Centre for Psychotherapy Knockbracken Healthcare Park 16 October 2006

1. 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 (c) P. Weinreich 2006

2. A basic premise for psychiatry: one’s sense of identity • Whatever the origins of people’s 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 (c) P. Weinreich 2006

3. Identity Structure Analysis provides the means for assessing fundamentals of people’s sense of identity… • Based upon the processes of appraisal and identification • Adaptable approach • A meta-theoretical framework (c) P. Weinreich 2006

4. A Metatheoretical Framework… • Psychodynamic approach…identity over the lifespan through identifications • Symbolic Interactionism…identity through communication • Social constructionism…identity through society • Reference Group Theory…identity through comparison and aspiration • Personal Construct approach…identity through experience and meaning • Cognitive-affective consistency theory…identity subject to emotional and cognitive pressures (c) P. Weinreich 2006

5. 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. (c) P. Weinreich 2006

6. Identity is defined as… “… the totality of one's self-construal, in which how one construes oneself in the present expresses thecontinuitybetween how one construes oneself as one was in the pastand how one construes oneself as one aspires to be in the future”. (c) P. Weinreich 2006

7. 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. (c) P. Weinreich 2006

8. 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. (c) P. Weinreich 2006

9. The process of appraisal… • Compatibilities between cognitions and affects secure and stabilise self’s evaluative connotations of one’s 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. (c) P. Weinreich 2006

10. The processes of identification… • People identify with elements of significant others who have influence over their personal well-being, either for good or ill. (c) P. Weinreich 2006

11. The processes of identification… • They form aspirational identifications with others when they wish to • emulate their prized features or • dissociate from their unpalatable aspects. (c) P. Weinreich 2006

12. 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. (c) P. Weinreich 2006

13. 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 person’s empathetic identification with another modulates according to situations, contexts and mood states (c) P. Weinreich 2006

14. Conflicted identifications… • When self empathetically identifies with another person while simultaneously contra-identifing with that person, self’s 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 people’s empathetic identification with others modulate according to situations, contexts and mood states, so will their conflicted identifications alter accordingly (c) P. Weinreich 2006

15. Identity diffusion … • People’s conflicted identifications with others may be dispersed across several persons. • A state of high identity diffusion is manifest when self’s 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. (c) P. Weinreich 2006

16. 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 (c) P. Weinreich 2006

17. How does it work? • Psychological definitions • Algorithms • Computer software • Analysis and interpretation (c) P. Weinreich 2006

18. 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 (c) P. Weinreich 2006

19. Customised identity instrument • E.g., • Entities – my best friend; my Member of Parliament • Construct – discourse about ‘trust’ • 9 point scale: …can be trusted …can’t 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? (c) P. Weinreich 2006

20. Identity, Depression & Anxiety (Alison McKenna) • Joiner, Coyne, & Blalock, 1999:3 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.” (c) P. Weinreich 2006

21. Depression & Anxiety • Prolonged, unresolved periods of anxiety often precede depressive episodes (Wolpe, 1971; Bittner et al, 2004). • Sloman, Farvolden, Gilbert, & Price, 2006:98 • “…[they] have complex and important co-regulating influences on each other that may explain [their] high comorbidity…” (c) P. Weinreich 2006

22. 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. (c) P. Weinreich 2006

23. 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. (c) P. Weinreich 2006

24. “Philip”: diagnostics of anxiety-depression co-morbidity • Being depressed is to realise that self in unable to effectively pursue one’s 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 … (c) P. Weinreich 2006

25. “Philip”: further diagnostics and etiological factors • He had endured numerous prejudicial attacks. • Nevertheless, he held strong aspirations towards positive social relationships (SP=99.69). • 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. (c) P. Weinreich 2006

26. 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…’ (c) P. Weinreich 2006

27. 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 …doesn’t think there’s who want to do them harm anyone out to hurt them (c) P. Weinreich 2006

28. 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. (c) P. Weinreich 2006

29. 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 Peter’s aggressive impulses. (c) P. Weinreich 2006

30. A Process of Intimate Defensive Identification is defined by … • Exertion of malevolent power over self • Perceived threat to self’s well being • Inability to escape the aversive situation • Identification with the coercive other while wishing to dissociate from that other (c) P. Weinreich 2006

31. 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. (c) P. Weinreich 2006

32. Evidence: “Peter” • Peter’s 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. (c) P. Weinreich 2006

33. Peter appraised his ex-wife as ‘impulsive’ and ‘aggressively impulsive’. Through a process of defensive identification, he appeared to have integrated his wife’s 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. (c) P. Weinreich 2006

34. 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 wife’s ‘aggressive impulsive’ stance into own self-concept (c) P. Weinreich 2006

35. Conclusions: ISA is able … • To provide diagnostic evidence of the nature of a client’s psychological distress • To elucidate ongoing psychological processes • To assist in comprehending etiological aspects of psychological distress based in biographical experiences (c) P. Weinreich 2006

36. www.analysingidentity.org • Website for ISA powered by Sycadex Ltd. provides • information about ISA and resources such as research papers • a discussion forum and network for ISA practitioners with postings about the ISA Study Group • access to the dedicated computer software (c) P. Weinreich 2006