What is reality testing in psychology. Levels of personality organization - psychotic, borderline and neurotic

Both neurotic and borderline personality organizations, in contrast to psychotic ones, presuppose the presence of the ability to test reality. Therefore, while the diffuse identity syndrome and the predominance of primitive defense mechanisms make it possible to distinguish the structure of the borderline personality from the neurotic state, reality testing allows us to distinguish between the borderline personality organization and serious psychotic syndromes. Reality testing can be defined as the ability to distinguish between self and non-self, to distinguish intrapsychic from external sources of perception and stimulation, and as the ability to evaluate one's affects, behavior and thoughts in terms of the social norms of the average person. In a clinical examination, the following signs tell us about the ability to test reality: (1) the absence of hallucinations and delusions; (2) the absence of clearly inappropriate or bizarre forms of affect, thinking and behavior; (3) if others notice the inadequacy or strangeness of the patient's affects, thinking and behavior from the point of view of the social norms of an ordinary person, the patient is able to experience empathy for the experiences of others and participate in their clarification. Reality testing must be distinguished from distortions of the subjective perception of reality, which can appear in any patient during psychological difficulties, as well as from distortions of the attitude towards reality, which always occurs both in character disorders and in more regressive psychotic states. In isolation from everything else, reality testing is only... in rare cases it can be important for diagnosis (Frosch, 1964). How does reality testing manifest itself in the situation of a structural diagnostic interview?

1. The ability to test reality can be considered to be present when we see that the patient does not and has not had hallucinations or delusions, or, if he has had hallucinations or delusions in the past, is now fully capable think critically about them, including the ability to express concern or surprise about these phenomena.

2. In patients who have not had hallucinations or delusions, the ability to test reality can be assessed on the basis of careful examination of inappropriate forms of affect, thinking, or behavior. Reality testing is expressed in the patient's ability to experience empathy for how the therapist perceives these maladaptive phenomena, and, more subtly, in the patient's ability to experience empathy for how the therapist perceives the interaction with the patient as a whole. The structured interview, as I have already mentioned, provides an ideal opportunity for reality testing research and thus helps to distinguish borderline from psychotic personality organization.

3. For the reasons discussed above, the ability to test reality can be assessed by interpreting the primitive defense mechanisms operating during the diagnostic interview between patient and therapist. Improvement in the patient's functioning as a result of such an interpretation reflects the presence of the ability to test reality, and an immediate deterioration after it suggests a loss of this ability.

Table 1 summarizes the differences between different personality organizations along three structural parameters: the degree of identity integration, the predominance of defense mechanisms, and the ability to test reality.

NON-SPECIFIC MANIFESTATIONS OF EGO WEAKNESS

Nonspecific manifestations of ego weakness include an inability to tolerate anxiety, a lack of impulse control, and a lack of mature modes of sublimation.

Table 1. Features of personal organization

These signs must be distinguished from the "specific" aspects of ego weakness - from those that are a consequence of the predominance of primitive defense mechanisms. Anxiety tolerance is the degree to which a patient can tolerate emotional stress beyond what they are accustomed to without experiencing increased symptoms or general regressive behavior. Impulse control is the extent to which a patient can experience an instinctual desire or strong emotion without acting impulsively, contrary to his or her decisions and interests. The effectiveness of sublimation is determined by the extent to which the patient can “invest” himself in his values beyond immediate gain or self-preservation, in particular by the extent to which he is able to develop creative abilities in areas not related to his upbringing, education or acquired skills.

These characteristics, reflecting personality structures, are directly manifested in behavior, which can be learned by examining the patient's history. Nonspecific manifestations of ego weakness help to distinguish borderline personality organization and psychoses from neurotic structure. But in the case where it is necessary to separate the borderline structure from the neurotic one, these signs do not provide criteria as valuable and clear as the integration of identity and the levels of organization of defenses. For example, many narcissistic individuals show far fewer nonspecific symptoms of ego weakness than might be expected.

COMPLETE OR PARTIAL LACK OF SUPER-EGO INTEGRATION

A relatively well-integrated, but very rigid Super-Ego is characteristic of the neurotic type of personality organization. Borderline and psychotic personality organizations are characterized by violations of the integration of the Super-Ego, as well as the presence of non-integrated precursors of the Super-Ego, in particular primitive sadistic and idealized object representations. Superego integration can be judged by the extent to which the patient identifies with ethical values and by whether the normal feeling of guilt is a significant regulator for him. The regulation of self-esteem through extremely strong feelings of guilt or depressive mood swings indicate a pathological integration of the superego (typical of a neurotic organization), in contrast to the calmer, concretely oriented, self-critical functioning of a normal person in the sphere of ethical values. Signs of Super-Ego integration are: the extent to which a person can regulate his actions on the basis of ethical principles; the extent to which he refrains from exploitation, manipulation and cruelty towards another person; how honest and morally integral he remains in the absence of external coercion. For diagnosis, this criterion is of less value than those described above. Even in patients with predominant primitive defense mechanisms, the Superego can be integrated, although it may be of a sadistic nature - there are patients with borderline personality organization who have a fairly high degree of Superego integration, despite serious pathology in the areas of identity integration, object relations and organization protection In addition, information regarding superego integration is easier to obtain by studying the patient's history or observing the patient over time than during a diagnostic interview. Nevertheless, the degree of integration of the superego has enormous prognostic value, which is why it is the most important structural criterion in the question of indications or contraindications for long-term intensive psychotherapy. In fact, the quality of object relations and the quality of superego functioning are the two most important predictive criteria in structural analysis.

GENETIC AND DYNAMIC CHARACTERISTICS OF CONFLICTS

The conflicts of instincts characteristic of the borderline personality organization appear only in the process of long-term therapeutic contact, and they are difficult to determine during a diagnostic interview, however, for the sake of completeness, they are described here.

Borderline personality organization is a pathological mixture of genital and pregenital instinctual drives with a predominance of pregenital aggression (Kernberg, 1975). This explains the bizarre or inappropriate combination of impulses of sexuality, dependence and aggression that we see in borderline (and also in psychotic) personality organization. What appears to be the chaotic persistence of primitive drives and fears, the pansexualism of the borderline patient, is a combination of various pathological solutions to these conflicts.

It must also be emphasized that there is a huge discrepancy between the patient's life history and his internal fixed experiences. In the psychoanalytic study of such patients we discover not what happened in their external world, but how the patient experienced significant object relations in the past. In addition, we should not accept as the pure truth the patient’s life story, which he talks about at the first meetings: the more severe the character disorder, the less we should trust this information. In severe narcissistic disorders, as in borderline personality in general, the account of early life is often empty, chaotic, or unreliable. Only after several years of therapy is it possible to reconstruct the internal genetic sequence of events (intrapsychic causes) and find a connection between it and how the patient himself is now experiencing his past.

Reality check- this is any action performed in order to find out whether you are currently sleeping or awake. Simply put, a reality check is a test designed to answer one single question: “Am I dreaming right now?”

The method of frequent reality checks is one of the most effective methods. In addition, it perfectly trains prospective memory.

Effective Ways to Check Reality

Pinch yourself . This is probably one of the most famous reality tests. In your sleep you will not feel pain. Instead, you will probably feel a special sensation that is difficult to describe in words. But having experienced it at least once, you will no longer confuse it with anything.

Try to poke your finger into an object . Usually they try to pierce their own palm. As you probably already understood, in a dream this will not present much difficulty.

Try to remember what you did in the last 5-10 minutes . You won't be able to do this in a dream. However, if you have, then you will not be able to do this even while awake. Therefore, traditionally this method is considered not the most reliable.

Close your lips and pinch your nose . Can you breathe in this state? If yes, then this is a dream.

Read some inscription . Then turn away for a moment and read again. If this is a dream, then the inscription will change. Why this happens is not known for certain, but the method works and is quite effective.

Use a wrist watch . Firstly, in a dream they will most likely look different than in reality. Secondly, in a dream, with each look they will show a different time (for example, they looked once - they show 2 hours 10 minutes, turned away, looked again - they already show - 2 hours 40 minutes). If you have a watch with hands, then they (the hands) may occupy impossible positions in a dream (for example, the hour clock points exactly to 3, and the minute clock points exactly to 6, although it should point to 12).

Try to fly . If you succeed, then naturally it’s a dream!

Close one eye and try to see your nose . Oddly enough, but in a dream with one eye (either) closed, you will not be able to see your nose. It’s not clear why this happens, but it doesn’t matter to us. The main thing is that this reality check method works great.

Count the number of fingers on both hands one at a time . If this is a dream, then the following options are possible: You count more/less than ten fingers; in the process of counting, the hands begin to change (change shape, color, etc.) It is noteworthy that counting all five fingers on one hand in a dream is usually not a problem (but if you count on both hands, then tricks begin).

Do a reality check as often as possible throughout the day. The more often you check reality, the faster the habit will develop, and the more likely it is that you will start doing this in your dreams.
If you constantly do the same reality test, then after a while it may lose its effectiveness. That is, both in a dream and in reality it will give the same result. In connection with the above, we recommend doing several reality tests at once and changing them periodically.
Analyze your dreams and identify moments or actions that often occur both in dreams and in reality. For example, you often dream that you are at your workplace and this is true in reality. Train yourself to do a reality check at these very moments, then the chances of becoming aware of yourself in a dream will increase many times over.
Do a reality check even if you are 100% sure that this is not a dream. You will be very surprised how often you are wrong!

Severe personality disorders [Psychotherapy strategies] Kernberg Otto F.

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This technique is good for beginners. Its essence is as follows:
1. Keep some text with you throughout the day or wear a digital watch. To check the degree of reality in which you are, read this text or the inscription you have, remember the time on the clock. Then look somewhere to the side and back at the inscription to check if the words or numbers have changed. Try also, by looking at them, to force them to change. If words or numbers change or look unusual, or don't make sense at all, then you're most likely dreaming. Enjoy it! If the symbols are normal, stable and meaningful, then you are awake and should proceed to step 2.
2. If you are sure that you are not dreaming, tell yourself: “I may not be sleeping now, but if I were, what would it look like?” Try to imagine as vividly as possible that you are dreaming. Deliberately imagine that everything you see, hear, touch and smell is a dream. Imagine that your surroundings are not constant, words change, objects transform, that you begin to float above the ground. Create within yourself the feeling that you are in a dream. Then, without losing it, proceed to step 3
3. Choose what you would like to do in your next lucid dream - fly, talk with some dream character, or simply explore the dream world. While you continue to imagine that you are dreaming, try to accomplish what you have planned for yourself in the next dream.

This exercise should be performed regularly several times a day. In addition, it should be done whenever anything unusual happens or when you are somehow reminded of or remembered about dreams. It is useful to choose a repetitive action for this: you look in the mirror, look at the clock, come to and from work, etc. The more often and harder you do this exercise, the better it will work.

Other Ways to Test Reality

Method of remembering the past. According to this method, when you want to do a reality test or suspect that you may be dreaming, try to reconstruct the sequence of your actions over the past few hours. In a dream, there are no memories of the immediate past or they contradict the principles of the real world (for example, you have just returned from a meeting with the Martians). In ordinary life, the past turns out to be quite meaningful, and it becomes obvious to you that you are not dreaming.

Breathing through your hand. You can test reality by trying to breathe through your palm. In the ordinary world, this is, of course, impossible if you completely cover your mouth with your palm and press your nostrils with your thumb and forefinger. If you breathe freely, then you are in the arms of sleep.

Managing the uncontrollable. This method consists of trying to change something that cannot be controlled in normal reality. Options include trying to control the sun (try changing day to night) and stopping the heart at will. Place your hand on your heart and feel its beats.

Then, with an effort of will, stop it. Since the heart works independently of the will, you cannot stop it in ordinary life.