Self-Fulfilling Prophecy

Imagine Bill Murray's Groundhog's Day, but without any insight into it.

Mental Health challenges can be discussed as, or lead to, repeated patterns. While this takes a more explicit front-row seat in some theoretical perspectives, it presents across orientations. A self-fulfilling prophecy refers to a symptom or interpersonal patterns that leads exactly where the person consciously wants to avoid. Like telling a teenage new driver "watch out for that tree" and they focus on it so intensely, they drive right into it. Or telling a golfer "pay attention to your back-swing" which is ostensibly intended to help, but ruins mindfulness and ubiquitously results in poorer performance.

When we are stuck in unintended patterns, we lack or have diminished free will.

Behaviorism

We always want to consider a functional behavior analysis (FBA - there are various terms for this process). This is rooted in the behavioral notion that nothing is repeated unless it is reinforced. If a maladaptive and often painful pattern is repeating, we would think it would be extinguished, so there must be a powerful reinforcer that is not only frequently not obvious or perceptible to the outside observer, but also not obviously reinforcing from the well-perspective (it may not be something other's would find reinforcing). This is a pitfall of behaviorism - without understanding some of the psychodynamics, we may overlook what reinforces the behavior.

Psychodynamic

Freud introduced the notion of a repetition compulsion. Language we might associate with the florid examples from OCD, but also refers to interpersonal patterns that repeat not simply by chance, but compulsively. This implies an, albeit often unconscious, intended function (the term function should be reminiscent of the above section on behaviorism: function implies reinforcement).

Interpersonal Dynamic

Lorna Smith Benjamin, in her books on Interpersonal Reconstructive Therapy (IRT), does an excellent job clearly defining some of the possible intrapsychic functions of interpersonal patterns. Intrapsychic means that it is something internalized from the past and comes to have personal meaning that has interpersonal consequences or reverberations (plays out interpersonally).

• "See mom, I'm just like you?"

• "Look, I'm treating myself just the way you treated me - can't you love you now?"

• "I already knocked myself down, you don't need to knock me down anymore."

This provides a sense of closeness with the internalized parental figure, but often has consequences that ultimately distance the individual from others in their lives. They must gain insight, resolve the past, and determine whether to repeat this pattern for the sake of internal security or prioritize actual and ongoing relationships.

These roles can be complimentary or identified. For example, feeling like the victim while the parental figure is a perpetrator would be complimentary, while acting like the perpetrator would be identified (AKA, "hurt people hurt people").

As IRT borrows from the Harvard model of interpersonal circumplex with Benajmin's Structural Analysis of Social Behavior (SASB), there is a risk of this model being circumscribed.

Cyclical Maladaptive Pattern

CMP is another Interpersonal approach to exploring patterns and their consequences that is more person-centered insofar as it is created for that individual rather than fitting the individual into existing boxes (referring to the circumplex model described above).

The adjusted model I use is depicted to the left, and a template is available below.

Tip: for couples or individual clients with an engaged partner, both can complete and compare, considering how their patterns interact both in ways that draw them together and potential clashes or pitfalls that are shaping ongoing relational problems.

Cyclical Maladaptive PatternCMP

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Cognitive Behavior Therapy

While this isn't the first bullet point in cognitive literature, it is a keystone of the theory that automatic thoughts and core-beliefs are either or both self-reinforcing of patterns, or prevent new patterns and consequently data or experiences that reinforce new patterns. For example, an automatic thought that elicits anxiety and avoidant impulses/behaviors precludes the person from engaging in new experiences that could challenge the beliefs (automatic thoughts) about the experience and lessen anxiety. If I believe I won't be received well in public speaking situations, avoidance both precludes new, opposing experiences (data), and reinforces avoidance/anxiety ("phew, I feel relieved that I avoided that!"). Consequently, we must identify the thoughts, challenge them with alternative considerations, and expose ourselves to new situations and behaviors.

Psychological Conditions

Depression and Social Anxiety

The mechanisms can be distinct or overlapping, but both involve beliefs about self, others and behaviors that result in social difficulties. In terms of beliefs about self, this may be self-esteem, feeling less than others, unlikable or somehow inadequate, that can result in social anxiety or depression. Some people with depression have more extreme beliefs about self, such as some sort of badness of their character even to the degree it could be toxic or contagious to others, and it would be irresponsible to expose others to it (we may be concerned about psychotic features with this degree of concern), or feeling they would burden others simply with their presence.

Combined with beliefs about others, this leads to avoidance. Beliefs about others could be that others are judgmental or critical, better than, or tired of / burdened by oneself. This results in two behaviors. The first is affect: poor eye contact, less engaging posture, all of which are uninviting and communicate disinterest and to "leave me alone." People with depression isolate and people with social anxiety avoid. This results in others' not engaging them, and incorrectly confirming the original beliefs about self and others: I'm not liked/likable / others don't or won't like me.

Ironically, others may think they are respecting this person's desire to be "left alone." Further, there is often an unconscious belief that others should take the lead, or take care of me: if the person with depression or social anxiety is disengaged but hopes others will still see something special or desirable about them, enough to go out of their way to force a relationship, there is a nearly hopeless interpersonal wish or fantasy, unconscious pressure and expectation on others, and maybe a deeply unconscious sense we are entitled to that special care or attention. In other words, there could be starkly polarized unconscious fantasies of specialness and worthlessness, as is often the case in issues of esteem. Recognizing, accepting and validating fantasies of specialness can be extremely relieving, but also marks the need and opportunity for grieving specialness in order to be able to put oneself out there as an equal, without expectation of being taken care of, socially.

These ideas are best highlighted by the PDM's taking up of Kohutian notions about esteem or narcissism being relevant conceptual considerations for any therapy clients. The depleted narcissistic state is depression (in which the specialness is not presented on the surface like DSM NPD, but a repressed fantasy).

Trauma Triangle

Traumatic experiences, acute or complex, can crystialize implicit (not conscious) roles into our mind. We unconsciously see the world through this lens, fitting others including oneself into these roles. Often the roles are blurred and oscillate even rapidly. What I mean by blurring and oscillating is that someone may feel victimized and consequently defend themselves in a manner that is experienced by others as the perpetrator. This is often associated with oral aggression (psychosexual stage) and splitting (defense) in borderline states (structurally). When I say borderline states, I refer to 3 possibilities: borderline personality disorder specifically, borderline personality organization broadly (includes BPD and other personality typologies functioning at that level of wellness/illness), or a period in time when a person is triggered and temporarily functioning in a borderline organizational state. This typically occurs when someone with a trauma history is currently and/or persistently triggered, such as living in a toxic situations/relationship, and/or an episode of acute psychological illness. The person who is the target of the splitting, sometimes the therapist, may be asking themselves "who is the victim anyway?" The therapist is being told they are the perpetrator while feeling victimized by the oral aggression.

The blurring and oscillation involve two other factors: fragmentation and poor boundaries. Fragmentation involves parts of self and experience being fragmented, such as the victim and perpetrator parts. Poor boundaries, in this case, does not refer to the contemporary colloquial use of setting interpersonal boundaries, but does affect the setting of boundaries. This refers to self-other boundaries within the personality. In a borderline or psychotic organization, there is a notably underdeveloped superego. The superego "buds" off of the ego and becomes its own faculty in healthy development, but somewhere along the way, this process is halted in severe personality pathology, resulting in the inability to truly distinguish self and/from others. Consequently, others are experienced as an extension of self. We see several analogies of this in BDP, such as a metaphor that BPD is like living without an outer layer of skin, or neurological implications that there are looser boundaries in the connections between parts of the brain.

Internal Family Systems and Parts Work

We can draw an analogy between the trauma triangle and the interpersonal circumplex: both can be circumscribed. Can we be more detailed than victim, perpetrator and savior? Each victim role is distinct and ideosyncratic. Let's think back to the discussion about the intrapsychic: the internalization of the parental figure and corresponding, complimentary role of the early-life self are highly specific to the individuals experience. Parts work is probably the most specialized psychological technology or tool to understand and work on these internalized parts and roles.

From an IFS standpoint, the crystialized version of our childhood, victimized self is called an exile. It is protected by our learned defense mechanisms, consolidated under an ego-state called the protector. Sometimes this protector is so polarizing that it needs an alternate polarity to balance it out, such as a firefighter. All of these should be under the umbrella of the healthy adult self, or core self. However, in states of illness or when triggered, one of the other states, parts or headspaces (I'm using these terms synonymously) takes over the driver's seat (such as the protector). At times, these states are extreme, and would related to the above description of when an individual may be in a borderline state, but does not have a severe personality disorder (as part of the definition of a borderline personality organization is its persistence across time and circumstances).

These parts typically have narrow, restrictive and highly-characteristic ways of coping with things and behaving. In other words, they drive interpersonal and intrapsychic patterns and the resultant self-fulfilling prophecies.

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