(based on materials from the book “Psychoanalytic Diagnostics” by Nancy Mc Williams)

Often from clients I hear confusion in terminology, so it will be useful to understand and sort out terms related to personality types using the ingenious systematization of the famous psychoanalyst Nancy Mc Williams, which she described in her famous book "Psychoanalytic diagnostics."

So, all people with psychological problems are divided into two large groups: neurotics, borderline people and psychotics.

Neurotics

Neurotics are people who feel bad about themselves and who are not happy with everything around them.  They are emotionally unstable and their usual state is uncertainty, worry, mistrust and fear. Because of this, such people are self-obsessed and tend to blame themselves or others for all their problems.

A mild form of neurosis of a healthy person does not interfere with adaptation in society, it simply creates internal discomfort and reduces the quality of life, and a severe form (when a person is already sick) is accompanied by obsessive states, asthenia (loss of strength) , hysterical behavior and a decline in performance, both mental and physical.

The higher the level of neuroticism, the more difficult it is for a person to stop activities that harm him (even if he understands it) and meet his fears.

Neurotics are  clients of psychotherapists and psychologists.

People with borderline conditions

Borderline state is a transitional form from neurotic to psychotic, when neurosis has acquired an acute form, but has not acquired changes in consciousness characteristic of psychosis.

Psychotic

Psychotics are people who feel great with themselves (they have impaired criticism of themselves and the surrounding reality) - but feel bad for everyone around them)).

Psychotics should be dealt with by psychiatrists (specialists with medical education who treat with medication) and the task of a psychotherapist or psychologist is to determine the level of psychological disorder at the first consultation or during a preliminary conversation - and refer to a psychiatrist . At some stage of drug treatment (when the severity of the problem has been relieved), the psychiatrist’s patient can visit a psychotherapist (by prior agreement between the psychiatrist and the psychotherapist), this is called “combined therapy.” When drug treatment is accompanied by conversational psychotherapy for the patient’s social adaptation.

Psychosis is accompanied by changes in consciousness (hallucinations, delusions, confused thinking, narrowing of consciousness), so this condition should be taken seriously and not self-medicate, but rush to a psychiatrist. The earlier, the better the prognosis for treatment of such a person.

Now about psychotypes. A psychotype can have varying degrees of severity as the problem worsens and a person, without engaging in treatment, moves from a healthy to a neurotic and psychotic personality.

One ​​person, no matter whether he is healthy, neurotic or psychotic, can manifest several types at the same time.

Why a person has developed this or that psychotype or their combination is difficult to say - it is always a combination of genetics, upbringing, parental example, the society in which he lived and the way he reacts to life circumstances and situations .

1.   Antisocial (psychopathic) type

Innate aggressiveness, impulsiveness, an above-average threshold of pleasure (what brings it to an ordinary person does not bring it to a psychopath, he needs a stronger “shake-up”), avoidance of experiences of weakness and dependence, rejection of his responsibility, low emotional intelligence, inability to connect emotionally and poor social learning are characteristics of the antisocial type.

As a rule, he processes his conflicts by defending himself using the mechanisms of repression (it's not me) or projection (it's others).

The childhood of such people was unsafe, unstable, a chaotic mixture of discipline and neglect. The mother is usually weak and depressed, and the father is an inconsistent and hot-tempered person. Often parents are alcoholics or drug addicts. At a time when the child was in especially dire need of power, there was none, so he spends his life searching for his omnipotence. Their usual emotions are associated with weakness - that’s why they deny it. Since words were not used to express emotions, but to control, in adulthood a person uses them exclusively to manipulate others. Most often, people of this type are men.

The strategy in psychotherapy is to find out whether psychotherapy is possible in principle. If possible, then you need to strictly adhere to the contract, not show empathy, and maintain a position of independent strength bordering on indifference. The goal of psychotherapy is awareness of one’s nature and its acceptance. 

2.   Narcissistic type

The term “narcissus” itself is taken from a Greek myth, where the main character fell in love with his reflection in water. For people of this type, their external form (appearance, success) replaces their internal content.  Their self-esteem is unstable, they often doubt themselves, and tend to judge and evaluate others. Constant fear that they “don’t fit in”, shame, a feeling of their low position compared to others. They cannot tolerate criticism and constantly rush between “everything is good” and “everything is bad” in the perception of their self.  This feeling of emptiness and inferiority is often compensated by vanity and superiority over others, contempt. They are suspicious (hypochondriac) and perfectionists.  

To survive the conflict, they either idealize, devalue or repress.

In childhood, as a rule, parents were interested in the child’s function itself, and not in his personality. Therefore, all feelings, especially negative or selfish, were rejected or humiliated. Accordingly, the child learned to present only those feelings that they accepted. As a rule, an atmosphere of evaluation reigns in the family.

The strategy in psychotherapy is to help accept people without judgment and use, without idealization and to express your true feelings (including bad ones) without shame, to accept your “I” without humiliating others. At the same time, try not to create strong shame when the client becomes aware of his nature, in order to maintain honesty in therapy and the desire to open up. Accept the client's fragile personality patiently and without judgment. >

     3.  Schizoid type

Characterized by high sensitivity and, accordingly, avoidance of situations where his sensitivity is affected - that is, introversion. Self-isolation and obsessive thoughts about the life they have imagined. Despite the fact that between proximity and distance they often choose the latter (due to not wanting to harm their “I”), they still show interest in the world around them. At the same time, they can express insensitivity and, instead of sympathy and feelings, they process problems through intellectualization (that is, thinking about them). This ability to think about abstract concepts often generates great creativity.  Their passionate desire for intimacy is suppressed by an acute fear of absorption by other people. In general, they are very vulnerable.

The above conflicts are difficult for them to process - hence their hypersensitivity, but the typical solution of a schizoid is to go into a fantasy world or projection

As a child, such a person was usually overprotected. His mother usually violated his personal boundaries, and his father criticized him. Communication in the family was contradictory and disorienting for the child. Thus, through withdrawal, the child defended himself from unbearable anger, doubt and feelings of hopelessness.

Psychotherapy should be very careful and not unhurried. Detachment is a defense that will subside as the psychotherapeutic relationship deepens. Therefore, it is necessary to avoid hasty interpretations too early in order to achieve the sense of security in the relationship that the client needs so much. The goal of psychotherapy is then to extend this feeling of security to relationships with other people. For the success of therapy, it is important that the psychotherapist himself is ready to reveal his “real” personality and has a high level of self-awareness.  

4 . Paranoid type

A paranoid person is characterized by a lack of trust, suspicion and lack of a sense of humor. He is obsessed with himself and his sense of grandiosity (I am to blame for everything bad in this world). Many have difficulty with sexual self-identification (they are torn by fear of same-sex intimacy and craving for it). As a rule, they feel lonely and have few, if any, friends. And they are friends “against” and not “with someone”. All negative feelings are experienced in the form of a projection (“Everyone is jealous of me, that’s why they attack me”) - although in fact it is their feelings of envy, guilt, shame, fear. It is difficult for them to understand where thoughts end and actions begin. Extremely jealous. They don’t know how to rest if there are tension in the body. There is always someone with whom they are annoyed, they constantly want to criticize others and actively do this, provoking aggression. The strength orientation has similarities with psychopathic personalities. Moreover, unlike the latter, despite constant jealousy and suspicion, they are capable of deep affection and fidelity (which is also expressed in a tendency to dependency). Betrayal is unbearable in a relationship.

They are protected as mentioned above with the help of projection (these are others) or denial (this is not me).

A child who grew up paranoid was subjected to severe humiliation and suppression, based on expectations that did not depend on the child, but were based on the whim of adults.  If the parents themselves were overly stressed, anxious and suspicious, then the child could learn this behavior from them.

Psychotherapy comes down to accepting hostility on the part of the client, which allows the latter to feel protected and reduces fear. The therapist’s gentle self-irony defuses aggression. You cannot avoid answers; you need to explore the thoughts that are hidden behind the client’s question. It is necessary to reflect the client's feelings without complex interpretations. Emphasize the difference between actions and thoughts (citing extreme fantasies as an example). Boundaries are something that needs to be focused on, and the therapist must strictly adhere to his role so as not to feed the client's paranoid suspicions that he is being used for other purposes.

5.

Depressed and m

aniac types

Oddly enough, they have a lot in common.  The only difference is in temperament (if there is little energy, then they are prone to depression, if there is a lot of energy, they are prone to manic behavior). Often people with these types experience both states (depression and mania) sequentially. And in its extreme psychotic form it becomes manic-depressive (bipolar) disorder.

Depressive type

Characterized by low self-esteem, they believe that they deserve to be rejected and will certainly be rejected as soon as they get to know them better. Low energy, tired quickly, little active, unable to rejoice (anhedonia), problems with sleep, nutrition, self-regulation (vegetative disorders). All negativity is directed at oneself, experiencing guilt (that is, aggression is directed at oneself, in contrast to anger - when aggression is directed at others). Vulnerable, vulnerable, constant in relationships, justifying the offender. More often women are like this.

Destructive behavior and depression themselves belong to masochism, as they are ways of processing feelings of guilt. Many authors, for example, Kernberg, even consider the “depressive-masochistic” personality type to be one of the three common neurotic personality types. Nancy McWilliams differentiates masochists as victims of persecution through no fault of their own from depressives who believe they deserve such a fate. Therefore, masochists, unlike depressed people, protest against their fate.

Defense mechanisms are introjection (negative traits of parents are experienced as part of oneself), reduction of separation anxiety through self-turning, and idealization.

It is difficult to understand how much the appearance of a depressive personality type is related to genetics and how much depends on the depressive behavior of parents. Some depressive personality traits are formed under the influence of early loss, not necessarily physical, it can also be psychological.

If parents deny grief and teach the child to have a negative attitude towards manifestations of pain and grief, to deny them, such experiences of the child become hidden. So in a child, these experiences go deep and turn into beliefs that “I” am not okay.

When it is difficult for a mother to go through the stage of separation, this gives rise to guilt in the child for his own separation. Because of this, the desire for separation at the stage of separation and growing up - a natural healthy process - is experienced as hateful and bad. And if the child is still experiencing loss, then depressive dynamics are practically guaranteed. Parents label such a child “vulnerable” because of hidden experiences that shape his emotionality.

Sigmund Freud discovered that during the normal experience of grief, the world is perceived as smaller (due to the loss of an important object), in contrast to the depressive experience of loss as the loss of a part of oneself. The normal experience of grief, even if it lasts for a long period, does not lead to depression. It could be said that depressed people experience grief in the opposite way than normal.

 The strategy in psychotherapy comes down to creating an atmosphere of acceptance and respect. It takes patience and effort to understand the client. Analyzing the client's expectation that he will be rejected and recognizing the client's desire to be “good” for the therapist to prevent this rejection is the main part of working with this type of personality. It is important to analyze the client’s reactions to any separation (even in the form of pauses and silence from the therapist).  In this case, you need not so much to praise the client as to deal with criticism of his super ego. (if, for example, the client reproaches himself for envy, then it is important to say that this is a normal human reaction and he can rather praise himself for the fact that this negative feeling was consciously experienced and not realized). Since depressed people behave approximately, as a rule, in therapy, but behavior that is resistance for other personality types (cancellation of therapy or delay in payment) here can mean the opposite, as progress in the fight against the fear of rejection due to conflict behavior. Anger and criticism towards the therapist are also in this case an indicator of the progress of therapy.

It is important that such clients decide for themselves when to end therapy. It is imperative to discuss possible obstacles to seeking help in the future.

If the depressive state lasts long enough, then it makes sense to seek advice from a psychiatrist to organize supportive drug therapy along with conversational therapy.

Manic type

It is known that mania is the other side of depression. Hypomanic people typically have a depressive personality structure, which is neutralized through denial.

Such people are very socially active, incapable of loneliness, prone to flirting and dependence on work, while despite the apparent cheerfulness and good sense of humor, inside they experience guilt associated with aggression towards other people. They find it difficult to love and show empathy. They enjoy charming others, which helps fuel their self-esteem. The speed of internal processes of hypomanic people is very high. They have a high rate of speech and gestures. They are able to distribute attention well, sleep and rest little, and are characterized by low fatigue. Moreover, their constant mobility rather indicates a high level of anxiety. Low fatigue suddenly ends in exhaustion and such a person goes into a phase of depression, usually unexpectedly for himself (this is due to a poor understanding of his own bodily needs).

Defense mechanisms boil down to denial (ridiculing or ignoring problems) and reaction (in the form of flight).

The formation of this type of personality is due to repeated traumatic losses (stories of separation/separation) without the opportunity to survive (death, divorce, separation, moving)

In a psychotherapeutic strategy, it is important not to interrupt therapy, because the client will always have an impulse to run away (therefore, it is important to immediately agree so that the client does not suddenly disappear when such a desire appears, but conducts at least a few more sessions to understand the reasons for such a desire and finish therapy in an emotionally healthy way). The focus of therapy should always be the denial of negative emotions and sadness. Psychotherapy should not be hasty; the slow pace is due to a strong fear of experiencing negative feelings. They usually talk down negative experiences so as not to find themselves alone with them. It is important to pay attention to whether the client’s words are truthful or whether they are just a show for the therapist, words spoken to justify themselves and escape from feelings.

6. Masochistic type

Despite how it sounds to the average person, masochistic (also called self-destructive) behavior is not a pathology in itself. After all, even motherhood, which is accompanied by the renunciation of comfort for the sake of something more important, is also healthy masochistic behavior, no matter how strange it may sound. Not only humans, but many animals also sacrifice themselves for the well-being of their offspring. People may sacrifice themselves for the public good or higher ideals. As you can see, masochism is not always a pathology and can have different manifestations.

How to recognize unhealthy, pathological masochism? Unhealthy masochism is characterized by feelings of being unworthy, guilty, rejected, and worthy of punishment. Usually a masochist gives the impression of an arrogant person who despises simple people who are unable to endure such suffering or grief. As a rule, he complains and is in the position of a victim, while enjoying his suffering, fueled by the pity of others. Unlike depressed people, they see the problem not so much in themselves as in the world around them (in this they are similar to people of the parietal type). Suffering is usually expressed either in refusal of treatment, in partnership with despots and sacrificing one’s life for the sake of children.

The main defense mechanisms of masochists are introjection, idealization, moralization and external response (in the form of self-harm)

Usually masochistic behavior looks like this: first there is a provocation, then a call for everyone to leave him alone, a demonstration of his suffering and blaming others for making him suffer .

Masochists, like depressive personalities, are formed due to great losses that were not mourned, criticizing parents who shift the adult role onto children. Unlike depressed people who feel useless, masochists, on the contrary, impose themselves in order to avoid emotional loneliness. 

In psychotherapy, it is important not to feel sorry for the client and not to make concessions to him. Rather, on the contrary, the conditions should be made more stringent (for example, the price should be raised). The therapist's strategy is to withstand the masochistic client's negativity and accept them not only when they behave exemplary. It is very important to avoid the role of rescuer and communicate with the client as an adult who is responsible for the consequences of his actions. It is also important to combat the client’s beliefs that suffering is followed by reward, and success is followed by punishment.

7. Obsessive - Compulsive type

From Latin, obsession is “obsession with an idea” and compulsion is “compulsion.” That is, this type of personality is prone to obsessive thoughts or actions.  In its extreme form, the obsessive-compulsive type is expressed in obsessive-compulsive personality disorder (OCD).  

For a person of this type, the most valuable thing is not his feelings, but his thoughts. In other words, his life goes by the motto “escape from feelings through thoughts and actions.” Such people are prone to isolation, concealment, and secrecy (in which they are similar to people of the schizoid type). As a rule, they are extremely clean, neat, and punctual in an obsessive manner. They strive to control everything. They are very stable with predictable behavior, which makes them successful workers, but at the same time they are unable to express their feelings without anxiety and shame, running away from experiencing emotions into thoughts.

Isolation, rationalization and moralization are used as defense mechanisms. Fight your desires for irresponsibility and disorder with obsessive conscientiousness and diligence.

This type usually develops under the influence of parents who demand that the child observe high standards of behavior. At the same time, showing excessive severity, they blame children not only for their behavior, but also criticize their feelings, thoughts and fantasies.

In psychotherapy, it is important to treat the client kindly, without criticizing what usually irritates other people. Thus, avoid the role of a critical parent. Patiently treats such clients during the therapy process, except in cases where compulsive actions are dangerous. It is important to encourage the client to recognize and express his feelings so that he learns to enjoy feelings that were previously devalued.

It is important to draw the client's attention to his tendency to criticize and become angry.

8. Hysterical (theatrical) type

Most often, the hysterical personality type is represented by women. It is characterized by extremely high emotionality, demonstrativeness, creativity and artistry. They are proactive and at the same time have a high level of anxiety and tension. This anxiety is especially evident in interpersonal relationships. They seek to overcome inner anxiety through love relationships or escape from them. They are drawn to situations that involve personal drama. A woman of this type, as a rule, when a man appears in a women’s group, begins to compete with them for the man’s attention, and in a men’s group, she forces men to compete for their attention. She perceives men as strong and important, and women as weak and unimportant.

The hysterical personality type is susceptible to influence, prone to superstition and mysticism. It is difficult for them to distinguish the boundary between their fantasies and reality. As a rule, these are people of the intuitive type. Outwardly they emphasize their sexuality, although at the same time they can be frigid and asexual. They are acutely aware of the fear of growing old. The dominant feeling of the theatrical type personality is the feeling of being a small, frightened child in a world of strong strangers.

The main psychological defenses are repression, sexualization and regression.

This type is formed under the influence of events or relationships that attribute greater value to the male sex, that is, they give rise to a feeling of problematic sexual identity. Typically, this influence is associated with emphasizing the power of men in society and less care on the part of men towards infants. This creates an idealization of the male gender and makes him more attractive.

This can also happen to boys if they grow up under the pressure of a “matriarchy” where their sexuality is questioned or despised in contrast to “real men”. They can also develop in this case into a theatrical type, which is typical for men of homosexual orientation. Some researchers believe that the reason for the appearance of the hysterical personality type is the inadequacy of the mother and the narcissism of the father.

The psychotherapeutic strategy begins with a very clear psychotherapeutic agreement (where the responsibilities of the parties are clearly stated) and the creation of a strong psychotherapeutic relationship. The therapist must avoid self-disclosure in order to better work with the client's transference. Working with transferences is helping the client to independently understand these transferences and withstanding the client’s strong negative reactions towards the therapist. You need to curb your strong desire to be appreciated for your cooperation. It is important to cultivate the client's confidence in his own ability to take responsibility for himself and make adult decisions. At the same time, the therapist should not lose sight of the threat of sexualization.

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