How We Change Volume 1: Theories of Change

How We Change

Volume I:

Theories of Change from Psychoanalysis to the Search for Common Factors

Richard L. Gilbert, Ph.D.

Published by Richard L. Gilbert at Smashwords

Copyright 2013 Richard L. Gilbert

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Contents

Preface to Volume I

Chapter 1. Identity Change: The Crown Jewel of Psychotherapy

Chapter 2: The Roots of Identity

Chapter 3: Sources of Identity Change I: Normative and Non-Normative Experiences

in Adulthood

Chapter 4: Sources of Identity Change II: Imposed Change vs. The Exercise of Will

Chapter 5: Embedded Models of Change

Chapter 6: Autonomous Models of Change

References

About the Author

Preface to Volume I

Over the years a variety of scholarly books and articles have been written that address the topic of psychological change. Most of these, such as Freud’s Remembering, Repeating, and Working Through, Kohut’s How Does Analysis Cure? and Roger’s Client-Centered Therapy, involve conceptualizations of psychological change that occur in the context of psychotherapy. In addition, a limited number of sources broaden this focus to consider psychological changes that occur in non-therapeutic settings as well. However, there is no single source that provides a comprehensive overview of the major conceptual and empirical models of change both within and outside of psychotherapy. The purpose of Volume I is to provide such an overview. Specifically, it 1) introduces the concept of identity change as the highest aspiration in the area of personal growth, 2) discusses models that attempt to understand the contribution of social (i.e., non-genetic) influences on the childhood formation of identity, 3) explores the range of normative and non-normative experiences in adult development, including psychotherapy, that have the potential to bring about significant changes in an individual’s inner life, and 4) presents a variety of theoretical and empirical models that attempt to explain the process of psychological change. Subsequently, in Volume II, a model of how significant internal change occurs in the specific context of psychotherapy will be described that builds on the foundation of this earlier theoretical and empirical work.

In order to use non-sexist language, without resorting to the cumbersome phrase such as him or her or he or she, masculine pronouns will be used in odd numbered chapters and feminine pronouns will be used in even numbered chapters.

Chapter 1: Identity Change - The Crown Jewel of Psychotherapy

Psychological changes can be classified according to two dimensions: stability and generality. With respect to the stability dimension, some psychological changes are temporary or ephemeral. From moment to moment we all undergo subtle shifts in our moods and changes in our immediate private experience. These shifts take the form of specific memories, thoughts, and fantasy elements that make up our ongoing stream of consciousness. Thus, just as we continually oscillate between biological states of inhalation and exhalation, of sleep and wakefulness, of hunger and satiation, so do we endlessly experience shifts and transitions in our internal, psychological lives. In contrast, other psychological changes are more permanent or enduring. They involve stable changes in important attitudes, behaviors, and capacities that are continuous over time rather than fleeting

Psychological changes can be classified according to their specificity vs. generality as well as their stability. Some psychological changes involve relatively focused alterations in behavior or thinking (the subject of briefer forms of intervention), while others represent broad shifts in the manner in which the individual perceives and conducts his life (the focus of moderate to longer-term psychotherapy). For example, consider the case of an individual who often alienates others because of a tendency to dominate conversations and to focus discussions primarily on himself. In a relatively brief time, this individual could be taught to ask more questions during a conversation and to pay more attention to issues of interpersonal balance, and these specific changes could be positive and valuable things for this individual to learn. At the same time, the individual’s interpersonal problems could be considered more broadly and deeply. Perhaps, as one possibility, the individual’s conversational limitations are reactive efforts to cope with a more general sense of inadequacy or vulnerability that is heightened in interactions with others. That is, the individual’s specific conversational problems could be embedded in more general issues of personal security and narcissistic regulation. In this later case, were these more general, underlying issues successfully addressed, the consequences for the individual’s life could be more broadly beneficial.

While the preceding discussion has highlighted the variety and range of psychological changes, this book will focus upon the most stable and general form of psychological change, what I will refer to as identity change. By identity change, I mean a fundamental and enduring shift in the individual’s:

1. Self-representations (that is, how he views himself) and object representations (how he views other people, especially those with whom he is involved in an emotionally-meaningful relationship),

2. Adaptive capacities (that is, the capacities to engage in intimate relationships, to work productively, and to make independent choices and to exercise will.)

3. Structural development (that is, the degree to which the personality can remain cohesive in the face of internal and external stressors).

Moreover, when identity change occurs, these alterations in the individual’s internal world, adaptive capacities, and structural development are experienced not as something outside of the self, like a new outfit, but as an integrated, real self. The old psychological economy comes to be experienced as alien, strange, as not me, while the new psychological organization is experienced as who I am. In the best case, at the end of psychotherapy or some other significant process of personal growth, the individual will demonstrate and experience these kinds of changes. At one point the person may look back and say, in effect;

You know, I feel different, and I don’t know how to go back to the person I once was. To not be like this feels alien, not part of my identity, and I don’t really know how this happened.

If we are honest, we will have to echo this uncertainty, because to some extent this kind of internal transformation will always be a mystery that we will never fully understand. Nevertheless, despite this ultimate mystery, we can still productively consider this question: Does this change in identity occur in any reliable sequence or pattern; does it follow a process that we can describe conceptually as well as observe clinically?

It is interesting to note that in the past year, whenever I mentioned that I was writing a book about How people change, the first question that invariably and understandably arouse was Do people change? To this question, I would reply:

Of course, psychological change is continuous and inevitable; the real question is: Can people change in ways that are general and stable? That is, can there be changes at the level of identity?

This is the question that will occupy our attention. However, before embarking on a discussion of identity change, it is important to consider how this internal organization originated and was consolidated over time.

Chapter 2: The Roots of Identity

Within contemporary psychology there is wide agreement that adult personality is determined by the interaction of biological factors (nature) and social experience (nurture.) According to behavioral geneticists, the biological substrate of personality accounts for upwards of half of the psychological characteristics of the person. The remaining variance in human psychology and behavior is determined by the influence of the individual’s environment, primarily the early social environment.

In considering the contribution of the individual’s social environment to the development of psychological identity, virtually all of the major models employ a stage theory approach. From this perspective, human development is divided into various periods or stages with the assumption that there are qualitatively different central issues at each stage. Freud’s model of psychosexual development, which involves a progression through the oral, anal, phallic, latency, and genital phases of development, is a well-known stage theory of personality development, as is Erikson’s psychosocial model in which core psychological issues are proposed for each of eight stages of the lifespan, such as Trust vs. Mistrust in infancy, or Autonomy vs. Shame or Doubt in toddlerhood. Similarly, within the more recent Object Relations School of psychodynamic theory, Margaret Mahler’s division of the early separation-individuation process into phases such as the autistic, symbiotic, practicing, hatching, and rapprochement phases has been an influential stage conception of personality development.

Despite their variety, all of these stage theories operate on the common assumption that the resolution of the issues of a particular stage of development will be influenced by, or rest upon, the nature of experience in the preceding stages. Thus, development is viewed to begin at a simple, foundational level and to build hierarchically, in sequence, to produce more complex and stable forms of organization. Because of this logic, it can be stated that stage theories are layer cake models of psychological development and organization. The resolution of each phase of social experience produces ascending layers of internal organization all of which rest upon the inborn, biological substrate of development. Having introduced the common logic of the major dynamic models of personality development, let’s examine each of these influential perspectives on social development in greater detail and highlight their specific ideas on how the resolution of each proposed phase of experience progressively builds toward the consolidation of an internal organization or identity.

The Classical (Freudian) Model

A. Drive-Culture Conflicts and the Stages of Development

In order to understand Freud’s model of personality development, it is important to appreciate his assumptions about human conflict. The notion that there are competing forces in human personality is now a common and familiar one. We all experience, and try to resolve, competing, incompatible feelings and motivations. We speak relentlessly of ambivalent feelings, of being torn between alternative possibilities and directions. However, it is important to stress that, while this now seems like a common exercise, the language of internal conflict was rarely spoken prior to Freud.

When Freud spoke about conflict, he had a particular conflict in mind: the conflict between biology and culture. Specifically, Freud maintained that the free, unbridled expression of biologically based drives of sexuality and aggression is incompatible, or in conflict with, the operation of a civilized society. He outlined this position in one of his briefest but most profound works, Civilization and Its Discontents (1930). In this volume he detailed how the unopposed expression of sexual drives could threaten the survival of the overall culture. He noted that if sexual drives were not constrained in some fashion, then the possibility of intra-familial sexuality and reproduction would greatly increase. As we know, and as Freud witnessed in his work with members of the Hapsburg dynasty, reproduction among genetically similar mates greatly increases the incidence of mental retardation, certain lethal diseases such as hemophilia, and, most importantly, reduces the genetic diversity of the population. In this case, the population risks elimination if it is exposed to an environmental threat to which it is not genetically adapted. Thus, the fact that every society in human history has imposed some controls on intra-familial sexuality is not only a function of the traumatic emotional consequences of incest, but of the broad cultural threat posed by widespread inbreeding. Similarly, every society has instituted some constraints on aggressive impulses in order to minimize the potential destruction of social order through rampant violence and murder.

Different societies impose different degrees of constraint on the expression of biological drives. In turn-of-the-century Vienna, where Freud’s ideas incubated, the repressive force of culture was evident in many forms – in the authoritarian political climate, in the layers of starched clothing that people wore, in the structured music that they listened to, and in the many proprieties of speech and conduct they were required to follow. In contrast, in contemporary America, the ratio or balance between cultural repression and drive expression is much more on the side of freedom and drives. Neither cultural model is correct, and each has its psychological strengths and flaws. In turn of the century Vienna, there was obviously a sense of clarity, structure, and containment. On a cultural level, people had a clear sense of expectations and limits. But, at the same time, it was a struggle to find acceptable avenues to express biological drives and, consequently, psychological disorders related to repression, such as were found in Freud’s early patients, were common. Conversely, in our culture, there is less psychological suffering related to repression and constraint. Yet we have serious problems related to disorders of impulse, disorders of excess, and disorders of discipline – a culture with too many diffuse, chaotic, under-controlled selves. These disorders are projections of the wider culture’s choice in the delicate balance, the conflict, between drives and culture. Personally, I’m not sure which solution is better. However, sometimes when I watch the parade of violence and perversity on the evening news, I think to myself, Well, if I had to choose between an extreme resolution on the side of drives or culture, I think I might chose culture.

While Freud talked extensively about the broad social implications of drive/culture conflicts, he was at heart a physician and a psychologist, rather than a sociologist. As such, he concentrated his efforts primarily on the manner in which the cultural position on drives and repression were transmitted in the microcosm of early family relationships. And this is where the stages of psychosexual development, Freud’s model for the formation of individual identity, are relevant. Each stage of psychosexual development is considered a new battleground between the forces of biology and the forces of culture. Each stage is a variation on the central theme of the conflict between drives and culture. And each stage-specific outcome or resolution of this drive-culture conflict is viewed as essential to the ultimate internal organization of the person.

In the oral stage of development, occurring in the first year of life, biology is demanding immediate and total gratification of its oral wishes: the wish to be fed, to receive liquid, to be given immediate emotional comfort and nurturance. In opposition to the immediate and total gratification of these oral needs are the internal and external limitations of the child’s caregivers to meet these needs. In this way, the broad incompatibility or conflict between biological drives and culture is now operating within the microcosm of early family relationships.

In the anal stage of development, which occurs in the second year of life, the primary zone of libidinal energy shifts to a new mucous membrane – specifically from the oral cavity to the anus. Anyone who has ever spent time with young children can understand the basis of this proposed sequence. While