ACA Blog

Ray McKinnis
Apr 12, 2011

A Strength-Based Approach to Axis II Diagnoses

More than once I have heard counselors cringe at working with clients showing Axis II disorders. My hunch is that they dislike the fact that so-called Adjustment Disorders are, by definition, ‘enduring patterns of perceiving, relating to, and thinking about the environment and oneself.’ Thus to try and change them would be almost impossible. But if you can’t change them, join them!

Vann Joines in his book ‘Personality Adaptations’ makes a good case for the view that the personality disorders identified on Axis II are actually the most negative aspects of personality adaptations that we all must figure out and use during the first 6 years of our lives to survive the environment we are born into.

Problems come, as the DSM-IV-TR points out, when an adaptation ‘deviates markedly from the expectations of the individual’s culture’. And the names the DSM gives them are such downers: paranoid, schizoid, schizotypal, antisocial, obsessive-compulsive, etc. These suggest the most negative aspects of the different adaptations.

So Joines suggests alternative names which suggest both the positive and negative aspects of these skills we all had to learn: Enthusiastic-Overreactor (Histrionic); Responsible-Workaholic (Obsessive-Compulsive); Brilliant-Skeptic (Paranoid); Creative-Dreamer (Schizoid); Playful-Resister (Passive-Aggressive); and Charming-Manipulator (Antisocial). See Joines and Stewart’s book for a fuller description of each of these but from just the names, I bet you can identify which you feel most skilled at using or which you fall back to when you are most under stress.

In planning a party, I would invite a couple of ‘enthusiastic-overreactors’ (DSM: Histrionic: ‘shows self-dramatization, theatricality, and exaggerated expression of emotion’, ‘has a style of speech that is excessively impressionistic and lacking in detail’, etc.). I realize such individuals might make us counselors who often exhibit at a party ‘odd thinking or speech’, ’inappropriate or constricted afftect’, ‘behavior or appearance that is odd, eccentric, or peculiar’, ‘excessive social anxiety’, etc. (The Creative-Dreamer—DSM Schizotypal).) It’s a party!

For preparing my taxes, I look for the responsible-workaholic (DSM: Obsessive-Compulsive: ‘preoccupied with details, rules, lists, order, organization or schedules’, ‘is over conscientious, scrupulous, and inflexible about matters of morality, ethics or values,’ etc.). Yes, thank God for them.

For my sales staff, I want the charming-manipulator. I am not comfortable marketing even my own skills but some individuals love to do it. For my artist, I look for the creative-dreamer; for my private detective, give me a brilliant skeptic; or better yet, a brilliant skeptic who is also obsessive-compulsive (like Monk).

We all have learned at least one of these sets of skills very well in order to cope with our first few years of life. Our primary adaptation is the one which we call upon when feeling stressed or threatened. Most of us have also learned more than one. These are our ‘secure bases’ (see my last blog) from which we then can more confidently go out into life, meet new people, explore new relationships, new ideas, become counselors, accept, even invite changes, etc. Problems come when we revert to our primary adaptation when it is not appropriate—like riding a bike on the freeway. Riding a bike is a great skill to learn but not useful every time we want to get from one place to another. When the personality adaptation we go to does not get what we need, we might escalate our behavior using the same (now dysfunctional) set of skills bringing an even greater feeling of powerlessness. It can become something like being in a foreign country. Not speaking the language very well. We say something. We are not understood, so we raise our voice and say the same thing. Sometimes even shouting! We lose our secure base and feel disempowered—an awful place to be.
(An aside: borderline and narcissistic disorders do not have a ‘positive’ aspect. The borderline can be understood as an individual who has no secure base—they are like an army in a foreign country without any secure position to fall back to. The counselor’s task is to help them develop a secure base through the experience of the therapeutic relationship and build from there. Truly a daunting task. The narcissistic personality uses themselves as their one and only secure base—all life revolves around that base. The task with such a client is to help them realize that the secure base in only temporary and that there is an entire country out there to explore where everyone else is living.)

As counselors, we need to identify which personality adaptation (or adaptations) our client feels most comfortable with and work from there.

Enough for this blog. My next blog will show how a client’s primary adaptation can be detected from the first 3-5 minutes on meeting the client for the first time. Since one of the most stressful experiences of a client is the first 3-5 minutes of meeting their new counselor, they will undoubtedly use their primary personality adaptation—the one they feel most secure and skillful with. And by carefully observing those first few minutes, that adaptation will manifest itself clearly. This judgment can subsequently be confirmed as the counselor and client continue to engage. And, as Joines explains, once the primary adaptation is understood, treatment techniques and goals follow fairly clearly.

Indeed personality adaptations (disorders) offer a very effective way of working with any client—even those not having a problem on Axis II. I like working with them—in fact they are a primary part of the entire process I use working with a client.



Ray McKinnis is a counselor with a special interest in 'spirituality beyond religion' and veterans 'beyond PTSD' with a website at counselingandcoachingforlife.com.

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