Clinical Theory Assessment, Planning
and Intervention Methods
SW6425
Professor Nan Van Den Bergh
Ego Psychology
Ego Psychology Assessment: Ego Functions
• Ego Functions:
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Reality Testing
Judgment
Sense of identity
Impulse control
Object Relations
Thought processes
Regression in Service of the Ego
Stimulus regulation
Defense Mechanisms
Autonomous functions
Ego Psych Assessment :Defense Mechanisms
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Denial
Displacement
Intellectualization
Introjection
Isolation of affect
Projection
Rationalization
Reaction formation
Regression
Repression
Somatization
Sublimation
Ego Psych Assessment: Psychosocial
Development
• Awareness of developmental stage, i.e. according to Erikson,
and mastery of developmental tasks, to date
EGO Psych: Intervention Goals
• Overall purposes of intervention:
– 1) Acquire problem solving and copings skills
– 2) Achieve insight through reflection about strengths, limitations, and
potential resources
• The above is achieved by:
– Enhance ego functioning by building new ego strengths or enhancing
existing ego strengths (includes greater self understanding)
– Modify or change environmental conditions
– Improve “goodness of fit” between a person’s ego capacities and
environmental conditions
Ego Psychology Intervention Strategies
• EGO SUSTAINING
• Exploration, description, ventilation: elicits clients thoughts
and feelings
• Sustainment: empathic, active listening and encouragement
• Person-Situation reflection
• Advice and guidance (direct influence)
• Partializing
• Education
• EGO MODIFIYING
• Developmental reflection
OBJECT RELATIONS
OBJECT RELATIONS: Assessment
• Assessing is similar to ego psychology except for placing a
closer focus on object relations
• Areas to assess:
– Preliminary assessment of relational patterns. Positive relationships
with some? Or, are all close relationships conflictual?
– Are relationship patterns rooted in present reality or is an old
relationship being repeated?
– Do client’s behavior repeat early experiences with parents?
– Do client’s behaviors represent efforts to master old traumas by
repeating them with other people?
– Do client’s behaviors reflect accurately what occurred in childhood or
are memories distorted?
OBJECT RELATIONS: INTERVENTIONS
• Similar to ego psychology but a greater emphasis on:
– Sustainment: worker must be able to sustain a positive clinical
relationship through periods of client anxiety, resistance,
confrontation and limits’ testing
– Developmental reflection: explore developmental history and
developmental milestones
• Early treatment:
– Provide “holding environment to reproduce early parenting
experiences
– Practitioners interpret patterns of behavior suggesting's their origins,
intentions and effects
– Uses therapeutic relationship to show that relationships can survive
periods of conflict and negative interactions
OBJECT RELATIONS: INTERVENTIONS (cont.)
• Middle Stage:
– Interprets clients maladaptive defenses such as splitting and projective
identification
– Helps client to look inward to understand feelings and attitudes she is
trying to disown and project
• End phase:
– Client helped to resolve major interpersonal conflicts and overcome
developmental arrests
– Client is guided to corrective experiences with people in her own
environment
– Opening explore the meaning of the ending of the relationship
• Review positive gains that have been made
Self Psychology
SELF PSYCHOLOGY: MAJOR ASSUMPTIONS
• Sense of self and self esteem are dependent on the quality of
relationship s with parental figures who serve as self-objects
• Self-objects are persons who are experienced intrapsychically
as providing an enduring sense of availability, which fosters
the developing self
• Three important self-object relations
– Mirroring self-object: recognizes a child’s unique capacities and talents
– Idealizing self-object: an admired caregiver
– Twinship self-object: provides a sense of sameness with the self object
that is essential to growth, attainment of skills and competence
• Self-objects perform adaptive functions of soothing and
tension regulation
SELF PSYCHOLOGY: MAJOR ASSUMPTIONS
(cont.)
• Transmuting internalization: person is gradually able to
perform soothing and tension regulation tasks by herself
• When child does not have important self-object experiences,
internalization of psychic structures cannot occur
• Shame and humiliation result from ongoing self-object failure
• Individuals fears his expression of needs will diminish selfobject experiences
– Result is falsely complying with the needs of other at the expense of
the development of the true self
• Merger bond is created that is an accommodation to the
needs of the self
– Failure to accommodate leaves the individuals feeling isolated and
depressed with no self-object support
SELF PSYCHOLOGY: MAJOR ASSUMPTIONS
• Early narcissistic needs are unmet
– Person involved in an ongoing search for self-object experiences that
will provide what is lacking
• As the self becomes more strengthened through self-object
responsiveness via therapeutic relationship, person is less
shameful of self-object needs
– Enables person to give without feeling anxiety about the needs of
another
• Self psychology defines maturity as the availability to evoke
and engage in mutually enriching self-object relationships
with others
Self Psychology Assessment
• Does presenting problem seem related to impaired sense of
self?
• What is capacity of client to engage in self-soothing
behaviors?
– Lack of self-soothing suggests failure in capacity for transmuting
internalizations
– Transmuting internalizations mean ability to take on care providers
mirroring and idealizing when by oneself
• Much emphasis on therapist’s awareness of dynamics within
the transference/countertransference dynamics
– What is it that the client appears to need through the relationship?
Self Psychology Assessment: Diagnostic Criteria
• Narcissistic disorder( DSM IV): pervasive pattern of grandiosity,
need for admiration and lack of empathy that begins by early
adulthood
• Diagnostic criteria for narcissistic personality disorder:
– Grandiose sense of self importance
– Preoccupied with fantasies of unlimited success, power, brilliance, beauty
or ideal love
– Believe is one’s specialness and sense of only being understood b y other
special people
– Requires excessive admiration
– Sense of entitlement
– Interpersonally exploitative
– Lacks empathy
– Envious of others and believes other are envious of him
– Demonstrates arrogant, haughty behaviors or attitudes
Self Psychology Interventions
• Therapeutic goal: building internal psychic structures that
enable the individual to move from early , narcissistic or selfreferenced needs to attachments based on empathic
connections appropriate to developmental stage
• Via empathy as the tool, therapist gathers psychological
information
– “vicarious introspection” is the ability of the therapist to investigate
the inner world of the patient
• The goal of treatment is to enhance the patient’s self esteem
and restore her to a level of functioning prior to the loss of a
self-object
– Loss of a self-object weakens the sense of self and engenders
symptomology
Self Psychology Interventions (cont.)
• Through empathic investigation, therapist provides mirroring,
idealizing and twinship functions
• Therapist offers needed self-object responsiveness which
restores self-cohesion, and decreases symptomology
• Therapist helps patient appreciate the legitimacy of
needs/feelings , promoting self awareness, understanding and
self-acceptance
• Exclusive focus on client’s experience not helpful
– Therapist needs to share her experience of the client, with the client
Self Psychology Interventions (cont.)
• By merging with calmness and competence of therapist, via
transmuting internalizations client can develop capacity to:
– Self soothe
– Self-comfort
– Empathize
• “Empathic failures” by therapist enable client to tolerate
frustration and generate more mature psychic structures
• Rather than earlier needs for mirroring, idealizing and
twinship, client can choose emotionally sustaining selfobjects and provide such experiences to others