I’ve been posting how a person’s dysfunctional ways of coping can be confronted in a manner that both honors the true meaning of the term confrontation and has the potential to prompt genuine change – even in someone of significantly impaired character (see also: Learning to Confront Benignly and Effectively and The Structure of Therapeutic Confrontation). Historically, helping professionals have been hesitant to engage in any kind of confrontation with their clients, and the main reason for this stems largely from assumptions flowing from the more traditional psychology paradigms – paradigms that are neither as appropriate nor as useful in our present age of more pervasive character disturbance.
As I assert in my book Character Disturbance, no problem has ever been successfully ameliorated in therapy until it’s been correctly identified (and also correctly labeled) and appropriately confronted. And it’s the artful manner in which the various problems needing attention are confronted that makes genuine change possible. Correctly identifying the problem – not merely the surface-level manifestations of the problem but also its root cause – is what diagnosis is all about. And as I’ve mentioned many times before, intervention in the absence of sound diagnosis is the very definition of malpractice. So, you have to know what’s really going on with someone, why it’s going on, and what the best means of addressing it is, if you’re going to be of genuine help. Defining the problem, its cause, and what needs to be done to correct it is what therapeutic confrontation is all about.
Now just because you’ve correctly identified a problem and know what needs to be done about it doesn’t mean things will necessarily get better. There are a lot of other variables that enter into that equation, not the least of which is a person’s willingness to accept the diagnosis and comply with the recommended intervention. But a person’s possible reluctance to “own” their pathology and commit themselves to the recommended treatment strategy should never be a reason not call out a problem for exactly what it is. This is the mistake so often made by clinicians overly aligned with traditional perspectives. When it comes to someone’s pathology, helping professionals are obliged to call it right and address it properly, even in the face of possible resistance. Certainly resistance can and should be dealt with. And sometimes, a person’s resistance can be really difficult if not impossible to overcome. But that shouldn’t be a license for a therapist to either “candy-coat” or otherwise misrepresent a problem and what really needs to be done about it.
In the Judas Syndrome (which, I’m pleased to announce, has recently been published in the Korean Language) I give an example of a young man who was simply not ready to consider change when I first encountered him (see the story of “Philip”, which like all the other vignettes presented in my books and articles contains deliberately distorted details to preserve anonymity and/or confidentiality). When his relationship partner took a serious look at him, she didn’t at all like what she saw. But when Philip looked in the mirror, he was more than pleased with himself. As I explain in both Character Disturbance and In Sheep’s Clothing, when it comes to personality and character patterns, many times the very aspects of a person’s makeup that trouble others are not only acceptable to but also fondly embraced by the person possessing them. Professionals call this egosyntonia. Now, there are certainly occasions when a person is actually troubled by certain aspects of their own personality. They might actually even hate the way they react in various situations but because they don’t seem to be able to help themselves, they’re miserable about it. In short, they’re not really comfortable with the person they are. We call this egodystonia. But most of the time, where significant character disturbance is present, the person with the disturbance likes who they are, prefers the way they feel and think about things, is quite comfortable with the way they do things, and believes not only that everyone else has a problem but also that the world would be a better place if everyone else thought, felt, and acted just as they do. Philip was one of those folks.
Now Philip didn’t like what I had to say about him and the nature of his problems. And more than being non-receptive, he sought to challenge me on my diagnosis at every turn. He fought pretty hard to get me to back down or change my mind. But while I was sure of the diagnosis and the intervention that would be necessary, I couldn’t make Philip be ready to embrace either, so I was prepared to let him go. Now Philip was an interesting case because he actually wanted to stay and fight (to get me to change my mind) and in response to that I had to firmly deny him access. I’m certain that sending Philip away and refusing to see him was the most potentially therapeutic thing I could have done at the time. And just because I sent him packing didn’t mean my door wouldn’t remain open to a Philip more willing to accept reality. That day would come, because as fate would have it, life ended up teaching Philip some very hard lessons. And when he was in a better place – a more humble (i.e. “defeated”), open, and amenable place – and really wanted the help, I’m certain he came back to see me because unlike the several other therapists he’d been dragged to see in the past, I “dared” (his words) to name his problem for what it really was (i.e. pathological ego-inflation). It wasn’t that he had “problems with communication,” or “commitment fears,” or “deep-seated insecurities,” or any of the many other fancy-sounding but mark-missing conditions suggested to him in the past. He was simply a man who thought far too much of himself and carried such a huge sense of entitlement into every relationship that he was always causing shipwrecks. And when he finally stopped kidding himself (He never forgot what I told him the problem was), became hungry enough for something more out of life, and knew he needed guidance to suitably reshape himself, he sought out someone he thought he could trust. Philip also came with the “positive expectation (shown by mounds of research to be the single most important factor for successful therapy outcome) that I would help him. And I firmly believe that’s because even though I “dared” to confront him (and pretty strongly as I remember) he still sensed in me not a malicious intent to wound or condemn him but a sincere desire to support his growth.
I’ve experienced scenarios like the kind I’ve described with Philip time again over the years. Of course, I’ve encountered plenty of folks who, unlike Philip, remained so prideful, stubborn, and self-satisfied that they possibly went to their graves the same disturbed character they’d always been. But I’ve met a lot more folks like Philip – folks who appeared almost impossible to deal with at the time and whom I simply had to let go of – and I’m grateful I learned relatively early on how to be at peace with wherever a person is at the moment with respect to their personal growth. There’s an old joke I’ve heard repeated many times at Social Work conventions over the years (Social Workers enjoy a reputation for being among the more compassionate, eager-to-help individuals on the planet) about two female social workers on the streets of Manhattan who get their purses snatched by a mugger on a bicycle and then give chase shouting: “Stop that man! Stop him! He clearly needs our help!” And I would have to be taught the hard way how not only disrespectful but also counter-therapeutic it is to try and help someone who’s neither asking for it nor is particularly open to it (besides, “giving chase” to an individual not asking for your help only invites them to disrespect you, question your motives, and mistrust you). But as disrespectful, “enabling,” and counterproductive as such behavior is, I doubt there’s anything more damaging than either fearing or refusing to call out a problem for what it really is.
Character Matters will be live again this weekend and because it’s a special holiday weekend, I hope for a good discussion about the integral relationship between character and the freedom so many have paid the ultimate price to defend. Join the discussion at 7 pm Eastern this Sunday.