Sunday, December 2, 2012

Personality Disorders Explained: Compass Therapy

On the eve of the publication of DSM-V, the world's major tool for understanding mental illness and personality disorders, psychiatrists are pulling their hair out, trying to find a central working model that makes sense of people's inner worlds.

The main problem psychiatrists and personality theorists find with the concept of personality disorders -- longstanding patterns of cognition, emotion, and perception -- is that so many of the present personality disorder categories overlap one other when observed in real life.

Called co-morbidity (a terrible word since it sounds like death warmed over!), it simply means that very few people are pure prototypes of the narcissistic, compulsive, antisocial, paranoid, dependent, histrionic, schizoid, or avoidant personality disorders. This rests on the assumption that human behavior and its attendant psychopathology should be neat and tidy, like the data found in most other hard sciences: chemistry, physics, and mathematics.

But humans are not purely objective creatures with totally predictable instincts. We are deeply subjective individuals with personal life histories and points of view. I say that it is time psychiatry wakes up to this fact of life, and accepts the simple truth that individuals seen in therapy can demonstrate elements of narcissistic entitlement, antisocial rule-breaking, and histrionic melodrama coexisting within their personality and relationships.

Compass Therapy makes a contribution here by asserting that all human beings possess personality rigidities that are behaviorally significant in varying circumstances. These rigidities increase under stress and decrease with personality integration, which needs to be a primary goal of all therapy.

What has blocked this perception from developing in psychiatry is the ongoing war between psychoanalytically oriented professionals who believe there exists an unconscious motivation for every inner conflict, the behavioral professionals who believe that medication and behavioral conditioning can remove symptoms without a client's subjective involvement in the process, and humanistic professionals who believe that giving a client an empathetic ear for airing their inner distress will eventually lead them into making more adaptive and self directing life choices.

Compass Therapy draws upon all of these perspectives in order to develop an overview that pertains to every single client: we need to see with X-ray vision into the objective structure of personality to grasp why people subjectively choose the way they do, especially when their choice patterns bring them anxiety, depression, hostility, withdrawal, alienation, and other symptoms that make life intolerable.


With a cursory glance at the diagram above you can recognize when your client is stuck favoring one of the universal compass points of personality to the exclusion of others, or if your client rigidly uses different compass points in different situations. This solves the co-morbidity problem because it is common for people to swing around the Self Compass in non-adaptive ways, precisely because they've never learned through cognitive and emotional maturity how to use a whole Self Compass to flexibly adapt to life situations.

The Compass Model introduces new learning on how mental health functions, exactly how it breaks down, and how to expand a client's personality into healthy compass points that foster health in personality and relationships. Understanding this system give a counselor invaluable information immediately, since it illuminates the client's personality structure in every moment of counseling.

Without this model you are left floundering, trying to figure out the complex causes of historical or developmental traumas, and then how how to promote healing and change. The Self Compass Model organizes an immense foundation of clinical and empirical data, yielding a simple and effective perception of the client's health or dysfunction. A second substantial advantage is that a therapist can share compass concepts directly with clients, since these concepts are understood even by school age children.

I encourage you to get an early start on grasping the new DSM-V by first mastering the principles of Compass Therapy. To help you along, here are five Compass Therapy books for you to consider adding to your core clinical and/or pastoral counseling library.