Clarification of projective identification

Article Abstract:

The psychological mechanism of projection involves an externalization by which an individual attributes unacceptable or unrecognized tendencies and wishes of his own onto others. Although the concept of projective identification is linked to projection, it has been described differently by various theorists and remains an elusive and difficult concept. Current related theories are discussed, and a broad reference model which defines projective identification as a three-step process is presented. Step one is basically a projection. Projection is thought to imply a blurring of one's self-representation with the recipient's (object's). For example, if an anxious man does or says things to make his girlfriend feel anxious (projects), then complains about her anxiety, it implies a blurring between an anxious self-representation and an anxious object representation. As long as she contains the anxiety, he can feel calm and competent. Step two requires control over the recipient of the projection (e.g. if the anxious man wishes to remain feeling calm, he must pressure and manipulate his girlfriend so that she continues to feel and think in accordance with his original projection). In step three, the projection is returned to the projector (reinternalized) after it has been psychologically processed and altered by the recipient. The returned version of the projection is highly dependent on the psychological makeup of the recipient. In some cases, the processed version may be modified so that the projector may be able to tolerate the original unacceptable feeling (such as anxiety). Case examples are provided to clarify the three steps. It is posited that in psychotherapy, accumulative returned versions of projections which have been modified by the therapist can lead to more positive self-regard and self-tolerance in patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Terminology, Projection (Psychology), Identification (Psychology)

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Exploring the meanings of substance abuse: an important dimension of early work with borderline patients

Article Abstract:

Many patients with borderline personality disorders also are involved in substance abuse. These two situations are frequently regarded as being independent of each other and are treated separately. Others believe that the patient's personality disorder causes the substance abuse behavior and represents an attempt by the patient at self-medication. This self-medication hypothesis is examined with a review of three cases. Evaluations were made of three borderline patients who used substances such as drugs or alcohol to manage their symptoms. It is recommended that, in treating these types of patients, the underlying psychopathology be focused on, with an emphasis on understanding the personality structure of these individuals. This approach will provide some clinical advantages. If these patients are viewed primarily as borderline personalities, clinicians may be more interested in them. Less emphasis will be directed to the substance abuse of the patient and psychologically relevant topics will receive more time; this will also interest the therapist more. Also, if psychological reasons for substance abuse are stressed, the patients will be more inclined to talk; patients are often less reluctant to discuss their feelings than their substance use. An awareness of his internal state will help the patient to develop an understanding of why he has turned to substance abuse. It is recommended that patients be detoxified prior to treatment. In conclusion, the authors feel that substance abuse should be considered a symptom of an underlying disorder, such as borderline personality, and clinical evaluation should be approached in this way. Treatment strategies and the effectiveness of this approach are not discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Causes of, Substance abuse, Medication errors

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Update on psychodynamic thinking regarding the diagnosis of the borderline patient

Article Abstract:

A new, expanded model of the ego-psychological approach to diagnosing the patient with borderline personality disorder is presented. For practical reasons, the model attempts to be compatible with the criteria for the disorder outlined in the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R), while providing a psychodynamic framework that is generally acceptable. In this model, the borderline patient's ego mechanisms are evaluated according to the ego's relative strengths and weaknesses. Strengths include relatively normal response in reality testing, thought processes, interpersonal relations, and adaptation to reality; weaknesses relate to low tolerance, primitive ego defenses, incoherent or vague sense of identity, and emotional instability. The author claims that the ego-psychological approach can be used either broadly or narrowly in classifying borderline patients. In addition to identifying relative ego strengths and weaknesses, the differences between borderline patients and those with similar conditions, such as normal-neurotics, narcissists, and psychotics, are outlined. A review of previous definitions and concepts of the borderline patient is also presented. (Consumer Summary produced by Reliance Medical Information, Inc.)

Models, Analysis, Diagnosis, Ego (Psychology)

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