Clinical Nurse Specialists (CNSs) are highly trained and skilled nursing professionals who can demonstrate outstanding performance in a variety of health care positions. Such versatility can sometimes become a burden causing CNSs to work in one position for long and give up their potential due to organizational or other issues. This can cause a range of physiological issues aggravated by family, friends, and colleagues’ lack of understanding of CNS’s role. Role vagueness is, therefore, a serious issue that requires a change of paradigm. Such paradigm is offered by Pamela Reed’s theory of Self-Transcendence. The theory views humans through his or her relationships with the environment, superior beings, and other people. By attuning their understanding of self and adjusting the connection with all that surrounds them, CNSs can gain a clear understanding of their role and explain it to others.
There is also another way to address the issue of role vagueness. Kohut’s theory of self-psychology is a prominent instrument that can be considered a tool for psychoanalysis and behavior alteration. Due to the fact that role vagueness is in its essence an inner psychological problem, it appears to be natural to explore its origins, significance, and practical application as a part of the present paper.
Description of the Borrowed Theory
The theory of self-psychology understands and resolves issues of an individual through interpretation of personal experience and introspection based on the understanding of self as a central item of conscious and unconscious. Kohut’s theory is comprised of several concepts that are essential for its understanding. The first one is self. Interestingly, the originator of the theory did not provide a clear definition of the concept of self. Instead, he compared it to reality saying that it can be studied and comprehended only in its manifestations. It is possible to learn its genesis and functions, yet its definition is beyond our understanding. Empathy is another key concept that is described as an emotional or psychological bond and the process of sharing and understanding each other’s emotions. It is the main pathway through which one could alleviate psychological problems and prevent them from arising.
Self-objects is another concept crucial to the understanding of the theory. A self-object is the manifestation of self. It is a real-world event, item, person, or function through which the self can be portrayed. For instance, it could be a job, friends, or habits. A problem when such object is wanted but cannot be achieved Kohut calls frustration. Frustration can be destructive for the self, which is why there is a need for building a tolerance to disappointments or maintaining optimal frustration. In the process of construction and interaction with self objects idealization works as a sub-process altering the perception of other objects and aspiring to establish a connection with an object of idealization. The majority of people are dependent on feeling likeness to some group in society, which is described as alter-ego needs. Personal development and maturity allow for higher degrees of accepted individuality.
All in all, the theory exists to better understand the process of development and functioning of a person within society through his or her own image of self. It appears to be metaphysical yet, possesses certain practical applications. It could be used to diagnose psychological conditions and underlying identity issues.
History of the Borrowed Theory’s Origins
Kohut’s theory of self-psychology was first described in the 1970s and since that time gradually developed into a more and more powerful and comprehensive psycho-evaluation and diagnostic tool. The theory originates in Freud’s works in psychoanalysis and psychiatry by which Kohut was deeply inspired yet considered some of his practices ineffective. The concept of self-psychology was first introduced in 1970 in Kohut’s work called The Analysis of the Self where he described critically assessed Freud’s approaches to the treatment of people with mental disorders. In particular, he dismantled the effectiveness of his approach to treating narcissistic personality disorder (McLean, 2007). The later path of exploring the interrelations of self, narcissism, empathy as a treatment intervention, self-esteem, and idealization led Kohut to the development of his own multi-concept self-psychology theory. In later years, he continued to further describe and study self through a variety of its manifestations and peculiarities until he tragically decreased in 1981.
As a skilled psychoanalyst himself, Kohut applied his theory to the field of psychological evaluation and analysis. In the 1970-the 1990s, it was used as a framework for studying and developing treatment options for patients with a variety of mental disorders including bipolar disorder, narcissistic personality disorders, and other issues (Patton & Meara, 2007). The theory was also used as a framework for creating effective counseling sessions with people suffering from personality disorders. It was proved to boost self-development and help patients regain control of their emotions, actions, and gain an adequate self-portrait (Patton & Meara, 2007). Researchers also noted the theory’s application to family and teacher consultation as promising. According to Palombo (2008), Kohut’s theory also helps to treat people who fail to internalize their self-object functions or connect with themselves and comprehend personal life issues.
Application to the Identified Problem
Kohut’s self-psychology theory applies perfectly to the problem of role vagueness in Clinical Nurse Specialists. It applies in a variety of dimensions pertaining to the problem such as self-concept, self objects, frustration, idealization, etc. Firstly, the issue of role vagueness starts forming due to the lack of clarity that stems from nursing education flaws. As such, progressing through educational programs, nurses who aim to become CNSs occasionally receive insufficient professional orientation and role definition, which results in poor recognition and awareness of their expertise as professionals (Foster & Flanders, 2014). Starting as an external problem, the lack of role comprehension develops into a self-image issue, which affects the actualization of self through areas of practice. In particular, concentration on one of the existing areas of clinical practice, CNSs tend to let go of a sufficient portion of their skills and knowledge that are not applicable to this field.
Secondly, due to the fact that CNSs graduate with a range of abilities and know-how, they are able to start practicing in a variety of settings and roles (Foster & Flanders, 2014). At this point, an idealized image of the CNS profession might form, which may lead to frustration when it comes to the actual application of the skillset. Another side of this can lead to overly large self-esteem with the transition to narcissism as evidenced by the theory’s applications to counseling and treatment (Kerr, 2014). Overly narrow use of skills of such a versatile professional directly questions the role of such specialist. The concept of self and its manifestations, as viewed through the prism of Kohut’s theory, can become incomplete or, rather, flawed due to frustration. From such situations stems the poor recognition of the role by self objects such as family, friends, co-workers, and managers.
A lack of understanding of the functions of a CNS by family and friends, who often confuse them with regular nurses, nursing managers, or even physicians, projects a strong negative message to a person (Foster & Flanders, 2014). The same may be an issue in CNS-administration relationships. The feeling of injustice and lack of recognition might also lead to long- and short-term self-evaluation issues. The lack of role clarity among colleagues might also undermine the value of self in CNSs and contribute to the above-mentioned self-evaluation issues.
Thirdly, the self-psychology theory can be applied to each participant in the process of role validation and clarification. Internalization and problem viewing can happen simultaneously in different actors. Recalibration of meanings and concepts with the corresponding manifestation in self objects might not only affect the CNS but also the people around him or her. The process of personal growth through empathy that is described as a part of the restoration process seems to apply perfectly within the realm of CNS’s scope of practice. It appears that Kohut’s theoretical framework is able to search, explain, evaluate, and alleviate the variety of causes and effects of role vagueness in CNSs, which speaks to its applicability to the current practice issue.
My own practice should change significantly with the use of self-psychology theory. The mere awareness of the concepts such as self, self-object, and the psychological interpretation of narcissism could help me become an informed CNS that does not let the environmental factors affect the balance and harmony of my inner self. In addition, the knowledge of empathy as a prominent tool to alleviate my own frustration and foster self-development would enable me to be more effective at shaping a clear image of my role as a future CNS and influence the perception of others.
Integration of the Borrowed Theory and the Middle-Range Theories
There seems to be a solid basis for the integration of both theories into practice to alleviate the role vagueness in CNSs. For one, as it was already noted, self-psychology is used as a framework for counseling. Frustration from the lack of recognition can seriously affect the ability of a CNS to perform. In its essence, it appears to be an issue within the borders of psychology that can and needs to be treated through the use of psychological theories (Palombo, 2008). According to self-psychology, the meaningful application of empathy could serve as an informed attempt to amend the failures of finding common ground defining the role of CNSs. Reed’s Self-Transcendence theory also speaks to the fact that the resolution can be found in close collaboration with the environment or, in Kohut’s terminology, self objects. In this manner, the frameworks can both work to the restoration of clarity within both CNS self and the selves of other actors.
Self-transcendence and self-psychology can also work in tandem to help Clinical Nurse Specialists to build further knowledge on their profession. Reed (2014) states that a mismatch in the understanding of one’s role can be detrimental to personal development and harmony, which postulates the need for self-education. The same implications can be drawn from self-psychology theory. The path to optimal frustration requires a person to develop self in order to withstand the adverse influence of mismatch between the idealized concept of CNS role and possible self-object’s lack of its understanding. In a way, these two paradigms serve as guides aimed to prepare an individual to be open to new ideas and progress professionally and personally through collaboration with other individuals.
The two theories can also serve the cause of alleviating role vagueness in different qualities. The difference between the paradigms points at a certain practical difference in their application. Self-psychology theory can serve as an effective treatment mechanism for professional counseling. It may work as an inward-directed intervention that aims specifically at a CNS to locate the major source of role vagueness and treat it through multi-directed empathy and application of other concepts. Self-transcendence, on the other hand, is better suited to utilize self-initiated peer-to-peer communication and advocacy to alleviate possible adversities. In this way, the most appropriate solution appears to include professional counseling sessions and personal initiative to maximize the positive effect of the two paradigms and effectively address the problem of role vagueness.
All things considered, role vagueness in Clinical Nurse Specialists is a serious issue that requires the intervention to be interprofessional. The decision to introduce Kohut’s self-psychology paradigm as one of the ways to increase the effectiveness of Reed’s middle-range theory appears to have positive implications. The applicability of paradigm’s concepts to the practical issue at hand and the previous use of the theory serve as evidence to the possibility of its employment as the intervention to address CNSs role vagueness.
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Kerr, J. (2014). Is there a self, and do we care? Reflections on Kohut and Sullivan. Contemporary Psychoanalysis, 50(4), 627–658.
McLean, J. (2007). Psychotherapy with a narcissistic patient using Kohut’s self psychology model. Psychiatry, 4(10), 40-47.
Palombo, J. (2008). Self psychology theory. In C. M. Sowers & C. N. Dulmus (Eds.), Comprehensive Handbook of Social Work and Social Welfare (pp. 134-153). New York, NY: American Cancer Society.
Patton, M. J., & Meara, N. M. (2007). Kohut and counselling applications of self psychology. Psychodynamic Counselling, 2(3), 328–355.
Reed, P.G. (2014). Theory of self-transcendence. (3rd ed.). New York, NY: Springer Publishing Company.