The place of ego building work in psychotherapy with children

Ego building is essentially a name given to a variety of interventions used to support an ego hampered by regression or deviation. The term has its roots in the concept of ego support but evolved specifically as a technical term in contemporary ego psychology closely connected with the developmental theory of separation individuation. Using four vignettes of psychotherapy work with children all of whom suffered from unresolved conflicts and developmental interferences from the separation-individuation process, an attempt is made to illustrate the technical place of ego building in psychotherapy with children. It is suggested that the use of ego building, particularly verbalizing adaptive aims facilitates an alliance, supports a safety feeling and positive self-esteem. This contributes to providing a treatment experience that reduces over-stimulation and anxiety and frees the expression and understanding of aggression which ultimately promotes separation-individuation.in private practice.This paper was presented at the Conference on the Continuing Evolution of Psychoanalytic Thought: Infancy to Adulthood, N.Y.C., Nov. 1990., sponsored by the Committee on Psychoanalysis of the National Federation of Societies for Clinical Social Work.     

The experience of divorce for the psychotherapy patient—A developmental perspective

In this article the dynamics of divorce are discussed from the perspective of psychoanalytic developmental psychology. This theoretical framework is used to highlight and to explain some typical internal and external responses of psychotherapy patients for whom divorce is an issue. A therapeutic stance is suggested that enables the patient to understand the connection between his or her marital situation, early life experience, and past developmental problems. The patient's preoccupation with the unsatisfactory marital relationship can serve as a catalyst for the strengthening of the patient's overall ego functioning. This article demonstrates Kris' (1951) concept that the material at the psychic surface-in this case divorce-needs to be explored in such a way that the patient's ego is enlisted in his or her total growth.     

One or Two Session Psychotherapy with University Students

Abstract

One or two session psychotherapy has a long history, and well-known practitioners have made use of it. Favorable results have been reasonably well documented. Often it has been done out of necessity, less frequently because all were satisfied that it sufficed. Problems that lend themselves to one or two sessions are: psychological work which has already been done but for which affirmation is sought, requests for diagnostic evaluation, and less often but more challenging, intrapsychic conflict requiring uncovering work. Patient characteristics and therapist attitudes are discussed. For one or two sessions of treatment to occur the therapist must be alert to the possibility, must assess quickly when a case is in hand, set the process in motion, and determine a satisfactory stopping point. It is suggested that the college population lends itself especially well to one or two sessions of psychotherapy, not only from the standpoint of the limited resources of many student health services but also for the ego strengthening potential it provides.     

Treatment of a four-year-old and her mother

Treatment approaches that only address very young children's environments or their family systems and exclude the child are frequently insufficient. Often direct psychotherapy of the preschool child should be the treatment of choice. This article uses a theoretical perspective that integrates ego psychology and systems theory to enable assessment and treatment from a dual perspective. Case illustration is presented.     

Out from under: Countertransference in the treatment of the masochistic youngster

The masochistic youngster tends to evoke in the treatment situation precisely the responses which impede progress. This article discusses countertransference issues and the dynamics of masochism, understood as a protection for a frightened ego rather than merely a willful manipulation. Difficulties in and approaches to dealing with the environment of children in residential treatment are presented.Ms. Smaldino is currently in private practice and supervisor of psychotherapy for the New Hope Guild.     

Group psychotherapy with legally blind patients

Psychological adjustment to disability involves recognition of the life changes and losses brought about by illness and a restructuring of the ego that will allow for the incorporation of one's self-image to include the person's disability. This paper addresses itself specifically to the difficulties blind patients have in developing a psychological acceptance of their blindness, and the way in which time-limited group psychotherapy can facilitate this process. The author discusses in detail the following issues: establishing a group, group cohesion, transference, countertransference, the mourning process, therapeutic tasks, and treatment interventions. The author's results indicate that time-limited group psychotherapy offers several distinct advantages over individual treatment, and that this modality should be seriously considered when working with patients suffering severe medical losses.     

The growth of psychoanalytic developmental psychology and the application of technique

The growth of ego psychology theory from Freud to the present has stimulated interest in the development of special techniques of a psychotherapy based on that theory—techniques that have evolved from but are different than those of psychoanalysis proper. Modifications in technical procedures address themselves to developmental failures rather than the resolution of the oedipal conflict. The newer concept of the borderline diagnostic category is understood in terms of the contributions of Kernberg and the Blancks, particularly as it is integrated with Mahler's developmental theory. Clinical examples are presented of some specific techniques of what is now called psychoanalytic developmental psychology.     

Unpacking Burt’s constraint measure

Burt (1992) proposed two principal measures of structural holes, effective size and constraint. However, the formulas describing the measures are somewhat opaque and have led to a certain amount of confusion. Borgatti (1997) showed that, for binary data, the effective size formula could be written very simply as degree (ego network size) minus average degree of alters within the ego network. The present paper presents an analogous reformulation of the constraint measure. We also derive minima and maxima for constraint, showing that, for small ego networks, constraint can be larger than one, and for larger ego networks, constraint cannot get as large as one. We also show that for networks with more than seven alters, the maximum constraint does not occur in a maximally dense or closed network, but rather in a relatively sparse “shadow ego network”, which is a network that contains an alter (the shadow ego) that is connected to every other alter, and where no other alter-alter ties exist.     

Integration and alternatives: Some current issues in psychoanalytic theory

The first great bridge between psychoanalysis and social work came with the concepts of ego psychology which provided a synthesis between the worlds of the social order and the psychological depths. Current psychoanalytic theorists now question whether any one psychological theory is sufficient to describe the complexity of human experience, and suggest that each theory has a piece of the truth because it states something that is correct about the patient at a particular time in the treatment. Adherence to multiple theories makes a complex problem for the clinical practitioner, who must decide from which perspective to respond to the clinical material of the moment. Psychoanalytic theorists are also questioning the degree to which it is actually the content of the therapist's interpretations which brings about change in the patient. This article suggests that these developments in psychoanalysis, with their emphasis on therapeutic flexibility and the importance of the relationship will renew and reinvigorate the bridge between psychoanalysis and clinical social work.An earlier version of this paper was presented at the First Clinical Conference of the National Federation of Societies for Clinical Social work.     

The differential use of metaphor in psychotherapy

Metaphor is seen to play a significant role in psychoanalytic theory and technique. While acknowledging this view, this paper examines the differences in which individuals of varying developmental profiles, experience, comprehend and use metaphor in the context of psychotherapy. Differences in the capacity to play, adaptively regress, regulate affect, maintain ego boundaries, and symbolize, are found to affect capacities to employ those figures of speech in words or phrases literally denoting one type of object or idea but used in place of others by suggesting likenesses or analogies. A rationale for differential use of interventions involving metaphor is offered.     

Exploration of the reasons for dropping out of psychotherapy: A qualitative study

Elucidating the reasons for dropping out of psychotherapy can lead to the development of interventions aimed at reducing patient drop out. The present study aimed to explore patients’ reasons for dropping out of psychotherapy in Kermanshah, Iran. The present qualitative study was performed using conventional content analysis. The current sample included 15 participants consisting of 7 patients who dropped out of psychotherapy and 8 psychotherapists who have previously experienced patient dropout. A semi-structured interview was used for data collection. All interviews were audio recorded and subsequently transcribed. Content analysis using constant comparisons was performed for transcribed interviews. Four main categories emerged as reasons for dropping out of psychotherapy: dissatisfaction with the quality of psychotherapy, financial problems in psychotherapy, unprepared socio-cultural context of psychotherapy, and psychotherapy as a non-user friendly treatment. Additionally, specific subcategories within each main category were documented. The results revealed distinct reasons for psychotherapy drop out in the current Iranian-based sample. These identified reasons should be considered and addressed at the onset of treatment as well as in the development of formal interventions aimed at reducing dropout. Further research investigating the antecedents leading to patient drop out is recommended.     

The validity and use of the family-of-origin scale

This study explores the Family-of-Origin Scale (FOS) with regard to its validity and potential use. Subjects included 100 adults currently in psychotherapy, 100 who were not, 32 who previously had sought treatment, and 41 college students. Between-group comparisons, correlations with both the 16PF and a scale of authoritarianism, factor analyses of both the patient and nonpatient FOS responses, and a review of patient feedback revealed several significant results. The FOS differentiates between patients and nonpatients, but it measures only one general factor and delivers little information. Therefore, it has little value as a research instrument, but it may be a useful adjunct to psychotherapy in individual cases.     

Ego Development,Ego Strengths,and Ethnic Identity Among First Nation Adolescents

Three conceptualizations of psychosocial development were investigated among Canadian First Nation adolescents. Loevinger's social cognitive model of ego development reflects the way in which an individual views the self and social reality. From Eriksonian theory, ego strengths refer to the emergent values or outcomes that represent resolution of the eight psychosocial stages of development, and ethnic identity is a domain of personal identity with special relevance for minorities. As expected, age and biological gender differences were found for ego development. Associations between ego development and ego strengths were supported as were age differences in ethnic identity status. Traditional students (strongly identified with indigenous culture) demonstrated greater ego strengths than bicultural (identified with both their own and mainstream cultures) adolescents.     

Categories for Exchange Analysis in Small Groups: With an Illustration from Group Psychotherapy*

Longabaugh's category system for coding interpersonal behavior in mother-child dyads as social exchange is revised for use in small group analysis by using a more comprehensive set of content categories based on Parsonian functional (AGIL) theory. The notation for exchange analysis is illustrated with an extract from a group psychotherapy session.     

Cultural Contributors to Ego‐Resiliency and Associations with Depressive Problems in Midwestern Latino Youth

Ego‐resiliency is an enduring psychological construct reflecting how individuals‐adapt to environmental stressors, conflict, and change which is linked to positive adjustment. Ego‐resiliency has not been examined in Latino youth, despite their high risk for mental health problems; nor have cultural precursors to ego‐resiliency been examined. Given these gaps, we examined whether familism values (supportive, obligation, and referent) were associated with ego‐resiliency and, in turn, depressive problems in Latino adolescents across two time points (N = 123, mean age = 11.53). Results indicated that supportive familism was associated positively with ego‐resiliency and negatively with depressive problems. Ego‐resiliency negatively predicted depressive problems across time, controlling for prior levels, suggesting that ego‐resiliency may have long‐term effects on depressive problems in Latino youth.     

Cross Cultural Perspectives in Treating the Gay Male Trauma Survivor

Summary

In recent years, there has been an increased emphasis on cultural considerations in psychotherapeutic treatment. Sound psychotherapy is ideally culturally sensitive and concerned with the context within which the client developed and exists. At the same time it is often difficult for many clinicians to navigate the cultural within the psychological framework. When both patient and clinician share more than one language in common, there are a variety of subtle issues that surface. In psychotherapy, “coordinate bilinguals,” those who learn their languages separately, during different developmental stages and contexts, tend to have greater access to their emotional experiences within their first language. When the client presents with a sexual trauma history, the language spoken during the abuse will also have an effect on the language used in the psychotherapy. The case history of Lucio, a Latino gay male, is discussed in terms of the cultural and psychological elements of his treatment by a bilingual North American therapist. This therapist's psychotherapeutic conceptualizations and treatment approaches are examined and reviewed in a written dialogue/ discussion with a Latino psychologist.     

Self psychology and the psychotherapy of psychotic patients: A case study

Self psychology has previously been employed in describing the treatment of narcissistic personality disorders. This article discusses the clinical application of concepts of self psychology to the psychotherapy of a psychotic patient. Empathy and the concept of empathic failure were very helpful in conceptualizing the therapeutic process. The two selfobject transferences of mirroring and idealization were both present in this case, and the recognition and interpretation of these transferences were critical in understanding the therapeutic process. The patient's delusional experiences receded and began to be less disruptive as the selfobject transferences emerged and remained in place. The resurgence of delusional material was usually indicative of a failure of empathy and a disruption of the selfobject transference. This patient's ability to regulate his anxiety and calm himself was considerably enhanced during the course of treatment. Self psychology and the understanding it provides proved to be of great value in the treatment of this patient and has wide applicability to the psychotherapy of psychosis.     

Therapy of the Conscience: Technical Recommendations for Working on the Harsh Superego of the Patient

An indispensable goal of intensive psychotherapy is to modify areas of the superego which are unreasonably harsh and punitive—yet, surprisingly little is written on this topic. In this paper, after discussing various aspects of the superego, I recommend an active treatment technique which involves educating the patient, over time, about how pervasive and punitive is—for lack of a better word—the conscience—of his or her mind. During this process, one can expect a softening and lessening of the patient's punitive superego and an expansion of the patient's benign or benevolent superego, as the patient begins to identify with and introject more of the compassionate attitudes which have been imparted and experienced in the intimate relationship of psychotherapy.     

Ego network betweenness

In this paper, we look at the betweenness centrality of ego in an ego network. We discuss the issue of normalization and develop an efficient and simple algorithm for calculating the betweenness score. We then examine the relationship between the ego betweenness and the betweenness of the actor in the whole network. Whereas, we can show that there is no theoretical link between the two we undertake a simulation study, which indicates that the local ego betweenness is highly correlated with the betweenness of the actor in the complete network.     

An Examination of the Historical and Current Perceptions of Love in the Psychotherapeutic Dyad

Since the initial dialogues on the treatment relationship began, a hierarchical structure of our profession was set forth. This was largely created by Sigmund Freud, often considered the initiator of psychotherapy and psychoanalysis. Our profession was characterized by a neutral, distant practitioner who performed his work upon an unknowing patient. The reality of the multiple complexities of this relationship has become clearer over time. This paper seeks to examine the steps that have taken us from the initially distant and non-mutual psychotherapeutic relationship to the more egalitarian and co-created format that many clinicians are working in today. Love, in both its absence and presence, is examined as a central concept and tenet of psychotherapy.