Analysing identity processes in psychiatric contexts using Identity Structure Analysis

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Analysing identity processes in psychiatric
contexts using Identity Structure Analysis
diagnostic and etiological features.

• Centre for Psychotherapy
• Knockbracken Healthcare Park
• 16 October 2006
• Prof Peter Weinreich, University of Ulster

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Analysing identity processes in psychiatric
contexts using Identity Structure Analysis
diagnostic and etiological features.

• Tavistock Centre
• 120 Belsize Lane, Hampstead, London
• 11 May 2007
• Prof Peter Weinreich, University of Ulster

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A basic premise for psychiatry ones sense of
identity

• Whatever the origins of peoples psychiatric
  distress whether these derive primarily from
  genetic predispositions or dysfunctional
  biographical experiences people generate a
  sense of identity that incorporates their
  interpretations of themselves living in the
  social world

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Identity Structure Analysis provides the means
for assessing fundamentals of peoples sense of
identity

• Based upon the processes of appraisal and
  identification
• Adaptable approach
• A meta-theoretical framework

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A Metatheoretical Framework

• Psychodynamic approachidentity over the lifespan
  through identifications
• Symbolic Interactionismidentity through
  communication
• Social constructionismidentity through society
• Reference Group Theoryidentity through
  comparison and aspiration
• Personal Construct approachidentity through
  experience and meaning
• Cognitive-affective consistency theoryidentity
  subject to emotional and cognitive pressures

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Integration of qualitative aspects and
quantitative parameters of identity

• Qualitative (emic)
• (1) Discourses in the vernacular
• (2) Biographical experiences
• (3) Case-study.
• Quantitative (etic)
• Quantification and standardisation of
  identification parameters.

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Identity is defined as

• the totality of one's self-construal, in which
  how one construes oneself in the present
  expresses the continuity between how one
  construes oneself as one was in the past and how
  one construes oneself as one aspires to be in the
  future.

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The process of appraisal

• People appraise the circumstances in which they
  are involved in order to bring meaning to the
  circumstance against the greater background of
  how they appraise self in relation to their
  social world.

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The process of appraisal

• During appraisals of the social world people use
  constructs to construe and evaluate other agents
  and events during which they interact. They form
  cognitions about these agents and experience
  emotional tones with respect to them.
• Such cognitions and affects may be compatible or
  incompatible, as when a good friend joyfully
  supports a valued objective, or an admired person
  engages in a despicable event, respectively.

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The process of appraisal

• Compatibilities between cognitions and affects
  secure and stabilise selfs evaluative
  connotations of ones constructs, whereas
  incompatibilities undermine and destabilise them.
• Core evaluative dimensions of identity are ones
  whereby constructs are used with high
  cognitive-affective compatibility.
• Dimensions under stress are designated by
  constructs associated with much
  cognitive-affective incompatibility.

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The processes of identification

• People identify with elements of significant
  others who have influence over their personal
  well-being, either for good or ill.

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The processes of identification

• They form aspirational identifications with
  others when they wish to
• emulate their prized features
• or
• dissociate from their unpalatable aspects.

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Aspirational identification in two aspects

• They form idealistic-identifications with others
  when they wish to emulate their prized features.
• They form contra-identifications with others when
  they wish to dissociate from their unpalatable
  aspects.

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The processes of identification

• a different mode in the here and now
• People empathetically identify with others when
  they recognise in the others features of
  themselves, whether good or bad.
• a persons empathetic identification with
  another modulates according to situations,
  contexts and mood states

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Conflicted identifications

• When self empathetically identifies with another
  person while simultaneously contra-identifing
  with that person, selfs identification with the
  other is conflicted.
• I.e., Self is as the other in several respects,
  while wishing to dissociate from some of the
  characteristics of the other - to be as the
  other, while not wishing to be
• Since peoples empathetic identification with
  others modulate according to situations, contexts
  and mood states, so will their conflicted
  identifications alter accordingly

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Identity diffusion

• Peoples conflicted identifications with others
  may be dispersed across several persons.
• A state of high identity diffusion is manifest
  when selfs conflicted identifications with
  others are both substantial and dispersed across
  many others.
• extent of identity diffusion may also modulate
  according to situations, contexts and mood
  states.

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Identity Structure Analysis is operationalised
through

• the Identity Exploration computer software
• IDEX-IDIO for individual analyses
• IDEX-PHASE for longitudinal analyses
• IDEX-NOMO for group analyses
• IDEX-NOMO-PHASE for group longitudinal analyses

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How does it work?

• Psychological definitions
• Algorithms
• Computer software
• Analysis and interpretation

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Customised identity instrument

• 2 lists
• Entities people, groups, emblems, images,
  events, abstractions, material objects, etc
• Constructs discourses about experiences and
  expectations, beliefs and values, attributes, etc

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Customised identity instrument

• E.g.,
• Entities my best friend my Member of
  Parliament
• Construct discourse about trust
• 9 point scale
• can be trusted cant be
  trusted
• 4 3 2 1 0 1 2 3 4
• Would you place your best friend at the same
  place on the scale as your Member of Parliament?

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Identity, Depression Anxiety (Alison McKenna)

• Joiner, Coyne, Blalock, 19993
• By ignoring the intricacies of depressed
  persons involvement with other people one may
  attribute to depressed persons characteristics
  they do not possess and leave significant
  aspects of their experience unexplained.

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Depression Anxiety

• Prolonged, unresolved periods of anxiety often
  precede depressive episodes (Wolpe, 1971 Bittner
  et al, 2004).
• Sloman, Farvolden, Gilbert, Price, 200698
• they have complex and important
  co-regulating influences on each other that may
  explain their high comorbidity

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Postulates Examined

• Participants biographical experiences within
  their social milieu are likely to be reflected by
  ISA through their modulation of identity indices
  with significant others.
• The psychological processes underlying
  comorbidity of depression and anxiety will be
  elucidated through examination of participants
  identifications with others across depressed and
  anxious selves.

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Case study Philip diagnostic results

• Anxiety was associated with his high identity
  diffusion that accompanied his engagement with
  the social world that entailed problematic
  conflicted identifications with others.
• Depression accompanied his social withdrawal,
  that is, diminution of his empathetic
  identification with others, which diminished his
  identity diffusion through resolution of his
  conflicted identifications with others.

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Philip diagnostics of anxiety-depression
co-morbidity

• Being depressed is to realise that self in unable
  to effectively pursue ones aspirations that
  require engagement with the social world.
• However, re-engagement with the social world is
  to reinstate problematic conflicted
  identifications, that is, high identity diffusion
  accompanied by greater anxiety.
• A vicious cycle ensues whereby social withdrawal
  that relieves anxiety results in depression, and
  efforts to come out of depression require social
  re-engagement that generates anxiety
  depression is traded off against anxiety, and
  vice versa

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Philip further diagnostics and etiological
factors

• He had endured numerous prejudicial attacks.
• Nevertheless, he held strong aspirations towards
  positive social relationships (SP99.69).
• Depression likened to loss related to loss of
  relationships due to prejudicial encounters.
• Idealized his well self states, thus inducing
  the retaliations of others and amplifying their
  prejudicial appraisals of him.

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A case of aggressive impulsivity in paranoid
schizophrenia (Cherie Part)

• Entities
• Past selves
• Me when I hurt someone
• Me when I calmed down after hurting someone
• Socially deviant others
• A violent prisoner
• A teenager who opens fire with a gun in his
  school
• Victim domain
• Someone I have physically hurt
• An abused child

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A case of aggressive impulsivity in paranoid
schizophrenia (Cherie Part)

• Bipolar Constructs
• Impulsivity BIS-11 (Patton et al., 1995)
• act/s quickly without think/s carefully
  before
• thinking doing anything
• Aggressive Impulsivity
• lose/s it stay/s calm
• suddenly gets violently think/s or talks
  things
• angry through calmly
• Perceived Threat (Link et al., 1998 1999)
• believe/s there are people doesnt think
  theres
• who want to do them harm anyone out to
  hurt them

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Paranoid schizophrenia - diagnostic and
etiological features Peter

• From case history notes
• 49-year-old Peter was first diagnosed with
  paranoid schizophrenia in his late teens. He had
  a history of verbal and physical aggression
  towards his wife. During one episode of an active
  psychotic state, he had attacked his wife with an
  axe. The couple had been separated for several
  years prior to this investigation.

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Paranoid schizophrenia - diagnostic and
etiological features Peter

• Postulate
• The experience of a process of intimate defensive
  identification with his wife, his perception of
  her threat to his well-being, alongside a desire
  to defend self and escape the aversive
  threatening relationship gave rise to Peters
  aggressive impulses.

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A Process of Intimate Defensive Identification is
defined by

• Exertion of malevolent power over self
• Perceived threat to selfs well being
• Inability to escape the aversive situation
• Identification with the coercive other while
  wishing to dissociate from that other

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Evidence Peter

• Peter contra-identified with my ex-partner to a
  profound extent (0.81), indicating a process of
  defensive identification with her.
• He referenced me when I hurt someone as being
  self when he had attacked his wife with the axe.
• His profoundly high empathetic identification
  with her as based in this past self-image
  (0.81) revealed that he felt closest to his wife
  when he was hurting her.

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Evidence Peter

• Peters simultaneous close empathetic and high
  contra- identification with his ex-wife accords
  with his attack on her.
• This extremely strong conflicted identification
  with her when cued into his impulsive
  aggressive state (0.82) highlighted a
  pathological identity problem for Peter.

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• Peter appraised his ex-wife as impulsive and
  aggressively impulsive. Through a process of
  defensive identification, he appeared to have
  integrated his wifes perceived aggressive
  impulsive stance into his own self-concept and
  had acted accordingly when cued by a particular
  social context, exhibiting the same abhorrent
  characteristics appraised in the coercive other
  (his wife).
• He was intensely ego-involved with his ex-wife
  (4.15) where her power over him was experienced
  as malign and perceived to have had a detrimental
  impact upon his sense of well-being.
• Peter indicated that he believed that there were
  people who wanted to do him harm when he
  expressed his aggressive impulses. Thus, he had
  felt threatened when he lashed out and may
  have been acting in defence.

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• Sharp decline in empathetic identification with
  wife following the attack illustrated an attempt
  to
• Reverse the exertion of her malevolent power
• Escape the coercive experience
• Resolve his conflicted identification with her
• Undo internalisation of wifes aggressive
  impulsive stance into own self-concept

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Conclusions ISA is able

• To provide diagnostic evidence of the nature of a
  clients psychological distress
• To elucidate ongoing psychological processes
• To assist in comprehending etiological aspects of
  psychological distress based in biographical
  experiences

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Reference

• Weinreich, P. and Saunderson, W. (Eds.) (2003)
  Analysing Identity Clinical, Societal and
  Cross-Cultural Applications. London Routledge
  Psychology Press.

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Next ISA Workshop

• University of Chester
• 27 28 September 2007
• www.analysingidentity.org