Self-Reflexivity, Intersubjectivity, and Therapeutic Change

Intersubjectivity theory holds that the self forms through relationships with others in a dialectic process. Although affect attunement is central to early self-other differentiation, infants do not see themselves as separate entities until 18 months and their minds as separate until approximately age 4. Transitional object relatedness thus often influences early childhood functioning. In self disorders, childhood disruptions in intersubjectivity

John S. Auerbach, PhD, Department of Psychiatry and Behavioral Sciences, James H. Quillen College of Medicine, East Tennessee State University, and Psychology Service. James H. Quillen Veterans Affairs Medical Center, Mountain Home, Tennessee: Sidney J. Blatt, PhD, Departments of Psychiatry and Psychology, Yale University, and Western New England Institute for Psychoanalysis, New Haven, connecticut.

This article derives from the work of the Object Representation Research Group, chaired by Dr. Sidney J. Blatt, at Yale University. We thank the other members of our research group—Drs. Basil Anton. Rebecca Behrends, Susan Bers, Diana Diamond. Rand Gruen, rebecca Johnston, Nadine Kaslow, Richard Kravit/, David stayner. and Roberta Stiel, as well as Ms. Cathy Havican and Ms. Helen Sayward—for their valuable suggestions.

An abbreviated version of this article was presented at the 19th annual spring meeting of the Division of Psychoanalysis of the American Psychological Association. New York, April 1999.

Correspondence concerning this article should be sent to John S. Auerbach. PhD, Psychology Service (I 16B3), Veterans Affairs Medical Center, P.O. Box 4000. Mountain Home, Tennessee 37684-4000. Electronic mail may be sent to

Page 427

create disturbances in integrating transitional fantasy with realistic cognition, such that one's own mental states are often confused with others'. In treatment, self-other differentiation is aided by adaptive projective identification, in which patients find in their therapists