Psychotherapy and the Promiscuous Patient

E Mark Stern

• Publisher: Routledge
• Year: 2014
• eBook ISBN: 9781317765103
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Learn effective strategies for therapy with promiscuous patients from this in-depth exploration of the phenomenon of promiscuity in the lives and backgrounds of patients seeking psychotherapy. This unique book features insights about the pitfalls of patients who cannot bear commitment to any one person, or who jeopardize their commitments with a need to spark their lives with promiscuity. Psychotherapy and the Promiscuous Patient teaches psychotherapists to respond to their patients'promiscuous behavior as a symptom of a problem, not the problem itself. A realm of aspects of promiscuity are explored within the psychiatric context. Promiscuity is very broadly defined in fascinating examinations of adult promiscuity as a result of childhood sexual abuse, hypersexuality in adult males, addiction to the sensation of "falling in love," career promiscuity, and even psychotherapy as an uncommon "promiscuity'--a nonexclusive, altruistic love. Timely chapters confront the changing distinctions between promiscuity and sex addiction and challenge readers to uncover the various emotional needs met by promiscuity in order to protect patients from their self-destructive behavior. Knowledgeable practicing psychotherapists relate methods for dealing with patients'constant restlessness and working with a variety of patients in an intimate setting. Psychotherapy and the Promiscuous Patient contains invaluable strategies that can be directly applied to practice including:

• the use of narrative construction and reconstruction as treatment for sexually promiscuous clients
• a self-psychological approach to treatment
• the importance of confusion as an introduction to change in therapy
• a method of self-investigation applied to promiscuous behavior
• the implications of the clinical meaning and therapeutic use of strong-laughter outbursts in psychology
• a self-psychology perspective on transference to therapistsPsychotherapy and the Promiscuous Patient is a valuable clinical book for psychotherapists, and it offers an across the board appeal to a wide variety of psychiatrists and related social scientists who are interested in today's shifting moral climate. It is also an ideal supplemental text for an introductory methods or applications in psychiatry course.

The Personal Valuation of Promiscuity: A Method of Investigation

Hubert J.M. Hermans
Els Hermans-Jansen

Dr. Hubert J.M. Hermans is Professor of Personality Psychology at the University of Nijmegen. In the ’60s he worked as a test constructor in the field of achievement motivation and fear of failure. Partly as a reaction to his dissatisfaction with work in this field, his interests shifted in the ’70s to the basic problem of human valuation. He has devised a self-confrontation method together with the underlying valuation theory as a procedure for self-investigation and organization.

Mailing address: University of Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands.

Ms. Els Hermans-Jansen was originally a youth worker before she started to study pedagogy. Later she qualified herself as a psychotherapist and has a private practice in Berg en Dall in which she applies the self-confrontation method as a procedure for assessment and intervention and as an instrument for the evaluation of the change process.

The authors thank Willem van Gilst for his statistical advice, and Lee Ann Weeks for her detailed editorial comments.

SUMMARY. In (his article a method of self-investigation, devised for the study of personal meaning in the context of one’s own history, is applied to promiscuous behavior. The method invites clients to investigate their own life in terms of valuations, a valuation being any unit of meaning that has a positive, negative, or ambivalent meaning in the eyes of the client. The valuation may concern any events occurring in his or her past, present, and future (e.g., a dear memory, an insoluble problem, an attractive person, an unreachable goal). The personal meaning of promiscuous behavior can be understood as part of the client’s organized valuation system. In the case studied here, promiscuity was found to be an effort to fill the void created by the early loss of a father.

We have two reservations about the general use of the term promiscuity. First, there is a strong dependence on the values of a particular society or epoch. Second, as a label promiscuity in fact covers a heterogeneous set of sexual and social behaviors.

The value-laden character of the promiscuity concept can best be demonstrated by pointing to the 1950s, when the dominant cultural sexual norm implied that premarital or extramarital sex was wrong, particularly for women. As Spreadbury (1982) observes, such behaviors often resulted in the label of “promiscuous” by one’s family, friends, and especially one’s enemies. One knew that having premarital or extramarital sex–regardless of the nature of the relationship–would lead to a negative label. In our time, however, having sex with many different partners is evaluated from the perspective of physical danger: The life-threatening, epidemiological consequences of AIDS have made themselves clear. Promiscuity is not so much seen as counter to the idea of marriage but as a threat to life.

The term “promiscuity” is commonly associated with “engaging in sexual relations with a considerable above-average number of partners” (Goode & Troiden, 1980). In this sense, however, the term covers a heterogeneous set of behaviors and this heterogeneity may even weaken the utility of the term. For example, Fluker (1983) wonders if the average prostitute who certainly regards herself as a professional, should be considered promiscuous. And perhaps Don Juan would have been most outraged if he was accused of anything so vulgar. In Mozart’s version he had 2065 conquests on his list in which he took great pride. In homosexual circles having contact with many partners is quite common. Some male homosexuals have a scorecard of a thousand and the majority have at least 100 partners. And in some peril of life there are developmental reasons for frequently changing social and sexual contacts. Teenagers may change boyfriends and girlfriends quite frequently, although they usually have only one at a time and therefore consider themselves to always be faithful (Fluker, 1983).

In the light of the above considerations we want to emphasize that it is very difficult, if not impossible, to psychologically characterize the general phenomenon of promiscuity. It seems to be more fruitful to ask what is the meaning of promiscuous behavior for a particular person in a particular situation? In other words, when we observe that an individual is engaging in sexual relations with a considerable number of sexual partners, this is not more than a factual observation. To understand the significance of this behavior for the individual, psychological investigation in the context of his or her own personal history is needed.

The purpose of this article is to present an assessment method for the investigation of the personal meaning of promiscuous behavior. The method is one of self-investigation, where the client is invited as a responsible individual to cooperate with a psychotherapist in the assessment of a particular problem in the context of his or her total life situation. This is done in such a way that the client is not only actively engaged in the assessment process but also in the change process. In the present study, we report on the self-confrontation of a middle-aged man involved in many sexual relationships.

The client is a 47-year-old man, who, although married and father of two children, had continual extramarital contacts with other women. The frequency of these contacts was so high and so disrupting to the contact with his wife and children that friends tried to persuade the woman to leave her husband. Before making her decision, the wife proposed therapy. The therapy was for the husband and wife to each, independently, perform a self-investigation and then discuss the results in cooperation with the psychotherapist who assisted them in performing the self-investigations. As the results indicate, there was clearly an experience of unfulfilled love due to the early loss of the father underlying the strongly self-enhancing behavior of the man in this case. His changing contacts with many women was obviously an attempt to fill a void. As will be seen, this diagnosis was formulated by the man, himself, in close cooperation with the psychotherapist. This insight had significant impact on his contact with his wife and led to the decision of husband and wife to stay together.

In the following a description of valuation theory–the theory underlying the self-investigation method–will be presented; the self-investigation method itself will be described; and the application of the method to an actual case of promiscuity will be discussed.

VALUATION THEORY: ORGANIZING ONE’S SELF

Valuation theory (Hermans, 1987a; 1988; 1989) was, as a self theory, developed for the study of individual experiences, their ordering into a meaning system, and their development over time. The theory’s view of the person is inspired by earlier philosophical-phenomenological thinking (James, 1890;Merleau-Ponty, 1945) and personality is conceived of as an organized process, as an articulated set of personally ordered historical events. The “process” aspect refers to the historical nature of human experience and implies a spatio-temporal orientation: A person lives in the present, and is therefore oriented from a specific point in time and space to the past and to the future. The “organizational” aspect is supposed to emphasize that the person, through orienting to different aspects of his or her spatio-temporal situation and self-reflection, creates a composite whole in which experiences are differentially weighted.

The theory’s central concept, valuation, includes anything people find to be of importance when thinking about their life situation. A valuation is any unit of meaning that has a positive (pleasant), negative (unpleasant), or ambivalent (both pleasant and unpleasant) value in the eyes of the individual. It can include a broad range of phenomena: a dear memory, a difficult problem, an admired person, a disturbing dream, an unreachable goal, the anticipated death of a significant other, and so forth. Through the process of self-reflection, valuations are organized into a single system. And depending on the individual’s orientation to the past, the present, and the future, different valuations emerge.

An essential feature of valuation theory is the assumption that each valuation has an affective connotation. More specifically, each valuation implies an affective modality: a specific pattern of affect. When we know which types of affect are implied by a particular valuation, we know something about the valuation itself. Note that affect in this theory is not considered a direct “result” of cognitive processing but inherent in cognition. Affect is considered the movement implicit in a valuation and clearly tied to the spatial character of a valuation (e.g., joy as “going up,” despondency as “going down,” strength as “getting a grip on things,” and intimacy as “getting into something or somebody”).

In order to capture certain differences in the functioning of the affective component of the valuation system, the latent-manifest distinction was introduced into valuation theory (Hermans, Hermans-Jansen, & Van Gilst, 1985). It is assumed that a small set of basic motives is represented latently in the affective component of a valuation. These basic motives are assumed to be similar across individuals and to be continuously active within each individual moving through time and space. At the manifest level, valuations vary phenomenologically not only between individuals but also within a single individual across time and space.

The model presented thus far allows for the inclusion of different theoretically well-founded motives. In the research concerning valuation theory two basic motives have thus far been developed to characterize the affective component of the valuation system: the striving for self-enhancement, or S-motive (i.e., self-maintenance and self-expansion), and the longing for contact and union with the other, or O-motive (i.e., contact with other people and the surrounding world). This distinction resulted from a review of a number of researchers’ conceptions of the basic duality of human experience: Bakan (1966), who viewed agency and communion as fundamental dynamic principles; Angyal (1965), with his concepts of autonomy (self-determination) and homonomy (self-surrender); and Klages (1948) who considered Bindung (solidification) and Ldsung (dissolution) as basic motives of human character. More recently, McAdams (1985) has identified the distinction between power and intimacy within a narrative context, again suggesting the basicness of the S- and O-motives. This does not, however, mean that other theoretically well-founded motives cannot be incorporated into valuation theory.

To illustrate the use of this model, when a person values something he or she always feels something about it and in these feelings the basic motives are reflected. When a valuation (e.g., “I enjoy watching my daughter play with her toys”) represents a gratification of the O-motive, then the person experiences a feeling of tenderness or intimacy in connection with the valuation. In a similar way a valuation (e.g., “I passed a difficult test”) can function as a gratification of the S-motive. Feelings of strength and pride experienced in connection with the valuation are indicators of this motive. The affective component of the valuation system can be seen as the representation on the manifest level of the motivational base on the latent level.

The latent-manifest distinction is particularly useful when it comes to analyzing the narrative structure of the self. When, for example, somebody tells about his past sports achievements and later on shifts the subject to his plan to write a book, this shift represents only a difference on the manifest level. From the perspective of the latent level the same self-enhancement motive may be guiding his two interests. Similarly, somebody can be engaged in different activities (e.g., singing in a group, caring for a friend, enjoying nature) whereas all these orientations stem from the same contact motive. And, of course, a person may shift from the one motive to the other motive in the course of life.

On the basis of the foregoing considerations, we chose the following starting points for the study of promiscuous behavior.

1. Promiscuous behavior has personal meaning; this behavior is attributed a positive, negative, or ambivalent value by the individual as part of his or her self-reflection.

2. The valuation of promiscuous behavior is contextual; that is, together with the other valuations from the same individual, promiscuous behavior is part of an organized valuation system.

3. The valuation of promiscuous behavior is rooted in a latent motivational base. Promiscuous behavior is one of the rich phenomenological variety of valuations that receive their organization and direction from a limited number of basic psychological motives.

STRUCTURE OF THE SELF-CONFRONTATION METHOD

The self-confrontation method, as a procedure for self-investigation, is based on valuation theory. It was designed to study the relation between valuations and types of affect and the way both variables are organized into a structured whole (Hermans, 1987a). The structured whole is reflected by a matrix where the rows represent the valuations and the columns the affects (see Appendix for an example).

The procedure involves three parts: (a) elicitation of a set of valuations; (b) associating each valuation with a standardized set of affect-denoting terms, and (c) discussion of the results with the client.

Elicitation of Valuations

The valuations (i.e., rows in the matrix) are elicited by a series of open-ended questions. The questions ask for important units of meaning from the past, present, and future. They invite people to reflect on their life situation in such a way that they feel free to mention those concerns that are most relevant from the perspective of the present situatio...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• More Than a Romp (A Preface)
• Assessment of Promiscuous Behavior
• Adult Promiscuity Following Childhood Sexual Abuse: An Introduction
• Addiction or Promiscuity?
• The Concept of Promiscuity: A Self Psychology Perspective
• Hypersexuality as a Disorder of the Self
• “Psychopathological Promiscuity” and “Refinding” in the Quest for Sexual Love: Recapitulations of Incest Fantasy and Narcissism
• The Bubble
• Introducing Confusion to Create Change
• Career Promiscuity: Patients Who Cannot Commit to a Career
• The Personal Valuation of Promiscuity: A Method of Investigation
• AIDS and the Client “In the Fast Lane”: Narrative Construction and Reconstruction
• Promiscuity, Psychotherapy, and Strong Laughter
• The Promiscuity of Psychotherapy