Self-reflexivity, intersubjectivity, and therapeutic change

Intersubjectivity theory holds that the self forms through relationships with others in a dialectic process. Although affect attunement is central to early self-other differentiation, infants do not see themselves as separate entities until 18 months and their minds as separate until approximately age 4. Transitional object relatedness thus often influences early childhood functioning. In self disorders, childhood disruptions in intersubjectivity create disturbances in integrating transitional fantasy with realistic cognition, such that one's own mental states are often confused with others'. In treatment, self-other differentiation is aided by adaptive projective identification, in which patients find in their therapists their own positive qualifies and then reappropriate them in more integrated ways. Case material from a research study of significant-figure descriptions in long-term psychoanalytically oriented treatment illustrates this process.