REALITY TESTING An important feature of the hysterical character is that special perception of the world, which leads him to the absence of truth, an objective picture in relation to both the surrounding world and other people and himself. Information entering our

REALITY TESTING Both neurotic and borderline personality organizations, in contrast to psychotic ones, presuppose the ability to test reality. Therefore, if the diffuse identity syndrome and the predominance of primitive defense mechanisms

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Your idea of ​​reality may interfere with your perception of reality. So, people often see not reality, but their idea of ​​it. They see not what is in front of their eyes, but what they expect to see. A concept is a useful thing when you form a vision about creation,

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Psychotic level

People at this level are devastated, disturbed, disorganized. These features are formed under the influence of early limitations of the Self and as a consequence of the formation of a psychotically preorganized Self in childhood. The psychotically preorganized Self is transformed either into a neurotically organized Self, and then into neurosis, or into a psychotically organized Self and then into psychosis.

Psychotics resort to primitive pre-verbal, pre-rational defense mechanisms - retreat into fantasy, denial, devaluation, primitive forms of projection and introjection, splitting and dissociation.

Identity is not integrated. Psychotics experience great difficulty in answering the question “Who am I?”, describing themselves superficially, distortively, and primitively.

Poor reality testing, confused and inadequate. Interpretation of psychotics' statements about reality can cause existential horror, leading the patient to an even worse state than what was observed at the beginning of therapy.

The nature of the basic conflict is existential - life or death, safety or fear. This is a problem of basic trust or mistrust caused by rigid parental attitudes or an uncertain, chaotic relationship (for example, having a masochistic mother and a sadistic father). Monadic object relations are typical for psychotics.

The main type of psychotherapy is supportive technique. Intensive analysis and expressive psychotherapy are not applicable. Talking through defenses and transference will lead to fear and mistrust. The therapist demonstrates reliability, proves that he is a safe object (and not an authority figure who can “kill”), behaves openly, and performs an educational function.

Border level

People at this level occupy an intermediate position between neurotics and psychotics. They are distinguished by some temporary stability compared to the second and a violation of stability compared to the first. According to J. Bergeret, the border structure is formed due to the fact that during childhood the child received trauma, which led to the organization of the border structure

Borderlines use primitive defense mechanisms, so they are sometimes difficult to distinguish from psychotics. The important difference is that when the conversation is properly structured, they may show a temporary ability to respond to the interpretations that the therapist makes.

In the sphere of identity integration, the borderline personality exhibits contradictions and breaks in the self. When describing themselves, they experience difficulties and are prone to hostile defense and aggression. However, self-exploration is not accompanied (as in psychotics) by a feeling of existential dread and fear. Rather, they may be accompanied by hostility. According to the criteria of ego identity and typical defenses, the borderline personality is more similar to a psychotic than to a neurotic character organization.

When properly structured, borderline clients demonstrate an understanding of reality, thereby distinguishing themselves from psychotics; able to observe their pathology. The main problem is the ambivalence of feelings they have towards their environment. This is, on the one hand, a desire for intimacy, a trusting relationship, and on the other hand, a fear of absorption, merging with another person.

The main conflict is associated with the second stage of personality development according to E. Erikson - autonomy/shame (separation/individuation). The main characteristic of the borderline personality is that they can almost simultaneously demonstrate a request for help and reject it. Children with this character structure seem to have mothers who resist separation or who refuse to come to their rescue when they need to regress after achieving independence. The borderline personality exhibits dyadic object relationships.

The goal of therapy when used with borderline individuals is to develop a secure, holistic, and complex sense of self as a client, developing the ability to fully love others despite their shortcomings. The ability to perceive the interpretation of defenses makes the use of expressive therapy possible. Its purpose is to establish safe boundaries, therapeutic boundaries that the borderline patient may violate; in pronouncing contrasting sensory states; in the interpretation of primitive defenses (unlike neurotics, where the transference reaction is tied to some figure from the past, in a borderline personality the interpretation of defenses is carried out in relation to a given, current moment); in supervision from the patient, i.e. in turning to him for help.

Neurotic level

The term "neurotic" is applied to relatively healthy people who have some difficulties associated with emotional disturbances. At the first stages of development - oral and anal, no serious character disturbances were observed. However, during the oedipal stage (3-6 years), problems arose that led to the organization of a neurotic structure. According to J. Bergeret, depending on how problematic the development is at the teenage stage, the neurotically reorganized can form either a neurotically organized self and develop into neurosis, or a psychotically organized self and develop into psychosis.

Neurotics rely on more mature defenses, having the opportunity to update more primitive defense mechanisms. The presence of primitive defenses does not at all exclude the diagnosis of character structure at the neurotic level, but the absence of mature defenses excludes such a diagnosis. Neurotics use as mature ones - repression, intellectualization, rationalization, etc. defenses, as well as primitive ones - denial, projective identification, isolation, etc.

They have an integrated sense of identity, i.e. are able to describe themselves without experiencing difficulties in determining their character traits, preferences, interests, temperamental characteristics, strengths and weaknesses. Neurotics are also good at describing other people.

Neurotics are in reliable contact with reality, they do not have hallucinations, manic interpretations of experience, they live in the same world as the psychotherapist. Some part of his ego, which worries the patient, and about which he turned to a psychotherapist, is considered by him detachedly. She is ego-dystonic. Thus, a neurotic-level paranoid person will believe that her suspicions come from her internal predisposition to perceive other people as hostile and aggressive. Paranoid borderline or psychotic patients believe that their difficulties are external and determined by the characteristics of the world around them, how painful and disturbed it is.

The nature of the difficulties lies not in the problem of security or attachment, but in the formation of identity and initiative. This is the problem of the Oedipus stage of development according to Erikson. Triadic object relations are typical for neurotics.

Apexithymia.

Alexithymia- psychological characteristics of a person, including the following features: difficulty in defining and describing (verbalizing) one’s own emotions and the emotions of other people; difficulty distinguishing between emotions and bodily sensations; decreased ability to symbolize, in particular to fantasy; focusing primarily on external events, to the detriment of internal experiences; a tendency towards concrete, utilitarian, logical thinking with a deficiency of emotional reactions.

All of these features may manifest themselves equally, or one of them may predominate.

Traditionally distinguished primary and secondary alexithymia.

Primary, or congenital, alexithymia, has a detectable organic substrate. These may be minor developmental defects, consequences of hypoxia during pregnancy or childbirth, illnesses suffered at an early age. This is a persistent form of alexithymia that is difficult to treat.

Secondary alexithymia appears at older ages in somatically healthy individuals. It can be the result of serious nervous shocks, stress, various psychotraumas, and neurological diseases. A number of psychiatric diseases (schizophrenia, autism, etc.) are accompanied by alexithymia.

Research is being conducted on microorganic disorders in the structure of the brain in people with alexithymia. There is evidence to suggest that such people have impaired communication between the hemispheres of the brain. The structure that makes this connection—the corpus callosum—is damaged at the microscopic level. In such a situation, the right hemisphere, already dominant in most people, takes on a dominant role. The left, which controls emotional manifestations, is suppressed. A person is in a situation of constant interhemispheric conflict. This pathology is detected in most people suffering from psychosomatic diseases.

There are a number of character traits common to people suspected of having alexithymia. Its signs cover not only the emotional sphere.

Difficulty perceiving and expressing one's own emotions. Alexithymics, of course, feel the full range of emotions inherent in people, but cannot describe what they feel. Accordingly, they have difficulty understanding the emotions of others. This can cause great difficulties in communication. Gradually, people with alexithymia develop a tendency toward loneliness.

Poor imagination, limited imagination. People with alexithymia are in most cases incapable of creative work. They feel confused by the need to invent or imagine something.

Rare dreams. A direct consequence of the previous point is the almost complete absence of dreams. If they appear, then the person performs ordinary, everyday actions in them.

Logical, clearly structured thinking and its predominantly utilitarian orientation. People with alexithymia are not inclined to dream or fantasize; they are closer to specific, everyday, clearly defined problems. They do not trust their intuition or even deny its existence.

People with alexithymia often confuse emotional experiences with bodily sensations. Therefore, when asked about feelings, they often describe bodily sensations - painful, uncomfortable, warm, tight, pressing, good.

The term alexithymia was coined in 1973 by Peter Sifneos. In his work, published back in 1968, he described the characteristics he observed of patients in a psychosomatic clinic, which were expressed in a utilitarian way of thinking, a tendency to use actions in conflict and stressful situations, a life impoverished in fantasies, a narrowing of affective experience and, especially, difficulties find the right word to describe your feelings.

To determine the severity of alexithymia, various questionnaires were used: BIQ (Beth questionnaire, Israel), ARVQ (created on the basis of the BIQ scale), SSPS (Sifnoes personality scale); The 22-item alexithymia scale of the MMPI was also used. But they all gave very contradictory data, so they were not widely used in scientific research.

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 wristwatch . 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 to exactly 3, and the minute clock points to exactly 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).

1. 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.
2. 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.
3. 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.
4. 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!

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 organizations.

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 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.