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Bellak, L. Meyers, B. (1975). Ego Function Assessment and Analysability. Int. R. Psycho-Anal., 2:413-427.
(1975). International Review of Psycho-Analysis, 2:413-427
Ego Function Assessment and Analysability
Leopold Bellak and Barnett Meyers
Systematic evaluation of ego functions for the assessment of analysability has been discussed. In concentrating on these aspects of the personality, evaluation of superego factors and, to some extent, drive factors have not been considered. Similarly, reality factors, specific maturational phase or general life situation, intelligence, various handicaps such as speech difficulties, hearing difficulties, congruence or incongruence of a given patient with a given psychoanalyst were also not discussed. It is in the nature of a paper that its scope be limited. In no way should this technical consideration be construed as a willingness or suggestion that factors other than ego function assessment should be ignored or considered unimportant, or even, less important.
On the other hand, we suggest that systematic
ego function assessment should be a valuable tool for all analysts. Though a very formal rating scheme, with detailed definitions, suggestions for inquiry and criteria for rating is available, it will be possible and sufficient for any analyst to engage in some clinical rating without much more effort than making a list of the 12 functions discussed, clarifying the definitions and some criteria for evaluation in his own mind and keeping list and criteria as a frame of reference in a clinical interview.
Of the ego functions discussed, stimulus barrier, mastery-competence and ARISE are the only ones somewhat less than routinely kept in mind by analysts. With regard to stimulus barrier, certain neurological or generally physiological factors and their effect on organizing ability—and its lack—were especially stressed. Minimal brain dysfunction was brought to special attention in this respect with regard to thought processes, impulse control and some specific symptoms particularly.
Mastery and competence may be something of a new consideration for many analysts because, among other things, the concept does not come from strictly psychoanalytic sources. Nevertheless, we feel that it is an important aspect of analysability: mastery and competence seems to be autonomous enough to permit the conclusions that if someone shows mastery in his general life-style, he is likely to have a very good ability to utilize analytic processes—have a good utilization factor—and a poor one if the general life-style shows little mastery and competence. This fact seems to override degree of general pathology in our clinical experience.
ARISE (Adaptive Regression in the Service of the Ego), as originally formulated by E. Kris, needs merely be brought more fully to the attention of the analyst considering analysability because it may not have been sufficiently the custom to consider it for this purpose.
Above and beyond the usefulness of systematic and careful ego function assessment for analysability, we also wish to suggest such assessment for other purposes.
This is the era in which peer review is playing an increasing role, at least in American psychiatry and psychoanalysis. Systematic ego function assessment may be as good a way as any for systematic comparison of the status of many patients at the beginning, the middle and the end of an analysis.
Third party roles are also steadily increasing. Compensation by insurance companies, government and others makes a systematic evaluation as well as one based on criteria intelligible to lay people more and more urgent. Ego functions are behavioural variables mostly, which can be so understood, and an assessment can be given without violating intimate data or material very meaningful to the patient.
Finally, ego function assessment may be a useful and much needed research tool for analysts who wish to have a clearly defined basis for diagnostic assessment and the evaluation of therapeutic results by independent judges at different points of the treatment process.
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