Rep36 Understanding Personality Disorder

2.1.5 Interpersonal approaches
An interpersonal approach to personality
disorder was first described by Leary (1957) and
has subsequently been developed by several
psychotherapists (Kiesler, 1996). As in object
relations theory, personality disorder is seen as
primarily a problem of interpersonal
relationships. Some theorists also draw on
cognitive social learning theory and focus on
dysfunctional beliefs (Carson, 1979), while
Benjamin (1996) presents a complex development
of the theory incorporating concepts from
psychodynamic and attachment theories. A
common emphasis is on using the interpersonal
context of therapy as a means of change.
The basis for theoretical developments is the
interpersonal circle, a descriptive system in
which interpersonal behaviours are portrayed as
varying combinations of two independent
dimensions of power or control (dominance-
submission) and affiliation (hostility-
friendliness). These appear to be the main
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themes elicited when people interact. The
interpersonal circle is an empirically well
supported scheme, which permits analysis of
interactions at the level of specific interactions,
but also at the broader level of personality traits
and disorders. 
The traits of personality disorder are
construed as rigid and inflexible interpersonal
styles or predominant modes of relating to
others that overemphasise a particular segment
of the interpersonal circle. For example, schizoid
and avoidant disorders are characterised by
withdrawn (hostile-submissive) styles, while
narcissistic disorders are expressed in arrogant
and aggressive (hostile-dominant) styles.
Psychopathy can similarly be construed in
interpersonal terms (Blackburn, 1998).
A central concept is complementarity. Leary
(1957) proposed that behaviour pulls a reaction
from the other person, within a limited range.
Along the dominant-submissive axis,
complementary behaviour is reciprocal
(dominant behaviour pulls submission), while
along the hostile-friendly axis, complementary
behaviour is corresponding or congruent
(hostility pulls hostility and friendliness elicits
friendly reactions). This produces expected
combinations around the circle. For example,
an accusation (hostile-dominance) is likely to
elicit an excuse or self-justification (hostile-
submission). Anti-complementary reactions (e.
g. friendly-dominance is met with hostile-
dominance) produce discomfort and
disengagement. People with rigid styles are
more likely to produce anti-complementary
reactions that are aversive to others.
Carson (1979) proposed a cognitive theory to
explain how people elicit and interpret signals
coming from the other person. In any
interaction, the two parties have certain goals
and behaviour aims to induce a reaction from
the other relative to those goals. People elicit
behaviour from the other in accordance with
their concept of self and the relationship. For
example, a friendly overture entails verbal and
nonverbal messages inviting a friendly reaction
that then provides feedback. People therefore
behave in ways that extract information from
others that confirms expectations.
Extending complementarity principles to
personality disorder, Carson (1979) proposes
that dysfunctional interpersonal styles are
maintained by the self-fulfilling prophecy. Early
adverse relationships restrict learning
experiences and create distorted expectations of
how others will react, and this creates destructive
styles of interaction. For example, a hostile
person expects hostile reactions and behaves in
ways that attract them. People with extreme
styles therefore create interactions that minimise
the chance of disconfirming experiences.
The implications for change through
therapeutic intervention are that the cycle of the
self-fulfilling prophecy needs to be broken by
providing clients with new experiences that
disconfirm distorted expectations of others.
Carson proposes that complementarity principles
can be used by the therapist to provide these
new experiences. Kiesler (1996) presents a
similar model of changing maladaptive
interpersonal styles.
One alternative to the interpersonal circle is
the interpersonal octagon (Birchnell, 2002). In
this model, interpersonal relationships are
thought to be best described again on two
dimensions. The first concerns becoming more
closely involved with other people versus
becoming separated from other people. The
second dimension is explained in terms of
whether the person tends to relate ‘from below’
as opposed to ‘from above’. The octagon is
based on evolutionary principles. Therefore, the
dimensions relate to the basic objectives of
relationships that carry advantages for the
individual and give pleasure. This results in eight
types of relationship – the four possible
combinations of the two dimensions plus the
difference between successful and maladaptive
relationships. Within this model, the problems
that lead to a diagnosis of personality disorder
can be understood as types of incompetence in
relationships. There has been research
suggesting that the interpersonal octagon can be
related to the ten DSM-IV diagnoses of
personality disorder (Birchnell & Shine, 2000),
and Birchnell (2002) has developed a model of
psychotherapy based on these ideas.