Rorschach Interaction Patterns, Alexithymia, and Closeness to Parents in Psychotic and Psychosomatic Patients

Disordered affect regulation has recently been proposed as an important etiological factor not only for the so-called classical psychosomatic diseases, as in the well-known psychoanalytic constructs of alexithymia (Sifneos, 1973; Taylor, 1987), pensée opératoire (Marty and de M'Uzan, 1963), and disaffectation (McDougall, 1989), but also for a broad spectrum of psychiatric disorders including substance use disorders, post-traumatic stress disorders, borderline personality disorder, and the major psychotic disorders (Ciompi, 1998; Krystal, 1988; Schore, 1996; Taylor et al., 1997; Westen, 1998). For at least some lines of psychoanalytic thought, affects have substantially replaced the drives as the primary motivators of human behavior (Emde, 1988; Jones, 1995; Lichtenberg, 1989; Stern, 1985). Somewhat similarly, affects are now proposed to be the constituents of drives (Kernberg, 1976) or to include them (Grot-stein, 1997), so that the latter lose their exclusively biological, immutable features. Though rooted in biology, affects include a cognitive/experiential component as well as physiological and behavioral/expressive components (Taylor et al., 1997)

All theories centered on affect development and affect regulation emphasize the importance of interactions with primary caregivers (Garber and Dodge, 1991; Schore, 1994). As Stern (1984, 1985) and Emde (1988) have demonstrated, emotions and their expression are fundamental elements in reciprocal attunement; circularly, interactions with caregivers play a primary role in structuring the experience and expression