There’s an old axiom in the medical sciences that basically asserts that any attempted therapeutic intervention in the absence of sound diagnosis constitutes malpractice. What this means is that to undertake a course of action that necessarily impacts someone’s life in a significant way without a scientifically well-founded rationale for taking that action is by nature both reckless and irresponsible. Think about it for a minute: Would you seriously consider going back to a dentist who, upon your first visit suggested that you allow him or her to simply start drilling your teeth just to see what they find and then confer an opinion later? I think not. You’d probably prefer that some examination was done to determine exactly what the nature of your problem was and then be apprised of the generally accepted remedy for dealing with that problem before you give consent. The same is true for psychological and behavioral problems. Before intervening, you have to know with some reasonable level of certainty exactly what the problem is and what’s causing it because that in large measure points dictates the course of action you most likely need to take to resolve the problem.
I’m not exactly sure how the term “confrontation” garnered such negative connotations or how the act of confronting – even confronting benignly and therapeutically – got such a bad wrap. But I have long suspected a few major reasons: First, traditional psychology paradigms had us all believing that most of the time, people do things with little conscious awareness about their underlying motivations. And these same paradigms also taught us that underneath it all, we all want the same things, have the same wants, needs, desires, etc., and while we might be misguided about how to secure these things, our basic desires are good and pure and to call attention in a way that seems judgmental to the unhealthy ways we might tend to seek these things would inevitably only prompt a person to become both “defensive” and uncooperative and possibly damage their self-esteem.
Many years ago in my early professional training, I was observing a therapy session with a married couple whose relationship was on the brink. And each time one partner complained about the verbally abusive, denigrating language the other partner frequently used, that partner would “justify” the behavior by asserting such language wouldn’t be necessary if the other partner would simply see things correctly (i.e. their way) and not provoke their ire. The therapist, in turn, would ask the partner making the justifications to search their feelings for the underlying fears or concerns giving rise to their anger and venting of hostility. Meanwhile, the abuse continued, often and unabated. Later, during a debriefing session, I was shocked when the therapist rightfully made the observation that the one partner showed both a degree of haughtiness and “entitlement” that was truly troubling, and I had the naivete to ask why that wasn’t confronted directly. Of course, the answer was: “On, you can’t do that! Your client will get so defensive they’ll just shut down, or perhaps they’ll even stop coming. That won’t get you anywhere.” We also discussed how the therapist viewed the problem. “Communication issues,” and more specifically, “communication issues stemming from unresolved fears and wounds in childhood” was the response. After all, why else would a person behave so callously to the person they purported to love and without much apparent empathy or remorse? So week after week, the couple would come in and work on “communicating” better and processing the feelings they were having that gave rise to their frustrations. But after many months of this kind of thing, and continuing episodes of even worse verbal berating when the couple was at home, what really really made a dent in the cycle of relational abuse was one party finally having enough, deciding to get out, and filing for divorce.
I reflected on this case long and hard before coming to some conclusions that at the time were considered more than a bit “radical” but are generally much better accepted today. And one of the more important things I decided had to do with what was and was not properly confronted during the sessions I observed. A clinician has to determine exactly what the main problem is, the root of it, and what would have to be done to ameliorate it, if that’s even possible. And in this case, I determined that “communication” was not in itself the problem, nor the root of any problems. Rather, I saw the kind of communication one partner was repeatedly willing to engage in as a cardinal sign (cardinal signs are objectively observable manifestations of a condition or disorder that are so indicative of one condition as opposed to another that their mere presence is both a strong and reliable predictor that someone has a particular disorder). I added up all the signs and symptoms: grandiosity, feelings of entitlement, repeated violations of boundaries without sufficient compunction or apparent remorse, and decided that the more fundamental and primary diagnosis was one of Narcissistic Personality Disorder (NPD). (For more information on Narcissism and Narcissistic Personality Disorder, and the kinds of abuse that sometimes accompany this syndrome see the relevant chapters in Character Disturbance, In Sheep’s Clothing, and The Judas Syndrome and also the articles: Egotists: “Above” the Need for a Governing “Higher Power” and Narcissism and Relational Abuse – Both Active and Passive.) And at the time, the field was truly in a quandary about how to best intervene with character disturbances, especially NPD (with many insisting, as some still do today, that when it comes to personality or character disorders, there is no effective treatment). For me, this was the beginning of a period of investigation and theoretical reorientation that would eventually define my career.
My years of experience have only solidified a perspective I came to quite some time ago: No problem has a chance of being successfully ameliorated until and unless it’s: 1) correctly identified and accurately labeled, and 2) confronted in the manner most likely to promote constructive resolution. And within this “structure, over the years, I sought to refine my own “art” of benign confrontation. I have never looked back.
To really help someone, you have to strip away all the superficial manifestation of a problem and get to the heart of matters, and a lot of the time, that points to character (whether a person is of a mind to admit it or not). And upon realizing how many people’s problems were in some way related to a person’s character disturbance (i.e. problems of their own making, arising out of their own deficiencies of character or problems caused by being in a relationship with a person of significantly disturbed character) I was inspired to write my books Character Disturbance and In Sheep’s Clothing – to give the average person a framework for understanding the true nature of the problems we so frequently encounter these days and how such problems really need to be addressed both at the interpersonal and professional level if they’re ever to have even a chance at resolve.
Character Matters will be broadcast live this Sunday at 7 pm Eastern (6 pm Central and 4 pm Pacific) so I can take your calls.