Advanced Clinical Practice

THE EGO AND ITS FUNCTIONS

[The Ego ] The organization and substructure (one of three) of mental apparatus.Defined by functions: Primary and Secondary (defensive).Innate potentials: developmental and sequential.Components are interactive/interrelated/ and mediated.A construction, an abstraction, a concept.“The whole is greater than the sum of its parts.”

PRIMARY FUNCTIONS:• The means by which a person is organized (psychological) and adapts to and functions in the external

world• Ego Strength: composite picture of internal psychological capacities.• Ego Weakness: Deficiencies in functions: range, expression, intensity, presence, absence, etc.• Assessment looks at stability, regression, variability and situations.

1. Autonomous Functions: Those arenas that are seen to be innate, have its own energy source, are not a result of the drives and are “conflict-free”: The Five Sensorium, attention, concentration, memory, learning, perception, motor function and intention. Appear to have biological components. Secondary Autonomy: specific notion of something that may begin with conflict and eventually become independent. Crucial: Assessment focuses on ability to maintain and regain autonomous functions in the face of stress.

2. Stimulus Barrier: The result of sensorimotor apparatus. Is responsive to internal/external stimuli. Regulates input. Note individuals have different thresholds [constitutional] and the environment mediates it. Crucial: the ability to maintain functioning/comfort when the rate, amount of stimulus changes.

3. Regulation Drives/affects/Impulses: The ability to modulate, delay, inhibit, or control these in accordance with the reality principle [environment]. Impacted by strength, intensity [biological] and reality pressure [environment]. Ability to tolerate a range of affect as “normal”..

4. Thought Processes: The ability to perceive, attend to stimuli, concentrate, anticipate, make symbols, remember and reason. Begins with autonomous, conflict-free apparatus. This function is reflected in the ability to communicate [thinking/speaking] in an organized, logical and oriented to reality manner. Two levels:

Primary Process: wish-fulfilling fantasies. Characteristics: 1) disregards logical connections; 2) permits contradictions; 3) has no conception of time; 4) sees wishes as “actual”, and 5) utilizes displacement and condensation [secondary defenses]. Note: Can be age appropriate or situationally appropriate.Secondary Process: Involves and reflects the reality principle. Demonstrates the ability to postpone instinctual gratification or discharge of tension. Is goal directed, organized, oriented toward reality. Influences and interacts with communication. Can fluctuate and is subject to change due to stress.

5. Reality Testing: The ability to have an accurate perception of the external environment, the internal world and the differences between them. Connected to the maturation of cognitive ability, ability to perceive stimuli (source), capacity to test reality, understands cause and effect. Clinically need to know distinction between distortion and impairment.

6 Sense of self, of the world: A complex function – at the core of one’s physical and psychological identity and relations to others. The ability to feel, be aware of the world & one’s connection to it as real, to experience one’s own body as intact, belonging to the self, a sense of self, and as having separation/boundaries. Clinically most apparent in its absences, e.g. derealization, depersonalization, & certain distortions in body image.

7. Judgment: Capacity to identify a course of action, anticipate and weigh the implications/consequences and take appropriate action to achieve goals. Is dependent on accurate perception, testing of reality, maturation of cognitive processes and experiences. Necessary for adequate problem solving. Deficits can be situation specific or general and pervasive.

8. Mastery & Competence: The degree to which one feels competent. Is a function of innate abilities, mastery of developmental tasks [Erickson], and appropriate feedback. Represents an inborn active striving toward interaction w/environment. Is a sense of effectiveness and is a part of self-confidence.

9. Object Relations: The development of one’s internalized sense of self and others. It is the capacity for mature relationships which is the context for personality development. The self and other are experienced as separate, three-dimensional. It is shaped a key stages of development. Goal is object constancy, assessed by pattern and not single situation.

10. Defensive Function [Secondary]: Unconscious, internal mechanisms that protect the individual from anxiety. They emerge developmentally: Primitive – younger, earlier in developmental sequence. Ranges to Sophisticated – later reflects maturation of individual. They either foster optimal (adaptive) functioning or less optimal(maladaptive). Need to consider range, flexibility or rigidity, whether it is selective or pervasive.

11. A.R.I.S.E. {Adaptive Regression in Service of the Ego}: Regression is seen as returning to an earlier stage of functioning. It is the ability to relax, let go, allow one’s self to be nurtured and replenished. Crucial issue is that it is adaptive (promotes increased functioning). e.g. sleeping, eating, playing, hobbies, sports, sexuality, etc.

12. Synthetic-Integrative Function: The ego’s organizing role. Ability to organize mental processes into a coherent form – binds, fits together all of the disparate aspects of personality. Some components innate (biological) and others are mediated by the environment.