Normal and Pathological Aspects of Self-Descriptions and Their Change Over Long-Term Treatment

Using a new methodology for assessing the subjective experience of the self, the spontaneous self-descriptions of 29 psychiatric inpatients at admission and 40 nonpatients, all females ages 13 to 28, were rated on agency, interpersonal relationships, and cognitive-affective aspects and dimensions. Patients' self-descriptions, compared to nonpatients', were more negative, expressed moderately more depressive feelings and less sense of effectiveness, lacked a sense of both striving and relatedness, used fewer dimensions, and were at a lower developmental cognitive level. Changes in one inpatient's self-descriptions during long-term, intensive treatment were evaluated and compared to independent treatment reviews. They reflected the development of a richer and fuller sense of self including: a more positive and effective self-view; more references to affect, relatedness, and agency; more differentiation; and the use of more dimensions. These changes paralleled independently assessed signs of progress. As behavioral expressions of depression decreased, there was a marked increase in the expression of depression in the patient's self-descriptions, which seemed central to her treatment gains.