A discordant consolidation of the self in a late adolescent male

A distinction is made between the cohesive self and the nuclear self. The latter represents a consolidation of the self that occurs in late adolescence and that results from the integration of life goals and ambitions into a coherent narrative. This paper presents a case in which a pseudo-consolidation appears to have occurred in an adolescent with an undiagnosed learning disability.Ms. Silbar is in private practice.     

Reactions of Adolescents to Their Therapist’s Serious Illness

Few publications exist on the reactions of children and adolescents to the serious illness of their therapist. This paper reviews the literature on the responses of adult patient’s and presents three vignettes of adolescents who were in treatment when their therapist was diagnosed with cancer. We discuss some of the theoretical and clinical issues these cases present and conclude that openly sharing an appropriate amount of information with the adolescents appears to further rather than impede the therapeutic process.     

Borderline conditions: A perspective from self psychology

This article begins with a distinction between the extrospective and the introspective points of view as they apply to understanding borderline conditions. The literature is reviewd using this distinction to organize the contributions that have been made to date. Two definitions of borderline conditions are given. The introspective point of view is used to further define the experience of patients with that condition and the dynamics as understood through self psychology.     

Some theoretical considerations on confidential adoption part IV: Countertransference

Psychological self-awareness is as essential to the maturation of one's professional self as is the development of theoretical and clinical expertise in child placement. This paper represents a first published attempt at examining countertransference in adoption. The focus is within the context of confidential adoptions, which the authors believe is more child-focused and intrapsychically based than the current experimentation with open adoptions. A distinction is made between countertransference and non-countertransference issues. Countertransference responses are divided into Racker's three categories: the concordant; the complementary; and the disjunctive. Clinical data illustrates these responses in actual practice from the perspective of confidential adoptions.This paper was presented in 1985 before the Illinois Infant Mental Health Association, National Society of Clinical Social Workers, and the National Association of Social Workers National Professional Symposium.This is the last of a series. Parts I, II, and III were published in Vol. 2, Nos. 1, 2, and 3.     

Perceptual deficits and self-esteem in adolescence

This paper attempts to conceptualize the dynamics of selfesteem in an adolescent suffering from a perceptual deficit. The interrelationship between the deficit and the development of self-esteem is discussed from two points of view, that of traditional ego psychology and that of the psychology of the self. In the case illustration given, the treatment methods were heavily influenced by the work of Heinz Kohut and by the insights provided by his psychology of the self.     

Adolescent development: A view from self psychology

Self psychology does not have a distinctive developmental theory. This paper discusses some of the methodological problems related to the articulation of such a theory, and goes on to outline a theory of adolescent development that is consistent with the tenets of self psychology. The major points made are: Adolescence does not represent a recapitulation of prior phase of development, the sense of self cohesion is fundamental to a healthy sense of self, and the culmination of the adolescent process is the formation of a nuclear sense of self.private practice     

Self psychology and countertransference in the treatment of children

The issues of countertransference in the treatment of children have received far less attention than those arising in the treatment of adults. This paper attempts to begin to redress this imbalance. Some of the major countertransferences in work with children are addressed, and the perspective of self psychology is presented. In the conclusion some thoughts are offered regarding some of the narcissistic injuries therapists must confront in dealing with issues of countertransference.     

Neurocognitive differences,self cohesion,and incoherent self narratives

This paper attempts to develop a framework through which the concepts of neurocognitive delays or deficits (generally referred to as learning disabilities) may be integrated into psychodynamic theory. The impact of these delays or deficits on the developmental dialogue is discussed. The child who suffers from such delays or deficits experiences the world in a unique way forming representations that encode personal meanings. These meanings are integrated into self narratives that have elements of incoherence in them. The incoherences in the self narratives result in the absence of self cohesion.Faculty, Continuing Education and Certificate Program, Smith College School for Social Work; in private practice.     

Spontaneous self disclosures in psychotherapy

The closeness and intensity of feeling that develops between therapist and patient raises complex issues related to the therapist's neutrality, the transference, the countertransference, the therapeutic alliance, and the very essence of the curative aspects of the relationship. The issue of the relationship of self disclosure and the evolving transference, countertransference complex is discussed. It is suggested that on some occasions, the pressure a therapist feels to spontaneously disclose something intimately personal is an indication that the therapeutic role has become reversed and the therapist is using the process to heal a vulnerability in himself or herself. The patient unconsciously participates in the interest of safeguarding the treatment process. In such instances the self disclosure need not interfere with the evolving transference. It may lead to great spontaneity in the process and to opening areas of affect previously unreachable. Self disclosures cannot be viewed as technical innovations to avoid stalemates in clinical practice. Rather, they are facts of our clinical life, facts that must be explained and understood rather than judged and condemned.