The psychotherapeutic utility of the five-factor model of personality: A clinician's experience - Miller - 1991 - Article

Why would you use a taxonomy of personality?

In psychotherapy, the clients are all very diverse. They are different in their behavior, and also in their Neuroticism (N), Extraversion (E), Openness (O), Agreeableness (A), and Conscientiousness (C). According to the author, N influences the intensity of the client’s distress, E influences the client’s enthusiasm for treatment, O influences the client’s reaction to the therapist’s interventions, A influences the client’s reaction to the person of the therapist, and C influences the client’s willingness to stick to the therapy.

This five-factor model is a descriptive, taxonomic trait theory.  This trait theory is helpful to the clinician in three ways. First, trait measures provide a useful portrait of the client’s feelings and needs. This can help the therapist to anticipate the client’s experience. Second, it helps the therapist understand and anticipate the problems presented in treatment. Third, it helps the therapist to formulate a practical treatment plan and anticipate the opportunities and pitfalls for treatment.

What is the role of the five factors in the clinical context?

The Big-Five factors can affect the client's behavior in the clinical context. Each factor's effect will be discussed. 

Neuroticism

As mentioned, Neuroticism affects the intensity and persistence of the patient’s distress. A patient who scores low on Neuroticism and who complains of recent onset panic attacks should be treated differently than a patient who scores high on Neuroticism, and has the same complaint. The patient with low Neuroticism probably expresses a reaction to a severe stressor with recent onset. In the case of the patient with high Neuroticism, this complaint probably has another source. Among patients with a diagnosable mental disorder, N was significantly correlated with the outcome measure. Higher Neuroticism means a worse outcome of therapy.

Extraversion

Extraversion has a big influence on clinical practice. For example, it affects the client’s enthusiasm for psychotherapy and his or her expressiveness in treatment. Patients who are high in Extraversion are more cheerful, laugh more often, joke more about their complaints, and express their opinions more often to the therapist. They also experience their emotions with more intensity than people who score low on Extraversion. So, Extraversion accounts for the difference between patients who anticipate each session and the patients who dread each session. Introverts do not like to talk, so they often dread going to psychotherapy, in which there is a lot of talking going on. Extraversion is positively correlated with outcome. It is also a strong predictor of well-being.

Openness

Openness affects the client’s reaction to the interventions that the therapist offers. Patients who are low in Openness often have difficulty fantasizing. This is called alexithymia. They are unable to fantasize or symbolize, their speech seems boring and conventional. They also do not accept or understand psychodynamic interpretations easily. Patients high in Openness are often seen as good patients. In turn, they also are seen as relatively healthy patients. The relationship between Openness and treatment outcome is complex.

Agreeableness

Agreeableness affects the subjective reaction to the therapist. Clients high in Agreeableness often admire or feel sorry for the people around them, even those people who victimize them. They smile, have a melodious voice, innocent humor that lacks irony and sarcasm. They rarely choose harsh words and concepts to describe their world. They often want to be liked, and they fear disapproval and conflict. They also accept social subordination in order to avoid them. Patients who are low in Agreeableness but high in Extraversion may also seem warm, funny, and enthusiastic. However, the difference in these patients is that the patients low in Agreeableness and high in Extraversion, do like to use sarcasm and irony. They are also willing to risk making people uncomfortable, in order for themselves to be admired or to achieve interpersonal influence. They also become distressed in subordinate situations. The therapist states that when clients are low on Agreeableness, he can expect skepticism about what the therapy has to offer, sensitivity to minor failures, and slowness in developing a collaborative relationship. There can still be a treatment alliance achieved, but only if the therapist anticipates transference problems. If he is unable to do this, treatment will probably go badly. This relates to the fact that the therapeutic alliance is one of the strongest predictors of treatment outcome. Clients high in Agreeableness are often willing to form a therapeutic alliance, and they accept interpretations uncritically. This is nice for the therapist, but not necessarily a good thing for the patient himself. So, the therapist sometimes needs to say something like “This is an excellent opportunity for you to make up your own mind even though you risk offending me or someone else. I refuse to brainwash you, even if you allow me to do it.” Agreeableness does not seem to predict the outcome. An important area for future research would be to examine whether patients low in Agreeableness have a higher therapy dropout compared to patients who are lower in Agreeableness.

Conscientiousness

Conscientiousness refers to differences in organization, persistence, dutifulness, and self-discipline. People who score high on conscientiousness are more likely to exert effort, to tolerate discomfort, and to delay gratification of impulses and desires. It has been found to predict academic and vocational success. Often, people high in conscientiousness are seen as relatively intelligent, but conscientiousness is not correlated with IQ. Patients low in conscientiousness do want to be relieved of their symptoms but are less likely to make an effort to change their behavior or to endure psychological or physical discomfort. Conscientiousness is correlated with a good outcome of therapy.

What are the conclusions?

If the model that the author described in the article is successful, then this would have some implications. First, it would contradict the idea that much treatment benefits from nonspecific factors common to many or all models. Second, if clinicians use this model and understand the effect of personality characteristics within social units, this can assist them in selecting interventions. Third, this five-factor model creates a new approach to humanistic philosophy and psychology. Lastly, this model can also help to illuminate the personality of the therapist, and it could help to create a new, richer source of clinical wisdom.