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.

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

Analysis on Credit: Concession to Reality or Flight from

Your idea of ​​reality may not correspond to reality One day, the artist and educator Arthur Stern took some students to Riverside Park in New York. Approaching the river, he showed them three structures on the other side of the Hudson River: a multi-storey apartment building,

Your idea of ​​reality can interfere with the 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,

Chapter 8 How to Distinguish Judgments about Reality from Reality Itself

Testing "I got the highest score on the test"Tests are conducted in schools to compare the level of education of children of the same age group in Western countries. Parents anxiously await the announcement of grades. A "well-bred" child should not only be

Psychotic level

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

Psychotics resort to primitive pre-verbal, pre-rational defense mechanisms - withdrawal 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, distortingly, primitively.

They test reality poorly, are confused and inadequate. Interpretation of psychotic statements about reality can cause existential horror, lead the patient into an even worse state than that observed at the beginning of therapy.

The nature of the underlying conflict is existential - life or death, security or fear. This is a problem of basic trust or mistrust, caused by rigid parental attitudes or vague, chaotic relationships (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. Speaking out defenses and transference will lead to fear and distrust. The therapist demonstrates reliability, proves that he is a safe object (and not an authoritative figure who can "kill"), behaves openly, performs an educational function.

border level

People of this level occupy an intermediate position between neurotics and psychotics. They are distinguished by some temporal stability in comparison with the second ones and a violation of stability - in comparison with the first ones. According to J. Bergeret, the border structure is formed due to the fact that during childhood the child was traumatized, which led to the organization of the border structure

The borderline personality uses primitive defense mechanisms, so it is sometimes difficult to distinguish them from psychotics. An important difference is that, with the right conversation, they may show a temporary ability to respond to the therapist's interpretations.

In the sphere of identity integration, the borderline personality has contradictions, breaks in the Self. They have difficulty describing themselves, they are prone to hostile defense, to aggression. However, self-exploration is not accompanied (as in psychotics) with a sense of existential horror and fear. Rather, they may be accompanied by hostility. In terms of ego-identity criteria and typical defenses, the borderline personality is more like a psychotic than a neurotic character organization.

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

The main conflict is associated with the second stage of personality development according to E. Erickson - autonomy / shame (separation / individuation). The main feature 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 prevent separation or refuse to come to the rescue when they need the regression that has come about since independence. The borderline personality has dyadic object relations.

The goal of therapy, which is applied to borderline individuals, is to develop a secure, holistic, and complex sense of being a client, developing the ability to fully love others despite their shortcomings. The ability to perceive the interpretation of defenses makes it possible to use expressive therapy. Its purpose is to establish safe boundaries, a therapeutic framework that the borderline patient can violate; in pronunciation of contrasting sensory states; in the interpretation of primitive defenses (unlike neurotics, where the transference reaction is tied to some figure of the past, in a borderline personality, the interpretation of defenses is carried out about a given, actual moment); in supervision from the patient, i.e. in asking him for help.

neurotic level

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

Neurotics rely on more mature defenses, being able to actualize more primitive defense mechanisms. The presence of primitive defenses does not at all preclude the diagnosis of the character structure of the neurotic level, but the absence of mature defenses precludes such a diagnosis. Neurotics use as mature - repression, intellectualization, rationalization, and so on. protection, 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 identifying their character traits, preferences, interests, temperamental characteristics, strengths and weaknesses. Neurotics also successfully describe other people.

Neurotics are in reliable contact with reality, they do not have hallucinations, manic interpretations of experience, they live in the same world with the psychotherapist. Some part of his ego, which disturbs 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 intrinsic predisposition to perceive other people as hostile and aggressive. Paranoid borderline or psychotic patients believe that their difficulties are of an external nature and are determined by the characteristics of the surrounding world, its morbidity and disturbance.

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 oedipal stage of development according to Erickson. Typical for neurotics are triadic object relations.

Apexithymia.

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

All of these features may be equally pronounced, or one of them may predominate.

Traditionally allocate primary and secondary alexithymia.

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

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

Research is underway 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, acquires a dominant role. The left, which just controls the 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 inherent in people who are suspected of having alexithymia. Its signs cover not only the emotional sphere.

Difficulty in 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 communication difficulties. Gradually, people with alexithymia develop a tendency to be alone.

Bad fantasy, limited imagination. People with alexithymia are in most cases incapable of creative work. They are 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 a 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 proposed in 1973 by Peter Sifneos. In his work, published as early as 1968, he described the features he observed in psychosomatic clinic patients, which were expressed in a utilitarian way of thinking, a tendency to use actions in conflict and stressful situations, a life impoverished by fantasies, a narrowing of affective experience and, especially, in 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 in the MMPI was also used. But all of them gave very contradictory data, therefore 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 sleeping right now?"

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

Effective Ways to Test Reality

pinch yourself . This is probably one of the most famous reality tests. In a dream, 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 not confuse it with anything.

Try to pierce an object with your finger . Usually they try to pierce their own palm. As you probably already understood, in a dream it will not be difficult.

Try to remember what you have been doing for the last 5-10 minutes . In a dream, you will not be able to do this. However, if you have, then you will not be able to do this in the waking state. 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 it 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 glance, they will show a different time (for example, they looked once - they show 2 hours 10 minutes, turned away, looked again - they show already - 2 hours 40 minutes). If you have a watch with hands, then they (the hands) can occupy impossible positions in a dream (for example, the hour indicates exactly 3, and the minute exactly 6, although it should be 12).

Try to take off . If you succeeded, then naturally this is a dream!

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

Count one by one the number of fingers on both hands . If this is a dream, then the following options are possible: You will 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, tricks begin).

1. Do reality checks as often as possible throughout the day. The more often you reality check, the faster the habit will develop, and the more likely you will start doing this in your sleep.
2. If you constantly do the same reality test, then after a while it may lose its effectiveness. That is, in a dream and in reality, it will give the same result. In connection with the above, we recommend that you do several reality checks at once and periodically change them.
3. Analyze your dreams and identify moments or actions that often occur both in a dream and in reality. For example, you often dream that you are at your workplace and this is true in reality. Accustom yourself to do a reality check in these 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're 100% sure it's not a dream. You will be very surprised that you are wrong very often!

Both neurotic and borderline personality organization, unlike psychotic, presuppose 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 makes it possible 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 between the intrapsychic and the external source of perception and stimulation, and also as the ability to evaluate one's affects, behavior and thoughts in terms of the social norms of an ordinary person. In a clinical study, the following signs tell us about the ability to test reality: (1) the absence of hallucinations and delusions; (2) the absence of manifestly inappropriate or bizarre forms of affect, thought, and behavior; (3) if others notice the inadequacy or strangeness of the patient's affects, thinking and behavior in terms of the social norms of an ordinary person, the patient is able to empathize with 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 a distortion of 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. in rare cases, it is important for diagnosis (Frosch, 1964). How does reality testing manifest itself in a situation of a structural diagnostic interview?

1. We can consider that the ability to test reality is present when we see that the patient does not and did not have hallucinations or delusions, or, if he had hallucinations or delusions in the past, he is currently fully capable be critical of 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 a close examination of inappropriate forms of affect, thinking or behavior. Reality testing is expressed in the patient's ability to empathize with how the therapist perceives these inappropriate phenomena, and more subtly, in the patient's ability to empathize with how the therapist perceives the interaction with the patient as a whole. The structural interview, as I have already mentioned, provides an ideal opportunity to explore reality testing and thus help to distinguish borderline versus psychotic personality organization.

3. For the reasons discussed above, the capacity for reality testing can be assessed by interpreting the primitive defense mechanisms operating during the diagnostic interview between patient and therapist. The improvement in the patient's functioning as a result of this interpretation reflects the presence of the ability to test reality, and the instant deterioration after it makes one think of the loss of this ability.

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