Understanding Self-Disorders

Many of the clients that I have treated over the years initially presented with a variety of symptoms including anxiety, depression, rage episodes, generalized helplessness and/or substance abuse.  What became apparent over time was that the presenting symptom was an indicator of the more pervasive and long-standing problem of having a "Self" that had never fully developed.  In a reasonably healthy environment, a child grows up in the care of adults who are available, attuned and, for the most part, responsive to their needs.  This process is described in the psychology literature in a variety of ways but is considered critical to the child developing into an adolescent, and eventually a young adult, who can meet the challenges and navigate the stresses associated with each developmental stage of life.  For some, it is only when they reach early adulthood that it becomes apparent that something crucial did not occur during their growing up, and they start to fumble in the face of new challenges.


Although there is no exact definition of the "Self", there are associated Self-functions that are necessary for leading a productive and reasonably happy life.  Some of the functions of the Self include: emotional regulation; self-activation; having a coherent and stable identity; self-esteem regulation; impulse control & and the ability to delay gratification; the capacity to differentiate one's fantasies from reality; capacity for good judgment; capacity to act to protect oneself; capacity for healthy interpersonal attachment; and the capacity to have a sense of self that is reasonably cohesive through time. 


When a person does not have an adequately functioning Self, it is a bit like driving a poorly cared-for car: one never knows when the brakes will give out, the steering will be unreliable, or the car will break down altogether.  Persons with Self-Disorders experience their own mood and behavior as unpredictable, and, thus,frequently find themselves "in trouble" because of lack of judgment or impulse control or remained walled-off and unable to get motivated or find a direction for their lives.  These persons may have tried to find a diagnosis that "fit" them, only to feel that the diagnosis of "Anxiety Disorder" or "Eating Disorder" does not fully capture their internal experience of moving through life without a compass or a means of getting oriented. 


Treatment for Self-Disorders involves a combination of understanding the impact of early experiences on their development in conjunction with a therapy focused on the "construction" of a more reliable and functional Self.  Therapy for Self-Disorders will include "talk therapy" but will also necesitate the client being an active participant both inside and beyond the therapeutic hour.  Unlike some of the traditional "uncovering therapy" that is frequently portrayed in the movies, this is a therapy focused on encouraging development of functions that have, until the person entered therapy, stalled or been inadequate in some way.  As a therapist, when I work with these clients, I am active, educating, supportive and (when appropriate) confrontational of dysfunctional behavior.  This is not short-term therapy, but my experience is that it can be life-changing therapy, helping the client to have the life that has always seemed out of reach.