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현대정신분석의개입기법
작성자  simonshin 작성일  2017.01.12 18:07 조회수 935 추천 0
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 신현근 박사 강의안: 자아 강화 (Ego Reinforcement)  
 

과목: 현대정신분석의 개입 기법

주제: 자아 강화 (Ego Reinforcement)

강사: 신현근 박사

내용: 강의안

교재: Nagelberg, and Feldman, Y. (1976). Ego reinforcement. In Psychopathology of preoedipal conditions (Spotnitz). Northvale (pp. 137-151), NJ: Jason Aronson, Inc.

 Ego Reinforcement

 

1.    Overview

1.1.  That the schizophrenic individual suffers from a high degree of pathological narcissism has long been known.

1.1.1.    Primarily, this has been regarded, and correctly so, as a manifestation of excessive self-love.

1.1.2.    What was not so well recognized is that the schizophrenic individual attempts to utilize pathological narcissism to strengthen his insulation or protective barrio.

1.2.   To prevent him from being stimulated to injure himself or any other person concerned in that disequilibrium, he child sacrifices his ego (sacrifices ego for object).

1.2.1.    He develops condition of nonfeeling, withdraws, maintains his ego in a “perfect” state from which objectionable and “crazy” impulses must be shut out, and resorts to pathological narcissism in order not to feel, think, and act on his destructive impulses towards others.

1.3.  It is well known that at certain ages children tend to find in other children similar to themselves a sort of ego support.

 

2.    Application in psychotherapy

2.1.  The use of ego reinforcement in treatment requires thorough understanding of the “contact functioning” of the ego, that is, its method of disobeying the implied or stated demand of the therapist that the patient give an emotionally significant account of his life.

2.1.1.    Sooner or later, in the course of the interviews, the child refuses to do so and tries to evoke a response from the therapist.

2.1.2.    The process whereby the therapist reflects these attempts at contact – mirror and reinforce them – is referred to as “ego reinforcement.”

2.2.  The therapist responds only to direct attempts to elicit his response, and only in kind.

2.2.1.    Any replies the therapist gives are designed to reinforce the defensive structure of the child’s ego.

2.3.  The child is helped to find a mirror image of his own go in the therapist.

2.3.1.    The ego thus obtains a wholesome type of reinforcement.

2.3.2.    His understanding has enabled the therapist to reproduce, ar times psychologically, method of child rearing.

 

3.    Clinical Illustrations

4.    Mastering pathological narcissism

4.1.  Pathological narcissism – an excessive amount of self-reviewing, self-preoccupation, autistic activity, and fantasy – appears to be a defense against the acting out of preoedipal and oedipal strivings, especially in their destructive aspects.

4.2.  It is vital that the schizophrenic child have enough control of those destructive instincts to be able to feel, think, and express some of them, initially in fantasy material, and later verbally with appropriate affect.

4.3.  Such control is possible by adequate insulation, or a good protective barrier; in its absence, an attempt is made to achieve insulation through pathological narcissism.

4.4.  It is found, however, that the inadequate barrier can be discarded when the child’s ego is reinforced by the presence of an understanding therapist.

4.5.  By mirroring the child’s contact functioning, the therapist enables the child to play out, to feel, and eventually to verbalize his destructive impulses.

4.6.  This has the effect of increasing his tolerance to frustration.

 

5.    Testing of social institutions

5.1.  A child is generally the firs member of a highly narcissistic family referred to our agency.

5.2.  The treatment of the child often serves as a test of the agency’s ability to handle the emotional problems of the family concerned.

5.3.  The child whose protective barrier is functioning effectively feels and acts on socially beneficial urges.


 
 
 
 
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