|This article is published in the book:
"Psych 101 -
What you didn't learn in nursing school."
by Kathi Stringer
Paperback: 320 pages
Unlocking the Secret of Terms
The Secret Language of the Psychotherapist.
Written by Kathi Stringer
Simple talk. It seems like it could be a solution for some of these far-out abstract concepts and a key to understanding them. But sometimes using simple talk makes it hard to grasp the full weight of the concept. So I decided to write a paper on the secret language of psychotherapists to enhance the reader’s ability to grasp ideas and enable the reader to explore how these fantastic concepts apply to themselves or to those they love.
Once you get into the meaning of the secret codes, you too can read and communicate with others that also understand the covert codes. Of course, this paper is likely to get longer as individuals request for the breakdown on codes that I forgot to include. So keep an eye out for updated revisions. To help out a bit further, in this paper I will be giving a lot of ‘For example.” I thought you would appreciate that!
- Object Relations
- Object Constancy
- Holding Environment
- Transitional Space
- Transitional Objects
- Projective Identification
- The Three Agencies of the Mind
- Observing Ego
- Ego Weakness & Strength
- Defense Mechanisms
- Execution Boundary
Affects are basically the emotions a client displays according to the content they are dealing with. For example, if the appropriate affect that a client should have would be in the range of excitement or enthusiasm, and the client is unresponsive, then the treater may see this as ‘flat affect’. Affect is usually appropriate when it matches content. When it does not match, then this is a signal for the treater to examine the situation a little more closely. Laughing inappropriately, lack of emotion from a devastating trauma and etc may be signals for closer exanimation.
Object relations is a term introduced by , Fairburn. He figured that humans were influenced the most by past and current relationships to other individuals as a main force for life. The need for the infant to bond with the primary caretaker was paramount and above the need for food, clothing and shelter. Hence, Object Relations because of the desire to form a Relationship with others is more important then need for sleep, food, shelter and clothing.
Fairburn viewed objects as internal and external. An internal object is a piece of psychic structure within the personality and external objects are those we relate to externally. For example, an internal object may be a piece of psych structure of how I react to criticism and another internal object may be a piece of psych structure how I react to rejection. Perhaps a few of these internal objects may mobilize and work together as several objects for a whole new affect. If enough objects get together and form a maladaptive recipe, then a person may come off as paranoid and upset. It sounds a bit cold and detached for some to think of parts of an individual and others as objects. However, it serves a purpose to articulate ideas and theory into a cohesive model for exploration and usefulness.
Each object has an affect that accompanies it. Some internal objects seemed to be buried so deep that they seemed closed off and no one can get to them. In a case like this I might say, “closed core internal objects are isolated.” It’s just a fancy way to say that a person is closed off and can’t be reached. But of course, it does say a bit more then that. This is why we use abstract psychic language; it helps get deeper into the process of the mind. Once you get used to it, it can become fun to learn and understand ideas from some of the great thinkers and masters of our time.
Now that you got the hang of what an object is, it makes sense to think that these objects can become separated and compartmentalized within the mind. When these internal objects become separated, and one object is not communicating with another object, then we call this ‘splitting’. In other words, the object relationship was split up and fragmented into areas of the mind that do not talk to each other. Lets look at how you would be able to observe if someone is suffering from internal fragmentation. For example, have you ever met anyone that can put you on top of the world one moment and then completely devalue you then next moment? Ever notice how some people cannot see a person as a ‘whole continuous person’ but rather as devils or as angels? Ever notice how some individuals have all the information but cannot make a rational statement? It’s because the mind is fragmented and the internal object relations are ‘split’ into different compartments.
So what causes a person to split up all these objects into different compartments? Why would anyone choose to be so darn confused and irrational? Hang back, there is an answer for this.
I might get this next point across a little easier if I ask you to pause and remember back if you ever had a time when you couldn’t make up your mind. “Should I use the blue paint or the red paint?” or even more stressful, “Should I stay in the marriage or divorce?” Most of the time, the higher the consequences of the decision, the more conflict it will cause within the individual. Conflict is to be ambivalent or of ‘two minds’ or to become ‘split’ in the decision making process. Splitting is a defense mechanism that infants and toddlers use to ward off unacceptable anxieties. It is unacceptable to a toddler to withstand unbearable anxiety and as a result, the toddler will split-off what causes the anxiety. A child may be want to be independent but at the same time experience feelings of dependence on the same person. This conflict is unacceptable and the toddler cries in psychic pain from the crisis. On the other hand if a fixated toddler continues to split-off the anxiety caused from the need to be independent, then a chronic dependence would out flank any strivings to become an individual.
Can you see how stress from the consequences of a decision or event may determine how and if the internal objects are fragmented? Ever notice when a person becomes really stressed out that their thought becomes more of a reaction, and at times irrational because it is not well thought out? For an individual that has not moved though the earlier developmental stages, splitting can be a way of life, and their stress will amplify the severity of the split. The more stressed out a person is, the more one hand does not know what the other hand is doing. In therapy, the therapist will try to help the individual become more integrated so that the internal objects can be experienced at the same time without splitting them away from each other. More on this in the ‘observing ego’ description.
This is a later stage of object relations theory, and overlapping the defense of splitting. It begins to take hold when mother is reliable and keeps returning and emotionally refueling the child. For instance, a toddler may achieve greater and greater distances from mother, but when anxiety in the child takes over, the child will return to mother to refill with her ‘essence’. But if the mother is not available upon return, and it happens often, the child may begin to get clingy and afraid to leave thinking he will lose her while he is away.
If mother is ‘good enough’, and present most times when a child returns (rapprochement), the child begins to develop a mental security of an image that mother is emotionally present, even while away. Some children (and adults) whose mental security is not completely developed may use items like security blankets or stuffed animals to help with the ‘transition’. These items are called ‘transitional objects’.
When a person is able to internalize a ‘constant’ representation of another person, even when that person is gone, then that person has developed object constancy. Object constancy comes from stability and trust. For example, if a child’s parent is radical, invalidating and mistrusting, then the child did not experience stability. The child lived on a roller-coaster without any point of reference for a ‘normal’ life. Or, if a treater threatens to ban the client for acting-out (yelling) then, the treater fails to become a constant object in the mind of the client. This is harmful because the client may feel less secure out of the presence of the treater, since when leaving the treater, the client becomes afraid he will lose the treater. Out of sight, out of mind. However, if the treater were available, constant and reliable, and able to listen, validate, teach and provided a new positive experiences, then this would have helped the client develop object constancy by modifying his old core beliefs.
Love this term and was coined by relations theorist named Winnicott. Winnicott figured that by providing structure and a consistent venue for the client, then a sense of safety and trust would develop from the ‘holding’ experience. The holding environment would set the stage and allow the client to cry, vent, and regress in transference (go back to an earlier stage of functioning). For example a client may feel ‘held’ with structured appointments, phone contact for crisis, and follow up from the treater looking in on the client’s welfare, and overall taking on a sort of parental function as outlined in the infant/mother dyad.
In this ‘in between’ space the client and the treater can take on assigned roles and act them out much like a child will take on roles when playing. For example, when a client is acting-out toward a treater because of feelings aroused from childhood abuse, the client can then been seen as assigning the treater the role of the abusive parent. It is in this space that old feelings, thoughts and behaviors are awakened for modification…to make a transition. For example, the treater may behave much more consistent and less punitive then the real parent, and this experience will provide a space for transition.
A transitional object is an object that helps the small child process through a transitional stage in life. Mostly, when the primary care taker is not available, a child may imbue an object with a symbolic meaning to represent mother to help with feelings of insecurity. The object can be a diaper, soft blanket, bottle or other similar item. It usually takes the form of something soft and perhaps the smell of mother.
The object is important to the small child since the child believed that they created it and they full control of the object. It is transitional because the child entered into the beginning of becoming an individual and separate from his mother. The transitional object helped comfort and soothed the child from maternal separations.
As adults, some individuals have not completely separated and are still attached to transitional objects. For example, a patient may view her pills as transitional object because they represent a link to her compassionate and caring doctor. Taking a pill would represent being empathically held and nurtured. Some adults still use infantile transitional objects from childhood. Others may view their therapist ‘as’ the transitional object, which makes it a bit more difficult for the client to have control over the object.
Freud came up with this term and it has been used widely ever since. Transference is basically the ‘transference’ of love or hate from past relationships onto the treater. A psychodynamic treater may try and ‘grow’ or ‘develop’ transference between them. Think of it as stirring the pot to see what comes up. For example a treater might make a slight criticism aimed at the client, and then the client may blow up in the treater’s face. Way over kill. But in the client’s mind, her mother was very critical as she was growing up, and then the slight criticism from treater came at a moody time for the client and was the fuse to ignite the bomb. Wham. Once the treater recovers, the treater would try to figure out exactly what that was all about. In this case, can you see how the client’s hate of criticism was transferred from a past relationship with mother and onto treater? This is how transference can be a handy tool to figure out how the client relates to life.
In the example above, with guidance the client may realize that the treater is not really their mother and that the harsh criticisms came from mother. Now in a psychotic transference, the client believes that the treater is the critical mother and none of the material is transferred from the past onto the treater. Basically, that the treater 'is' the client’s mother.
A client may be afraid to open up and trust a treater. A client may be terrified of what may come as a result of the formed transference. For example, if the client regresses and begins to depend on the treater, then of course the client with abandonment issues will be freaked out at the thought the treater may reject them. This could be viewed as a terrifying transference. Transference because the trust hoped for from a maternal relationship was ‘transferened’ to the treater; assigned to the treater to play the role as the good-enough mother. A client may resist forming this sort of transference with the treater since the thought of getting dumped and thrown out is too ‘terrifying’.
This is a handy little tool to give insight into thought patterns that leads at times to behavior. The treater tries to ‘grow’ a transference between them, so a treater will have some clues as to how the client relates to life, and how the personality works with interpersonal material from self, others and the environment.
The treater takes the material (transference) that has formed in the therapeutic relationship and seeks to clarify what is going on in the transference that has developed between client and treater. That is the whole goal of getting a transference going anyway, to get something going to work with. Once the treater has something in their hands, they seek to get a handle on exactly what it is they are looking at. A treater may ask a client if they are looking at the situation correctly, according to the way the clients sees things. If yes, then the treater goes to step two.
Once the treater figures out what is going on in the transference, then the client may get the boom lowered on them. Confronted. Once confronted, and things get hashed out between them, and a sort of agreement is made, then it goes to step three.
Once clarified and confronted, and the time is right, then a treater may interpret their take on why a client behaves the way they do. Of course, the treater first should make every opportunity to get the client to figure out what is going on for themselves. In this way, the client can ‘own’ the results and insight a little better then if it was handed to them verbally from the treater. In some cases though, the client will never get it and the treater will have to spell it out because no amount of guidance will lead the client to where the treater is leading them.
This is a term first used by Freud and has taken on different properties throughout the century. I am mainly interested right now in describing the current meaning of countertransference as illustrated by Gabbard  et al (APA)
Countertransference is transference from the client ‘colored’ with the unresolved issues of the treater. For example, a client my transfer hate from a critical father onto the treater. The treater feels this transfer of critical hate, and since this hate from the client is not deserved and distorted, then may raise some unfinished feelings inside the treater. The treater is now experiencing a combination of the feelings from the client in ‘addition’ to their own feelings activated by the client.
Sometimes countertransference can be a tool that the treater can use that can act as a gage or barometer (Gabbard)  to measure what is going on inside the client. For example, if the treater is feeling a lot of anxiety from the client’s material, then the same thing is likely going on inside the client. If the treater feels anxious from countertransference, then using countertransference as a gage, the treater can get an idea of how the client is feeling at the moment; anxious too.
Of course every treater reacts according to what is said to them. What might bother one treater may not bother another treater. So every treater has their own countertransference hook, depending upon their unique personality (Gabbard) . Sometimes a client can tell if a treater has been hooked by their facial or body expression.
This happens when a treater reacts to the countertransference. This could take the form of giving out a maladaptive and untruthful diagnosis that could hurt the client, or drift off daydreaming and ignore the client, or cancel appointments, or end session abruptly, or threaten to ban them for the practice (execution boundary), or raise their fees, or feel sexually attracted toward the client, or have a desire to do heroic endeavors to protect the client, or… I think you get the idea.
For example, if the client enjoys beating animals, then hearing this can trigger a hate toward the client.
A skillful treater knows the importance of having countertransference management. It can prevent the treater/client relationship from going beyond repair. For example, a mental health worker (MH) might say to a client, “Get back on the other side of the Red Line!” A client may react after perceiving this as a harsh tone by saying, “Or what???” At this point if the MH worker does not manage their countertransference, they may say, “Or you will go into seclusion and restraints!” Which fosters hate toward the treater in the client. On the other hand with countertransference management a treater could say, “The reason we need you to stay on this side of the Red Line is so that you will be safer on the unit. We care about your safety and this is way we need you to be on this side of the Red Line.” This would come across as much more thoughtful with a warm personal regard.
A treater that is fed up might secretly wish the client would succeed in killing themselves so the treater can escape the problem of having to deal with the client. With this thought a treater may withdraw and become aloft and withhold redirection to keep the client from killing themselves. Or, for another example, if staff on an inpatient unit would put a client into seclusion as a form of a penalty, this is also called countertransference punishment. This is illegal since a client can’t be put into seclusion unless they are a danger to themselves, others, or destroying community property. However, even though a client does not meet any of this criteria, staff has been known many times to put a client into seclusion for ‘convenience of staff.’
Countertransference if used correctly can be used as sort of a gage to measure what is going on inside of the client. For example, it a treater feels like his veins are about to pop out of the side of his neck, then the feelings generated inside of the treater will give an indication of what is going on inside of the client. Ever notice how when two people are yelling at each other that both of them are angry and frustrated? The same with countertransference because it acts as sort of an internal mirror of what is going on inside the client. This is why it is called a countertransference gage. The treater, by measuring their own discomfort they can get an idea of how uncomfortable the client is feeling. A handy little tool if used correctly.
Love this one. When a client is ticking off the treater, the client usually expects that which has always been given….to get it back in their face, or to get something back anyway. Yet, if the treater viewed countertransference as an opportunity to answer back in a less hurtful tone, then the treater was able to offer a therapeutic experience for the client.
So far the type of countertransference I have been talking about is anger in the treater from the client. There are all kinds of different countertransferences though. For example, a narcissist countertransference is working when the client idolizes the treater and the treater promotes it and distorts it….“I am the all good treater, all knowing and all good” type of thing. Or a client may present as more helpless then they truly are and the treater becomes the ‘rescuer’ of the client. The treater may then feel obligated use heroic efforts to save the client repeatedly and this creates misery in the treater, which can change from countertransference-rescuer to countertransference-hate. The point is, countertransference comes in many forms and not just from anger.
Projective Identification (3 Levers)
This term was coined and introduced by Marie Klein. However not much was elaborated on its significance. The term at times takes on different meaning according to the author. Ogan helped resolve getting a grip on this extremely difficult concept by dividing the dynamic into three levers as outlined below. This is the current modern concept as published by the APA, Gabbard et al, and the Minniger Clinic of Kansas.
In the examples below, I am referring to anger being projected. But remember, as internal objects of the mind, any object, or cluster of objects can be split-off and projected. Similar, as there can be many types of countertransference feelings in the treater, many different types of objects can be projected onto the treater from the client. A projected object is not isolated to only anger, yet anger does seem to be the most frequent projection to deal with.
Projective Identification (anger / Lever 1)
This can be related to pushing the treater’s ‘buttons’. After a client is able to find the treater's weak spots (a countertransference hook), the client can then push a treater’s buttons as a way to gain control over the treater.
Think of a client that is dealing with unresolved anger from childhood and the treater said something that ticked off the client. The get even, the client may start looking for ‘hot spots’ in the treater and once found, a client can push a treater’s hot buttons. A client may think, “you made me upset, so now I’m going to get even and get you upset, to show you what it feels like.” See how there is an element of control here? To get even, the client needs get control and ‘make’ the treater feel just as bad or worse then the client.
Projective Identification is different then countertransference due to one single element. Projective Identification has a ‘force’ behind it. A client is projecting (forcing) a part of themselves (identity) onto the treater. It’s all about force and the strength of that force. The bigger the hot button in the treater, the stronger the force. Control, control and control.
So far in this first lever, a client is projecting anger onto the treater. At this point nothing will happen unless the treater identifies with the projected object of anger. If this happens, we go to stage two, projective counteridentification.
Projective Counteridentification (anger / Lever 2)
At this point a treater has identified with the projected object of anger. In other words, the client has successfully found the treater’s hot buttons and pushed them and the treater is really ticked off. A treater will usually feel so ticked off, that they are no longer themselves. It is as if an alien force has taken them over. A treater at this point may feel very miserable and want to dump the client. The anger that now resides in the treater is a product of the treater’s repressed anger (the hot button) in ‘addition’ to the anger projected from the client. It is quite a lot to handle.
Introjective Identification (Lever 3)
This third lever is where the magic comes in. Of course for this lever to work, the treater must be working to identify what has happened in the first two levers. This may take some time.
A client may expect the treater to react the same as other persons, usually from past childhood relationships. A client may expect to get dumped and abandoned just like in the past. And in the client’s mind, this proves they were right all along. The client may think, “See, I am bad and I can be cast out. You were lying to me all along and you are just as rejecting as everyone else, and just as hurtful.” And then the cycle repeats, unless a treater is able to get a grip and use these two tools:
A treater can act as a container for the projected objects (Gabbard)  from the client. Note, this is far different then the treater acting as a sponge and absorbing the vile projections. Rather, the Container in the treater acts like a pot to hold that projected anger. Once the anger is in the pot (container) a treater can identify and work with the anger (contained).
Now that the anger has been contained carefully within the treater, the treater can skillfully detoxify, metabolize and modify the object of anger. For example a treater might not react badly to the client and rather more calmly, emphatically, and totally different then what was expected. A treater may act in a structured, soothing and continuous affect. This of course modifies the client’s perception of reality.
Once the treater has acted as a container, and contained the object, and has further modified that object, the treater can now offer something more manageable back to the client for assimilation. Of course the treater ‘cannot make’ the client accept what is offered. The client may just blow it off. But usually if what the treater's offers is attractive for the client, the client will then take in and assimilate the modified object of anger. The returned anger from the treater is less harsh and defused.
This third step is magic because a treater is able to modify that which was ‘closed’ off or hidden inside the client. The treater, like a wizard that is able to execute magic, can change the client can change the client by offering a new and better internal world for the client. Sort of like cutting down on the inside pain by responding much different then abusive past relationships and offering a new role model.
Lever One, Projective Identification:
A client splits-off and projects (with force) an object (anger) into the treater via the countertransference hook.
Lever Two, Projective Counteridentification:
The treater has identified with the projected object (anger) and has taken it in. The treater feels as though not themselves. Like an alien force has taken them over.
Lever Three, Introjective Identification:
When skillfully used, a treater can act as a container and contain the object (anger), and modify it into something (a modified introject) that is much more attractive for the client. The client may now identify and assimilate the offered introject, hence we now have Introjective identification.
The following is an analogy of Transference, Countertransference, Countertransference Management, Projective Identification, Projective Counteridentification, Introjective Identification, and the Container and the Contained. The analogy is a spoof off Star Trek with the Client acting as the mysterious new Life Form and the USS Enterprise and Crew acting as the Treater.
Star Date: 2002 – Captain’s Log 4231: Recording of ship’s transcripts of an unknown life form in uncharted space.
Sulu: “Captain, there appears to be an unknown Life Form ahead.”
Captain Kirk: “Put is on screen Sulu [Treater visual assessment] and Spock, report.”
“I am picking up strange readings, it appears that we are being scanned
[client developing a transference]
“The Life Form is beginning to change shape Captain, and it appears to
[Client as developed an transference consisting of anger toward the Treater]
Captain: “Reverse engines, full impulse power, Scotty, give me all ya got” [countertransference reaction]
Spock: “Captain, we are still being scanned, and the life form now resembles lethal anti-matter that could destroy this sector if it should converge with our dilithium crystals housed in the engine room.
Kirk: “Raise shields and go to Red Alert!”
Spock: “Captain, the Life Form has fired a Probe and will make contact right about…now!”
[attempt at projective identification]
Captain Kirk: “Damage Report!”
Sulu: “Our shields holding Captain.”
Spock: “The Life Form has fired another probe, and scanners show a slight configuration from the last probe, and will make contact….now!”
[another attempt at projective identification as the Client is looking for a weak spot in the Treater]
Sulu: “Shields down 20% and auxiliary power is ready to go on-line Sir.”
Spock: “Captain, the Life Form has fired another probe and it is configured once again. Probe should make contact about …..”
FLASH, AND BURST OF BLUE LIGHT
**The Probe has made contact with the ship
Captain: “What’s happening”
“The Probe as penetrated our shields and I detect a strong surge of
energy from the Probe taking command of the ship’s computer.”
[projective counteridentification is complete, the Client will now attempt to control the treater.]
Captain Kirk: “Spock, what was that? What happened!?” I need answers and I need them fast!”
Spock: “Sir, the Probe has been configured to get past our shields and has attached itself to the haul of the ship. The Probe has interfaced with our ships communications node and is reassigning our electronic parameters to that of the host Life Form that launched the Probe.”
Captain: “Spock! Is there anything we can do? Think of something!”
“Captain, most of the Ship’s database is infected and the control of
the Ship is being redirected by the probe. Life support is at risk and
the ship’s energy seems to dwindling away.
It is if an alien force has taken us over.”
[confirmation of projective counteridentification onto the Treater]
Computer: LIFE SUPPORT WARNING: “Ship’s oxygen 72% and decreasing”
[effects of projective counteridentification is miserable for the Treater]
Captain: “Spock! Talk to me! Think of something, we don’t have much time!”
Spock: “My analysis confirms a power surge in communication node C-32 on deck four from the alien probe. We can reroute the Ship’s command and reinitialize the contaminated database to contain the projected energy radiating from the probe. It seems Captain, that the probe is receiving instructions from the host Life Form.”
Captain: “Okay Spock, reinitialize and retake command of the Ship”
[Treater has identified and contained the project object]
Sulu: “Sir, the Life Form shows signs of distress. Should we follow procedures as outlined in the Prime Directive?”
Captain: “You are absolutely right Sulu. Spock, can you send the Probe back to the host Life Form with a message of good will from Star Fleet?”
Spock: “Yes Captain, now that we have contained the Probe we are able to detoxify and metabolize the opposing forces within the Probe. We can modify the Probe’s circuits and offer something more attractive to the Life Form.”
Captain: “Do it Spock. The quicker, the better.”
“Captain, the modified Probe is ready to be launched.
Shall I proceed?”
[the projected object from the projective identification onto the Treater has been detoxified, modified and made into something more manageable for the Client.]
Captain: “Proceed Scotty. Spock, target the Life Form and the reuptake of the Probe. Record activity into Ship’s log for Star Fleet.
ENTERPRISE FIRES THE ALIEN'S PROBE BACK TOWARD THE HOST LIFE FORM FOR
[once modified, the Treater can offer a more attractive object to the Client for assimilation]
“It appears Captain that the Life Form, has accepted and
assimilated the Probe that we modified back into its core structure.”
[intorjective identification, the Client accepted the modified object]
Sulu: “CAPTAIN! Look! The Life Form is changing! It somehow looks less threatening…and…and…it looks….happy Sir?!”
“It appears Sir, that you have helped give birth to new Life Form.
Even though it cannot communicate, which is puzzling, it does
seem to have a bit of…humanness?
[the Client can now see the world as a better place in which to live]
Captain Kirk: “I think you are right about that Spock. Attention bridge, since we are going to be in this sector of space for a while, design and implement a system to address additional Probes from the Life Form. Perhaps over time and with each Probe we modify, we can offer a bit more of humanity to a race that does not understand us. “
Spock: “Captain, what should we call the project?”
Captain Kirk: “Spock…lets call it……First Contact”
Star Date 200[*] -- Captain’s Log 4232 The threatening Live Form was able to penetrate our shields with a projected Probe. The crew was contain and modify the Probe and fire it back to the Life From. First contact was successful.
Freud theorized (Hall)  that the mind works from a system governed by an executive agency, the ego. The other two agencies are the id (infant) and the superego (parent). This in its self suggests the mind is fragmented. Over time, and with experience with what works and what doesn’t work, the mind is able to act more as a team unit
The Id is the demanding part of the mind. It acts on getting its needs met immediately and impulsively. The id remains infantile in character throughout life (Hall)  with traits that are demanding, irrational, asocial, selfish and pleasure-loving. The id lacks organization compared to the ego and superego, and does not change with time. More interesting, the id cannot be modified be experience since it has no contact with the external world.
Primary Process (Id processing)
Primary Process (Hall)  comes out of the Id. It is raw impulses without any rationalization. For example, if I suggest a person acts impulsively out of the Primary Process, then I am suggesting a person is acting irrational and their thought is without consideration from the demands of reality. For example, Primary Process thinking my be, “I got to go pee” and then just pee on the spot, and not wait until going to the restroom.
The superego is the ideal agency of the mind. It is the moral or judicial branch of the personality, the inner critic. It seeks unrealistic perfection rather then pleasure or reality. The superego develops its moral code out the ego though absorption of discipline from parents, schoolteachers, religious agents and authority figures. The Superego will bug you to be the ‘perfect’ human being according to the rewards or punishment you got when growing up. Consequences from discipline give rise to the formation and incorporation for what is bad, good, moral, and immoral. It the Superego that will lay the guilt on you.
The superego formed out of the child’s wishes for love. Not being loved means an unloving mother that withholds food, emotional soothing and other vital life necessities. For the superego to be effective it must exercise the same power as the parents as the child gets older.
Even though this guy is in the ‘middle’ I saved him for last. The ego is the decision maker, making transactions between the self and cultural reality, controlling and governing the id and the superego while maintaining socially accepted behavior with the external world. The ego acts as a negotiator between 3 pressures. The Id wants its way, the Superego usually wants it much different, and then there are the demands on what is acceptable in the world. .i.e. reality. For example, a person out hiking has to go pee, the Id thinks, “Pee right now!” the Superego thinks, “not until you get home!” and the Ego thinks that both are unreasonable and checks out the path for a hidden place to go pee. What happened here is that the Ego delayed the Id’s impulse to go right away, and negotiated with the Superego not to wait forever, and dealt with reality to find a hidden place as not to attract attention as culturally discouraged. . The ego is basically an executive agency (Hall)  of the system dedicated to thinking and problem solving. The growth of the ego comes from reality testing which will improve perception, thinking, memory and action. As function of the ego develops it can perceive the external world with greater precision and accuracy, and of course, make better choices.
Secondary Process (Ego processing)
Out of the Ego comes thought that is more rational. It is the Ego’s job to check with all the demands of the mind. Each part of the agency has it own agenda. When the Ego checks with each agency and with reality, it is performing a Secondary Process. Secondary Process (Hall)  comes from contemplating, experience and thinking things out and getting in touch with all fragments of the mind. So if I say something like, “His thought process resembles more of the impulsive Primary Process, rather then the more rational Secondary Process. Sort of an insult to some by referring to them a main a Primary Process thinker….meaning life has not taught them very much.
This guy keeps track of what is going on once a person begins to develop it. For example, Nancy and her treater are barking at each other and nothing is getting resolved. The treater has usually developed an ‘observing ego’ to keep track what is going on, to whom does what. With clients the feelings in the treater get aroused. In this example, a treater is getting angry at Nancy for her remarks. Because of the wonderful training of the treater, she will check with the observing ego and search for what is ‘really’ going on. Perhaps the observing ego might offer that Nancy is using her anger as a defense because the treater is getting to close to some walled off feelings and it is making Nancy uncomfortable and defensive.
Another example could be when two people are fighting and nothing is getting resolved. If one person has a developed observing ego, then that person may ‘fall back and regroup”, and try and approach the fight from a different perspective. The observing ego would be like a third person looking down from above and ‘objectively’ keep track of what is going on. The observing ego is more detached from the ‘feelings’, which gives it a base to be more logical.
It takes some practice to develop an observing ego, but it is well worth it.
Ego strength enables a person to withstand stress while deciding on what to do with the problem. If a person caves to stress, and does not weigh out each area of the Id, Superego and Reality, then there is a weakness in the Ego. For example, lets say a couple are getting frustrated in a conversation. One person finally became so overwhelmed with stress that they told the other person to ‘stick it’ and stormed off. In this case, the person became vulnerable to impulsive action as the stress became intolerable. The anger of the Id overtook the strength of the Ego and won. The idea is to develop Ego strength as life moves on.
Ego strength also helps the mind become less fragmented. For example, part A of the mind may have strong tendency to see a person as all bad. Part B sees the person as all good. There is a conflict going on here. If a person had weak ego strength, they would just give into side A or to side B. It is the Ego’s job to be strong enough to withstand the conflict and see areas of gray in the person. The higher the ‘stress’ the higher the Ego strength needs to be to maintain a level head.
The mind uses defenses to protect its self from injury or stress. These defenses have been giving names to help identity what is going on and get to the bottom of it. Persons with greater Ego strength tend to use more advanced defenses then a person with regressed or weak Ego strength. The names of some of these defenses are listed below (Stringer) .
This is the most dreaded of all boundaries in therapy. Some treater’s will bring up the Execution Boundary (Stringer)  to blackmail the client into behaving a different way. For example a treater might say, “if you yell at me one more time, I will ban you from my practice” or “if you don’t try harder, I will not see you anymore.” Usually when a treater is not as qualified, they will tend to use the threat of the Execution Boundary, which in most case can have a devastating effect on therapy. The client might think, “See, I was right all along, I am bad, I can be cast out, and you are ‘never’ to be trusted.” Then the trust issue is scraped out and everything gets set back…again.
1. Integrated Treatment of Borderline Personality Disorder - Glen O. Gabbard, M. D. - Video Lecture / APA Series
Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR -
American Psychiatric Association (APA)
Cognitive-Behavioral Treatment of Borderline Personality Disorder -
Countertransference Issues in Psychiatric Treatment - Glen O.
Object Relations Approach to Understanding Unusual Behaviors and
Disturbances - Kathi Stringer