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Differentiating ego functions of borderline and narcissistic personalities.

This study investigated differences in ego functions of borderline and narcissistic personality disorders through examining responses to Rorschach structural and content variables. Reality testing, thought process, affective regulation, impulse control, and the defenses of splitting and grandiosity were examined from Rorschach protocols of 50 borderlines and 26 narcissists. The borderlines produced greater distortion in reality testing, p less than .05; the narcissists produced more insidious thought process disturbance, p less than .05; and higher functioning groups demonstrated greater control of impulses, p less than .05. Borderlines in this sample demonstrated more affective constriction than the narcissists and used more splitting, p less than .05; narcissists used more grandiosity, p less than .05. Implications of this study are (a) ego functions mature inconsistently, (b) affective responsivity influences ego disorganization, and (c) level of functioning and IQ are related to the production of Rorschach variables.

Adolescent

Managing strain in a classical analysis: re-establishing the therapeutic relationship or interpreting unconscious wishes.

The therapeutic relationship frequently comes under a strain during the course of an analysis. At these times, the analysand perceives and reacts to the analyst as if the analyst were a critical or seductive archaic object. When this occurs, the analyst has the choice of interpreting the unconscious source of the analysand's non-therapeutic reactions or of interacting with the analysand in a manner which re-establishes and potentially strengthens the therapeutic relationship. Interpretations during the early phases of an analysis are unlikely to mitigate the strain until the therapeutic relationship has become stronger and until considerable reality testing has promoted a context which allows the analysand to understand and to tolerate her or his unconscious wishes.

Humans

Effects of oedipal triumph caused by collapse or death of the rival parent.

It is suggested that the threat of castration at the phallic-oedipal phase results in repression, effecting no change in the unconscious fantasy, that the resolution of the Oedipus complex depends on developments during latency and adolescence, and that during this period one of the determinants impeding the resolution may be the collapse or death of the rival parent. Death of the oedipal rival results in a confusion of the unconscious wish with an external happening. The child, unable to cope with the consequent guilt, resorts to repression. Thus, the critical aspects of the oedipal triumph remain potentially operative in the unconscious, hindering the patient's functioning in all closely associated areas. Three clinical illustrations of oedipal triumph are described to indicate some of the psychodynamic issues that arise in the analysis of such patients. Of particular importance are: the concept of reality testing; differential adaptation to the unconscious sense of guilt; the varying degrees of resistance evidenced in the analysis of such patients; and the impact of oedipal determinants in differential outcome of bereavement.

Adult

Assessment of ego functioning in multiple personality disorder.

The dissociative disorder known as multiple personality disorder (MPD) presents a diagnostic challenge to psychological assessment techniques. A case example is presented in which a new self-report, multifactorial measure of ego functioning discriminated distinct profiles for four personalities within one multiple personality organization. Interpretations of characteristics of the primary and secondary personalities based on the Bell Object Relations Reality Testing Inventory (BORRTI) are presented. The relationship between these findings and other approaches to psychological testing for dissociation and MPD are discussed. It is suggested that this approach will facilitate the clinical assessment of suspected MPD subjects and contribute to affording appropriate treatment to this population.

Adult

Measurement and modification of delusional beliefs.

It has been proposed that delusional thinking may be on a continuum with normal behavior and can be assessed by taking account of factors such as the client's degree of belief conviction or the extent of preoccupation with the belief. In our research a number of measures were used to assess the delusional thinking of people diagnosed as schizophrenic. Two interventions were used: (a) a structured verbal challenge and (b) a reality test in which the belief was subject to an empirical test. We used a multiple-baseline, across-subjects design. Of the 6 clients, 2 completely rejected their beliefs, and 3 others significantly reduced their belief conviction. Maintenance was good, and there was evidence that the intervention had enabled 5 of the 6 clients to effectively regulate their delusional thinking.

Adult

Psychological factors in the treatment of chronic low back pain. Follow-up study of a back school intervention.

The aim of the study was to investigate the role of certain psychological factors (e.g. neurotic features, alexithymia, and hostility) as intervening variables modifying the outcome of the back school intervention or correlating with spontaneous recovery. The results indicated that those patients who reacted favorably to the back school intervention could be described as emotionally well adjusted and controlled showing relatively good cognitive capacity with undisturbed reality testing. The poor responders in the treatment group were less capable cognitively and not so well balanced emotionally. Patients showing spontaneous recovery in the control group were characterized by a more lively and less controlled way of expressing emotions and affects. In contrast to these, patients who showed increasing disability during the 1-year follow-up were characterized by restricted expression of emotions and affects indicating alexithymia.

Adult

Prognostic scale for chronic schizophrenia.

Although prognostic scales are available for schizophrenia, these focus on acute or subacute populations where premorbid functioning and established chronicity are the best predictors of outcome. Their usefulness in chronic schizophrenia is limited. The authors describe a simple and reliable 5-item, 12-point prognostic scale for chronic schizophrenia independent of chronicity. It measures prognosis as the product of a dynamic interplay between the highest level of adaptive occupational and social functioning ever achieved by the individual and the "invasiveness" of the Axis I disorder as manifest by genetic loading (family history of schizophrenia), erosion of reality testing (psychotic assaultiveness), and preservation of affect in psychopathology (depressed mood). Among chronic schizophrenic patients in the Chestnut Lodge Followup Study (n = 163), the prognostic score (based on history and admission clinical picture) allowed strong probabilistic statements to be made about long-term outcome. Tables present the conditional probability or risk of specific outcomes in the domains of institutionalization, work functioning, social relations, and global outcome for patients at varying levels along the prognostic spectrum. Close examination of these predictor-outcome relationships suggests that prognosis in chronic schizophrenia may be thought of as the variability (as opposed to fixedness) remaining in the individual's future life course, and poor outcome can be predicted with greater sensitivity than good outcome.

Adaptation, Psychological

Object relations and self-reported AIDS self-care behavior.

This study examined the relationship between object relations and AIDS self-care behavior among 509 urban college students. The literature indicates that maturity of object relations is related to comfort in interpersonal relations and to taking responsibility for self-care. These concepts are widely accepted by psychoanalytic psychologists but have rarely been tested empirically. Object relations, measured by the Bell Object Relations and Reality Testing Inventory, was significantly related to AIDS knowledge as measured by the AIDS Prevention Survey of Thomas and to self-reported safer sex behavior, measured by Bassman's HIV Infection Prevention Scale. Knowledge about AIDS correlated with self-reported sexual risk behavior, and with a low level of self-reported social behavior aimed at preventing AIDS. Implications of these findings for public health education policy are discussed.

Acquired Immunodeficiency Syndrome

An investigation of psychological factors involved in the predisposition to auditory hallucinations.

Previous research by the author (Slade, 1972, 1973) and others has suggested that psychological stress plays an important role in triggering off the experience of auditory hallucinations. Clearly, however, predispositional factors are involved as well. The present study is an attempt to investigate some of the psychological factors which may predispose the individual to such experiences. A battery of tests involving cognitive, personality and mental imagery variables and the verbal transformation effect was administered to two small groups of psychotic patients differing only in respect of a history of auditory hallucinations and a normal control group. The main conclusion was that the results lend direct support to the proposition of Mintz & Alpert (1972) that a combination of vivid mental imagery and poor reality-testing in the auditory modality provides the basic predisposition for the experience of auditory hallucinations.

Adolescent

Psychotherapeutic schema based on the paranoid process.

A psychotherapeutic schema is proposed based on the analysis of the paranoid process. The paranoid process involves a paranoid construction of the patient's view of reality and his environment, particularly the social environment. The paranoid construction sustains and makes sense out of the patient's projective system. These projective elements reflect and are derived from the introjects--the internalized objects around which the patient's inner world and his experience of himself are organized. The schema aims at focusing the therapy on these introjects as central to the psychopathology. The following steps of the schema are outlined and discussed: establishing the therapeutic alliance, defining the projective system, testing reality, clarification of the introjects, derivation of the introjects, motivation of the introjects, mourning of infantile attachments, emergence of transference dependence, transference resolution, and termination.

Attitude of Health Personnel

Fantasy or structural defect? The borderline dilemma as viewed from analysis of an experience of nonhumanness.

The experience of nonhumanness, a crucial aspect of the phenomenal self of borderline states, is studied in two cases to test assumptions concerning the application of the classic ego-psychological or object-relations and self-psychological models. Are these experiences to be seen as fantasy and treated as manifest content, with dynamically active unconscious conflict and meaning, requiring interpretation, or as a developmental arrest in which structural disturbances are ameliorated through clarifying and empathic interventions? The first case is of a patient with a neurotic depression and hysterical and obsessional character traits, treated in a classic psychoanalysis. Even though dyadic oral and anal fantasies were strongly in evidence, the ego was well integrated. The second case is of a severe borderline patient who showed depressive panic and agoraphobia. Her major ego disturbances, poorly integrated and differentiated self- and object representations, and primitive defenses prevented effective psychoanalytically oriented treatment. Interventions were used to consolidate self-representations, internalize tension-regulating structures, promote adaptive ego functions and reality testing. These clarifications were necessary to move the patient to where she could tolerate facing unconscious dynamic conflicts. Only at that point could repression be lifted, memory emerge, and interpretation be utilized.

Adult

Infertility: psychotherapeutic issues.

In supportive therapy with infertility patients, the clinician tries to relieve dysphoria and enhance self-esteem. Dynamically informed supportive interventions are designed to decrease guilt that may relate to past sexual activities, sexually related diseases, or abortions. These interventions should also be empathetic, promote optimism and reality testing, help with problem solving, allow catharsis and ventilation, decrease feelings of isolation and loneliness, educate and clarify, and praise and encourage where appropriate. Mental health clinicians have an important role to play in the treatment of these patients, provided they learn enough about the psychology of the experience of infertility and about the technology utilized in its treatment. As the number of people seeking treatment for infertility grows, the need for skilled therapists for this population will grow at a parallel rate.

Female

Though disorder in high-functioning autistic adults.

Examined thought disorder in a sample (n = 11) of high-functioning autistic young adults and older adolescents (mean IQ = 83) utilizing objective ratings from the Thought, Language and Communication Disorder Scale (TLC Scale) and projective data from the Rorschach ink blots. Results from the TLC Scale pointed to negative features of thought disorder in this sample (e.g., Poverty of Speech). Rorschach protocols revealed poor reality testing and perceptual distortions in every autistic subject, and also identified several areas of cognitive slippage (e.g., Incongruous Combinations, Fabulized Combinations, Deviant Responses, Inappropriate Logic). Comparing TLC Scale and Rorschach results to schizophrenic reference groups, autistic subjects demonstrated significantly more Poverty of Speech and less Illogically on the TLC Scale, and on the Rorschach they evidenced features of thought disorder that are encountered also in schizophrenia. Results are discussed in relation to the measures employed, and to areas of similarity and difference between autism and schizophrenia.

Adolescent

Self-esteem and perceptions of conveyed impressions: is negative affectivity associated with greater realism?

Two studies examined the notion that negative affectivity (Watson & Clark, 1984) is associated with more accurate perceptions of conveyed impressions in social interactions. In Study 1 (n = 160), low self-esteem (LSE) and high self-esteem (HSE) subjects were paired with either an LSE or an HSE partner. After a 15-min interaction, they rated themselves, their partners, and how they believed their partners would rate them on 20 adjectives related to social competence. Study 2 (n = 40) was identical except that each interaction was observed by 2 observers who rated each participant, and participants also rated how they believed an observer would rate them. LSE subjects exhibited greater accuracy only with respect to the elevation component of observers' ratings; HSE subjects overestimated the positivity of observers' evaluations, whereas LSE subjects were relatively accurate. However, LSE subjects exhibited less overall accuracy with respect to their partners' ratings. We argue that when these results are considered with earlier research, there is no support for the notion of depressive realism in assessing conveyed impressions.

Adult