Self psychology and the psychotherapy of psychotic patients: A case study

Abstract

Self psychology has previously been employed in describing the treatment of narcissistic personality disorders. This article discusses the clinical application of concepts of self psychology to the psychotherapy of a psychotic patient. Empathy and the concept of empathic failure were very helpful in conceptualizing the therapeutic process. The two selfobject transferences of mirroring and idealization were both present in this case, and the recognition and interpretation of these transferences were critical in understanding the therapeutic process. The patient's delusional experiences receded and began to be less disruptive as the selfobject transferences emerged and remained in place. The resurgence of delusional material was usually indicative of a failure of empathy and a disruption of the selfobject transference. This patient's ability to regulate his anxiety and calm himself was considerably enhanced during the course of treatment. Self psychology and the understanding it provides proved to be of great value in the treatment of this patient and has wide applicability to the psychotherapy of psychosis.