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Assessment for Psychotherapy: Clinical Indicators of Self Cohesion and Self Pathology

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Assessment for Psychotherapy: Clinical Indicators of Self Cohesion and Self Pathology

Abstract

For a skilful psychotherapist clinical hunches may be finely differentiated and reliable, yet the evidence on which they are based tends to remain pre-articulate. The aim of this paper is to discuss this evidence and to organise it in terms of structural considerations regarding the cohesiveness of the self. The prognostic significance of these considerations is discussed. The complexity of the issues and the value of thinking structurally are illustrated through a clinical study.
... Individuals with a self-pathology feel that their body is alien and feel depersonalized or unreal (Brooke, 1994). Patients with schizophrenia and schizoaffective disorders have consistent body image disturbances and often present restricted body movements (Hedlund & Priebe & Röhricht, 2001). ...
... Subjective experiences of Dohsa-hou relaxation might be different depending on features of body-mind psychopathology (such as hypochondriasis). In this study, relaxation was largely a comfortable experience; however, patients with ego pathology or self-pathology (Brooke, 1994) could experience the relaxation as an invasive treatment. ...
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The body is an important aspect of the psychotherapy process, having substantial links with the development of psychological functions. This study aims to describe and categorize the subjective experiences of Dohsa-hou relaxation. Twenty university students participated in this study. Participants received three Dohsa-hou relaxation sessions and were interviewed after each session. Interview data were analyzed using content analysis, and the responses were segregated into categories. Reported experiences changed over the three sessions, with some participants reporting subjective changes in their daily lives. Through Dohsa-hou, participants eased their unintended tension and became more aware of their bodily feelings. These findings further contribute to understanding the changes in body awareness and subjective experiences.
... Is the story told sequentially, or do they diverge frequently? Chaotic and disorganised stories point towards senses of self which are lacking coherency (Brooke, 1994). An emphasis on narration may have to be maintained until some sense of self is established. ...
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The authors argue that the formation of self is at the heart of many addiction issues. Likewise issues of love (sought) and hate (found) are central to both the formation of a self vulnerable to addiction and to fostering recovery. So the negative feelings towards addicts (hate) is not simple prejudice, but inherent to the condition itself. As such this needs careful reflection by therapists. The authors argue that love, as compassion, is the central healing feature in addiction recovery. This paper is written by two addiction professionals, one of whom (AB) has over thirty years of lived addiction experience. We hope therefore that the paper combines both theoretical and experiential rigour. As such the purpose of this paper is to explore the issues of love and hate as they manifest in the recovery process of individuals who are described as having addictions. By using the word 'addiction' we do not mean to denigrate these individuals or to create alienating labels which can hinder authentic living. However, based on our clinical and personal experience, we are convinced that there exists a commonality of suffered lived experience which can be called 'addiction'. With the caveat that addiction will manifest differently for each individual, and also for different cultures and groups, there does appear to be commonalities across various types of addictions. It is not possible however to explore this issue further here. Our intention is to briefly review the existential literature on addiction and then to more deeply explore the issue of relationships in addiction. Thus we will eventually explore how the relationship between skilled helper (therapist) and addict is impacted and how this can help or hinder the recovery process. Our argument is that love and hate are central issues in the development, maintenance and eventual transcendence of addiction. Addiction develops in some cases as a mechanism to deal with issues of self and identity. However addiction only serves to further alienate addicts
... Interiority has to do with boundary and space. It is fundamental to psychic health and depth (Brooke, 1994). Much of Winnicott's work documents in careful detail the environmental provisions and psychic processes in which this developmental accomplishment occurs. ...
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Interiority and any reference to an inner life have been radically deconstructed by the philosophical anthropologists, who find in the psychological constructions of the self and the theories of mental life the legacy of Descartes and Galileo. This critique is argued in some detail. However, the language of interiority is not merely an epistemological error on the part of the speaker. Psychoanalysis and psychopathology have documented the developmental significance of interiority and its absence. A phenomenological analysis of interiority, based in part on a clinical example, reveals several interrelated themes: temporal continuity; imagination; responsibility and ownership; privacy; self-reflection. Each of these themes is interpreted existentially in terms of being in the world. A critical discussion of interiority in Giegerich's work concludes the paper. It is argued paradoxically that the dialectical tension between interiority and exteriority – psyche and its grounding in events and relations to others – is a dimension within interiority itself.
... Various types of primary disturbance in the experience of self can be distinguished, these distinctions capturing different aspects of the phenomenology of 'personality disorders'. However, there is no straightforward correlation between these distinctions, based on psychodynamics and phenomenology, and psychiatric classifications (Brooke, 1994;Kohut & Wolf, 1978: Wolf, 1994. In this section I will present a general account of the development and disruption of the sense of self that will be relevant to most if not all personality disorders. ...
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A Psychodynamic ModelCognitive Theory of Personality DisorderThe Cognitive Analytic ModelThe Dialectical Behavioural ModelConclusion References
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This paper takes as its starting point Jung's definition of the self as the totality of the psyche. However, because the term psyche remains conceptually unclear the concept of the self as totality, origin and goal, even centre, remains vague. With reference to Heidegger's analysis of human being as Dasein, as well as Jung's writings, it is argued that Jung's concept of psyche is not a synonym for mind but is the world in which we live psychologically. An understanding of the psyche as existentially situated requires us to rethink some features of the self. For instance, the self as origin is thus not a pre-existential integrate of pure potentiality but the original gathering of existence in which, and out of which, personal identity is constituted. The ego emerges out of the self as the development and ownership of aspects of an existence that is already situated and gathered. Relations between the ego and the self are about what is known, or admitted, and its relation with what is already being lived within the gathering that is existence. The self as psyche, origin, and centre are discussed, as well as the meaning of interiority. Epistemological assumptions of object relations theory are critically discussed. The paper also includes critical discussions of recent papers on the self.
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This paper has stressed the importance of maintaining intact self representations and thereby the corresponding self experience or cohesive sense of self in terms of the metapsychology and treatment of the severe borderline disturbances. A partial schematic review of the psychoanalytic theory of internalized object relations is undertaken as a vehicle to explore some of the therapeutic problems involved in the loss of the self experience from disintegration of the self representations. Also considered are some problems of altering technique resulting from the condensation of oedipal and pre-oedipal fantasies, in association with an ego regression into the realm of the representational world. Likewise, primitive self-protective 'defences' involving depersonalization are discussed, as well as elaborating the concept of inner-outer congruence as related to the integrity of the self representations and thus the sense of self.
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Kernberg's and Kohut's ideas concerning the idealizing transference are explored. It is postulated that their disparate ideas are explicable in terms of their different beliefs concerning human nature. The ontological status of these beliefs cannot be verified but they lead Kernberg and Kohut to adopt different observational stances. These stances influence their interpretations of the data perceived and the theories they construct. It is argued that Kernberg and Kohut are not unique in this regard. The link between psychological theories and deeply held convictions about human nature is an inextricable one. The controversy between Kernberg and Kohut simply serves to illustrate this.
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I propose to summarize some of the conclusions presented in this paper. One of my main points was the suggestion that in the first few months of life anxiety is predominantly experienced as fear of persecution and that this contributes to certain mechanisms and defenses which characterize the paranoid and schizoid positions. Outstanding among these defenses is the mechanism of splitting internal and external objects, emotions, and the ego. These mechanisms and defenses are part of normal development and at the same time form the basis for later schizophrenic illness. I described the processes underlying identification by projection as a combination of splitting off parts of the self and projecting them on to another person, and some of the effects this identification has on normal and schizoid object relations. The onset of the depressive position is the juncture at which by regression schizoid mechanisms may be reinforced. I also suggested a close connection between the manic-depressive and schizoid disorders, based on the interaction between the infantile schizoid and depressive positions.
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In his foundational work The Restoration of the Self, noted psychoanalyst Heinz Kohut boldly challenges what he called “the limits of classical analytic theory” and the Freudian orthodoxy. Here Kohut proposes a “psychology of the self” as a theory in its own right—one that can stand beside the teachings of Freud and Jung. Using clinical data, Kohut explores issues such as the role of narcissism in personality, when a patient can be considered cured, and the oversimplifications and social biases that unduly influenced Freudian thought. This volume puts forth some of Kohut’s most influential ideas on achieving emotional health through a balanced, creative, and joyful sense of self. "Kohut speaks clearly from his identity as a psychoanalyst-healer, showing that he is more of a psychoanalyst than most, and yet calling for major theoretical revisions including a redefinition of the essence of psychoanalysis.”—American Journal of Psychotherapy