The Psychotherapeutic Utility of the Five-Factor Model of Personality: A Clinician's Experience

This article summarizes experience using the five-factor model of personality, operationalized by the NEO Personality Inventory (NEO-PI), to facilitate psychotherapy treatment with 119 private-practice, outpatient, psychotherapy patients and their family members over a period of 2 years. Trait theories such as the five-factor model implicitly challenge the premises of much clinical theory, yet they can be useful to clinicians, as they provide a detailed, accurate portrait of the client's needs, feelings, proximate motives, and interpersonal style. I suggest that: Neuroticism (N) influences the intensity and duration of the patient's distress, Extraversion (E) influences the patient's enthusiasm for treatment, Openness (O) influences the patient's reactions to the therapist's interventions, Agreeableness (A) influences the patient's reaction to the person of the therapist, and Conscientiousness (C) influences the patient's willingness to do the work of psychotherapy. Fundamental questions raised by the five-factor model about the nature of psychopathology and psychotherapy are discussed.     

Behavioural Consistency Within the Prisoner's Dilemma Game: The Role of Personality and Situation

Mixed‐motive games represent situations that confront people with a conflict between cooperative and non‐cooperative alternatives. Despite this common basis, recent research has shown that the consistency of people's choices across different mixed‐motive games is rather low. The present research examined behavioural consistency within the same mixed‐motive game, by presenting participants with a series of one‐shot Prisoner's Dilemma Games. Across this set of games, payoffs were manipulated in order to intensify or weaken the conflict between self and the other party while maintaining the game's underlying structure. Our findings indicate that significant differences in choice behaviour are observed as a function of both situational (i.e. manipulations of the Prisoner's Dilemma Game's payoff structure) and personality differences (i.e. individual differences in personality and motivational traits). Moreover, our included situational variables and personality features did not interact with each other and were about equally impactful in shaping cooperation. Crucially, however, despite the significant behavioural differences across game variants, considerable consistency in choices was found as well, which suggests that the game's motivational basis reliably impacts choice behaviour in spite of situational and personality variations. We discuss implications for theorizing on mixed‐motive situations and elaborate on the question how cooperation can be promoted. © 2018 European Association of Personality Psychology     

Clinical Commentary

This paper describes a lengthy period of psychotherapy with a child. This treatment began only after a prolonged contact with other child and adolescent mental health services during which the child's difficulties, which had initially seemed to be ordinary behavioural problems, had proved puzzlingly intractable to a variety of interventions. Subsequent psychotherapy revealed a profound disorder of development which lay bath the Surface presentation. In a climate where Asperger's syndrome is often felt to be untreatable, this paper argues that some children, at least, can benefit from psychotherapy and can be helped towards real mental growth. Asperger's syndrome in children bears some striking similarities to narcissistic personality disorder as described in the adult psychoanalytic literature and this paper discusses some of the theoretical and clinical implications of the innate origins of Asperger's syndrome.     

Disintegration of the self and the regeneration of ‘psychic skin’ in the treatment of traumatized refugees

This paper presents a tentative understanding of the characteristics of the extreme traumas, elsewhere called ‘complex PTSD’, that some refugees and asylum‐seekers bring into therapy. It suggests that these kinds of traumas suffered during adulthood may involve a disintegration of the self and a loss of ‘psychic skin’. This conceptualization is derived from the treatment of a refugee who survived multiple extreme traumas and with whom efforts were made in therapy to identify a complex methodology making use of supplementary therapeutic tools in addition to individual psychotherapy. The case demonstrates how the disintegration of self implies not only a deep somato‐psychic dissociation, but also a loss of intrapsychic and interpersonal space. In the treatment this was worked through via repetition of the victim‐aggressor dynamics at multiple levels. In the end, the therapeutic context was structured like a set of concentric layers, creating a ‘bandage’ over the patient's wounds whilst his ‘psychic skin’ was able to regenerate. The conditions triggered by extreme traumas in refugees challenge some of the cornerstones of individual psychoanalytic technique, as well as the idea that individual therapy may be thought of as existing in an environmental vacuum.     

Deutende Interventionstechniken bei Patienten mit schweren Persönlichkeitsstörungen

The growing influence of ego-psychology, self psychology, object relations theory, and interpersonal concepts on the psychoanalytic psychotherapy of patients with personality disorders is reflected in a preference of relational therapeutic strategies and in a controversial discussion of interpretative techniques. It is shown that interpretative strategies are of invaluable importance in many patients with personality disorders. However, modifications of technique necessary for this group of patients should be considered. Especially, transference interpretation in the here and now can be of great use even in the treatment of patients with severe personality disorders. It is of outstanding relevance for the therapist to understand the interactional message a patients infers from his interpretation and to take into account the patient's reaction to the interpretation.     

Dimensions of Normal and Abnormal Personality: Elucidating DSM‐IV Personality Disorder Symptoms in Adolescents

ABSTRACT The present study aimed to elucidate dimensions of normal and abnormal personality underlying DSM‐IV personality disorder (PD) symptoms in 168 adolescents referred to mental health services. Dimensions derived from the Big Five of normal personality and from Livesley's (2006) conceptualization of personality pathology were regressed on interview‐based DSM‐IV PD symptom counts. When examined independently, both models demonstrated significant levels of predictive power at the higher order level. However, when added to the higher order Big Five dimensions, Livesley's higher and lower order dimensions afforded a supplementary contribution to the understanding of dysfunctional characteristics of adolescent PDs. In addition, they contributed to a better differentiation between adolescent PDs. The present findings suggest that adolescent PDs are more than extreme, maladaptive variants of higher order normal personality traits. Adolescent PDs seem to encompass characteristics that may be more completely covered by dimensions of abnormal personality. Developmental issues and implications of the findings are discussed.     

The effect of Axis II disorders on the outcome of treatment of anxiety and unipolar depressive disorders: a review

Psychiatric and other clinicians have often speculated on whether the presence of a personality disorder would indicate a poorer course of treatment for an Axis I disorder. Starting around 1990, the standardized criteria of the DSM increased interest in examining this area empirically. This report updates my previous reviews and examines other writing in this area. There is still a considerable body of evidence indicating that personality may cause a poorer treatment outcome of an Axis I disorder; however, there are also intriguing new developments. The introduction of new drug treatments that may be helpful with some dysfunctional personality traits changes some of the findings and may suggest that there may be preferential treatments for some Axis I patients with certain comorbid personality traits. (In certain cases this may apply to some specific psychotherapy techniques as well.) In addition, at times, personality traits may predict a positive outcome to treatment. This review is an attempt to bring together this diverse area and suggest where fruitful areas of research and intervention may possibly be found.     

An overview of the treatment of severe narcissistic pathology

This paper provides an overview of narcissistic personality disorders as they present clinically along a spectrum of severity ranging from the best functioning forms of pathological narcissism to the most threatening to the patient's psychosocial and physical survival. It proposes a general interpretive psychoanalytic stance with all these clinical syndromes that range from standard psychoanalysis to a specific psychoanalytical psychotherapy for the most repressive and life threatening conditions that may not respond to standard psychoanalysis proper. This general psychoanalytic approach is placed into the context of related developments in contemporary psychoanalytic understanding of pathological narcissism and its treatment.     

Personality and gender differences in global perspective

Men's and women's personalities appear to differ in several respects. Social role theories of development assume gender differences result primarily from perceived gender roles, gender socialization and sociostructural power differentials. As a consequence, social role theorists expect gender differences in personality to be smaller in cultures with more gender egalitarianism. Several large cross‐cultural studies have generated sufficient data for evaluating these global personality predictions. Empirically, evidence suggests gender differences in most aspects of personality—Big Five traits, Dark Triad traits, self‐esteem, subjective well‐being, depression and values—are conspicuously larger in cultures with more egalitarian gender roles, gender socialization and sociopolitical gender equity. Similar patterns are evident when examining objectively measured attributes such as tested cognitive abilities and physical traits such as height and blood pressure. Social role theory appears inadequate for explaining some of the observed cultural variations in men's and women's personalities. Evolutionary theories regarding ecologically‐evoked gender differences are described that may prove more useful in explaining global variation in human personality.     

The NICE guidelines are misleading,unscientific, and potentially impede good psychological care and help

NICE guidelines have been given the authority to determine what psychological therapies can be provided within the UK National Health Service. This also has implications for private practice. The guidelines are based on a medical model and consider psychotherapy as analogous to a drug. Psychological thinking is discouraged by this approach. A large amount of psychotherapy research evidence is ignored by NICE, particularly the persistent finding that differences in effectiveness between therapies are minimal and elusive. Differences between the skills of therapists are a more significant factor. Practice-based evidence, and learning from the patient's feedback (both conscious and unconscious) may be a better approach. For most forms of psychological distress, none of the main psychological therapies studied in randomized controlled trials can be considered to be clinically effective, even though they facilitate some degree of statistically significant change.     

Attachment Security,Personality, and Adjustment of Elementary School Children

Children's development is assumed to be closely related to their attachment security and their personality. The authors’ aim was to examine the joint contribution of attachment security and personality traits to children's adjustment by examining diverse children's outcomes (emotional symptoms, social functioning, and behavioral problems) and using various perspectives (children, parents, and teachers). The sample comprised 247 8–12-year-old children from low socioeconomic status neighborhoods. Personality and attachment contribute to the different domains of adjustment. In cases of moderation, attachment security moderates the implications of personality traits on children's adjustment. The findings highlight the contribution of positive personality tendencies in playing down the difficulties of insecurely attached children.     

PREDICTORS OF ENGAGEMENT IN PSYCHODYNAMIC PSYCHOTHERAPY DERIVING FROM PRE‐ASSESSMENT QUESTIONNAIRES

Patients attending the Maudsley Hospital Psychotherapy Unit complete a semi‐structured questionnaire as a matter of standard procedure prior to assessment. Clinical experience suggests that this instrument reveals important aspects of a patient's internal world, regularly borne out at the assessment interview. The questionnaire may thus contribute to predicting engagement in the therapeutic relationship. To evaluate this hypothesis we conducted a qualitative analysis of 40 questionnaires, 20 of patients who attended 20 sessions or more, the other 20 of patients who discontinued at or before the sixth session. We differentially explored characteristics that may indicate the probability of patients' engagement and, hence, help to predict outcome in terms of completion of the treatment. The results indicate that there are no strong discriminating factors discernable in the questionnaires for the prediction of engagement in psychotherapy. Two themes emerged from the analysis that seemed to have a moderate bearing on completion. These are the willingness of patients to observe themselves reflectively as well as the awareness that psychotherapy might be a difficult but necessary and beneficial undertaking.     

The face of personality: Adaptive inferences from facial cues are moderated by perceiver personality and motives

Humans have historically been interested in understanding stable individual differences in behavioral tendencies, often referred to as personality traits. Recent work suggests that between‐person personality variability may be adaptive insofar as certain variations in personality constellations facilitate survival and reproduction across various types of groups and ecological niches. While past research has demonstrated that personality can be accurately inferred from self‐reports, other‐reports, and targets' past behavior, we discuss a more contemporary, yet understudied, means of personality inference: facial structure. We summarize research on personality traits that can be accurately inferred from facial structure, as well as how aspects of individuals' own personality, chronically accessible motives, and acutely activated goals lead to preferences for facially communicated personality that would aid in the satisfaction of these goals (e.g., higher need to belong predicts a stronger preference for faces whose structure communicates greater extraversion). We also discuss limitations of current approaches to understanding the relationship between perceiver personality and motives and their relation to perceptions of facially communicated personality as well as fruitful directions for future research.     

Integrating Divine Attachment Theory and the Enneagram to Help Clients of Abuse Heal in Their Images of Self,Others, and God

For victims of childhood abuse, healing their unconscious images of themselves, others, and God is of utmost importance in therapeutic work. Addressing the healing from both a scientific and a spiritual-contemplative approach is ideal in the context of spiritually integrated psychotherapy. Combining the frameworks of divine attachment theory and the Enneagram can help abused clients on their journey towards holistic healing in a way that addresses both the scientific and soulful dimensions of their deep unconscious wounds. This integration has the potential to heal multiple aspects of wounding, including unconscious images of clients, their offenders, and God. It also has the potential to dignify clients by showing how their unique God-given personality has a finite correspondence to God’s very own infinite personality and by outlining potential points of existential connection between aspects of their personality traits and the personality traits of the eternal God. Finally, clients can also grow in empathy and compassion for their abusers, which will help in the process of forgiveness.     

Adaptive and maladaptive personality traits as predictors of violent and nonviolent offending behavior in men and women

The aim of this study was to assess both violent and nonviolent offending behavior in a single, mixed‐sex population. The rationale for this is that the two types of offending are usually researched separately, despite evidence that they overlap. A comprehensive measure of general violence, intimate partner violence (IPV), and nonviolent offending behavior was administered to 116 men and 181 women, together with measures of personality and personality disorder (PD) traits, to investigate whether predictors of violent and nonviolent offending were similar or different for men and women. Men were found to perpetrate higher levels of general violence and nonviolent offenses than women, but women perpetrated significantly more IPV than men. Cluster B PD traits predicted all three offense types for women and also men's general violence and nonviolent offending. Women's general violence and men's non‐violence also had one unique risk factor each, low agreeableness, and low conscientiousness, respectively. The main difference was for IPV, where men's IPV was predicted by cluster A PD traits, indicating that men's and women's risk factors for IPV may be different, although their risk factors for the other offense types were fairly consistent. Aggr. Behav. 36:177–186, 2010. © 2010 Wiley‐Liss, Inc.     

Virtues in action – the new look of character traits

The present study aimed to take fresh look at the nature and psychological meaning of consistency in character traits and virtuous behaviour as manifested in everyday life. To this end, a 10‐day experience‐sampling study was conducted. Using smartphone technology, a sample of 83 working mothers and fathers provided a total of 4,342 momentary behavioural reports while being in the role of the parent versus being in the job role. Consistent with recent research on personality traits, the findings of the present study showed that people express a wide range of virtue states in their everyday lives. Within‐person changes in virtue states were not random but were contingent on people's current role context and also meaningfully related to their momentary affective experiences. At the same time, people's average level of virtue states, their degree of variation in virtue states, and their signature ways of reacting to role contexts turned out to be stable, trait‐like individual difference characteristics. Discussion focuses on the implications for the conception of character traits in scientific psychology and beyond.     

Altruistic love in psychoanalysis opportunities and resistance

Many patients manifest a desire to help the analyst. This is usually understood as being derivative of defensive aims or in the service of other primary motivations. This paper argues for the developmental and clinical importance of primary altruistic aims, which are often warded off by the patient because of his or her fears of exploitation or rejection. Several pathogenic beliefs and varieties of psychopathology result from the failure of the patient's caretakers to allow the child to contribute to their welfare, to “take”; the child's “help.”; Similarly, some patients require tangible evidence that they are having a positive impact on their analyst. Ordinary “good‐enough”; technique often reinforces the patient's view that he or she has nothing to offer. A full appreciation by the analyst of the importance to patients of having their altruistic gestures and concerns recognized and accepted can open up possibilities for analytic progress and therapeutic growth. Various sources of resistance to and misunderstanding of these dynamics are explored, ranging from ethical concerns to certain traits that cluster in the personalities of analysts.     

Traits in Transition: The Structure of Parent‐Reported Personality Traits from Early Childhood to Early Adulthood

The present research was conducted to map the hierarchical structure of youths' personality traits, to identify the foundational level of this structure, and to test whether the meanings of some youth personality dimensions shift with age. We addressed these issues by analyzing personality parent reports describing a cross‐sectional sample of 16,000 children, adolescents, and young adults (ages 3 to 20). These parent reports were made using a broadband measure of youths' personal characteristics, the common‐language California Child Q‐Set. Analyses of the full sample and comparisons of 16 age groups supported three main conclusions. First, the hierarchical structure of youths' personality traits both resembles and differs from the adult personality hierarchy in important ways. Second, a set of six dimensions—Extraversion, Agreeableness, Conscientiousness, Neuroticism, Openness to Experience, and Activity—may constitute the foundational level of the youth personality hierarchy from middle childhood through adolescence. This “Little Six” structure represents a union of the most prominent personality and temperament dimensions. Third, the meanings of some youth personality dimensions (e.g., Activity, Conscientiousness) shift systematically with age. These findings advance our understanding of when and how personality structure develops during the first two decades of life.