Showing posts with label psychopathology. Show all posts
Showing posts with label psychopathology. Show all posts

Wednesday, December 30, 2015

Understanding Dan Montgomery's Compass Therapy

My fifteen years of collaboration with Everett Shostrom, a Stanford research psychologist and psychotherapist who carried out pioneering work in the field of counseling, planted the roots for Compass Therapy in what we at that time called Actualizing Therapy. Our approach combined a health model of personality with an explanatory system of psychopathology. We suggested that actualizing growth fosters maturity, flexibility, and purpose in life, and constitutes a reasonable goal of therapy. Further, that therapeutic gain always involves the integration of polar opposites within the personality and an acceptance of individual differences in relationships.

Historically, Dr. Shostrom had produced the “Gloria” films during which Carl Rogers, Fritz Perls, and Albert Ellis each worked in hour-long sessions with a counselee named Gloria. These films demonstrated the usefulness of showing exactly what happens in counseling sessions so that others can replicate beneficial techniques. Some years later Shostrom and I produced a second film series that featured Arnold Lazarus (Multimodal Therapy), Carl Rogers (Client-Centered Therapy), and Everett Shostrom (Actualizing Therapy) each working with a counselee named Cathy.

In the decades followed I continued this eclectic theory building by developing Compass Therapy, an approach that links together the Self Compass model of personality with operational definitions of psychopathology found in the universal standard for mental health professionals: Diagnostic and Statistical Manual of Mental Disorders. The use of compass-like diagrams made a user-friendly graphical interface that not only highlighted the principles of Compass Therapy, but also allowed counselees to readily understand how to participate more fully in their own transformation.

DSM

Though Compass Therapy has distinctions of its own, I was careful to construct an open-ended conversation with other major counseling theories. This partnering philosophy makes Compass Therapy a co-proponent of some of the most reliable therapeutic principles found in Psychoanalysis, Jungian Therapy, Gestalt Therapy, Transactional Analysis, Family Therapy, Existential Psychotherapy, Behavioral Therapy, Cognitive Therapy, and Positive Psychology. Perhaps this accounts for why Raymond Corsini, considered by many as the dean of American counseling and psychotherapy, has described my Compass Therapy approach as a “supersystem” that represents “the therapeutic system of the future.”

What has differentiated Compass Therapy from other theories is the idea that human nature and personality are comprised of dynamic opposites that need integration around the core self, and that action techniques are often required to move people forward in therapeutic progress. Like the alternating AC/DC current that powers an electric appliance, polar opposites in human beings create aliveness and health. For instance, healthy individuals find rhythms between solitude and sociability, activity and passivity, involvement and detachment, and work and play.

It’s when the dynamic movement between polarities breaks down and you get an extended flat line of stasis that people become sick, depressed, or devitalized. Dynamic movement fueled by the rhythmic swings of polar opposites expresses itself in mental health as well. Healthy individuals are spontaneous and flexible precisely because they are alive with new possibilities and passionate about the pursuit of creativity. If something doesn’t work, they try something else. If they are frustrated in fulfilling a goal, they explore novel options. They resist becoming stuck in a one-dimensional life.

Psychopathology, however, works differently. Rigidity replaces rhythm. Resourcefulness succumbs to sameness. Relationships perpetuate superficial actions and reactions. Life grows dull. Symptoms set in. The personality and human nature become frozen in intractable patterns that resist change and growth. Actually, the whole range of psychopathological alternatives to healthy living have a strangely attractive appeal, for they seem to make life safe, to make life predictable, and make life familiar.

The Compass Model
 
Healthy individuals can be loving or assertive, and weak or strong, as a situation requires. Rigid individuals are stuck in chronic behavior patterns that are too loving, too aggressive, too weak, or too strong. If healthy living lets you play the eighty-eight keys of the piano with both hands, then psychopathology makes you play only “Chopsticks” with two fingers.

Compass Therapy's Self Compass as well as the Human Nature Compass offer crucial dimensions for growth of personality and human nature that give a person all eight-eight keys, and unlimited capacity for composing the creative melodies and harmonies required for successful coping.

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.








Friday, November 2, 2012

Christian Counseling, Psychotherapy, and Truth

Many therapists have been overly trained to view a client's ego as fragile and unable to handle dynamic truths about their condition and behavior.

I agree and disagree with this training. I agree that we therapists must provide a safe interpersonal environment in which our clients can risk disclosing themselves. I disagree that we must walk on eggshells in order to do so.

Would you rather a physician or dentist hide the results of what they knew about your condition in order not to make you anxious, or describe what is causing your pain and what effective treatment will entail?

However, professionals who do optometry, dentistry, and surgery perform physical treatments to a patient's body, whereas we therapists rely upon a client's subjective and personal dialogue with us to achieve therapeutic goals.

I had this point driven home to me when I worked in a medical clinic and received physician in-house referrals to treat people's anxiety or depression. Every one of the fifty or so clients I worked with perceived me through the lens of the medical model. That means they would sit there passively looking at me while waiting for their anxiety or depression to magically go away. I found it extraordinarily difficult to engage them in dialogue to draw out the attitudes, thoughts, and feelings behind their clinical symptoms. They just didn't see the point.


This disappointing experience guided me all the more to affirm in Compass Therapy the need to be straightforward with people from the first session forward. Yes, a therapist listens with empathy and reflect feelings accurately so clients know they are being understood. But we must be fearless in bringing forth our clinical intuition and the findings of our psychological testing so that clients can perceive how important their free will choices are in relieving their symptoms.

This rhythmic movement between empathic listening and truthful engagement gives clients tools, concepts, and practice in thinking and feeling their way to personality health and wholeness.


Here is where Compass Therapy introduces a construct not present in secular psychotherapy; that is, the human soul. Human beings are God-created individuals who are called by God to purposeful lives. As therapists we are called upon when people feel bogged down by overwhelming stress, relationship dysfunction, or the grinding self-defeat of personality disorders.

We are graced with a degree of scientific knowledge about psychopathology and healthy personality growth, combined with our spiritual faith that God will help the therapeutic process along. I don't know about you, but I never begin a day of therapy without prayer for God to bless, heal, and guide the clients he sends to me.


 In the Compass model, where psychological truths are co-mingled with spiritual and biblical truths, clients are encouraged to face their disorders so that they can meaningfully outgrow them. I may tell a man with a paranoid arguer pattern that his perpetual anger and need to put people down is going to assure that he'll die as he has lived...grumpy and all alone. This is a wake up call to his soul that says, "Your therapeutic growth stretches need to include learning to make amends to the people you have abused, and learning to value love and forgiveness more than hatred and revenge."

Or, I might tell a woman who is trapped in the rigid pattern of dependent pleasing and placating, "Your efforts to make everyone happy is what leaves you depressed. Learning healthy assertion will help you develop a personal identity."

In my experience, clients respect truthfulness and take pride and pleasure when they act on psychological and spiritual growth stretches and get gratifying results.

The Compass Therapist does not hesitate being a cheerleader when people start thinking more effectively and regulating their emotions more appropriately. "Don, I really like how you stood up for yourself to your boss this week. Now he's lost his power to damage your self-esteem."

Scripture has a way of illuminating all human activities. In providing therapy, Jesus passed on a truth worth trusting: "And you shall know the truth, and the truth shall make you free" (John 8:32).


Saturday, September 8, 2012

Fuller Seminary Professor Commends Compass Therapy Book

In the decades it required to develop Compass Therapy, I kept two principles in focus:

  • most people want to know how to transform personality disorders and negative behavioral patterns into  health
  • many people seek to integrate reason with faith, so they can actualize the divine endowment of human spirituality with psychological wholeness

Further, I sought to connect psychotherapy with Christianity, a religion that encompasses about one quarter of all human beings living today. Does this show a preset bias toward Christians? Does it mean that the principles of Compass Therapy won't work in clinical practice where faith in God plays no role?

I do acknowledge that I am a Christian, and I choose to view the world through the lens of the Bible and Christian orthodoxy.

I respectfully leave to other colleagues the integration of counseling with Buddhism, Islam, New Ageism, Hinduism, agnosticism, or scientific atheism.

Yet I've learned from years of training graduates students in counseling that Compass Therapy theory and techniques can enrich the skill-sets of therapists using psychoanalysis, transactional analysis, gestalt therapy, family systems therapy, humanistic therapy, behavior therapy, or cognitive therapy.

Beyond clinical work in counseling centers and private practice, Compass Therapy opens new horizons to pastors, pastoral counselors, chaplains, and spiritual directors, for it unites Christian personality theory with practical counseling tools for healing human brokenness, whether in individuals, families, or churches.

These psychological and spiritual horizons can help any person successfully solve the three most universal human needs: identity, intimacy, and community.

In 2008 I emailed the final draft of the new Compass Therapy book to the senior professor of theology and ministry at Fuller Theological Seminary, to see if what I had said resonated with his lifelong mastery of theology. When he responded overnight with the commendation cited below, I exploded with joy!

From that moment Dr. Ray S. Anderson become a theological mentor and dear colleague. Through innumerable phone conversations we covered vast amounts of territory: historical theology, progressive theology, evangelical theology, feminist theology, liberation theology, and post-modernism. I found Ray quick in wit, strong in humor, and vibrant in faith. 

I dedicate this post to the memory of Ray Anderson. 

His words encourage me even now. "Dan, you've got to bring out your unique brand of compass knowledge to pastors, to Christians, and to the world..." 

And he kept providing creative ideas for doing so, right through his last months of painful fatigue from daily kidney dialysis, before he joined Jesus Christ in heaven.

Now I say this to Ray, as he stands among the cloud of witnesses who have faithfully served the Lord throughout time: "Thank you so much! I could not do this without your help."


Ray S. Anderson, Ph.D.


Ray S. Anderson, Ph.D.
Senior Professor of Theology and Ministry
Fuller Theological Seminary, writes:


"At the core of Compass Therapy is the divine endowment of human spirituality in each person that comes to expression through the mental, emotional and physical spheres of the self. Through diagrams and dialogue this book takes the reader directly into the counseling experience where a therapeutic alliance between the therapist and the counselee is created, releasing the innate spiritual capacity of the self to overcome negative and counter-productive personality patterns of behavior. 

"Dan Montgomery rightly views emotional and mental health as more than merely removing pathology; rather it is the movement of the self in relation to others where identity, intimacy and community are actualized as an achievement of the holistic self.
 
     "I am not aware of any other book that succeeds as well as this one in providing both professional therapists as well as Christian counselors with a theoretical and practical model that combines psychology and theology in an integrated way. It has a profound simplicity that covers a wide range of personality disorders. Readers will say, ‘Now I see why typical patterns of dysfunctional and disruptive behavior have a common root but also a specific cause.' Put this book on top of your reading list!

To learn more about Compass Therapy, read: 

 

Thursday, August 9, 2012

Compass Therapy on Personality Disorders

The term "personality disorder" -- described in DSM-IV and DSM-V (Diagnostic and Statistical Manual of Mental Disorders) -- captures the chronic and rigid inflexibility of a personality pattern. Unfortunately, this term can also have a side effect of diminishing a person's self-esteem and creating futility about the future. Even therapists can feel pessimistic about treating personality disorders.

Compass Therapy changes this by using the term "personality patterns," thus emphasizing that rigid patterns are merely growth deficiencies that can be replaced with healthy personality growth. People are familiar with the concept of laying aside old patterns, such as eating too much or driving too fast. They quickly grasp that growth stretches into unused compass points makes their behavior more resourceful and their life happier.

Therapists can remember nine major personality patterns by their location around the Self Compass. Each pattern is stuck on one or two compass points to the neglect of the others. Compass Therapy guides the expansion of personality into rhythmic use of all four complimentary points.

Personality Patterns Self Compass

*The dependent and histrionic patterns are located on the Love compass point, where the dependent trend intensifies into chronic pleasing and placating (dependent) or the melodramatic craving for attention (histrionic). Both patterns share intense needs for approval and affection, as well as a fixated focus on others that blocks access to the spiritual core.

*The paranoid and antisocial patterns are stuck on the Assertion compass point, where the aggressive trend develops into edgy suspicion (paranoid) or impenitent exploitation (antisocial). These two patterns frequently co-vary as personality mixtures, and share an undercurrent of hostility. They consider others as adversaries over whom they must triumph.

* The avoidant and schizoid patterns are located on the Weakness compass point, where the withdrawn trend intensifies into fearful loneliness (avoidant) or isolated detachment (schizoid). Both patterns create flat affect, a lack of motivation in personal development, and massive deficiencies in interpersonal skills.

* The narcissistic and compulsive patterns are lodged on the Strength compass point, where striving for superiority pushes the controlling trend into either the grandiose entitlement of the narcissist or the judgmental perfectionism of the compulsive. These two patterns share a common preoccupation with issues of adequacy, power, and prestige. Both patterns are quite comfortable taking control and dictating. Both patterns share the demand for perfection, the narcissist seeking the glory of ambition and the compulsive enforcing the status quo.

*The borderline pattern blends elements of the top and bottom halves of the Self Compass, flip-flopping in rapid swings from one extreme to its opposite. A built-in ambiguity within the pattern makes unpredictable whether the person will come across as a “top dog” (Strength and Assertion compass points) or an “underdog” (Love and Weakness compass points). This oscillating fluctuation forms the “rigid fluidity” of the borderline pattern.

I've taught students at several universities how to understand and treat these personality disorders. When I first used the material found in the Diagostic and Statistical Manual of Mental Disorders, my students remained puzzled, because they could never remember what distinguished one disorder from another, let alone how to construct an effective treatment plan based on each pattern's unique needs.

However, when I started using the Compass Therapy model, based on the user-friendly model of the Self Compass, students and veteran therapists alike said they could finally locate each disorder relative to the others, and understand the rationale regarding the facilitation of therapeutic growth toward a healthy and balanced personalty.

Here's what Lallene Rector, Professor of Psychology of Religion and Pastoral Psychotherapy, Garrett-Evangelical Seminary, Northwestern University, writes about the Compass Therapy perspective on Personality Disorders: 

"One of the real gems in the Montgomerys’ work is a systematic analysis of 'personality patterns' following DSM descriptions of the personality disorders. Attention is paid to the pattern’s interior, its origins, cognitive self-talk, emotional dynamics, and impact on others, as well as its way of relating to God."

To connect the diagnosis of a personality pattern
with a successful compass treatment, read




Sunday, July 29, 2012

Compass Therapy Promotes Direct Action

Not long ago I was in a therapy session with a twenty year old woman (I'll call her Rachel) who was struggling to recover her battered self-esteem from an eight-month relationship with a domineering and misogynistic man. Of course her boyfriend (I'll call him Bill) had his charm. He bought her a few gifts. He made her laugh sometimes. But that hardly compared to how badly he ran her down in his presence.




We began our work with her describing Bill's many ways of verbally abusing her, at the same time trying to convince her that she deserved this treatment. 

Now in the present session I show her the Self Compass diagram, explaining how people need access to the four compass points of Love and Assertion, Weakness and Strength—the LAWS of personality health.




Rachael immediately got it. She said, "I was definitely stuck on the Love compass point, pleasing and placating Bill in every way, always trying to keep the peace, and always wondering why he was so mean and critical. I didn't dare show Assertion or Strength." Likewise, she identified Bill as stuck on the Assertion compass point with relentless aggression. "He always became angry and impatient, especially if I hesitated to do whatever he wanted."

Once we both grasped the relationship dynamics, I offered insights for developing healthy Assertion and Strength in Rachel's personality. But we needed more than insight alone. We needed to exorcise the emotional anxiety from his reign of terror in her life. In the next session, I moved into a Compass Therapy action technique.

"Rachel, our talking so frankly and fully about the emotional wounding you received from Bill is the first step in recovery. But the next step requires action on your part."

"What do I need to do?"

"Just relax where you are sitting and follow my instructions for the next couple of minutes. We're going to go deep in your psyche, where your unconscious has stored hundreds of painful memories—humiliation, false guilt, and fear of displeasing Bill or any other man. We're going to cast these feelings out of you by replacing them with their polar opposite: peace, dignity, and self-love."

Rachel agreed to follow my lead. I guided her into a deep breathing and muscle relaxation sequence, where she tensed and then relaxed muscle groups from the crown of her head to the tips of her toes.

Once she was physically and mentally relaxed, I said, "Now while you continue to melt your muscles and breathe deeply, I'm going to speak to you the way Bill often did, and use the same tone of voice. Your task is to keep relaxing, and come up with new responses that tell him now—based on your newly developing Assertion and Strength—what you wish you had said back then, but were too afraid."

Once she fully understood what we were doing, and did indeed relax, I repeated many of the criticisms that Bill once used, and was pleased to see her standing up to them. She drew from the Strength of our relationship, and trusted the process of Self Compass expressiveness that Bill inhibited. I cheered her on until she actually felt this healthy assertion in her body/mind/spirit.




A session like this isn't an instant fix. But it does have psychological power to generalize into a person's current and future life. And for Rachel it was lifesaving to develop a new sense of peace and self-confidence. She was taking the first steps to learning how to build a self-boundary strong enough to ward off any future encounter with a misogynistic man.

There are twenty-five counseling techniques in one of my books on Compass Therapy. To read the first chapter, 
visit Amazon.com here:

Monday, July 2, 2012

Philosophical Underpinnings of Compass Therapy

As the founder of Compass Therapy, I'm occasionally asked why I choose a Christian worldview as the philosophical foundation of this approach to counseling. The obvious answer is that I am a Christian by faith and choice, though in coming to this experience I did try out atheistic and agnostic perceptions of reality. 

Beyond my personal faith, I want to take a stand as a professional psychologist who believes that spirituality is essential to human nature and vital to mental health. I agree with many world religions that are rooted in a community of faith, where people find purpose in suffering, hope in times of loss, and meaning in their sacred scriptures and traditions.

So why am I selective about making Christianity the foundation upon which Compass Therapy arises? Because the Trinity, the core teaching of Christian faith and doctrine, reveals a spiritual reality that underlies all human experience: the reality of One God in Three Persons. In other words, human life and history, deriving from being created in the image of God, is fundamentally interpersonal, just like the divine Trinity is fundamentally interpersonal: the Father, the Son, and the Holy Spirit.


But aren't these religious assertions a far cry from modern psychology and psychotherapy, and shouldn't there be a permanent barrier that separates what happens in a house of worship from what happens in a therapist's office?

I think not.

Whether we like it or not, we are born into a social context of Life Together. Therefore our mental health is linked to the progress we make in getting along with God and other people. No person is an island, and alienation from community (ie. the inability to give and receive love) is a sure mark of psychopathology.

Compass Therapy suggests that developing a healthy personality and fulfilling interpersonal relationships are primary aims of good therapy. Toward that end a therapist uses techniques of psychotherapy to relieve symptoms of anxiety, depression, relationship dysfunction, addiction, or a host of other disorders and psychological disabilities. Yet let's never forget that the primary aim remains the development of personality health and social integration, a pursuit that lasts a lifetime.

For more about this, see

COMPASS PSYCHOTHEOLOGY:
 Where Psychology & Theology Really Meet