ACA Blog

Ray McKinnis
Apr 18, 2011

A Diagnosis and Treatment Plan after 5 Minutes. Warning: This Blog Contains Some Highly Technical Information

Last week I blogged about how the DSM axis II so-called personality disorders could be understood as the most negative aspects of those personality adaptations which we all learn in the first few years of life in order to survive this strange, new world. I find them fascinating and extremely useful. Research indicates they are real. But their real benefit comes from the fact that they can be used to rapidly diagnose a client and develop a precise treatment plan. Rapidly means 3 to 5 minutes after meeting a client, a counselor can pretty well know what issues a client is dealing with that keeps that client from making the changes they need to make to resolve their problems.

You see, we all revert to our primary personality adaptation in times of stress since we developed them to survive our greatest stress—just after birth. And for a client, the first few minutes after meeting their new therapist poses one of the greatest threats they could experience. So they rely on their most developed personality adaptation in that first encounter. And more often than not, the inappropriate use of that personality adaptation in their life is the source of many of the difficulties that brought them to therapy.

So, as a therapist, if I know what I am looking form, I can easily identify the client’s primarily, go-to adaptation in those first few minutes. I can do this if I can get my own personality adaptation and issues out of the way and truly observe my client.

The rest of this blog will give a brief description of how to do this. Vann Joines has conveniently presented details in the book he and Ian Stewart co-wrote, Personality Adaptations.

Key to identifying personality adaptations is identifying a client’s ‘driver behavior’. Taibi Kahler detected these five drivers which are manifested through our personality adaptations: be perfect, be strong, please others, try hard and hurry up. By watching and listening to certain aspects of a client’s words, tones, gestures, postures and facial expressions during those first 5 minutes of meeting her or him, one can get a fairly good indication of the client’s primary adaptation.

I don’t want to give all the details of what to look for each driver. But I think it would be unfair not to give some of what to look for and listen for.

For example, a person with a ‘Be Perfect’ driver often: counts points by number, even using fingers; uses qualifying phrases in parentheses such as ‘that is to say’, ‘as it were’; uses clipped, even tones with precise enunciation; strokes chin; walks upright and balanced; mouth is slightly tensed, and eyes up and to one side during pauses. See how many of these you can catch your CPA doing.

‘Be Strong’ is indicated by distancing phrases such as ‘you make me angry’, ‘it feels good’; speaking in flat, monotonous tones with few or no gestures; body is immobile and face is expressionless.

In contrast, ‘Please Others’ is expressed with phrases such as ‘OK? All right?’, ‘Kind of, sort of’ in a high, squeaky voice which rises at the end of sentences; head nods and hands reach out; shoulders up and forward, leaning toward the other person; face turns downward with eyes looking up; exaggerated smile with teeth bared.

‘Try Hard’ comes through phrases such as ‘Huh? Uh?’, ‘I’ll try to’, ‘I can’t’, ‘It’s difficult’ spoken in tense, strangled, muffled, hesitant tones; hand by the side of head or clenched fists; strains forward, hunched up and screws up the brow.

Finally, the pressure of ‘Hurry Up’ is easily detected with words such as ‘Quick’, ‘Must rush’, ‘Let’s go’ said in a staccato like tone but words running together; fidgets, tapping fingers or wagging a foot; agitate posture changes with rapid, frequent shifts in gaze.

Of course the client may do and say many other things that do not indicate any particular personality adaptation, but these are good clues and the first diagnosis can subsequently be confirmed or expanded as the session proceeds.

Each of these drivers is unique to one of the personality types: the ‘Enthusiastic Overreactor’ (histrionic) expresses the ‘Please Others’ driver; the ‘Responsible-Workaholic’ (obsessive-compulsive) is driven by ‘Be Perfect’; the ‘Playful-Resister’ (passive-aggressive) embodies the ‘Try Hard’ driver; the ‘Charming-Manipulator’ (anti-social) combines the ‘Be Strong’ and ‘Please Others’ drivers; the ‘Brilliant-Skeptic’ (paranoid) equates ‘Be Perfect’ with ‘Be Strong’; and the “Creative-Daydreamer’s” (schizoid) main driver is ‘Be Strong’. That’s a lot to wrap one’s mind around but it is so useful.

The final major element of this process concerns the ‘doors’. To me the doors are the most useful aspect of slicing things this way. Once we have identified the primary personality adaptation by identifying the primary driver, what do we do next? How does this information help us in the counseling process? While Taibi Kahler was identifying the personality adaptations and the role of the five drivers in each of them, Paul Ware was also discerning the same adaptations and how clients expressing each of the adaptations preferred one particularly way of being interacted with. Ware called these ‘doors’. There are three of them: feelings, thinking and behavior. Each personality adaptation has one particular way it likes to be interacted with, at least at first. This Ware called the ‘open door’ in therapy. It is the way a counselor can most easily and quickly form an effective, empathetic alliance with the client. After engaging the client through their open door, therapy can proceed on to the ‘target door’. This is the area where change will be most effective. However, beware of the ‘trap door’. Engaging a client initially through their trap door can get the therapeutic process stuck—conceivably forever with change never taking place. These 3 doors are conveniently referred to as: Behavior (B), Feelings (F) and Thinking (T). Each personality adaptation has its own sequence of doors that is most effective for change.

For example, for a responsible workaholic (obsessive-compulsive), the door sequence is TFB. That is, a counselor would be most effective engaging the client in thinking, which is the open door for this adaptation. Through thinking then the client can access their feelings. If the counselor tries to engage the client initially through their behavior, counseling will probably get stuck and go nowhere, because this is the client’s trap door. The client is already doing everything they can. Behavioral therapy will not work; cognitive counseling would be a good way to begin.

On the other hand, for the playful resister (passive-aggressive), the door sequence is BFT. Many counselors do not like working with these clients because the counselor tries to engage them in thinking—cognitive therapy but that is their trap door and you could struggle with them until you finally give up trying. Begin with their behavior—play with them to engage them; then move to their feelings and change will begin to take place.

Charming-manipulators (anti-social) have the same door sequence (BFT). Engage such clients though their behavior. If you try cognitive therapy (T) first, they usually think circles around you messing with your mind getting nowhere and enjoying the process.

Briefly, the other adaptations have the following door sequences: enthusiastic-overreactor (histrionic) FTB; sensitive critic (paranoid)—TFB; and creative-dreamer (schizoid)—BTF.
The bottom line is that once you identify the personality adaptation of a client, the direction of the most promising therapeutic process is suggested. But be careful, many clients have a secondary adaptation. So as a counselor, you must continually track which adaptation (and which driver) is operative at any one moment in the counseling dialogue. But if you do, the results can be almost magical! And so satisfying for both you and your client.

However, finally, as a counselor, I must be very clear about my own drivers and personality adaptations as I engage my client because it is a stressful time for me too. I can choose then to use the strengths of my own adaptations to engage the client in the most effective way—that truly is strength-based counseling.



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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