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This paper illustrates the use of self-psychological constructs in the treatment of a depressed 9-year-old boy with inherited genetic abnormalities. He experienced low self-esteem and a poor self-image due to faulty mirroring in the extended environment, beginning at birth.
Interpretations were rarely tolerated; the therapy centered on the enactment of the mirror transference. Wolf (1988) defines mirror transference as the mobilization of an early need for confirmation and acceptance by the selfobject. The mirror transference is manifested as demands on the therapist to “confirm the patient's self by recognizing, admiring, or praising the patient” (p. 125).
This child demonstrated a propensity for antisocial behavior, such as lying and cheating, which Lipton (1970) discussed as pertinent to children with physical defects, although it is certainly not limited to that population. Kohut (1971) described lying as resulting from pressure on the grandiose self, causing the liar to attribute great characteristics to himself. This child's tendency to lie and cheat at games was, therefore, understood as an effort to restore his damaged self-esteem, thus serving an adaptive function, as documented in the literature (Kavka 1985, Kohut 1971, Meeks 1970, Ornstein 1985); it was not a direct focal point of his therapy. Kavka (1985) makes an important distinction between the perception of lying in self psychology versus classical psychoanalysis. “In psychoanalytic studies that emphasize structural analysis, lying tends to be seen as defensive and maladaptive. Where the emphasis is on self-esteem regulation, lying may be seen as an adaptive function of a weak ego-structure—an adaptation needed to maintain narcissistic equilibrium” (p. 401). The gradual decrease in antisocial behavior followed the pattern of transformation of lies to fantasies, quasi-jokes, and ultimately into reasonable action, as outlined by Kohut (1971). The therapist followed the child's lead, staying empathically