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IJP 33:75-76 (1952)

The Psychoanalytic Quarterly, 20, 1951, No. 1: Merton M. Gill. 'Ego Psychology and Psychotherapy.'

Abstract

Various problems of psychotherapy are discussed from the standpoint of ego psychology.

1Indications. The choice between psycho-analysis and psychotherapy is determined by the therapeutic goal that is thought desirable or practicable in any particular case. This depends on various factors, including the reality situation, but fundamentally it is a matter of deciding whether

the defences of the ego should be strengthened in order to reinstate the position prevailing before the neurotic breakdown or whether they should be broken through in order to achieve a re-integration of the ego. Psychotherapy is indicated when strengthening the ego is all that is necessary. Analysis is indicated in a middle range of cases in which the ego is sufficiently damaged to require repair but remains sufficiently strong for defences to be analysed without risking disintegration of the ego. Analysis plus supportive therapy is indicated in borderline cases, where there is a danger of impairing what little integration the ego still retains. Cases in which symptoms and character disorders have become ego-syntonic also demand analysis.
2Techniques. Various principles underlying the techniques of strengthening defences are formulated. (i) Ego activities in which defence is combined with adaptive gratification should be encouraged, while those which are maladaptive should be discouraged. (ii) Important defences should not be attacked unwittingly. (iii) Remote derivatives of defensive systems that are not being used maladaptively should be ignored. (iv) The theory of strengthening defences can be formulated in terms of Glover's suggestion that artificial neuroses may be set up which offer partial discharge for instinct derivatives, and thereby decrease the amount of defensive work demanded of the ego.
3Hypnosis. Earlier work by the present writer and his co-workers has shown that the view that defences are abolished by hypnosis is incorrect. The defence mechanism of repression is often

IJP 33:75-76 (1952)

The Psychoanalytic Quarterly, 20, 1951, No. 1: Merton M. Gill. 'Ego Psychology and Psychotherapy.'

Abstract

Various problems of psychotherapy are discussed from the standpoint of ego psychology.

1Indications. The choice between psycho-analysis and psychotherapy is determined by the therapeutic goal that is thought desirable or practicable in any particular case. This depends on various factors, including the reality situation, but fundamentally it is a matter of deciding whether

the defences of the ego should be strengthened in order to reinstate the position prevailing before the neurotic breakdown or whether they should be broken through in order to achieve a re-integration of the ego. Psychotherapy is indicated when strengthening the ego is all that is necessary. Analysis is indicated in a middle range of cases in which the ego is sufficiently damaged to require repair but remains sufficiently strong for defences to be analysed without risking disintegration of the ego. Analysis plus supportive therapy is indicated in borderline cases, where there is a danger of impairing what little integration the ego still retains. Cases in which symptoms and character disorders have become ego-syntonic also demand analysis.
2Techniques. Various principles underlying the techniques of strengthening defences are formulated. (i) Ego activities in which defence is combined with adaptive gratification should be encouraged, while those which are maladaptive should be discouraged. (ii) Important defences should not be attacked unwittingly. (iii) Remote derivatives of defensive systems that are not being used maladaptively should be ignored. (iv) The theory of strengthening defences can be formulated in terms of Glover's suggestion that artificial neuroses may be set up which offer partial discharge for instinct derivatives, and thereby decrease the amount of defensive work demanded of the ego.
3Hypnosis. Earlier work by the present writer and his co-workers has shown that the view that defences are abolished by hypnosis is incorrect. The defence mechanism of repression is often