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Know yourself

November 23, 2009 Leave a comment Go to comments

From the book Practical Management of Personality Disorder by W. John Livesley (2003).

“Most patients have some awareness of their problems, although they may be unable to articulate it fully. It is unusual for something totally new to appear during treatment. What seems to be involved in “know[ing] the place for the first time” is investment in the idea and an understanding of the implications of this knowledge.
This focus changes something that was on the fringes of awareness into something that is a fully recognized and accepted part of self-experience. Shapiro (1989) described the process in this way: “The sort of self-understanding that is thought to be liberating or therapeutic, in fact, is generally understood to involve not new information so much as a rediscovery of what was in some sense already there. It is thought to involve a clarification of some aspect of mental or emotional life that had been unclear, unrecognized, or unconscious, yet had its effects […] Knowledge about a maladaptive behavioral pattern, way of thinking, or trait focuses attention on the problem as the first step toward change. At the same time, it “changes the person’s experience of himself [or herself]” (Shapiro, 1989, p.12).
Awareness also leads to the realization that behavior has causes and consequences. Events that were thought to be unrelated are seen to be the consequences of one’s own actions, and events that were considered unavoidable or inexplicable are seen to have origins and even a purpose. This increase in self-knowledge builds competency by improving feelings of control and mastery. Realization that the causes of many events lie within the self challenges the passivity associated with personality disorder, so that the person no longer feels him- or herself to be a pawn of circumstance but rather an actor in the drama of his or her
life. In turn, this realization leads to another: that it is possible to behave differently and that problems can be solved. Choice replaces passive acceptance, and autonomy replaces helplessness. […] As Yalom (1975) pointed out:

One way that self-understanding promotes change is that it encourages individuals to recognize, to integrate, and to give free expression to previously dissociated parts of themselves. When we deny or stifle parts of ourselves, we pay a heavy price—we feel a deep amorphous sense of restriction, we are “on guard,” we are often troubled and puzzled by inner, yet alien, impulses demanding expression. When we reclaim these split-off parts, we experience a wholeness and a deep sense of liberation. (pp. 92–93)

Self-knowledge is related to self-acceptance. A hallmark of satisfactory adjustment is acceptance of one’s personal qualities, with minimal conflict and distress, including those characteristics that one would like to change. This acceptance is rare in people with personality disorder. Almost without exception, patients seem at odds with themselves, locked in a continual struggle not to recognize or own important aspects of themselves and their experience. Even apparently obvious behaviors, such as self-harming actions, bulimic behavior, and substance abuse, may not be fully acknowledged let alone “owned” as self-generated. Problems with self-acceptance limit self-knowledge. As one patient expressed it: “I have realized that acceptance and understanding go hand in hand.
I used to think that acceptance would come from understanding. Now I know that’s not the case. I can only begin to understand myself when I accept myself.” Self-acceptance does indeed contribute to self-understanding, but simple, uncritical self-acceptance also can obstruct change. When people are too comfortable with themselves, there is little incentive to change. Nonetheless, self-understanding with too little self-acceptance can create a demoralized state that is paralyzing. The task is to promote self-acceptance while maintaining the motivation to change; this means helping individuals to accept, without self-condemnation, personal qualities that they find less than desirable—something that many personality disordered individuals find difficult. All too often insight leads to further self-criticism.-”” (p.86-87)

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