Self Psychology and Psychosis

Nowhere do psychoanalysts and psychotherapists of all persuasions more clearly find distortions of the self than those they encounter who are caught in the throes of psychosis. As hallucinations, delusions and thought... [ view full abstract ]

Nowhere do psychoanalysts and psychotherapists of all persuasions more clearly find distortions of the self than those they encounter who are caught in the throes of psychosis. As hallucinations, delusions and thought disorder take hold, patients struggle mightily to regain their footing. Here, a positive coloring of the self, a temporal continuity withi the self and a cohesiveness of the slef are frequently lost or stand in immediate danger of dissolution. Where could we finda better place for an understanding of the essence of the self than in these x-rays of a shattered mind?

Throughout the history of psychoanalysis, references to and understandings of the self are almost too numerous to count. Yet, what makes psychoanalytic self psychology so compelling as a framework for understanding psychosis is how it links together the early recognition of narcissistic impairment in these disorders to the "experience-near" focus which is the hallmark of self psychology. Fredu, early on, had eschewed the wisdom of using psychoanalysis as a vehicle for cure in the "narcissistic neuroses" and even Kohut took years before he embraced the idea that psychoanalysis could have a salutary effect on psychosis. this panel will review the key ideas of forward edge transference, fears of retraumatization, the centrality of affect in the body/mind, vitality affect attunement, the establishment of mirroring, idealizing and twinship self object experiencing, the vertical splt, the therapeutic mechanism of action of disruption and repair and finally, the idea of enlistment of a vitalizing selfobject mileu in staying out of psychosis.