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Barton, H.R. Kovan, R.A. (1979). Childhood Ego States and Adult Clinical Practice. Am. J. Psychoanal., 39(2):137-145.

(1979). American Journal of Psychoanalysis, 39(2):137-145

Childhood Ego States and Adult Clinical Practice

Howard R. Barton, M.D. and Robert A. Kovan, M.D., MSP

Psychiatric practice in a community mental health clinic in the central city area requires rapid assessment of cases for proper therapeutic management. As a useful model, we have formulated the concept of correlating adult clinical states with known specific ego stages of childhood. Our patients come in with various degrees of ego regression which we consider to be recapitulations and reflections of ego states which previously existed in early life. By using this correlative tool, we can more quickly grasp the nature of the psychiatric illness existing currently and better plan for crisis management.

In a previous article,1 we have presented these correlations between the first two ego stages: the stage of autistic symbiosis and the stage of differentiation-of-the-self. We related these to the following adult clinical syndromes: acute schizophrenic episodes; borderline character disorders in the phase of psychotic anxiety; hysterical dissociation and depersonalization neurosis; paranoid states; process schizophrenia; hypochondriacal neurosis; borderline syndrome in the phase of neurosis of abandonment; certain psychophysiologic disorders; psychotic depression and involutional melancholia; some adult adjustment reactions; and schizoid personality disorder.

We now continue to explore the phases of ego separation-individuation as they are related to adult clinical syndromes.

Schecter2 and Sours3 have summarized and elaborated on the stages of ego development which follow the first two listed above: the third stage begins at the completion of lap-babyhood and is designated the stage of fearful separation-practicing; this blends into the fourth stage, that of ecstatic separation-practicing; the fifth is that of the rapprochement crisis, and the final, sixth, stage is well on its way to being completed normally by age three and has been referred to as the stage of individuation.


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