Self Psychology is surprise surprise, a psychotherapy process that focuses on the self of the individual.
What is a self? Good question.
William James describes a self as “that which we think and feel ourselves to be”. In many ways, it sounds simple or obvious, but this deceptively simple statement is quite profound. How do we feel ourselves? How do we think about our self? In other words what is our relationship to our Self?)
This relationship to Self is the defining foundation of our psychological health.
Self Psychology was developed primarily as a tool for treating people with:
- Personality disorders
It is also very useful for treating:
- A complex post-traumatic stress disorder
- Major depression
Self-psychology would argue that these presentations relate to disorders of Self.
What is the Self?
In the understanding and management of self there exist a recurring set of questions:
1. What are our emotions and feelings?
2. What is our relationship to our emotions and feelings?
For some patients, this fundamental process of emotional recognition is often limited. For example, they can feel anger but cannot identify sadness, distress, fear, joy, etc. Or there may exist just one on/off switch. It’s just from zero to one hundred, from mild irritation to rage with no emotional gradient. Or from sad to deep despairing anguish.
3. What happens to us when we are under stress-big stress, small stress? Do we get angry? Do we fall apart? Do we get drunk, stoned, have sex, get depressed, behaviourally or emotionally act out?
4. Do we have a sense of ourselves in time (past present future)? Can we learn from the past to modify our future? Can we plan and achieve? Or do we stumble through and watch the day’s, weeks and years tumble by? Making the same mistakes over and over.
5. Do we have a sense of being the authors of our own experience (I am avoiding using the word or concept of “control” because of the negative connotations, but it is in that realm). Are we the drivers of the bus or do we find ourselves buffeted about by circumstance-others needs/anxieties/fear/control issues? Or do we have a sense of who we are, what we want and how we can get it while maintaining an appropriate moral/ethical position?
These factors relate to a concept of self-identity. From which precedes the common question of “who am I?” A simple yet profound question.
The history of Self Psychology
Self-psychology was developed by Heinz Kohut. He was a German practising in the USA. He was known as Mr Psychoanalysis (no joke).
Famously, within psychoanalytic circles at least, he was treating a patient who was diagnosed with Borderline Personality disorder and she said to him during one session ”You’re ruining my analysis with your interpretations!!”
This struck him because he knew, or thought he knew, exactly what he was doing. He was doing what most analysts had done before him, interpreting the transferential material. This process is fundamental to the psychoanalytic position its goes something like this: the patient says “I want to leave my husband because he doesn’t love me any more” and the analyst will put that in context of the therapeutic relationship and he will reply “You think you are unworthy of my love and that I want to leave you”. So the therapeutic relationship is reflected in the external relationship. The theory suggests that the highlighting of what is happening with the analytic situation releases repressed unconscious material that can now be worked through and integrated.
This approach can be very effective when dealing with a neurotic anxious patient but when the developmental disruption was much earlier, and usually much more severe, the properties that bind the self together are much less secure. They are less tethered to that sense of self.
The earlier the developmental disruption the more likely the personality of the individual is less able to self-soothe and it’s less likely the individual is able to tolerate environmental stressors. They are more likely to feel in a state of chaos-circling around confusion, anger, pain-anguish, loss or feelings of emptiness. One of the primary outcomes of this state is seen in fractured and highly difficult relationships that permeate all aspects of the individual’s life.
The process of Self Psychology
Self-psychology developed the concept of being “experience near” as opposed to “experience distant”. Experience distant reflecting the potentially judgmental position. Experience near reflecting the internal experience of the individual-empathy.
Within Self Psychology empathy is the primary tool. It allows the therapist to enter the experience of the person at their level of experience. For example, if someone struggles to identify their sadness the therapist may see the facial display of sadness on the person but instead of saying “you’re sad” they might say “I wonder if you feel a bit down right now”. This might seem like a too subtle distinction but it is a very important one.
The person’s response invariably will let the therapist know if they have pitched the observation at the correct level. If the person takes what the therapist has said and expands on it, even a little bit, the empathic observation fits with the patient’s current self-state. But (and this is a big “but”) if the patient doesn’t respond or becomes confused or silent or whatever the therapist will know that the observation is out of tune with the patients self-state, and has, in fact, been unempathic. Getting in tune with the patient at the patients level is the goal of the Self Psychologist.
This idea of getting in tune with the persons self-state is the central building block of this approach.
This approach is especially suited to dealing with people with personality disorders. People with personality disorders can feel very turbulent. They often feel that everything is in chaos, relationships form and dissolve destructively, moods swing from high to low and back again with a destabilising rapidity, constant feelings of emptiness, suicidal thoughts, chronic feelings of being abandoned and unresolvable shame and guilt. For this person the environment that they are in needs to be very stable, very predictable, and very safe for them to feel anything close to an ongoing feeling of comfort or peace.
The experience near approach is very suited to these people. Often they feel misunderstood, judged, belittled, shamed, and less-than because it reflects directly the environment in which they grew up in. this may include some of the following:
- Consistent exposure to unsafe parents with little or no chance of escape.
- The inconsistency of safe parental engagement combined with an impinging uncontained negative emotional exposure. (chronic anger/shame attacks)
- Disinterest in the actuality of the infant with more focus on the parents own disengaged and chaotic self –state, disallows the infant to grow with a functioning self-regulating self-aware self-state. (The infants self gets pushed aside and is filled with the toxic self of the parent).
- As time goes on the infant’s self is sequestered to the background-this is how their feelings can feel foreign or nonexistent-feelings of emptiness dominate-anger and rage take over every emotional experience-there is no passing of time just space filled with chronic despair and unhappiness.
Invariably as a counter to this when these children become older they strive for an environmental context that is totally controlled, obsessively measured and contained. In other words, if friends, relatives, and workmates aren’t focused on them in a very specific demonstrably soothing way they can feel very threatened, very unsafe. (Just like when they were children/infants).
Therapeutic outcomes of Self Psychology
As the therapy proceeds the empathic position of the therapist allows the therapeutic relationship to develop. Out of this position the patients self-expands. No or little feelings expand into a more sophisticated emotional awareness. “I don’t know how I feel!” turns into more specific self statements like “I feel this” or “I think that.” the persons self has been turned into and allowed to expand, first by acknowledging its existence (however small or remote it may feel) and then supporting its growth through self-awareness.
The other significant marker of change is the quality of close personal relationships. There exists within a greater capacity to tolerate relational dynamics that before treatment may have been overwhelming or injurious to the persons self. For example, arranging a social event that gets cancelled- before treatment, the patient may have an uncontained reaction to this event and accuse the other of purposely abandoning them-where the reason for the cancellation could be something much more benign like genuine sickness or having to work late or a car breaking down. After treatment, it is much easier for the patient to accept and understand that sometimes things happen that are beyond anybody’s control and a negative outcome is not evidence of hatred.
Treating people who have been diagnosed with personality disorders can be very challenging. This methodology proves to be very useful in facilitating the movement from fractured chaos to a more stabilised integrated and expansive sense of self.
It is therefore very useful in dealing with many presentations not only personality disorders. The sustained empathic position is a highly effective tool as is the idea of “self” as a psychological and therapeutic model.
As with any psychological theory, one can get very lost in the complexity (especially a psychoanalytically based relational psychotherapy) so I have tried to keep to the main points of this approach.
As a point of reference for this paper, I have attempted to stay with the points that manifest in my practice every day and the fundamental approach that facilitates the therapeutic process.