Ego Boundaries Research Articles

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.

Developing Emotional Insulation

An important goal of therapy is to help patients develop ego boundaries that are flexible and adaptive. This paper proposes use of the term "insulation barrier" to describe the defensive structure that allows a person to withstand toxic stimuli and also enables nutrient experiences to flow through. There is no better arena in which to develop a serviceable insulation barrier than group therapy. In this setting the insulation deficiencies of both rigid overinsulated patients and oversensitive underinsulated ones are easily diagnosed. The author explicates specific techniques that the therapist may employ to help patients become aware of their limitations and practice ways of reacting to stimuli that make them more receptive to new learning.

The Two Faces of Language Ego

A fair amount of attention has been paid over the years to a unique domain in second language behavior, namely pronunciation. Pronunciation seems to be different from other domains, such as vocabulary, grammar, syntax and idiom. The difference lies in its intractability beyond a certain age. Most people, most of the time, in most circumstances will fail to acquire native pronunciation in a foreign language. Guiora has offered a psychological theory, a theory of inhibition, to account for this phenomenon (Guiora, 1991, 1992). This theory is based on the constructs of language ego and permeability of language ego boundaries. It can account, alone of the contending hypotheses, for both the extreme rigidity and relative flexibility of the pronunciation behavior.The need arises now to develop a general theory that could also explain the reasons why other language domains, such as voca-bulary, syntax, grammar and idiom seem to be governed by rules different from the rules governing pronunciation. In this paper an attempt is made to formulate such a theory, going beyond the psychological theory of pronunciation, and extending it to all language behavior. And perhaps suggesting a theoretical relevance that may go beyond language behavior itself.

Influencing and being influenced: the other side of 'bizarre delusions'. 2. Clinical investigation.

A clinical follow-up lasting from 1 to 6 years on 25 outpatients affected by endogenous psychoses and manifesting ego disorders demonstrates the presence of both activity and passivity experiences in schizophrenias and affective psychoses. No differential diagnosis between the two nosographical groups can be based on the phenomenological characteristics of passivity and activity experiences. Regarding the schizophrenic sample, our observations suggest reconsidering on theoretical grounds the validity of the construct 'loss of ego boundaries'.

Maharishi Ayur-Veda

To the Editor. — I am writing in response to the article on Maharishi Ayur-Veda written by Sharma et al. 1 It was surprising for me to open my weekly issue of JAMA and discover the article written about a practice that has clearly been identified as cultic practice. (I am a psychotherapist who specializes in dealing with individuals who are involved with cults.) While I cannot comment on the medical component of the article, I certainly wish to comment on the psychosocial aspects of the article and the movement. Cults are generally identified by the presence of a living leader, exploitation (financial and sexual being the most common), deception, thought reform, and coercive mind control. In addition, we have knowledge that prolonged and intense periods of meditation (especially in vulnerable individuals) can lead to severe and exacerbated psychopathology. Looseness of associations, sleep deprivation, loosening of ego boundaries, and disintegration

The Use of Meditation in Psychotherapy: A Review of the Literature

This article has explored research to date concerning the efficacy of introducing meditation into the therapeutic setting. I have presented the views of proponents and critics of the relaxation model of meditation and of theories describing the cognitive changes brought about by meditation--for example, Deikman's theory of the deautomatization of consciousness and Delmonte's view that meditation may be utilized to bring about "ascendence," "descendence," and "transcendence." After summarizing psychoanalytic and Jungian arguments against meditation, the writings of several transpersonal psychologists have been cited to demonstrate the differences in how psychotherapy and meditative disciplines conceptualize personal identity, work with unconscious material, and view the experience of emptiness. I conclude that the question of whether meditation should be used in therapy can be answered only by considering what therapeutic goals are being sought in a particular instance and whether or not meditation can reasonably be expected to facilitate achievement of those goals. Meditation may, in some cases, be compatible with, and effective in, promoting the aims of psychotherapy--for example, cognitive and behavioral change, or access to the deep regions of the personal unconscious. In other cases, it may be strongly contraindicated, especially when the therapeutic goal is to strengthen ego boundaries, release powerful emotions, or work through complex relational dynamics--ends which may be more effectively reached through standard psychotherapeutic methods than through meditation. Meditation may be of great value, however, through its capacity to awaken altered states of consciousness that may profoundly reorient an individual's identity, emotional attitude, and sense of wellbeing and purpose in life.

The Creative Person as Maverick

The innate talents that are the essence of creativity are associated with a particular type of character structure. The child's creative potential has to be supported by the infantile milieu, which also happens to have a characteristic stamp. Within this context of personality configurations and developmental antecedents associated with creative ability, there can be considerable variation. I am not postulating a specific or stereotypic creative character. There are, however, certain qualities that can be found in various character types (and can even exist alongside psychopathology) that are often found in creative scientists and perhaps artists as well. I believe the maverick often possesses these character traits and many of the scientists I have had the opportunity of treating proudly considered themselves mavericks. The creative personality is characterized by paradoxes; these cast it in the maverick mold. Possessors of this personality belong and do not belong. They do not break the rules but bend them a little. They are nonconformists but not rebels. They display many features that do not seem to belong together. The paradoxical qualities that dominate the creator's personality and behavior are the outcome of a certain fluidity of character and ego boundaries. The creative process involves a broad range of functioning and traverses various levels of the psyche, frequently reaching down to the very earliest, primary-process-oriented parts of the self. Ego boundaries, in turn, can become quite fluid and permeable, even though they are ordinarily firmly established and well structured. It is this broad spectrum, a prominent feature of the creative process (Giovacchini, 1965, 1971, 1981), that has been often confused with psychopathology. These paradoxical elements are the outcome of an infantile environment that has provided considerable gratification. Again the early milieu of creative personalities may be extremely varied, but there has always been some person or persons who have had a considerable emotional investment in the child. As the developing psyche incorporates and introjects these gratifying and security-establishing experiences, they become amalgamated into the self-representation. In the face of adversity, they provide confidence and reassurance and allow the creator to soothe him- or herself when upset by inner tension. Consequently, creative scientists do not depend so much on the outer world as they do on inner resources. One scientist told me that he could not understand how anyone could ever be bored. Even if he were denied access to his work, he could always find something interesting to do or explore.(ABSTRACT TRUNCATED AT 400 WORDS)

The Two Faces of Language Ego

A fair amount of attention has been paid over the years to a unique domain in second language behavior, namely pronunciation. Pronunciation seems to be different from other domains, such as vocabulary, grammar, syntax and idiom. The difference lies in its intractability beyond a certain age. Most people, most of the time, in most circumstances will fail to acquire native pronunciation in a foreign language. Guiora has offered a psychological theory, a theory of inhibition, to account for this phenomenon (Guiora, 1991, 1992). This theory is based on the constructs of language ego and permeability of language ego boundaries. It can account, alone of the contending hypotheses, for both the extreme rigidity and relative flexibility of the pronunciation behavior. The need arises now to develop a general theory that could also explain the reasons why other language domains, such as voca-bulary, syntax, grammar and idiom seem to be governed by rules different from the rules governing pronunciation. In this paper an attempt is made to formulate such a theory, going beyond the psychological theory of pronunciation, and extending it to all language behavior. And perhaps suggesting a theoretical relevance that may go beyond language behavior itself.

An Overview of the Psychopathology of Perception: First Rank Symptoms as a Localizing Sign in Schizophrenia

Schneider considered that first rank symptoms always signify schizophrenia. They appear to have in common permeability of the barrier between the individual and his environment, or a loss of ego boundaries. They may be a manifestation of a specific disturbance which may be caused pathologically by a limbic lesion in the dominant hemisphere.

Relationship of Schizophrenia to the Environment

Attention was first drawn to the importance of this topic by Schneider (1957) when he proposed that some of his first-rank symptoms could be grouped together under the concept of ‘permeability’ of the barrier between the individual and his/her environment — the ‘loss of ego boundaries’. Similarly, in a recent series of papers (Strauss et al, 1987), the essence of schizophrenia was conceptualised in the processes of interaction between biology, behaviour, and environment. The two main syndromes — acute and chronic — can each be precipitated or made worse by environmental factors, and although most patients with the negative syndrome appear to show some irreducible impairment, poverty of the social environment has been found to worsen their condition, while on the other hand, a moderate degree of social stimulation promotes relative improvement (Wing, 1987).

Anticipatory Scenarios in Psychotherapy

Patients bring certain expectations to psychotherapy. These unvoiced, often unconscious, reservations affect the transference relationship and give rise to resistances. Such resistances may take the form of self-containment through withdrawl, reflecting a fear of exposure or reluctance to change. Fear of self-disclosure can take the form of anticipatory projections of a paranoid type, and intellectualized struggle of wills, denying the legitimacy of the therapist, and extreme constriction lest the patient "destroy" the therapist by his anger. Reluctance to change expresses itself through impermeability of inner and outer ego boundaries. Essentially, the patient avoids growth either through narcissistic identification with the therapist, or by submitting to the dictates of a stern superego that equates increased freedom and spontaneity with the "bad" me.

The Interminable Refusal to Be a Patient and the Equally Interminable Opposition to End the Non-Treatment Relationship

This effort might be seen as an exploration of therapeutic impotence with a borderline personality in a treatment procedure that went on for a ten-year period. The main body of the paper is on the first four years of treatment which were intense in terms of the frequency of sessions and in terms of the successful efforts of the designated patient to frustrate the therapist and undo the treatment. The orientation of the therapist was based on the theory and technique of psychoanalytic developmental psychology so the patient's negativism and resistance were interpreted as his effort to maintain his ego boundaries. The blows to the therapist's professional narcisism were a measure of the patient's degree of pathological narcissism and low self-esteem.

The psychophysical effects on the dance/movement therapist working with a schizophrenic population

This article is based upon thesis research investigating the psychophysical effects experienced by dance/movement therapists who work closely with patients diagnosed “schizophrenic.” This particular patient population was chosen because of the severe level of regression in ego boundaries and because of the emotional intensity cited in such therapist-patient relationships.

Photography's use as a metaphor of self with stabilized schizophrenic patients

Photography has the ability to concretize and capture a moment so that we, the spectators, can look at the image closely and discover the subtleties and nuances that otherwise often escape our awareness. Because the photograph both duplicates an experience and alters it to our subjective way of seeing, it simultaneously acts as a metaphorical device to incorporate idea. image and symbol into one frame while reflecting the reality-oriented aspect of the world. Also because of this, photography can be used as a therapeutic tool to help schizophrenic patients gain familiarity with their surroundings and firm up their ego boundaries, attain a sense of mastery and control and gain insight into their metaphorical way of thinking and perceiving. My work at a hospital day program with chronic, stable schizophrenic patients has allowed me to view the difficulties this population has in establishing relationships. Arlow and Brenner (1964. p. 22) describe these difficulties as follows:

Regressive experiences in Vietnam veterans: Their relationship to war, post-traumatic symptoms and recovery

Regression has been commonly associated with war and postwar symptomatology. Posttraumatic symptoms have been considered regressive when manifested by chronic dependent behavior or outbursts of primitive, aggressive behavior. Recovery from regressive symptoms may in itself induce regressive experiences since recovery necessarily leads to another change in ego boundaries; rigid or fused boundaries becoming realigned, intact, and flexible. Recovery therefore requires a stable and trusting therapeutic relationship to gradually permit such changes. Psychological treatment of Vietnam veterans often has occurred in phases with immediate management of regressive symptoms occurring during early phases and induction of regressive states has often occurred during late phases to facilitate integration of “split-off” traumatic experiences and emotions.

The use of hypnotic techniques with psychotics.

Abstract This is a review of selected literature related to the hypnotic susceptibility of psychotic patients and the efficacy of utilizing hypnotherapy with this clinical population. Psychotic patients are equally amenable to treatment by hypnosis as any other group of psychopathologies, when certain conceptual and technique considerations are addressed. An egopsychological perspective is utilized to develop the conceptual framework underlying this approach, and a paradigm for hypnotherapeutic intervention is outlined. Consideration is given to induction technique, the management of specific psychotic symptoms, the utilization of hypnotic imagery to strengthen ego boundaries and enhance ego functioning, and the significant manifestations and management of psychotic transference in hypnotherapy.

Dreams, hallucinogenic drug states, and schizophrenia: a psychological and biological comparison.

Many observers have noted similarities between dreams, hallucinogenic drug states, and schizophrenia. In the present article, certain fundamental areas of convergence between the three states are described. Consideration is given to the hallucinogenic drug model of psychosis: the reasons for its initial attractiveness, and the reasons for its current disfavor. The concept of ego boundaries is defined, examined, and applied to the three states. In these states, the ego's capacity to average or synthesize various self-representations into a continuous, coherent self is compromised--leading to an impairment of the reality-oriented secondary process, and the emergence of the florid attributes of the primary process. This can account for many of the familiar characteristics of the three states. Current neurophysiological theories of dream and hallucinogenic drug states are presented, with emphasis upon serotonin neurotransmission. Serotonin appears to play a prominent role in the regulation of these states. The analogy contained in the present article suggests that serotonin may play a role in regulating schizophrenic states as well.

Treatment of Borderline Conditions

An arrest-in-development at the symbiotic stage characterizes borderline conditions. Use of this model, rather than the more familiar triadic Parent-Adult-Child, facilitates work with these clients. Adaptation to powerful figures is not a new response for them. A recognition important for the therapist to retain is that the dynamics and structural aspects of the borderline are consistent, rather than being chaotic as their appearance often suggests. Describes a “cookbook” approach developed for working with borderlines. The approach emphasizes analyzing: 1. observable power plays; 2. acting out; 3. symbiosis, and 4. ego splitting and ego boundaries. Elements of the cookbook are discussed in detail, and illustrative examples provided. Appropriate and effective variations of each element are described, together with the necessary caveats.

Issues of separation related to psychosis in twins

The subject of twins has been surrounded by a mystique from ancient times. The literature on twins is reviewed. A case study of a pair of schizophrenic twins is presented and issues involving separation as a precipitating factor in the decompensation of twins are identified and discussed. Feelings of ambivalence, rivalry, competition, diffusion of ego boundaries, mutual complementariness, and a sense of one being incomplete without the other are reviewed and illustrated in the clinical material. Normal unconscious fantasies in twins may become concrete and delusional in psychotic twins. The inpatient treatment of the two patients emphasizing their separateness was not effective. A change in technique in which they were permitted to resume their mutual clinging and were treated as a unit was followed by resolution of symptoms. In contrast to advice in the literature that attempts be made to separate psychotic twins in order to promote their individuation, the authors suggest that the need for fusion be reinforced in psychotic twins as a therapeutic maneuver during the acute episode.

Screening criteria for the diagnosis of schizophrenia in deaf patients.

Confusion about symptoms of schizophrenia in deaf patients leads to misdiagnosis or failure of diagnosis in some individuals. Consequently, we used Schneider's symptoms of schizophrenia, the International Pilot Study of Schizophrenia's list of discriminating symptoms of schizophrenia, and a symptom checklist from DSM-III to evaluate retrospectively 13 deaf adult schizophrenic patients in whom diagnosis were made using DSM-II. Fifteen signs and symptoms were identified in those schizophrenic patients; six symptoms (poor insight, lability of affect, poverty of content, poor rapport, vagueness, and inability to complete a course of action) are usual in nonpsychotic as well as psychotic deaf patients. The nine "primary" symptoms (loss of ego boundaries, delusional perceptions, restricted affect, illogicality, abnormal explanations, hallucinations, inappropriate affect, remoteness from reality, and ambivalence) are useful screening criteria in the diagnosis of schizophrenia in deaf patients.