Personality Type and Patient Education in Hand Therapy ^∗

Joel Moorhead, Cynthia Cooper and Patricia Moorhead

The MedlinePlus Medical Dictionary defines “personality” as “the complex of characteristics that distinguishes an individual, especially in relationships with others.”¹ Personality theorists in the early 20th century began to challenge the assumption that people are inherently similar in character and temperament. In 1907, Adickes identified four basic ways of viewing the world, “dogmatic, agnostic, traditional, and innovative.”² Kretschmer proposed different classifiers, “hyperesthetic, anesthetic, melancholic, and hypomanic.”² The Myers–Briggs type indicator (MBTI) classification, developed in the 1950s, is based on the views of Carl Jung.² Personality classifications do not describe biological differences, such as being male or female; rather, such classifications provide a structure for appreciating the different ways in which people view the world and process information. For the sake of simplicity, this article will discuss aspects of personality as classified by the MBTI profiles.

Each patient who enters the hand therapist’s office arrives with an upper extremity problem and a personality that can influence the therapist–patient relationship. The clinical setting for hand therapy encourages close therapeutic relationships. The therapist meets with the patient multiple times, face-to-face, helping the patient to reach goals that are of vital importance. The patient often enters the therapeutic relationship in a vulnerable state, feeling traumatized and unable to regain a high level of function without help. The personality characteristics of both the patient and the therapist can help build or can hinder this therapeutic relationship. A patient’s personality characteristics may be an important aspect of his or her illness experience.

Injury is a universal human experience, more common in some people than in others. Factors associated with frequent accidents include emotional dissatisfaction, external locus of control, impulsiveness, hostility, and antisocial attitudes.³ Marušič et al.⁴ identified three personality factors that could identify injury-prone individuals. The first is “sensitization”: the tendency to report more intense emotional reactions than those reported by other persons under similar circumstances. The second is an “avoidance coping style”: the tendency to withdraw from sources of stress rather than to engage stressors directly. The third is a tendency toward extraversion, although this may be mitigated somewhat by a preference to cope with stress by direct engagement. Marušič et al.⁴ suggested that the risk of injury may be increased in extraverts because of a tendency to become distracted and in persons whose intense emotional reactions prevent them from engaging situations directly.

The tendency to be competitive may increase injury risk when accompanied by personality factors, such as impatience, aggressiveness, and achievement drive.⁵ Ekenman, et al.⁶ found that runners scoring high on competitiveness and dependence on exercise for mood regulation were more likely to be diagnosed with a tibial stress fracture. Athletes with these personality traits may not reduce the frequency or intensity of their chosen sport in spite of symptoms, such as pain or swelling. This intensity of training can be adaptive, resilient, and healthy, but it can be taken too far in some circumstances.⁶

How can the knowledge that personality factors affect recovery from illness or injury increase the effectiveness of our patient education efforts? Do patients with different personality traits have distinctive learning styles based on their personality preferences? How can hand therapists recognize and apply this information in daily practice? This article will explore ways for therapists to transfer knowledge to patients most effectively by adjusting to differences in personality and learning style. The goals of this article are to present the MBTI profiles as a model for illustrating personality differences, to highlight the differences in learning styles that may be associated with personality preferences, and to provide examples of ways in which patient education can be tailored to each patient’s learning style preferences.

Patient Narratives

Medical anthropologist Arthur Kleinman ⁷ described a five-step process to reach agreement on a treatment plan. The first of these five steps is to listen to the patient’s explanatory model for his or her illness or injury.⁷ The patient’s explanatory model is the basis for achieving mutually accepted explanations of illness and plans for treatment. Hand therapists have the opportunity to learn from rich patient narratives, such as those discussed by Cooper in this issue, fostered by responsive listening over multiple patient visits. Empathy is demonstrated as the therapist understands in greater detail the meaning of the illness to the patient and the goals that the patient would like to achieve through treatment. To paraphrase a quote attributed to William Osler,⁸ “Listen to the patient—he or she is telling you the treatment plan.” Empathy flows more easily into a mutually accepted treatment plan if the patient and therapist share basic personality traits and preferences.⁹

One widely used model of basic personality traits and preferences is based on MBTI profiles. A discussion of the reliability and validity of the Myers–Briggs instrument is beyond the scope of this article but is available online.¹⁰ The MBTI model will be used as a frame of reference for this discussion of personality types and patient education.

The MBTI profiles are expressed as four letters, one from each preference pair, indicating the stronger characteristic within each preference pair. For example, an extravert with sensation, feeling, and judging preferences would be assigned MBTI type “ESFJ.” An introvert with intuition, thinking, and perceiving preferences would be assigned MBTI type “INTP.”

The words that patients choose as their narratives unfold can provide important clues to their preferences in each of the aforementioned dimensions. An extravert with a feeling preference may begin his or her narrative promptly with little coaching, talking about friends and family and how the injury has affected his or her own life and the lives of loved ones. In contrast, an introvert with a thinking preference may initially say very little, breaking silence to ask clinically oriented questions about his or her illness or about the natural history of recovery experienced by patients in general. A person with intuition and perceiving preferences may ask a number of “what if” questions about hypothetical future scenarios, whereas a person with sensation and judging preferences may ask for details of the therapist’s current assessment and a treatment plan with specific dates and milestones.

Personality classifications, such as the MBTI, are nonspecific and are not intended to guide clinical treatment of psychological disorders. It is important to recognize that therapists will not be making a “personality diagnosis” based on the awareness of personality traits. Every patient will exhibit each preference to a different degree and may have an approximately equal balance of both dimensions of a preference. Preference terms like “extravert” are not intended to be labels or stereotypes. Preference terms describe relative tendencies, not a rigid or immutable state of being. Preference terms are concepts that can help the therapist to work effectively with each individual patient.

The purpose of developing a greater understanding of different personality preferences in the setting of clinical hand therapy is to communicate with the patient more effectively. The therapist’s first efforts at communicating may be based on perceptions that are inaccurate. The patient’s responses can give the therapist important clues about the effectiveness of the initial approach to patient education. If one approach is not effective, the flexible therapist can try another approach more tailored to the patient’s personality characteristics. Packaging health care information in a form that is easily accepted by the patient may be more effective clinically and is ultimately most respectful to each patient as an individual.

Recommendations Based on Myers–Briggs Type Indicator Preferences and Learning Styles

Schedule extraverts with other patients or overlap their appointments. Schedule introverts with one-on-one time and no overlapping of appointments.

Extraverts may do best when a strong external motivator spurs them to learn. Extraverts may talk while they learn and do well if they can interact with others in a learning situation. In contrast, introverts may be motivated more by internal factors. Introverts may need time to think before they talk or act and may process an idea for an extended period of time before being ready to discuss it.¹²

Provide sensing patients with fewer exercises or activities that are graded in difficulty and spend more time on each. Provide intuiting patients with more variety of exercises or activities; allow them to explore the therapy equipment.

Persons with a sensing preference may anchor their learning on familiar facts. Sensing persons may relate well to concrete examples, moving in relatively linear fashion from one established reality to the next. Persons with a sensing preference are likely to be comfortable with repetition. In contrast, persons with an intuiting preference are more likely to focus on general concepts, as those concepts relate to the “big picture.” Intuiting persons may respond well to creative and imaginative ideas that are complex, inventive, and original. Persons with an intuiting preference may be less comfortable with unvarying repetition, preferring frequent opportunities to look at situations from a different frame of reference.¹²

Talk about clinical evidence and evidence-based practice with thinking patients. Offer them references or articles. In contrast, express concern and caring messages to feeling patients.

Persons with a thinking preference are likely to question a statement if that statement is not supported by reasonable supporting analysis. Persons with a thinking preference may respond best when given the opportunity to challenge, explore, and analyze all aspects of a situation. In contrast, persons with a feeling preference may respond well to a warm professional relationship with the therapist. Persons with a feeling preference may make the best progress if they feel that the therapist cares about them personally and is working with them in the context of their own personal values.¹²

With judging patients, be on time, provide objective feedback regarding the clinical picture, and relate clinical findings to the status of goals. With perceiving patients, ask what they would like to start with or which activity or exercise feels most helpful to them.

Persons with a judging preference may respond best if they know exactly what is expected of them and when it is expected. Persons with a judging preference may value orderly, consistent adherence to schedule. In contrast, persons with a perceiving preference may respond more positively to choices and options at each step of the therapeutic process. Persons with a perceiving preference may value openness to new and changing circumstances and possibilities and may respond well to playful techniques that are educational as well.¹²

The clinical recommendations in this section are summarized in Table 17-1.

TABLE 17-1

Clinical Recommendations Based on the Myers–Briggs Type Indicator Preferences ¹²

Preference Pair	Preference	Characteristics	Learning Style	Recommendation
E/I	Extraversion	Motivated by external factors	Talk while learning	Overlap appointments so that extraverts can interact
	Introversion	Motivated by internal factors	Need quiet time to process before talking	More one-on-one time with therapist
S/N	Sensing	Anchor learning on familiar facts	Linear thinkers; move from one concrete reality to the next	Few exercises; repetition; concrete facts
	Intuition	Focus on general concepts	Global thinkers; comfortable with complexity; “big picture” view	Original and imaginative exercises; let patient explore potential of equipment
T/F	Thinking	Analytical frame of reference	Challenge ideas based on thorough knowledge	Cite literature; be prepared for far-reaching analytical discussion
	Feeling	Personal frame of reference	Value approach based on caring and context of personal values	Create warm and caring professional relationship; context of patient’s personal life
J/P	Judging	Value structure and schedule	Adhere to schedule with orderly progression	Create and follow written schedule of treatment with concrete milestones and goals
	Perceiving	Value choices and options	Explore options on choices at every step	Flexible treatment plan with goals and milestones that change as therapy progresses