Mental representation, severe psycho pathology, and the therapeutic process

Mental representation is a central construct in psychological development. A method for assessing the developmental level of representation of self an d significant figures is described, and changes in the developmental level of these representations are reported in a sample of forty seriously distur bed, treatment-resistant adolescents and young adults in intensive, psychoa nalytically oriented inpatient treatment lasting more than a year. Increase d differentiation-relatedness of descriptions of self and significant figur es (mother, father, and therapist) was significantly correlated with improv ed clinical functioning. Over the course of treatment, representations move d from descriptions of self and significant figures dominated by polarizati on and splitting to representations involving the emergence and consolidati on of object constancy. Improved clinical functioning was correlated with m ore positive descriptions of self, mother, and therapist and, paradoxically , with more negative descriptions of father. Two prototypical case studies of these self- and significant-figure descriptions are presented, one for a borderline patient and one for a schizophrenic. Intense negative affect, p redominantly anger, and a relative preservation of self-reflexivity are typ ical of the self- and object representations of borderline individuals, but representations in schizophrenic individuals are characterized by affectiv e muting and marked disturbance in reflexive self-awareness. The assessment of cognitive-affective schemas of self and significant others provides a m ethod for investigating therapeutic change and for identifying important di fferences among various forms of psychopathology.