The use of self-psychological concepts in a Veterans Affairs PTSD clinic

The authors describe the advantages of self-psychological concepts in the treatment of combat veterans with posttraumatic stress disorder (PTSD). Classical psychoanalytic views of PTSD opened the door to understanding PTSD as a type of "narcissistic neurosis." Although many psychological and psychoanalytically oriented treaters of PTDS acknowledge that the entire personality needs rehabilitation and, thus, a comprehensive approach to the PTSD patient is indicated, most stay close to the primacy of pathological memory. Self psychology, with its specific view on damage and repair of the self and the key importance of the selfobject transference in that process, provides a focus wherein damage to the self comes first and alterations in other psychological systems take on an important but secondary emphasis. The authors outline the central elements of PTSD in combat veterans and review the contributions of psychoanalysis to their treatment. Core concepts from self psychology are detailed, and three vignettes of veterans treated in an outpatient PTSD clinic are offered to illustrate the specific mirroring, idealizing, and twinship selfobject transferences they bring to the treatment situation. Finally, a discussion of each vignette highlights how self psychology's focus on strengthening the damaged self has aided in patients' improvement.