Based on clinical evidence and theoretical writings on pathological forms of concern and the destructive role they might play in close relationships, we conducted 2 studies aimed at developing and validating the Pathological Concern Questionnaire (PCQ). This scale comprises items tapping a fragile view of the self, as well as a compulsive need to care for others. Findings indicated that all questionnaire items loaded on a single factor of pathological concern, which was significantly associated with egocentric motivations, attachment insecurities, imbalanced forms of relational entitlement, low self-esteem, low life satisfaction, and negative emotionality. In addition, the PCQ was found to tap a unique psychological construct that differs from constructs of healthy concern and unmitigated communion. The discussion focuses on the developmental and psychodynamic sources of pathological concern as well as its significance in the intrapersonal and interpersonal domains.
The present article addresses the therapeutic potential of salvaging the historic good object and its revival in the patient's mind. This goal is particularly challenging in the context of psychotherapy conducted with adolescents and adults who have a background of relational trauma, when the approaches and histories of both patient and therapist are liable to join forces and bring about a split: between seeing significant objects from the patient's past as essentially bad and seeing the therapist as all good. One of the potentially troublesome outcomes of this situation is the danger of a Gordian knot being created, between the perception of the historic object as all bad and the parallel and persistent experience of the individual as undeserving, destructive, and devoid of love. To loosen this knot, which would allow feelings of vitality and hope to take root, it is important to salvage the historic good object of both participants in the therapeutic encounter. These issues will be illustrated by means of a case study of psychotherapy conducted with an adolescent.
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