Prof. Joseph Levine

Conversation 44: Adjusting the character of the therapist, which is internalized by the patient, to achieve regulation and positive change within the patient's "board of internalized characters"

By Prof. Levine & Dr. Salganik

Hello to our readers,

The current article is aimed more at mental health professionals but may also be of interest to those who are not therapists and are interested in the issues of mental health care. As we mentioned in previous conversations, we also hold that within us, in our minds, the social "self" is represented by a kind of "jury" or "board" of internalized characters [which for short we will call a board of directors].

The "secondary self" contained in the "social self" includes: 1] the variety of representations of the "self" that originate from attitudes and feelings towards the self and its representations in different periods of life 2] representations of internalized figures that often originate from significant figures that the person is exposed to during his life, but as mentioned may also be imaginary characters represented in books, movies, etc. that have greatly influenced the person. 3] internalized representations of "subculture" [subculture refers to social influences in the environment in which the person lives and are not necessarily related to a particular person]. We call the social self metaphorically "the directorate of the characters" or more precisely the "directorate of the internalized characters". We note that, as we mentioned before, this board usually has a hierarchy in which there are more influential and dominant characters that we metaphorically called "the dictator self or selves" and these set the tone and even censor which content, attitudes and behaviors cannot be included in the board of characters. We note that the person as a whole is not aware of the influence of the character board and recognizes the influence as arising from himself and his will and attitudes. We will also note that, as a general rule, the board is very dynamic and there are constant struggles and power relations between the internalized characters that make it up over the positions that will be expressed when the internal dictator or dictators dictate the tone.

This is how it is possible to internalize various external figures that influence the person, but we emphasize that usually the most important internal internalization is that of what we will call the internal "dictator self". Here it is about internalizing a character that has a great influence and shapes the person for good and/or bad, that has a great influence on the board of internal characters that build the social "self". To this internal dictator we assume a decisive role and a profound influence on the internalization of external figures [or in professional parlance external objects]. The dictator's positions (attitudes) play a central role in making decisions about character internalizations. He decides whether the internalization should be rejected or, if accepted, in what form it will be internalized.

In other words, in a certain sense, we assume that this influential figure is also a kind of internal censor. It should be emphasized that we are not talking or conjecturing concretely about the presence of figures in the inner world as a sort of “little people”, kind of mental homunculus, but in their representations whose nature and manner of representation in the brain still requires research. We will also note that although we call this character "dictator", except for a certain type, his characteristics are not the same as that of a dictatorial ruler of a certain country, but rather that this character is dominant and influential among the "Directorate of Characters".

Illustration: The board of internalized characters and the internalized dictator self [Courtesy of Sarit Shimshoni].

We claim that the therapist has to adapt the character that he will represent and that will be reflected in the therapy, so that it will be internalized by the patient and will have a positive effect on his board of characters and especially on patient’s dictator self. This featured character should be accepted by the censor of the internal dictator and gradually acquire an increasing place in the hierarchy of characters on the board. In order for this to happen, the therapist has to treat the dictatorial figure (figures) with respect, and learn to contain them. We note that this step is extremely important for the success of the treatment.

On the other hand, the therapist has to find ways that will be accepted by the dictatorial figure and soften its effects [in a meaning that it will undergo a certain change] while presenting and demonstrating a figure that will be accepted by the board of directors and during the treatment will even rise in the hierarchy of figures and its influence will increase, and it is possible that at a certain stage it will even gradually become the most influential figure. We emphasize that the character the therapist presents to the patient is usually not his own character he represents in his daily life, but as mentioned one that fits the structure of the patient's board of directors. Although it could be mentioned that this requires the therapist to lose his authenticity, we’d like to note that training therapists for desired behaviors has long been practiced in a variety of therapeutic methods.

For example, this is how psychoanalytic therapists learn to be attentive, to demonstrate neutrality towards their patients, while cognitive therapists learn to adopt Socratic approaches and ask questions that lead their patients to see and notice alternatives to their usual thinking. Supportive therapists, on the other hand, learn to encourage, demonstrate the positive aspects and give advice to their patients, while Rogerian therapists learn to reflect the words and behavior characteristics to their patients. The difference between our approach and these approaches is that we require the therapist not to adopt one particular approach which he will project and behave towards his patients, but rather be versatile and change the characteristics of his behavior and treatment of his patients according to the needs of the inner dictator and their board of characters.

Teaching mental health therapists to adapt their attitudes and behaviors to the unique needs of each patient and to internalize key therapeutic concepts is therefore essential for effective treatment. Here are ways to implement this:

Personal evaluation:

Teaching therapists to perform thorough assessments in order to understand the set of internalized characters, experiences and unique needs of each patient. They must be taught to map the board of directors of the patient's internalized figures and the hierarchy within it and especially to identify the most influential internalized figures, i.e. the dictator selves.

Training for cultural competence:

Cultural sensitivity training should be provided to help therapists adapt their approaches to diverse patient backgrounds and understand the internalized schematic character of the subculture and its importance.

Flexible treatment plans:

Therapists should be encouraged to develop flexible treatment plans that are adaptable to the patient's personality, changes, patient progress, and individual challenges.

Patient-centered language:

Learning to use patient-centered language, especially centered on an internal "dictator self" and adopting communication styles that resonate with the person in front of you and his board of directors.

Exercises that build empathy:

Conduct exercises to increase therapists' empathy and understanding of the diverse perspectives and types of internal dictators.

Role playing scenarios:

Training therapists in various role-play scenarios to practice adapting their approach to the different personalities reflected in the patient's character board.

Continuous professional education:

As a general rule, continuous education and professional development should be promoted to update therapists with new therapeutic approaches. which enable the regulation of the board of directors of the internalized figures of the patient and the internalized dictator self.

Supervision and feedback:

It is also advisable to implement regular supervision meetings on the above topics and provide constructive feedback to help therapists refine their skills.

Reflective practices:

It is desirable to encourage therapists to engage in reflective practices in order to improve their self-awareness of behaviors they project and to identify areas for improvement.

Art and expression therapies:

Training can be combined with approaches that use art and expressive therapies to tap into non-verbal forms of communication that can help communicate with the patient's board of internalized figures.

Encourage self-care in the therapist:

The importance of the therapist's self-care should be emphasized in order to prevent burnout and maintaining a positive attitude and knowing the therapist's weak points.

Use of technology:

We note that today it is already possible to integrate technological tools that can improve the provision of treatment and communication with the patient.

Interactive workshops:

Organizing workshops where therapists can share and learn from each other's experiences.

Regular Peer Support:

Establishing a system for regular support of colleagues and sharing of best practices.

Story techniques:

Teach therapists storytelling techniques to engage patients and communicate therapeutic concepts effectively.

Flexible communication styles:

As mentioned, therapists must be trained to adjust their communication styles to align with the preferences of each patient.

Simulation training:

Using simulation training to expose therapists to a variety of patient scenarios.

Encouragement to write a diary:

Encouraging therapists to keep a reflective journal to track their experiences and insights.

The implementation of these strategies can contribute to a dynamic and responsive therapeutic environment according to the patient's character directory and the autocratic or dictatorial characteristics of the patient, thus ensuring that mental health therapists can adapt to the diverse needs of their patients effectively.

Below is a breakdown of specific techniques that can be used to help:

Using past patient experiences:

Using the patient's past experiences to emphasize the benefits of changing the attitude of the board of characters and dictator selves. This will be done on the one hand while respecting past experiences and the motivation behind past behaviors, and on the other hand demonstrating the benefits of adopting new attitudes and strategies for behavior.

Mirroring the patient's language and non-verbal cues:

Train therapists to mirror the language, tone, and nonverbal cues of the patient and their inner board to create rapport and align with the patient's internalized figures, allowing for a sense of connection and understanding.

Identification with positive role models:

To encourage therapists to identify and embody positive role models within the patient's social self, while adapting their therapeutic approach to figures who have a positive influence in the patient's internal hierarchy.

Story techniques:

Guide therapists to use narrative techniques that resonate with the patient's internalized characters, while incorporating narratives that match the therapeutic goals and values.

Gestures and symbolic objects:

Teach therapists to incorporate in therapy symbolic gestures or objects that are meaningful to the patient's internalized characters, which foster a sense of familiarity and comfort.

Cultivating positive associations:

To guide therapists to associate therapeutic interventions with positive emotions, and to strengthen the positive influence of the therapist's figure within the board of the patient's internalized figures.

Collaborative goal setting with internalized characters:

To teach how to create a therapeutic meeting in which the therapist and the patient together set therapeutic goals with the patient's internalized figures, recognize and integrate the influence of these figures in the healing process.

Dealing with internal conflicts:

Training therapists to identify and treat internal conflicts within the directorate of the patient's figures, while helping the patient navigate power struggles between internalized figures to promote therapeutic harmony.

Providing models for adaptive behavior:

An adaptive behavior model that is consistent with the therapeutic goals, and demonstrates to the patient's internalized characters how positive change can be implemented and maintained.

Empowerment through internalizing therapist’s figure:

To empower therapists to recognize the potential for creating positive influence within the patient board figure hierarchy, to help them understand how their figure can contribute to the patient's growth and resilience.

Combining metaphors:

Teach therapists to incorporate metaphors and symbols that match the patient's internalized figures, and help convey therapeutic concepts in a way that is easily internalized by the patient's figure board.

Negotiation and compromise skills:

To provide training in negotiation and compromise skills, which allows therapists to navigate the internal power dynamics within the patient's character board and work in cooperation with them towards achieving the therapeutic goals.

Normal self-reflection:

To encourage therapists to regularly engage in self-observation in order to assess their influence within the directorate of the patient's characters, promote their awareness of their positions and adapt their approach according to the evolving needs of the patient's internalized characters.

These additional methods are intended to offer a comprehensive array of strategies to mental health therapists for adjusting their behavior and attitudes, and to ensure effective internalization in the complex hierarchy of the patient's "character’s directorate".

Below we present 12 types of dictatorial figures [see conversation 11 on this topic].

Regarding each one, we will indicate how it perceives the characters in the world, what are its positions, and the strategies it uses. We will then indicate what the desired figure of the therapist is in relation to this particular internalized dictator self.

Classification of the "dictator self" into its types:

1] "Dictator similar to that of a dictatorial state leader"

This figure is based on the perception of a continuous state of emergency (threat). Such a self-dictator will initiate the state of emergency (virtual or real) which can be related to an external threat (enemy) or an internal threat (internal chaos and anxiety). The filtering of the content will be done so that it fits the positions of an emergency situation: looking for human characters that are threatening or weak. If there are none – then it will try to distort the characters in such a way that they are perceived as threatening or weak. The inner world is seen as defined and very clear.

Any opposition to this concept is seen as coming from the outside and stemming from the bad intentions of the external "bad" figures. And yet, in the event that the inner world is perceived as ambivalent or as weak – impulses of self-destruction are legitimized.

Attitudes:

Black/white thinking. Always beware of an enemy: anyone who is not an ally is an enemy! The environment is dangerous! You can't trust anyone. The weak are always extinct and they are replaceable, the strong always wins. Ambiguity equals chaos and it is dangerous! If you are weak, you are not worth to live!

There are attempts to split external characters into allies or enemies. A lot of tension. suspiciousness. defensiveness Seeking weak allies who obey him completely. Avoiding strong "enemies" and attacking the weak. If it is not possible to avoid a strong "enemy" – then either try to create a coalition against him, or try to obey him: "If you can't fight them – join them".

The desired character of the therapist: one who sees the world not only in black and white but in shades of gray, who believes that the world is in general not that dangerous and most situations are not emergencies, moderate in his reactions, inclusive, and sees alternatives to given situations, demonstrates behavior based on compromises,. Emphatic and not confrontational.

2] "Attachment dictator, a dictator who emphasizes bonding with the other": Based on conception of exploitation of status and attachment channels. Extensive use of guilt feelings, criticizing, social comparison, “honey trap”.

Extensive use of feelings of guilt, criticism, social comparison to manipulate the other. The characters are seen as humiliating or ignored by default, this can only be corrected by an intense attachment to the other, which in fact is never enough – the idea is of an unconscious attempt to improve the status by improving the attachment to the other. The perception of the person is that it is the ultimate victim.

Attitudes:

The world is full of injustice towards me. Tendency to emotional correction of others. Tendency to acquire status through others.

The desired figure of the therapist: one who does not see himself as a victim and does not feel the need for social comparison, his self-worth does not necessarily depend on social status and has other sources. Emphasizing this alternative thinking during the therapy, simultaneously addressing the patient as a person in its own worth, underlining his strong points not associated with leaning on others.

3] "A rational dictator (as a kind of positivist scientist)":

Based on the monopolistic supremacy of acquired positivist knowledge and experience. Eliminating the emotional approach, based on intuition. Everything is in some logical relationship to one another, each change is caused by something that can be traced, at least theoretically, and can potentially be explained by a logical cause. Man's self-perception as a kind of analytical device. There is a misjudgment about the limitations of logical thinking.

Attitudes:

"Cogito ergo sum" I think means I exist. Logically sophisticated knowledge and empirically gathered experience are critical. The perception of emotional experience as an inferior way of seeing things.

Tendency to search for innovations – dogmatic concepts must be challenged. Communication and reasoning is based on the rules of formal logic. Avoiding emotionally hypocritical behavior – limited and maximally controlled body language. Extensive use of rationalization in explaining phenomena including those in the emotional field.

The desired figure of the therapist: the therapist connects with the dictator who has become his language and in rational ways explains to him why it is worth listening to emotional parts as well, shows this in his responses, shows in episodes that happened to the patient in the past that paying attention to emotional parts could improve the results. Emphasis on providing space for the perception of the emotional experience. The goal is improving of the emotional intelligence.

4] The dictator who feeds on the "idol":

Based on the concept of maximum possible attachment to some idol. The status channel of the dictatorial self is fed by the external idol and this leads to an immediate drop in self-esteem once the real idol leaves the scene. The idol is a value unto itself and is necessary, irreplaceable and unquestionable. This internal dictator views the world through the idol's eyes, as part of a symbiotic connection. Everything is captured and accomplished with the idol in the background. Only the positions of the idol are considered, everything else is meaningless. The idol is a source of perception in itself, it is necessary, it has no substitute, and it is unassailable.

Trying to imitate the behavior of the idol, sometimes down to the smallest details, appearance, clothes, occupation, choice of sexual partner, etc. The status channel is fed by the idol and this leads to a steep drop in self-esteem once the real idol figure leaves the scene.

The desired figure of the therapist: one whose self-worth comes from diverse sources, is not fed by the external idol and its positions. One that is connected to a variety of characters perceived in shades of gray. There is a chance that the idol figure could be replaced by the internalized therapist figutr so it’s important that this figure be associated with the multifaceted world view and positive position towards meaningful and productive life.

5] A dictator who is a "moral apostle":

Based on the dictator self's unquestionable moral superiority. It's all a matter of norms. The perception of the world as divided into good and bad. All interactions are examined around their moral legitimacy based on ideals, which are personal in essence, but are seen as universal and not within the framework of the relationship between people. Human characters that are seen as illegitimate in a moral sense (dictated by the subculture, for example), are rejected. The self-concept is of a morally superior self, flawless and complete inner perfection.

Attitudes:

Moral norms are of universal significance and of the highest value.. Any deviation from these norms is unacceptable and must be punished. Good must always prevail over evil.

Often involved in the fight for justice, ignores any activity that does not meet his/her moral standards, tries to convince others to accept him/herself in a missionary way. Often tends to extreme positions on the degree of punishment for moral betrayals. Is not particularly interested in material values but praises moral and spiritual values.

The desired figure of the therapist: accepts principles in proportion to the situation. An alternative figure emphasizes relational approaches. Moral norms are seen as relative. One whose self-worth has diverse sources and accepts alternative positions without demonizing them. Scrutinizing patient’s history showing moments that led to alienation towards important others and suffering due to too decisive actions on a side of a moral apostle.

6] An "anarchist" type dictator:

Based on the perception of the dominance of the primary self. There is little consideration of the secondary "selves" except for secondary "selves" that have similar aspirations and, in fact, seem to be designed to reinforce the primary self. This is a sort of "primary self-dictator" situation rather than a "secondary self-dictator". Perceives the environment as a source of fulfilling an instinctive wish. Every object is seen as enabling the fulfillment of a wish, or hindering it.

Attitudes:

Do anything you like. Norms are irrelevant and can be easily violated.

Driven primarily by immediate desires or impulses. Aggressive behavior without remorse towards characters who prevent him from immediately fulfilling his wishes.

Manipulation of others to fulfill his wishes. Total lack of empathy. Fearlessly takes uncalculated risks.

The desired figure of the therapist: one in which norms are relevant and necessary for social distancing. One in which there is control by immediate desires or impulses. One whose self-worth has diverse sources. Scrutinizing patient’s history emphasizing problems in fulfilling patient’s own wishes due to total lack of consideration to accepted social norms and rules.

7] A "perfectionist" type dictator:

Based on the concept of ad hoc superiority of the secondary dictatorial self over the primary self. The primary self is by definition worthless, something that can only be corrected by perfect functioning. Human objects are evaluated in terms of function and perceived as either perfect or not worthy. Internally: overestimates his intellectual and emotional abilities and overburdens his energy resources. His thinking is in black and white.

Attitudes:

Man should always be first – if he is not the best, he is seen as last. Everything should be done 100% or not done at all.

Mainly tense and not satisfied with the results of his and others' activities. Extensive criticism, always looking for inconsistencies.

Always makes sure to improve his performance by further education/training. Chronically overworked, not taking physical or mental limitations into account ("workaholic"). Having trouble making decisions between best and excellent.

The desired therapist's figure: human objects are valued not only based on function but on a variety of characteristics. His thinking is not black and white. but sees shades of gray. Self-worth is measured in a variety of sources, not only by performance. Scrutinizing patient’s history with emphasis of suffering associated with over-achievement practices especially addressing mental and physical breakdowns and deterioration in relationships with significant others.

8] Dictator of the "annihilator" type:

is based on the notion that there is a constant oscillation between the persecutory dictatorial self and the illusory protective self. Fluctuations in identification with the dictator self – at one time feeling like a dictator and at another time feeling like his victim. Characters are seen once as evil and deserving destruction, they cannot do anything to justify their existence. On the other hand, they can be perceived as forever loving and supportive. Black and white thinking exists.

Attitudes:

Osculation between: You have no right to live, you must die! And you deserve all the love in the world!

Demonstrating extreme negative emotions, rejection, hateful attitude, frustration about basic trust and need for love. Physical and mental abuse, negation of all human qualities – which leads him to extremely low self-esteem, self-hatred and even suicide.

Creating an illusory image of a defensive character that conveys eternal love and total acceptance.

The desired figure of the therapist: one whose thinking is not black and white. but sees shades of gray. Self-worth is measured in a variety of sources and is not perceived in black and white terms. A moderate character who is not punishing and is not prone to extremism. Working with persecutary and punishing internalized figures and counterbalancing them with the internalized figures having positive attitude towards the patient.

9] Dictator of the "phobic" type:

is based on the concept that the primary self is very vulnerable and tends to be hurt by almost anything. The only possible way to avoid danger is to avoid potentially threatening objects and situations, while these become more and more numerous over time. Non-human objects are easily perceived as threatening or potentially harmful, until they are perceived as an actual danger. Human figures are seen as providing a sense of security, the interrelationships between them are in a hierarchical order, according to the degree of the sense of security they provide.

Attitudes:

Life is full of danger! Threat must be avoided by all means! Never face a threat but run!

Avoiding potentially dangerous situations and non-human objects, seeking reassurance from human figures.

The desired figure of the therapist: life is diverse. Life is never completely save and that is the basic situation we have to accept. There is a balanced approach to risks, an approach that does not avoid challenges. Scrutinizing the patient's history demonstrating how the phobic approach was limiting the patient and lowering his quality of life.

10] Dictator classified as "emotional":

Based on the concept that emotional understanding is the most authentic and that intuition cannot be wrong. Objects are perceived as positive, or negative, or in between – according to their emotional valence. The interrelationships between them are hierarchical and are measured by the degree of positivity of the emotional valence.

Attitudes:

Always trust your feelings – they never lie! Reality equals emotional expressions.

Theatrical behavior, decision-making based mainly on emotion, the attachment is usually superficial, based on the associated emotion rather than the character itself.

The desired figure of the therapist: the therapist shows by scrutinizing the patient’s history that in past situations paying attention to influencing factors rationally could have given better desired results. Demonstrating a personality that combines a rational approach with consideration of the emotional pan.

11] A dictator of the "social psychopath" type:

Based on the concept that "the results justify the means". Unlike Anarchist, social rules are formally accepted (but not internalized) and used to manipulate others to achieve personal goals (often violating ethical and moral norms along the way). The others are seen as a means to achieve personal goals. The characters are related to each other in a hierarchical order according to their potential importance in the process of achieving these goals while taking into account their potential. A tendency to ruthlessly crush the people who stand in a dictator's way if this seems beneficial to achieving the goal (and in the dictator's estimation, this would not be dangerous to himself).

The desired figure of the therapist: an approach in which there is consideration for others and an attempt to empathically understand the other's needs.

12] a "hedonist" type dictator:

The others are perceived according to their potential to provide pleasurable emotions, and they are related to each other hierarchically according to this quality. Avoiding characters associated with unpleasant feelings. Unlike the anarchist, the character qualities are seen as fixed.

Attitudes:

Live according to the "pleasure principle": seize every moment as giving you pleasure. Life is "here and now" and not in the future.

Looking for pleasant people and a pleasant environment.

Desired figure of the therapist: the therapist builds a character where suffering is not considered as always counterproductive and sometimes less pleasurable moments are leading to more success and more pleasure in the future, in other words accepting suffering on the way to the goal. Does not live only "here and now" but also sees importance in considering the future.

So far for now,

yours,

Dr. Igor Salganik and Prof. Joseph Levine