Integrative Psychotherapy XI: Relationship focused interventions

We’ve been following the development of the theory and application of McMinn and Campbell’s 3 tiered Integrative model of persons and change. Now, in chapter 10, we arrive at the deepest and least objective level of change that takes place in counseling: therapeutic relationships. While some problems can be dealt with through skills and behavior change and other problems can be dealt with by exploring core beliefs and schemas, there are some core or “soul” problems that are best handled by being in a healing relationship. We’ll get to what that means in a moment…

The authors begin to tackle the problem of personality disorders. They describe how we all have personality styles, how some of those styles turn into problems (unthoughtful engagements with others), and how some turn into full-blown disorders (“defined as consistent patterns of behavior, evident since childhood or adolescence, which impair social functioning and cause significant distress to self or others.” (320)).

Functionally, some people are unable to step back from their assumptions and schemas and consider alternative perspectives. Such a person experiences their life but has a hard time observing their life without being sucked into negative experiences (see inset on p. 322). The therapist’s job is to try to maintain a relationship, focusing on the here and now (the relating that is going on between the counselor and counselee) in order for the counselee to gain new experiences and thereby develop a greater capacity to step back and see self.  “The working assumption of relationship-focused IP is that relationships change people” (p. 324).

Then the authors give a little summary of key personality theory by reviewing Freud, Horney, Stack Sullivan, and family systems models regarding how interpersonal patterns develop. They conclude by saying that our interpersonal patterns, “are formed early in life as a means of reducing interpersonal anxiety, maintaining a consistent perception of self in relationship to others, and as a means of stabilizing family life” p. 331). 

McMinn and Campbell dig deeper to ask the question: how is it that these developing styles become rigidly used? How is that an early experience get “re-enacted” in adult life? They turn to 3 theories:

1. Interpersonal Process Approach. Unmet needs leads to anxiety which leads to internalizing negative feelings about the self which lead to treating others the same (ad nauseam). These interactions continue because they are familiar and they “work” for us by reducing anxiety (we can make sense of the world and they work to some degree).

2. Cyclical Maladaptive Patterns. A cycle develop that is played out in every relationship. These cycles are organized into 4 parts: acts of the self, expectations of others’ reactions, acts of others toward the self, and acts of the self toward the self (p. 335).

3. Reciprocal Role Procedures. As a person grows, they “develop more sophisticated ideas of where self ends and other begins. The growing child learns ways of relating with the other so as to maintain attachment between the I and the Thou….But each of these roles is reciprocal; that is, they are met with a response on the part of the other.”

Is there a Christian perspective on personality problems? The authors explain their take on the creation (that we are created to be in relationship) and fall (that because of our tendencies to use relationships for our own pleasures, self-deception, sins against us) we form patterns of how we see ourselves (usually victims). And finally, they briefly explore how redemption means experiencing safety and grace now in a manner to “reform faulty interpersonal patterns.”

My thoughts.Here the authors inject dynamic models of relating into the development of a mostly cognitive model–up to this point. They rightly recognize that we develop much of our sense of self in early stages of life and then cement those views in an on-going way–even when we hurt ourselves with those views. And true, we often see ourselves as victims. What is hard is to see that we are both victim AND victimizing at the same time. Unfortunately, they used up their space in the chapter in talking about how interpersonal processes can be broken without much theorizing about how and why present, positive interpersonal experiences change us and shape our constructs of self and why they change so slowly. It is somewhat easy to point out that our acting on and being acted on shapes us when we are vulnerable. But what happens in the now that enables us to open up and reconsider our identity without feeling like we lose ourselves?