Change in Self- and Object Representation During Long-Term Dynamically Oriented Treatment

Recently psychoanalysis has begun to consider how cognitive—affective structures and schemata of self and others, guide and motivate behavior. Impaired and/or distorted representations are assumed to play a significant role in psychopathology. One goal of long-term treatment should be the modification of pathological images of self and other. In this article, we present material from two patients in long-term, dynamically oriented treatment; one, a schizophrenic patient, the other, a patient with a borderline character disorder. Changes in representations of self and others over the course of treatment are examined in conjunction with ongoing independent assessments of changes in the transference in individual therapy. Significant changes in representational structures were closely related to changes taking place in the transference relationship. The findings suggest that growth in representational structures follows a developmental continuum, and that the integration and consolidation of conflicting self-images is dependent on the resolution of central psychological conflicts involving parental representations. The patient's development of a capacity for empathy seems to play an important role in this process.