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treat psychotic patients with analytically informed psychotherapy (Garfield, 2011), aiming to improve autonomous ego functioning, including reality testing and adaptation. When individuals show little damage or delay in ego functioning, the method of choice is the interpretative psychoanalytic technique, which today includes not only interpretation of the individual’s layered unconscious conflictual and compromise constructing activity, but also sensitive attunement and interpretation of the spectrum of nuanced unconscious ego activity involved in construction of multiple transferential configurations, pertaining to different eras of patient’s life (Rangell, 1969b) as they are occurring within the psychoanalytic setting, but also in the patient’s involvements outside of treatment (Blum, 1983a). Such nuanced assessment of unconscious ego functioning and ego strength allows for individualized modification of technique for those who demonstrate some interference with one or more ego capacities, such as poor impulse control (e.g., over-drinking), which caused mistakes in judgment (disturbed ego function). The assessment of etiology of such interferences in ego operations assists in determining the individualized modification of technique. The treatment for deficits in impulse control and deficits in judgments is different from that for addressing maladaptive defenses and compromise formations, although the presenting problem may be almost identical. One technique for distinguishing between different causes of ego function disturbance is a “trial interpretation” of the probable defensive inhibition that led to the problem possibly associated with the defenses of provocation of punishment and denial of a reality. Addressing these defensive elements should, in most neurotic individuals, lead to agreement with the analyst, revelation of new material, recollection of a dream, or a change in defense configuration – which may or may not be more adaptive (Waelder, 1960; Brenner, Reporter, 1975; Schlesinger, 1995). Such responses are usually not forthcoming from people whose disturbance in ego functioning is not defensive, but more due to deficit; they tend to require various (ego and superego) supportive measures (such as thinking through the range of alternatives and their consequences, setting safeguarding limits, etc.). In crafting an intervention, Hartmann’s (1951) ‘ principle of multiple appeal ’ may be instrumental: after first discovering unconscious conflict (Blackman, 2003), the analyst clarifies specific elements of a patient’s pathological compromise formations, elucidating inhibitions of function and defenses managing the affects generated by conflicts among drive wishes, reality, and self-punitive tendencies. The idea is that when a person’s autonomous ego functions, especially abstraction, integration, reality testing, and self-preservation, are relatively intact, a new understanding of the previously unconscious elements of any compromise formation will lead to the ‘resonance effect’ through adjacent psychic structures and processes, and realignment of the internal conflictual milieu, recalibration of instinctual investments, object relations, and relief of symptoms. Ego psychologically-based interventions look to resolve “inter-systemic conflicts” (between the systems ego, superego, and id), example of which might be shyness and overeating to relieve shame over masturbation fantasies; and/or at “intra-systemic” deficits or
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