According to ego psychology, which of the following is seen as the primary function of the ego?

From Ego Psychology to Object Relations

Ego psychology's interest in the evolution of typical functioning lent itself to the founding of what some have termed ‘developmental ego psychology’ [Mitchell and Black, 1995]. Margaret Mahler [1897–1985] recognized the importance of early relationships. She took the idea of an average expectable environment and proceeded to describe the normal developmental stages an infant goes through in such an environment. These stages include the autistic, symbiotic, and separation–individuation phases, the last referring to the child's understanding of him- or herself as a separate, autonomous human being. If a child is ‘stuck’ in the earlier phases, serious disturbances of the personality can develop [Hamilton, 1988]. Because of her interest in both the ego and the emergence of severe disturbances in childhood, Mahler serves as a bridge connecting ego psychology and object relations theory.

Object relations theories recognize the centrality of the early mother–infant relationship for several arenas: personality development, development of internal representation of self and others, and the child's early understanding of and expectations for interpersonal relationships. Further, object relations theories attribute psychopathology to inadequate early environments rather than to internal drives or conflicts.

Influential early object relations theorists include Melanie Klein and D.W. Winnicott [1896–1971]. Klein was one of the earliest analysts to work with children and to use and interpret symbolic play as a way to access children's inner world. Thus, she helped to set the stage for the use of what is today referred to as play therapy. Winnicott saw the self as having competing desires for individuation and intimacy. He developed the idea of transitional objects, such as a blanket, that help children transition from their early symbiotic relationship with their mother to genuine object relations, providing them some protection against separation anxiety [Winnicott, 1953].

Otto Kernberg [b. 1928] utilized object relations theory in developing an understanding and treating the complex nature of borderline personality disorders [Kernberg et al., 1989]. In his conceptualization, the primitive defenses of splitting and projective introjections fail to mature, leading to intolerable close relationships in adulthood. A recent summary of his theories [Kernberg, 2012] describes his approaches to therapy with patients with severe pathology.

In terms of its implications for treatment, object relations theory leads the therapist to place less emphasis on the goals of traditional psychoanalysis, such as bringing the unconscious into consciousness. Instead, the focus is more on the patient–therapist relationship, which is used as an agent of change by correcting a patient's experience with prior bad relationships [objects]. The goal of therapy is, at least in part, for the patient to choose more appropriate people with whom to form relationships [i.e., to select more appropriate objects] and to alter maladaptive interpersonal patterns [Eagle and Wolitzky, 1992; see the article on Object Relations Therapy].

6 Future Directions

In terms of ego psychology theory, there are suggestions of new integrations of this theory with contemporary psychoanalytic studies of focuses on intersubjectivity, object relations development, and dialogue. Related to this is the theoretical challenge to find connections of the highly creative work of Erik Erikson to other psychoanalytic theory and practice. A second direction in the recent effort to apply ego psychology observations and theory to clinical practice with respect to the nature of clinical observations as well as techniques relevant to facilitating the expansion of insight and development. Arguably, these advances in moving from ego psychology at a theoretical level to ego psychology within clinical theory and practice are important ones that will likely continue in the next decades. Finally, several research programs are inspired by ego psychology constructs. Longitudinal studies of ego development now include psychopathology and normal development. Systematic studies of ego defenses and related processes are embedded within these longitudinal investigations. Additional operational definitions of ego processes will likely be developed in the future. It is vital and completely consistent with the work of such ego psychologists as Heinz Hartmann and Erik Erikson, that the perspectives and constructs of ego psychology become even more explicitly integrated with the insights, theories, and empirical approaches of neighboring disciplines [Holzman and Aronson 1992]. These disciplines include those investigating aspects of stress, social context dimensions [e.g., family, school, neighborhood], coping, and individual development.

2 The Real Self

In keeping with ego psychology and object relations theory, the term ‘real self’ is used in the intrapsychic sense of the sum of self and object representations with their related affects.

The term ‘real’ is synonymous with healthy or normal. It is used to emphasize that the representations of the real self have an important conscious reality component even though unconscious and fantasy elements occur. It also indicates that the real self has an important reality function: to provide a vehicle for self-activation and the maintenance of self- esteem through the mastery of reality.

The term real self also helps to differentiate it from the false selves of the borderline and narcissistic patients that are based primarily on defensive fantasy, not on reality, and are directed toward defense, not toward self-expression in reality. When using the term real self, both the collective subordinate self-representations and their supraordinate organization are referred to.

The real self exists as a parallel partner of the ego and has its own development, its own capacities, and its own psychopathology. The self and the ego develop and function together in tandem, like two horses in the same harness. If the ego is arrested in development, so is the self. One aspect of the self could be viewed as the representational arm of the ego, although it is obviously more than that. Similarly, one aspect of the ego, since it deals with volition and will and with the activation and gratification of individuative wishes, could be viewed as the executive arm of the self. However, it is also obviously more than that as its primary function is maintaining intrapsychic equilibrium.

Erickson [1968] referred to the dual and inseparable nature of the self-ego as follows: Identity formation can be said to have a self aspect and an ego aspect. What could be called the self identity emerges from experiences from which temporarily confused [subordinate] selves are successfully reintegrated in an ensemble of roles which also secure social recognition. One can speak of ego identity when one discusses the ego's synthesizing power in the light of its central psychosocial function and a self identity when the integration of the individual's self role images are under discussion.

To differentiate between personal identity [or in my terms the real self—JFM] and ego identity: personal entity is a conscious feeling based on two simultaneous observations: the perception of the self sameness and continuity of one's existence in time and space, and the perception of the fact that others recognize one's sameness and continuity. Ego identity, however, is the quality of that existence in its subjective aspect; it is the awareness of the fact there is a self sameness and continuity to the ego synthesizing methods.

The real self, then, provides an internal repertoire that, although finite and fixed, is varied and flexible enough to blend the need for real self-expression with the external roles required by adaptation.

Further Development

The full-scale development of ego psychology was one of the main developments of psychoanalytic theory since the late 1930s, and it silently incorporated most of the central objections that people such as Adler and Jung had had to Freud's original formulations.

Following Freud's death in 1939, more attempts were made to correct the negativism that had been built into his earlier work. Freud's whole system was designed to explain motivation when a person is in conflict and the ego has relatively failed at its integrative task. As a therapist, Freud was preoccupied with pulling problems apart and tearing fixations asunder, on the assumption that the patient's ego would be able to put the pieces back together again. For Freud, analysis was automatically synthesis; constructive processes had originally been taken for granted by him.

Freud was a master at understanding the main means of self-deception, but he ignored many processes of self-healing. Therefore, a main trend after his death was to correct this imbalance and to focus on the ego as an agency integrating inner needs and outer realities. The ego has a unifying function, ensuring coherent behavior and conduct. The job of the ego is not just the negative one of avoiding anxiety but also the positive one of maintaining effective performance. The ego's defenses may be adaptive as well as maladaptive. Adaptation is itself bedeviled by anxieties and guilts, but the ego's strength is not measured by the earlier psychoanalytic standard of what in a personality is denied or cut off but, rather, by all the extremes that an individual's ego is able to unify.

At the same time, psychology shifted from the more traditional concern with the defensive ego to the problems of growth and adaptation; it looked for the collective sources of ego development. For instance, there can be a need for a sense of identity to be confirmed by social institutions, as Erik H. Erikson [1902–1994] pointed out; and here organized religion and ritual can play a positive role. Cultural institutions not only can play a constructive role, but they help account for the variety of psychological patterns that can be found in different societies.

In his respect for the dignity of his patients, which made his innovations possible, and in his conviction that despite appearances all people are psychologically one, as well as in his individualistic goals, Freud was a great heir of the enlightenment. He was among those who are ever demanding more freedom. At the same time, however, in the development of psychoanalysis the open-ended quality of liberalism led to a revision of some of its most cherished premises; Freud represents an aspect of liberalism's self-examination. In Freud's quest for an understanding of human feelings, he transcended liberalism and joined hands with thinkers usually associated with traditions alien to it. He demonstrated the degree to which the child lives on within the adult and the way psychological uncertainties can prevent people from ruling themselves.

The humanistically oriented revisionists of Freud's views, for example, Erich Fromm [1900–1980], were trying to inject genuine humanitarianism into a psychoanalytic worldview that appeared with Freud to have ended in therapeutic despair and ethical nihilism. In correspondence and conversation, Freud acknowledged that health was only one value among others and that it could not exhaust morality as a whole. If he was wary about this whole subject of normality, it was because he realized what kind of quagmire he was in danger of entering. He touched on the subject of normalcy only on the rarest occasions. Freud typically took for granted that the people he liked best to work with were creative and self-disciplined.

Freud feared that the most original and disturbing aspects of his ideas would be destroyed by the widespread popular acceptance of his ideas in North America, yet it is questionable whether he did enough to prevent precisely this outcome. By not providing more hints about normality and not owning up publicly to the wide variety of psychological solutions he found both therapeutically tolerable and humanly desirable, Freud contributed to what he most sought to prevent. He had set out to transform Western values; he was eager to go beyond accepted good and evil. When he assaulted the maxim “love thy neighbor as thyself” as both unrealistic and undesirable, he was explicitly trying to overturn Christian ethics.

See also:

Cognitive Psychology: History; Defense Mechanisms; Ego Psychology and Psychoanalysis; Feminist Theory: Psychoanalytic; Freud, Sigmund [1856–1939]; Gender and Feminist Studies; Gender and Feminist Studies in Economics; Gender and Feminist Studies in History; Gender and Feminist Studies in Political Science; Gender and Feminist Studies in Psychology; Gender and Feminist Studies in Sociology; Jung, Carl Gustav [1875–1961]; Klein, Melanie [1882–1960]; Personality Disorders; Personality Theories; Personality Theory and Psychopathology; Psychiatry, History of; Psychoanalysis: Adolescence [Clinical–Developmental Approach]; Psychoanalysis in Clinical Psychology; Psychoanalysis in Sociology; Psychoanalysis: Overview; Psychologism, History of; Psychology: Overview; Psychotherapy, History of: Psychiatric Aspects; Social Psychology; Transference in Psychoanalysis; Unconscious: History of the Concept

2.1.2 Mechanisms of defense

Classical psychoanalytical theory and its modern equivalent [ego psychology] see conflict at the core of mental functioning. They see defenses as adaptations to intrapsychic conflict. Within object relations theories, defenses are seen as helpful to the individual to maintain an authentic or ‘true’ self representation or a nuclear self [see Defense Mechanisms. Attachment theory understands defenses as assisting in the maintenance of desirable relationships. The Klein–Bion model makes limited use of the notion of defense mechanisms but uses the term in the context of more complex hypothetical structures called defensive organizations. The term underscores the relative inflexibility of some defensive structures which are thus best conceived of as personality types. For example, narcissistic personality disorder combines idealization and destructiveness; genuine love and truth are devalued. Such a personality type may have been protective to the individual at an earlier developmental stage, and has now acquired a stability or autonomy which must be rooted in the emotional gratification which such a self-limiting form of adaptation provides.

Irrespective of the theoretical frame of reference, from a therapeutic viewpoint clinicians tend to differentiate between so-called primitive and mature defenses based on the cognitive complexity entailed in their functioning. In clinical work, primitive defenses are often noted together in the same individual. For example, individuals loosely considered ‘borderline’ tend to idealize and then derogate the therapist. They maintain their self-esteem by using splitting [clear separation of good from bad self-perception] and then projection. Projective identification is an elaboration of the process of projection. An individual may ascribe an undesirable mental state to the other through projection but when the other can be unconsciously forced to accept the projection and experience its impact, the defense becomes far more powerful and stable. The analyst's experience of a fragment of the patient's self state has in recent years been considered an essential part of therapeutic understanding.

Through projective identification the patient can experience a primitive mode of control over the therapist, whether in fantasy or in actualized form. Bion argued that when the self is experienced as being within another person [the therapist], the patient frequently attempts to exert total control over the recipient of the projection as part of an attempt to control split-off aspects of the self. Bion also argued that not all such externalizations were of ‘bad’ parts of the self. Desirable aspects of the self may also be projected, and thus projective identification can be seen as a primitive mode of communication in infancy. There are other aspects of projective identification which we commonly encounter clinically. These include the acquisition of the object's attributes in fantasy, the protection of a valued aspect of the self from internal persecution through its evacuation into the object, and the avoidance or denial of separateness. It is thus a fundamental aspect of interpersonal relationships focused on unconscious fantasy and its appreciation is critical for the adequate practice of long-term psychotherapy.

Some mechanisms of defense are thought to be more characteristic of the less severe psychological disorders [e.g., depression, anxiety, obsessive–compulsive disorders, etc.]. It is beyond the scope of this article to consider the various defense mechanisms in detail. Since Anna Freud's classical work, these defense mechanisms have become fairly generally accepted, if only as terms of mild rebuke between mental health professionals. Thus we generally accept that motivated repression may be associated with momentary forgetting of conflictual contents, that denial may be invoked by individuals wishing to disavow the emotional significance of an experience, that reaction formation is helpful in turning terror into aggression, and that identification with the aggressor may be the only solution available to a maltreated child who becomes an abuser in adolescence.

The diagnostic significance of defense mechanisms is controversial. Some researchers have claimed that an individual's habitual mode of defense has predictive value beyond that of psychiatric diagnosis. Given the theoretical ambiguity that surrounds the concept, it is unlikely that its use as part of a diagnostic formulation is justified. It does, however, assist the psychoanalytic clinician in conceptualizing the patient's reactions. In particular, these defenses are likely to be encountered in the course of psychoanalytic treatment at moments of intense emotional resistance. For example, it is common to observe patients experiencing considerable difficulty in recalling the contents of treatment sessions, yet their memory for other less central aspects of their lives appears to be exceptional. Being alert to the presence of defenses is important, not because it provides an opportunity for confrontation with ideas which the patient seems reluctant to acknowledge, but rather because it alerts the analyst to the presence of underlying anxieties which need to be tackled if resistance to the therapy is to be overcome.

1.14.3.1.1 Hartmann's classical model

Freud's third, structural, model was refined and advanced in the ego psychology of Heinz Hartmann and his colleagues. Hartmann et al. [1946] postulated an initial undifferentiated matrix which contains the individual's endowment and from which both the id and the ego originate. They also introduced the concept of an “average expectable environment,” which affirmed the importance of the parental contribution to development, and outlined a scheme for the phase-specific maturation of autonomous, conflict-free ego functions, accommodating both environmental and maturational influences upon personality development.

Development of the ego is driven by a maturational pull, whereby independently emerging components and functions come to be linked, forming a coherently functioning organization [the ego] which is more complex than the sum of its parts [Hartmann, 1958, 1964c]. Stages of ego development represent nodal points at which “fixation” may occur and to which, under the stress of conflict, the individual may return. For example, obsessive-compulsive disorder is seen by structural theorists [Arlow & Brenner, 1964] as a regression to the phase of ego functioning characteristic of the two-year-old [magical phenomenalism, repetitive, ritualistic behaviors].

Hartmann [1958] accurately claimed that psychoanalysts frequently used the developmental point of view in a reductionist way. His concept of the “change of function” [Hartmann, 1958, p. 25] and secondary autonomy [Hartmann, 1964a] pointed to how the same behavior in the adult may serve quite different functions and is likely to be functionally independent from the childhood wish from which it may have originated. The persistence of dependent behavior in adulthood cannot be treated as if it were a simple repetition of the individual's early relationship with the mother. Adult behaviors should be seen as having multiple functions [Brenner, 1979]. The failure to recognize this has been termed the “genetic fallacy” [Hartmann, 1964b, p. 221]. It is not uncommon for primitive modes of mental functioning [e.g., splitting or identity diffusion] in severe personality-disordered individuals to be treated as evidence for the persistence or regressive recurrence of early pathogenic developmental experiences. Yet, their reemergence in adult mental functioning may be linked to later or persistent trauma [see Tyson & Tyson, 1990].

VII. Self Psychology

The theories of object relations were successful in addressing the limited ability of ego psychology and defense analysis to address the problems of those patients whose problems lay deeper than those of the classical neuroses. A different approach to the same challenge gave rise to self psychology. In the 1960s, Heinz Kohut was a prominent figure in the mainstream of psychoanalysis. Erudite, articulate, and charismatic, he was widely assumed to be the heir to Heinz Hartmann's mantle as the leading spokesman for ego psychology. But his disappointment in the limitations of classical and ego psychologies led him to follow his curiosity in a new direction.

Kohut began by redefining the observational position of the analyst. Exploration of the external world, Kohut reasoned, requires an outwardly directed observational stance. Exploration of the internal world, the realm of psychotherapy, requires an empathic, introspective stance. He rejected the objective mechanical formulations of the ego and object relations psychologies, promoting instead a vantage point from within the patient's experience.

Psychopathologies, from this perspective as well as from most object relations perspectives, were seen not as the emergence of oedipal wishes, but as the reactivation of early needs the satisfaction of which in childhood should have served as the basis for healthy development. Self psychology went further to assert that unempathic interventions in psychoanalysis repeated early traumata. Symptoms and unpleasant affects represented fragmentation products of an injured self. Psychoanalysis, then, should properly focus not on the meaning of the products, but on the reconstruction of what precipitated their emergence in the transference, and on the genetic precursors of this constellation.

Whereas the object relations theorists continued at least to pay lip service to the classical drives, and maintained their allegiance to the structural model, Kohut ultimately rejected the need for the constructs of drive, id, ego, and superego. Instead, he formulated normal and pathological development and function around the single notion of the self. The nuclear self, which is present at birth, develops structures that allow it to take over functions previously needed from outside. This structure building happens by maturational transformation of what is internally given, and by the process of transmuting internalization, whereby functions of objects are metabolized into the self.

Self psychology, like object relations psychology, emphasizes the primacy of objects in healthy and pathological mental function. The objects in self psychology, however, are not separated from the self, but exist in the context of a self-selfobject matrix. The selfobject is an intrapsychic concept, describing how the self experiences the specific functions provided by others en route to the attainment of development goals. The need for self objects never disappears, but matures from infantile neediness to mature adult intimacy.

The self that emerges was described by Kohut as the bipolar self, bridging two poles. The pole of self-assertive ambitions contains the capacities for self-esteem regulation, the enjoyment of mental and physical activity, and the pursuit of goals and purposes. Its development requires a mirroring selfobject. This pole is paired with the pole of values and ideals, which is associated with self-soothing, the regulation of feelings, the capacity for enthusiasm and devotion to ideals larger than the self. The development of this pole is promoted by an idealizable selfobject. Between the poles there exists a tension arc that gives rise to innate skills and talents, including empathy, creativity, humor, wisdom, and the acceptance of one's own mortality.

Psychopathology results from imbalances between the poles of the self, and these imbalances are themselves the product of deficient selfobject experiences. Psychotherapy identifies these deficits by empathic reading of the transference. Therapeutic correction requires both interpretation of the selfobject needs and their successful reenactment in the therapeutic dyad.

6.05.4.3.2 Sifneos' short-term anxiety-provoking psychotherapy [STAPT]

In the USA, short-term psychodynamic psychotherapy retained close links with the classical ego psychology tradition. Sifneos developed a psychodynamic treatment focused on the oedipal concern of individuals whose psychological problems could be relatively readily linked to this common type of unconscious conflict [Sifneos, 1979, 1987, 1992]. Sifneos, probably accurately, pointed out that psychodynamic therapists were frequently more ready to acknowledge issues of dependency and frustration in relation to caregiving figures than concerns about childhood sexual fantasies about parents of the opposite gender. The recommended strategy is for the therapist to listen carefully for material pertaining to oedipal issues and to address this directly without regard to the defenses which individuals may have erected to protect themselves from the anxieties these thoughts might engender.

Sifneos adopts a somewhat didactic stance and does not shrink from explaining his reasoning in identifying material as relating to oedipal anxieties. He also confronts patients' defenses, being particularly sensitive to instances of intellectualization. A strong point of his approach is the availability of a relatively comprehensive manual for short-term anxiety-provoking psychotherapy [Sifneos, 1992].

There is only very limited evidence available to support the usefulness of this approach. Sifneos and colleagues reported a comparison of 22 treated patients and eight waiting list controls [Sifneos, Apfel, Bassuk, Fishman, & Gill, 1980]. While 18 out of 22 were reported to have recovered in the treated group or to be much better, none of the waiting list group reported a similar degree of change. In a somewhat larger study reported in 1987, 30 of 36 patients were rated as having recovered or being much improved whereas 80% of the 14 waiting list patients were unchanged. Unfortunately in neither study were the measures sufficiently clearly described to permit generalization, nor were raters blind as to treatment group. Independent studies examining the relationship of therapeutic process to outcome found no evidence that therapists' competence at practicing STAPT predicted good outcome. In fact, competence was inversely related to improvement [Svartberg & Stiles, 1992, 1994].

Post-Freudian Development of Theory

Since Freud's death in 1939, the theory has evolved in many directions. The structural model turned into ego psychology, in which intrapsychic conflicts between the ego, id, and superego occupy center stage. In this model, a therapist or analyst attempts to understand and explore these conflicts as well as the patient's defensive attempts against accepting them. Beginning in the 1930s and 1940s, the object relations theory came into psychoanalytic discourse, primarily in London, where the focus shifted from drive discharge to the internalized world of relationships and how they manifested themselves in everyday interactions with others.

Beginning in the 1960s, another development in the theory was the focus on the self, which turned into self-psychology. Based largely on the writings of Heinz Kohut, this view evolved in a direction in which self-cohesion and self-esteem were the focus rather than intrapsychic conflict. This model also focused more on deficit, that is, what was missing in the self, rather than conflicts between agencies.

Attachment theory has also become an important element of modern psychodynamic theory. John Bowlby, working in the UK, wrote a series of books that drew attention to the role that secure attachment plays in healthy development. This point of view has now been integrated into the theoretical underpinnings of psychodynamic theory so that early attachment relationships are seen as highly influential in the development of the child.

Most recently, the field has begun to accept postmodern theories that question objective truths or ‘factual’ observations about patients. These models involve such schools of thought as intersubjectivity, constructivism, and relational theory. In brief, they view the clinical situation as involving two perspectives: that of the therapist and that of the patient, each stemming from highly subjective experiences that influence the way one views external reality. Hence negotiation is necessary between therapist and patient to take both views into account.

A few core principles run through all psychodynamic theory. These are summarized in Table 1.

Table 1. Basic principles of modern psychodynamic theory

In psychodynamic theory, a great emphasis is placed on the unique, the idiosyncratic, and the subjective in each patient. In other words, unlike descriptive psychiatrists, psychodynamic clinicians would not be so concerned about how patients are similar to each other and how they fit into large diagnostic groups. Rather, they would be more interested in how patients are different from each other based on diverse life experience.

Unconscious mental functioning continues to be at the core of psychodynamic thinking since the time of Freud. Contemporary neurobiological research has confirmed that much of mental life operates unconsciously, and, as a result, the understanding of the unconscious has been revised over the years.

Psychic determinism refers to the notion that our symptoms, feelings, thoughts, and behaviors are mentally determined by factors largely outside of our awareness. Different influences from childhood converge to make our behavior meaningful. The choice of profession, romantic partner, and personal choices are often markedly influenced by the patient's early life experience.

The principle that the past is prologue simply refers to the developmental emphasis in all of psychodynamic theory. Genetic factors in concert with early experiences shape who we are as adults. Current genetic research has confirmed the notion that the expression of genes is heavily influenced by life experiences, and the two are inextricably tied together in shaping the human person.

Transference refers to the automatic and unconscious tendency in all of us to look at a clinician as a significant figure from our past. This phenomenon also occurs outside treatment settings. In short, all of us are unconsciously reenacting our past relationships, attributing qualities and characteristics of significant figures from our past to other people.

The counterpart of transference is known as countertransference. In other words, each time a psychotherapist is sitting with a patient, that therapist is experiencing a number of feelings toward the patient that may derive from the therapist's past. In addition, patients induce certain feelings in the therapist in their unconscious effort to recreate past experiences. Hence countertransference includes both feelings from the therapist's past as well as those induced by the patient.

The last common factor among the psychodynamic theories involves the construct of resistance. Patients may wish to get better, but that wish is opposed by anxiety about change. Hence patients often resist the therapist's efforts to help them by hanging on to patterns of behavior, symptoms, or perspectives on reality. This resistance may manifest itself by not talking in a session, coming late to a session, forgetting a session, or arguing with anything the therapist offers by way of observations or insight.

In the material that follows, we survey each of the leading theoretical perspectives that are in use today among psychoanalysts and psychodynamic clinicians. We then outline the fundamentals of technique in psychodynamic psychotherapy and survey the research data attesting to the efficacy of psychodynamic psychotherapy. The application to dynamic psychotherapy is also briefly addressed in the course of this theoretical overview.