As a sample for psychotherapeutic utilization we chose a 48/84 coded profile, Early sexual abuse and the poisoning of trust. For years I said, "This MMPI code has no diagnosis that matches it, not depression, not personality disorder, and not schizophrenia even if it has a bit of each." Then the DSM III came out with Borderline Personality Disorder which is a good codetype fit, although the conspicuously loose DSM boundary problem has led to a notably overinclusive use of the term (sometimes I think it mainly means, "I don’t like this person). The striking historical issue with this codetype, time and again, has been a history of relatively early sexual abuse. The question arises, what is the connection between the often deep and pervasive distrust and the prevalence of sexual abuse? When I finally focused on that, the answer seemed to jump out at me: what is the relationship to the perpetrator? So often it is a highly trusted family member or other esteemed adult whom the child feels helpless or too frightened to oppose. The great intensity of the abuse experience thus implants the violation of trust at a deep level. The new Adaptation and Attachment supplement to the narrative report then explores this abuse-trust conjunction in considerable detail. This is longer than most of these supplements; there seemed more that needed to be said compared to most of the code types.


Clients with 48/84/248 codes (the meaningful core of the Borderline Personality Disorder category) can be difficult challenges for the professional not to be judgmental. The self-empathy of the 48 is about as poor as their empathy for others, so they often give the professional little help in gaining empathy for them. Given the pervasiveness of distrust, I think they have somehow experienced empathy (in almost any direction) as a dangerous vulnerability. This is an MMPI-2 pattern where guidance to etiology can be especially helpful, which is why we chose it as a sample profile for psychotherapy utilization - or, as I would prefer, the facilitation of adaptation.






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