In Horney's practice, she began to see patterns of needs in the neurotic patients she treated. She noted in The Neurotic Personality of Our Time in 1942 that neurotics utilize extreme and unrealistic measures to meet these needs, and will not even be aware that they are doing it.
She categorized these need patterns as the following:
• The need for acceptance and affection: All human beings need acceptance and affection, but in people with healthier selves, the need is balanced by an understanding of what is possible and what is not. This need in neurotics can be manifested by an obsessive need to please others and be liked by them, or an unreasonable belief that others will meet every need. As these techniques are unrealistic and doomed to failure, anxiety is constantly generated when this need, as perceived by the neurotic, is not met.
• The need for love: Obviously all people want and need to be loved, but again, the neurotic's perception of what this means is unrealistic. Loved ones are expected to completely take over the neurotic's life, and solve all difficulties and conflicts for them.
• The need to simplify what is seen as the complexity of life: This is clearly a need that is tempting to all people at times, but again the neurotic takes this need to a problematic level. He or she may desire a very small number of material possessions, or wish to have no laws or schedule to follow. The neurotic seeks to be able to virtually become invisible when stress-increasing confrontation occurs. This invisibility is aimed at making them safer and decreasing their stress.
• The need for having power: We all desire to be empowered, but the neurotic feels a desperate need to control and have power over others.
• The need to manipulate others: Generated in a basic belief that others are simply there to be used, the neurotic, who perceives him- or herself as having been manipulated and used, tries to carry out a preemptory attack against others. The primary rationale for this behavior is to avoid looking stupid or being used by others.
• The need for social recognition: Again, it is the outer limit of a desire that is considered normal, our innate need for prestige and recognition. The neurotic takes this to another level with overwhelming fear of not looking good, being popular, or considered "in the loop." No matter how difficult it may be, the neurotic tries to be sociable.
• The need for the admiring recognition of others: Among the greatest fears of the neurotic is that the people they interact with every day will see them as being less than important, or as worthless or irrelevant.
• The need for achievement: Clearly setting goals and reaching them are important facets of all people. But the neurotic becomes obsessed with succeeding at meeting goals and being the best in whatever they attempt to do. Failure to achieve their unachievable goals results in more mental pain and/or the devaluation of whatever it is that they try to do.
• The need for independence: Autonomy is important to all people, but the neurotic takes this to the extreme. The illusion of self-sufficiency becomes more important than seeking help when it is needed. At some level neurotics truly believe that they can handle the situation by themselves, but there is also the self-centered portion of their psyche that does not want another person to help them and be recognized for an achievement. This would take away from the individual attention they feel should belong only to them.
• The need for perfection: Neurotics have an innately immature view of the world in which they live. There should be happy endings for everything, and the neurotic should be in control of all situations at all times. There is a terror of being flawed, of others seeing the mistakes the neurotic makes.
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