This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Blatt, S. J. Articles by Auerbach, J. S. Search for Related Content PubMed PubMed Citation Articles by Blatt, S. J. Articles by Auerbach, J. S. Pubmed/NCBI databases Medline Plus Health Information Mental Health Schizophrenia Social Bookmarking                   What's this?

Mental Representation, Severe Psychopathology, and the Therapeutic Process

Psychiatry and Psychology, Yale University, Sidney.blatt{at}yale.edu, Department of Psychiatry, Yale University School of Medicine, Western New England Institute for Psychoanalysis

John S. Auerbach

College of Medicine at East Tennessee State University, Department of Psychiatry, Yale University School of Medicine

Mental representation is a central construct in psychological development. A method for assessing the developmental level of representation of self and significant figures is described, and changes in the developmental level of these representations are reported in a sample of forty seriously disturbed, treatment-resistant adolescents and young adults in intensive, psychoanalytically oriented inpatient treatment lasting more than a year. Increased differentiation-relatedness of descriptions of self and significant figures (mother, father, and therapist) was significantly correlated with improved clinical functioning. Over the course of treatment, representations moved from descriptions of self and significant figures dominated by polarization and splitting to representations involving the emergence and consolidation of object constancy. Improved clinical functioning was correlated with more positive descriptions of self, mother, and therapist and, paradoxically, with more negative descriptions of father. Two prototypical case studies of these self- and significant-figure descriptions are presented, one for a borderline patient and one for a schizophrenic. Intense negative affect, predominantly anger, and a relative preservation of self-reflexivity are typical of the self- and object representations of borderline individuals, but representations in schizophrenic individuals are characterized by affective muting and marked disturbance in reflexive self-awareness. The assessment of cognitive-affective schemas of self and significant others provides a method for investigating therapeutic change and for identifying important differences among various forms of psychopathology.

Journal of the American Psychoanalytic Association, Vol. 49, No. 1, 113-159 (2001)
DOI: 10.1177/00030651010490010201


CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?