“The Disorders of the Self and Their Treatment: An Outline.”

Kohut and Wolfe (1978) co-authored a book titled “The Disorders of the Self and Their Treatment: An Outline.”

The book builds on Kohut’s previous work on self psychology and expands on his theory of self-structure and the importance of the therapeutic relationship. The authors argue that psychological disorders often arise from disturbances in the development of the self, which can be caused by a variety of factors including childhood trauma, neglect, or emotional deprivation.

Kohut and Wolfe propose that the goal of therapy should be to help patients to develop a stronger sense of self and to integrate disowned aspects of themselves. They emphasize the importance of the therapeutic relationship, particularly the role of the therapist in providing empathic understanding and support.

The book outlines a number of therapeutic techniques that can be used to help xpertspatients develop a healthier sense of self, including mirroring, idealization, and transmuting internalization. These techniques are designed to help patients build a stronger sense of self and to repair the damage caused by early experiences of emotional deprivation or trauma.

Overall, Kohut and Wolfe’s work was influential in the development of the field of self-psychology, which emphasizes the importance of the self in psychological functioning and the need for individualized, empathic therapy to promote healthy self-development.


Who is an expert and what is expert evidence?

  • A practice nurse writes a letter saying a patient is too unwell to attend court
  • A GP letter says a patient is depressed and anxious and that dealing with the other parent over contact is contributing
  • A counsellor whose report on a client/patient is submitted with a witness statement (opinion that P has complex PTSD and has suffered domestic abuse) 
  • A paediatric ST1 who attends as child arrive in ambulance, notes blood coming from right nostril, boggy swelling on right side of head and hears mother on phone saying “He did it again”   
  • A radiologist StR who sees an x-ray of a child and recorded in medical notes a spiral fracture of the left humerus indicative of a twisting action, possible abusive injury.
  • A consultant paediatrician who sees a child and parents. Child has marked petechiae on one side of face and neck. No history of  choking or vomiting. Consultant considers suffocating event most probable cause and child protection protocols initiated.
  • Consultant psychiatrist and psychotherapist treating P for several years provides report confirming P does not have personality disorder or a substance related addictive disorder.
  • Local authority file a report from a psychologist working with the childrens services department opining mother and child have  insecure attachment linked to neglectful parenting.   
  • Part 25 Psychologist recounts conversation with parent which is disputed by parent. 


When is a psychologist expert not a psychologist expert?

  • F v M (3) (2022) EWFC 89 “need for legal definition”
  • FJC/BPS 2022 guidance very clear 
  • Academic psychologists ‘chartered with BPS’
  • Practitioner psychologists ‘HCPC registered’

ALL others are not psychologist experts

Other bodies which affiliate / represent / market expert witnesses are not able to accredit or regulate the practice of psychology and should not contradict guidance given by the body for that profession about competence.


Parental alienation and the unregulated experts

Dr Jaime Craig, lead author of the guidance and a consultant clinical psychologist who has been an expert in the family courts for 20 years, said: “There has been longstanding worry about inappropriately qualified psychologists giving evidence in sensitive cases involving children. We wouldn’t let a psychologist who wasn’t regulated by the HCPC [Health and Care Professions Council] work in the NHS or in the forensic services, and the assessments being made in the family court are no less complex.

“If anything, the decisions being made have a greater impact on children’s lives.”

An expert report can cost as much as £10,000, but the costs of therapeutic interventions can run into tens of thousands of pounds. This is in addition to legal fees, which can prove crippling to parents embroiled in drawn-out litigation.

“Several mothers reported they had lost their homes and life savings during lengthy court battles that ultimately resulted in the removal of their children,” said Natalie Page of the Survivor Family Network.


Shortage of experts

A shortage of child/ child and family psychiatrists and psychologists was widely reported throughout the country. As Table 1 demonstrates, adult psychiatrists too were in short supply across England and Wales (37% (n=110)). Risk assessors were also identified by a wide number of respondees (33% n=98) to be limited across the country. These experts are often considered to be “necessary” at the “welfare stage” in public law proceedings and in assisting the court in providing evidence as to mental illness, personality disorder, attachment issues and risk to a child. This shortage of experts self-evidently has significant implications; it is usually an assessment that cannot be undertaken by another professional within the proceedings.

Parental Alienation PA

Role of psychologists as expert witnesses in family proceedings

As set out in Psychologists as expert witnesses: Guidelines and procedure (BPS, 2015): ‘An expert is a person who, through special training, study or experience, is able to furnish the Court, tribunal or oral hearing with scientific or technical information which is likely to be outside the experience and knowledge of a Judge, magistrate, convenor or Jury’. Experts may be instructed in the family courts when their expertise is necessary to make decisions in the case.

Download the full document here:-

Parental Alienation PA

Fast facts on borderline personality disorder

Here are some key points about borderline personality disorder. More detail and supporting information is in the main article.

  • People with BPD have problems regulating thoughts, emotions and self-image, can be impulsive and reckless, and often have unstable relationships with other people.
  • Most cases of BPD begin in the early stages of adulthood, seem to be worse in young adulthood, but may get better with age.
  • Experts do not yet know what causes BPD.
  • Genetics, environmental factors and brain abnormalities are thought to play a role in the development of BPD.
  • About 85% of people with BPD also meet diagnostic criteria for another mental illness, such and often suffer fromdepression, anxiety disorders, substance abuse, and eating disorders, along with self-harm, suicidal behaviors, and completed suicides.
  • BPD and schizophrenia often co-exist, but the two are distinct conditions.
  • A person can be diagnosed with BPD if they display at least five of nine recognized symptoms.
  • Symptoms of BPD can be triggered by situations others find untroubling.
  • As many as 80% of people with BPD go on to develop suicidal behavior, and 4-9% go on to commit suicide.
  • BPD is commonly treated with psychotherapy, aided with medication and, occasionally, hospitalization.
  • There is no cure for BPD, but symptoms can improve over time and many people with BPD find ways to manage their condition successfully to lead satisfying lives.


Experts in personality disorders

One of the foremost experts in personality disorders, Theodore Millon, describes the propensity for the narcissistic personality structure to decompensate into persecutory delusional beliefs under stress,

“Under conditions of unrelieved adversity and failure, narcissists may decompensate intoparanoid disorders. Owing to their excessive use of fantasy mechanisms, they are disposed to misinterpret events and to construct delusional beliefs. Unwilling to accept constraints on their independence and unable to accept the viewpoints of others, narcissists may isolate themselves from the corrective effects of shared thinking. Alone, they may ruminate and weave their beliefs into a network of fanciful and totally invalid suspicions. Among narcissists, delusions often take form after a serious challenge or setback has upset their image of superiority and omnipotence. They tend to exhibit compensatory grandiosity and jealousy delusions in which they reconstruct reality to match the image they are unable or unwilling to give up. Delusional systems may also develop as a result of having felt betrayed and humiliated. Here we may see the rapid unfolding of persecutory delusions and an arrogant grandiosity characterized by verbal attacks and bombast.”

The reenactment of attachment trauma is also documented in the clinical treatment literature,

“Reenactments of the traumatic past are common in the treatment of this population and frequently represent either explicit or coded repetitions of the unprocessed trauma in an attempt at mastery. Reenactments can be expressed psychologically, relationally, and somatically and may occur with conscious intent or with little awareness. One primary transference-countertransference dynamic involves reenactment of familiar roles of victim, perpetratorrescuer-bystander in the therapy relationship. Therapist and client play out these roles, often in complementary fashion with one another, as they relive various aspects of the client’s early attachment relationships. (Perlman & Courtois, 2005, p. 455)

In response to three separate but interrelated psychological stresses associated with the divorce, 1) the threatened collapse of the narcissistic defenses against the experience of primal inadequacy that is triggered by the perceived interpersonal rejection inherent to the divorce (i.e., narcissistic personality processes), 2) the activation of immense anxiety fromsevere abandonment fears triggered by the divorce (i.e., borderline personality processes), and 3) the reactivation of attachment trauma networks when the attachment system becomes active to mediate the loss experience associated with the divorce (trauma processes), the narcissistic/(borderline) personality decompensates into persecutory delusional beliefs centering on the other parent’s “abuse” potential relative to the child.