An Introduction to Temperament and communication

1
An Introduction to Temperament and communication

• Daniel Robitshek, MD
• Professor of Medicine
• Hospitalist Program
• Department of Medicine

2
Premise I

• Effective communication and relational skills are
  key to successful interactions
• Communication styles vary from individual to
  individual
• Temperament type influences relational tendencies
  and communication style

3
Premise II

• Most complaints about doctors relate to poor
  communication/relational skills, not clinical
  competence
• Good communication/relational skills is a key
  determinant of patient satisfaction which, in
  turn influences compliance, outcomes and other
  factors
• Doctors often misunderstand what information
  patients want and often use language that is
  unclear

4
Premise III

• Communications courses in medical training focus
  on generic skills and do not take into account
  differences in temperament
• Temperament type, such as that described by the
  Myers-Briggs Type Indicator (MBTI), can help in
  characterizing how people process information
• Individuals with similar MBTI types or those who
  can more easily adjust to the communication style
  preferences of others tend to derive more
  satisfaction during interactions

5
Thesis

• Recognizing temperament tendencies in yourself
  and others is a key component in optimizing
  interactions with patients, families, colleagues
  and ancillary staff
• Temperament theory reflects differences in how we
  see, experience and interact with our world
• All temperaments offer tremendous contributions
  and have the potential for
• Contributing wonderfully to an interaction
• Creating some conflict in an interaction

6
Historical Development

• Date Author Artisan temperament Guardian
  temperament Idealist temperament Rational
  temperament
• 590 BC Ezekiel's four living creatures lion
  (bold) ox (sturdy) man (humane) eagle
  (far-seeing)
• 400 BC Hippocrates' four humours cheerful
  (blood) somber (black bile) enthusiastic (yellow
  bile) calm (phlegm)
• 340 BC Plato's four characters artistic
  (iconic) sensible (pistic) intuitive (noetic)
  reasoning (dianoetic)
• 325 BC Aristotle's four sources of happiness
  sensual (hedone) material (propraietari) ethical
  (ethikos) logical (dialogike)
• 185 AD Irenaeus' four temperaments
  spontaneous historical spiritual scholarly
• 190 Galen's four temperaments sanguine
  melancholic choleric phlegmatic
• 1550 Paracelsus' four totem spirits
  changeable salamanders industrious gnomes
  inspired nymphs curious sylphs
• 1905 Adickes' four world views innovative
  traditional doctrinaire skeptical
• 1912 Dreikurs'/Adler's four mistaken goals
  retaliation service recognition power
• 1914 Spränger's four value attitudes
  artistic economic religious theoretic
• 1920 Kretschmer's four character styles
  manic (hypomanic) depressive oversensitive
  (hyperesthetic) insensitive (anesthetic)
• 1947 Fromm's four orientations exploitative
  hoarding receptive marketing
• 1958 Myers' Jungian types SP (sensing
  perceiving) SJ (sensing judging) NF (intuitive
  feeling) NT (intuitive thinking)
• 1978 Keirsey/Bates four temperaments (old)
  Dionysian (artful) Epimethean (dutiful)
  Apollonian (soulful) Promethean (technological)
• 1988 Keirsey's four temperaments Artisan
  Guardian Idealist Rational

7
Meyers-Briggs Temperament Indicator THE FOUR
DICHOTOMIESAs expounded by Dr. David Kiersey
8
The Inner Ring Abstract or Concrete

• According to Keirsey, everyone can engage in both
  observation and introspection.
• When people touch objects, watch a basketball
  game, taste food, or otherwise perceive the world
  through their five senses, they are observant.
• When people reflect and focus on their internal
  world, they are introspective.
• However, individuals cannot engage in observation
  and introspection at the same time.

9
The Inner Ring Sensing or Intuition

• The extent to which people are more observant or
  introspective directly affects their behavior.
• People who are primarily observant are more down
  to earth.
• They are more concrete in their worldview and
  tend to focus on practical matters such as food,
  shelter, and their immediate relationships.
• Carl Jung used the word SENSING when describing
  concrete people.
• People who are primarily introspective are more
  head in the clouds.
• They are more abstract in their world view and
  tend to focus on global or theoretical issues
  such as equality or engineering.
• Carl Jung used the word INTUITION when describing
  abstract people.

10
Preferred Mode of Information Gathering and
Learning

• The anchor of the temperament matrix
• Describes how new information is understood and
  interpreted
• Sensation
• Prefer to assimilate information using the five
  senses
• Prefer to trust information that is tangible and
  concrete
• Live more in the real world of present experience
• Intuition
• Prefer to assimilate information by seeing the
  big picture
• Tend to trust information that is more abstract
  or theoretical
• Learn best through contextual associations
• Live more in the world of ideas and concepts that
  are future oriented

11
Preferred Mode of Information Gathering and
Learning
12
The Second Ring Cooperative or Pragmatic
(utilitarian)

• Keirsey uses the words cooperative and pragmatic
  when comparing the differing temperaments.
• People who are cooperative pay more attention to
  other people's opinions and are more concerned
  with doing the right thing.
• People who are pragmatic (utilitarian) pay more
  attention to their own thoughts or feelings and
  are more concerned with doing what works.
• This ring, in combination with the inner ring,
  determines a person's temperament.
• The pragmatic temperaments are Rationals
  (pragmatic and abstract) and Artisans (pragmatic
  and concrete).
• The cooperative temperaments are Idealists
  (cooperative and abstract), and Guardians
  (cooperative and concrete).

13
WHAT YOU SAY AND WHAT YOU DO
Saying
Doing
People Patterns A Modern Guide to the Four
Temperaments (Paperback) by Stephen Montgomery
14
The Third Ring Directive or Informative

• The third ring distinguishes between people who
  primarily communicate by informing others versus
  people who primarily communicate by directing
  others.
• Each of the four temperaments is subdivided by
  this distinction for a result of eight roles.
• The directive roles are Operators (directive
  Artisans), Administrators (directive Guardians),
  Mentors (directive Idealists), and Coordinators
  (directive Rationals).
• The informative roles are Entertainers
  (informative Artisans), Conservators (informative
  Guardians), Advocates (informative Idealists),
  and Engineers (informative Rationals).

15
Preferred Focus of Attention

• Describes how energy is derived and where it is
  spent
• Extraversion
• Focus of attention is in the outer world of
  things and people
• Tendency is to act, then reflect, then act
  further
• Energy tends to be derived from EXTERNAL sources
• Introversion
• Focus of attention is devoted mostly to the inner
  world of ideas and experiences
• They prefer to reflect, then act, then reflect
  again
• Energy tends to be derived INTERNALLY

16
PREFERRED FOCUS OF ATTENTION
17

• Both strive to make rational choices, based on
  the data received from their information-gathering
  functions (S or N)
• Thinking
• Prefers to make decisions by applying logical
  analysis
• Makes choices from a more detached standpoint and
  by
• Measuring the decision by what seems reasonable,
  logical, causal, consistent and matching a given
  set of rules or principles
• Uses their intellect to support decisions with a
  focus on objectivity
• Feeling
• Prefers to make decisions based on personal
  values
• Makes choices by weighing the situation and
• Through a desire to achieve, on balance, the
  greatest harmony, consensus and fit, considering
  the needs of and the impact on the people
  involved
• Uses personal values in an attempt to empathize
  with the situation

18
PREFERRED BASIS FOR DECISION MAKING
19
Preferred Approach to Managing Organizing

• Judging
• Prefers to live in a planned and structured way
• Likes to have things settled and decided
• Derives more satisfaction when finalizing a
  process than by the process itself
• Likes to bring life under control as much as
  possible
• Perceiver
• Prefers to live in a flexible and spontaneous way
• Likes to leave things open
• Feels more invigorated by the process and by
  considering all options
• Likes to understand and adapt to the world rather
  than control and organize it

20
PREFERRED APPROACH TO MANAGING ONE'S LIFE
21
The Fourth Ring Expressive or Reserved

• The fourth ring describes how people interact
  with their environment.
• Individuals who primarily act before reflecting
  are described as expressive, whereas people who
  primarily reflect before acting are described as
  attentive.
• Each of the eight categories can be subdivided by
  this distinction, for a total of 16 role
  variants.
• These 16 role variants correlate to the 16
  Myers-Briggs types.
• The expressive role variants are Promoters
  (expressive Operators), Performers (expressive
  Entertainers), Supervisors (expressive
  Administrators), Providers (expressive
  Conservators), Teachers (expressive Mentors),
  Champions (expressive Advocates), Fieldmarshals
  (expressive Coordinators), and Inventors
  (expressive Engineers).
• The reserved role variants are Crafters (reserved
  Operators), Composers (reserved Entertainers),
  Inspectors (reserved Administrators), Protectors
  (reserved Conservators), Counselors (reserved
  Mentors), Healers (reserved Advocates),
  Masterminds (reserved Coordinators), and
  Architects (reserved Engineers).

22
SJ THE GUARDIANS
Adapted from www.keirsey.com
23
GUARDIAN SJs

• Being CONCRETE and COOPERATIVE , they can become
  highly skilled in LOGISTICS manage and supply
• Most practiced and developed in supervising and
  inspecting (SJT administering), or supplying and
  protecting (SJF conserving)
• They take pride in being reliable, have
  self-respect when doing good deeds, and feel most
  confident when being respectable
• They are the "Security Seeking Personality" --
  trusting in legitimacy and hungering for
  membership.
• They are usually stoical about the present,
  pessimistic about the future, fatalistic about
  the past, and their preferred time and place is
  the past and the gateway.
• They tend to be enculturating as parents,
  helpmates as spouses, and conformity oriented as
  children.
• There are more Guardians than any other
  temperament, at least 40 and as many as 45 of
  the population.

Adapted from www.keirsey.com
24
ESTJ - SUPERVISORS
Adapted from www.keirsey.com
25
ISTJ - INSPECTORS
Adapted from www.keirsey.com
26
ESFJ - PROVIDERS
Adapted from www.keirsey.com
27
ISFJ - PROTECTORS
Adapted from www.keirsey.com
28
SP - ARTISANS
Adapted from www.keirsey.com
29
ARTISAN SPs

• Being CONCRETE and UTILITARIAN can become highly
  skilled in TACTICS - employing means to
  accomplish an end securing objectives set by
  strategy
• Usually most practiced and developed in promoting
  and operating (SPT expediting), or displaying and
  composing (SPF improvising). They strive to be
  virtuosos of any form of artistic operation.
• Artisans are proud of themselves when they are
  graceful in action, respect themselves when they
  are daring, and feel confident when they are
  adaptable.
• This is the "Sensation Seeking Personality" --
  trusting in spontaneity and hungering for impact
  on others.
• They are usually hedonic about the present,
  optimistic about the future, cynical about the
  past, and their preferred place and time is the
  here and now.
• They tend to be permissive as parents, playmates
  as spouses, and play oriented as children.
• There are many Artisans to be found in many
  places where the action is, at least 35 and as
  many as 40 of the population.

Adapted from www.keirsey.com
30
ISTP - CRAFTERS
Adapted from www.keirsey.com
31
ESTP - PROMOTERS
Adapted from www.keirsey.com
32
ISFP - COMPOSERS
Adapted from www.keirsey.com
33
ESFP - PERFORMERS
Adapted from www.keirsey.com
34
NF - IDEALISTS
Adapted from www.keirsey.com
35
IDEALIST NFs

• ABSTRACT and COOPERATIVE, can become highly
  skilled in DIPLOMACY
• Most practiced and developed in teaching and
  counseling (NFJ mentoring), or conferring and
  tutoring (NFP advocating).
• They strive to be sages and have an instinct for
  interpersonal integration, learn ethics with
  zeal, sometimes become diplomatic leaders, and
  often speak metaphorically of the abstract world
  of their imagination.
• They take pride in being empathic in action,
  respect themselves when they are benevolent, and
  feel confident when they are authentic.
• Idealist types search for their unique identity,
  hunger for deep and meaningful relationships,
  wish for a little romance each day, trust their
  intuitive feelings implicitly, aspire for
  profundity
• This is the "Identity Seeking Personality" --
  gullible about the future, mystical about the
  past, and their preferred time and place are the
  future and the pathway.
• Social relationships In their family
  interactions they strive for mutuality, provide
  spiritual intimacy for the mates, opportunity for
  fantasy for their children, and for themselves
  continuous self-renewal.
• Idealists do not abound, being as few as 8 and
  no more than 10 of the population

Adapted from www.keirsey.com
36
INFJ - COUNSELORS
Adapted from www.keirsey.com
37
INFP - HEALERS
Adapted from www.keirsey.com
38
ENFP - CHAMPIONS
Adapted from www.keirsey.com
39
ENFJ - TEACHERS
Adapted from www.keirsey.com
40
NT - RATIONALS
Adapted from www.keirsey.com
41
RATIONAL NTs

• Being ABSTRACT and UTILITARIAN, can become highly
  skilled in STRATEGIC ANALYSIS.
• Most practiced and developed in marshalling and
  planning (NTJ organizing), or inventing and
  configuring (NTP engineering).
• And they strive to be wizards.
• They are proud of themselves when competent in
  action, respect themselves when they are
  autonomous, and feel confident when they are
  strong willed
• Ever in search of knowledge, this is the
  "Knowledge Seeking Personality" -- trusting in
  reason and hungering for achievement.
• They are usually pragmatic about the present,
  skeptical about the future, solipsistic about the
  past, and their preferred time and place are the
  interval and the intersection.
• Rationals tend to be individualizing as parents,
  mind mates as spouses, and learning oriented as
  children.
• Rationals are very infrequent, comprising as few
  as 5 and no more than 7 of the population.

Adapted from www.keirsey.com
42
INTJ - MASTERMINDS
Adapted from www.keirsey.com
43
INTP - ARCHITECTS
Adapted from www.keirsey.com
44
ENTP - INVENTORS
Adapted from www.keirsey.com
45
ENTJ - FIELDMARSHALS
Adapted from www.keirsey.com
46
Communication Styles and Personality Preferences
Adapted from Allen Brock. FLEX CareParticipant
Materials. Gainesville, FL Center for
Application of Psychological Type.30 (In Press)
47
HOW PATIENTS WITH DIFFERENT PERSONALITY
PREFERENCES SAID THEY PREFERRED TO HEAR BAD NEWS
Adapted from Allen Brock. FLEX CareParticipant
Materials. Gainesville, FL Center for
Application of Psychological Type.30 (In Press)
48
Clack, G. B., et al Personality differences
between doctors and their patients, MEDICAL
EDUCATION 200438177-186
49
Clack, G. B., et al Personality differences
between doctors and their patients, MEDICAL
EDUCATION 200438177-186
50
(No Transcript)