Self Psychology is 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 ourselves? In other words what is our relationship to ourselves. (Our Self)

This relationship to self is the defining foundation of our psychological health.

 

The Self

In the understanding and management of self there exist a recurring set of questions:

1. What are our Emotions-Feelings
   
   

2. What is our relationship to our: Emotions-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 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 years tumble by. 
   
   

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.

History

Self psychology was developed by Heinz Kohut. He was a German practicing 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”youre ruining my analysis with your interpretations!!” He was struck by this 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-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 and is very affective when dealing with a neurotic anxious character/patient but when the developmental disruption is much earlier and usually much more severe the characterological properties that bind the self together are much less secure. They are less tethered to that sense of self as discussed above. The earlier the developmental disruption the more likely the personality of the individual is less able to self soothe. The less likely then individual is able to tolerate environmental stressors. And the more likely to feel in a state of chaos-circling around confusion/anger/pain-anguish/loss/feelings of emptiness. 

The Process

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 (as explained above) someone struggles identifying 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 patients current self-state. But (and the 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 too low and back again with a destabilising rapidity-constant feelings of emptiness-suicidal thoughts-chronic feelings of being abandoned-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 a 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 that is the environment in which they grew up in. Inconsistency of safe parental engagement combined with an impinging uncontained negative emotional exposure-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. Invariably these people strive for an environmental context that is totally controlled and 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. 

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 tuned 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. 

Summary/Conclusion

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 envelop oneself in the specific idiomatic complexity (especially a psychoanalytically based relational psychotherapy) so I have tried to keep to the main points of this approach. I have attempted to stay with the fundamental points that manifest in my practice everyday and the fundamental approach that facilitates the therapeutic process. 

References available on request.