Ch 6: Responsibility II Flashcards
Responsibility and Psychotherapy: Research Evidence
Two propositions between responsibility and psychotherapy
- Avoidance is not conducive to mental health
- Acceptance leads to success
However, this oversimplifies.
- Some defense mechanisms such as innocent victim, externalization, losing control are maladaptive
- Some defense mechanisms such as belief in grace or divine providence can be helpful
- Some take on responsibility too fully and without the internal resources to face anxiety
IS RESPONSIBILITY AVOIDANCE BAD FOR MENTAL HEALTH?
External locus of control
Warm, attentive, responsive family environment
Didn’t find a lot of research with ‘freedom’, ‘responsibility’, ‘willing’, but did find it with external locus of control:
- Feelings of inadequacy
- More tense, anxious, hostile, confused
Imaginative, more frustrated, more apprehensive
- Schizophrenics are more likely to have an external locus of control
- Severely impaired patients are more likely to be externals than are mildly impaired patients
- Depressed patients also often external locus of control
There’s some evidence that a warm, attentive, and responsive family environment is a precursor of development of an internal locus of control while an inconsistent, unpredictable, non-friendly environment predicts an external locus of control
- Older siblings tend to have an internal locus control as well, compared to younger ones
DOES PSYCHOTHERAPY INCREASE RESPONSIBILITY AWARENESS? IS THAT HELPFUL?
Several findings:
- Gillis and Jesser demonstrated that hospitalized patients who improved shifted from external to internal locus
- Dua reported a behavioral program with delinquents that resulted in internality
PS! Unfortunately, the above studies don’t have control groups and are subjective to hawthorne effects (acting as expected because of being observed)
Yalom had a 12-category 60-item questionnaire with successful group therapy patients, and “Learning that I must take ultimate responsibility for the way I live my life no matter how much guidance and support I get from others” was in TOP5
- York and Eisman repeated Yalom’s study with drug addicts and the same item was in TOP2
Dreyer demonstrated that majority of patients entering a psychiatric ward expect that others will help them, but 8 days later they stated that they must assume greater personal responsibility
Lieberman with women’s consciousness-raising groups reports patients central theme as “I alone am responsible for my own happiness”
The data suggest that successful psychotherapy patients become more aware of personal responsibility for life. “It seems that not only seeing that relationships - intimacy and relatedness - is a key learning point for patients, but also what one cannot get from others, in therapy as well as in life.”
Therapist Style: Research Evidence (for locus of control)
Findings
Helweg asked people to look at videos of Rogers (non-directive) and Ellis (very directive), and found that internals preferred Rogers and externals preferred Ellis
Jacobsen asked therapists to construct profiles of their approaches, and found the same - internals preferred more non-directive ones, and externals more directive ones
Wilson looked at a similar thing through perception: internals will select therapists who they perceive will permit them full participation and control in the process
Yalom on danger of therapist style
Encounter groups
Yalom: “The danger: the more active and forceful the therapist (even when in the service of helping the patient assume responsibility), the more the patient is infantilized.”
Yalom studied this with colleagues in encounter groups, they measured all sorts of different aspects:
- Level of activity
- Consent of comments
- Degree of executive function (setting limits, rules, norms, goals, time management, pacing, stopping interceding)
- Number of structured exercises
Feedback exercises, hot seat, psychodrama
When analyzing the outcomes between leader behavior and outcomes (self-esteem, coping mechanisms, peer evaluations etc,)
- A curvilinear relationship between executive function an outcome: too much resulted in a highly structured authoritarian group in which members failed to have a sense of autonomy; too little resulted in a bewildered floundering group
- The more structured exercises used by the leader, the more competent did the members deem him to be immediately at the end of the group but the less successful was the outcome of his group’s members measured six months later
Limits of Responsibility
The concept of responsibility pragmatically “works” for psychotherapy. But how far does this truth go?
Many therapists work towards responsibility in their clients but secretly believe in a deterministic world (Yalom: “and I don’t exclude myself”)
- The doubt can leak out, e.g. with a divorced depressed woman, the therapist can think “well, but it is hard as a 45-year-old to find an attractive, single, straight man in San Francisco. Her job, which she needs to survive, to pay her bills, also doesn’t offer a lot of opportunities to meet new people. Perhaps Mr. Right would make 90% of her troubles go away”
- Then Mr.Right does come along, and happily ever after never transpires
- So what is right about responsibility?
Determinist vs Libertarian
Skinner
Binswanger
Generally in a debate the logic and reality seems to be on the side of the determinist; the libertarian is “softer” and appeals to unmeasurable, emotional argument
- Dilemma for psychotherapists: being libertarian is effective in their work, but many with backgrounds in science find that a deterministic argument is unassailable
- However, even Skinner said that “since we are determined by our environment, each of us may manipulate behavior by manipulating our environment”
- Binswanger about Freud: “The fact that our lives are determined by the forces of life is only one side of the truth; the other is that we determine these forces as our fate. Those who, like Freud, have forged their fates with the hammer - the work of art he has created in the medium of language is sufficient evidence of this - can dispute this fact least of all.”
Reciprocal determinism
Bandura: “We all know problem-prone individuals who predictably breed negative social climates wherever they go. Others are equally skilled at bringing out the best in those with whom they interact.”
- I.e. reciprocal determinism
- “In deciding which movie to attend from many alternatives in a large city, there are few constraints on the individual so that personal preferences emerge as the predominant determinants. In contrast, if people are immersed in a deep pool of water, their behavior will be remarkably similar, however uniquely varied they might be in their cognitive and behavioral make-up.”
- Yalom: “but even immersed in the neck, they can choose how they feel about the situation” (but can they?!)
- However Bandura also said: “for every chicken discovered by an unidirectional environmentalist, a social learning theorist can identify a prior egg”
Epictetus
Crux of being human
Epictetus: “I must die. I must be imprisoned. I must suffer exile. But must I die groaning? Must I whine as well? Can anyone hinder me from going into exile with a smile? The master threatens to chain me: what say you? Chain me? My leg you will chain - yes, but not my will - no, not even Zeus can conquer that.”
Yalom: “One’s attitude towards one’s situation is the very crux of being human
- Even with our handicaps, we are responsible of how we approach them
- Yalom: “It was Abraham Lincoln, I believe, who said that after forty everyone is responsible for his face.”
Yalom had a patient who felt that because of his handicap she can’t find a mate and without a mate life was without value
- She closed off any options for herself, including an intimate friendship with another woman or a nonsexual friendship with a man
Acceptance of the external ‘given’
The true task
Yalom: “Recognition and acceptance of the external ‘given’ do not involve a passive stance toward one’s external environment.
Indeed neo-Marxists and proponents of radical psychiatry have often levied this very charge towards mental health: that it neglects the adverse material circumstances of the individual, whom it urges to unquestioningly accept his or her (capitalist-imposed) lot in life.”
The true task is to then identify one’s true coefficient of adversity; to help patients reconstrue that which they cannot alter.
PHYSICAL DISEASE & RESPONSIBILITY
Personal responsibility extends farther than responsibility for one’s psychological state
Freud was the first to suggest that accidental injuries are not just accidental, but instead a manifestation of psychic conflict: he described the “accident prone” individual who suffers an unusual amount of accidental injury.
- Following Freud, two generations of analysts developed the field of psychosomatic medicine in which a number of medical illnesses - arthritis, ulcers, asthma, ulcerative colitis - were discovered to be powerfully affected by psychological state
Simonton: Even cancer?!
The concept of responsibility is now being also applied to such illnesses as cancer - long though to be far beyond the individual control
- Simonton basically reasons that since the individual is constantly exposed to cancer cells, one’s body resists these cells unless resistance has been lowered by some factor, e.g. stress, then psychological focus may well be marshaled to influence the course of cancer
- He suggests daily visual meditation of a metaphor regarding the cancer, e.g. that the cancer is a piece of raw meat and that white blood cells are bulldogs that are devouring the meat
- No evidence that this increases survival
- However, cancer introduces a lot of helplessness, e.g. compared to heart disease in which you can diet and exercise and rest better, thus the simonton approach could help with helplessness
If Simonton is a lie?
Nevertheless, if Simonton is based on a lie (doesn’t increase survival) then what else could one do
- Yalom: “First, one is always responsible for their attitude towards cancer”
- Some give in to despair and die an early psychological death
- Some use cancer as catalyst for change towards a meaningful life
Frankl:
- During WWI a Jewish army doctor was sitting in a fox hole with his gentile friend, an aristocratic colonel, and heavy shooting began. Teasingly the colonel said: “You are afraid aren’t you? That’s just another proof that the Aryan race is superior to the Semitic one.” “Sure, I’m afraid,” was the doctor’s answer. “But who is superior? If you, my dear colonel, were as afraid as I am, you would have run away long ago.”
Yalom has developed cancer groups in which members helped each other to assume more responsibility in the process, e.g.
- to ask for more information from the doctor, to learn to read the X-rays, some found it sensible to refuse medication at certain points
- Some became activists and advocated for tax credit for breast protheses
- Some also assumed responsibility of affecting the group itself
Neurotic guilt & real guilt
A distinction may be made between neurotic guilt and “real” guilt, or in Buber’s terms, between “guilt” and “guilt feelings”.
- Neurotic guilt emanates from imagined transgressions against another individual, against ancient and modern taboos, or against parental or social tribunals
- “Real” guilt flows from an actual transgression against another
- Though the subjective dysphoric experience is similar, the meaning and the therapeutic management of these forms are very different
- Neurotic guilt must be approached through a working through of the sense of badness, the unconscious aggressivity and the wish for punishment
- “Real” guilt must be met by actual or symbolically appropriate reparation
Existential perspective on guilt
Heidegger
Tillich
Susya
Rollo May
An existential perspective adds important dimensions to guilt: no longer can the individual rely on such alibis as: “I didn’t mean it”, “I couldn’t help it”
- More importantly, it adds the dimension of being guilty about something you did towards another, but also being guilty of transgression against oneself.
Heidegger used the same word - schuldig - for both guilt and responsibility: “being guilty also has the signification of ‘being responsible for’ - that is, being the cause, or author or even the occasion for something.”
- Heidegger then proceeds to say that “in the idea of ‘guilty’ there lies the character of the ‘not’, dasein is always constituting, and it “constantly lags behind its possibilities”.
- Guilt is thus intimately related to possibility or potentiality - feeling guilty of failing to fulfill one’s authentic possibility
Tillich: “Man’s being is not only given to him, but also demanded of him. He is responsible for it; literally, he is required to answer, if he is asked, what he has made of himself. He who asks him is his judge, namely he himself. The situation produces the anxiety which in relative terms is the anxiety of guilt, in absolute terms the anxiety of self-rejection or condemnation.”
Susya, a Hasidic rabbi: “When I get to heaven, they will not ask me ‘Why were you not Moses?’ Instead they will ask ‘Why were you not Susya? Why did you not become what only you could become?’”
Rollo May suggested to look at repression as a source of information: “What is this person’s relation to his own potentialities? What goes on that he chooses or is forced to choose, to block off from his awareness that he knows and on another level knows that he knows?”
- May also describes (existential) guilt as a “positive constructive emotion” - it’s compatible, even necessary for mental health. “When the person denies his potentialities, his condition is guilt.”
