Interpersonal Patterns in Group

INTERPERSONAL PATTERNS IN GROUP PSYCHOTHERAPY

Jay Earley, Ph.D.

Draft

6/15/97

[This is a rough draft which has not be thoroughly edited. It will not be made into a book. It contains much useful information about an older version of the Pattern System.]

PART 1: PRELIMINARIES...........................................................................

CHAPTER 1: INTRODUCTION.....................................................................................................

CHAPTER 2: BASIC THEORY.....................................................................................................

PART 2: CONNECTEDNESS PATTERNS................................................

CHAPTER 3: THE NEEDY PATTERN.........................................................................................

CHAPTER 4: THE NEED-DENYING PATTERN.........................................................................

CHAPTER 5: THE INSECURE PATTERN...................................................................................

PART 3: AUTONOMY AND SAFETY PATTERNS...................................

CHAPTER 6: CORE ISSUES RELATED TO AUTONOMY AND SAFETY...............................

CHAPTER 7: THE ISOLATED PATTERN....................................................................................

CHAPTER 8: THE COMPLIANT PATTERN...............................................................................

CHAPTER 9: THE DEFIANT PATTERN......................................................................................

CHAPTER 10: THE PASSIVE-AGGRESSIVE PATTERN...........................................................

CHAPTER 11: THE VICTIM PATTERN.....................................................................................

CHAPTER 12: THE CODEPENDENT PATTERN......................................................................

CHAPTER 13: THE SUSPICIOUS PATTERN............................................................................

PART 4: VALUE PATTERNS....................................................................

CHAPTER 14: THE SELF-JUDGING PATTERN.......................................................................

CHAPTER 15: THE CHARMING PATTERN.............................................................................

CHAPTER 16: THE BRITTLE PATTERN...................................................................................

CHAPTER 17: THE PRIDEFUL PATTERN................................................................................

CHAPTER 18: THE ENTITLED PATTERN................................................................................

PART 5: CONCLUSION.............................................................................

CHAPTER 19: THE OVERALL PATTERN SYSTEM................................................................

CHAPTER 20: OTHER ISSUES..................................................................................................

BIBLIOGRAPHY.........................................................................................................................

PART 1: PRELIMINARIES

This book describes the Pattern System, which is a new way of understanding interpersonal behavior, its underlying dynamics, and treatment strategy. It applies the system to group therapy. Future publications will apply the system to individual therapy.

chapter 1: introduction

This book describes a system for understanding interpersonal behavior and its underlying psychological dynamics. This is a new way of organizing into useful form the extraordinary amount of data we absorb about our clients. It provides a way for therapists to clarify the unique character structure of each client, leading to an understanding of his or her special needs, strengths, and difficulties. This makes it easier for you to apply your existing therapeutic knowledge in a way that is tailored to each person. The pattern system is especially useful when your treatment of a particular client is stalled or you are confused about how to proceed. By diagnosing his or her patterns and core issues, you are guided to a clearer understanding of where the therapy is stuck and how to proceed.

This system involves about 15 typical interpersonal patterns exhibited by clients, such as the needy, isolated, victim, defiant, and charming patterns. Each pattern represents a particular style of problematic relating deriving from a certain psychological dynamic. The system describes each pattern’s behavioral manifestation, childhood origins, defenses, underlying pain, treatment strategy, and typical transference and countertransference issues. Each person will exhibit roughly five to eight patterns, each representing a different interpersonal issue for that person.

The system also describes a similar number of core issues, each of which represents an underlying issue, such as deprivation, domination, violation, betrayal, or shame. Each pattern represents a particular way that clients act out these underlying issues. For example, the needy pattern involves dependent behavior and derives from deprivation or abandonment. The need-denying pattern involves a denial of the client’s needs; it is a defense against these same issues and also derives from punishment-for-need.

Each of the core issues can be acted out or defended against in various ways. For example, the compliant pattern involves pleasing others and trying to be who they want you to be. This is an acting out of the domination issue, where the client was dominated as a child. However, a client could also develop a defiant pattern as a defense against domination. The passive-aggressive, controlling, or isolated patterns can also be defenses against domination.

Related Concepts

Character Types. Let’s first examine related concepts in the field. There are a number of existing systems of personality or character types, beginning with Freud’s original psychoanalytic description of oral, anal, and genital character. Alexander Lowen (1958), the creator of bioenergetic analysis, developed this into five character types—schizoid, oral, masochistic, psychopathic, and rigid. David Shapiro, in his book Neurotic Styles (1965), introduced four other useful types which are extensions of traditional diagnostic categories—paranoid, obsessive-compulsive, hysteric, and impulsive. Perhaps the most sophisticated system of character types is that of Stephen Johnson (1994) who integrates much of the material from these other systems. And of course, there are the personality disorders described in the DSM-IV (APA 1994). However, these do not constitute a system of personality types because these disorders only apply to individuals who are extreme enough in their dysfunction to warrant a psychiatric diagnosis. The Enneagram (Palmer 1988) is a system of nine personality types that has more of a spiritual than clinical orientation; it has become popular recently. There are also research-oriented systems for understanding interpersonal functioning using various behavioral dimensions, such as Benjamin’s (1996) very interesting method of Structural Analysis of Social Behavior.

All of these systems can be quite useful in understanding character and the structure of personality, but I find that using character types doesn’t provide a fine enough delineation of the various possibilities. Human beings do not divide neatly into five or nine different character structures. The human psyche is much more complex and varied than that. Even though some character systems recognize that a person can be a mixture of types, this still doesn’t cover the richness of possibilities with enough accurate clinical detail, and therefore it introduces too much distortion when trying to fit people into a narrow set of types.

Patterns. I have developed a system of patterns and core issues rather than types. While a character type is supposed to describe a person’s entire character, a pattern is only designed to describe one particular dynamic that a person may use. For example, when you say that a person has an oral character, you are attempting to describe the essence of his entire character structure. However, if I say that a person exhibits the needy pattern, I am only referring to one aspect of the person; he may exhibit many other patterns as well. In the ensuing chapters I will describe 15 different interpersonal patterns. A particular person may exhibit five to eight different patterns in her interpersonal life, and even more if you consider patterns that show in minor ways. In other words, using character types, a client can be described using one or two of a limited number of types, while using patterns, a client might be described using five to eight of fifteen patterns. This allows us to give a much more detailed and accurate description of the person’s behavior and intrapsychic dynamics. For example, a particular client might be needy, charming, prideful, entitled, defiant, and suspicious.

Both character types and patterns are focused on describing a person’s character, the problematic side of his personality. One might also use the theory from this book to describe the positive side of a client’s personality, but here my intent is to describe and explain those aspects of a client’s personality that may need to be changed in therapy.

Definitions

Definition. A pattern is a class of similar behaviors with the same underlying dynamics. It consists of an underlying core issue and the behavior that people typically use to express and/or defend against this. There are three elements here: (1) The core issue refers to the deeper pain behind the person’s behavior and feelings, for example feeling needy and deprived because of a lack of nurturing as a child. (2) The person’s external behavior can be a pain-driven reaction which is a direct expression of the core issue, for example, being dependent, or it can be a compensation or defense against the issue, for example, avoiding feeling or acting on any needs.

(3) The pattern includes both the core issue and the behavior. A pattern is a class of similar issue/behavior pairs. Notice that any given core issue can have a number of different behaviors associated with it, each belonging to a different pattern. In the example just mentioned, the client with a deprivation issue could act either dependent or independent. Conversely, a particular behavior can derive from a number of different core issues, therefore coming from different patterns. For example, if a person is judgmental toward others, this could derive from at least two different situations: (1) It could be a defense against closeness, caused by core issue in which the client is afraid of being harmed in an intimate relationship. (2) It could be a way of feeling superior to others as a way of compensating for an underlying feeling of inadequacy. The behavior by itself doesn’t determine the pattern. In fact, neither the core issue nor the external behavior, by itself, can determine the pattern; both are required.

Many patterns and core issues are only activated under certain conditions. Therefore when we say that a person has a certain pattern, this doesn’t mean that it is active in all circumstances. The person may only exhibit this pattern in certain situations or with certain classes of people. For example, a client with a needy pattern might only act dependent in close relationships and be perfectly self-sufficient when on her own.

Restricted to Interpersonal Patterns. The patterns that are explored in this book are only those that have the most relevance for group therapy. Thus I have largely restricted myself to interpersonal patterns. There are many other patterns that are primarily intrapsychic (such as the intellectualizing pattern) or that involve behavior that isn’t especially interpersonal (such as the incompetent or workaholic patterns). These are not discussed here. Therefore, even though this system of patterns is applicable to individual as well as group therapy, it is not sufficient to describe all the relevant issues that come up in individual work. Even at the interpersonal level this system is only a beginning attempt to delineate all the vicissitudes of dynamics and behavior. I expect that it will be refined, modified, and improved over time by myself and others.

Jeffrey Young (Young 1994, Young & Kolsko 1993) has devised a system for understanding personality and treatment that is close to the Pattern System in many ways. He also looks at a variety of core issues that affect people rather than trying to type someone’s entire personality. However, he is interested in personality disorders, so he is exploring only the more problematic end of the spectrum, and he doesn’t focus primarily on interpersonal patterns as I do. But the biggest difference between his system and mine is that he doesn’t distinguish between the behavior patterns and the underlying core issues. This is a crucial distinction that allows my system much greater descriptive and explanatory power.

Organization of the Book. I have placed together those patterns and schemas that are most related to each central capacity—connectedness, autonomy, safety, and value. For each pattern, I discuss its core issue or issues, its behavioral manifestation, typical countertransference issues, common group roles for clients exhibiting that pattern, and the operation of the therapeutic change process with that pattern. Part 2 covers connectedness patterns. Part 3 covers those patterns related to autonomy and safety. There is so much overlap in autonomy and safety patterns that I have included them together. Part 4 discusses patterns related to value. Part 5 covers some other important behavioral patterns and summarizes and organizes the entire pattern system.

Table 1.1 provides a brief summary of the patterns. It will be helpful to glance over this now to get a feeling for the overall pattern system and a rough idea of each pattern. Each pattern chapter concludes with a more detailed table describing the patterns in that chapter.

chapter 2: basic theory

This chapter briefly introduces the theoretical concepts on which the patterns are built.

Healthy Capacities

First some basic definitions. Human beings have the potential for a variety of healthy capacities. This theory focuses on interpersonal capacities such as connectedness, safety, and autonomy. These capacities are present to a certain extent in young children, but most of them must develop during childhood (and to a lesser extent also during later life). For optimal development of these capacities, a child requires the appropriate parenting and other influences (from siblings, relatives, peers, teachers, and the culture at large) that support and nourish these capacities. Each capacity includes both inner experience and behavioral ability.

Understanding Psychological Health. I believe that healthy living derives primarily from healthy capacities using flexible schemas (see next section) for guidance. Most object relations theories and self-psychology take the stance that health derives from healthy psychological structures. These theories don’t include any concept like healthy capacities. Healthy capacities are not structures; they are the actualization of innate abilities. Let me explain further.

Human beings have an innate potential for healthy living and relationships, which requires the right environment, especially the right parenting, to be actualized. In genetics, the “genotype” is the actual genetic endowment and the “phenotype” is the physical characteristic of the organism which will be realized under the influence of an appropriate environment. For example, a man might have the genes to be muscular and strong, but he would need good nutrition and the right physical activity in order to actualize this strength. The genotype is comparable to a person’s innate potential for psychological health and the phenotype to the actualized healthy capacity.

To the extent that a person has an adequate environment, he[1] will develop healthy capacities for interactions and relationships, characterized by his ability to creatively initiate and respond in the moment, taking into account both his desires and the needs of the person or group he is relating to. His response will be flexible in the moment, not rigid or stereotyped. He will expect things to go well but be prepared to handle the situation if they don’t. When a child develops a healthy capacity, it is not just a structure in the psyche based on the good parenting he received. It is his real self, an actualization of his innate potential, enabled because of good parenting but not simply an internalization of it. In other words, psychological health derives from the actualization of our human potentials, made possible by a favorable childhood environment. It is not simply based on psychological structures (object relations or the “self”) that represent the interactions in such an environment. My ideas on this are consistent with Gestalt therapy (Perls et al. 1951) and humanistic psychology in general (Rogers 1951; Maslow 1971), but since I differentiate psychological health into various capacities, I am able to develop a theory with more clinical detail. In chapter 9, I will discuss further the advantages of this way of conceptualizing psychological health.

Central Capacities. There are four healthy capacities that are especially important for psychological well-being which I focus on in this book. These are connectedness, autonomy, safety, and value. They are described later in the book when we cover the patterns that are related to each one.

Schemas

A schema is a structure in the psyche based on past events that influences the way people see and feel about themselves, relate to others, and act in the world. This influence can be conscious or unconscious. A schema is a way of coding memory so that it can be used in future interactions with the world. Schemas are the internal basis for transference reactions. A schema can include a representation of the self, other people, and other aspects of the world. Because of my clinical interest in therapeutic change in group therapy, I focus on schemas which consist of either self-representations or representations of interpersonal relationships (Safran & Segal 1990). These representations involve more than just beliefs and images; they also include emotion, perception, motivation, body sensation, expression, and action.

Let’s look at an example of a schema. If a girl, Marcy, was consistently rejected by her father, she might develop a schema with an internal representation of the self as needy and unlovable, and a representation of the other as desirable and rejecting. This schema would likely influence her self-esteem and the way she relates to men.

Rigid and Flexible Schemas. If the influences that create a schema are traumatic, painful, pervasive, and/or dysfunctional, then the resulting schema will likely be rigid. This means it will be applied inappropriately, will block the exercise of the person’s healthy capacities, and won’t be modified according to experience. For example, if Marcy’s rejection by her father was severe and pervasive, then the resulting schema will tend to be rigid, and Marcy will fear rejection from all men regardless of how they actually treat her. She will probably also feel negatively about herself. Her healthy capacities for intimacy, self-esteem, and the ability to reach out to others would be blocked by this schema.[2]

A flexible schema is held more lightly, applied more appropriately, and allows the creativity of the person’s healthy capacities to be used. It will also be modified according to what happens in the moment. For example, if Marcy had a more flexible rejection schema with men, she would be able to discern when a particular man really liked her and enjoy his warmth. With enough reassurance, she might be able to reach out to certain men. She might not need to defend against her desire for men, or if she did, the defense would be less extreme and more easily relaxed. After meeting some men who clearly respond well to her, her “men” schema would change in a positive way to reflect this new reality.

Activity. I will use the term activity whenever I want to refer to either external, observable behavior or internal experience, such as feelings, self-image, and motivation. Problematic activity[3] is activity that derives from rigid schemas, producing psychological pain or symptoms, problems in living, or harm to others. Healthy activity enhances the well-being of self and others. It means that a person feels positively about herself and trusting of others unless there is evidence to the contrary. It means that a person can get what she wants from others while respecting their needs. With healthy activity, a person can have close, intimate relationships and also be a separate, self-directed individual. Healthy activity results when people live and relate primarily from their healthy capacities with guidance from flexible schemas. The goal of psychotherapy is then to make rigid schemas more flexible and to develop and liberate healthy capacities, thereby promoting healthy activity.

Painful and Defensive Schemas. Schemas that are rigid tend to be of two types: (1) Painful schemas are those that reflect the original traumatic or dysfunctional relationship (or aspect of a relationship). In this book I also use the work core issue to refer to a painful schema. For example, Marcy has a painful schema that is based on her rejection by her father. (2) Defensive schemas are those that are used to defend against the awareness or experience of a painful schema. For example, Marcy might develop a schema in which she sees herself as superior to men and therefore not needing anything from them. This schema would protect her from experiencing the low self-esteem and fear of rejection that derives from her rejection schema with her father. Defenses derive from defensive schemas. For example, Marcy’s acting aloof from men would be a defensive reaction.

Three Classes of Activity. To summarize, most interpersonal behavior can be divided into three broad classes: (1) Healthy behavior comes from healthy capacities with some guidance from flexible schemas. This is the goal of therapy. (2) Some behavior is a living out of a painful schema or core issue. This is problematic, of course, but if the person can experience and understand the pain, it becomes an important step toward healing. (3) Defenses are an attempt to escape the pain of painful schemas. These must be softened or relinquished for the change process to proceed. In addition, much activity is comprised of mixtures of these three.

The Change Process

Access. The client explores those feelings and memories that are buried deeper in the psyche behind defenses. This includes uncovering pain or healthy capacities that have been blocked.

The most common kind of access involves experiencing the pain of the underlying painful schema and exploring its meaning and possibly its origin in childhood. Through this process the person accesses the painful schema, both experientially and cognitively, in a way that opens it up for therapeutic change. The greater the client’s emotional presence, interpersonal involvement, transference, and insight, the greater the access, and therefore the deeper the change that is possible. For example, in the access phase, Marcy might let herself experience her fear of being rejected by Ben and allow this to show in the group. For even greater access, the leader might encourage her to connect this fear with her rejection by her father and to feel this childhood pain. The more fully she can experience this and the deeper her insight, the greater her access. This opens up her psyche to inner healing in the subsequent steps. Access is not always necessary, and sometimes not possible, but when it occurs, it increases the degree of therapeutic change that can result.

Clients can also access healthy capacities that have been blocked because of the fear of negative responses. For example, Marcy might have blocked her experience of needing contact with people because of her father’s rejection of her. The access process might open up Marcy to experiencing her need for a connection with Ben. This need is part of Marcy’s healthy capacity for connectedness. A later step could be to experiment with expressing that need.

Healing Response. The group member receives something which redresses and heals the original painful, traumatic event or relationship. This is usually a parenting-like activity that comes from another group member, the leader, or the group-as-a-whole. We can think of it as reparenting, though it need not come in a parent-child form. The most common healing response is caring, which includes empathy, identification, compassion, acceptance, appreciation, or understanding. For example, after Marcy explored the pain associated with her father’s rejection, Ben might tell her that he appreciated her openness and courage. This would be the kind of response that she needed to receive from her father, and would be a step in healing the wounds from that relationship.

Other healing responses may also be necessary, depending on the original trauma. Sometimes protection is needed, sometimes closeness without harm. Sometimes a healing response must come after experimenting. With certain types of painful schemas, the person is afraid of a negative reaction to her healthy behavior. When she experiments with this forbidden behavior, she will need to receive acceptance or even appreciation instead, which is a form of healing response. For example, if Marcy was rejected or ridiculed for reaching out to her father, she will likely be frightened after reaching out to Ben. She will need to receive a clear response from him indicating that he appreciates her reaching out and (ideally) that he likes her, too. (This, of course, can’t be faked.) This appreciation can also come from the group and/or the leader. These healing responses would disconfirm Marcy’s negative expectations and reinforce her healthy activity.

A healing response doesn’t always have to come from outside, from another person; sometimes it comes from the group member herself. For example, Marcy might learn to be loving and accepting of herself. This often happens over time as a person’s work advances. In fact, sometimes the later steps of healing must come from within.

Experimenting. Experimenting means trying out new, healthier behavior. Experimenting has two purposes—to bring up material to be explored and to develop more functional behavior. For example, suppose Marcy likes a group member, Ben, and she has been keeping a distance because she’s afraid he doesn’t feel the same way toward her. Marcy could experiment with the healthy behavior of reaching out to Ben by telling him that she likes him. If she is able to do this, it may lead to healing (see below). If she even tries to do this, the attempt may bring up pain or defense, setting the stage for the next step in the change process, access. Experimenting can be planned out with the client or it can happen spontaneously. Experimenting may also happen later in the change process as described below.

Inner Healing. This is the actual internal therapeutic change, often brought about by a healing response. The person takes a step toward experiencing herself and the world differently. There is an internal restructuring, changes in schemas, and liberation of healthy capacities that can be directly experienced by the group member.

There are three specific effects: (1) A painful, rigid schema becomes more flexible. In Marcy’s case, her painful schema with men will not be held so tightly, and she will be more easily able to recognize when a man feels positively about her. (2) The painful schema is modified in a positive direction. Marcy’s schema will begin to reflect the possibility that men can like and appreciate her. (3) The healthy capacities that were blocked are liberated and developed, or existing capacities are extended to new situations. Marcy’s self-esteem would be enhanced, her ability to reach out would be extended to men, and her capacity for intimacy would be developed.

Once a healthy capacity has been liberated and developed, it is helpful to exercise the capacity through experimenting with new healthy behavior. This leads to additional inner healing by developing the capacity even further. By engaging in healthy activity, the group member furthers and consolidates the healing by integrating it into her behavior. For example, in Marcy’s reaching out to Ben, she is developing her capacity to initiate contact with people, or if she already had the capacity to reach out to women, she is extending its range to men.

In addition to the healing that can occur in a momentary interaction, the deepest healing comes through inner reorganization over time. Often this comes through developing a healing relationship with a person in the group who relates to the client in a different way than her parents[4] did. For example, if Ben and Marcy develop a relationship in the group that involves mutual respect and liking, this could have a profound healing effect on Marcy’s father schema, especially because Marcy’s father transference with Ben provides a significant level of access. Longer term healing also happens as the group member integrates her healing experiences from the group into her life over time.

These four aspects of the change process can occur in different sequences and inter-relate in various ways. They can happen in one session or over a period of months. They can occur inside or outside of the group.

PART 2: CONNECTEDNESS PATTERNS

Preview. Part 1 deals with those patterns that are related to connectedness, perhaps the most fundamental and important healthy capacity. We cover the needy, need-denying, and insecure patterns, and the underlying core issues—deprivation, abandonment, rejection and punishment-for-need. At the end are tables that summarize the information about these patterns and issues.

Connectedness

Connectedness is characterized by feeling close to important others, connected with people in general, and accepting and loving toward yourself. It means being in touch with your need or desire for connection with other people, including needing others to care for you and needing help from others. Connectedness includes the ability to care for and express affection toward others; this ability is important for developing group cohesiveness, promoting vulnerability, and responding in a healing way to others. Connectedness also includes the ability to receive love and caring from others and take it in.

A connected person expects that most people will like her, value her, and want to connect with her, and she has the ability to reach out to others in a confident, contactful way. Such a person can feel a sense of belonging to a group. Connectedness also includes the ability to commit yourself to a relationship, group, organization, or community, when that is warranted. It also means the ability to feel secure when you are in a stable relationship.

Most people have some deficiency in connectedness. Since connectedness is such a fundamental human need and one that starts from the moment of birth, deficiencies in it can thwart the development of other central capacities as well. Connectedness is important in developing a positive sense of value and also forms a base for the later development of autonomy.

chapter 3: the needy pattern

Clients with the needy pattern have underlying deprivation and abandonment issues. We will discuss these first.

Deprivation

When the core issue is deprivation, the child didn’t receive sufficient nurturing. The child was not given enough love, emotional nourishment, touch, and caring. This lack is especially important during the early years, especially the first year and a half. In extreme cases, this can include a lack of simple physical care-taking, such as feeding and cleaning. This deprivation can produce a schema where is self is seen as needy and unlovable and the other is seen as desirable and not caring or unavailable.

This issue tends to block connectedness in general. More specifically, it can block the ability to receive from others, because the person is so used to not getting what she needs from others that she doesn’t feel worthy of love. This prevents her from allowing love in despite how much she wants it. This issue can also make it difficult for a person to love herself, because she intensely needs caring from others and didn’t received enough love as a child so she could internalize it. This issue may produce the thought, “No one loves me or cares for me.” As with most of the cognitions associated with issues and patterns, this can be conscious or unconscious. A client with this issue feels deficient in basic nurturing and caring, and her behavior is driven by this need and defenses against it.

Notice that here “needy” refers specifically to a deficiency in early nurturing, not to a lack of other kinds of parental caring or support; other deficits are covered by the other types of issues to be discussed in the next four chapters. Today many people have some deficit in nurturing and therefore some form of this issue. Especially for the baby boom generation, who were bottle and schedule fed, deprivation is very common, though there are still wide variations in its degree.

Value. In addition to a deficiency in connectedness, this issue can also produce a deficiency in the feeling of value. However, this is not unique to this issue, virtually all core issues tend to produce value deficiencies. This is because when children are deprived or abandoned, abused or judged, they tend to assume that this has happened because of something wrong with them. In their attempt to make sense of their world, this may be safer than seeing the parents as flawed. Even when children become old enough or smart enough to realize that there is something wrong with the parent for treating them this way, they usually persist in feeling (at some deep level) that there is something wrong with them, or their parents would have treated them better, would have loved them in the way they needed. Therefore, even though deprivation has primarily to do with connectedness, it also has an effect on the person’s sense of value—not as strong an effect as those issues that specifically relate to value (see chapter ?), but a significant effect nonetheless. And this is true for all core issues.

Clients who primarily act from deprivation, rather than defending against it, exhibit the needy pattern. Those who defend against the issue by denying their need or avoiding intimacy may exhibit the need-denying pattern or the isolated pattern. Those who attempt to induce others to meet their needs may use the charming, victim, controlling, or intrusive patterns.

Abandonment

The abandonment issue can originate when a child loses an important person (or people) in her life, permanently or temporarily, due to death, illness, or abandonment. This also includes the situation where a parent (or other person) emotionally abandons the child at times through withdrawal or use of alcohol. It can also include the experience of severe losses that happen later in life. Abandonment is clearly related to deprivation, but includes the sense of having something that can then be lost. A person with deprivation may not feel that she ever had love, and conversely may not be so afraid of losing it once she gets it. Abandonment tends to block connectedness, especially the ability of a person to feel secure in a relationship because of the fear of impending loss. It may also cause a person to be afraid to open up and receive love because then it may be taken away. This issue may produce the thought, “I can lose those I love at any minute.”

Abandonment can coexist and overlap with deprivation. The difference is that abandonment has to do with having love and then losing it, while deprivation is an experience of never having had enough of it.

Needy Behavior

Clients with the needy pattern are those who act primarily from deprivation. They don’t employ much in the way of defenses against the underlying sense of need but rather show their neediness and dependence in their behavior. Clients who act from abandonment also exhibit the needy pattern.

Needs. Needy clients usually feel an intense need for connection with others and a painful lack of this connection in their lives. This may be because they actually lack satisfying relationships or because their need is so great. This may also be due to their difficulty in taking in the caring and love they do receive. Needy clients want not only connection but specifically caring and nurturing, especially when they are in pain, which is fairly often. They have an on-going need to talk to others about the difficulties in their lives and receive support. This is a common activity for them in a psychotherapy group. It can lead them to call other group members frequently on the phone and get together outside of group for help and comfort. They can become dependent on family, friends, and other group members.

They frequently put a good deal of energy into making connections with other group members and helping the group to bond. Some needy clients do this by being nice and pleasing to others, by being friendly and supportive and suppressing any negative feelings. Needy clients can be relatively easily hurt if their interest and affection for others is not returned or if their need for support is not met. Some needy clients express considerable anger when this happens while others don’t.

Loneliness and Relationship Addiction. It is difficult for needy clients to be alone, both in the moment and in their lives. Being alone at any time brings into painful relief the deep underlying sense of deprivation and abandonment, and therefore they often attempt to fill their lives with connections with others, even those that aren’t very rewarding. This is a compensation for the internal connectedness that is lacking. It is also hard for needy clients to be without a love relationship, actual or potential. They always need to have someone with whom they are involved romantically, even if the relationship is just beginning or is troubled. When they are in a relationship, they usually become quite dependent on their partner. In the absence of this, they may rely on sexual addiction or obsessive romantic fantasy, also forms of compensation. They also have a tendency to continue a relationship even after it is clear that it has become destructive for them. This behavior is called relationship addiction.

Defenses. Though clients with the needy pattern don’t act primarily from defenses, they do use some, such as relationship and sexual addictions. They may sometimes block themselves from feeling or expressing the pain in their lives for fear that it will lead them deeper into their early pain. In addition, needy clients often defend against really taking in caring from others even though that is what they most want (see Taking in below).

Gender. Though both men and women show this pattern, it is more common in women because men are often taught to suppress or deny their needs, leading to the need-denying or isolated patterns.

Conditions. The needy pattern might be activated with everyone, or it may only be activated by people who show some promise of meeting the person’s needs. Since women tend to be more nurturing than men on the average, clients are more likely to show this pattern around women. It may also be activated by people who are older than the client or who are naturally nurturing. For example, it may be activated around people who have the codependent pattern. The needy pattern especially gets activated when the client is in a love relationship, because this is often the place where people have the best chance of having their needs for nurturing met. In fact, this pattern is frequently activated when a love relationship is becoming particularly intimate. Sometimes only then will a person’s defenses relax and allow her needs to come out. This hopeful activation often happens without any awareness of the reason and can be quite frightening. It sometimes seems to the client that she is regressing, but it is really a sign that the relationship is now close enough for the needy pattern to emerge.

Levels of Functioning. Like all issues and patterns, the needy pattern includes a wide range of functioning. A client is included in this pattern because of the kind of relating and underlying pain, not the degree of it. For example, at the low end of functioning, this pattern would include a person with borderline issues who is extremely needy and forms intense relationships which soon blow apart over his desire and fear around merging and his rage over imagined rejection or abandonment. At the other end of the spectrum, this pattern would also include a relatively healthy person with a stable, successful marriage, who nonetheless has unresolved dependency needs which come out in her difficulty in being alone when her husband is away on business trips. Any pattern includes all levels of functioning, from the most disturbed to the relatively healthy, from the situation where the pattern dominates the person’s life to where it appears only occasionally in minor ways.

Related Concepts and Patterns

Related Concepts. Depression is a common symptom for needy clients, though it can have other roots as well. The needy pattern is similar to the traditional Freudian concept of the oral character. Extreme neediness is also related to the borderline personality disorder (see chapter ?).

Related Patterns. The insecure pattern is similar to the needy pattern in that both involved not getting important forms of love and caring in childhood. However, the insecure pattern comes from a deficiency in acknowledgment while the needy pattern derives from a deficiency in nurturing. The most important issue for needy clients is their degree of need, while for insecure clients, it is their fear of rejection.

Combining Patterns. Each person is likely to show roughly five to eight patterns in their interpersonal life, and even more if you consider patterns that show in minor ways. This means that we can examine combinations of patterns. For example, when a person has both the needy and insecure patterns[5], he tends to be both needy and afraid of having those needs rejected by others. When a person combines the needy and entitled patterns, he feels that he deserves to have all his needs met, no matter how extreme they are, because, of course, he doesn’t see them as extreme. When a person has both the needy and controlling patterns, he tends to be demanding about having his needs met. When a person is both needy and self-judging, he tends to feel bad about having needs. When a person has the needy and brittle patterns, he can be devastated if his needs aren’t met or if there is even a hint of judgment about them. A person who combines the needy and codependent patterns will try to get his needs met by taking care of others. Someone who has the needy and compliant patterns will try to mold himself to others’ desires in the hopes that they will take care of him. An extreme form of this produces the dependent personality disorder.

The Change Process

Responsibility. Many needy clients are not aware that their needs are excessive by adult standards. They are aware of their needs but often think that their problem is not being able to get them met. Therefore an important step in working with a needy client is for him to own his neediness so that he becomes interested in exploring its origins and healing it. Be careful that this doesn’t encourage the client’s inner critic to shame him for having too many needs. Your goal is to help the client understand his needs with compassion and acceptance.

Accessing Pain. Each time a client has a deprivation schema activated by a life event or by an experience of hurt in the group, this is likely to bring up the old pain. For example, Susan was drawn to Marie but felt that Marie wasn’t paying much attention to her and didn’t seem to like her. When Susan brought this up in the group, the leader helped her to explore her feelings about this, and she discovered a deep sadness that was out of proportion to the degree of her involvement with Marie. This sadness came from on old deprivation schema. It is very helpful for a needy client to access and relive her feelings about the lack of nurturing in her early life. The client may only be able to begin this access work after the group is fairly established and cohesive. This work can be very intense, and therefore it often needs to proceed slowly. The client may need to go into this deep pain gradually, one step at a time.

Healing Responses. Each time a client with a deprivation issue accesses the underlying pain, it is helpful for her to receive a healing response involving some form of caring and support, which is what she failed to get as a child. Fortunately many of the generic healthy responses in a good therapy group provide this kind of healing. These include empathy, compassion, identification, understanding, appreciation, and acceptance. The client might also need healing in the form of mirroring, nurturing, and the expression of liking and affection. These will come up naturally in the other group members, and if they don’t spontaneously offer this, you can encourage it by asking for feedback from the group. Make sure, however, that the group members are offering genuine responses rather than simply being nice because they think it is expected or needed. There is enough real caring in a group that it doesn’t need to be manufactured. In the rare case that the group members don’t seem to feel caring, the leader can provide the appropriate healing response (or explore what is stopping the members from wanting to).

When a truly needy client accesses her pain in a genuine, vulnerable way, our hearts open to her. Most group members feel touched and close to her; they want to give to her. And if she is able to take in what is given, this is very satisfying for the whole group. It is one of those special moments that make group therapy fulfilling.

Touch. Healing responses can even go as far as touching. Many clients have suffered some level of deprivation in the area of touch, so after appropriate access it can be healing to have another group member offer some supportive touch. There are rules against this in most psychoanalytic groups, and this comes from a legitimate fear of gratification which might prevent the client from accessing her pain. However if a leader excludes touch altogether, in the name of preventing acting out, you throw the baby out with the bath water. Under the right circumstances (after access), touch can be very healing. In fact, in some cases touch is absolutely required as a healing response. Anything else would be a pale substitute. In these cases, it is important that the client not be deprived once again. If a group member accesses an issue that involves early deprivation in the area of touching, it can bring up not only great pain, but powerful needs for touch and physical soothing. Once accessed in a genuine way, these needs should be met directly.

I suspect that the most important reason for my disagreement with the psychoanalytic position on touch is theoretical. The analytic view is that therapeutic change occurs by making the unconscious conscious, part of what I call access. Therefore it makes sense that they would see touch as a possible distraction from the access process and not recognize the importance of it as a healing response.

When a client accesses deep pain having to do with deprivation, there are usually group members who feel a natural urge to hold or comfort the client through touch. If they express these desires, you can encourage them to take action, after asking the client if this would be OK. If no one initiates or mentions touch, you could bring it out by saying to the client, “It looks to me like you really need to be touched right now.” When dealing with touch, make sure that the client receiving the touch is not being violated in any way. Her permission should be asked, and you should make sure that her answer is genuine and not just compliance before allowing any physical contact to happen.

Taking In. One of the reasons that needy clients remain that way is that many of them have difficulty really taking in caring and nurturing when they do receive it. Because they don’t really take in love that is available, they remain in a deprived state. This resistance is usually quite unconscious and happens despite how much they want it. They may not feel worthy of receiving love because of an underlying value deficiency. They may also resist because they are afraid to open up deeper levels of need and the pain involved. Their needs feel so enormous that no one could begin to fill them. Their needs seem unending and so it seems best to keep them buried. The client knows that the group meeting will end soon and doesn’t want to be alone with the full, heightened experience of need and vulnerability.

With certain clients who are more disturbed, these fears are warranted (see chapter ?). However, most clients are capable of dealing with the depths of their needs if approached gradually in a loving atmosphere. Therefore, you can work with the client on her fears of taking in. First help her to be aware that she is blocking taking in what she is getting from people. Then have her explore how she is doing this. Does she close herself emotionally? Does she feel unworthy? Does she distract herself with other thoughts? Then explore what the client is afraid will happen if she takes in the caring. This will gradually allow her to open up to the nurturing she receives so that the process of inner healing can be completed.

Healing Relationship. Even more important than receiving healing responses in the moment is for a needy client to develop long term relationships in which he is cared for and loved. These relationships can be with other group members, the leader, and the group-as-a-whole. This is especially important for clients with abandonment issues (see below), because they usually suspect any momentary healing responses, being afraid the person giving them will disappear. Within a healing relationship, the client comes to realize that the person he is close to (or the group) will be responsive and trustworthy, so he develops a positive relationship schema representing this relationship. Although there may be times when the other person is angry or distant, these are worked through (with the help of the group) and the bond is not broken, so the client learns to integrate this experience into the emerging positive schema. As a result, his sense of connectedness develops and also his ability to receive from others and to care for himself. The more deeply the client is involved in a healing relationship, the more profound the inner healing that takes place. This is one of the advantages of allowing clients to develop relationships with each other outside of group.

As the process of inner healing proceeds, the client begins to feel a new inner strength and groundedness. He feels connected and whole within, so he doesn’t need so much from the outside. He is more able to pursue activities and people for the fulfillment they bring rather than pursuing people to fill his holes.

If a client who seems needy and deprived is repeatedly given healing responses without there being any therapeutic change, the person may not actually have a deprivatoin issue but instead a shaped-dependence issue. When a child’s behavior is shaped by her parents in the direction of dependence, this can produce behavior that appears needy. However, such a client is deficient in autonomy, not connectedness, and needs encouragement for self-assertion, not nurturing. This issue is discussed in the next chapter.

Accessing Aggression. It can also be useful to help clients access their anger and aggressive responses to deprivation or abandonment. Since this also applies to the insecure pattern, it is discussed later in that section.

Potential Problem

There is a serious problem that can happen with a needy client in a group, when the other group members become turned off by the degree of her need. Sensing that she has extreme needs, and not wanting to be drawn into a relationship in which they are constantly the caretaker, many clients will hold back from connecting with a needy client. This is especially true of group members who deny need in themselves or who are just overcoming codependence or boundary problems. This distancing reaction can be very hurtful for the needy client. It is an example of a therapeutic mismatch. What this client needs for healing is a warm reception and response, to have her needs accepted and met. Instead some group members may avoid connecting with her.

Of course, this problem may already have happened in the person’s life, where people have rejected her for having too many needs. This may have produced a schema where the client fears rejection because of her needs (see need-denying pattern later in this chapter). The group setting provides an opportunity to turn this around, if it is handled correctly.

Solution. If the group seems to be responding poorly to a client’s needs, focus her group work on access. In doing intrapsychic work, she can fully express her pain and needs without putting them on other group members. They will also be more understanding and compassionate with her when they see and experience the origins of her neediness. If she is able to access her pain in a vulnerable way without playing victim (see chapter ?), they will probably feel close to her and want to respond in a healing way, at least in that moment.

You may also need to help her refrain from acting out her needs with the other group members. Explain that her needs are completely OK, but they are child needs that belong to the past, and she can’t necessarily expect others to meet them in the present. Focus on her developing inner support rather than looking for gratification in the group. As she heals and grows, her inner strength and sense of connectedness will develop and the intensity of her needs will diminish. Then when she brings her needs to others in the group, they will be more likely to respond in a positive way.

Example. Joseph grew up with an alcoholic mother who continually abandoned him. As a result, he struggled with depression, suicidal impulses, and sexual addiction as an adult. In the group, he showed his neediness openly. He showed his pain and his need for connection with others. He became upset whenever someone left the group and even when certain people went on vacation for a few weeks during the summer. He developed phone relationships with a number of group members in which he talked about problems in his life. Luckily he was a very open, supportive, and appealing person, so most of the group members liked him and wanted to connect with him despite his needs. One of the women, Georgia, had boundary problems and difficulties in standing up for herself, so she became resentful of the fact that their phone conversations seemed to revolve around him. She brought this up with him in group and stopped the phone contact. However, he was receptive to hearing what she had to say and they were able to work this through in group over a number of weeks. He was able to take in her feedback, and when they resumed contact on the phone, he gave her an equal amount of attention.

When Joseph went into deep pain in the group, the degree of his needs scared Georgia and a couple of other group members who were fighting against codependence. A few other members responded by wanting to give to him. By then Joseph had a good enough inner sense of connectedness that he could tolerate the fact that some members didn’t respond well to his needs. He could access his pain and receive healing from those who offered it without being too hurt by the ones who didn’t. This allowed his therapy to proceed, and eventually he was highly respected by the entire group and his therapy was quite successful.

Abandonment

When clients with a needy pattern have an underlying abandonment issue, the emphasis is on loss as well as deprivation. In this case, the client is afraid that any connection he makes, any nurturing he receives, may be taken away or lost at any moment. He feels helpless in the face of this possibility.

Clients with a abandonment fears tend to become upset when other group members terminate, when the leader is on vacation, or even when a group member is absent. In fact, each new termination presents such a client with another opportunity to deal with this deep pain he carries. A client with abandonment issues also may become upset at any sign of withdrawal of a group member he has connected with. This upset can take the form of rage or tears or depression. Such a client may also be afraid to connect with others for fear they will withdraw emotionally or because of the knowledge that they will eventually leave the group.

Healing Responses. Healing depends largely on the development of long-term healing relationships. Therefore it is especially important that a client with abandonment issues be in a therapy group that is reasonably stable. Any lack of stability will upset such a client; if there isn’t too much of this, it can be used to access the deep material. However, if there is too much turn-over in a group or if the group changes leaders, it may be too much for such a client to handle.

Working with Grief. For clients with abandonment issues stemming from losses, an important part of their work is to do the grieving that didn’t happen at the time of the loss. Grieving is a natural process that must be allowed to happen when there is a loss. If it is aborted or blocked for any reason, the person is left with incomplete grief, waiting to erupt at the next experience of loss. In the past, proper grieving may have been blocked by parental (or other) messages that grief wasn’t OK, by lack of parental support for grieving, or because the child was overwhelmed by the degree of pain and had to avoid it. Grief can also be blocked because earlier unresolved losses have generated defenses that now close off that ability. For a client like this, the work in the group is primarily to allow the grief to happen with the support of the leader and group. In those cases where the client was taught not to grieve as a child, she will also need to access and heal the resulting punishment schema.

Example

Shanna was drawn to Alan and kept trying to connect with him in the group. However she had underlying issues about deprivation and abandonment and acted them out by being needy and demanding at times. Alan reacted to this with a great deal of anger and distance because it triggered mother transference for him. Alan’s rejection of Shanna caused her to increase her demands, and they were caught in a defense cycle. They worked on their relationship over a period of months, achieving a fair degree of access but little resolution or connection between them. One session Shanna allowed herself to access deep pain about her inability to connect with Alan, taking it back to her mother’s emotionally abandoning her when she was in need. In the process she made herself quite vulnerable and let go of the usual behavior that activated Alan’s transference. He let her know that he felt very strongly for her despite the fact that he didn’t show it because of the rage that got triggered in him. This reaching out on his part really touched Shanna and she began crying deeply, partly in pain and partly as a response to this healing overture from Alan.

This then prompted him to go over and sit next to her on the couch. After asking her, he put his arm around her and held her, and she clung to him and continued crying while taking in his caring. This was deeply healing for Shanna with regard to the deprivation she suffered from both her parents. After this, their relationship took a wholly different turn, and though their defense cycle still occurred occasionally, they were able to work through these reactions and maintain their connection with each other. Over time this deepened into a strong sense of caring for each other.

Group Roles

Emotional Member. The needy client often plays the role of emotional leader in the group, the person who is willing to show her pain and express her feelings, the first one to go deep into access. Because of her intense need for caring and help, a needy client will often lead the way in this area. This can help to encourage o

Pattern	Similar Meaning	Behavior	Conscious Statement	Unconscious Thought	Core Issues
Needy	Dependent	Needs much caring, over-reacts to loss	No one loves me or cares for me.	I am unlovable.	Deprivation or abandonment
Need-denying		Defends against feeling and showing needs	I don’t need very much. I can take care of myself.	If I show my needs, I will be shamed.	Punishment for need
Insecure	Self-effacing	Avoidance or awkwardness in self-expression or reaching out, easily hurt	No one sees me or likes me.	I am not interesting or desirable.	Rejection
Isolated	Distant, cold	Avoids relationship or commitment	I don’t need anyone.	If I am close to someone, I will be harmed.	Harm
Compliant	Pleasing	Tries to be what others want	I am a nice person.	Others are in charge of my life. It isn’t safe to exert power.	Harm, punishment for aggression, shaped dependence
Subservient	Masochistic	Seeks to be dominated or exploited (or otherwise harmed)	Your power is attractive.	The only way I can be loved is if I am controlled.	Harm paired with the only love the child received.
Defiant	Rebellious, oppositional	Rebels against power and authority	Don’t tell me what to do.	If I allow anyone else to be in charge, I will be harmed.	Harm
Passive-aggressive		Tries to please and fails in a way that indirectly expresses anger and defeats others	I want to please people but I can’t do it.	I am angry at being controlled, and I will fail in order to preserve my autonomy.	Harm, shame, punishment for aggression
Victim		Doesn’t take responsibility for his life	It’s other people’s fault that I’m unhappy. My situation is impossible.	I will force people to care for me by blaming them and being helpless.	Deprivation, exploitation, indulgence of weakness or blaming
Codependent	Caretaker	Cares for others rather than self	I care about people.	My only value comes from caring for others.	Deficiency, responsibility for others
Suspicious	Paranoid	Mistrustful of others, expects to be harmed	You can’t trust anyone.	If I trust anyone, I will be harmed.	Betrayal
Self-judging	Ashamed	Feels bad about self	I am bad/worthless.	same	Shame
Charming	Entertaining, charismatic	Charms people with force of personality, seductive	Look at me. Aren’t I terrific?	If I charm people so they like me, I won’t feel deficient.	Deficiency, shaped charming
Brittle	Fragile	Devastated by criticism or brittle defense against this	People don’t understand me.	I am terrified that they will see how deficient I am.	Shame, pride
Prideful	Grandiose	Overly invested in performance, condescending	I am special and better than others because of my performance.	If I impress people and feel superior, I won’t feel so deficient.	Deficiency, pride
Entitled	Self-centered	Self-absorbed, lack of empathy, intrusive, controlling	My needs are important.	Other people are extensions of me.	Indulgence, exploitation, pride
Negative transference*	Angry, judgmental	Reacts angrily to a certain behavior X in others	It is bad to do X.	I’m angry at my parents for doing X.	Parents did X.