Jon Frederickson, MSW : Separating Ego and Superego in a Recovering Drug Addict

Hopefully this case illustrates an important principle. Although ISTDP is focused in the end on the breakthrough to unconscious emotions, our fragile patients require much preparatory work. Their ego adaptive capacities must be developed first so that they can bear the impact of their own emotions. But to mobilize the ego, we must first separate the ego and superego. As this case illustrates, this can not be done with one magical intervention, but only through moment to moment attention by the therapist and patient to every element of superego pathology which blocks ego capacities from emerging. And to do this, the therapist must be patient. The therapist’s superego may push the therapist to get frustrated with small advances rather than celebrate and recognize each minute shift toward health. Yet each minute shift for a fragile patient like this woman is cause for celebration.