Assessing Ego Strength: Spinning Straw into Gold

TOPIC. The reexamination of ego function from the perspective of ego strength rather than ego deficit. PURPOSE. To promote the assessment of ego strength as a valuable skill for nurse psychotherapists, and to underscore the importance of ego strength as a relevant construct for both assessment and psychotherapy outcome measurement. SOURCES. The literature of modern psychoanalysis and ego psychology, Bellak's research on ego function, Parse's nursing theory, and the nursing literature on ego assessment. CONCLUSIONS. Identifying and assessing ego strength helps nurse psychotherapists locate clients on a developmental continuum, suggests a place to join with the client at the inception of therapy, and provides data to develop therapeutic goals. Key words: Ego function, ego strength, nursing assessment, psychoanalysis, psychotherapy The goal of psychotherapy in a nursing context is to facilitate, through personal use of self and within a relational or intersubjective context, the growth and development of another human being. Growth and development occur intrapsychically and interpersonally and can be observed in a person's interactions with the environment--the interpersonal environment as well as the larger sociocultural and familial environment in which the individual is embedded. Growth and development also are reflected in a changing sense of self as a person moves toward the consolidation and integration of a cohesive identity. Psychotherapy in this context of intersubjective relatedness promotes growth and development by enhancing adaptability, personal resourcefulness, self-efficacy, self-esteem, interpersonal competence, and life satisfaction. In classical psychoanalytic parlance, psychotherapy strives to improve a person's capacity to love and to work, that is, to engage in (1) reciprocal, mutually validating, individually satisfying, interpersonal relationships; and (2) meaningful activity from which a sense of purpose, creativity, and fulfillment are to some degree derived. Current client capacities for adaptability, personal resourcefulness, self-efficacy, self-esteem, interpersonal competence, life satisfaction, and all other measures of mental health are succinctly encapsulated in the phrase "to love and to work" (Freud, 1961) are reflected in the strength of the ego, a construct very broadly defined as the capacity for effective personal functioning (Burns, 1991). Ego strength supports the individual, ensures coping abilities, provides an individual with a sense of identity, can be recognized during initial assessment and throughout therapy, represents a foundation on which to build psychotherapeutic gains, and increases as clients grow in maturity. Identifying and assessing ego strength can locate clients on a developmental continuum that deepens understanding of the client's vicissitudes and suggests a place for the psychotherapist to join with the client at the inception of therapy. These strengths can provide data to develop therapeutic goals (Burns). In sum, ego strength is a relevant construct for both assessment and outcome measurement. Theoretical Framework Within the context of a postmodern nursing paradigm, joining with a client at the inception of therapy--in other words, starting where the client is--means more than speaking a client's language and crediting his point of view. It also means recognizing and understanding the client's reality as partially co-constructed by the therapist, and vice versa. Horowitz (1998) contends that postmodernism was signaled as early as 1927 in atomic physics with Heisenberg's "uncertainty principle," which proved that the observer affects the observed. Empiricism, as the scientific method for validation of truth, and the objectivist epistemology of Immanuel Kant, which placed reason at the center of how one knows things, yielded to a postmodern zeitgeist. Scientists and philosophers began to recognize the impossibility of objectivity in the search for a single truth (Horowitz, 1998). …