Last night’s lecture was part 2 of clinical personality types and it was fascinating. The previous week was all about the schizoid (fixated in the oral development) and the obsessive (hiding of feelings). Last night covered the depressive and hysterical types. The important thing to remember in all of this is that this is just a map, as nobody is a “pure” type. However, we do have preferences. Depressives and hystericals are more likely to turn up for therapy.
Depression can be endogenous, reactive and bi polar (manic). Endogenous depression is not type of depression rather it is biological depression. One of the main causes of endogenous depression is chemical imbalance in the brain. Endogenous depression appears to come from nowhere. Reactive depression specifies that depression from some event or some stress occurring. For example, problem in relationship, death of closed one, loss of love one, changing job or anything that directly affects one’s life. Bi polar depression is the toughest to live with and requires medication for chemical rebalancing.
The purpose of therapy is to uncover the true feelings of the client. Depressives usually look for the script to confirm their feelings of worthlessness. There is no magic solution for the treatment of depression in therapy. The truth is before it gets better it will probably get worse. CBT interventions such as “to do lists” can be very useful. Depressives have a difficult time with boundaries. They get attached and want to extend the session and can want to see the therapist outside the therapeutic relationship.
In Freud’s day the hysterical type was seen as classically female. Hysterical types seek attention by whatever means. They can be manipulative, larger than life and have an egocentric craving for attention. There is always a drama going on with them. Hysterical types are prone to sexually provocative behaviour or to sexualizing nonsexual relationships. However, they may not really want a sexual relationship; rather, their seductive behavior often masks their wish to be dependent and protected. They make mountains out of mole hills. The proverb rings true: “Empty vessels make most noise”.
Psychotherapy is the cornerstone of most treatments and usually must continue for more than a year to change a person’s maladaptive behavior or interpersonal patterns. The therapy sessions must build a positive transference. The therapist is the stable core, providing accurate mirroring and allowing for reality checking.
A good book to read is the Art of Psychotherapy by Anthony Storr.