 3. At this session, Alan reported that he had been able to spend about an hour with his friend John after deciding to drop by his house unexpectedly. Alan avoided the topic of his work and talked with John about their dogs, antiques, and history. Before their conversation, Alan had identified what he described as a tendency to “speak in non sequiturs . . . just because some thought overwhelms me.” He recognized that he was often “internal” during his conversation with others, speaking directly from the progression of his own thoughts without linking them to what was going on around him in any way. In Robert’s role, he tried to be attentive to what was occurring in his conversation with John so that his comments were relevant and comprehensible. As we had discussed, Alan went into the interaction open to sharing something personal about himself that he had not discussed with John before. When he and John were talking about something John’s dog was doing, Alan transitioned smoothly into a conversation about his own dog’s interactions with his ex-girlfriend, and from there into his own struggles with her that led to their breakup. Alan reported that he felt “good” about sharing this information with John, and about how John responded to him as he was doing so. While Alan experienced John’s response as “basically noncommittal,” he also recognized that “[John] was saying in enough different ways
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of body language . . . [that] he understood it and accepted it . . .” Alan then interpreted John’s response in the context of what he knew about John as a person: “he probably doesn’t express things like this strongly, like if he felt bad for me . . and that’s enough from his character and personality.” In other words, while he did not receive a demonstrably supportive response, he was nevertheless able to see that John understood and empathized with his experiences. Thus, in this situation, it appeared that Alan was able to experience John in a relatively constant way. He felt supported despite the fact that John did not commiserate with him or make obvious displays of encouragement. In addition to trying to link comments about himself more closely to the conversation, Alan tried to make sure he left John “some room to talk.” Because Alan had been thinking about how he often could “take over a conversation” to the point where he gets “tired of it,” he purposefully transitioned from his comments about his ex-girlfriend back to topics John might be more interested in. While Alan usually finds this difficult to do, as Robert he found it relatively easy. Since we had not discussed this issue in planning for this experiment, I asked Alan what had brought this idea up for him. Alan replied that in thinking about the “superman thing,” he realized that, as Alan, he rarely was concerned that he “might be overwhelming people with that.” One way of overwhelming people, he thought, was to focus too much on himself and not enough on others. Because Robert was attuned to the potentially distancing consequences of the superman role, he was able to recognize that getting “tired of it” was a signal that he needed to take the focus off of himself and let someone else have the spotlight. Alan recognized that his tendency to keep the focus on himself was related to a sometimes desperate search for validation: “Depressed people often want sympathy and I think that’s why they . . . finish telling you about something and start at the beginning again. And they’re after a magic word.” In the group’s eyes, Alan had identified in himself a potentially intriguing manifestation of self-other constancy problems. When he becomes wholly absorbed in negative constructions of himself, Alan craves the kind of feedback that he can use to reverse these interpretations. However, because no amount of validational feedback from others is ever enough to counter the problem, Alan feels compelled to continue his search, keeping the focus of conversation on his good qualities until he becomes convinced of his own worth. In other words, when Alan becomes convinced that he is a terrible person, he does everything he can to convince others that he is not. His efforts may involve talking for a very long time about all the ways that
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other people have hurt him. When he convinces his audience that he is good and others have been bad, he can stop. This “magical” result is so elusive because it would require an unending stream of unambiguously positive feedback – an environment that no one can provide on such a consistent basis. As he was preparing for this experiment, Alan had apparently recognized the connections between this dilemma and his superman role. Seeing that superman was burdening others with an impossible task, he sought to interact differently with John. Because he did not want to put John in the “uncomfortable” position of curing his own ills, Alan paid attention to the subtle cues that indicated that he needed to “make a transition back” to a different topic of conversation. The group saw this as an indication of improved self-other constancy (or at the very least, improved awareness of his ways of compensating for the constancy problem). Following our discussion of his meeting with John, Alan described some past interactions with people that provided additional support for the hypothesis that he struggles with (under) discrimination issues. One of the reasons he was particularly attuned to John in this interaction, according to Alan, was that he had recognized a tendency in himself to “contrive” some way to talk to almost anyone about personal issues. At one point he remembers actually “[blurting] it out to like a woman running the checkout at [the grocery store].” At times, he has noticed that “spilling [his] guts without any judgment” assumed a level of closeness that made others uncomfortable. Others tended to convey, in body language and facial expressions that, “I’m not comfortable with, you know, you telling me this, something this close in your life or intimate.” The group saw this as an excellent example of under-discrimination. At least in some circumstances, Alan would fail to take into account the nature of his relationship with a person before divulging very personal information. The fact that Alan saw Robert as a character who was “refining” and balancing out this tendency to “beat [people] over the head” with details about his personal life indicated that he was coming to understand the character at a deeper level. His insights into the character were also instrumental in helping the group see potential connections between his constancy and discrimination struggles. For example, intolerable feelings of guilt and worthlessness (lack of self-constancy) were underlying and leading to indiscriminate self disclosure (under-discrimination) in the pursuit of interpersonal validation. Unfortunately, the consequence of inappropriate self disclosure is often invalidation, which for Alan would likely exacerbate the feelings of worthlessness that led to the disclosure in the first place. While in Robert’s role, it appeared that Alan was able to successfully break this cycle.
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Alan also explained that he had experienced an “epiphany” that his reasons for taking on the superman role in his own life were more complex than he had originally thought: “Have I been using the superman element of the lawyer to protect myself from others? All along I thought it was, I was doing this only as a way to get people interested in me, or accept me.” This particular suggestion, built into the Robert sketch, now came to Alan like a revelation from within. He began thinking about how he had taken on the superman role in our interactions, reading up on my professional accomplishments and sharing his own with me. While he was initially pleased that we could “regard each other as professionals” he had recently discovered that “being accomplished or not is superceded by our discussions. Which is a good thing.” I wondered aloud if the “war of the vitas” no longer seemed quite as relevant to our discussions as they once had. Alan agreed that our interaction was now “a dyad rather than a competition.” He thought that perhaps his superman role was a “shield” designed to obscure those aspects of his background that he found “embarrassing” and feared he might be judged negatively for. Overall, the group’s impression of this session was that Alan had taken great strides in understanding the Robert character. One result of that understanding was increased insight into the struggles and motivations underlying the way he interacted with others. Fittingly, his mood also appeared to be improving. As we turned to planning the next experiment, Alan struggled to think of a person in his life that might fit the significant other role. While he did technically have a girlfriend, their current relationship was quite distant, more like a casual friendship. Because he did not have any interest in reviving the relationship, I suggested to Alan that Robert would probably choose to invest his time nurturing relationships with more potential. While there were several women he knew that he was attracted to, Alan was concerned that beginning a relationship with someone else would be hurtful to his current partner, and did not want to pursue anything until he officially ended that relationship. As an alternative, we discussed the possibility of Alan having lunch with a person he found attractive and interesting, but without the intention of disclosing these feelings or beginning a romantic relationship. Considering our discussion about Alan’s struggle to hold back on his desire to share excessively about his own personal experiences, he thought it would be “interesting to see if, as Robert, I feel compelled to disclose romantic feelings.” Because Alan had difficulty naming a particular person he would be willing to approach, we did not have the opportunity to discuss the experiment in much detail. The general
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plan was to approach a potential romantic interest with the intention of having a friendly conversation, but without expressing attraction or romantic interest. Because he had developed a fair degree of insight into the Robert character over the last few experiments, it seemed likely that he would be able to apply these insights in this new situation. In retrospect, however, I felt that I didn’t do enough to help Alan plan this interaction and discuss specific approaches Robert might take. Fixed Role Session 4. When Alan arrived for this session, he reported having had a “big crash” in the three days since our last meeting. Because his accounting of his experiences was disjointed, I found it difficult to establish a timeline of events. Alan began the session by describing recent transmission problems with his car, lack of money to fix these problems, a delay in a project he was working on, various kinds of physical pain, and ruminations about dental problems as well as not having a romantic relationship. He found that he was too distracted by these things to try the experiment we had discussed previously, and found himself focusing “obsessively” on a new writing project. Since beginning his participation in this experiment, Alan had been writing a book of short vignettes describing different scenes from his childhood entitled: “Surviving my family.” While he had been enjoying working on this project, he now found himself working on it to the exclusion of all other activities, even when he didn’t actually feel like doing so. When asked how he felt as he was working on this, Alan replied, “I feel energized. I feel really drawn to it.” Alan had written several volumes of vignettes, estimating his work at 32,000 words. Coming to the point where he didn’t feel “composed enough to compose,” he had begun to create photo collages of significant images from his childhood for the cover of each volume. I asked Alan what meaning these images held for him. He pointed to a picture of himself from high school: “I like this guy . . . My parents are trying to destroy this guy and I’m not going to let them win . . . Maybe this is in part a desire to tell everybody off.” In listening to Alan talk about the intense nature of his attraction to this project, I was reminded of his tendency to compensate for feelings of worthlessness with excessive productivity and a drive toward accomplishment. While the project was originally helping him organize his feelings about his past, he now was compulsively driven to produce a document that would protect him from attack and vindicate him in the eyes of others. I saw potential constancy issues at work in this. I wondered if Alan, feeling very badly about himself, had chosen to swing
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into the protective stance of the superman role. I had a mental image of him slaying dragons with his pen. While this was exactly the kind of struggle that the Robert character was designed to help with, it seemed that Alan had fallen completely out of role and did not see a way to transition back into it (e.g., “I despair of doing anything as Robert”). I thought the first step in getting back into Robert’s character was for Alan to recognize that he was playing the superman role and understand his reasons for doing so. I began by commenting to Alan that his current “obsession” with churning out volume after volume reminded me of superman. Alan had some trouble seeing the connection at first: “Really? How’s that?” In response, I pointed out that an intense desire to do something extraordinarily impressive that other people will admire was a defining characteristic of superman. I reminded him that Robert purposefully plays this role when he’s feeling small, and that right now he would be asking himself “am I feeling small? Is that why this pile [of papers] is getting so large?” Alan, asking himself this question, responded that, “it could be.” We started exploring how Alan had felt as he had anticipated approaching a romantic interest as Robert. He remembered that he felt “foolish to have an expectation” that he would be able to meet someone that he could interact with: “I started looking at myself. I mean I already, I was already feeling really down about myself . . . and I was a little embarrassed and that’s where I felt foolish . . . how can I approach someone and say, oh let’s talk, whatever. It just became this amorphous thing.” Alan had apparently started feeling badly about himself when his car broke down and he didn’t have the money to fix it. This event started a flood of memories of painful experiences and negative evaluations of himself that Alan described as “[adding] up my circumstances.” Alan’s description reminded me of one problem associated with constancy issues – the tendency to take what is usually peripheral to one’s sense of self (e.g., my car breaks down) and experiencing it as intimately linked with various other “circumstances” to the point where it becomes globally devastating (e.g., I am worthless). In other words, coming face to face with one thing he felt negative about (not having money to fix the car) snowballed to the point where he no longer felt that anyone would want to spend time with him. This interpretation was underscored by a later comment by Alan that he had “stabilized things” emotionally speaking since he had gotten his car working. Having explored the emotional experiences that had prompted Alan’s new superman-like writing “obsession,” I wanted to move Alan into observing superman from Robert’s perspective.
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Alan had reported that he was feeling “emotionally weak,” to the point where he could not be “outgoing . . . aggressive . . . even reactive,” and that he tended, at times like these, to “keep myself sequestered, like in my office.” I was reminded that the Robert character looks for experiences like this to signal him that superman was becoming too distanced from others. I suggested that Robert would be looking at the relational effects of his current obsession to determine whether superman was helping or hurting him at the moment: “I wonder if Robert has any time left in his life for people if he’s churning out volume after volume. I’m wondering if he’s starting to feel lonely?” Alan identified with this feeling immediately: “Lonely, yes. Very lonely.” Alan, disjointedly diverting onto other topics for a time, eventually came back around to this issue. He was not sure if his current project was taking away from time he could be spending with others. At first glance, it appeared to have only the positive effect of organizing his feelings about his family: “I wonder if all that . . . to paraphrase you, has not left me time for other people. I don’t know. Actually, right now I feel like I’ve got a target for all that energy. I usually try to channel anger.” I thought this project probably was helping him in this way, but challenged him about whether it also was having other effects: “I wonder if this is superman flying too high for his own good where it starts hurting him instead of helping him deal with feeling small and vulnerable.” I thought the amount of time he was spending alone working on this project was physically distancing him from others. Alan started thinking about additional effects his current project was having, stating that it “excludes me from more things than just being unhappy about my family or being angry.” However, his concern was that it was keeping him from other more productive professional projects, not that it was an isolating activity. Alan moved quickly on to other topics, and we eventually transitioned into planning Robert’s next encounter. To the group, one of the most striking things about this session was the way Alan would jump from topic to topic in a disorganized manner. They were reminded of Alan’s statement in the previous session that he can tend to “speak in non sequiturs . . . just because some thought overwhelms [him].” It seemed apparent in this session that he was struggling with integrating his felt sense of humiliation and weakness with a felt sense of righteous indignation and power. One or the other of these feelings would “overwhelm” him in any moment, then fade to make way for the other. In other words, he seemed to be experiencing either end of a continuum, but little in between. They wondered if the disorganization in conversational focus reflected these rapid changes in how he viewed himself and the world around him. The group suspected that others
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who encountered Alan were likely to be left with the sense that he was confused and uncertain about his own identity. At the same time, Alan’s internal experience often was of absolute conviction about this issue – he could be absolutely convinced of his worthlessness or his worth at alternate times. While Alan had not mentioned feeling confused about who he was, they thought it likely that he had or would at some point. The next experiment was designed to be enacted with a parent. Alan, however, was extremely reluctant to approach his mother, expecting that she would “immediately attack me with something.” I suggested that Robert would probably be hesitant about approaching mom as well, based on the fact that he is “not naïve” and “saves his courage” for approaching those who are able to validate and encourage him. Thus, I tried to reframe the situation – it was not that Alan could not deal with mom from Robert’s perspective, but that Robert himself probably would not have chosen to pursue a relationship with mom. Alan suggested that he have an interaction with some other family member instead. He remembered that a few years ago he had sent some accounts of his early childhood experiences to an aunt and a cousin who were the only family members he felt he could “entrust or at least dump this stuff out to.” He had felt hurt when they did not respond to his letters, and observed that “as Alan I’m thinking they’re repelled by this and maybe they’re going to tell me, if I call or go see them, ‘don’t bother me’.” When I asked him if he had some reason to think this might be so, he admitted that he did not and that the reason for their non-response was unclear. As Robert, he thought he would try to remain open to the possibility that they would be willing to speak with him, trying not to be swayed by his first impressions. At the same time, he thought he might be more comfortable maintaining some distance by calling on the phone instead of visiting in person: “I feel like a telephone call is investing less and its quicker and easier to disengage.” I told him I thought that Robert, not being naïve, might look at a telephone call as a way of “gauging the waters,” testing to see if it was indeed safe to open up to these family members. While I felt that Alan generally used telephone calls as a way to physically distance himself from others, in this case I thought it could be used as a tool for evaluating the viability of these relationships from a relatively safe position (a.k.a. good discrimination.) The group’s reaction to the planning stages of this session was that Alan was fearful of his family members in general and typically on guard against suspected attacks. They thought his fears derived not only from a long history of painful invalidations, but also from other-constancy
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problems. In other words, Alan was likely to perceive anything that was not obviously supportive and encouraging as rejecting and attacking. While he had obviously been subjected to a variety of abuses in his relationship with his mother, there were probably other aspects of her that he was having difficulty integrating with these more painful memories. However, given that mom had a demonstrated potential to act in hurtful ways, interacting with her could serve as a major trigger for other-constancy issues. Thus, it did seem safer for the moment for Alan to experiment with other family relationships that would provide a milder challenge. The group felt that Alan’s original choice to send letters to his aunt and cousin was probably indicative of under- discrimination. While he felt they were the people most likely to be supportive of him, it seemed likely that he had not discussed with them his intention to send these letters or asked if they would like to be privy to the information. The group suspected that there was a disparity between the level of closeness of Alan’s relationship with these family members and level of intimacy implied by his disclosures. They thought this disparity was a possible reason for their lack of response to the letters, though, as Alan also had concluded, the situation was unclear. They thought is was a positive sign that Alan was able to take a second look at his assumptions and acknowledge that the situation was indeed ambiguous. To the group, this indicated a move toward viewing his aunt and cousin with greater constancy. Interestingly, at the end of the session, Alan returned to talking about the possibility of approaching a person of romantic interest. He brought up two issues that he thought were potential obstacles for him. The first was a sense of extreme self consciousness about the condition of his teeth. Alan began by telling a story about an attractive woman who was very self conscious about a physical deformity: “I wanted to tell her ‘you are really attractive and I enjoy talking to you. Forget about your [disability]’.” I reflected that “it was her self consciousness, not her appearance, that really disconnected her from others,” and that something similar seemed to be happening for Alan. He agreed, but commented that he was feeling “worn and tired,” and having a hard time imagining that someone might find him attractive. I suggested the approach that I thought Robert would take: “Robert’s got that curious contemplation, remember. So he’s going to go out saying: ‘hmm, I wonder what will happen? I’m not going to decide ahead of time that people are going to reject me for my teeth or that they’re going to love me.’ But he’s going to find out.” Alan thought this was an approach that he could take. He then brought up a second concern: “how as Robert might I deal with this need I have for everyone to like me? . . . If
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someone else is unhappy, I feel like it’s me.” I reminded him of Robert’s approach to blame and responsibility – that he would take a step back and “contemplate” these matters before coming to conclusions about them. Ultimately, Alan decided that, “if the opportunity presents itself,” he would try to do this experiment again: “I think that I will work harder on not making presumptions. Maybe just go ahead and do it, I think you put it as ‘what if.’ What if I try this? What if I talk to this person?” I thought this was a good approach, telling him that the most important thing was to “do the experiment instead of deciding ahead of time what the result will be.” Fixed Role Session 5. When Alan arrived at this session, he reported that although he had procrastinated “a bit” due to feeling “intimidated,” he had been able to do the experiment we had planned. He decided to call his older cousin, but was afraid that the things he had written to her years before had made her feel bad. He worried that she was avoiding him because she did not want to talk about those topics. Nevertheless, he called her and found that she was “friendly as usual.” After they talked about their children for a few minutes, Alan brought up the topic that he was concerned about: “I said I wanted to apologize to her for having dumped everything on her in those letters in a presumptuous manner . . . [I said] I’m just embarrassed that I may have made you feel uncomfortable.” Alan’s choice to apologize for sending the letter seemed to reflect a sensitivity to how his disclosure may have been received. The group suspected that his feeling of “intimidation” reflected his awareness that he had put himself in an excessively vulnerable position and needed to scale back on his disclosures. His conversation with his cousin appeared to correct this uncomfortable situation, balancing the extent of personal disclosure with the level of intimacy in their relationship. Alan received a positive response from his cousin, who was “fine with that,” and shared in return that she had once written a similar letter of her own to another family member. He was pleased that she decided to share this information with him, as they had never really “met on a level where we could exchange things that were personal.” Alan felt “good” about how the conversation was going at this point, and thought about how he wanted to proceed. He was aware that, as Alan, he might have used this opportunity to “get into the specifics of my complaints about my family.” As Robert, however, he reminded himself that, “If you’re going to discuss something serious, you have to do it when both parties know there’s a long period ahead of them and they have enough time to be comfortable.” He noticed that his cousin was sounding tired and
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was the first to suggest concluding their conversation. I commented to Alan that he had really effectively brought out that part of Robert that can be vulnerable around others. He agreed, comparing his actions during this experiment to what he probably would have done otherwise: “Alan would have endlessly said to himself why this is not a good idea and that she’ll react badly.” He stated that he would not feel as apprehensive about calling his cousin in the future. He also thought he might call another family member soon. The group noted that, during this experiment, Alan was very aware that his typical approach would have been to disclose more information than would be appropriate, given the nature of his relationship with his cousin. He paid close attention to the needs of the person he was talking to and the particular situation that he was in, evaluating the appropriateness of further intimate disclosures. Despite his wanting to talk about his “complaints,” he refrained from doing so, even after he received a supportive response to his initial apology. They felt that Alan had done an excellent job of portraying the Robert character, and that he was continuing to develop insight into his tendency to under-discriminate in his relationships. In addition, they noticed that approaching his cousin with better discrimination had actually resulted in Alan feeling closer to her (and less “intimidated”) than before. This underscored for the group the connections between good discrimination and healthy relationships, particularly for Alan. They thought that Alan could use feelings of “intimidation” or “embarrassment” in the future as signals that discrimination issues needed to be addressed. Based on the interaction with his cousin, Alan began to wonder whether excessively sharing information about his past with others (i.e., under-discrimination) might be related to his superman role. While we had been talking about the superman role in terms of a heavy-handed focus on his professional accomplishments, Alan thought about other incarnations of this role: “I kind of extrapolated the thing and put it over another aspect of my character, which has to be this suffering from my parents.” Alan thought that, just as focusing exclusively on his accomplishments was a “shield” against criticism, focusing exclusively on stories of childhood abuse shielded him from invalidation as well: “I wonder if the temptation to blurt things out might be kind of a protection thing to cover something else. Well, it may be my concern about my appearance for which talking about my accomplishments was a shield. Maybe my misfortune serves as a shield too.” In these statements, the group could again see Alan addressing potential links between discrimination and constancy struggles. Alan, at times feeling weak and
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embarrassed, will over disclose information about his “misfortune” to shield himself from invalidation. While he does play the victim role in these stories, his focus is on the heinous actions of others and not on himself. With others focused on these elements of his stories, their attention is directed away from his felt area of vulnerability. In other words, as long as they see him as a blameless victim, they will not challenge him in ways he is unable to tolerate. Alan thought that, at the very least, sharing excessively about childhood abuse made him seem one-dimensional: “The last thing I want people to think is that that’s all I am, is suffering, hatred for my father.” Alan thought that, by presenting himself to others solely as the blameless survivor of torturous abuse, he might actually prevent them from knowing him more fully. I thought the point was an excellent one. In sharing his stories of abuse with me, I was often misled by the impression that he was a self-confident survivor who had triumphed over endless adversity. It was difficult to see the pain, insecurity, and doubt through this smokescreen. His interaction with his cousin struck a more appropriate balance. He allowed himself to be vulnerable by referring to a decision he was embarrassed about, and stayed away from compensating for this by jumping into the superman role and either telling stories about his writing or his childhood experiences. Overall, the group felt that while Alan had started out experimenting with discrimination issues, and had wound up experimenting with constancy issues as well. He had discovered that the things he would “blurt out” reflected a “one- dimensional” person – a person without complexity or depth. He justifiably feared that others would think that “that’s all I am.” Alan often experienced himself in a one-dimensional way that contributed to feelings of depression and led to interpersonal isolation. During these experiments however, Alan appeared to be recognizing – and valuing – that he was more than what he often portrayed to others. During this session, I decided to check back in with Alan about how he was dealing with his “obsession” with his “Surviving My Family” project. Alan reported that, he had worked hard to “disengage” from this project since our last session. He had spent some time on another project he was interested in, and found this work enjoyable. Alan felt “something close to relief” when he disengaged from the book about his family. He was still working on the project and enjoying it, but he no longer felt “ate up by it.” He had thought some more about his motivations for writing it: “I really don’t feel a lot of self-pity about it. But maybe down inside I do and maybe that’s why I want somebody to acknowledge that this happened.” It seemed to the group
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that this writing project was, in part, an expression of Alan’s doubts about the legitimacy of his perspective on his family and childhood experiences. Not having received any validation of his perspective from his family, he was uncertain and prone to questioning the reality of his memories. The project was, in a way, his attempt to center himself in what he knew to be true. It was also an interpersonal communication – a cry for a witness to the past who would declare his experiences real. The group thought there were several possibilities as to why the intensity of Alan’s attraction to this project had been reduced so substantially over the course of several days. First, during his conversation with his cousin, Alan had the chance to connect with someone who knew the details of his childhood experiences. Further, she did not reject him as he expected. It seemed that even without talking about the content of his letter, Alan felt heard and understood. Thus, the conversation with his cousin may have satisfied some of the relational needs the project was designed to fulfill. Second, Alan appeared to be recognizing that his “obsession” reflected only one “dimension” of him and that he wanted to be “more” than what the stories reflected. This desire pointed to a greater sense of self-constancy because Alan could experience himself as multifaceted, as having many different feelings and experiences at once. To the group, it seemed important that Alan’s reduction in emotional distress coincided with both greater self-other constancy and an increased sense of connection with others. Alan and I then planned the next experiment – to approach some kind of religious activity as Robert. Alan shared that he used to meditate a great deal. He credited the practice with helping him through some difficult experiences. However, he quit because he got, “so mellow that if somebody punched me in the nose, I would have thought about it a week later . . . I was so detached from life around me.” Currently, he felt that he could benefit from getting back into the practice. I was intrigued by the fact that Alan had become “scared” by the detached feeling of meditation to the point where he decided to quit the practice. While I did not know enough about the practice of meditation to know if detachment was a desirable outcome, I knew that I wanted Alan to experiment with maintaining his connections with others while in the role of Robert. I suggested that Robert might approach meditation from a more balanced perspective, in a way that would allow him to maintain his connections to the world and other people. Alan was interested in seeing if he could do this.
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However, Alan quickly moved to discussing various activities that he does not engage in because “the depression tells me it’s not worth it.” Uncertain about the reason for the abrupt change of topic, I wondered if this line of discussion could be related to a reluctance to meditate. I asked him if this discouraging message about the “worth” of activities was related to the “superman drive to accomplish something, do something, and be productive?” Alan had not thought about this before, but decided that it could be. He remembered that he always finds a “rationale for activities to validate them for myself . . . figure out a way to make money on it was my rationale to do something productive.” Alan seemed to feel that unless he had something concrete to show for himself, his activities would not be considered worthwhile. Within this dichotomy (i.e., worthless – productive), the group saw another manifestation of the connection between depressive symptomatology and Alan’s choice to take on the superman role. There were worthless activities on the one hand, and productive activities on the other. Not wanting to be worthless, Alan would swing into his superman role, producing things that others would be impressed by. Simply by identifying this pattern, Alan was quickly able to challenge the link he was making between productivity and worth. He left the session prepared to spend some time meditating in the role of Robert, and no longer seemed concerned about making this time “productive.” Fixed Role Session 6. Before this session, Alan had spent some time thinking about organized religion from both his perspective and Robert’s. He described his own perspective as “cynical.” He thought that the main purpose of the Christian religion was both alleviating and perpetuating feelings of guilt: “The primary services of the church have to do with discharging guilt, which in turn serves to bond the individual with the church. Which serves the church’s purposes of perpetuation. Which makes the individual open to taking on more guilt.” Since we had not discussed Robert’s approach to organized religion, I was interested to see how he thought Robert would construe these issues. Alan thought that Robert’s perspective was “less antagonizing” because he was able to “look at it from the outside more.” Robert’s viewpoint was that it was “people using the church instead of the church using people.” Because people go “willingly,” it must be that they are gaining something from it. Robert thought what people gained was an “explanation for things they didn’t understand” so that they did not have to worry about or try to understand things, much less “effect a change” in them. When asked what in Robert’s character made him think he would see things this way, Alan responded that this
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approach was “calmer, more analytical, and less involved.” By “less involved,” Alan meant that he was able to step outside of his own negative experiences with the church as a child and try to see what other people might be getting out of it. I asked him how he might feel walking into a church as Robert. He thought that he “wouldn’t look down on the people . . . I would have a mild feeling of thinking of them as innocents. People innocent of knowledge. Yet they have something they need.” While, as Robert, he pictured himself being “high up looking down, looking at how they interacted within themselves,” as Alan, he pictured himself “right in the middle of it, struggling with strife, with people.” He added that, “it’s always people. People mess up everything.” Alan revealed during this session that, as a child, he had told several church officials about his father’s abuse and had been told that the solution was for him to “get right with God.” To the group, it seemed clear that Alan had had some very negative experiences with organized religion, and that his attitude toward it now was colored by feelings of anger. He seemed to have a good eye for the aspects of religious doctrine that can make it possible for horrific abuses to go unacknowledged. At the same time, the group was concerned that Alan was having difficulty appreciating the wide variety of motivations, values, and attitudes with which people can and do approach religion. He seemed to be approaching religious people as if they were a universal other, all alike in their desire to either perpetuate or alleviate guilt and fear. It was the universality of Alan’s descriptions of religious people that the group thought suggested problems with flexibility, or “the ability to suspend one’s meanings around an issue to see another’s” (Leitner et al., 2000, p. 189). In other words, Alan assumed that the meaning religion has for him is also the meaning it has for other people. He then explains away any difference in their perspectives as the result of the other’s “innocence.” This difficulty in flexibly taking another’s perspective was evident in his attempts to understand how Robert might approach these issues. While Alan made attempts to explain the differences between his approach and Robert’s, the group found them remarkably similar. Alan also made some contradictory statements about Robert that suggested that he was having difficulty separating his own perspective from Robert’s. For example, Alan stated that Robert “wouldn’t look down on the people,” but then stated that he imagined Robert to be “high up looking down” on people. The group was aware that Alan had intended the former statement to mean that Robert didn’t think he was better than religious people. Likewise, the latter statement
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was intended to convey that Robert viewed others from an objective or dispassionate perspective. In the context of his other statements, however, the group thought that Alan’s version of Robert did indeed “look down” on others with a somewhat condescending attitude. Thinking of religious people as “innocents” suggested that Robert was in a superior position, possessing knowledge and truth of which others were unaware. While Robert could, at the very least, say that people were “getting something they need” from religion, he still felt disdain for that need. The group felt that this perspective was very similar to Alan’s “cynicism.” Both Alan and Robert apparently felt superior to churchgoing people, and both construed religion in terms of one party using another for its own gain. The group felt strongly that the Robert character, as he had been envisioned, would have approached organized religion from a much different perspective. They imagined Robert as someone who would have recognized and appreciated that people can employ a variety of potential constructions of religious experience. They anticipated that Robert also would have found a way to do so while he was also “right in the middle of it, struggling with strife, with people.” They thought that Alan’s choice to place Robert in a distant observer role contrasted with Robert’s investment in intimate relationships with people. It also suggested a superman-like perspective which, for Alan, usually suggested problems with self-other constancy. Though Alan’s version of Robert felt “calmer” than Alan himself, this reduction in distress seemed to be more the result of detachment than a reconstrual of his experiences with religion. Because Alan and I had not specifically discussed how Robert might approach organized religion, it made sense that Alan might struggle with this particular experiment. Furthermore, the Robert sketch did not specifically address either religion or potential struggles with flexibility (which was not included in the original EPCP diagnosis). At the same time, it seemed that Alan felt quite threatened by this particular experiment, and may have struggled with it even if Robert’s approach had been more explicitly laid out in the sketch. In addition to thinking about organized religion, Alan had spent some time meditating prior to this session. He reported that his approach as Robert was not visibly different from his own, because “there’s only [one] approach to it that I can think of.” This approach was to “totally empty my mind . . . not be perceptive . . . I conjure a wind to blow [thoughts and perceptions] away.” The result, he said, was “always a feeling of being connected to something really big.” He had not experienced the detached feeling that had caused him to quit the practice
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of meditation before. He had experienced “an immediate calming effect” rather than detachment. As Robert, he had approached meditation differently, as he was “more open to the experience.” When I asked what it meant to be more “open,” he responded: “It’s not fearing it, the detached feeling. Not being distracted by the fear of it. I really feared that. I don’t like being not in control of things in my life.” I reflected that “at the same time you weren’t fearing becoming detached, you found you didn’t get as detached as you had been in the past.” Alan agreed, stating that the contradiction was “Zen-like.” He described being “calm and a little more ordered” afterwards. Alan reported at this session that he felt “detached” from various writing projects he had been working on and had realized that he “didn’t want to bother with them.” He also found that he did not want to read the stories in “Surviving My Family” anymore: “I know what’s there. I don’t want to go through it again. It’s ugly.” He felt “better” after deciding not to read them. Alan described a recent event that he thought might be related to his “recoiling” from these stories — he had received a phone call from his brother asking him to sign their mother up for a game show program on the internet. Alan decided to do this favor for her, and described his feelings as he did so: “I didn’t set aside all feelings, but they just all . . . negative things, most positive feelings about my mother, they just sort of damped out. They were a sine wave up and down that just flat-lined.” Alan thought there was something of Robert in his experience in that moment: “It was that . . . different kind of calm feeling. I can look at my mother and see this 75- year-old woman who lives alone and had a lot of bad things happen in her life. . . At the same time I see all the things she’s done to me . . . to an extent I can see the reasons – not excuses – for her behavior, and for my father’s . . . I had this flash of this old woman sitting there alone and said, ‘I can do this for her.’” From Robert’s perspective, he felt a kind of compassion for his mother. He speculated that had he approached the situation from Alan’s perspective, he would have “wanted a gold star” for his good deed. In reading the above description of Alan’s experience of his mother, the group felt that he had experienced a true moment of self-other constancy. Several different statements Alan made led them to this conclusion. First, his emotional experience was like a “sine wave” that “flat- lined.” Instead of feeling the intensity of one emotion or its opposite, Alan felt something that fell in between. The “flat-lined” experience did not seem to be a “detached” one either. Alan was still making efforts to construe/reconstrue his experiences of his mother, in contrast to the more “objective” stance with which he had approached the experiment with religion. In other words,
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he was still “struggling with strife, with people” as he described his mother. Second, Alan was able to see both himself and his mother as people who had been hurt in their lives. This perspective contrasted with Alan’s tendency to view one party as abuser and the other as victim. Alan’s experiencing his mother as someone who hurts but has also been hurt indicated that he was construing her in that moment as a multi-layered human being. Third, the group viewed Alan’s statement that he could see “the reasons – not excuses – for her behavior” as a sign that he could feel hurt but also see that there was more to his mother than a simple intention to hurt him in that way. He could be angry with her and also empathize with the choices that she made. The group was pleased that Alan associated this particular approach with Robert, as this was exactly the kind of experience that Robert was designed to evoke. Taking Robert’s approach also resulted in the improvements in functioning that we expected would follow, including 1) a reduction of distress (e.g., “a different kind of calm feeling”) and 2) increased feelings of connectedness with others (e.g., wanting to reach out to mom). Fixed Role Session 6: Retrospective. For the latter half of this session, I asked Alan to look back over his experiences in the previous two weeks and think about the effects playing the Robert character had on his feelings of depression and relationships with others. The purpose of this part of the session was to see if playing the Robert character made a difference in the areas I had suspected it would. I first asked Alan if there were aspects of Robert’s character that made him feel more “hopeful” about life, relationships, and the future. He immediately identified his struggle with the “superman thing” as a very important aspect of his experience over the last two weeks. He could clearly identify a tendency to “throw up my accomplishments or weaknesses” and recognized that, with some people, it prevented him from “bringing out some deeper feeling.” When asked how he felt during those times he tried to refrain from using the superman role, he said, “it made me feel like I knew the other person better, or received something from them.” He specifically mentioned his conversation with his cousin as an example. He speculated that his original intention in playing the superman role was to “offer a way for people to relate to me, see me as someone distinctive . . . making myself look good.” The idea that it could be distancing as well had not occurred to him until he had read the Robert character sketch. While Alan could see the potential benefits of moderating his superman role, he reported that it felt more like an intellectual insight to him than an experiential one: “I can see that logically. But emotionally I have a little trouble with that.” Alan’s experience of being protected
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by the role overwhelmed any concern about the potential disconnection from others it might entail: “I’m fearful of presenting myself as I am. Would I feel weak? . . . I would be rejected, plain and simple . . . I need some accomplishment to haul around.” As I had suspected in the beginning, Alan found it very difficult to believe that others could care for him in light of both his strengths and weaknesses. He had to eliminate the negative, or else risk being cast away for not being good enough. While he recognized on some level that his compensation could be distancing, he was still convinced that it did actually facilitate and maintain his relationships. In some cases, it probably did. That Alan assumed this was true for all relationships indicated continued problems with self-other constancy and discrimination. The group found it intriguing that Alan would report such positive results from his actual experiments with Robert, yet remain convinced that he would be “rejected, plain and simple” if he were to continue experimenting with moderating his use of the superman role. Ultimately, it seemed prudent to acknowledge that Alan had been invested in his current approach to relationships for a very long time, and that his need for protection was very strong. To expect a few experiments, regardless of how successful they were, to inspire lasting changes would not do justice to the depth of the injuries that Alan had experienced. He would need additional assistance and work around the issues that had led him to adopt his current interpersonal style in order to make the changes suggested by the Robert character. What seemed important was that Alan had experienced a greater sense of connection with others and a reduction in depressive symptoms during those times he made successful efforts to moderate the superman role. These results suggested that the diagnostic hypotheses underlying this particular aspect of the character had been useful ones, pointing to potential areas for future growth. As we continued talking about his experiences over the past few weeks, Alan reported that he thought “jumping to conclusions” was a major problem for him – and that Robert’s character helped him to “not think in terms of blame and responsibility.” He felt that Robert’s “curious contemplation” helped him to both “not accept guilt” and to stop “projecting possible thoughts and feelings” onto others. He felt more positively about accomplishing this task in his own life, and reported that he had been “working on it everyday.” He felt better when he was engaging in “emotionless analysis” (his term for Robert’s “curious contemplation”). I was interested in his construction of this approach as “emotionless,” as I had not intended it to be understood this way. I wondered what happened to Robert’s emotions as he became analytical. I
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asked Alan, “Where do the emotions go for Robert?” His response: “in some cases like contacting a relative I have an image of setting them aside. In other cases, it’s a little like doing the thing for my mother, it’s more difficult . . . I can’t come up with a good analogy or metaphor. They’re not there. The best thing I can come up with is that they were active, but flat-lined. They were still there, but they weren’t active.” The group initially found Alan’s statements about his emotional experiences as Robert to be somewhat contradictory and difficult to understand. What exactly did it mean to “set them aside?” How could feelings be both “active” and “not active” at the same time? I had the sense that Alan had two different experiences he associated with Robert. The first, which involved “setting [feelings] aside” and engaging in “emotionless analysis,” required Alan to divorce himself from his past experiences and approach the world as if those things had never happened. This was a present-focused approach that did not require Alan to reconstrue his past or evaluate is relevance to the present. The second was an approach that Alan had a great deal of difficulty describing in a consistent way (e.g., feelings that were “active” but not “active” at the same time) and for which he did not have a “good analogy or metaphor.” Alan had used this approach with his mother, and the group felt strongly that it coincided with good self-other constancy. It did not require Alan to dissociate himself from his past; rather, it required integrating different aspects of his experience into a comprehensible whole. While the first approach resulted in reduced distress for Alan, the second resulted in something qualitatively different – a “different kind of calm feeling.” Alan seemed to find both helpful, though the group felt the second most closely matched Robert’s intended approach. In addition to Robert’s “curious contemplation,” Alan thought the “what if” attitude was useful to him as well. In approaching other people, Alan found that it was helpful for him to be open to what the other person had to offer instead of deciding ahead of time that the interaction would go badly: “to be able to think, to deal with these things on a ‘what if’ basis and be open to someone’s reaction. Instead of assigning it in advance, what I think someone’s reaction is going to be.” Alan reported that adopting this attitude “made [him] feel different, better, more effective as a person.” While the specific “what if” attitude was not originally incorporated into the Robert sketch, I had introduced the idea later on as a potential outgrowth of Robert’s efforts to “see people in all of their complexity.” Thus, it was intended to address other constancy issues. I had suspected that one manifestation of other-constancy issues for Alan was a tendency to filter all of
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the varied and complex actions of others to the point where his environment appeared to be populated solely by people who would do nothing but reject, scorn, and humiliate him. Alan needed to be able to trust that a variety of things could happen in relationships before he could gather the courage to emerge from his protective isolation. The fact that Alan found the “what if” attitude to be helpful to him lent some support to the hypothesis that other constancy issues were at play for him. As a final question, I asked Alan if he thought he would be depressed if he were to approach life from Robert’s perspective. Given that Alan reported that there were several aspects of Robert’s character that he found helpful, I was surprised when he answered, “definitely.” He went on to describe what sounded very much like constancy issues: “there are all these dichotomies that come with depression . . . there’s that monitoring persona that watches . . . and recognizes dichotomies. I think Robert . . . would recognize the fact that he feels accomplished at the same time he feels vulnerable . . . But it’s so amplified. For Robert it’s almost as amplified as it is for Alan.” However, Alan thought that Robert’s depression might affect him a “little less” because he had the capacity to separate his feelings about the past from his expectations for the present, which he called “separating out the emotion.” The group found Alan’s answer to this question a difficult one to interpret. His initial statement that Robert would be just as depressed as Alan suggested that the hypotheses behind the Robert character had not been useful in understanding and addressing his symptoms. At the same time, the way Alan was describing Robert contrasted with how the group understood that character. They felt that if Robert saw the world in terms of the same “dichotomies” that Alan did, then Alan’s version of the character differed significantly from theirs. In other words, Alan might not be referring to the same “Robert” that we thought he was. Thus, in order to accurately interpret his statement that Robert would be depressed, they had to take into account how similar Alan’s understanding of Robert was to their own. Throughout the experiment, Alan had demonstrated varied success in approaching others as our version of Robert would. He appeared to have a partial understanding of the character as we envisioned him. The fact that his Robert was depressed might simply indicate that his version did not address some important issues underlying Alan’s symptoms. In the end, it seemed that the question I had asked could not be used in the way I had intended to use it. Alan could not assess whether “Robert” (as we conceived him) would feel depressed unless he had fully understood and experienced that
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version of Robert. As this was only partially the case, it seemed appropriate that Alan would state that Robert would be almost as depressed as he was. Ultimately, the question “would Robert be depressed?” was one best answered by looking at the results of the experiments Alan had completed. Beck Depression Inventory/SCL-90R. Alan completed the BDI-II again following his final fixed role session. His score (8), dramatically lower than his initial score of 25, is low enough to be considered not depressed. Alan reported minor (1’s) remaining symptomatology in the areas of sadness, pessimism, feelings of past failure, loss of pleasure, indecisiveness, reduced sleep, and concentration difficulty. Alan also completed the SCL-90R a second time. His original responses showed elevated levels of all symptom groups. On this day, however, Alan earned no elevated scores in any symptom group. There was only one symptom (“trouble falling asleep”) that he reported experiencing “quite a bit.” The group was pleased to see that Alan’s depressive symptomatology had decreased so dramatically. It was, however, difficult to determine what was responsible for these changes. They could have been the results of some of Alan’s successful efforts to portray the Robert character (i.e., improved self-other constancy). However, Alan does typically experience improvements in his mood when he is receiving consistent validation of his worth from others. Given Alan’s assertion that he was able to successfully present his “credentials” to me during our sessions, it seemed likely that his mood would have improved even without corresponding improvements in self-other constancy. In other words, Alan felt respected and valued in our meetings – a situation that provided less of a challenge to self-other constancy issues than other situations in his life. Thus, the group felt that the improvements in symptomatology Alan experienced could be attributed to either environmental or internal changes, or some combination of both. In either case, they thought it likely that these changes would be short-lived. If it was consistent validational feedback from me that was responsible for his improved mood, Alan would begin feeling depressed again once our meetings ended. If improvements in self-other constancy were responsible, these changes might be longer lasting. However, because Alan’s understanding of the Robert character was tenuous and enacting the role required purposeful and sustained effort, they thought he would have difficulty maintaining those changes on his own. Final Feedback Session. I met with Alan to provide him with feedback about his participation one week after his final fixed role session. Though only a portion of the above
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analysis had been completed at the time I met with him (the data analysis group did not meet until after this session), I wanted to provide Alan with a general description of how I saw self- other constancy struggles impacting his life and how the Robert character addressed those struggles. To this end, I provided Alan with the following written summary: “Robert Harvey was created as a way for you to experiment with several things I thought might be related to your experience of depression. First, you appear to be struggling to maintain an awareness of all of the different parts of you at once. Sometimes, you feel completely worthless, as if you have never accomplished anything and have nothing of value to offer to others. At other times, you seem to have the opposite experience. At these times, you experience yourself in terms of the number of cases you have won, the amount of praise you have received, and the number of lives that you have saved. While most of the time you experience yourself in terms of the former description, the latter is especially likely to come up when you are interacting with others. Your own “superman” character tries to protect you from being hurt by others by showing them only the parts of you that you hope they will admire. Because both parts are integral and important to who you are, the Robert character was designed to be a man who was able to integrate all of these different facets of you at once. One of the most difficult things about having different parts of you that are kept separate is that it can sometimes make it hard to form meaningful relationships with other people. If you experience yourself solely in terms of your failures and weaknesses, it becomes difficult to recognize and accept caring and affection from others. When you experience yourself this way, you tend to physically distance yourself from others, making it difficult for them to offer you companionship. If you experience yourself (or present yourself to others) solely in terms of your accomplishments and strengths, it becomes difficult for others to know you fully and value you for all of your complexity. Of course, there are ways in which your current approach to life keeps you safe. If you never share yourself completely with others, they cannot hurt or invalidate you. For many, the loneliness that comes with this safety often feels like an acceptable price to pay. However, I believe that your experience of depression can be understood as a signal that this price has become too high for you. In other words, your depression is the way you tell yourself that you are sacrificing too much for your safety. Robert is a character that tries to balance out the tension between the safety of disconnection, on the one hand, and the risk of connection on the
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other. It is not a bad idea to protect yourself in some situations and with some people by playing the part of superman or by withdrawing physically into the privacy of your own home. The extent of your feelings of depression can be a signal that you are having difficulty choosing which situations and which people require this protective response. In trying to negotiate this balance, it is important to remember that the people who truly care for you will value you for all of the different parts of you – weaknesses, strengths, failures, and successes alike. Being more open and vulnerable with others carries with it the risk of being hurt by and hurting others. Because relationships are complex, it can be difficult to decide how to understand what has happened when things go wrong. In some cases, your depression seems to be related to a tendency to understand interpersonal injuries solely in terms of your lack of worth or personal failure. The converse problem is that seeing these injuries solely in terms of the other person’s lack of worth or personal failure can lead to chronic feelings of anger and resentment on your part. The idea to adopt an attitude of “curious contemplation” was created to allow you to experiment with taking the time to understand interpersonal injuries in all of their complexity before deciding how you will respond to them.” I discussed all of these issues in turn with Alan before giving him the written version. We started by talking about the idea of “integration” in the first paragraph above. At first, Alan thought that the problem was that he needed to “be the same person around family that I am around students or whatever.” He thought doing this would be problematic. To correct this misinterpretation, I explained further that “integration” referred to being able to “remember all of the different parts of you at once, even if you are choosing not to share it with different people.” When this issue was framed in terms of memory, Alan identified quickly with the idea: “yeah, that’s important. It is. It echoes a bit my thoughts about – sometimes I can’t remember that I can do things.” I added that the problem as I saw it was that Alan tended to “look at one half or the other half [of himself] at any one time and lose the rest.” He agreed, commenting that “it’s overwhelming . . . when one part comes out.” In reading Alan’s comments here, the group agreed that he was validating the hypothesis that self constancy issues were at play for him. They also thought it was a good sign that Alan had objected to the idea that he should be “the same person” around all people, as this suggested he was aware of the importance of discrimination. We discussed the consequences of “one part” coming out exclusively in relationships with other people, starting with the part that only recognizes his weaknesses. Alan agreed that it
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was difficult for him to accept caring and affection from others when this part takes over, commenting that he typically felt “annoyed or threatened . . . like there would be some expectation from me in return” in these situations. He gave several examples of rejecting the efforts of someone who tried to be nice to him, often hurting the other person’s feelings in the process. The group felt that Alan’s experience of “threat” when someone expressed caring for him supported the hypothesis that he struggles with self-constancy issues. Caring is threatening if one cannot experience the self as worthy of such a gift. Alan struggled with being unable to experience a flawed self as worthy of love – a defining characteristic of self-constancy issues. I then described for Alan the interpersonal consequences of inhabiting the opposite role – the one we had been referring to as superman. I reminded him of how he had said that there were people who did not appear to be impressed by his accomplishments, and that he found it very difficult to understand their reactions. I suggested, that in these situations, people might be wanting to see more of him than just his resume and were feeling disappointed that they could not get a more complex picture of him. Alan found it very difficult to imagine that someone might feel this way: “I would love to know that that was coming from somebody. But I can’t trust it.” In other words, Alan could not imagine a situation in which someone could care for him in the absence of information about his various accomplishments. So, while Alan could agree that he had a tendency to emphasize his accomplishments when interacting with others, he saw this as a necessary interpersonal strategy rather than a potential problem. The group found it interesting that Alan could identify with the relational consequences of one pole of the constancy dilemma, but not the other. While he saw the ways that experiencing himself as unworthy of love could be distancing, he could not see that an inflated sense of self could cause just as many relational problems. The issue did seem to be one of “trust,” as Alan had suggested. We all must trust that others will forgive our shortcomings before we will risk revealing them. If we cannot forgive our own, we rarely assume that others will. Alan expected that others would view him in the same (inconstant) way he viewed himself – if he was not fantastically accomplished, he was (and would be perceived as) worthless. To Alan, the superman role was his protection against a less preferred alternative. Overall, Alan felt that the above conceptualization of his struggles was understandable and helpful: “It makes sense. I’m learning that I’m deeper in isolation than I had thought . . . Just from the very beginning from when I got the Robert character I recognized more symptoms of
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the depression. The superman thing was a real eye opener.” It had also given him some ideas about what he needed to do to start feeling better: “I’m aggravating the depression by remaining isolated. But maybe I want to come out on my terms. But maybe I can’t . . .” By “my terms,” Alan meant that he had been hoping that people would approach him, and was starting to realize that this may not happen. Alan asked if he should be trying to “consciously” assume the Robert role in his life now. When I told him it was his choice whether to let Robert become a part of him, Alan responded that, “Oh, I aspire to that! The first time I read it, I circled those points that are like, ok, I need to do this.” He reported that he had “an ambition to try to put the Robert persona in place.”
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Results – “Lauren” Interview 1. Lauren was a student enrolled in an introductory psychology class during her first semester at college. She had been previously diagnosed with depression, had spent a significant period of time in psychotherapy during high school, and was currently taking an anti- depressant. Lauren was a friendly, personable young woman who smiled throughout her interviews. She seemed outgoing and articulate, and was able to discuss her struggles with depression with a fair degree of psychological sophistication. Lauren first remembers feeling depressed in the 7th grade, when her self esteem took a nose dive that continues to this day: “I’ve always been unhappy with myself. I always thought I was never pretty enough . . . I just really hated myself . . . I just didn’t feel like anything I did was good enough . . . I just always thought the worst about everything, myself.” While she focused on her “looks” as the source for much of her self-hate, she found little else about herself to feel good about either. When asked if there were particular situations that would prompt such feelings of self-loathing, Lauren indicated that her triggers “could be something small” or something that she didn’t necessarily even “care about.” For example, earning a C on a paper, even one that a teacher would let her rewrite, would make her day “horrible” and “trigger everything else that has been built up inside.” She would cut herself as a way of coping with feelings as a way of, “escaping, getting out, releasing everything that’s going on inside of me.” She does not feel any physical or emotional pain when she cuts herself, and when “trying to work [her feelings] out on [her] own” fails, she starts to “crave” cutting again. Lauren last cut herself about six months prior to her participation in this study. Lauren is extremely sensitive to things that other people say to her, even if those things are not meant to be critical: “I let every little thing bother me. I take things so literally.” For example, Lauren described how she became “paranoid” about having a “big head” after her cousins teasingly suggested so to her. In general, Lauren finds that she bases her opinion of herself on what other people think: “if someone calls me fat, I think ‘oh, I'm fat.’ If someone says I'm ugly I’ll believe it.” However, when asked what it would be like if someone said she was pretty, she indicated that the situation was more complicated: “I don’t believe it, that’s the thing. I [only] believe the negative things. If someone told me I’m pretty, I’m like ‘ok, whatever’.” In other words, her willingness to believe what other people say about her does
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depend on the content of the message. While she lets criticisms cut her deeply, she disregards compliments as suspect. Lauren reported that she blames herself for everything that goes wrong in her interpersonal relationships: “if someone doesn’t like me, or if things don’t work out, I always think it was something that I did. That maybe I could have done something different.” She finds it almost intolerable to have someone else be angry with her, describing her internal experience in these situations as an “uncomfortable feeling” that she “can’t stand.” Her self-blame extends even to situations where it is “blatantly obvious” that the problem is not her fault. Similarly, she finds that she “can’t be angry” with other people or express feeling hurt by or upset with them: “I’m always out to please the other person. That should be my job to make sure they’re ok, take care of them.” Several people in Lauren’s life have become upset with her because she has refused to honestly discuss angry feelings she had toward them. Despite their assurances that they want to hear about her thoughts and feelings, Lauren finds it extremely difficult to share these things with even her closest friends. Lauren reports that in general, she tries to “always have a smile on [her] face, bright and bubbly.” It is especially important to her that no one worry about her: “I figure if I smile, they think I’m happy.” Lauren reported that her biggest problem in relationships is that she tends to “trust the wrong people” and get hurt a lot. She feels she has “bad judgment of character,” trusting the people she should not and not trusting the people she should. Now, she finds herself assuming that everyone will hurt or leave her. To protect herself, she will often “push people away” when she is starting to feel close to them: “I pick fights with them. I’ll find a way to basically be a bitch. I’ll distance myself from them. Any way I can to push people away from me so I don’t get too close, I’ll do it.” Afterwards, because she hates herself for what she has done, she sometimes tries to “get them back and make things better,” but only finds herself pushing the person away again. However, she has noticed that she does not do this with all people. She mostly pushes away those people who have the potential to be supportive and caring toward her: “The people that really do hurt me, I keep around. The people that I'm afraid to let hurt me, I push them away so they can’t . . . I know if I pushed them away they were probably a good person.” Lauren feels like she is a “magnet for bad people,” who treats “good” people “horribly.” While she acts this way in an attempt to protect herself from being hurt, she acknowledged that she winds up getting hurt anyway.
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Lauren connects many of her current struggles to her parents’ divorce when she was about six. She, her mother, and her brother had gone on a family vacation together. When they returned home, they found her father and all of his belongings gone. They also found a note explaining that he had left them. He left the country for several years, only to return and begin a pattern of inconsistent contact and broken promises to spend time with Lauren and her brother. Lauren described her father as someone who would not be able to tolerate her expressing the hurt and anger his behavior caused: “He’s the kind of person that you can’t be mad. If I told him how angry I was or how hurt . . . if I got mad at him and he got mad or hurt, I would have the chance of never talking to my dad again. He’ll withdraw totally.” Lauren reported that she felt ambivalent about speaking with her father, who didn’t even know where she was going to college. She wanted a relationship with him, but also didn’t want to “keep going through the pain” of “caring what he thinks” and “always trying to please him.” On the other hand, Lauren described her relationship with her mother in very positive terms: “We have a pretty good relationship. We’re awesome. She’s awesome.” She described her mother as a “good role model,” “amazing,” “fun to be around,” who had “a great sense of humor,” and had “accomplished a lot” by earning a law degree while raising two children on her own. Lauren reported that she liked “hanging out” with her mom and that they would rent movies and go shopping together on a regular basis. However, Lauren also described her mother as an alcoholic who she would not talk to “after a certain time of day” because of her behavior. She summed up her feelings about her family at the end of her interview: “My family’s awesome. I love them. I wouldn’t change them for the world. Even my mom’s drinking. It really does bother me. A lot was said and stuff. It hurt, but at the same time I wouldn’t change my mom for the world. Besides that, I wouldn’t change her for the world. She’s awesome.” Beck Depression Inventory/SCL-90R. Lauren completed the BDI-II at her first interview. Her score (28), is considered “moderate” depression. She endorsed her two highest scores (3’s) in the areas of self-dislike (“I dislike myself”), and self-criticalness (“I blame myself for everything bad that happens”). Her scores also indicated problems (2’s) in the areas of past failure (“As I look back, I see a lot of failures”), guilty feelings (“I feel quite guilty most of the time”), punishment feelings (“I expect to be punished”), indecisiveness (“I have much greater difficulty in making decisions than I used to”), and worthlessness (“I feel more worthless as compared to other people). She also reported significant physical problems, including sleeping
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less than usual, low appetite, concentration difficulties, and loss of interest in sex. Lauren reported some symptoms that appeared to be less severe (1’s), including sadness, pessimism, loss of pleasure, agitation, and irritability. She denied experiencing suicidal thoughts, crying, loss of interest in people or activities, and loss of energy/tiredness. Lauren also completed the SCL-90R at her first interview. Her responses showed elevated levels of interpersonal sensitivity (t=76), paranoia (t=72), depression (t=70), psychoticism (t=69), and obsessive compulsive behavior (t=66). Lauren reported that she was “extremely” bothered by the following symptoms: “loss of sexual interest or pleasure, feeling that most people cannot be trusted, blaming yourself for things, trouble concentrating, feeling uneasy when people are watching or talking about you, feeling that people will take advantage of you if you let them, and never feeling close to another person.” She also reported that she experiences the following “quite a bit”: “repeated unpleasant thoughts that won’t leave your mind, feeling critical of others, poor appetite, feeling shy or uneasy with the opposite sex, feeling blocked in getting things done, feeling lonely, feeling blue, worrying too much about things, feeling that people are unfriendly or dislike you, feeling inferior to others, feeling that you are watched or talked about by others, difficulty making decisions, feeling very self conscious around others, feeling lonely even when you are with people, feelings of worthlessness, and feelings of guilt.” Interview 2. During the second interview, Lauren and I continued to discuss themes similar to the ones we had touched on in the first interview. Lauren had written a self- characterization sketch prior to this meeting, and had mentioned that she had a difficult time figuring out how to describe herself. In response, I asked her to tell me a little bit about her sense of her own identity in general. While she could articulate clear career goals, she felt unfocused and confused about who she was as a person: “I don’t even know what it is, but sometimes there would be times when I feel I have no idea who the heck I am . . . I just don’t know what I expect of myself or what I want of myself. Or what I want out of life . . . What do I consider to be good morals? My values? I don’t know what I want out of anything I do. What I want to be. What I want to become.” She thought that this confusion might be related to her tendency to focus too much on other people and not enough on herself: “[I] lose [myself]. I just get caught up in everything that’s going on. I don’t take enough time for myself.” Lauren felt bad about what she saw as a pattern of doing “stupid stuff” and linked this behavior to uncertainty about how she
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really wants to live her life. While she loved to “analyze” herself and her reasons for doing certain things, she nevertheless felt stuck, not knowing “where to go from there.” Self Characterization Sketch. Lauren provided the following self-characterization sketch following her first interview: “Lauren is a person of growth. She tries hard to learn from past and present experiences, yet always winds up making the same mistakes over and over. Sometimes others may be confused about what she is feeling – whether she is truly happy, angry, or sad. She has discovered over the last [number of] years how to disguise these intimate feelings. For the most part, Lauren is always smiling. Not only does she know that it attracts guys (which will be discussed later on), but it hides what is going on inside of her. She can’t tell people she is angry at what upsets her or discuss any drama that occurred between her and another. Instead, she shuts down – closing herself up and ignoring those who care about her. When she is hurt, she withdraws from everyone and drowns herself in all the sorrows that she can think up at the time. She’ll tell herself over and over that she’s worthless and nothing about her is right – “I’m fat … I’m ugly … No one will ever love me – guys will use me and I’ll let them, but they’ll never love me … I’m stupid … I’m boring … Nothing about me is special …” She tears herself up inside and pinpoints every little fault she has. But what is the reason that Lauren is afraid to show her true emotions? She’s afraid of being hurt, of being disappointed, of being rejected. Before her parent’s ghastly divorce, Lauren was the epitome of “Daddy’s Little Girl.” She got away with everything and basically got whatever she wanted. When her dad left, he didn’t just move out into another house or apartment on the other side of town. Lauren’s dad left the country while her and the rest of her family were on vacation. She didn’t really see or talk to him for years until he would return to the United States and the courts allowed him visitation. Even after visitation was granted, her father would make plans to meet her and her brother at a restaurant for lunch, and then cancel at the last minute, shattering her young heart all over again. Months would go by without seeing him or even talking to him, and the same thing still occurs today. Every time her father disappoints her with a broken promise, she feels rejected and loses another part of her, almost like a dying flower slowly losing its petals. Lauren is afraid that if she shows her true feelings toward someone, they will use them against her or take advantage of them … and eventually leave her.
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As well, she hates having people worry about her. Granted she loves attention and basks in it, the one type of attention she does not like is worrying. She herself is a constant worrier – constantly being concerned about others to the point where much of the time she forgets to take care of herself. She continually worries about her mother’s excessive drinking at night, health (she was diagnosed with [serious illness] in [date]), and her eating habits (many times her mother will forget to eat during the day). Perhaps because she sees herself as the worrier and the “caretaker” of the people in her life, she doesn’t like to be the one who is worried about. She tries her hardest to make sure people think that everything in her life is going fine and that all is well. And she will admit that she does like being cared for, sometimes almost being babied, but that is because she does love the feeling of being liked/loved and because she was brought up to have the “Princess” mentality. But one of Lauren’s biggest issues has to do with male gender. Due to the enormous fact that her father left her life completely back in [year] when her parents divorced, she is always trying to fulfill a void inside of her with other guys. She tries to replace her father and make up for all the pain that he caused her through other guys. She has learned through therapy that this is what she does and that it is not only impossible, but unfair, for someone to make up for all of her pain. Despite knowing this, she still feels the same way. Any comfort in men she will take – she relishes being admired or even gawked at by the opposite sex. People who don’t really know her, her personality, and why she does what she does may sometimes think of her as desperate or a floozy. But it is not that she will “hook up” with guys for the fun of it or the conquering aspect, she does it because she is looking for comfort and a sense of being wanted. All Lauren really wants is to be loved, truly loved and cared for. Yet oddly enough, when people do show genuine interest in her (not just guys and not just in a romantic sense), she pushes them away. She, again, is afraid that they will leave her or deceive her. She mostly does this, however, with males. With guys that truthfully like her and she knows this, she will draw them in, then push them away – hurting them before they can hurt her. Then after a little time she will go back to them, see if they still like her, and do the wounding process all over again. This is Lauren in a nutshell, as simplified as can be made without this being 50 pages of each in-depth and meaningful experience in her life. While she does know all of these things about herself, and while she does enjoy learning why she does what she does, it is a struggle for her to change her ways. It takes her time and serious thought as to why and how she got that
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way, but she is always up for growth to make her a better person and relieve her of the pain that she is feeling.” Analysis of self-characterization. In reading this sketch, the class initially was struck by the apparent contrast between the first two sentences. While Lauren indicated that she was a “person of growth,” she also wrote that she makes “the same mistakes over and over,” suggesting a stalled process of personal evolution. One class member suggested that Lauren “grows like a plastic flower,” a metaphor that later became important in the creation of the fixed role sketch. The first major theme that the class identified in Lauren’s sketch was one of concealing her innermost self from others. For example, she describes herself as always “smiling,” “disguising intimate feelings,” or “closing herself up.” The class speculated that since every feeling was too intimate to share for Lauren, she might experience anything other than a perfect façade as excessively vulnerable and avoid it at all costs. They quickly identified this as a potential discrimination issue. It seemed that Lauren had a great deal of difficulty matching her level of personal disclosure to the relative trustworthiness of the other person and the level of intimacy in their relationship. Her felt sense of danger and impending betrayal in such a wide variety of relationships (“Lauren is afraid that if she shows her true feelings toward someone, they will use them against her or take advantage of them . . . and eventually leave her”) suggested that she tended toward over discrimination. In other words, Lauren found it very easy to come up with reasons why it would be dangerous, inappropriate, or unwise to share herself openly with someone. When in doubt, it was clear that she would typically err on the side of concealment. The class also identified a theme of pursuing relationships that do not require the vulnerability of true intimacy. They identified two specific ways that Lauren typically tried to create a modified form of intimacy that felt safe for her. The first strategy was to be “the worrier and the caretaker” of others. In focusing exclusively on other’s needs, Lauren could limit the amount of personal disclosure required of her. Therefore, Lauren “hates” when others attempt to create a more equal exchange by caring for and worrying about her. In the words of one class member, being the target of someone else’s worry would “imply a relationship” and all of the vulnerability of being known. The second strategy was to try to gain the “attention” or “admiration” of men by acting in a way that makes her look like a “floozy.” The class saw this
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behavior as a strategy designed to elicit the love and caring that Lauren craved. Being “gawked at” gave her some sense of being valued; however, that validation was based on a superficial understanding of her as a person. The class suspected that, as a result, the “attention” that Lauren received felt hollow and unfulfilling to her. They saw her attempts to draw people in and then push them away as a tug of war between her need for more genuine form of intimacy and her fear that such intimacy would only result in rejection. EPCP Diagnosis. Lauren’s major struggles appeared to lie in the area of self-other constancy. The first place where this became apparent was in Lauren’s description of the complete and utter loss of self esteem that she experiences when she is faced with minor invalidations. The language that she used to describe her feelings about herself in the first interview (she was “never” good enough, always thought the “worst” of herself) suggested a regular loss of awareness of areas of strength and competence, accompanied by globally negative constructions of her own worth. She conveyed similar sentiments in her self-characterization sketch (“I’m fat … I’m ugly … No one will ever love me . . . I’m stupid … I’m boring … Nothing about me is special …”) that also pointed to severe feelings of worthlessness. While these global, monolithic constructions of herself suggested the possibility of constancy problems, it was Lauren’s experience of sudden, rapid swings into these interpretations that made this diagnosis seem appropriate. For example, the fact that feelings of utter worthlessness are triggered by “small things” that she doesn’t even “care about” pointed to a lack of distinction between core and peripheral construing (see pages 12-14) for discussion of links between this phenomenon and constancy issues). In other words, minor challenges to her sense of self worth are followed by major alterations in her own understanding of herself. Lauren appeared to have one specific trigger for self constancy issues that stood out: perceived rejection from others. Lauren’s description of many of these invalidations as relatively minor and even unintentional (e.g., a poor grade, good natured teasing) was what distinguished her particular struggles from those of people with more firmly established sense of self constancy. Lauren’s reports also suggested that she struggled with maintaining a sense of the constancy of others. The major area where this problem was evident was in Lauren’s description of what it is like for her when other people become angry with her. While it is the rare person who likes it when others are angry with them, it was the strength of Lauren’s aversion to anger (“I hate it so much”) as well as her feeling that language itself was inadequate to convey her
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feelings (“I can’t even put it into words”) that suggested that something more was going on. Part of Lauren’s aversion to anger in others appeared to be linked to self constancy issues because she often interpreted the anger in terms of her own worthlessness (e.g., “I always blame myself for it”). At the same time, it also appeared that Lauren would lose a sense of connection to others and faith in the stability of their relationship when conflicts occurred. For example, in her first interview, Lauren described her fears of how her mother would react after she was involved in a minor car accident during high school: “I was like ‘my mom’s going to kill me.’ I just couldn’t deal with having her disappointed in me or being mad at me.” It would be very easy to dismiss these statements by simply observing that every teenager at some point suggests that a parent is going to “kill” them for something they have done wrong. However, someone with a problem with other-constancy means these things quite literally. For Lauren, mom’s “disappointment” may have felt like a complete loss of caring, supportive, loving mom. Before mom had a chance to find out about the accident, Lauren attempted suicide. While fear of a parent’s disapproval is a common experience for teenagers, suicide in response to that fear is not. As discussed previously, the all-or-nothing construing associated with self-other constancy problems leaves people vulnerable to what Kelly (1955) termed the “depressive suicide” (refer to page 17). In Lauren’s case, she may have considered suicide the only viable alternative to (what she saw as) the imminent and inevitable loss of her relationship with her mother. As is common for people with structural arrests, Lauren also appeared to be struggling with various aspects of interpersonal attachment. Leitner et al. (2000) describe “attachment” difficulties as problematic ways that people respond to feeling frightened or insecure in relationships. Lauren, for example, described a tendency to constantly appear to be “bright and bubby,” as well as to take on the role of “caretaker” with others. Both of these patterns can be seen as attempts to establish a sense of constancy where there is none. (See compensatory mechanisms, p. 21) When feeling worthless, Lauren may maintain some sense of composure by swinging to the other end of the spectrum, denying and disowning her current experiences and essentially acting the opposite of what she feels. In doing so, she also prevents others from knowing about things that they might find upsetting or objectionable. Others therefore are not provided with any information that they might be able to use to invalidate what is a very tenuous sense of self-worth.
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Caretaking appeared to serve the same function. Lauren may believe that she is less likely to be rejected or invalidated if she is continuously pleasing and helpful to others. In this role, she can avoid the kind of invalidations that she is unable to tolerate. This interpersonal style is a common response to constancy issues: “A person may attempt to be so nice, unassuming, and nonburdensome that others will not abandon or betray him or her . . . A person may implicitly or explicitly construe the relationship between the world and the self as ‘If I am nice enough, you will love me’” (Leitner et al., 2000, p. 183). However, Lauren also described an alternate, apparently contradictory interpersonal style in her tendency to “pick fights” and “be a bitch” to distance herself from others. This behavior appeared to serve the same function as caretaking – preventing others from being in a position to hurt her. This second pattern, essentially, “if I am distant and uncaring enough, you cannot hurt me” (Leitner et al., 2000, p. 183), also is a common way of coping with constancy problems. Again, the link between these patterns and constancy problems is in the fact that they functioned to prevent Lauren from being faced with the kinds of invalidations that would result in a complete loss of self-esteem or sense of connection with others. The issues described up to this point serve as the backbone of Lauren’s EPCP diagnosis. Within this theory, Axis I issues are primary and underlie any issues subsequently identified on Axes II and III. Lauren described a variety of experiential (Axis III) struggles that seemed directly related to problems with self-other constancy. First, Lauren’s tendency to conceal “intimate feelings” from almost everyone suggested she struggles with over-discrimination. That is, Lauren tends to overestimate the degree of risk involved in forming intimate relationships with others. For people with self-other constancy problems, it often is necessary to be over- discriminating in relationships because minor invalidations are experienced as devastating. In over discriminating, Lauren actually makes accurate assessments of the degree of risk that relationships hold for her given her perspective. Lauren’s report that she is a “bad judge of character,” also points to discrimination problems because she cannot trust her own ability to accurately evaluate other people and the impact they may have on her. However, Lauren also reported that she is fairly consistent in trusting the “bad” people and rejecting the “good” people, suggesting that she can tell the difference and makes deliberate choices to surround herself with people who are likely to be rejecting of her. These apparently contradictory reports were initially a source of significant
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diagnostic confusion. How could Lauren be a “bad judge of character” and yet also display such consistency in choosing obviously “bad” relationships? Can she really not predict who she can and cannot trust? Or does she do this particularly well, but deliberately choose to remain with the people she knows are untrustworthy? Trying to choose whether this particular issue constituted either very good or very bad discrimination did not prove to be fruitful. Since Axis I issues ultimately subsume Axis III issues in any case, it was more helpful to return to looking at this problem through the lens of self-other constancy. Lauren’s report that she was a “bad judge of character” seemed to refer to her tendency to choose relationships with “bad” people, rather than an inability to accurately evaluate others. Though the phrase itself is usually used to convey a confused, random, or inaccurate evaluation of the moral qualities of others, Lauren described her relationship choices as purposeful and consistent. A pattern of choosing to remain in relationships that are consistently destructive can be conceptualized in terms of problems with self-other constancy. During those times when people with self-other constancy problems are viewing themselves in purely negative terms, they may actually feel more validated by people who treat them badly than by those who treat them well. This could account for Lauren’s assertion that she consciously pushes away “good” people. I decided to proceed under the assumption that Lauren was a fairly good “judge of character” who sometimes used this ability to surround herself with people who would treat her the way she thought she deserved to be treated – badly. Lauren also appeared to be struggling with responsibility. She had a wonderfully compassionate ability to examine her own actions and consider the impact they were having on other people. She was able to acknowledge that there were things that she had done that had been hurtful to others, and appeared to feel genuinely regretful for her actions. Where Lauren struggled in terms of responsibility was in denying that others played a role in interpersonal conflicts: “if someone doesn’t like me, or if things don’t work out, I always think it was something that I did.” While in some ways an extension of an otherwise admirable trait, her difficulty in allowing others to bear their share of the responsibility for conflicts ultimately prevented any honest discussion of problems or true resolution of them. Thus, the people in Lauren’s life were not receiving the feedback they needed in order to learn how to care for her. In other words, without the ability to acknowledge to herself and convey to others the ways they had been hurtful to her, Lauren limited their ability to refrain from making the same mistakes
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again. This issue also can be linked to constancy problems. Lauren’s swings into feelings of complete worthlessness leave her little room to consider more complex ways of understanding interpersonal problems. Lauren’s reports that she bases her opinion of herself solely on what other people think suggest that she struggles with excessive openness (i.e., willingness to reconstrue when invalidated). If other people insult her or criticize her in any way, she automatically believes that what they are saying is true (e.g., “I take things so literally.”) The fact that it is only criticisms, (not compliments) that Lauren is excessively open to points problems with self-reverence (i.e., inability to validate another’s revering of oneself). Lauren’s fear of sharing her “intimate feelings” with others, initially identified as a discrimination issue, also could be a struggle with courage (i.e., willingness to engage in activities despite an awareness of the risks involved.) As mentioned before, it is difficult to act courageously when constancy issues make any invalidation a reason for self-loathing. Lauren also very clearly linked her struggles with men to “the enormous fact that her father left her life,” pointing to potential problems with forgiveness (i.e., assuming that injury in one relationship will be repeated in all future relationships.) She pushes away men who show “genuine interest” in her, “afraid that they will leave her or deceive her.” Given her problems with self-other constancy, it is possible that Lauren would experience even a minor relational injury now as equal in intensity to her father’s initial betrayal. The following table shows the three axes of the EPCP diagnostic system, with the areas Lauren appeared to be having difficulty highlighted in bold print. Diagnostic Axes of Human Meaning Making Developmental- Interpersonal Experiential Structural issues components components Self vs. other Undispersed Dependency Discrimination Self-other permanence Excessively dispersed dependencies Flexibility Self-other constancy Dependency avoidance Creativity (Attachments) Physically distancing self Responsibility Psychologically distancing self Openness Commitment Courage Forgiveness Reverence Table reproduced from Leitner, Faidley, & Celentana (2000).
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Creation of Fixed Role sketch. I began this fixed role sketch with a very general paragraph outlining the essential dilemma of human existence described by experiential personal construct theory – that people are engaged in a struggle between engaging in terrifying yet meaningful interpersonal relationships versus retreating into the relative safety and emptiness of a life without these connections. I wanted to bring this dilemma to the forefront of the sketch by using language that would make sense to Lauren. In looking back over Lauren’s self characterization sketch, I noticed that she had chosen the image of a flower to describe herself. Since this was an image that appealed to her, I decided to use it in the fixed role sketch as a way of describing the central human relational struggle and an alternative approach to dealing with it. I wanted to create an image of relationships with others as potentially devastating as well as nurturing, much the same way that fertilizer can stunt or facilitate the growth of living things. Flower metaphors thus became a way of describing the essential dilemma of human existence. The first paragraph of the FRS addressed this fundamental struggle: Simone Davis is a complex woman who has many different aspects to her personality. She has ups and downs and strengths and weaknesses just like everyone else does. Simone, however, has a unique approach to her life. For example, she likes to think of herself as a flower – but not just any flower. Simone is like a hardy mum, a beautiful plant that is also strong enough to last through frosts and snows to bloom again year after year. But however hardy and beautiful Simone is all by herself, she also knows that close relationships with other people are the Miracle-Gro that allow her to continue growing even in harsh conditions. She knows from experience that too little will starve her of the nutrients she needs to survive, while too much could burn her. Having introduced this general approach to relationships, I needed to incorporate those specific characteristics that EPCP theory suggested Lauren could benefit from experimenting with. I structured the rest of Simone’s character around self-other constancy issues. To illustrate what is an otherwise abstract theoretical concept, I chose the image of a see-saw. This piece of children’s playground equipment, because it requires a balancing of two sides to work optimally, provided an excellent metaphor for the psychological balancing of opposites that self-other constancy requires. Where I incorporated Axis III experiential issues into the character, I did so in a way that referenced this image as well. Because the EPCP diagnostic system theoretically links axis III issues to underlying axis I issues (when they are present), I wanted to make sure
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that this link also was present in the actual sketch. Thus, in the process of working on Axis III issues, we would ultimately be addressing the constancy issues that were underlying them. The second paragraph began by addressing Lauren’s tendency to be “bright and bubbly” most of the time because it was the most salient interpersonal pattern that others were likely to observe when meeting her. This approach appeared to represent one side of the constancy struggle, while something darker and heavier represented the other. Since I suspected that Lauren used the “bright and bubbly” approach to completely avoid its opposite, I first wanted Lauren to experiment with recognizing herself using this approach. Next, I wanted her to use that awareness to make more strategic choices about when and with whom she would take on the “bright and bubbly” role. The philosophy behind this paragraph was that Lauren’s current approach was not a bad one; rather, it was one that had both positive and negative consequences for Lauren and her relationships with others. I began by describing Lauren’s current “bright and bubbly” approach in terms of playing the part of a plastic flower. This image was designed to convey both the positives (an appealing façade and a feeling of invulnerability), but also the negatives (a misleading superficiality and inability to absorb nurturance) associated with Lauren’s current approach to relationships. I introduced the see-saw image to describe a way of using the plastic flower approach with more flexibility. Since I suspected that stepping outside of the plastic flower role would arouse some anxiety for Lauren, I also suggested the see-saw metaphor here to address problems with courage (i.e., acting in spite of fear). Simone has been burned in the past by relationships, and in some ways these injuries still influence her. When she’s scared of getting hurt, she struggles with the temptation to be more like a plastic flower to others – pretty and pleasing while requiring no care. Simone gives into this temptation sometimes, when she most needs to protect herself. But Simone is also a courageous woman. When she feels afraid she often chooses to plunge bravely into a relationship anyway. She treats her fear like a see-saw that she needs to steady. On one end, her fear is a signal that she needs to hide, and on the other it is an opportunity to push herself to new heights by being more open and vulnerable. The third section of the FRS was dedicated to addressing several additional ways that self-other constancy issues manifested themselves in Lauren’s life. For example, Lauren had a great deal of difficulty expressing anger to others and tolerating others being angry with her. Both struggles appeared to be related to other-constancy issues in that Lauren was afraid that
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anger only would be destructive to her relationships. In other words, another’s anger would destroy her faith in the other as also loving, kind, etc. and potentially end their relationship. Because her own anger could evoke anger in others, she could not allow herself to express it without risking the relationship as well. Lauren withdrew into the plastic flower role on a regular basis to avoid being faced with this issue. Therefore, I wanted Lauren to experiment with acknowledging and expressing anger toward others, as well as dealing with interpersonal injuries without losing a sense of the constancy of self or others (and requiring a return to the plastic flower role). However, avoiding anger was intertwined with Lauren’s tendency to over- discriminate (i.e., automatically assume it is not safe to be open) in her relationships with others. Therefore, the sketch specifically incorporated the idea of sharing intimate feelings like anger with those most likely to value them, and choosing not to share with people who were likely to invalidate those feelings. Since Lauren’s fear was that anger was only destructive to relationships, I wanted her to consider the possibility that it could be constructive under the right conditions and play with figuring out what those conditions might be. However, in reflection of self-constancy issues, Lauren tended to blame herself exclusively for conflicts (i.e., responsibility). Thus, I wanted to make sure that Lauren was able to recognize and honor her own feelings of anger when she had them (and refrain from automatically turning them back on herself). The last sentence of this section addressed this concern: When she does choose to risk a relationship with someone, Simone struggles to bring all of herself to it, good and bad. While she is understanding and caring toward others, she also allows herself to be angry with them when they hurt her. Simone is slowly learning to use her anger in growth-affirming ways. For example, she often shares her anger with people who will value and respect her feelings, using their intimate knowledge of her to avoid hurting her again in the future. If she is not sure how someone will react to her feelings, she will sometimes choose not to share them. However, she will not apologize for her feelings or judge herself for having them. The last section of this FRS addressed the way constancy issues were expressed in Lauren’s conflictual relationship with men. It was based on the assumption that during those times when she is especially vulnerable to invalidation, she tends to protect herself by pushing away anyone who might be in a position to hurt her (e.g., by being a “bitch”). I wanted Lauren to experiment with using this protective stance more strategically, based on her needs in the
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moment and an honest evaluation of the people involved, as opposed to applying a blanket rejection of all possibilities for closeness. In addition, I wanted to suggest some signposts that she could look for that might indicate that she had used this approach in a way that was more destructive than protective. For Lauren, sadness typically indicated that she was feeling lonely as a result of passively withdrawing from others, while guilt typically signaled that she had engaged in more actively hostile behavior to push others away. This sketch incorporated the idea of using these feelings as indicators that changes were needed. However, I was concerned about Lauren’s tendency to be especially harsh on herself for pushing others away, and did not want this experiment to increase the feelings of guilt she was already experiencing. Therefore, I added a final sentence suggesting that she view mistakes as opportunities for growth, rather than as reasons for self-abuse. This was a final attempt to address self-constancy issues by suggesting Lauren experiment with experiencing guilt without becoming consumed by it. Simone tries hard to understand other people’s feelings, thoughts, and perspectives. While she is usually fairly successful in her attempts at understanding, her biggest struggle is around what to do with this information. Like everyone, she sometimes uses her understanding to limit the depth of her relationships, particularly with men. At other times, she uses her understanding to enhance the level of intimacy in her relationships. Simone treats this issue like a see-saw as well. She views extreme feelings of sadness or guilt as signals that she might be off-balance. However, she does not judge herself too harshly for her mistakes. Instead, she looks at them as a valuable opportunity to reevaluate her approach to her current relationships and grow in the process. Fixed Role Session 1. When I first introduced Lauren to Simone, she agreed that Simone sounded like a real person, and thought that she seemed “cool.” She wasn’t sure what sorts of concrete actions or behaviors Simone would engage in, stating that, “I just wouldn’t know how to like bring myself to be her.” Assuring her that we would spend our sessions together exploring exactly that issue, I asked her for some initial hypotheses about the parts of Simone’s character that might be easy or difficult for her to enact. The first characteristic that Lauren thought would be challenging for her was “being courageous” by “speaking [her] mind” or “confronting” things instead of letting people “walk all over her.” I knew that Lauren would feel anxious about this particular characteristic of the FRC. I was concerned that, as a result, she might miss some of the more subtle aspects of the character, construing Simone as someone who would do the
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opposite of what she does. I decided to respond by addressing one of the major purposes of the sketch, which was to get Lauren to experiment with balancing some of her natural tendencies, rather than denying them altogether. Making a see-saw out of a pen, I described how Simone would respond to her own fear in a variety of different ways, depending on her needs in the moment: “So she’s viewing her fear as ‘ok, I’m feeling afraid.’ Does this mean I have to tip this way and hide? Does this mean that I have to tip this way and push through it? . . . So she’s going to be going like this [back and forth] trying to make sure she doesn’t hit the ground on either side.” The second area that Lauren thought would be “extremely hard” for her was “allowing herself to be angry with someone when they hurt her.” Lauren was concerned about experiencing anger and worried about the consequences of expressing it to others, who might “use it against [her].” Part of her fear that others would respond poorly to her anger was related to her conviction that she was a “bad judge of character” who would not be able to distinguish who was or was not safe to express her feelings to. I told Lauren that Simone would view this concern as another potential “see-saw” issue as well, and that together we would try to balance between seeing all people as untrustworthy vs. all people as trustworthy. However, Lauren thought it would also prove to be “extremely extremely hard” for her to refrain from apologizing for and judging her feelings in the first place: “Cause I apologize for how I feel all the time. Even if I’m right to feel the way that I do. I just can’t do it because I’m afraid you know to be angry with people or to have people be angry with me.” In other words, Lauren found herself discounting her own feelings in an effort to avoid conflicts with others (described in the previous section as struggles with excessive openness). Seeing that Lauren seemed to be equating being angry with expressing anger openly to others, I pointed out that while Simone does not judge her own feelings, she does get to choose who she does and does not express them to. This way, Lauren could experiment with balancing out excessive openness (by holding on to her own feelings), while also practicing appropriate discrimination (by keeping them to herself when necessary). By the end of our initial discussion, Lauren understood that Simone was a person who was allowed to have struggles, and who did not necessarily always choose the routes that Lauren found most difficult. For example, in addressing Simone’s approach to men described in the final paragraph of the FRS, Lauren remarked that Simone “wouldn’t necessarily try not to use – like how I’d do that, push people away from me, people I think or know are really good – Simone
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would struggle with that, but she tries not to.” The contradictory nature of her description of Simone (that she allows herself to have struggles while she also tries to work through them) was actually an appropriate understanding of the complexity of the character. I told Lauren that “yes, Simone lets herself have both sides of that struggle.” Lauren smiled and remarked, “I think this will be really interesting. Like I’m excited to do this.” The group who participated in analyzing the data for this participant looked through the transcript of this session for statements that might support or challenge the initial EPCP diagnosis. What stood out at this initial phase was that Lauren immediately identified several of Simone’s characteristics as being in contrast to her own and potentially difficult to enact. This indicated to the group that the sketch had focused in on important problems and presented challenging alternatives. Also of note was the fact that Lauren highlighted speaking her mind and expressing anger as the most immediately apparent difficulties for enactment. In the initial EPCP conceptualization, Lauren’s difficulty in doing these things was linked primarily to constancy issues and secondarily to over-discrimination, excessive openness, and excessive internalization of responsibility. Thus, Lauren’s focus seemed to indicate that these were indeed problems for her. What underscored the importance of constancy to understanding Lauren’s struggles, however, was that the see-saw intervention (which was specifically designed to convey the essence of the self-other constancy process) appeared to increase Lauren’s confidence in being able to enact Simone’s role. For example, her initial hesitation (“I just wouldn’t know how to like bring myself to be her”) gave way to eagerness (“I’m excited to do this”) and visible relaxation following an exploration of a few potential implications of the see-saw metaphor. The next portion of this session was devoted to planning the first fixed role experiment – approaching someone in a position of authority (e.g., a teacher, boss, or supervisor) while in character. Lauren indicated that the only people who filled these roles for her at the moment were professors of the various classes she was taking. When asked who she might have an excuse for talking to in the next couple of days, Lauren indicated that she had been struggling lately in her economics class, and could use this experiment as an opportunity to discuss her struggles with the professor of the class. However, she had never before asked a professor for help, and felt afraid to do so. Her fear stemmed from not wanting to “admit that I do need help,” since she already felt “inferior to everyone else” and didn’t want to look “stupid.” The only approach Lauren had been able to use so far was to send an email to the professor asking him if
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there were other study strategies she could use to improve her test performance. His response (“not really”) had done little to solve her problem. I asked Lauren how she thought Simone might approach the professor. Lauren identified Simone’s struggle to “push herself to new heights by being more open and vulnerable” as potentially applicable in this situation. Lauren described how she would typically approach this situation by slowly putting her things away after class, wanting to talk to the professor but ultimately leaving without doing so. She thought that Simone would be nervous too, but “push herself more to actually go do it.” I agreed that Simone might indeed “feel the fear and do it anyway” under these circumstances. Lauren and I talked about the kinds of things that Simone might say to explain her needs to the professor. Lauren began with the idea of going to him at the end of class and asking him to explain any concepts that she hadn’t understood. Picturing in my head a busy professor who probably had a few minutes after class before another meeting, I wondered if this scenario would be sufficient to meet Lauren’s needs. I also knew that Lauren’s typical response to stress, adopting the plastic flower role, would not allow her to assertively advocate for herself. I asked Lauren if her needs could be satisfied in a short conversation following class, or if she thought she required the one-on-one attention offered during office hours. Lauren readily acknowledged that she needed the latter, but that it would be hard because it involved an extra level of vulnerability that came with openly acknowledging her struggles with economics. Turning to how Simone might approach this dilemma, I suggested that she would think of her professor’s help as Miracle-Gro and evaluate how much she needed right now. When asked to evaluate the extent of her need when it came to economics, Lauren indicated that “it’s great.” After I reminded her that playing the plastic flower role would limit her ability to absorb that nurturance, Lauren decided that Simone “definitely [couldn’t] be a plastic flower” with her professor and still get what she needed from him. By the end of this session, Lauren had decided that Simone was going to go talk with her professor one-on-one during office hours. While she was still feeling afraid, she was going to “push herself” and felt some confidence in being able to carry through on the experiment. In looking at the transcripts from the second half of the session, the data analysis group saw Lauren’s fear of approaching her professor as potentially related to constancy issues. Her assertion that she already felt “inferior to everyone else” pointed to loss of awareness of her strengths and accomplishments, while not “[admitting] that I do need help” served to protect her
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from what she saw as inevitable rejection (which would result from looking “stupid”). Lauren’s tendency to compensate for feelings of inadequacy by reverting to the plastic flower role was evident in her avoidance of needed one-on-one interaction with her professor. This strategy did protect Lauren from the face-to-face invalidation that would be very difficult for her to tolerate. However, it also guaranteed that she would continue to struggle with economics, which would result in continued invalidation in the form of poor academic achievement. It appeared to be helpful to Lauren to consider that her plastic flower role might be failing as well as succeeding in its protective function. Her increased confidence in her ability to “push herself” to talk with her professor by the end of the session suggested that this more evenhanded view was important to her being able to experiment with experience outside of the plastic flower role. Fixed Role Session 2. Lauren returned for the second fixed role session and described her experience of anticipating and initiating a conversation with her economics professor. As she had imagined, she did pack up slowly after class, hoping for an opportunity to speak with him. However, she decided that she could not do it after she saw that there were other students lingering in the classroom as well. When asked what it would be like to speak with him in front of other students, Lauren initially indicated that “it would have been fine. They wouldn’t have cared.” But a questioning look from me brought out the real story: “I think everyone’s gonna listen to what I'm saying and judge me for it.” It was clear from her description of this experience that Lauren had had a great deal of difficulty enacting Simone’s role in this situation. Anticipating the kind of impact that even a judgmental glance from a classmate would have on her self-esteem, Lauren had withdrawn to protect herself. Lauren decided to visit her professor during office hours instead, initially walking away when she saw he was speaking to another student. However, the professor saw her and invited her in, and she waited there while he finished. After the other student left, Lauren shared with her professor her experiences in his class: “I’ve always struggled with economics. It takes me a little longer to grasp it. But I've never done this bad on something before.” At this point, Lauren was feeling very nervous, expecting that the professor would doubt her abilities, further adding to the negative feelings she already held toward herself: “I thought he was totally going to tell me that ‘you should drop the class.’ . . . I was scared. I didn’t want to hear that. I didn’t want to be disappointed. I was already disappointed in myself. Cause I studied so hard for so long. I didn’t want something else.” In her second attempt at this experiment, Lauren’s actions started to look
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more like those of Simone. Though she was scared, she pushed herself to speak openly about her struggles with her professor, as we had discussed previously. However, her internal experience of this portion of their interaction clearly illustrated an underlying struggle with constancy. Given the negative nature of her feelings about herself, discouragement and rejection were the only responses she could imagine receiving from others. In addition, she knew that she would not be able to tolerate this kind of invalidation without losing whatever remained of her self- respect. Thus, while Lauren was acting more like Simone (in terms of increasing courage), she was not feeling like her. Fortunately, Lauren reported that instead of focusing on how badly she had done, her professor actually validated her sense that economics was very difficult, pointed out all of the things she was doing well, and encouraged her to come back and see him anytime she had questions. In response, Lauren felt relieved: “that made me feel so good . . . now I feel like a lot more comfortable.” She had decided that her professor was “understanding” and “nice” and that she would go and see him twice a week if she needed to. Lauren looked hopeful as she described this interaction, and said she felt much less fearful. The group felt that this result was positive in that it gave Lauren the kind of validation that she would need to continue experimenting with Simone’s role. However, her reduced fear and increased hopefulness appeared to have resulted from the particulars of the situation (i.e., the professor having invited her into his office, receiving positive feedback), rather than from a move toward greater self-other constancy. Lauren and I then turned to planning the next experiment, interacting with a friend in the role of Simone. Lauren was planning to spend time with a variety of people over the upcoming weekend, and could not think of “what kind of situation or how to use it for them.” We decided to talk about how Simone might interact with friends in general, as opposed to a specific person, starting with Simone’s struggle between being the plastic flower and being more open and vulnerable. Lauren thought she might start by trying to let the people she met over the weekend get to know her a little bit better: “kinda like open myself up even though it would be opening myself up to the potential of getting hurt.” This way, Lauren thought, she would be sharing more than, “the me that I let everyone see.” Since Lauren had noted that she would be making herself more vulnerable to being hurt, I added that she might have the opportunity to experiment with the final part of the fixed role sketch, potentially having to balance out a desire to push others away in response to feeling vulnerable. Lauren agreed that she would have to carefully consider
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her options when responding to these situations over the weekend: “I could really use that last paragraph . . . learning more about people and then like what am I going to do? Am I going to push them away? Am I going to let myself be open? Am I just going to see where it goes a little?” By the end of the session, Lauren wasn’t feeling nervous like she had been at the end of our previous meeting. Part of the reason for this was that there wasn’t a specific anxiety provoking situation that she was anticipating. She had the flexibility to choose when she would do the experiment. I suspected that the anxiety was still there for her, even though she was not feeling it in the moment. When asked if she might be tempted to ignore opportunities to do this experiment because of the open nature of the assignment, Lauren laughed. Her response: “definitely.” This one word conveyed important information about where Lauren was in the process of learning to inhabit Simone’s role. Her desire to avoid the experiment suggested that Simone’s actions felt alien to and frightening for her. I interpreted her anxiety as a signal that she was not prepared to deal with the potential negative consequences of interacting more authentically with others. The group suspected that the previous experiment had gone well only because she had received unambiguous encouragement and support in response to her increased level of openness. It would be her response to invalidation that would determine how well Lauren really understood Simone’s role. Fixed Role Session 3. Lauren came to this session reporting some distressing troubles that had resulted from her most recent experiment with Simone. Lauren had been talking to her friend Jason over the internet, and in an effort to be more open, had decided to tell him that she found him physically attractive. While Lauren did not feel romantically attracted to Jason, he interpreted her comment as indicating that she did: “And he was just like, I think he took it as I like him. It wasn’t that at all. And so like he was just totally like ‘yeah, you know you’re cool and everything, but you know I guess some people think that I'm just like you know – that there’s more there and there isn’t.’” In other words, Jason knew that he acted in a way that many women interpreted as romantic attraction on his part. Hearing Lauren’s comment through this lens, Jason had attempted to clear up what he thought was Lauren’s misinterpretation of his behavior. Lauren, however, was extremely embarrassed that Jason misunderstood what she was trying to convey, and tried to clarify her feelings toward him: “I’m not saying that I like you or anything. I’m just saying that yeah, you’re a good looking guy and you’re fun to hang around
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with. I don’t want anything more than that.” Jason, apparently confused by this turn of events, tried to figure out what was going on: “[Lauren quoting Jason] What do you mean? You don’t want anything more? What are you talking about?” In looking at this interaction, the analysis group had a few initial observations. First, Lauren had done her best to initiate a more open and honest interaction with Jason. She had acted with a great deal of courage, disclosing something she normally would not have shared, just as we had discussed previously. On the other hand, Lauren appeared to have reversed her tendency to over-discriminate by sharing something especially intimate with someone she hadn’t known for very long. Expressions of physical attraction generally carry a high degree of risk – the other usually feels compelled to respond with an expression of their own feelings (or lack thereof). In choosing this particular disclosure, Lauren had put herself in an especially vulnerable position. The disclosure itself was not necessarily uncharacteristic of Simone, however. Up until this point, the group felt that Lauren had made a risky move, but was still being true to the character. They looked next to how the interaction unfolded after this initial exchange. Lauren reported that, “I’m pretty talkative or whatever, but like after the conversation or whatever where he just totally took what I was saying wrong, I just backed off. I like was barely talking . . . I closed myself back up. It was just like the whole protective thing. I’m not going to get myself hurt . . . I turned back into my little plastic flower.” Lauren, looking sad, reported that she had been “telling myself over and over that it was stupid” to share her feelings with Jason and that she should not have done so. She hated herself and was struggling with a desire to cut herself. Lauren used cutting as a way of not having to “deal with it.” She explained further that “it” included far more than her feelings about this particular situation: “Cause then like, you know, you start thinking about everything, not just like this situation. Oh, I shouldn’t have done that, but like, thinking about everything. Everything that like you’re not happy with or that you have been ignoring or like. Find like … my best way to like not be so like down all the time is to just ignore a lot of stuff. Stuff that bothers me. I just don’t think about it or don’t talk about it. And just push it to the back of my mind. But when something like this happens, it all just resurfaces. I don’t have to but I force myself to think about it all.” The group felt that at this point, Lauren had abandoned Simone’s role and was experiencing a great deal of trouble maintaining self-constancy. Her description of the dichotomy between
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“ignoring” everything and “thinking about it all” implied a split in her experience of herself. Either she thought about none of the negative things happening in her life, or she “[forced]” herself to think about all of them. She clearly reported a very rapid and abrupt alteration of her experience of herself. The situation was having implications far in excess of what it would have had, absent the flood of negative memories and associations that came up for Lauren. Simone, with a sense of self-other constancy, might have been able to acknowledge that she had misjudged the level of safety in her relationship with Jason without doubting all of the other decisions she had made throughout her life. Or, she may have decided that the situation was awkward, but not necessarily a mistake at all. Lauren, however, was not able to construe the situation with this level of flexibility. To her, it was a bad choice and it meant that she was “stupid.” In addition, she could think of nothing other than all of the other events in her life that she construed as “not happy.” Lauren knew of no way to moderate her experience. The only solution appeared to be cutting, which would enable her to “ignore” it all. Without any way to negotiate a middle ground, Lauren’s options were either to completely avoid her experience or allow herself to be completely overwhelmed by an intolerable emotional state. The group also looked at how Lauren was experiencing Jason during this interaction. After their initial interaction, Jason continued to indicate that he liked Lauren and would like to meet with her again soon. She responded by telling him “whatever,” a word she typically used when she was angry, but wanted to avoid openly discussing her feelings. A friend who was observing the conversation told Lauren to stop using this word with him because he was likely to think she was being “mean.” Lauren dismissed her friend’s advice, reporting that the next time she saw Jason she was going to “act weird,” speaking in short sentences and telling him “yeah, whatever.” The group felt that Lauren’s experience of Jason during this interaction pointed toward problems with other-constancy. Lauren’s perception of the level of safety in the relationship changed dramatically in response to a misunderstanding and the awkwardness of subsequent efforts to fix it. In addition, this perception of greatly increased vulnerability and risk persisted despite Lauren’s clarifying the situation and Jason’s subsequent expression of positive feelings toward her. Her decision to completely shut Jason out by acting “mean” suggested a significant reconstrual of him as a person. Her tendency to internalize responsibility in the form of guilt probably prevented these problems from being expressed in terms of derogatory evaluations of
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Jason’s character. At the same time, the feeling of being hurt loomed large, overshadowing all other aspects of Lauren’s experience of him. This interaction also shed additional light on Lauren’s assertion that she is a “bad judge of character.” Up until this point, I had been assuming that Lauren could make clear distinctions between “good” and “bad” people but sometimes deliberately chose to push away the “good” ones. The situation with Jason, however, suggested that Lauren’s ability to distinguish “good” from “bad” was significantly influenced by self-other constancy problems. She decided to distance herself from Jason not because he was “good,” but because in her eyes, he had become suddenly and completely unsafe. He had displayed that he had the capacity to misunderstand her in one situation, and this was enough to make any kind of a relationship with him dangerous. During our meeting, I remarked to Lauren that she seemed to have swung in two very different directions on her “teeter-totter,” sharing something that made her extremely vulnerable and then completely shutting down when it didn’t go well. Lauren acknowledged that she had stepped out of Simone’s character by responding this way, but seemed reluctant to step back into role: “I could just put myself back in Simone’s shoes or whatever and yeah the whole teeter totter thing, but like . . . I could. I know that Lauren would just totally just shut down and back away from it. But I guess I could just put myself back in Simone’s shoes and just . . .” When asked what she thought Simone might do instead of shutting down, Lauren indicated that she would “probably not be that open, like again. Maybe she’d be like not as much of a bitch as I would be.” She thought Simone might even tell Jason that she was upset that he had misunderstood her comments and wanted to “get it straightened out.” However, having decided that “being so truthful isn’t good,” what Lauren really wanted to do was “go back in time” and try out that part of Simone’s character that chooses not to share if she’s not sure how someone will react to her disclosures. In this interaction, Lauren’s statements supported the hypothesis that she struggles with discrimination issues. While she initially may have under-discriminated (i.e., shared too openly) in her conversation with Jason, this appeared to have been an artifact of the experiment itself. She likely would not have done so without my suggesting that she experiment with being “more open” with others. Lauren’s response to the misunderstanding, however, illustrated how she might use over-discrimination as a typical response to stress. In pulling back and sharing less, she denies people the information they need to hurt her. Lauren felt an intense need for this
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protective mechanism in this moment, and wasn’t able to return to Simone’s role despite clear knowledge of how Simone would be handling the situation. The group felt that self-other constancy issues made it difficult for Lauren to take a more moderate and flexible approach to discrimination issues like these. The consequences of invalidation for Lauren (e.g., complete loss of self esteem) impacted her evaluation of the level of risk in her relationships, and discrimination problems followed accordingly. During our meeting, Lauren and I made some efforts to work on these underlying self constancy issues by discussing what Simone’s experience of herself might be like in this situation. For example, for Simone, part of maintaining self constancy was not apologizing for or judging her feelings. In contrast, Lauren reported that she was judging herself for not only having certain feelings, but for her choice to be open about them. She thought Simone would say “they are my feelings and I'm not sorry that I have them – they’re mine whether you’re ok with that or not!” In the moment, however, Lauren could not bring herself to view things from this perspective. Overall, she felt that this experiment was a “learning experience” that she would feel happy about after she was “done with all these feelings.” The group interpreted this comment in terms of Lauren’s report that she avoids her own experience instead of “dealing with it.” With enough time and distance from Jason, her current feeling might indeed fade and take on a rosier glow. However, reframing this situation as a “learning experience” appeared to be a “press release” (Wiersma 1988) Lauren was using to obscure and distance herself from her feelings in the moment. At this point we moved on to planning the next experiment, approaching a best friend in Simone’s role. Lauren’s closest friend on campus, Michelle, was someone that she had only known for a couple of months. However, she felt that they were very similar, “basically like the same person . . . like twins.” Since Michelle was someone who Lauren felt did not “judge” her, she naturally took on Simone’s more open approach with her already. I thought a conversation with Michelle might be a good place for Lauren to continue processing her feelings about the previous experiment. Since Michelle was someone who naturally brought out Simone-like characteristics in Lauren anyway, I thought she might be able to help Lauren get back into role. I suggested to Lauren that she have a conversation with Michelle, letting her know about the feelings that her interaction with Jason had brought up. In addition, I suggested she ask Michelle
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for help in balancing out some of her more distancing impulses. Lauren agreed to try this approach, and thought that Michelle would be willing to help her with these issues. Fixed Role Session 4. Lauren had her conversation with Michelle prior to this session, telling her that she regretted her decision to talk to Jason and wished that she had not “gone out on a limb” so much. Michelle validated her distress, letting Lauren know that she thought she should be “upset” about Jason’s response, and that she herself was “confused” by it. When it came to Lauren’s perception that she had been too open, Michelle disagreed, remarking that Lauren “blew it out of proportion.” Lauren felt both supported by and skeptical of Michelle’s comments, noting that they were the “typical friend response.” Her ambivalence about Michelle’s response echoed her own mixed feelings about what she had done: “I feel kind of like the same about how stupid [I am] for doing it, telling it. But I’m not as harsh on myself about it because I do have that reassurance from my friend that it’s going to be ok, it’s not a big deal.” When asked what was different about approaching Michelle in the role of Simone, Lauren responded that even “[bringing] it up” was going beyond what she normally would have done: “my whole thing is that even though its not true at all, if you say it out loud, it’s real . . . I was a little better as the day went on and . . . I didn’t want to go back to being like totally sad or anything like that.” However, instead of feeling worse, she found that she actually felt a little bit better. In her interaction with Michelle, Lauren fought her impulse to pull away and decided to risk sharing her feelings with another person again. In this situation, she received the support and validation she needed, and the result was a slight improvement in mood. This underscored for the group the essential paradox of over-discrimination – that pulling away protects one from both invalidation and validation equally. While Lauren had been hurt by Jason in the course of attempting more authentic relating, she had also been powerfully affirmed by Michelle. Thus, her typical way of dealing with stress (i.e., to pull away from all people) helped and hurt her at the same time. In addition to using over-discrimination as a way to protect herself from invalidation from others, Lauren indicated that she used it to minimize her awareness of her feelings (“if you say it out loud it’s real”). This statement pointed again to developmental arrest as essential to a conceptualization of Lauren’s presenting problems. Arrests function to suspend meaning making processes around problematic experiences. Lauren’s statements could be reworded to echo
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Kelly’s original definition of developmental arrest: Because I cannot understand this situation in any kind of tolerable way, I am going to pretend it isn’t happening. During our meeting, Lauren and I again discussed how Simone might deal with potential interactions with Jason in the next few days. I wanted her to experiment with balancing her desire to push Jason away with her hopes for a continued friendship with him. Lauren reported that her current plan was “not dealing with it” by pretending it “never happened.” She expected to see Jason at a party over the next weekend, and planned to be “cool” by limiting their conversation to statements like “what’s up?” and walking away. When asked how she thought Simone would deal with this situation, Lauren remarked that she would probably be “nicer” to him in an effort to balance out her needs for safety and closeness: “She does have that whole plastic flower about her . . . not dealing with it really. But at the same time she does allow herself to be a little bit more real about issues.” I agreed, framing Simone’s actions in terms of “correcting, but not overcorrecting” for a level of openness that did not go well. When asked if she had noticed herself struggling with other aspects of Simone’s character over the last few days, Lauren indicated that some recent events had made it difficult to stay in role. She reported that the day before this session, her parents had been scheduled to meet in court to resolve some leftover legal business still pending from their divorce years earlier. When her father did not show for the hearing, the family found out that he had moved out of his house and that his whereabouts were unknown. To Lauren, this meant that she and her brother were probably never going to see or talk to their father again: “my dad’s not coming back – this is it.” Lauren felt extremely hurt by her father’s behavior: “It just hurts so bad. It hurts like caring for someone so much. And it’s one thing to care for someone and then lose them, like a death or something like that. But it’s another thing to care for them and have them desert you.” Lauren reported that she had been crying the whole day before, and though she had her father’s cell phone number, she refused to call it, wanting to shut him out of her life forever. Lauren remarked that this is why she “totally shuts people out of [her] life,” especially men. At the moment, she felt like she “couldn’t take a guy showing interest” in her, and that the moment she found out she would “find a way to push him away – just so he wouldn’t like [her].” Again in this session, Lauren clearly linked her current interpersonal struggles with ongoing problems with her father. This link made sense to the group as well, who felt that Lauren had experienced such powerful abandonments at an early age that trusting anyone had
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become extremely difficult. Her father’s betrayals were unpredictable and persisted over time, a situation that would cause pain and turmoil for any child. At the same time the group felt that they could empathize with Lauren’s pain in this situation, they also wondered if that pain was being aggravated by other-constancy problems. They suspected that Lauren’s current desire to cut her father out of her life forever had a complement – desperately craving a relationship with an idealized version of him. They wondered if Lauren cycled between the two, swinging in opposite directions depending on how much time had passed since his most recent abandonment. In other words, she may, during fairly stable times, fail to fully appreciate his weaknesses, leaving herself especially vulnerable to their effects when they abruptly appear. Having left herself open to a devastating injury, Lauren then vastly alters her approach, vowing never to trust him again. Further complicating Lauren’s relationships during these times are problems with forgiveness, or assuming that “injury in one relationship portends similar injury in all future relationships” (Leitner et al., 2000, p. 193). Men become the universal other (see pages 14-15), all understood solely in terms of their capacity to inflict injury. This may be when Lauren pushes away the “good” men, convinced that eventually they will become “bad.” Because Lauren described all of the above without emotion during this meeting, I asked her if she felt herself being pulled toward the plastic flower role. She did, trying to present a smiling façade that conveyed to others, “everything is ok, you don’t need to worry.” Her experience of playing this role was mixed. On the one hand, she was able to minimize her own distress by ignoring a lot of her feelings: “Like if I talked about it I’d be crying. When I turn myself into that plastic flower, like I’m just about the basics or whatever. Now, just like telling you about it, it’s just like . . . everything is ok, I don’t want to be worried about … that whole thing.” In other words, Lauren was essentially giving me another “press release” version (Wiersma, 1988) of her feelings about the previous day’s events. Anything more resulted in an intolerable overwhelm of emotion. Again, Lauren’s statements suggested the kind of shutting down that characterizes developmental arrest. She fled from what was overwhelming and it reduced her felt sense of distress. On the other hand, Lauren reported that she thought her strategy of avoidance would ultimately lead to even greater distress for her: “when I start acting like that plastic flower or whatever, I know that I fall back into like total depression. Like I just get really hard on myself and really down.” When asked what this critical “voice” sounded like, Lauren replied that it
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would tell her to not “trust people so much,” or “put her whole self into something.” It also told her to get her “stuff done,” and got angry when she lacked the energy or motivation to do so. Thus, in some ways, Lauren was not able to fully suspend meaning making around the issues that felt overwhelming to her. She continued to experience them, but only through extremes of self reproach. The few people who knew what was going on (her mother, brother, and best friend) appeared to recognize Lauren’s critical voice even through her plastic flower façade, and had been comforting her and telling her that her father’s actions were not her fault. Lauren’s reluctance to share her feelings with others, however, was limiting her ability to ask for support from most people. I suggested several things that Lauren could do to get back into Simone’s role that would also help to alleviate some of her current distress. First, I suggested she use the see-saw metaphor as a way of dealing with her feelings about herself, trying to balance out her current pull to focus solely on her perceived mistakes (e.g., trusting too much, not accomplishing enough). I also suggested she use the same metaphor to understand her relationships with men. For example, instead of viewing all men as solely sources of injury, I suggested she remain open to noticing the ways in which the men in her life were being supportive and nurturing of her as well. Not wanting her to construe this suggestion as meaning she should re-engage in a relationship with dad, I reminded her that Simone uses what she knows about men strategically, limiting her relationships with them when it is best for her. At this point, we moved into planning the next experiment, approaching a parent from Simone’s perspective. I suggested Lauren use mom for this experiment, since she was not in a position to quickly reconcile her feelings about contacting her father again. Lauren thought she might use this exercise as an “opportunity” to tell her mom that she was “falling back to [her] depression,” since she had been lying to her mom in response to her questions about it. She had avoided disclosing this to her mother because it might cause her to “worry.” Never giving others cause for “worry” was one way that Lauren psychologically distanced herself from others, and was part of the plastic flower role that Simone was learning to use more sparingly. I thought Lauren’s idea sounded like a good way for her to get back into Simone’s role. Lauren also thought that her mom might be angry with her because she had lied. Though Lauren had spoken previously about her aversion to anger (which was linked to other constancy problems in the original EPCP diagnosis), she did not seem particularly concerned about it in this case. Lauren
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stated that her mom “just gets mad because there’s nothing she can do . . . it’s out of her control.” She thought she might respond by simply “listening to what [mom] had to say.” I thought it was curious that Lauren should be so comfortable with the possibility of her mother becoming angry with her, considering that she appeared to be struggling significantly with self-other constancy issues at the moment. Fixed Role Session 5. Lauren was not able to speak with her mother prior to this session, so we spent the time talking about how Lauren was dealing with the news about her father’s disappearance. She continued to try to “keep [her] mind off things” by staying busy and thinking about “everything else but real problems.” The alternative, Lauren described, was thinking about it to the point where it was “too much,” “tired [her] out,” and “totally controlled [her].” She thought this alternative would probably lead to her thinking about cutting herself. I asked her what sorts of things she would think about that would lead her to feel so overwhelmed. Lauren indicated that shutting down was the preferable alternative to the difficult task of trying to reconcile her conflicting feelings about her father: “I feel bad for hating him because I love him. And I feel bad for loving him because I hate him . . . It’s hard to love and hate someone at the same time. I think that if you love someone, you love them unconditionally and you know good and bad comes with that. But with my dad it’s like two extremes. It’s hard for me to find a middle ground with that.” One extreme that Lauren found herself being drawn to was idolizing her father and “putting him on a pedestal.” Doing this felt like being “stuck” in the place where she was when her father left them originally, acting the part of the little girl who adores the wonderful father who wants nothing more than to be with his daughter. Lauren felt that playing out this fantasy had always left her in a vulnerable position: “I give him the benefit of the doubt to the point where it’s too much . . . And I think that’s when I get hurt a lot . . . I know he’s not someone I should count on, but I still do.” However, Lauren felt herself coming to the point where it was no longer feasible to try to balance out her desire for a relationship with her father with her need to protect herself from being hurt by him: “there just comes a point where like it’s not even balancing really anymore. I’m starting to see kind of that it’s better that he’s not in my life.” Lauren had found that reminding herself that he was responsible for the way he was treating her helped her move away from apologizing for things that are not her fault.
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In this session, Lauren spoke directly to some of the issues that she had only hinted at in the previous session, adding support to some of the hypotheses that the group had generated. She was drawn toward viewing her father from two different extremes, idealizing him at one end and hating him on the other. Trying to stay in the “middle,” where she could acknowledge both love and hate at the same time was very painful, as if each feeling was unacceptable in light of the other. Lauren, like many people with constancy struggles, would choose either love or hate, or suspend meaning making around these issues altogether. It was as if she were saying to herself, I must have one or the other or nothing at all. Lauren’s statements in this session also highlighted her struggles with internalizing responsibility for interpersonal processes. For example, she had to purposefully remind herself that she was not responsible for her father’s actions –letting him take responsibility did not come naturally for her. However, she was actively trying on Simone’s role and found that it was helping her move toward a decision to reduce her father’s role in her life. The group felt that Lauren’s considering this decision constituted improved discrimination for her. Lauren’s reports suggested that she typically under-discriminates in her relationship with her father (i.e., underestimates the risk of continuing in a relationship with him). Interestingly, her father appeared to be the one exception to her overall tendency over-discriminate in her relationships. Next, Lauren and I planned the next experiment, to engage in some kind of religious or spiritual activity in Simone’s role. Because there was nothing specific about this topic built into Simone’s character, I spent some time talking with Lauren about her current spiritual life. I wanted to know if and when self-other constancy struggles were influencing Lauren’s spiritual relationships and then work collaboratively with her to plan how Simone might approach those particular issues. Lauren reported that she was not especially religious, but she did attend a Christian church on a weekly basis. She described her prayer life as having “just a conversation” with God, where she might ask questions like, “why am I going through this?” or “why couldn’t I have a normal dad?” Even though she rarely found answers to these questions in prayer, she would often feel more comfortable “not having the answers and knowing that not having the answers is ok.” When asked if there was something that Simone might do differently in her conversations with God, Lauren indicated that she had a tendency to “put [herself] down” or “judge [herself] too harshly” while praying. Lauren noted that Simone uses feelings of guilt as an opportunity to
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reevaluate her approach to life, and thought she might try replacing her self-recriminations with this sort of activity while praying: “Instead of putting myself down, saying, ‘why am I this way?’ just say, ‘I understand that I do this, but I don’t have to be like – and there’s nothing wrong with me for it, but I don’t have to do this, I can do this instead.’” In other words, Lauren thought she might switch her focus in prayer from berating herself for her mistakes to asking for God’s help in moving forward into a different approach to living. I agreed that this sounded like something Simone would do. Lauren’s statements suggested that struggles around self constancy and excessive internalization of responsibility could be playing a part in her prayer life. While confessions of wrongdoing are an important part of Christian religious practice, Lauren would stay mired in her guilt, trying to figure out why she was “this way.” The alternative, inspired by Simone’s character, was changing her focus from guilt to action. With a constant sense of self, Simone could acknowledge that she wanted to change her behavior without feeling like there was something fundamentally “wrong with [her]” for having acted that way in the first place. Looking back at Simone’s character during our meeting, I also was reminded of Lauren’s tendency to avoid accepting care from others, and wondered if this tendency might extend to her spiritual life as well. When asked about this possibility, Lauren agreed that her ability to be open to acceptance and caring in her spiritual life was limited by how she was feeling about herself in the moment. I suggested that, in addition to talking to God in a way that was more affirming of herself, Simone would listen openly for the wide variety of messages she might get in return. Fixed Role Session 6. Lauren was able to have a conversation with her mother prior to this meeting, so we began by discussing this interaction. While Lauren reported that she had told her mother that she felt herself “falling” back into her depression, she decided not to be “as open with her as like the truth” by not revealing that she had been thinking about cutting herself. Ordinarily, Lauren said, she would not have told her mother anything at all, and would have been “really defensive and really short and [had] an attitude” in response to her mother’s inquiries about how she had been feeling. In Simone’s role, however, Lauren felt more like an “adult,” answering all of her mother’s questions without defensiveness (with the single exception of cutting). While her typical approach usually resulted in her mother “really worrying and stuff and asking all sorts of questions,” this time she found that her mother “just listened,” telling her how much she loved her and that she understood that college could be very difficult. Lauren,
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who reported that she was always afraid that her mom would “be disappointed in me or judge me or not be happy with me or what I do,” was very relieved to hear her mom tell her that she loved her “unconditionally.” Overall, Lauren felt that while she had anticipated that approaching mom from Simone’s perspective would be very difficult, she discovered that it was not as hard as she expected it to be: “I make everything seem worse in my mind. I always expect the worst. I’m always, ‘oh, it’s going to be horrible.’” Lauren reported that this experiment had “reinforced” for her what she had “always known” – that her mom was a source of support for her and that she does not “judge” her. At various points throughout their reading of this intervention, the data analysis group had suspected that Lauren had difficulties in her relationship with her mother that could be linked to constancy problems. This session was no exception. First, Lauren’s fear that her mother would “judge” her or be “disappointed” in her was reminiscent of the concerns that led to her suicide attempt several years before. (Again, the original hypothesis was that Lauren experienced “disappointment” as a global loss of love and support from mom.) Her typical way of dealing with these fears (i.e., being really “short” and having an “attitude”) is an interpersonal style often used to cope with constancy problems. Lauren used this style, captured by the attitude “if I am distant and uncaring enough, you cannot hurt me” (Leitner et al., 2000, p. 183) to protect herself from the anticipated emotional pain of losing mom’s love and support. The group found the interaction between Lauren and her mom during this experiment revealing as well. In particular, they were interested in the possible implications of mom’s choice to specifically state that she loves Lauren “unconditionally.” They asked themselves what kind of interpersonal dynamic might create a need for an overtly stated, unequivocal and unambiguous expression of affection. Usually, these sorts of statements are made to reassure someone who is uncertain or insecure within the relationship. In addition, they are made to convey that various mistakes, weaknesses, and faults will not destroy the other’s commitment to them. Thus, the group felt that mom’s expression of “unconditional” love may indicate that she has also witnessed Lauren struggling with other-constancy problems. Concerned about Lauren’s ability to tolerate anger and disappointment and still feel secure in their relationship, her mother chose to provide messages of unconditional support. Because these kinds of messages are not likely to trigger self-other constancy issues, Lauren is able to feel secure and supported in that particular moment.
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Overall, Lauren was able to successfully portray some aspects of Simone’s character. She did act in spite of fear (increasing courage) and made a more accurate assessment of the risk involved in relating more openly with her mom (decreasing over-discrimination). However, because mom had expressed such unambiguous support and encouragement, the group felt that Lauren did not have the opportunity to directly experiment with self-other constancy issues. Lauren did experience a reduction in distress following this experiment. However, they were not able to reach a clear consensus about what role, if any, improved constancy may have played. Lauren also had spent time praying in Simone’s role, initially putting herself down in the conversation, but then stopping herself and changing focus. For example, Lauren had been feeling bad about the fact that she had started drinking since she came to campus. While her prayers typically had included statements like, “why am I such a bad person?” Simone spoke from a more moderate position: “I know I’m not a perfect person, and I know that I’m not a bad person, but … you know there are just some things that I need help like working on.” While Lauren didn’t feel any “huge” or “immediate difference” in her feelings about herself or her experience of connection with God, she did think that asking more “affirmative questions” was something that would be good for her in the long run. In the moment, however, she did feel somewhat more “upbeat” noting that “you’re not walking away from the situation still thinking, ‘oh, I’m such a horrible person.’” The group felt that Lauren did an excellent job portraying Simone’s character in this final experiment. She had acknowledged responsibility for behavior that she wanted to change, but she refrained from slipping into global self-recriminations. She was neither “perfect” nor “bad,” but something in the middle. She had approached her prayer from a position of greater self constancy, and apparently felt that this was a positive change for her. Post-intervention discussion (FR session 6). Following our discussion of the sixth fixed role experiment, I asked Lauren to look back over the past two weeks and evaluate her experiences with the character of Simone. When asked about aspects of Simone’s character that made her feel more or less hopeful about life, her relationships, or the future, Lauren indicated that she thought the “see-saw” metaphor was an approach to life that she felt positively about: “you can’t go to either extreme, but you should try to even things out. Like I see that as being more hopeful and everything. Especially when it comes to relationships for me. Instead of like totally pushing people out of my life . . .” Thus, from the beginning, Lauren affirmed the
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helpfulness of the see-saw analogy, which was designed as a metaphor for self-other constancy. In this particular passage however, Lauren appeared to be using the see saw metaphor to describe the general process of ROLE relating. For example, she had found that it was more helpful for her to balance out her needs for closeness and distance, instead of just “totally pushing people out of [her] life.” The group interpreted this as an indication that the basic premise of EPCP (i.e., that psychological distress is related to excessive retreating from intimate relationships) had been helpful to Lauren. Lauren reported that there was nothing in Simone’s approach that made her feel less hopeful about relationships. However, I was curious at this point about how Lauren was dealing with her feelings about Jason, as their interaction had sparked some intensely negative feelings for her. Lauren reported that she had talked to Jason since that time, and that “things [were] fine” between them. She was still “hard” on herself about her choice to be so open with him, but not as much as she had been before. She had been trying to think about the situation from Simone’s perspective: “Things don’t go right all the time and you have to put yourself out there. And you do make mistakes, but it isn’t life threatening. It isn’t going to kill you. It might hurt for the moment . . .” While she did feel less hopeful in the moment due to the outcome of her choices, she ultimately believed that it was a “good idea for me to just do something I normally wouldn’t have done.” Lauren addressed a variety of diagnostic issues in the course of the above conversation. In stating “you have to put yourself out there,” she again suggested that she had been retreating excessively from relationships, and felt that evening out that trend was a positive change for her. The group felt that her next sentence (“You do make mistakes, but it isn’t life threatening”), described struggles around self constancy. The implied opposite of her statements (i.e., mistakes will kill you) summed up the typical manifestation of these problems in Lauren’s life. In other words, when she would make a mistake, it would fundamentally alter her sense of self. Lauren’s stating that she could make a mistake without this happening may indicate a move toward greater self constancy. I also asked Lauren about aspects of Simone’s character that made her feel more or less connected to the people in her life. While remarking that the process of role playing in general involved a degree of artificiality that felt disconnecting at times, Lauren felt that there was nothing about Simone herself that left her feeling disconnected from others. On the contrary,
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approaching relationships with the image of the see saw in her mind helped her move toward connection with others when her natural tendency would have been to move away from them: “My one extreme is just totally like coming away from everything and ignoring things and like not dealing with it. There is that see saw . . . that makes Simone feel more connected to people.” The interaction with her mother was the one experiment that had left her with the greatest feeling of increased connection. Ironically, Lauren reported that the experiment with Jason, which resulted in a loss of connection in the moment, ultimately left her feeling closer to him than before. In risking being more open with him, Lauren was able to test out a major assumption she held about the effects of openness on relationships: “I think that when I'm open with people, they will use it against me. Or just like totally they’ll back away from me. And with him, the way I kind of felt more connected was that he didn’t do that. Like I saw that like he doesn’t do that or like not everyone does that when you are open.” During this part of our discussion, Lauren addressed struggles around discrimination and forgiveness. Her sense that “openness” could be dangerous had led her to “come away from everything,” over-discriminating in her relationships to protect her self from that danger. At the same time, that tendency had left her without the opportunity to observe that not all relationships involved the same amount of risk. Choosing to risk during these experiments had given her that opportunity. In addition, the group wondered if Lauren’s belief that people will use her openness against her was a reference to her experiences with her father. She had previously indicated that expressing her feelings (e.g., of anger) openly to him would result in his abruptly terminating their relationship. The group was convinced that this was a likely possibility, given her description of his previous behavior. However, expecting similar behavior from all people indicated that Lauren struggled with issues of forgiveness. In this experiment, Lauren directly challenged the applicability of the constructions she had created in the context of her relationship with her father. She was beginning to consider that there might be better ways to understand her other relationships, possibly a move toward improved forgiveness. Overall, Lauren felt that Simone’s character “just kind of like became like a part of me in a way.” She thought that adopting Simone’s approach to life would probably decrease her feelings of depression, so that it would not be “as rough as it is now.” But she also thought that it would be hard for her to stay in the “whole see saw thing” because she had become so good at
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hitting “either end” throughout her life. If she were able to maintain Simone’s approach, however, she believed it would leave her more “confident” and with “better self esteem.” During the course of the experiment, the group had the impression that Lauren had, at the very least, an intellectual understanding of the Simone character. However, they ultimately wondered to what extent Lauren actually felt like Simone during these experiments. Did she embody or experience this character? The above conversation shed some additional light on this issue. Lauren’s assertion that Simone had become a “part of [her]” suggested that she felt a sense of embodied connection to the character. However, in stating that adopting Simone’s approach would result in her life being not as “rough as it is now” she implied that she was not currently approaching life from Simone’s perspective. Lauren acknowledged that she had been approaching relationships a certain way for a very long time, and given this history, staying in Simone’s role continuously would be very difficult. Overall, it seemed that she had gotten a good enough sense of the role to suspect that it offered some positive opportunities for change. At the same time, she didn’t feel equipped to effect those changes currently. Beck Depression Inventory/SCL-90R. Lauren completed the BDI-II again following her final fixed role session. She scored a 22, slightly lower than her initial score of 28, but still in the “moderate” range of depression. There were several areas where she showed the greatest reduction in symptoms (decreasing each score by 2) over the previous two weeks, including: punishment feelings, indecisiveness, and loss of interest in sex. There were also several areas where she showed slight improvements (reducing her scores by 1), including: past failure, loss of pleasure, guilty feelings, self-dislike, self-criticalness, and agitation. However, she did report somewhat more (increasing her scores by 1) sadness and crying. She also experienced a shift in physical symptoms. While previously she reported having normal energy levels and sleeping and eating less than usual, at this session she reported loss of energy combined with increased sleep and appetite. It would be difficult to make definitive interpretations of the meaning of changes on individual items on this questionnaire. Speculatively, the significant decrease in “punishment” feelings could indicate a lessening of Lauren’s tendency to internalize responsibility (i.e., blame herself for things). A general pattern of answers suggesting improvements in self esteem appears to support this speculation. Overall, a comparison of Lauren’s two BDIs indicates slight improvement in depressive symptomatology following her participation in the fixed role experiments. It may be notable that Lauren experienced these improvements during a period of
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time when she was faced with some difficult stressors – including one (her father’s disappearance) that may be linked to the original trauma underlying Lauren’s developmental arrest. The group suspected that Lauren’s partial understanding of the fixed role character allowed her to process these events without the increase in symptomatology that typically followed them. In other words, her modest decrease in symptoms, given the circumstances, might actually reflect significant progress. Lauren also completed the SCL-90R a second time. Her original responses showed elevated levels of interpersonal sensitivity, paranoia, depression, psychoticism, and obsessive compulsive behavior. On this day, however, Lauren earned elevated scores only on measures of depression (t=70) and obsessive compulsive (t=65) symptomatology. These two scores matched the ones she earned previously. The biggest reduction in symptoms was in the area of interpersonal sensitivity, which dropped from an elevated score of t= 76 to an unelevated score of t=62. While Lauren originally reported that she was “extremely” bothered by seven of the symptoms on the checklist, she did not use this description for any of the symptoms at this administration. Of the seven “extremely” troublesome original symptoms, two were eliminated completely (loss of sexual interest or pleasure, feeling uneasy when people are watching or talking about you), one was reduced to “moderately” problematic (feeling that people will take advantage of you if you let them), and four, while lessened, still bothered her “quite a bit” (feeling that most people cannot be trusted, blaming yourself for things, trouble concentrating, never feeling close to another person). Overall, Lauren’s responses on the SCL-90R also indicated significant improvements following the fixed role experiments. Her biggest improvements were in the interpersonal realm. Because the “interpersonal sensitivity” scale includes items assessing the degree of fear and anxiety surrounding interpersonal interactions, it seems possible that her scores here reflect reductions in Lauren’s tendency to over-discriminate in relationships. Again, this interpretation is offered speculatively, as I did not ask Lauren to elaborate on how she was construing these questions or how she had gone about choosing her answers. Final Feedback Session. At this session, over a week after the previous one, I shared with Lauren the results of the questionnaires she had completed, noting that there were several symptoms that seemed to have improved since she first filled them out. Lauren agreed with this assessment, despite that fact that events had transpired during the course of the fixed role
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experiment that had made her life “a lot worse.” One thing that stood out for her was that she had developed a greater sense of confidence: “My confidence is changed . . . I’d be more willing to talk about stuff and like bring stuff up with people or confront more people than I would.” The experiments that had “good outcomes” (like the one with her mom) had left her with the sense that “there’s nothing to be scared of,” while the one with a “bad” outcome (the experiment with Jason) had reminded her that even when things don’t work out well, “you’re still like, it’s ok.” At this point, I provided Lauren with both an oral and a written explanation of the interpersonal issues that I thought might be at play in her experience of depression, as well as how these hypotheses went into creating the Simone character. The following is the written version that Lauren received: “Simone Davis was created as a way for you to experiment with several things I thought might be related to your experience of depression. First, you appear to be struggling to maintain an awareness of all of the different parts of you at once. When you feel hurt by others, you experience yourself as completely worthless, focusing on all the mistakes you have made and losing touch with all of the things about you that are truly beautiful. Your way of dealing with this pain has been to swing in the other direction, convincing yourself and others that you are all smiles and that everything is wonderful. Simone was designed to be a woman who was able to integrate all of these different facets of you at once. Simone understands that the “plastic flower” part of you is essential in protecting you from being hurt, but she also recognizes that playing that role too often prevents you from feeling truly connected with others. At times, you starve yourself of the very thing you need to grow and thrive in order to protect yourself from being hurt. Simone’s approach was designed to help you experiment with a more balanced approach to openness and vulnerability with others. One of the most difficult things about swinging back and forth between extremes is that it makes it hard to form meaningful relationships with other people. If you experience yourself solely in terms of your failures and weaknesses, it becomes difficult to recognize and accept caring and affection from others. You may reject people who truly seem to care about you because you cannot understand why they would feel that way about you. (This can also protect you in a way from having to become even more vulnerable with people.) On the other hand, if you are all smiles and pleasantness, it becomes difficult for others to know you fully and value
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you for all of your complexity. Without feeling truly connected to the important people in your life, you are vulnerable to feeling especially devastated when you are hurt. Like you, everyone struggles in some way with how open and vulnerable they should be with others. Your tendency is to allow your fear of being hurt to overwhelm your need for intimate connection with others. Sometimes, withdrawing or playing the “plastic flower” is the safest thing to do when you are dealing with a person who continually hurts you. However, when you are dealing with someone who truly cares about you, playing this role can hurt you by depriving you of a meaningful connection with that person. For example, your tendency to hide your anger from the people who are closest to you prevents them from knowing you fully. They may actually be more likely to hurt you in the future because they don’t know what you need. Anger is something that can strengthen or weaken relationships, and also something that can enhance or inhibit your own personal growth. Your tendency has been to focus on its potential negative effects, which could be contributing to your feelings of depression. Sometimes, if you don’t know what kind of person you are dealing with, it can be difficult to judge how open you can be without getting too hurt. Sometimes you will misjudge someone and get hurt in the process. This is a part of courageous living and it happens to all people who let themselves take risks! It is ok to respond to being hurt by pulling back and sharing less at times. Your tendency however, has been to judge yourself harshly for having risked, or for having the feelings that you chose to share. Sometimes, being invalidated by someone means that you need to reevaluate or change some aspect of yourself – and sometimes it does not. You depression seems to be related to a tendency to assume the former (i.e., that there is something wrong with you and that you need to change). In summary, your depression seems to result from struggles with two related “see-saw” issues. The first is a tendency to view yourself solely in terms of your weakness and failures while forgetting about all of the other parts of you. The second is a tendency to withdraw from intimate connections with others by picking fights or by playing the “plastic flower” role. When you feel particularly depressed, you may want to look for ways in which one or both of these see-saws have “hit bottom” and need to be rebalanced.” I asked Lauren for her reaction to these ideas, and to address whether they seemed to fit with what she knew about herself. Lauren reported that she agreed with “all of it,” and then focused in on several specific things that stood out to her. First, she agreed strongly with the idea
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that she “judges” herself when she is hurt. The term “judge” was used in the above document to describe the hypothesis that Lauren struggles with a tendency to internalize all responsibility for interpersonal conflicts. Though Lauren said very little about this topic, her choice to mention it suggests that this diagnostic construct was meaningful to her. Moving quickly into a second, related area, Lauren reported that just as she judges herself harshly for her own feelings and choices, she also allows most others to judge her as well: “I even remember who said ‘no one can make you feel inferior without your consent.’ Yeah, I give everyone my consent. That’s my problem.” This quote, from Eleanor Roosevelt, poetically captures the essence of the EPCP construct of experiential openness. People who are optimally open make strategic choices about whether or not they will reconstrue when invalidated. They usually protect their most core meanings from the daily whims of passing strangers, reconsidering only when faced with the carefully considered opinion of a trusted friend. Lauren, however, confirmed the hypotheses that she struggles with excessive openness, allowing a wide variety of people to invalidate her on a regular basis, regardless of the level of trust and closeness in their relationship. The most important aspect of this assessment to Lauren, however, was the idea that her depression is related to swinging back and forth between extremes. Lauren felt that this offered a novel and accurate description of what she went through on a daily basis: “That whole plastic flower concept and the Miracle Gro [is a new way of looking at things for me]. Not just like those metaphors and stuff, but that whole like how I am. Just like one extreme and then, like needing to balance that out . . . and like the whole teeter totter thing . . . you have no idea how much that’s helped me a lot. It really has.” Using the “teeter totter” metaphor offered Lauren a sense of hope that something could help her overcome her feelings of depression. Before she began thinking about her struggles in this way, Lauren felt that she “wouldn’t know how else to deal with [feeling depressed], or how else to change it.” Now, however, she felt like she had a “guide” she could use to move herself in the right direction: “it helps you come up with different ways for you to change how you feel based on like how well the balance is.” Lauren and I concluded our conversation by turning to the topic that was a subject of some debate in the initial case conceptualization – to what extent discrimination issues explained Lauren’s assertion that she was a “bad judge of character.” As described previously, I had been operating under the assumption that Lauren could tell the difference between the people who would be “good” or “bad” people to form relationships with. However, I also thought that
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swinging back and forth between extremes sometimes made it difficult for her to use this ability in the traditional way (i.e., to surround herself with people likely to be supportive and avoid problematic relationships). One of my goals in this session was to describe this particular interpretation to Lauren, and see if it fit for her. When I initially suggested that she might be a decent “judge of character,” Lauren reported that this idea was “hard for [her] to like really grasp.” However, when I stated that her pattern of consistently pushing away the “good” people and keeping the “bad” people around suggested that “you know the difference and that you’re making a choice,” Lauren brightened and laughed, stating “now I see it!” Having established that discrimination was not the best diagnostic construct for understanding this particular interpersonal pattern, I wanted to test out my hypothesis that self constancy issues offered a better way of understanding what was going on. My interpretation was that during those times that Lauren lost awareness of her “good” side, any affection, support, or encouragement from another person would feel invalidating, while the opposite would validate her views of herself and feel more meaningful for her. This process might lead to consistently choosing “bad” relationship and rejecting “good” ones. I presented this idea to Lauren, asking her if she ever found herself being “suspicious of why someone would like [her] and accepting it when they don’t.” This sounded immediately familiar to Lauren, who reported that she does this “all the time.” Of course, in retrospect, it also seems possible that Lauren saw the people she consistently rejected as “good” only because she never let them close enough to eventually feel hurt by them in some way. Though I did not get a chance to ask Lauren about this particular possibility, it is a likely manifestation of other-constancy problems. Following our meeting, and after further analysis, I developed an additional hypothesis regarding Lauren’s assertion that she is a “bad judge of character.” People with self-other constancy problems, due to their tendency to experience anything inconsistent with love and support as indicative of globally “bad character,” may feel that their judgments of others are regularly in error. When evaluations of others regularly undergo rapid and major alterations, it is very easy to begin to think of oneself as a bad “judge” of people. Someone without a constancy problem may conclude that they misunderstood intentions or misread a particular aspect of someone’s personality when something unexpected happens. However, without a sense of the constancy of others, events typically seen as minor imply the need for a radical reconstrual of the other. If this happens frequently enough, a person may start to question his/her ability to
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accurately evaluate others. In other words, other-constancy problems necessarily involve difficulty seeing others in all of their complexity and accurately anticipating their actions. This is, for all practical purposes, the definition of problematic discrimination. In this sense, Lauren was a “poor judge of character.” For example, Lauren felt that she was a “bad judge” of Jason’s “character” because she construed a temporary empathic failure on his part as indicative of a global lack of safety in the relationship. This interpretation seems to fit this particular situation better than a tendency to purposefully push away “good” people. Certainly in this situation, Lauren did not experience Jason as “good.” Thus, it seems that there are several different ways of understanding Lauren’s experience of being a “bad judge of character,” all of which can be linked to struggles around self-other constancy.
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Discussion The aim of this study was to examine the usefulness of the EPCP theory and diagnostic system for conceptualizing recurrent depression. In the first section of this paper, I outlined the potential connections between one particular diagnostic construction – self-other constancy – and symptoms of chronic depression. I then recruited participants with long-standing struggles with depression, and through interviews and self-characterization sketches, arrived at an EPCP diagnosis for each. Since self-other constancy (in combination with related struggles within the EPCP diagnostic system) seemed the predominant clinical issue for each, I then asked them to spend two weeks experimenting with approaching life from a position of greater self-other constancy. The purpose of these experiments was to examine the relationship between depressive symptomatology and struggles with self-other constancy. In witnessing their approaches to these experiments, as well as their reactions to the events that then transpired, I described how, over time, self-other constancy struggles interacted with depressive symptomatology. It was not necessary for participants to successfully portray their fixed role characters in order to examine the usefulness of this diagnostic system. In general, where Alan and Lauren struggled to portray or understand their fixed role characters (i.e., experience self and other as constant), their feelings of depression increased. For example, during the (fourth) session where he was most depressed, Alan stated that he “despaired of doing anything as Robert” (see page 67). Similarly, Lauren felt most depressed during her third session, where she abandoned Simone’s role by “[turning] back into my little plastic flower” (see page 110). For both, abandoning the role went hand-in-hand with increased distress. When they were successful in enacting the role, however, they felt better. Alan experienced what he called a “different kind of calm feeling” when (as Robert) he was able to view the mother who had treated him poorly with a sense of compassion (see page 78). Lauren also felt better when (as Simone) she was able to non-defensively approach her mother with the understanding that mom’s anger typically reflected feelings of concern and helplessness (see pages 117-118). Both Alan and Lauren not only felt better during these sessions, they experienced greater connectedness with others. There were times, of course, when degree of mood disturbance did not correspond with degree of success in portraying the fixed-role character, particularly when positive external events (particularly, validation from others) occurred while the participant was struggling significantly with understanding his/her character.
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Alan, for one, started feeling better before he was even introduced to the Robert character. This change appeared to be related to the validation he received during his first few interviews. I will examine this particular confound in more depth later. In the following discussion, I first take a look at Alan and Lauren’s experiences to see what they in combination suggest about the most and least useful ways of understanding chronic depression within the EPCP diagnostic system. Second, I look at the strengths and weaknesses of the system itself for understanding depression. As part of this discussion, I will share some of the struggles I have observed in both myself and others as we attempted to understand these concepts and apply them to clinical problems. Third, I examine the implications of this study for therapeutic intervention with depressed persons. This study was not intended to provide empirical validation for a particular therapeutic approach (e.g., fixed role therapy). However, certain interventions that I used with these participants could be usefully incorporated into a variety of therapeutic approaches. Finally, I will examine some of the limitations of this study and suggest ideas for future research. Alan and Lauren: An integration of results For both participants in this study, self-other constancy was the most useful lens (within the EPCP diagnostic system) through which to view their particular struggles. While Alan and Lauren were different in many obvious ways, the underlying struggle with constancy can be seen as a unifying theme. The various manifestations of constancy described in the introduction portion of this paper (all or none construing, identity confusion/guilt, internalizing/externalizing, compensatory behaviors, relational disconnections, and suicide) were all important aspects of Alan and Lauren’s experiences. Thus, I organize the following discussion of their cases according to those original categories. In addition, because there are a variety of explanations (other than constancy) for the above problems, I offer some differential diagnoses and suggest ways of distinguishing when and where those problems point to constancy versus something else. This section should make clear why, among multiple explanations, struggles with constancy best explained Alan and Lauren’s experiences. All or none construing. Alan and Lauren’s constancy problems often manifested as a tendency to understand both self and others in all or nothing terms (see pages 10-12). When under stress, they construed their worlds using the extreme poles of constructs (e.g., smart- stupid, worthwhile-worthless), rather than developing more complex and nuanced constructions.
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In addition, single experiences resulted in an apparent chain reaction of “slot” (Kelly, 1955, p.128) changes where one polarized construction would trigger another until all experiences were construed in similarly monolithic ways. They would lose awareness of other experiences that were inconsistent with these polarized views. The most potent examples of all-or-none construing for Alan and Lauren occurred during those fixed role sessions where they had just experienced what most people would consider a minor invalidation. For example, Alan reported a significant increase in feelings of depression at his fourth fixed-role session following some car troubles, while Lauren reported a similar exacerbation of symptoms in her third fixed-role session following a misunderstanding with her friend Jason. Alan and Lauren both described quite eloquently the kinds of processes characteristic of all-or-none construing. Both found that one invalidation triggered memories of other invalidations, which triggered memories of still others. Alan referred to this process as “adding up my circumstances,” while Lauren phrased it in terms of “[forcing] myself to think about it all . . . about everything, not just like this situation.” For them, it was incredibly difficult to moderate one negative experience with memories of other, more positive ones. A typically minor invalidation was followed by a flood of images of similar incidents, triggering a rapid reconstrual of both self and others. The sessions where they demonstrated the greatest degree of polarized construing were also the sessions where they experienced the most distress. For example, following the stressors above, Lauren thought about cutting herself and Alan could not leave the house. From an external perspective, the degree of distress was in excess of the precipitating event. What connected the precipitant to the resulting level of distress was the all-or nothing manner in which that event was construed. Thus, moderating this tendency toward all-or-none construing was an important part of reducing symptomatology in response to stress. Polarized construing is a relatively common phenomenon. Flagrant examples of this kind if thinking abound in the political arena, where debate is often polarized into conservative and liberal camps. Conservatives accuse those who question governmental policies of being unpatriotic, while liberals accuse fiscal conservatives of not caring about the poor. This kind of polarized thinking is usually not linked to self-other constancy problems for obvious reasons. Discourse like this is socially sanctioned on a large scale and often is used strategically to persuade or obscure. Alternatively, it may reflect lack of exposure to (or willingness to consider)
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alternative viewpoints. What most clearly distinguishes polarized construing due to constancy problems is the rapid reconstrual of self and other in response to even minor changes in experience. Alan and Lauren’s internal experience of their worlds changed in fundamental ways with little provocation. In contrast, those who construe politics (or any other topic) in polarized ways rarely relinquish their ways of viewing the world so easily. Metaphorically, those with constancy problems experience themselves as alternately conservative or liberal depending on whatever aspect of their experience is accessible to them in the moment. Those with (non constancy related) polarized construing will construe themselves and others in extremely monolithic but unchanging ways. In other words, it appears to be the relative consistency of one’s constructions that tends to differentiate the two groups. Future work could explore these proposed differences more specifically – it may be useful to determine if there are additional criteria that may distinguish polarized construing in people with and without constancy struggles. Identity confusion and guilt. Alan and Lauren also reported experiences consistent with a sense of identity confusion. Lauren was able to be most articulate about her struggles around identity issues: “I have no idea who the heck I am . . . I just don’t know what I expect of myself or what I want of myself.” She experienced such frequent changes in her behavior and approach to relationships that she could not identify overarching moral beliefs or personal goals. While Alan did not articulate a sense of identity confusion, he acted it out in terms of disorganized descriptions of his thoughts and experiences (particularly in his fourth fixed-role session). The extended process of writing the self-characterization sketch (where he was essentially asked to answer the question: who are you?) also illustrated his difficulty arriving at a succinct and organized understanding of himself. Statements like Lauren’s require some ability to evaluate oneself over time – a skill that is difficult to maintain during the extreme swings of self-other constancy problems. Thus, it seems likely that people with self-other constancy problems will make statements like hers only in periods of relative calm. When people are in the midst of experiencing themselves in an extremely polarized way, it becomes much more difficult to make ambiguous statements like “I don’t know.” Thus, the ability to even articulate identity “confusion” could be a positive prognostic sign. Self-other constancy is only one of the issues that can result in a sense of identity confusion, which can be part of a normal adolescent developmental process or result from a habitual avoidance of introspection. Or, it can be a sign of a more serious disturbance such as a
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developmental arrest at the level of self-other permanence. There were several reasons why Alan and Lauren’s identity confusion appeared to be linked to constancy, rather than to any of these other issues. Both appeared to have an enthusiasm for introspection, and did not typically avoid addressing the question of identity or engaging in critical self analysis. In addition, neither Alan nor Lauren seemed to struggle with self-other permanence. People with permanence problems cannot maintain an awareness of their existence when faced with the reality of the other. They often experience an absence of self in addition to confusion about its nature. Finally, Alan was beyond the age where adolescent identity crisis offered a sufficient explanation for his struggles. Lauren, however, at the tail end of adolescence, was probably struggling with some developmentally normative issues around identity. It is really only in evaluating the entirety of her case that one can infer the influence of self-other constancy struggles on her sense of identity confusion. Future research may want to examine the normal development of self-other constancy throughout childhood and adolescence. Currently, there is no research within EPCP to suggest a developmental timetable for the acquisition of this ability. Adolescence may be a time when many young people naturally struggle with constancy issues. The concept of developmental arrest does not apply at those ages where the ability cannot reasonably be expected to have formed. Future work in this area may help distinguish those adolescents who are successfully working toward establishing self-other constancy from those who may need intervention to assist them in overcoming a recent developmental arrest. I linked experiences of pervasive guilt to self-other constancy problems in my initial conceptualization of depression, and Alan and Lauren both reported experiences consistent with this portion of the theory. Pervasive guilt feelings can reflect inordinately strong links between peripheral and core construing (see pages 12-14). Consequently, changes along peripheral dimensions trigger changes along core dimensions – prompting pervasive feelings of guilt (defined as “dislodgement from core role” (Kelly, 1955, p. 502). It should be noted that Alan and Lauren didn’t always use the word guilt when describing this experience. Often, they talked about being “worthless” or “stupid” or expressed a general sense of self loathing or hatred. However, they both reported changes in peripheral construing that had profound implications for their most basic sense of self. Lauren, for example, reported that feelings of utter worthlessness are triggered by “small things” that she doesn’t even “care about.” Similarly, Alan reported feeling “bad about myself” for days after a small event like being cut off in traffic. Both clearly
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articulated the disconnect between the apparently trivial (i.e., peripheral) construction of the original experience and the significant impact it had on fundamental evaluations of the self (i.e., core). There were times when both would make small mistakes or expose minor flaws and yet feel so guilty (or worthless, or stupid) that they became extremely depressed. Not all guilt is associated with constancy issues. There appear to be two ways to distinguish guilt associated with constancy problems from other kinds of guilt. First, I may feel guilty in acknowledgement of the ways that I have retreated from or injured others. I may feel guilty for not living up to my potential or violating my own moral standards. I may even do this repeatedly and so feel guilty a great deal of the time. All of these experiences of guilt involve my violation of my core role. However, if I have a sense of self constancy, I feel guilty only when my actions deviate from my core role. I may change along peripheral dimensions without risking my core. In contrast, people without self constancy may feel overwhelming guilt for more peripheral violations. Second, people with constancy problems experience their flaws as defining them entirely, not as parts of them. If guilt reflects my being unable to access those parts of me that do not deviate from core role, then I have a constancy problem. If, however, I can feel guilty for one action while simultaneously maintaining awareness of the other ways my actions are consistent with core values, then I am experiencing normal guilt. Future research may want to specifically examine the experience of guilt in those with and without constancy problems to evaluate the usefulness/accuracy of these proposed distinguishing characteristics. In the course of this analysis, I realized that I had left anger, the flip side of guilt, out of my initial conceptualization. If pervasive guilt results from a polarized understanding of the self, intense anger may result from polarized understandings of others. (I am assuming here that the polarized constructions are negative, since we are dealing with the topic of depression. Positively polarized constructions of self and other could lead to affective experiences associated with mania). Alan, for example, described the feeling of “hanging fire” that resulted when he became aware that someone was trying to “get away with” something. If one’s experience of another is limited to whatever base desire or intention they are exhibiting in that moment, furious anger is the likely result. Alan’s description of his experience as “hanging fire” conveyed the qualitative difference between this kind of anger and the anger everyone experiences in response to interpersonal injury or threats to core values. This kind of anger has the power (like fire) to
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destroy, leading to Alan’s fear that if he “let it go” he would hurt someone. Someone without constancy problems may experience intense anger as well, but will not lose awareness of aspects of the other that are caring, loving, or otherwise inconsistent with their hurtful behavior. Internalizing/externalizing. Alan and Lauren’s experiences highlighted the usefulness of the internalizing/ externalizing construct for understanding the experience of depression. Alan demonstrated both internalizing and externalizing tendencies: “Anything happens around me, a part of me is always saying, did I do something? . . . Then the anger comes.” Lauren seemed to lean toward internalization in most cases: “I always think it was something that I did.” For Alan and Lauren, externalization often was linked to loss of other constancy, while internalization was often linked to loss of self constancy. For example, when Alan received inquiries from a textbook editor about the status of his revisions (see fixed role session 2), he lost all sense of their interest in and valuing of his work, construing the situation solely in terms of anger and disapproval: “they didn’t like the work I did . . . they’re pissed at me for being late.” He then externalized responsibility for the problem, deciding that they were inappropriately “putting the pressure on me.” Alan ultimately discovered that this was a defense against the opposite tendency, which was to lose all awareness of the quality of his own work and attribute the “pressure” to his own failings. When Alan (as Robert) made efforts instead to acknowledge the quality of his work, and saw that the editors appreciated it as well, he no longer felt the need to externalize (by blaming the editors for the “pressure”) or internalize (by blaming himself for temporarily putting the project aside) responsibility for this situation. He could see the contributions of both sides and accept them without feeling excessively guilty or angry. Internalization and externalization can reflect problems with responsibility but not constancy. People who blame external events for personal gain or to avoid punishment may be aware of their own contributions to problems (unlike those who externalize secondary to constancy struggles) but unwilling to acknowledge them. Someone may truly believe that another is solely responsible for a particular problem, yet that person does not necessarily struggle with constancy – unless blaming reflects an inability to simultaneously experience that other as caring, etc. Similarly, blaming the self may not be related to constancy unless this reflects loss of awareness of other parts of the self. For example, a person may construe his/her marital problems as “all my fault” without believing he/she is a bad person in general. Alan and Lauren’s experiences did not appear to fit any of these exceptions. When they blamed others,
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that other was all bad. When they blamed themselves, they were all bad. Their discounting of one or the other side of the person-environment dynamic was preceded by a loss of awareness of parts of self and other. Compensatory behaviors. Alan and Lauren engaged in a variety of compensatory activities to cope with (or forestall) loss of self-other constancy. As I described in the introduction, they did make attempts to be perfect (e.g., Lauren’s acting like a “plastic flower”) and/or force others to be perfect (e.g., Alan’s “engineering” conflicts) to avoid threats to a fragile sense of self-other constancy. As long as neither they nor others deviated from a perceived ideal, Alan and Lauren maintained a sense of affective stability. They displayed other interesting coping mechanisms that I did not initially anticipate. Lauren, for example, developed the philosophy that “if you say it out loud, it’s real” to limit her awareness of experiences that would upset her. Alan adopted a communication style characterized be extreme verbosity, as if operating under the assumption if I explain myself well enough, you will agree with/love/admire me. While Lauren and Alan had apparently opposite approaches to the use of language (Lauren would say less while Alan would say more), both used these strategies to avoid threat. Interestingly, there seemed to be a link between internalizing versus externalizing tendencies and the chosen method for dealing with interpersonal attachments. Lauren (who tended to internalize), adopted an interpersonal style captured by the attitude “if I am nice enough, you will love me.” Alan (who tended to externalize), approached others with the attitude “if I am on my guard and powerful enough, you will not betray me” (Leitner et al., 2000 p. 184). Their compensatory behaviors seemed adequately suited to the particular struggles they experienced. It seems unlikely that a person who tends to externalize would choose to adopt the “if I am nice enough” approach, and vice versa. It is possible that those without constancy struggles could present with mild versions of these attachment styles or interpersonal strategies. They reflected constancy problems for Alan and Lauren because they served the compensatory function – they were designed to minimize exposure to those situations that could not be tolerated without loss of constancy. If a person can give up the strategy and still construe self and others in consistent ways, these tendencies may reflect a less severe problem. Future research may want to explore this possibility more specifically. If problematic attachment is not always associated with structural arrest, then it may be more appropriate to move this issue from (EPCP’s) Axis I (where it is currently) to Axis II.
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Relational disconnections. There were a variety of ways in which Alan and Lauren experienced disconnections in their relationships with others. Ironically, it was their efforts to secure those relationships and themselves from perceived threats that led to many of these disconnections. For example, what the practicum class found most distancing about Alan in his self-characterization sketch was his heavy-handed emphasis on his achievements and abilities. Alan used his “superman” character in an effort to get people to like and admire him, as he could not imagine them doing so in the absence of this volume of information. Alan did not trust that others could accept and value him for both his strengths and his weaknesses, and therefore made efforts to flaunt his accomplishments and hide his insecurities. However, the class reported that they found it difficult to relate to him for precisely this reason – they found it too difficult to see the person behind the list of accomplishments. Alan struggled with understanding that “superman” had this particular drawback, as it seemed so vital to securing the relationships Alan desperately wanted. Instead of friends, however, what Alan actually attracted was either admirers or skeptics. Lauren too made efforts to present to others what she thought most likely to gain their affections. She either adopted the “plastic flower” role (acting nice and bubbly and taking care of others), or she acted the part of the “floozy” (flirting and otherwise playing up her physical attractiveness). In each role, she managed to form relationships with others without fully revealing herself to them. In seeking friendships, she settled for acquaintances; in seeking love, she settled for lust. Because they could not tolerate interpersonal difficulties without losing a sense of the constancy of self and other, neither Alan nor Lauren could risk being truly authentic in their relationships. The roles of “superman,” the “plastic flower” and the “floozy” all provided some basis for relational connection while also protecting Alan and Lauren from intolerable threats. In other words, they withdrew from authentic interaction with others in order to minimize their experience of invalidation. Whatever is revealed is subject to evaluation and censure; however, what remains hidden is protected from such threats. For those with constancy problems, it is essential to protect one’s core from even the most minor threat. When that core is not adequately protected, the experience of self and other is altered radically, often in very painful ways. Thus, relational disconnection may seem a necessary evil to those with constancy problems.
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All people have ways of retreating from authentic connection with others. We all experience terror, or the threat of invalidation that accompanies efforts to engage in ROLE relationships. This is the foundational premise of EPCP, and therefore, relational disconnections characterize every aspect of the diagnostic system. So when does retreat signify a constancy problem, versus something else? A good rule of thumb is to evaluate the level of threat involved in authentic interaction, and the implications of any subsequent invalidation. All people experience invalidation as painful, and will avoid it to varying extents when possible. For those with constancy problems, the terror is greater, and the devastation caused by invalidation more acute. (Of course, people with an arrest at the level of self-other permanence will experience an ever greater level of threat within relationships.) If one stands to lose all sense of the goodness of self or other in response to invalidation, relational disconnection reflects constancy struggles. If what one is avoiding is the potential for pain, but not the inevitable reconstrual of one’s entire world, then constancy does not explain one’s relational struggles. People with constancy problems retreat to reduce intolerable threats. Those who have established constancy retreat to avoid what is painful and uncomfortable, but nevertheless tolerable. Alan and Lauren’s fears of connection reflected the former. Suicide. I had limited opportunity to explore the proposed conceptualization of suicide described earlier. None of the participants in this study was currently suicidal as this was a criteria for exclusion from the study. However, Lauren did describe a suicide attempt that occurred several years earlier. This attempt was rooted in Lauren’s fear that her mother would “kill” her following a minor car accident. It seemed quite useful to conceptualize this fear in terms of struggles around other constancy. When confronted with her mother’s anger, Lauren would lose her felt sense of connection and closeness with mom. Rather than experientially lose mom, she tried to kill herself. In other words, suicide was a way for Lauren to protect her connection with her mother. If suicide can be used as a means to forestall loss of other-constancy (and thereby maintain a significant relationship), it seems likely that it can also be used to forestall loss of self-constancy (and thereby maintain a preferred view of self). In fact, one of the other participants in this study described entertaining serious thoughts of suicide in response to a less than optimal (e.g., B) performance on a test than was about to be reflected in a mid-term grade. Her rationale for suicide (“I don’t deserve to live”) reflected both loss of self-constancy and a desire to eliminate awareness of any further evidence of her failure or badness. While she
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did not follow through on her thoughts, they did motivate her to do extremely well in the future. Lauren’s impulses to cut seemed to serve a similar function – to limit awareness of experiences that were too painful to construe. With her focus on physical pain, she was given reprieve from processing information that would lead to a loss of self or other constancy. This strategy apparently only worked at certain levels of awareness, as it seemed to temporarily reduce, but not eliminate, feelings of depression. Complicating factors Overall, these two cases clearly illustrated the intimate connection between struggles around self-other constancy and recurrent depressive symptomatology. However, there were several circumstances where the relationship between depression and constancy was more complicated. For example, there were multiple occasions when Alan and Lauren did not appear to have a solid grasp of self-other constancy, yet – due to fortunate events – experienced temporary relief in feelings of depression. Interpersonal validation seemed to be the most significant factor influencing this reduction in depressive symptomatology. Lauren felt better after her interaction with her economics professor because he validated her perception that the material was difficult, and suggested that she could still do well in his class. If he had suggested, instead, that the material was easy, or that she might not be able to do well, she would likely have swung back to thinking of herself as “stupid,” increasing feelings of depression again. The importance of validation in reducing symptomatic distress for people with structural arrest cannot be overstated. People who lose all sense of competence and worth the moment they become aware of having a small difficulty may feel fine as long as the world around them colludes with their efforts to suppress awareness of those difficulties. When they are affirmed, they may experience nothing but the ‘wonderful me,’ resulting in improved mood, but not necessarily improved constancy. The strategies that people use to compensate for a lack of self-other constancy are, at times, successful. Alan, for example, made purposeful efforts to “present [his] credentials” to me during our initial meetings, and felt better once he was convinced that I was regarding him as an accomplished professional. I listened attentively to his stories and expressed interest in the papers and newspaper articles he brought with him to his sessions. As he grew to trust that I would not challenge his reports of these accomplishments, he felt more confident and secure. Had I not expressed interest, or conveyed skepticism about his reports, Alan may not have
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experienced the degree of symptomatic relief that he reported. It is my suspicion that his dramatically reduced BDI-2 and SCL-90R scores reflect (at least in part) the relative success of his compensatory activities in his interactions with me. It can be difficult to distinguish symptomatic improvements that result from unambiguous validation from those that result from a radically new way of construing self and other. True improvements in constancy are much easier to identify when a person successfully negotiates an ambiguous or invalidating interpersonal interaction. Longitudinal data can be helpful in determining the meaning of symptomatic improvements. Those that are due to interpersonal validation will not be maintained over time, as eventually circumstances will arise that challenge a fragile sense of constancy. This was apparently the case for Alan, who entered into long-term psychotherapy following his participation, despite his dramatic symptomatic improvement. There was one other area where the relationship between constancy struggles and level of depressive symptomatology was difficult to ascertain. This occurred when the participants described both constant and inconstant ways of understanding their relationships during the course of a single session. For example, in his sixth fixed role session, Alan had significant struggles construing organized religion in a constant manner. In that same session, however, he described how he had integrated his feelings of anger at his mother with a felt sense of compassion for her – the clearest example of good other-constancy in the entire course of his fixed role experimentation. It was clear that Alan felt less distress when he was describing his mother than when he was describing his attitudes toward religion. In this way, the expected association between self-other constancy and feelings of depression was still evident. However, it appeared that Alan’s ability to experience his world as constant could change with the particular relationship or situation he considered. This happened independent of interpersonal validation – Alan did not interact with either his mother or a representative of a religious organization. The same interesting juxtaposition occurred in Lauren’s experiences of her mother versus her father in her fourth fixed-role session. During that session, Lauren described how she was experiencing her father in terms of extremes of love and hate. At the same time, she was able to explain her mother’s potential anger at her (i.e., for lying about her depression “coming back”) as the result of feelings of helplessness – a much more nuanced construction of mom than she had used in previous sessions. Just like Alan, Lauren expressed more distress when describing the
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person/situation she could not experience as constant than she did when she was describing the person she could. Thus, struggles with other-constancy can be person/situation specific, and severity of depressive symptomatology may vary throughout a single day depending upon the specific context in which the person finds him/herself at any moment. This phenomenon suggests an extension of current EPCP theory may be in order. Leitner et al., (2000) propose that those frozen in a transitional state (e.g., who have partially developed constancy) may experience their worlds as constant during periods of calm, but lose this ability when under stress (see pages 5-6). This seemed to be the case for both Alan and Lauren. What their experiences also demonstrate, however, is that general level of life stress may not fully explain the variability in meaning-making processes at a micro level. It is unclear at this point what exactly led to Alan and Lauren’s ability to experience their mothers in a more constant manner in these sessions. Clearly, they both had significant trouble doing so with these very same people in the past. Predicting with whom or in what particular interpersonal situation a person is likely to show spontaneous improvement in self-other constancy seems, for the moment, out of reach. Future research could examine what specific factors influence the extent to which people frozen in transitional stages might spontaneously experience self and other as constant. Finally, it seems important to acknowledge that evaluating both depressive symptomatology and degree of self-other constancy was complicated by what participants were aware of and willing to report. In their own ways, both Alan and Lauren were motivated to present as less distressed and more competent than they actually felt. Alan’s dramatic efforts to play the part of “superman,” as well as Lauren’s quietly assuming her “plastic flower” role obscured portions of their internal experience during our interactions. Alan had a strong need to be admired, while Lauren had a strong need to please. What better way to gain the admiration of (or please) a researcher than to report dramatic symptomatic improvement (Alan) or insist that “you have no idea how much [this experiment] helped me” (Lauren)? In addition, the data analysis group was charged with the task of determining to what extent Alan and Lauren embodied the spirit of their fixed-role characters. This required the ability to distinguish cognitive (e.g., I know what this person should feel) from emotional insight (e.g., I have lived this person’s experience) into the character. While we felt we accomplished this task, it is more difficult to infer experience than to evaluate self-reports at face value.
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Theory – forward progress Links between axis one and three. Perhaps the most illuminating part of looking at Alan and Lauren’s cases was in the way they clarified how the experiential (axis three) components of EPCP diagnosis can be subsumed by issues of structural arrest (axis one). Within this system, a diagnosed structural arrest is considered the primary clinical issue, despite the inevitable presence of co-existing issues on axes two and three. (Axis three issues are primary only in the absence of a structural arrest.) Although this theoretical point has been made before, the reasons for it never have been sufficiently elaborated in the case of self-other constancy. Why is it useful to conceptualize constancy issues as primary? How exactly do constancy issues lead to problems on Axis three? How can we best explain the connection between the two? Alan and Lauren’s experiences clearly illustrated how self-other constancy problems can result in struggles with the experiential components of the diagnostic system. For example, both Alan and Lauren struggled with (axis three) issues of discrimination. While Alan typically under-discriminated (by sharing deeply personal information with relative strangers), Lauren typically over-discriminated (by keeping her “innermost feelings” from most people). Underlying these disparate tendencies for both Alan and Lauren, however, was an acute vulnerability to invalidation. Neither could sustain a sense of worth or value in the face of even minor challenges to their self-esteem. Given this vulnerability, Alan and Lauren both experienced interpersonal interactions as fraught with incredible danger. In response, they came up with creative ways to minimize the threats that they were unable to tolerate. For each, discrimination problems actually served as a protective mechanism, forestalling threats to a tenuous sense of self worth. Alan indiscriminately shared a sympathetic version of his personal story to others in a desperate attempt to win their support, preemptively defending himself against feared attack/invalidation. Lauren kept her “innermost feelings” to herself, affecting an invulnerable persona, thereby depriving others of any information that they could use to either validate or invalidate her core. They used two very different strategies, but both had the same goal – to eliminate challenges to a tenuous sense of self-other constancy. Neither could be expected to give this particular coping strategy up without first being able to moderate the impact of invalidation on his/her perception of self and other. Alan and Lauren actually had quite similar diagnostic profiles on axis 3. I have reproduced the tables highlighting their particular areas of struggle below:
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Diagnostic Axes of Human Meaning Making - Alan Developmental- Interpersonal Experiential Structural issues components components Self vs. other Undispersed Dependency Discrimination Self-other permanence Excessively dispersed dependencies Flexibility Self-other constancy Dependency avoidance Creativity (Attachments) Physically distancing self Responsibility Psychologically distancing self Openness Commitment Courage Forgiveness Reverence Table reproduced from Leitner, Faidley, & Celentana (2000).
Diagnostic Axes of Human Meaning Making – Lauren Developmental- Interpersonal Experiential Structural issues components components Self vs. other Undispersed Dependency Discrimination Self-other permanence Excessively dispersed dependencies Flexibility Self-other constancy Dependency avoidance Creativity (Attachments) Physically distancing self Responsibility Psychologically distancing self Openness Commitment Courage Forgiveness Reverence Table reproduced from Leitner, Faidley, & Celentana (2000). Both Alan and Lauren struggled in the areas of discrimination, responsibility, forgiveness, and reverence. It is ambiguous at this point whether this overlap is due to 1) coincidence, 2) diagnostic bias, or 3) or some inherent connection between these issues and self- other constancy or depression. The first possibility could be addressed in several ways. A larger scale quantitative study could be used to examine correlations between self-other constancy issues and each of the experiential components. Alternatively, a qualitative study could explain the concept of constancy to someone struggling with those issues and ask them to discuss the ways that issue might reveal itself in each experiential component. Diagnostic bias is another important consideration. Certain issues on axis three may be easier than others to understand and identify. Discrimination and responsibility, for example, seem to be most clearly delineated from other diagnostic constructions, and thus may be more reliably diagnosed. This is also an issue that can be explored empirically. Researchers could ask
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clinicians to read the concepts and rate them in terms of clarity and ease of use. A case vignette study could determine how consistently clinicians use the concepts to diagnose actual clinical problems. There are a few reasons why the four experiential components mentioned above might have especially strong links to self-other constancy problems. For example, problems with discrimination are likely results of struggles with other constancy. As I described previously (see pages 130-131), people who cannot see others in terms of a complex web of different (i.e., both positive and negative) attitudes, beliefs, and actions will have difficulty evaluating the impact that those attributes with have on the possibility of meaningful connection. Idealization of others may lead to underestimation of the risk of relationship, while devaluation may lead to overestimations of risk. Furthermore, in order to reliably “construe the differences between two people” (the definition of discrimination – Leitner et al., 2000, p. 188), one must experience self and others as stable, consistent entities. Otherwise, the “differences” between them will seem to be constantly shifting. Thus, it seems likely that struggles with self-other constancy would result in discrimination problems. For similar reasons, struggles around responsibility are likely to follow from problems with self-other constancy. A person who functions optimally in this area understands that within relationships, self and other share responsibility for the meanings that are created within their interaction. People without self-other constancy are especially prone to negating one side or the other in this complex dynamic. When someone loses all sense of the goodness of others it becomes very difficult for them to consider their own contributions to the interaction. Alan, for example, described a tendency to become “completely irrational,” furiously yelling at someone for some minor slight. Due to his intensely negative experience of the other, Alan was unable to consider the contributions that his own fears and insecurities played in how he chose to construe that person’s actions. Conversely, losing all sense of one’s own goodness makes it very difficult to consider the contributions of the other. Lauren, for example, could focus only on how much of a mistake it was for her to trust Jason with her feelings in her third fixed-role session. Had she also been able to experience this as a courageous move (i.e., construe her actions in both positive and negative terms simultaneously), she might have been able to also consider Jason’s contributions to (or responsibility for) the misunderstanding. In sum, any highly polarized understanding of self or
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other makes it difficult to fully consider the many intricacies of interpersonal interaction. With a limited understanding of these many factors, one cannot experience optimal responsibility. Forgiveness (“reconstruing self and other, such that major invalidations are not allowed to hinder the development of future ROLE relationships”) also is unlikely in cases where invalidations have been severe enough to lead to structural arrest. One does not experience structural arrest without being subjected to major invalidations (i.e., trauma). If major invalidations are not hindering the development of future relationships, then a person cannot truly be said to have a structural arrest at all. Both Alan and Lauren had identifiable traumas in the interpersonal realm (childhood physical/emotional abuse and parental abandonment, respectively) that they clearly linked to their current relational struggles. They did not experience the people who had wounded them so deeply (a parent, in both cases) as constant. For example, Alan described two very different constructions of the father who had abused him. One version of dad was a victim who would “[beat] himself” in response to self-hatred, while a second version was simply “vile, evil . . . and hateful” – a person with no redeeming qualities whatsoever. Lauren was able to describe the “two extremes” of loving and hating her father. She made efforts to try to reconcile these extremes, but found this so painful that she tried not to think about the issue at all. Both Alan and Lauren expected the injuries they experienced with their fathers would be repeated again in future relationships. In a way, they were. Lacking other-constancy, they experienced any current injury as equal in intensity to the original trauma. Alan approached his current relationships with the intention of winning the admiration that he was never able to receive from his father. Similarly, Lauren acted like a “floozy” to get the love and attention that she never received from her father. Without a sense of the constancy of others, however, they never felt admired or loved for very long. They quite literally experienced the same interpersonal traumas that led to the original structural arrest over and over again. To expect someone with self-other constancy struggles to approach their relationships as if that were not going to happen would be unrealistic. Reverence (“affirming the core role processes of another”) is another experience that self- other constancy problems may preclude. In order to affirm the core of another, one must fully appreciate the depth and complexity of that person. Without experiencing the other as constant, one can merely idealize (i.e., selectively affirm the loving, caring parts of) that person, never
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truly appreciating them for who they are. Similarly, without experiencing the self as constant, one may only accept reverence from others during periods of perceived perfection. Both Alan and Lauren struggled to accept that others were willing to revere them despite their flaws. Alan expected rejection from his law journal editors in response to his delays, while Lauren expected ridicule from her professor in response to her struggles with economics. They could not revere themselves despite these flaws, and it took significant work for them to begin considering that others may be able to do what they cannot. I have described the interplay between these four experiential components and self-other constancy in order to examine the premise that issues of structural arrest are primary and subsume other struggles within the system. These concrete examples better illustrate what has been, until this point, an abstract theoretical point within the published literature. While Alan and Lauren shared struggles around discrimination, responsibility, forgiveness and reverence, we cannot infer that the remaining experiential components are any less likely to follow from self- other constancy issues. It is possible that constancy struggles, in combination with distinct combinations of difficulty within axis three, might result in a different symptom pictures. For example, one of the participants I did not describe in this paper presented with a combination of recurrent depression and significant social anxiety. Her struggles with self-other constancy manifested in terms of an obsessive-compulsive adherence to routine and familiarity that suggested problems with creativity and courage. Unfortunately, an exploration of all of the possible links between varied symptom pictures and specific experiential components is beyond the scope of this paper. Theory – unanswered questions Perhaps one of the most difficult aspects of learning and using the EPCP diagnostic system lies in differentiating diagnostic constructs with similar themes. Leitner et al. (2000) state that these concepts are not meant to be independent and mutually exclusive. Rather, they are interconnected lenses through which one can view the client’s struggles. However, the very nature of their interconnectedness may make it difficult for clinicians to decide which lens is the most useful way to view a particular struggle. The axis II construct of psychologically distancing self is a prime example. This issue captures the objectification of others resulting from viewing relationships as a way to “solve a particular problem, [or] meet a specific need” (Leitner et al., 2000, p. 187). However, there are ways in which all of the other clinical issues within this system
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reflect a process of psychologically distancing the self from others. This is the bedrock premise of the theory – that psychological distress can be conceptualized in terms of the variety of ways that people distance themselves from others. Often, the “specific need” that the person seeks to meet is simply validation. Leitner et al. (2000) argue that the “mutual subjectivity inherent in ROLE relating [is] sacrificed for a safe pseudo-connection” when one is psychologically distancing oneself from others. This is an excellent point, but one that applies to many of the diagnostic constructs in the system. Quite often during the process of data analysis, some member of the group would identify psychologically distancing self as a potential clinical issue, then make a confused remark such as “what axis was that on again?” and flip through the original descriptions to clarify the actual definition of this problem. Usually, what resulted was them coming across some other diagnostic construct that more clearly conveyed the interpersonal process of concern. You may note that psychologically distancing self was not identified as part of either Alan or Lauren’s EPCP diagnoses. This was not because the concept did not apply in either case (it did), but because other diagnostic constructs had more detailed and specific descriptions that made them stand out as distinct clinical issues. There are other areas of the diagnostic system that have similar kinds of theoretical overlap. For example, the research group had difficulty deciding whether it was more useful to view certain patterns through the lens of dependency or discrimination concepts. Undispersed dependency (i.e., depending on a limited number of others to affirm core meanings) can be indistinguishable from over-discrimination (i.e., using any difference between self and other as a reason to limit intimate relating.) Similarly, excessively dispersed dependency (i.e., depending on a large number of people to affirm core meanings) appears to be equivalent to under- discrimination (i.e., willingness to form intimate relationships with almost anyone). If there are subtle differences between dependency construing and discrimination issues, they have yet to be adequately elaborated. As it currently stands, discrimination appears to be the construct that is easiest to understand and use in clinical practice. While Alan and Lauren could be seen as struggling with dependency issues, the data analysis group seemed to prefer conceptualizing these issues in terms of discrimination problems. The reasons for this preference are unclear, and could be an interesting subject for future research.
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Within axis three, flexibility (i.e., the ability to entertain alternative constructions of experience) seems to be the construct with the most potential for being confused with other experiential components. The terms flexibility and openness have similar colloquial meanings, and so these two diagnostic constructs are likely to be used interchangeably for this reason alone. However, they share some similarities beyond their traditional meanings that contribute to this possibility as well. For example, one manifestation of flexibility involves “suspending one’s meanings around an issue to see another’s” (Leitner et al., 2000 p. 189). One would have to engage in this process in order to be willing to “reconstrue when invalidated” – the definition of optimal openness (pg, 191). If one cannot see another’s meanings, one is unlikely to reconstrue one’s own. In Lauren’s case for example, I found it difficult to determine if her tendency to “take things [people say] so literally” was best understood as excessive flexibility or openness. She very quickly suspended her own meanings to see those of others (i.e., flexibility), and then immediately reconstrued when those meanings invalidated her own (i.e., openness.) Since both basically described the same process for Lauren, picking one seemed sufficient for the purpose of designing an appropriate intervention. Another manifestation of flexibility problems – “bringing the same set of construals to every relationship” (p. 189) – is reminiscent of the definition of problematic forgiveness – assuming that “injury in one relationship portends similar injury in future interpersonal relationships” (p. 193). Problems with forgiveness may involve inflexibly applying past constructions to present circumstances. Thus, in some cases, problems with forgiveness may be mistaken for problems with flexibility. Both Alan and Lauren were diagnosed with problems around forgiveness because they were able to link a specific past invalidation to their current relational struggles. Those who cannot do so may be more likely to be diagnosed with flexibility problems instead. The diagnostic overlap within the EPCP system does not cause insurmountable problems when attempting to clearly conceptualize clinical problems. Each component, though listed separately, was never intended to be viewed as independent of the others. However, there may be helpful clinical ideas contained within the system that are diluted because they are not sufficiently elaborated. Future work on the diagnostic system could entail developing clearer descriptions of the above diagnostic components, perhaps using additional clinical examples.
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Research could examine the subjective clarity of different versions of the diagnostic descriptions, and then provide some measurement of subsequent diagnostic reliability. Intervention In this study, I used fixed role interventions as a research tool to examine the applicability of a theory to a clinical problem. In other words, the interventions were a means by which to explore EPCP and depression, and were not intended to be the focus of analysis themselves. I do not believe that fixed role therapy is an ideal or even a sufficient form of treatment for either recurrent depression or self-other constancy problems. These issues are too complex and too long-standing for such a time-limited intervention. In addition, as I have shown, the relative severity of these problems varies in response to daily events. It is thus very difficult to determine if changes are enduring if the intervention lasts only a few weeks. At the same time, the experiments described in this paper do suggest some principals that could be useful in clinical practice. Axis one comes first. As described previously, EPCP theory considers axis one issues primary and links other struggles within the system to this underlying structural arrest. Thus, issues of structural arrest should be the primary focus of intervention. The importance of focusing on self-other constancy was made clear during those times when my focus shifted to secondary issues. For example, in preparing Lauren for her second fixed role experiment (with a friend), I focused on how Simone would balance her tendency to play the part of the “plastic flower” with her desire for more intimate relationships. While Lauren noted that this would leave her more open to being “hurt,” I did not explain how Simone might internally experience self or other in the aftermath of such invalidation. Instead, I focused on the importance of her continuing to moderate her use of compensatory mechanisms (i.e., the plastic flower role). Essentially, I asked Lauren to avoid her typical way of coping with constancy problems without first helping her deal with the constancy problem itself. The subsequent interaction with Jason was the result. Looking back, I do not believe the Simone sketch itself incorporated enough information around maintaining self constancy, other than noting that Simone does not “judge herself too harshly for her mistakes.” While we did address this issue in the sessions themselves, it was unfortunate that it was not incorporated more fully into the actual sketch. Any issue that results from a constancy problem – or serves as a way to cope with it – cannot be meaningfully resolved without first addressing self-other constancy itself.
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Therapeutically speaking, people with struggles limited to the experiential realm (i.e., axis three) can be directly challenged to even out their preferred tendency. However, for people like Alan and Lauren – who cannot tolerate minor invalidations without losing a sense of self-other constancy – such a challenge could prove detrimental. To risk authentic relating with others is to make oneself vulnerable, and vulnerability is an entirely different beast for those with and without self-other constancy problems. Truly risking oneself in a ROLE relationship with another requires some modicum of perceived safety that is absent for those without self-other constancy. It is not safe to be truly authentic with another when the slightest hint of annoyance, anger or disinterest will destroy a felt sense of connection to that other. Before challenging someone to interact with others in a new way, it is helpful to address how they experience self and other when those interactions are not unambiguously positive. At the same time, it may be difficult to experiment with new ways of being if one is never faced with a situation one is not fully prepared to handle. Progress on these issues is not likely to occur in an interpersonal vacuum. For example, even though Lauren was not fully prepared to deal with what occurred between her and Jason, she nevertheless came to conclude that “you do make mistakes, but it isn’t life threatening” – a statement that came from a place of greater self constancy than she had in the immediate aftermath of the interaction. It seems that Lauren had to make mistakes before she could learn that they did not have to be all-consuming. Thus, while it is important to consider whether someone can tolerate a risk before encouraging them to take one, important work can still be accomplished in the aftermath of perceived disaster. Increasing self awareness. This study offered participants a perspective through which they could view and understand the function of their symptoms. Both participants reported that this was very helpful to them. This benefit need not be specific to EPCP conceptualizations of depression. Simply having some structure that can serve to organize chaotic experiences can provide a sense of hope and possibility for the future. Having a helpful way of understanding one’s experiences suggests avenues for growth. As Lauren noted, “it helps you come up with different ways for you to change how you feel . . . [beforehand I] wouldn’t know how else to deal . . .” The participants in the study would often react to their experiences in ways that were quite different from their peers. Their reactions didn’t always make sense to them. Sometimes, when they did have a way of understanding their actions, that understanding did not prove to be helpful to them. Alan, for example, knew that his felt need to prove himself to others was related
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to his family’s refusal to acknowledge his accomplishments. However, he could not understand why his efforts were not working. What seemed to be helpful for participants in this study was 1) identifying the interpersonal strategy they were using, 2) understanding how it functioned to meet their needs, and 3) seeing how/why it also failed to meet other needs and/or compounded the problem. All were essentially challenged to answer the question: what are you trying to do with this strategy, and how is it working/not working to way you envisioned it? Regardless of the theoretical perspective of the clinician, simply assisting a person in answering this question in some comprehensible way seems to be extremely important. Balance. One of the guiding principals behind the creation of the fixed role sketches in this project was to acknowledge and honor who these participants were, while simultaneously challenging them to do something new. The fixed role characters were specifically created to be – as Alan pointed out – “more me than not.” This was a purposeful decision based on the particular clinical issue that these participants were confronted with. The problem of self other constancy can be most simply summed up as a tendency to experience self and other as one thing or its opposite (and nothing in between). Thus, it seemed prudent to avoid engaging in this same process when creating the fixed role characters by having them embody “too many opposites” (Alan) of the participants themselves. Instead, these characters incorporated aspects of Alan and Lauren’s current approaches to relationships while simultaneously suggesting ways to balance out those tendencies. They were not asked to give them up, but to use them more flexibly and purposefully. Lauren did not have to completely give up being the plastic flower, and Alan did not have to completely give up being superman. Everybody has their ways of retreating from others, and it is not always a bad thing to do so. Epting & Nazario (1987), as well as Viney (1981) have suggested that it can be useful to employ the perceived “opposite” approach when constructing fixed-role characters. I believe that the participants in this study would have found this approach particularly threatening, and that it would have paralleled the problem they were struggling with. (Future studies may want to empirically explore this hypothesis by asking people with constancy problems to enact the “opposite” approach and comparing their experiences to those of Alan and Lauren.) The problem was not them sticking too rigidly to one preferred pole of a construct, but alternating rapidly between the two. There were times, for example, when both Alan and Lauren interpreted their fixed role characters as if they were their opposites. Lauren decided to reverse her tendency
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toward over-discrimination and share something quite risky with Jason in an effort to be more “open.” Alan started engaging in “emotionless analysis” in an effort to adopt Robert’s attitude of “curious contemplation.” For all people, efforts toward change occur along the dimensions (constructs) available to them. For those with constancy problems, initial efforts toward change may involve significant amounts of slot rattling, or jumping to the perceived opposite approach. Thus, it may be important for clinicians anticipate this possibility and plan to intervene when this occurs.
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Neimeyer, R.A. (1984). Toward a personal construct conceptualization of depression and suicide. In F.R. Epting & R.A. Neimeyer (Eds.) Personal meanings of death: Applications of personal construct theory to clinical practice. New York: Hemisphere Publishing Corporation. Neimeyer, R.A., Klein, M.H., Gurman, A.S., & Greist, J.H. (1983). Cognitive structure and depressive symptomatology. British Journal of Cognitive Psychotherapy, 1, 65-73. Neuringer, C., & Lettieri, D. (1971). Cognition, attitude, and affect in suicidal individuals. Life threatening behavior, 1, (2), 106-124. Neuringer, C. (1967). The cognitive organization of meaning in suicidal individuals. Journal of Consulting Psychology, 76, 91-100. Neuringer, C. (1961). Dichotomous evaluation in suicidal individuals. Journal of Consulting Psychology, 25, (5), 445-449. Osgood, C.E., & Walker, E.G. (1959). Motivation and language behavior: A content analysis of suicide notes. Journal of Abnormal and Social Psychology, 59, 58-67. Pierce, D. L., Sewell, K.W., & Cromwell, R. L. (1992). Schizophrenia and depression: Construing and constructing empirical research. In R.A. Neimeyer & G.J. Neimeyer (Eds.) Advances in personal construct psychology, Vol. 2. Greenwich, CT: JAI Press. Rowe, D. (2003). Depression: The way out of your prison. (Third edition.) New York: Brunner-Routledge. Rowe, D. (1978). The experience of depression. New York: Wiley. Space, L.G., Dingemans, P., & Cromwell, R.L. (1983). Self-construing and alienation in depressives, schizophrenics, and normals. In J. Adams-Webber & J.C. Mancuso (Eds.) Applications of personal construct theory. New York: Academic. Space, L.G., & Cromwell, R.L. (1980). Personal constructs among depressed patients. The Journal of Nervous and Mental Disease, 168, (3), 150-158. Viney, L.L. (1981). Experimenting with experience: A psychotherapeutic case study. Psychotherapy: Theory, Research, and Practice, 18, (2), 271-278. Wiersma, J. (1988). The press release: Symbolic communication in life history interviewing. Journal of Personality, 56, 205-237.
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Appendix A
On the Waiting List?
If you are going to be on the waiting list for 3 or more weeks, you may be eligible to participate in a research study at the Miami University Psychology Clinic while you wait.
You might want to participate in this study if you: ♦ Have been feeling depressed for more than 2 years and started feeling depressed for the first time as a child or a teenager ♦ Want to learn more about why you might be feeling depressed ♦ Like trying new things ♦ Want to use your life experiences to help others understand depression better
As a part of this study, you will: ♦ Meet with an interviewer 3 times a week for 3 weeks. ♦ Fill out 2 short questionnaires ♦ Experiment with role-playing the part of a made-up person ♦ Keep a journal ♦ Receive an explanation of the kinds of problems that may be leading you to feel depressed
To find out more about this research project, visit www.users.muohio.edu/loefflva. Please contact Valerie Loeffler at [email protected], or the Miami University Psychology Clinic at 529-2423 to participate.
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Feeling Depressed?
If you have been feeling depressed for a long time, you may be eligible to participate in a research study at the Miami University Psychology Clinic.
You might want to participate in this study if you: ♦ Have been feeling depressed for more than 2 years and started feeling depressed for the first time as a child or a teenager ♦ Want to learn more about why you might be feeling depressed ♦ Are not currently seeing a therapist, are on a waiting list for psychotherapy, or are not sure you want treatment at this time ♦ Want to use your life experiences to help others understand depression better ♦ Like trying new things
As a part of this study, you will: ♦ Meet with an interviewer 3 times a week for 3 weeks. ♦ Fill out 2 short questionnaires ♦ Experiment with role-playing the part of a made-up person ♦ Keep a journal ♦ Receive an explanation of the kinds of problems that may be leading you to feel depressed
To find out more about this research project, visit www.users.muohio.edu/loefflva. Please contact Valerie Loeffler at [email protected], or the Miami University Psychology Clinic at 529-2423 to participate.
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Appendix B
Informed Consent
Description of study. I am participating in a research study in the Miami University Psychology Department. The purpose of this study is to better understand the relationship between interpersonal relationships and depression. My participation in this study includes three phases. In the first (assessment) phase, I will be asked to 1) participate in a clinical interview where I will be asked to describe my experience of depression and my social/relational history, 2) complete two short questionnaires, and 3) write a short essay about myself. This phase will require two meetings with an interviewer that will last approximately 1-2 hours each. In the second (intervention) stage, I will be given a description of a character and asked to act out the part of that character in several situations on my own. This phase will require five meetings with my interviewer, where I will be given instructions about what to do and will practice role-playing the part of this character. These five meetings will occur every other day, and will last approximately 15-50 minutes. While I am completing these role-play experiments, I will be asked to keep a journal. In the third (evaluation) stage, I will participate in an interview where I will be asked to discuss my experiences, feelings, and thoughts during my role-playing experiments. This interview will take approximately 1-2 hours. My interviewer will provide me with any hypotheses that have been generated about the struggles that may underlie my symptoms of depression. I will be asked to evaluate how accurate and/or useful these hypotheses seem to me. I will also be asked to complete 2 short questionnaires at the end of my participation. My total participation will require 8 meetings with an interviewer, approximately every other day, for a period of 3 weeks.
Risks. I may experience some discomfort at being asked to disclose personal information during my interviews. I may choose not to answer any questions or discus topics with which I am uncomfortable, and may discontinue my participation at any time. I may also experience some uncertainty or anxiety during my role-play experiments. I will not be asked to role-play in any situations in which it would be dangerous to do so, but I am free to decide not to complete any activity that I think would not be in my best interests. I may continue my participation in the study even if I decide not to do a specific assignment. I am being asked to complete assignments that are expected to decrease my feelings of depression. However, if I think that I might act on a desire to hurt myself or someone else, I will no longer be able to participate in this study and will be referred for treatment at an appropriate mental health agency immediately.
Benefits. My participation may help advance psychological understandings of depression. I will also receive some information about the struggles that may be underlying my depression. I may be able to use this information to make positive changes in my life on my own or in subsequent psychotherapy.
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Alternatives. This study is not designed to provide a treatment for depression, and is not guaranteed to decrease my symptoms. I may not pursue any psychological treatment or begin taking psychoactive medication during the course of my participation in this study. However, I am free to discontinue my participation at any time, should I decide to pursue these options. If I am already taking psychoactive medications, I agree to postpone any additional medication changes and/or dosage alterations during the course of my participation. If I decide changes are necessary, I may discontinue my participation in the study. I will be referred for appropriate psychological and/or medical treatment following my participation.
Confidentiality. Only my interviewer will have access to identifying information about me (e.g., my name, where I live, etc.). A group of clinical psychology graduate students will be asked to read the essay that I write about myself, but my name will not be included with it. Any verbal and written information I provide about myself may be used in published research reports. I understand that someone who knows me well may be able to recognize some of my statements. I have the right to specify which personal information that I would like falsified (i.e., changed) to protect my anonymity in the event of written publication of this research. My interviewer may disclose essential information about me to other people if it is necessary to protect my safety or that of others.
Questions. If I have questions about my participation in this study or about the study itself, I may contact Valerie Loeffler at 529-2423 ([email protected]), or Dr. Larry Leitner (faculty advisor) at 529-2410. If I have questions about my rights as a research participant, I may contact the Office for the Advancement of Research and Scholarship at 529-3734 ([email protected]).
Compensation. I will not be paid for my participation in this study. However, the regular clinic fees will be waived.
______Participant Signature
______Witness Signature
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Appendix C
Caitlyn’s Self-Characterization Sketch
Caitlyn was a redheaded girl with wild ambitions. She preferred not to let one thing define her, but in this attempt she did. Her seeming lack of ability to relate with the world around her. In theory, she knew everything, but in reality, she knew nothing. And it was this fact alone that nearly crushed her spirit, and held her back from realizing all of her many dreams. It wasn’t that she didn’t try to know, it was simply that something separated her from the life that she desperately wanted to claim, a certain anxiety which prevented her from doing some of the things she knew she wanted to do. A fear of failure. It was better to be safe than sorry, she had always heard, and perhaps she lived it out a bit too voraciously. It wasn’t that she never took any chances, because from an outside perspective, she took chances, and she took them greedily, but from an inside perspective, she never took any chances at all. It was better to bite her tongue, than risk sounding stupid. And so, for the fear of not knowing what to say, she often said nothing at all, and remained on the outside. She would tell herself it was ok because there it was comfortable, no risk of getting hurt, but she was wrong. It seemed that in trying to protect herself, she ended up in more pain. For she missed out on all the little things that everyone else got to partake in: the inside jokes, the hugs, the pictures. It felt to her that everything she did was “fake,” merely a shadow of the real thing that everyone else was allowed to have but her. And if the things she did were just empty shadows, then what was her life? Was her life doomed to be another shadow, a shell without a soul? Many times, she clung to her beliefs as an answer that no, her life was indeed much more than just a shadow, her life was real, vivid, meaningful … but more often than that it was just her mind that knew the answer; her heart didn’t know it at all … her heart couldn’t know it because of everything the world had told her about herself … that she didn’t matter, that she could never escape the seeming snare that was set for her, that she could never fulfill her dreams to become the person she had always hoped to be. And still other times, it seemed that although she knew all of this mattered, she did not seem to care … A sense of apathy sometimes overtook her, so that it seemed she had a world full of cares and worries, and at the same time, not a care in the world …
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Caitlyn’s Fixed Role Character: Erin Moore
Erin Moore is a quirky redheaded girl with a great sense of humor. She likes to do and say things that are funny, out of place, or unusual and laugh at the responses she gets from other people. And she doesn’t always do it on purpose either. But when she notices an accidental quirk, she makes sure to laugh at herself anyway. Erin’s philosophy is that “variety is the spice of life.” She wants to be able to do and say all sorts of different things and not be constrained by someone else’s notion of what she is supposed to be.
Because Erin is a person who values and accepts her own quirks, she also naturally revels in the little idiosyncrasies of others. When she is with a friend, or even an acquaintance, she’s not completely satisfied with the conversation until she finds out something weird, strange, or illogical about that person. She likes to use these little tidbits as a way of connecting with people in a lighthearted and easygoing way. Erin uses her own eccentricities as a way of letting other people know that they can relax and be themselves around her.
Though Erin is generally a lighthearted girl, she has experienced hurt and pain in her life. She has been hurt by other people at times, and she finds it important to honor these injuries. While she feels no need to laugh and joke when she truly feels sad, she also makes sure that she doesn’t let her injuries define her completely either. Sometimes she chooses to pull back to make sure she won’t get hurt again, and other times she plunges bravely forward, knowing that she will face both joys and sorrows if she does so.
In addition to having been hurt by others, Erin has made her own mistakes in life. She has hurt people here and there, and done a few things she regrets. But underneath it all, Erin has a fundamental respect for herself that allows her to mess up without feeling like she is defined by these mistakes. This respect for herself allows her to consider criticism from others and make a thoughtful choice about whether or not she will make any changes in herself based on it. Her solid sense of self-respect also allows her to courageously pursue her dreams and goals in life even when she knows that she isn’t perfectly suited to those goals.
Overall, Erin is a person who lets herself take chances. She’s willing to face whatever comes her way as a result because she knows who she is and what she wants. She has her quirks, and she makes mistakes, but she considers these necessary parts of being a well-rounded person.
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Caitlyn’s Feedback Letter
Erin Moore was created as a way for you to experiment with several things I thought might be related to your experience of depression. First, you appear to be struggling to maintain an awareness of all of the different parts of you at once. When you make a mistake, say or do something out of place, or fail to meet your own expectations, you seem to lose touch with the parts of you that have done well, fit in, or succeeded in the past. During these times, you feel completely worthless, like you don’t deserve to live. To cope with these feelings, you try to swing in the other direction, striving for perfection in terms of academics, physical appearance, and social interactions. Erin was designed to be a character that could integrate all of these different aspects of your experience. In reveling in her own “quirks,” and having a sense of humor about them, Erin is able to let herself have shortcomings at the same time that she remembers all of her good qualities.
One of the most difficult things about swinging back and forth between extremes like this is that it makes it hard to form meaningful relationships with other people. When you think of yourself solely in terms of all of your weaknesses and mistakes, you tend to become frightened of others, who you believe will not be able to value and appreciate you. It also becomes very easy to be intimidated by others, who you begin to see as either perfect, or at least so much better than you. Erin’s character incorporated an appreciation for the idiosyncrasies of others for two reasons: 1) so that you could experiment with noticing that everybody makes mistakes, has quirks, and does things that others might consider odd, and 2) that these less-than-perfect aspects of people can be a potential source of connection between them. Some of your depression seems to be related to a tendency to assume that anything less than perfection on your part will lead to invalidation or rejection from others. As a result, you want to hide yourself away from others both physically and psychologically (e.g., “shyness”) in order to prevent being invalidated or criticized. While some measure of protection from invalidation is a good idea for everyone, too much can prevent others from truly knowing and valuing you, which can leave you feeling lonely and depressed.
When it comes to dealing with criticism or hurtful comments by others, you appear to have a tendency to quickly assume that you have done something wrong. This may be true, not true, or partially true depending on the situation you are in. Erin’s approach included taking the time to make a thoughtful choice about whether or not criticisms are valid and call for a change in her own behavior. This aspect of Erin’s personality was included in order to give you the chance to take a step back and take the time you need to decide what comments from other people mean for your life. There may be times when you decide that criticisms from others are warranted. During those times it will be important to remember another aspect of Erin’s character – to have enough respect for yourself to allow yourself to make mistakes without being completely defined by them.
Many relationships can grow and thrive through acknowledging mistakes and working toward change. Others grow and thrive in response to standing your ground and refusing to compromise your position or values. It will be important for you to remember and consider both of these options when faced with criticism in the future.
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Appendix D
Tara’s Self-Characterization Sketch
Tara is shy and reserved, but more intelligent that most people know. She feels underappreciated for her accomplishments, and has no motivation to have any more accomplishments. She is very awkward in social situations and either sits alone saying nothing or rambles incessantly and makes a fool of herself. For this reason, she does not make friends easily, especially not with boys. Tara is a great writer, and her dream is to be a novelist, but her fear of being poor and/or disappointing her parents prevents her from trying to achieve this goal. Tara is smart, but does not live up to her potential and get better grades because she is bored by school. Part of this is laziness. Part of it is because Tara prefers instant gratification. Watching “Sex and the City” is more appealing than studying for a psychology exam so she can get an A. Tara really wishes she could be studious and successful, but something is holding her back. Tara really wishes there were something she were really good at, but even though she is good at playing the piano, writing, or dancing, she is never the best and never receives any recognition for excelling at these activities. Tara has a very dry and sarcastic sense of humor. Some people get it and are amused, but most people think she’s a rude spoiled brat. Tara is spoiled, but is definitely not a brat. Tara is very insecure and does not like her appearance. There is the occasional time when she thinks she’s pretty, but her teeth, her complexion, and her weight make her feel ugly. Her appearance and her annoying social skills are probably why she does not have any male friends, or at least very few. Tara enjoys athletics and backpacking and being active, but is usually too lethargic and lazy to go out and do anything. She tends to avoid going out with people as well and often prefers to be alone, but then becomes very sad and lonely. Tara is a very complex person and hard to describe why she is the way she is.
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Tara’s Fixed Role Character: Audrey
Audrey is a complex young woman who is trying to decide who she wants to be and what she wants to do with her life. When they first meet her, people tend to think that Audrey is shy and reserved. People who only have the chance to meet her briefly might not appreciate her, but those who spend more time with her find her warm and easy to connect to. Audrey lives her life by the motto “still waters run deep” – she is more interested in wearing well over time than in making fantastic first impressions. She has a quiet and confident intelligence about her that is apparent to those who take the time to get to know her well.
Audrey is thinking about being a writer and has some talent for the craft. However, she knows that many talented people don’t succeed in this field, and that she may have to fall back on something more practical at times. Audrey struggles to make these compromises in ways that also honor her talents and interests. She is determined to find creative and unique ways to provide for the necessities of life so that she can also do the kind of work that she finds fulfilling and meaningful.
One thing that Audrey struggles with is integrating a desire for success with an acceptance of her limitations. Academically speaking, she knows she has tendency to swing back and forth between pursuit of perfection and complete disinterest. In trying to find a middle ground for herself, Audrey draws on a fundamental respect for herself that allows her be “good enough” even if she doesn’t meet her own expectations or those of others. Audrey also has a complex definition of success that incorporates academics, but extends to other areas of her life as well. For example, she views having close personal relationships with others as an essential component of a successful and meaningful life.
When she is with other people, Audrey tries to understand other’s perspectives and feelings. Like everyone, she is concerned about how people view her and wonders if they find her interesting or attractive or funny. At the same time, she believes that there is a close relationship between intimacy and beauty. She has found that the more intimately people know each other, the more interesting and beautiful they become to each other. She has learned to trust that the things that people initially find off-putting or annoying about her will become endearing and precious to them as they come to know her more deeply and appreciate her for who she is.
Like many young adults, Audrey struggles with understanding her parent’s actions and beliefs. Many times, she is unsure that they will love and support her as she pursues her own desires. In dealing with this uncertainly, Audrey tries to honor her own anger and disappointment in them at the same time she acknowledges that their expectations are based in concern for her. She knows that there will be times when they disagree with her choices as she strives to establish her own identity, but she trusts that they will still be able to love her despite these differences.
In general, Audrey is struggling to find her way in the world and create a professional and personal identity for herself. While this is confusing and difficult at times, Audrey allows herself to sit with her confusion without forcing herself to come to a conclusion before she is ready. At the same time, she is actively exploring her options, looking for creative ways to live her life and pursue her dreams.
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Tara’s Feedback Letter
Audrey was created as a way for you to experiment with several things I thought might be related to your experience of depression. First, you appear to be struggling to maintain an awareness of all of the different parts of you at once. When something negative happens, like you get a poor grade in school, you make a mistake, or someone criticizes you, you seem to lose touch with memories of all the things you have done well or correctly, or the times others have been supportive of you. During these times, you feel worthless, stupid, and/or uninteresting. In response, you tend to want to swing in the other direction, striving to accomplish something really impressive that will convince you and everyone else that you should be admired and are worth loving. However, any accomplishment that falls short of this lofty goal feels so devastating for you that you become essentially paralyzed, withdrawing from active participation in your own life for fear of not living up to your own expectations for yourself. Audrey incorporates a couple of different approaches to this dilemma. First, the idea of being “good enough” was introduced so that you could play with the experience of retaining a sense of respect for yourself during those moments when you fall short of your own expectations. “Good enough” is a complicated idea, and is something different from being “mediocre.” Accepting mediocrity means being indifferent to your own faults and failures. Being good enough, on the other hand, means being able to see the value and meaning in what you are, even if what you are is something different from what you are striving to be. People who are content with being good enough still strive to be better and do more, but they are also able to cherish and appreciate what they have accomplished. Second, Audrey’s character incorporated the idea that there are many different ways in which people can succeed in their lives. Winning a Pulitzer Prize or earning a Ph.D. are certainly noteworthy successes, but so are having meaningful interpersonal relationships or making small differences in the world around you. The people who truly care about you will value you for your small, daily accomplishments, as well as the big ones that come once in a lifetime. Adding to your definition of what it means to be successful and accomplished could be an important step in creating a life that you look forward to engaging in. “Lack of motivation” may be an important signal to you that you need to reevaluate your expectations for yourself or widen the scope of your search for meaning in your life. The same can be said for preferring “instant gratification” – this can also be a signal that you need to rework your vision of the future so that it holds the promise of some meaning and gratification for you. One of the hardest things about swinging back and forth between extremes is that it can make it difficult to form meaningful relationships with other people. For example, one common experience for you is to see others as incredible witty, clever, and attractive, while you are uninteresting, shy and even deformed. This situation at times becomes so intolerable that you find yourself trying desperately to be the opposite, or the thing that you think other people want you to be. You have found that it is difficult to do this successfully, and that others tend to be more rejecting of you when you try. Audrey’s sketch incorporated the idea of “wearing well over time” to encourage you to notice what happens when you allow yourself to do what comes naturally to you, even if you are naturally shy and not inclined to be instantly identified as the life of the party. True friendships do not require you to be continuously witty and clever. They only require that you be able to share yourself honestly and authentically – strengths and weaknesses alike – with another human being that you are truly interested in getting to know.
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Appendix E
Clinical Interview Outline
Questions regarding symptomatology
• When did you first start feeling depressed? What kinds of things did you notice about yourself at that time? What kinds of things were you feeling and thinking about?
• What, if any, changes have you noticed in your experience of depression since that time? What kinds of experiences are bothering you most right now?
• Some people who feel depressed report that they feel guilty or bad about themselves, confused about who they are, and/or suicidal – have you experienced any of these things? Can you give me an example of a time when this happened?
Questions regarding interpersonal history
• You mentioned that you were most/least depressed at X time. Can you describe some of the relationships in your life at that time? How did you feel about yourself and the other person over the course of those relationships? Can you give examples of some of the ups and downs of those relationships? How did you respond to these ups and downs?
• How would you describe the relationships in your life right now? Have you noticed any patterns in those relationships?
• When you feel hurt by someone, how do you typically deal with that injury? What are your major struggles and strengths in relationships with others today?
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Appendix F
Fixed-Role Experiments: Instructions to Participants
For the next two weeks, you will be playing the role of (fixed-role character’s name). (Participant’s name) is going to go on a vacation, and (FRC’s name) is going to take over until then. This will be a little like acting in a play, or playing a game of make-believe.
There are a couple of rules to this experiment: • Don’t tell anyone that you are doing a role-play. One purpose of this exercise is to see how others naturally react to (FRC’s name). If others know that you are doing an experiment, you won’t be able to find out what their natural responses to (FRC’s name) would have been, and you will lose some valuable information. • Don’t role-play in any situation in which it would be dangerous to do so. Your safety is more important than any information that can be gained from this experiment.
For the next 2 weeks, try to spend as much time as possible in character. There are several things you can do to help you stay in role: • Read the description of (FRC’s name) several times a day: when you get up in the morning, when you go to bed at night, and before any planned social situations (going out with friends, going to class, etc.). • Think ahead about the kinds of situations you will be facing during the day. Ask yourself several questions: How would (FRC’s name) approach these situations? How would (FRC’s name) interact with others in these situations? What would (FRC’s name) be feeling and thinking before, during and after these situations?
Over the next 2 weeks, you will be asked to approach each of the following people/situations while in character: • A boss, teacher, or supervisor • A friend • A significant other (or, your best friend) • Your parents (or, a person who plays the role of a parent for you) • Something of religious/spiritual significance (or, some ultimate value or ideal)
Your interviewer will help you figure out which situations and people you will want to role-play with. Each time you meet, you will have the opportunity to 1) ask questions about how (FRC’s name) might react in specific situations, 2) practice role-playing, and 3) discuss the experiences you have had while role-playing.
For the next 2 weeks, keep a journal about your experiences role-playing. Some questions you might want to address in your journal entries are: • Before you begin role-playing, ask yourself: “If I met (FRC’s name) today, what would I think of him/her?” “How would I approach him/her?” “If I were (FRC’s name), how would I feel about myself?” “How is (FRC’s name) similar or different from me?”
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• While you are role-playing, ask yourself: “What is it like to play the role of (FRC’s name)?” “Which characteristics are difficult/easy to enact?” “What am I thinking and feeling while in character?” • After you are finished with your role-plays, ask yourself: “What kinds of reactions did I get from others?” “What was it like to see their reactions?” “How did I feel about myself while I was playing the part of (FRC’s name)?” “Which of (FRC’s name) characteristics would I like/not like to have as a part of me?” “What is different/the same about my life now as compared to the beginning of this experiment?”
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