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How Does Psychotherapy Influence Personality?A Theoretical Integration John D. MayerUniversity of New Hampshire A given type of psychotherapy (e.g., psychodynamic) is associated with aset of specific change techniques (e.g., interpreting defenses, identifyingrelationship themes). Different change techniques can be conceived of asinfluencing different parts of personality (e.g., interpreting defense increasesconscious awareness). An integrated model of personality is presented.
Then, change techniques from different theoretical perspectives are assignedby judges to areas of personality the techniques are believed to influence.
The results suggest that specific change techniques can be reliably sortedinto the areas of personality. Thinking across theoretical perspectives leadsto important new opportunities for assessment, therapy outcome research,and communication with patients concerning personality change. 2004Wiley Periodicals, Inc. J Clin Psychol 60: 1291–1315, 2004.
Keywords: psychotherapy integration; psychotherapeutic techniques;personality change; change techniques The journalist Paul Solotaroff experienced harrowing panic attacks as a young man: Tinglingfeet and hands, sweats, heart palpitations, and shortness of breath that were made more terri-fying by a pre-existing asthmatic condition he feared might suffocate him. Haunted at day byfears of panic attacks, he found it difficult to sleep at night as well. After 11 years of self-described psychic imprisonment, he got "out of jail" by taking the anti-anxiety drug Anafranil.
After his dramatic improvement, however, Solotaroff desired further change. He wanted tofind out who he was now that his panic attacks were over; he wanted to create a new identity.
He next entered group therapy, which increased his confidence, allowed his journalistic skillsto flourish, and helped him to begin a satisfying marriage. (Solotaroff, 1999, p. 23–25) A number of people helped strengthen this article. A discussion of the Systems Framework for PersonalityPsychology, which underlies many of the ideas in this article, led to a stronger case for the ideas presented here.
In particular, Marc Brackett, Lewis Goldberg, Zorana Ivcevic, and Jefferson Singer all commented on themodel for connecting personality with other systems. This led me to clarify the model in its presentation here.
In addition, the visual presentations of the structural models of personality presented in Figures 1 through 3were greatly enhanced by the comments of Sherry Palmer, of UNH Photographic Services. The article furtherbenefited from the comments of Zorana Ivcevic, who identified several problematic issues in earlier drafts andmade useful recommendations for addressing them. Robert Eckstein was instrumental in recruiting clinicallytrained judges for the demonstration study regarding change techniques. I would like to extend my considerablethanks to them all.
Correspondence concerning this article should be addressed to: John (Jack) D. Mayer, Department of Psychol-ogy, 10 Library Way, University of New Hampshire, Durham, NH 03824; e-mail: [email protected].
JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 60(12), 1291–1315 (2004) 2004 Wiley Periodicals, Inc.
Published online in Wiley InterScience ( DOI: 10.1002/jclp.20076 Journal of Clinical Psychology, December 2004
Solotaroff 's account provides an example of how different interventions can alter per-sonality in different ways. In this case, psychopharmacological treatment alleviated hisanxiety, whereas group therapy helped him clarify his identity.
A psychotherapeutic approach such as psychodynamic therapy can be conceived of as utilizing a set of change techniques. Each such technique may exert a distinct action onan individual's personality. In this context, a change technique can be defined as a spe-cific, discrete, and time-limited act, which may involve providing information, directingbehavior, or otherwise exerting influence, and which is aimed at modifying an aspect ofan individual's personality and its expression. Although change techniques can be inter-preted broadly so as to include drug interventions, religious teachings, or even legalinjunctions, the focus here will be on techniques of psychotherapy.
Psychotherapy often acts in a broad and general way, through common factors— factors that most or all therapies employ such as creating a therapeutic relationshipand establishing an expectation of psychological benefit (Frank & Frank, 1991; Messer,2001; Nathan, Stuart, & Dolan, 2000; Smith & Glass, 1977). Psychotherapies arealso compared with one another according to how well they work. For example, apsychodynamically-inspired therapy may be compared with a cognitive-behaviorally-inspired one in the treatment of depression. Such comparisons reveal that therapies alsopossess specific, detectable effects (Lambert, 1992; Nathan & Gorman, 1998; Nathanet al., 2000; Smith & Glass, 1977). Such research reflects the view that a given psycho-therapy is a coherent and unified expression of a corresponding theory. For example, itviews cognitive-behavior therapy—and the specific change techniques that make it up—asemerging coherently from the theoretical statements of that perspective. The question ofwhether the different change techniques of a given psychotherapy might bring aboutdifferent kinds of personality change has rarely been addressed.
It is possible, however, that change techniques within a given psychotherapy may be quite different from one another as to their effects, and that change techniques acrosspsychotherapies may be more alike than they seem at first glance (e.g., Malik, Beutler, &Alimohamed, 2003). For example, a specific psychodynamic technique may be intendedto change the same area of personality as a specific cognitive technique, even though thetheories that give rise to them are otherwise different. Understanding the specific changetechniques in psychotherapy may require de-emphasizing theoretical orientations, and awillingness to approach both psychotherapy and the personality system itself using anintegrated perspective.
Understanding change techniques and other psychological phenomena apart from their theoretical origins is part of a broader movement for integration across psycholog-ical theories and topics of studies. These integrations have been forthcoming not only inpsychotherapy research (Arkowitz, 1992; Beutler & Clarkin, 1990; Norcross & Beutler,2000; Smith, 1999; Wachtel, 1982, 1997), but also in personality psychology (Mayer,1993–1994, 1998, 2001; McAdams, 1996) and in psychology more generally (Hen-riques, 2004; Sternberg & Grigorenko, 2001). Such integrations make possible the ideaof studying change techniques based on their specific impact on personality.
In the second section of this article, "The Problem and Its Significance," I outline the theoretical perspective-by-perspective approach employed in the teaching of psychother-apy, as well as in teaching personality psychology; consideration is given to why thestudy of change techniques can be facilitated by a more integrative framework and whysuch studies might matter. In the third section, "The Systems Framework Approach," anintegrated overview of the discipline of personality psychology is described. The systemsframework allows for a structural division of personality into broad functions such as"self-guidance," and "social acting." In the following section, "Organizing Types of Psychotherapy and Personality
Change," a description is given of how 52 change techniques were sampled from differ-ent theoretical modalities and how they were connected to the areas of personality theymight change. The idea here is that by collecting change techniques from across theoriesand resorting them, possible types of change can be better understood, their classes enu-merated, and the rationale for why they do or do not work elaborated. Such comparisonsmay help explain why therapies are similar to or different from one another (e.g., Chwal-isz, 2001; Malik et al., 2003). In the Discussion section I examine the strengths andlimitations of this approach, its research consequences, and its potential applications. Forexample, outcome measures that assess specific areas of personality as opposed to gen-eral measures such as symptom relief and general adjustment may be called for (e.g.,Messer, 2001, p. 10–11). Finally, connecting specific change processes to the areas ofpersonality they influence could allow therapists to better communicate with their patientsabout what they are doing.
The Problem and Its Significance To connect specific therapeutic techniques to the areas of personality they influencerequires employing an integrated framework that is different from the customary waysthat clinical psychology is usually taught and discussed. Like other disciplines, clinicalpsychology is typically taught with the assistance of a field-wide framework. Such aframework is an outline that a discipline employs to communicate its knowledge. Clinicalpsychology is most often taught according to a theoretical perspective-by-perspectiveframework. That is, authors of clinical psychology textbooks typically describe a sequenceof theoretical perspectives, beginning with psychodynamic approaches, including thepsychotherapies of Freud, Jung, and others. They then proceed to detail a second theo-retical perspective, such as the behavioral, that covers therapies such as systematic desen-sitization and contingency control. From there, the author(s) proceed, perhaps, to thehumanistic perspective, with its person-centered and existential therapies, and then con-tinues through other theories. If the book is integrative, the author(s) might begin or endwith a chapter or two on the common factors that exist across therapies, and eclectic orintegrative approaches to psychotherapy (e.g., Day, 2004; Ivey, D'Andrea, Ivey, & Simek-Morgan, 2002; Prochaska & Norcross, 2003; Scharf, 2004).
It is worth noting that this perspective-by-perspective field-wide framework is very similar to that commonly employed in the field of personality psychology. In that disci-pline as well, textbook authors commonly proceed through most of the same theoreticalperspectives, in much the same order: Freudian, Neo-analytic, Behavioral, Humanistic,etc. (see Emmons, 1989; Mayer, 1998, for reviews). The subject matter of these text-books focuses on the psychological theories themselves, and the empirical predictionsand the findings they generate (e.g., Burger, 2000; Carver & Scheier, 2000; Funder, 2001;Hall & Lindzey, 1978; Larsen & Buss, 2002). The content differs from that in psycho-therapy books by its de-emphasis of the practice of psychotherapy.
The counseling and clinical psychology framework has worked well in presenting the theories of the field in an accurate and careful fashion. The framework highlights suchissues as the theoretical bases for psychotherapies, whether the psychotherapies work,and which theoretically-based therapies work best. Contemporary research suggests thatabout 45% of the variance of therapy outcomes is due to general factors of the therapeuticrelationship (Lambert, 1992). By contrast, about 15% of the differences among thera-peutic outcomes is due to specific theoretical approaches, although recent analysessometimes put the specific effects lower still (Ahn & Wampold, 2001; Lambert, 1992).
The remaining variance is due to client and chance factors (Krupnick et al., 1996). The Journal of Clinical Psychology, December 2004
theory-by-theory approach, however, has not done as well in examining change at thelevel of specific techniques; nor does it analyze how therapy works in the context of ageneral model of personality.
Recall that, in the introduction, change techniques were defined as a specific, dis- crete, and time-limited act, which may involve providing information, directing behavior,or otherwise exerting influence, and which is aimed at modifying an aspect of a patient'spersonality and its expression. Change techniques are interesting because each possessesa discrete character, definition, and rationale that can often be expressed apart from anytheoretical orientation. They are a part of virtually every psychotherapy, and some tech-niques appear across—and indeed migrate across—therapies. For example, the empty-chair technique of Moreno's psychodrama of the 1920s was later employed in gestalttherapy (Wulf, 1998). Change techniques can be thought of as building blocks ofpsychotherapy.
Yet little is understood about individual change techniques themselves. The question of whether all of personality or a part of it is changed—and by which techniques—isimportant to informing therapy outcome research and yet not much research addresses it.
Generally speaking, many criteria employed in clinical research concern symptom reliefand general adjustment. One exception has been in the examination of whether psychi-atric disorders influence specific areas of personality or the whole system—about whichthere is some controversy (e.g., Clark, Vittengl, & Kraft, 2003; Oltmanns, Melley, &Turkheimer, 2002). The more commonly employed measures of therapy outcome, how-ever, measure general adjustment and cannot indicate which parts of personality havebeen altered, if any. Indeed, if more attention were paid to which parts of personalitychange with therapy, more change might be discerned relative to what has already beenfound (Chwalisz, 2001). So, an important way to sort the various kinds of personalitychange techniques depends on matching them to the areas of personality they most directlyaffect. This process, in turn, requires a pan-theoretical, generic model of personality.
The Systems Framework Approach The Integrationist Impulse One needs an integrated view to effectively discuss what parts of personality change andwhat stay the same and to attract research effort to the question. If some researchersdivide the personality system in a psychodynamic way, into the Id, Ego, and Superego(Freud, 1923/1960), whereas others divide personality in a humanistic way, into the RealSelf versus the False Self (Rogers, 1951, pp. 526–527), and others employ other divi-sions, research becomes fragmented and difficult to interpret.
There is a means to organize personality that provides an alternative to such theory- by-theory perspectives (Mayer, 1993–1994). Such an approach begins with a view ofpersonality as a unified system. It has evolved from Wilhelm Wundt's original view ofpersonality psychology as the discipline that would explain the collective action of theindividual subsystems of psychology; it is similar as well to Allport's conception ofpersonality as involving ". . the dynamic organization within the individual of thosepsychophysical systems that determine his unique adjustments to his environment" (All-port, 1937, p. 48; Wundt, 1897, pp. 25–26). Once personality is conceived of as anorganized system in this way, the focus shifts to topics that are appropriate to describingit. Beginning with Robert Sears in his mid-20th century Annual Review of Psychologyarticle, and proceeding to the present, personality psychologists have sought to integratethe field according to a rational set of topics rather than by competing theoretical per-spectives (Pervin, 2003; Sears, 1950).
Psychotherapy and Personality
The systems framework for personality employed here divides the study of personal- ity into four topics: (a) What personality is, (b) what its major parts are, (c) how those partsare organized, and (d) how personality develops. The present model provides an advantageover earlier similar integrations in that each of its topics has been carefully defined andhas a carefully worked out expository approach associated with it (Mayer, 1993–1994,1995a, 1995b, 1998, 2003, in press). In short, such outlines are coming of age.
Situating Personality and Dividing It Into Areas The systems framework depicts a generic model of personality that clinical change tech-niques can be associated with. The generic model is most readily grasped in the systemframework's third topic, "personality organization," which follows on the introduction tothe field (first topic) and the study of personality's individual parts (second topic). Per-sonality organization itself is subdivided into structural and dynamic aspects. Structuralorganization involves two aspects. The first concerns the position of personality amid itsneighboring systems, according to a connective structural model. The second concernsdividing the personality system itself into the relatively long-term, stable areas that reflectits operation. These two structural models will be introduced in the next section. Then,the change processes of psychotherapy, which are hypothesized to bring about dynamicalterations in the areas of personality, will be examined.
The Structural Model of Personality: The Connective Overview One structural view of personality concerns how personality connects to its neighboringsystems of scientific study. Scientists commonly use several conceptual dimensions todistinguish among the topics they study. Among the most important of these is themolecular-molar dimension or dimensions (Henriques, 2003). The molecular-molar dimen-sion separates smaller systems of interest from larger ones. For example, at its extremes,this dimension describes subatomic particles toward one end, and the entire universe as asystem toward the other.
In the case of personality, however, we are interested in a specific portion of the molecular-molar dimension. This spans several levels, illustrated by the horizontal linesof Figure 1, from the level of smaller physical, chemical, and living things, to the level ofbrain processes and psychologically significant objects and locations, to that of psycho-logical structures, and meaningful relationships, to the level of groups and cultures. Per-sonality itself is positioned "Inside the Person," or "within the skin," in this model.
Various psychological subsystems—motives, emotions, knowledge, and the self—c-ombine together to form personality. These areas are represented in the central, "Insidethe Person," column of Figure 1. Where a number of people and their personalities oper-ate in groups, the study of groups and cultures applies, as represented toward the top ofFigure 1.
There exist, actually, multiple, intertwined molecular-molar dimensions that ascend in a generally parallel pattern. For example, one can follow the dimension from the brainthrough personality, to groups and cultures, as is depicted in the central "Inside the Per-son" column of Figure 1. It is also possible, however, to follow a strand from physicalprops and objects, such as chairs, desks, telephones, at a lower level, to psychologicallymeaningful situations at the level of personality, to finally arrive at the same groups andcultures in which both personality and such situations, too, are embedded. This secondstrand of the continuum is shown in the "Outside the Person" column of Figure 1, to theright.

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Figure 1.
Personality amid its surrounding systems. The horizontal lines represent levels of the molecular- molar continuum (see text). The "inside the person" box shows personality and its emergence from majorpsychological subsystems and from the brain. The "outside the person" box shows the psychological situationand the setting from which it emerges. Both personality and the situation are incorporated within larger socialsystems (shown above them).
Regarding this second strand of the molecular-molar continuum, social psycholo- gists often draw an analogy between the drama of the individual's social interactions, onthe one hand, and the theater, on the other (Brissett & Edgley, 1990). The props andscenery form the social elements (the stage), and the actors upon it and the script combineto represent a situation (the dramatic scene). "The situation," as described here, is anchored Psychotherapy and Personality
at the same level as personality, because personality interacts most directly with themeanings and actions that occur at the level of a perceived ongoing drama. Finally, theaudience, theater troupe, stagehands, and business managers make up the incorporativeworld (the theater).
Personality processes take place within the person at a psychological level. Person- ality is expressed when its intentions are transmitted across communication channelssuch as language, movement, and facial expressions, to the outside world. The dichotomybetween personality, in the center, and the situation in which it is expressed, to the right,corresponds to the distinction between private and public personality, and between covertand overt mental behavior (Henriques, this issue; Singer, 1984, 1987).
Utility and Generality of the Integrated Model The relative generality of this picture of personality can be appreciated by comparing it toseveral more specific theoretical perspectives, as well as to other integrations. It is con-sistent with Freud's proposition that the individual must compromise biological needs toobtain social satisfactions (Freud, 1930/1961). It is consistent with Lewin's notion thatpsychological behavior (B) is a function of the person in the psychological environment,or B f (PE) (Lewin, 1935, p. 79), and similar but more elaborate equations denoting aperson's expectations of rewards and his or her likelihood to behave in particular way(Rotter, 1954, p. 108). This connective model has proven useful for relating the individ-ual to his or her external life style or life space (Brackett & Mayer, 2004; Mayer, Carl-smith, & Chabot, 1998), and also has provided a new more organized approach to classifyingdata in personality psychology and related fields (Mayer, 2004b). Finally, it is consistentwith general integrations of psychology such as Henriques' unified theoretical formula-tion (Henriques, this issue).
A Note on Implications of the Model for Personality Change The connective model draws a broad distinction between the inside and outside of theperson that can be used to divide sources of change as well. Outside change sourcesinclude one's spouse, one's boss, or one's therapist. Change that starts from the insidemay involve one's will, or self-control, or goal setting. The therapeutic alliance ofteninvolves an agreement by the therapist to help guide the client in changing. That is, theresponsibility for change is shared by the internal person (e.g., the conscious executive),in collaboration with the external guidance provided by the therapist. The shift fromexternal to internal control is often viewed as enhancing motivation, and as movingforward a person's stage of change (Prochaska & Norcross, 2001; Ryan & Deci, 2000).
The target of change can be similarly divided according to whether it is external or internal to personality. Regarding the surrounding environment first, one can changeone's underlying biology by eating well, or exercising. Or, one can change the situationby altering the props, such as one's clothes or by buying a new car. Or, one can change thesituation altogether by leaving home to visit a relative, or making a phone call, or goingto the supermarket. Finally, one can change groups by joining a different book club,transferring to a different college, getting married, or changing nationalities.
With or without psychotherapy, people are quite ready to change their outside worlds, judging by the statistics on the number of moves, divorces, and job changes peopleundertake in developed nations (Kreider & Fields, 2002). Many people are likely to trychanging jobs a few times if they are unhappy at work. Similarly, many people try to Journal of Clinical Psychology, December 2004
change partners if they are unhappy in a relationship. Changing one's job or relationshipin young adulthood may involve relatively few costs. Such external changes themselvesserve as natural experiments that vary the environment but keep one's personality more-or-less constant. If a person observes him or herself reacting in a similarly problematicfashion in job after job, or with partner after partner, his or her own personality maybecome identified as an issue.
Other pressures that promote inward change may simultaneously come to bear. As one's activities and skills become more specialized and fitted to context, the generalemphasis may shift away from change to preserving what one has achieved (Carstensen,1998; Hill & Miller, 1981; Kanfer & Ackerman, in press). Moreover, changing careers orgetting divorced and remarried later in life can be far more costly than in youth, and onlysome people will have the resources to allow for it. Preserving external gains may there-fore require changes in specific areas of one's personality: Reducing anxiety, or improv-ing social skills.
The Structural Model of Personality: Elaborating the Internal World Personality, as defined in the systems framework, is the organized, developing, mentalsystem within the individual. The mental system is composed of such major psychologicalsystems as consciousness and attention, the self system, models of the world, the emo-tion system, and the like (cf., Mayer, 2004a, p. 12). Those major subsystems along withothers are depicted in Figure 2. Right away the problem with dividing such a systembecomes clear: Functions overlap, interpenetrate, and are multiply connected. Where isone to draw the lines? It is certainly possible to divide any complex system—such as aperson's psychological system—in multiple valid ways. And yet, laying out some orga-nization is important to grasping the system and organizing its areas.
The division of personality employed here is called The Systems Set, and divides personality into four areas. Approximations of the divisions are represented in Figure 2by the dashed lines. The areas were formed such that, as a group they were: (a) as distinctas possible, (b) collectively covered the personality system well, (c) corresponded toareas of brain function, and (d) conveyed through their functions a dynamic sense of whatpersonality does (Mayer, 2001). The four parts of the system are called the energy lattice,knowledge works, social actor, and conscious executive. The choice of dividing linesamong them was also influenced by earlier successful divisions of the mind.
The first structure, the energy lattice, includes the motivational and emotional sys- tems (Fig. 2, lower left). It directs the individual's motivations into appropriate activities.
It represents the functions responsible for channeling motives and guiding emotions, andguiding the organism's energies according to its needs. Examples of similar functionalgroupings include Freud's Id, a combination of the motivation and emotion areas of thetrilogy-of-mind, Murray's motives, and similar entities (Freud, 1923/1960; Mayer, Chabot,& Carlsmith, 1997; Murray, 1938).
The second structure, the knowledge works (Fig. 2, center), represents the function responsible for mental representations of both the self and the real world, and the use ofthose representations to guide the individual. It also involves various intelligences andimagination. Examples of similar, functional groups include the "reality-process" of Freud'sEgo, cognition (in the trilogy-of-mind), Kelly's personal construct systems, and James'self-as-known (as opposed to the self-as-knower) (Freud, 1923/1960; James, 1892/1920;Kelly, 1955; Mayer et al., 1997).
The third structure, the social actor, represents the expression of personality in a socially adaptive and adept fashion. It includes social skills, role knowledge, and emotionally pre- Psychotherapy and Personality
Figure 2.
Personality and some of the major psychological subsystems it organizes. Each subsystem performs a unique set of psychological functions necessary for human existence. These functions are integrated acrosspsychological subsystems in the sense that they blend into one another and often operate in parallel with oneanother.
ferred expressions (Fig. 2, right). Earlier structures roughly corresponding to this functioninclude Singer's public personality, role playing in Hogan's socioanalytic theory, the socialpsychologists' "social behavior" (as part of "cognition, affect, and social behavior"),Jung's persona, and the like (Hogan, 1982; Jung, 1953/1945; Singer, 1987).
The fourth structure, the conscious executive, represents the function of execu- tive supervision over the rest of the parts. It includes consciousness and attention,self-awareness, and working memory (Fig. 2, upper left). Earlier structures roughlycorresponding to this function include James' self-as-knower (as opposed to the self-as-known), Freud's observing Ego, Jung's conscious Ego, and the like (Glickauf-Hughes, Journal of Clinical Psychology, December 2004
Wells, & Chance, 1996; James, 1892/1920; Jung, 1953/1945). In this system, the uncon-scious consists of those extensive areas to which the conscious executive has impededaccess, or no access at all.
The four areas of personality interact dynamically. The system's activities begin with the energy lattice, which provides direction to the system to get what it needs. Thosedirections are sometimes directly expressed by the social actor. The social actor, how-ever, is also guided by the knowledge works and the conscious executive, which serve toguide or restrain its social acts—sometimes thwarting the energy lattice's needs in theprocess. The knowledge works provides the human center of the system, capable ofknowledge, wisdom, and creativity in understanding the self, the world, and how to act inrelation to them. Finally, the conscious executive monitors and guides the other structuresin an attempt to facilitate their working together.
The systems set appears to meet the criteria for a good structural division and has proven useful in organizing traits according to the four areas of personality it demarcates(Mayer, 2001, 2003). Its capacity to organize parts of personality distinctly and compre-hensively suggest that it is one of several possible relatively optimized divisions of per-sonality. Psychotherapeutic change techniques can be connected to this functionalbreakdown as well to see which techniques influence which areas of personality.
Organizing Types of Change Identifying Specific Change Techniques There are a vast variety of change techniques used in psychotherapy and no official list ofthem exists, although Prochaska and Norcross provide an inventory at a general level(Prochaska & Norcross, 2003, pp. 516–519). To develop a representative sample of spe-cific change techniques, I sampled 52 such techniques, and descriptions of them, fromseveral psychotherapy and counseling textbooks, and ancillary sources (Day, 2004; Iveyet al., 2002; Prochaska & Norcross, 2003; Scharf, 2004). A sample technique was, "anal-ysis of transference," described as "bringing into consciousness–by pointing out–overgeneralizations of early relationships through reference to the current psychotherapeuticrelationship." The change techniques were sampled from 10 different therapeutic approaches to ensure that a wide diversity of possible interventions was represented. Six tech-niques each were drawn from four "classic" groups of therapies: (a) psychodynamic,(b) behavioral/learning, (c) client-centered/experiential, and (d) cognitive/social cogni-tive (e.g., Smith & Glass, 1977). A specific change technique from each perspective isshown in Table 1. In addition, three change techniques each were drawn from six nar-rower therapies that were still significant enough to warrant mention in one or another ofthe textbooks above, including: the (a) Adlerian, (b) emotion-focused, (c) multi-cultural/gender, (d) psychodynamic-interpersonal, (e) reality therapy, and (f ) transpersonal. Anattempt was made to sample techniques that represented innovations (e.g., did not over-lap) with techniques from the four classic groups. A sample technique in the emotion-focused group, for example, was "Developing self-soothing" and was defined as"Encouraging the client to be receptive to and compassionate about emerging painfulemotional experiences." Four more techniques came from a (g) other category (e.g.,hypnotic analgesia), and six "common factors" of change were selected, including, "Estab-lishment of a therapeutic relationship" (e.g., Frank & Frank, 1991).
The systems set itself was divided into nine specific groups of personality function, shown in Table 2, and approximately corresponding to the systems shown in Figure 2.
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Table 2The Major and Subsidiary Areas of Personality Represented by the Systems Setand the Whole Personality The Major Areasand Whole Personality Related Parts and Processes • Need to achieve, need for affiliation, need for • Socially constructed motives• Non-conscious processes that channel motives Emotions and emotional • Basic emotions and emotional responses • Constructed emotions• Emotional expressions such as facial expressions Energy-related knowledge • Understanding one's own motives and emotions General knowledge area • Long-term conceptions of the self—stable self-concept, life story, etc.
• Beliefs, politics, attributions, and other models of • Cognitive intelligences and creativity• Thought styles Social-related knowledge • Understanding social situations • Understanding social relationships• Understanding culture and politics• Understanding practical knowledge Basic styles of social • Shyness or extroversion • Dominance or submission• Grace or clumsiness• Dimensions associated with temperament Strategic social behavior • Social skills • Social roles• Strategic self-presentation• Deception Conscious Executive Consciousness control • Pure awareness• Conscious self-control Self-monitoring and • Defense and coping • Self-attention and self-monitoring• Dynamic changes and re-evaluations of the self The Whole Personality • All of personality• A person's developmental progress• Overall functioning For example, the conscious executive was divided into two areas: first, a consciousawareness that involved "pure awareness, and conscious self-control;" second, self-monitoring and defense, including "defense and coping, self-attention and self-monitoring,and dynamic changes in self-understanding." These nine smaller units clarify the con-tents of each system set area (Mayer, 2003). The four areas and nine more specific pro-cesses they divide into are shown in Table 2, along with a tenth category for the wholepersonality.
Psychotherapy and Personality
Demonstration Rating Study The approach taken here is mostly theoretical but testing whether independent judgesagree that certain change techniques can be associated with specific areas of personality,and using their collective judgments to make such assignments can heighten confidencein the classification. So, a demonstration study was conducted. Note that the study con-cerns experts' judgments, as opposed to the actual, demonstrable effects of change tech-niques on personality. The study therefore tests whether there exists reliable agreementamong judges as to the theoretical influence of change techniques on specific areas ofpersonality. Further studies will be required to understand whether the techniques actu-ally bring about the changes they are expected to.
The combined (e.g., modal) judgment of the judges was employed to assign change techniques to a given area of personality. Aggregating the responses of judges tends toreduce errors of judgment in complex tasks requiring complex judgments, and to increasetheir validity (Epstein, 1983; Legree, 1995; Nunnally, 1978). For example, an earlierstudy was conducted examining the assignments of personality traits (e.g., extroversion,intelligence, self-consciousness) to the personality areas of the systems set. In the study,aggregated raters agreed in placements approximately 70% of the time, compared to pairsof individual judges, who agreed at the 50.8% level, and versus a 20% agreement rate bychance. The average kappa coefficient for judges was significant; its level was not readilyinterpretable, however, because the statistic inappropriately corrects for nonrandom base-rate responding in this context (Uebersax, 1987). In the sorting task for traits, the systemsset proved superior to the trilogy of mind (the most used system for sorting traits). Forexample, at the level of pairs of judges, agreement was 35.1% for the trilogy versus theaforementioned 50.8% for the systems set, which was statistically significantly higher.
Chance levels were approximately 20% in both studies.
To test the hypothesis that judges can assign change techniques to personality areas with some reliability, 10 judges with knowledge of personality and psychotherapy sortedthe change techniques according to the areas of personality they believed them to target.
The judges varied in educational level from doctoral level, licensed therapists, to honors-level undergraduates, with graduate students in between; I also served as one of thejudges. All judges had courses in both personality psychology and counseling or clinicalpsychology. Each judge received slips of paper on which were printed each of the 52change techniques, and 10 larger pieces of paper with the 9 personality areas on themfrom Table 2 (middle column), and the last labeled, " The Whole Personality." Judges were asked to assign each change technique to the given area of personality that would be most influenced by the technique. The procedure took about 45 minutesand the all judges except the author received a $10 gift certificate as an expression ofthanks.
Analysis and Results of the Study Sortings into the 10 categories were first recoded into the systems set classification. Forexample, ratings for the "pure consciousness" and "defense and coping" categories wereboth re-coded so as to refer to the conscious executive. After re-coding, there were fivepossible categorizations: (a) the energy lattice, (b) the knowledge works, (c) the socialactor, (d) the conscious executive, and (e) the whole personality. If judges' assignmentsof techniques to areas were random, they would be expected to agree 20% of the time(i.e., on 1 out of 5 placements).
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The odd- and even-numbered judges were compared as to their modal ratings of the change techniques. In cases where the ratings of the group exhibited no mode, the firstjudge in either group was used as the tie-breaker (and, if that rating wasn't relevant tobreaking the tie, the second rater was employed). The agreement level between odd andeven groups of judges was 75%, and significantly and meaningfully exceeded chancelevels of 20% (t(51) ⫽ 25.6, p ⬍ .001). It seems conservative to conclude that the groupof 10 raters as a whole would agree with other groups of 10 raters at an 80% level ormore.
This aggregated level was, as expected, a considerable improvement over the pair- wise average interjudge agreement across the 45 pairs of raters [(10 judges ⫻ 9)/2]. Thatvalue, 47.5%—was still, however, well above chance levels (20%; t(51) ⫽ 9.47, p ⬍.001). There was no statistically significant difference in rater agreement as a function ofeducational level; indeed, the individual raters with the highest and lowest degrees ofagreement with the rest of the group both had attained their doctorates.
Another way of assessing interjudgment agreement is through the use of the kappa coefficient, which provides a more limited test of rater agreement, because it employsassumptions that do not all apply here (e.g., correction for nonrandom base rate respond-ing; Uebersax, 1987). The kappa based on the aggregate odd and even judges was ␬ ⫽.68. The average pairwise kappa coefficient was lower but still significantly differentfrom zero ␬ ⫽ .33; t(44) ⫽ 20.4, p ⬍ .001).
Each change technique was assigned to a personality area based on the modal rating it received from the 10 judges together, as shown in Table 3. The number of judgesagreeing is shown in parentheses. Three of the 52 techniques were rated as bi-modal, andin that instance, the author made a final determination as to the technique's best place-ment (indicated by an asterisk). Generally speaking, the placements made a good deal ofsense. For example, the conscious executive was influenced by "meditation," and "inter-pretation of defense." The energy lattice was rated as most closely targeted by techniquessuch as "changing emotion with emotion" and "problem expression." The knowledgeworks was targeted by techniques such as "developing a new life story" and "developingnew philosophies." Similarly, the social actor was targeted by "role playing," and "lan-guage statements" (e.g., learning to use "I" statements). Finally, the whole personalitywas influenced by such techniques as "establishing a therapeutic relationship" and "instill-ing trust, hope and confidence." Another question raised at the outset of this article was whether different psycho- therapies might use different change techniques, and yet end up targeting the same areasof personality. Table 4 illustrates that change techniques drawn from different therapeuticapproaches often targeted the same areas of personality change. For example, all fourmajor therapeutic approaches employ techniques that influence the knowledge works. Tochange a client's knowledge works, psychodynamic therapists employ "looking for rela-tionship themes," humanistic/experiential therapists employ "empathy," and cognitivetherapists help "develop new philosophies." Similarly, three of the four therapies employtechniques to change the conscious executive. Psychodynamic therapists employ "inter-pretation of defense," behaviorists teach relaxation, and the humanists reflect meanings.
On the other hand, there were clear differences. Table 4 shows the number of times raters assigned a change technique from one of the four major areas of psychotherapy toa particular part of personality. For example, consistent with Freud's (1933/1965, p. 80)dictum "Where id was, there ego shall be," psychodynamic techniques were rated asinfluencing the conscious executive 58.3% of the time, whereas the cognitive techniqueswere rated as influencing the knowledge works 68.3% of the time. A chi-square testamong the four major approaches indicated that there were highly significant differences Psychotherapy and Personality
as to which areas of personality they targeted overall (␹2(12) ⫽ 124.7, p ⬍ .001). Ofcourse, the selected change techniques representing each orientation are small in number.
Still, the findings do appear to reflect some intuitions about the areas under discussion.
A final question was whether adequate techniques exist to influence each of the areas of personality and personality as a whole. The change techniques were rated most fre-quently as influencing either the conscious executive (31.3%), or the knowledge works(35.8%). Change techniques were also viewed as influencing the energy lattice and socialactor with some frequency (14.6% and 10.8%, respectively). The remaining ratings oftechniques assigned them to the whole person (7.5%). That is, techniques were rated asapplying to all areas of the personality system.
Synopsis of the Argument Thus Far In this article, I have argued that different parts of personality are differentially targetedby specific change techniques used in psychotherapy. Determining whether this is thecase is best done by comparing change techniques apart from their theoretical perspec-tives and relating them to a generic view of personality's major functions. That is, match-ing change techniques to personality function requires thinking outside the theoreticalperspective-by-perspective frameworks of clinical psychology and personality psychol-ogy. The generic model of personality employed here divides it into four areas: An energylattice that interweaves motives and emotions; a knowledge works, that creates, stores,and employs mental models of the self and world to create understandings; a consciousexecutive that brings information into awareness and acts on it; and a social actor, thatexpresses personality.
Fifty-two change mechanisms were sampled from across 10 therapeutic traditions and from a group of common factors. Judges then sorted these techniques according tothe areas of personality the change techniques targeted (i.e., energy lattice, knowledgeworks, etc.). The rating study indicated that judges were able to reliably agree at 75%levels which areas of personality are influenced by which change techniques (comparedto 20% by chance alone). The four major groups of therapies each possess techniques thatinfluence different parts of personality. For example, both psychodynamic and cognitive-behavioral perspectives employed techniques that would affect the belief systems of theknowledge works (looking for relationship themes; identifying irrational thoughts). Onthe other hand the different approaches appear to specialize in changing one part ofpersonality or another. For example, the psychodynamic approach employs many tech-niques to influence the conscious executive, whereas the cognitive approach employsmore techniques to alter the knowledge works. Across therapies, the largest number ofchange techniques was regarded as directed toward the knowledge works and the con-scious executive, with smaller but still appreciable numbers of techniques directed towardthe energy lattice and social actor.
Limits and Issues With Findings There are some limits to the results. Fairly high agreement was obtained in the placementof techniques by aggregating judges. Still, individual pairs of judges agreed at alow-to-moderate level. This and earlier findings raise interesting questions as to what Journal of Clinical Psychology, December 2004
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Table 4Number of Times (and Percentages) the Representative Change Techniques of the Four MajorTheoretical Approaches Were Rated as Influencing a Specific Area of Personalityor All of Personality Across All Raters Total times techniques were associated with the area might be limiting judges' agreements (e.g., Mayer, 2003). At least three factors are likelyinvolved. First, the change techniques (and traits, in earlier studies) are often not definedas clearly as would be desirable for classifications of this type. Second, the areas ofpersonality to which the techniques are assigned represent broad divisions. Althoughthese distinctions are often useful, they are made in the context of a generally integratedsystem (see Fig. 2), and it is likely that a number of borderline discriminations are nec-essary. Consider, the humanistic (Gestalt) technique "staying with the feeling." It wasrated as changing the knowledge works, probably because it involves improving emo-tional self-understanding. Yet "staying with the feeling" is also thought to bring aboutchanges in emotions, and hence, could also be classified with the energy lattice. Third,judges themselves vary in expertise and theoretical perspective and are otherwise subjectto errors in judgment in complex tasks. Given these three limitations, the aggregate reli-abilities of 75% seem reassuring.
Rater Agreement Versus Actual Change In this study raters agreed on the placement of therapeutic change techniques accordingto the areas of personality they should influence. That is they showed conceptual agree-ment that certain change techniques influence specific parts of personality. However, thisdoes not mean that the change techniques actually change those parts of personality andthose alone. At the same time, at least a few specific techniques have research evidencethat supports their specific action (e.g., Wolpe, 1997). Even by itself, the demonstrationthat change techniques and areas of personality correspond in theory is not trivial. Creat-ing a connection between change techniques and areas of personality marks a first steptoward determining what kinds of such specific changes actually take place. The questionthen arises, what is needed next in such research? The Problem of the Outcome Measure These analyses suggest the kind of research needed to answer questions about specificpersonality change requires changing the sort of assessment battery that is currently usedin clinical research. Therapy outcome studies employ data from literally hundreds ofdifferent scales. Many such measures are used on a single occasion with little or nopsychometric information associated with them (Froyd, Lambert, & Froyd, 1996). Even Psychotherapy and Personality
in a relatively clearly defined research area such as treatment outcomes for depression,many different measurement techniques are employed (Basco, Krebaum, & Rush, 1997;Piotrowski & Lubin, 1990); a recent survey of APA Division 38 members found that 13different depression scales were in common use by its practioner-members. This lack ofa standard has led to the call for a core battery of assessment, yet no such agreement onwhat it might be has been reached (Barkham et al., 1998; Strupp & Hadley, 1977; Strupp,Lambert, & Horowitz, 1997).
There are many obstacles in the way of a core assessment battery, and yet answering questions about personality change plainly requires some consideration of the assess-ments that would be needed to understand them. Future batteries would be enhanced ifthey included instruments capable of detecting change in specific areas of personality. Inthe instance of depression, for example, outcome measures of the energy lattice wouldassess a motivation and depressed affect (e.g., Senecal, Koestner, & Vallerand, 1995).
Measures of the knowledge works would assess irrational and depressogenic beliefs (e.g.,Beck, Rush, Shaw, & Emery, 1979; Seligman & Schulman, 1986). Measures of socialactions would assess depression-related social-skill deficits (e.g., Oltmanns et al., 2002).
Measures of the conscious executive would assess the individual's capacity to regulatenegative emotion and emotion-related thoughts (e.g., Senecal et al., 1995). Similar four-fold approaches to developing and selecting instruments would be employed for otherdisorders and to assess a person's positive adjustment as well. Psychotherapy research isamong the most challenging and important types of research to conduct, but most psy-chologists would agree it has not fully matured. Better understanding the therapy–personality connection will likely be fostered by assessments specific to the differentareas of personality.
The Chart on the Wall A further application of this approach is to create a "chart on the wall" with which toillustrate to clients how their personalities might change. When someone goes to aphysician's office for a particular problem, there is often a representation of the bodyhanging on the wall—its muscles, bones, and major organs: in short, the body's structure.
The doctor and patient refer to the chart during discussions. "This is the ligament in yourarm," the doctor might say, pointing to the chart, "and the theory is, that you have torn it."The chart's presence provides a comforting sense that such injuries have been seen before.
Some knowledge has been organized around similar injuries; there exist answers to thespecific problem. This is not a specifically medical approach. Nutritionists employ a foodpyramid for educational purposes, chemistry instructors employ a periodical table of theelements, and management consultants sometimes discuss change in the context of anorganizational chart.
A wall chart that outlines therapeutic change and its impact on personality would serve a similar educational purpose to the use of charts in other fields. Personality psy-chology and the structural models of it communicate well about the theories of our dis-cipline. As an indication of what a chart of therapeutic change might look like, a numberof the change techniques are shown in Figure 3, arranged according to the areas of per-sonality they influence. As a therapist summarizes his or her treatment plan, he or shemight make reference to a chart and use it to explain what might be accomplished: (Pointing to the overall chart . .) You can think of personality as involving several broadfunctions shown here. This is an example that divides personality into its motives and emotions(the energy lattice), its beliefs (the knowledge works) its conscious executive, and social Journal of Clinical Psychology, December 2004
Figure 3.
A proposal for a psychotherapist's wall chart. The chart would be used to explain some of the change techniques therapists employ and how they will influence the therapy client's personality. Personality isdivided into four structural areas: The conscious executive, the energy lattice, the knowledge works, and thesocial actor. Within each area of personality are specific change techniques directed toward changing thoseareas. These techniques are drawn from diverse psychotherapies and represent examples of the kinds of changemethods that therapists employ.
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actions. (Then, to some clients:) Any such division is a simplification, but it can serve as ageneral outline of what we will be addressing here.
The chart would then be used to discuss the person's particular problems and how they might be addressed during therapy. For example, in the case of depression, thetherapist might continue, ". . Our plan will be to alter the emotional states you experi-ence by examining beliefs in the knowledge area that could be making you feel bad . .
[Pointing to the social actor] . . we will also examine any interactive patterns you havethat may be causing you social difficulties . . ," and so on. Such a chart and the discus-sion around it may serve to demystify our science and convey the hard-earned researchfindings that support it.
Concluding Comments There are many who believe that both the study of psychotherapeutic change techniquesand the study of personality can benefit from pan-theoretical, crossdisciplinary views. Ihave presented one such unification that reorganizes certain ideas from two fields: clin-ical and personality psychology, by matching change techniques to the parts of person-ality they may influence. It is but one way that the integration of the fields may yield newinsights about the research and practice of psychotherapy.
There is more than one way to unify a discipline, of course. And there is more than one way of dividing any complex system. Yet the unifications of today may be far closertogether than the competing therapeutic perspectives of the 20th century ever hoped tobe. By their very claim to be unifications, such perspectives are forced to interact morewith one another. For example, the systems framework for personality makes critical useof the same molecular-molar dimension that Henriques (this issue, pp. 1207–1221) employsfor his unification of psychology in general. Much of what he says concerning the expres-sion of personality is consistent with the views here. The unity among unifications, inother words, may be rather substantial. A unifying framework for a discipline is, of course,a very abstract thing. Yet, such frameworks can have far-reaching practical implications.
In clinical psychology, integration may influence everything from how therapy outcomeresearch is conducted, to how a therapist communicates the changes that will be carriedout in psychotherapy.
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Effect of divalproex on brain morphometry, chemistry, and function in youth at high-risk for bipolar disorder: a pilot study

JOURNAL OF CHILD AND ADOLESCENT PSYCHOPHARMACOLOGYVolume 19, Number 1, 2009 ª Mary Ann Liebert, Inc.Pp. 51–59DOI: 10.1089=cap.2008.060 Effect of Divalproex on Brain Morphometry, Chemistry, and Function in Youth at High-Risk for Bipolar Disorder: A Pilot Study Kiki Chang, M.D., Asya Karchemskiy, M.S., Ryan Kelley, B.A., Meghan Howe, M.S.W., Amy Garrett, Ph.D., Nancy Adleman, B.S., and Allan Reiss, M.D.


Role of Olivary Electrical Couplingin Cerebellar Motor Learning Ruben S. Van Der Giessen,Sebastiaan K. Koekkoek,Stijn van Jornt R. De Gruijl,Alexander Cupido,Sara Bjorn Kerstin Wellershaus,Joachim Degen,Jim Deuchars,Elke C. Fuchs,Hannah Monyer,Klaus Marcel T.G. De and Chris I. De ,1Department of Neuroscience, Erasmus MC, 3000 DR Rotterdam, The Netherlands2Institute of Genetics, Division of Molecular Genetics, University of Bonn, 53117 Bonn, Germany3Institute of Membrane and Systems Biology, University of Leeds, LS2 9JT Leeds, UK4Department of Clinical Neurobiology, Interdisciplinary Center for Neuroscience, 69120 Heidelberg, Germany5Netherlands Institute for Neuroscience, Royal Academy of Arts and Sciences (KNAW), 1105 BA Amsterdam, The Netherlands6These authors contributed equally to this work.*Correspondence: DOI 10.1016/j.neuron.2008.03.016