Active development of the positive introject in severely disturbed patients

We describe the structure of the positive introject functionally as the ability to calm oneself. In elucidating the essential action involved in this function we focus on a certain kind of fantasying which allows a person to re-experience a way of thinking about and feeling toward oneself that has occurred in the relation with a therapist and that was experienced as calming. Three clinical vignettes are presented. The same psychological event is occurring in each one. However, the mode varies from consciously to preconsciously to unconsciously. In the first two modes the process is made clear and the patient is enabled to practise the action until the function becomes reliably available. In the unconscious mode, which seems to be required in certain cases where the patient's internal actions are predominantly aggressive, the process is not made explicit to the patient. Nevertheless the function can develop adequately given enough time and care in titrating positive experiences. The requirement that patients assume the role of agent in developing particular functions may well be one of the important ingredients that helps them break out of chronicity. For the requirement represents the bridge from a passive, dependent mode typically associated with chronicity, to an active responsible mode associated with healthier functioning.