By Prof. Levine & Dr. Salganik
Hello readers,
The field of psychotherapy is constantly evolving, with an increasing emphasis on innovative approaches to addressing the multifaceted nature of mental health challenges. Among these developments, Reference Group Focused Therapy (RGFT), originally developed by one of us [I.S.], stands out as a contribution to short-term interventions based on social psychology.
RGFT distinguishes itself by taking a comprehensive view of an individual's social environment, which includes both external reference groups such as family and workplace, and internalized representations of significant others. This holistic perspective recognizes that an individual's thoughts, feelings, and behaviors are profoundly shaped by their interactions and identifications within these social contexts.
It is assumed that understanding and addressing the dynamics within the person’s social matrix is essential for therapeutic progress. This fundamental principle creates a compelling rationale for exploring tools that can effectively represent and interact with this complex social environment in the therapeutic setting.
At the same time, the application of artificial intelligence (AI) in mental health heralds growth in the development and use of AI-generated avatars in various therapeutic contexts.
The potential application of AI avatars in areas such as the treatment of auditory hallucinations in people with psychosis demonstrates the transformative potential of digital representations to alter deeply internalized experiences.
We hypothesize that the success of these interventions suggests that similar approaches may be effectively adapted to represent the internalized significant others that are central to the principles of RGFT.
Below we will delve into how AI-generated avatars of significant others can be effectively and ethically integrated into RGFT to improve therapeutic outcomes. By examining the theoretical foundations of RGFT and the current landscape of AI avatars in psychotherapy, we seek to provide an understanding of the possibilities, benefits, challenges, and ethical considerations associated with such an innovative integration.
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By Prof. Levine & Dr. Salganik
Hello to our readers
Recently, one of us [Y.L.] saw Professor Asa's book "The Book of Presence" in a bookstore. From the caption on it, it seems that the book discusses what presence is and the meaning of human presence [Asa Kasher, "The Book of Presence", Keter, January 2025].
Asa Kasher (born 1940) is an emeritus professor of philosophy at Tel Aviv University, specializing in the pragmatics of language and professional ethics.
About the book, it is written that "A dear person who has passed away sometimes leaves an unbearable gaping wound in the hearts of his or her loved ones… The understanding that it is possible to continue to give a rich existence to the human presence of the deceased, even after his or her physical existence has passed from this world…
On his journey [after the death of his son Eliraz], Kasher gradually began to understand that all the memories, people and experiences that a person holds close to his heart have a presence, even if it is not physical…
The presence of a deceased person in the lives of his loved ones does not have to be based solely on facts… A person can create imaginary situations in which he is together with the dear person who has passed away. He can tell him about events in his life, receive reactions and ask for advice."
So much for the book.
The classical approach to mourning, defined by Freud in his article “Mourning and Melancholia” (1917), saw mourning as a process of gradual separation from the deceased in favor of emotional rehabilitation and reintegration into life.
Sigmund Freud
Freud (1917) argued that “normal” grief is characterized by complete emotional detachment and renewed investment of emotional resources after a period of mourning. Worden (2009) published four central tasks: acceptance, coping with pain, reacclimatization, and distancing from the deceased.
William Worden
Klass and his colleagues advocated the “continuing connections” approach and emphasized that creating an internal connection with the deceased contributes to the preservation of identity, emotional regulation, and spiritual meaning [the deceased as an internal object].
Dennis Klass, Professor Emeritus, Webster University, St. Louis, Missouri, USA.
Stroebe & Schut (1999) described a Dual Process Model, in which the bereaved person “oscillates” between focusing on the depth of the pain (loss-oriented) and focusing on restoring life (restoration-oriented). The model allows for a combination of internal connection with the deceased and learning coping skills.
Prof. Dr. M.S. Margaret Stroebe
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By Prof. Levine & Dr. Salganik
Hello to our readers,
Identifying preverbal experiences in psychotherapy poses unique challenges because these early experiences occur before language development and are therefore encoded primarily through sensory, affective, and somatic pathways rather than through verbal memories.
Below, we offer a speculative but clinically informed exploration of psychotherapeutic strategies for accessing and interpreting such preverbal content.
Nonverbal Expression and Bodily Memory
Preverbal memories are often encoded somatically – through sensations, emotions, and physiological responses rather than through language.
Somatic Experiencing: Trauma-based therapies such as Peter Levine’s Somatic Experiencing help clients tune into subtle bodily sensations (Levin, 2010). Feelings of pressure, heat, nausea, or trembling, especially in response to triggers, may indicate distress or preverbal comfort.
Movement Therapies: Movement therapy or sensorimotor psychotherapy encourages expressive bodily movement.
Observing patterns, postures, muscle tension, and spontaneous gestures can help identify emotional states rooted in preverbal experiences (Ogden, Minton, & Pain, 2006).
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By Prof. Levine & Dr. Salganik
Hello to our readers,
This time we will expand on the subject of self-identity and then try to understand it and its development throughout the individual's life in the light of the integrative social self theory (ISST) that we are developing.
In general, self-identity describes a person's overall perception of himself, that is, who he is and what makes him unique.
It is a complex system of beliefs, values, experiences, and emotions that shapes his inner image.
The development of self-identity is an ongoing process that is integrated with life experiences and personal challenges.
The environment, family, and social connections play a central role in defining this essence.
Ultimately, self-identity forms the basis for continued personal growth and the realization of meaning in one's life.
The literature on building self-identity throughout life
Self-identity is a dynamic process that develops throughout life, and is influenced by cognitive, emotional, social, and cultural factors.
Below, we will review key theoretical perspectives, including psychosocial and social identity theories, and examine empirical research that traces the developmental trajectories of self-identity from childhood to late adulthood.
We will explore the integration of narrative, relational, and cultural dimensions, and offer a framework for understanding how people construct and even reshape their identities in response to life transitions and social connections.
The process of constructing self-identity is central to understanding human development. Self-identity is not a static entity but an evolving construct that reflects an individual's personal narratives, social affiliations, and cultural contexts.
Scholars such as Erikson (1950) and Mercia (1966) have provided fundamental insights into identity development, emphasizing that self-identity is shaped through various developmental stages and psychosocial crises.
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By Prof. Levine & Dr. Salganik
Hello to our readers,
As a rule, dissociation is a complex mental mechanism that includes biological and psychological brain processes. Many studies are trying to clarify the mechanisms involved in this phenomenon. Below is a detailed explanation of the various mechanisms with reference to brain, biological and psychological processes, plus an up-to-date list of references.
The biological-brain mechanisms of dissociation
Biological factors that could contribute to dissociative disorders might include:
- Genetic Predisposition: A family history of mental health issues might increase vulnerability.
- Neurobiological Factors: Abnormalities in brain areas involved in memory, identity, and emotion regulation, like the hippocampus and amygdala.
- Neurochemical Imbalances: Imbalances in neurotransmitters that affect mood and stress responses.
- Hormonal Influences: Chronic stress can alter cortisol levels, potentially impacting brain function related to dissociation.
These factors can interact with psychological and social influences, creating a complex picture.
Dysfunction of the amygdala and hippocampus: These two regions are directly involved in emotional processing and memory. Dissociation has been linked to changes in amygdala function, particularly reduced or increased responses to extreme stress, as well as to disruptions in hippocampal activity that affect memory formation.
Amygdala: Dissociation has been linked to altered amygdala reactivity, leading to impaired or disconnected emotional processing in response to trauma (Lanius et al., 2010).
Hippocampus: Decreased hippocampal volume has been observed in individuals with a history of repeated trauma associated with dissociative symptoms (Vermetten et al., 2006).
Prefrontal Cortex Changes: The prefrontal cortex is responsible for emotional regulation, attention, and self-control. Studies have shown reduced activity in this region during dissociative states, leading to a reduced ability to regulate emotional experience (Brand et al., 2012).
Hypothalamic-pituitary-adrenal (HPA) axis: Disruption of this system, which manages stress responses, may lead to chronic dissociation following repeated exposure to trauma or chronic stress, due to dysregulation of the hormone cortisol (Schalinski et al., 2015).
Brain Connectivity Patterns: Functional magnetic resonance imaging (fMRI) studies have demonstrated changes in brain network connectivity, particularly in the Default Mode Network (DMN), which is responsible for the sense of self and awareness (Daniels et al., 2015).
In dissociative states, a disruption occurs in the integration of these brain networks.
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By Prof. Levine & Dr. Salganik
Hello to our readers,
Procrastination is generally defined as the voluntary delay of a planned course of action despite the expectation that the situation will be worse because of the delay. In other words, people knowingly postpone or delay necessary tasks to their detriment.
This behavior is extremely common—by some estimates, about 15-20% of adults (and about half of students) are chronic procrastinators who experience frequent and problematic delays in important tasks. Procrastination is not a trivial habit; it is considered a “common and harmful form of self-regulatory failure.”
Chronic procrastination is associated with a variety of negative outcomes, including poorer academic or work performance, higher stress, and reduced psychological well-being. Studies have found that people who regularly procrastinate report greater anxiety, along with depression, and higher feelings of distress and hopelessness compared to those who do not procrastinate. Given the widespread prevalence and harm of procrastination, understanding the mechanisms underlying the phenomenon is of great interest.
AI-assisted illustration of procrastination
Historically, procrastination has been viewed primarily as a psychological phenomenon—essentially a failure of self-regulation or the inability to resist immediate temptations. Indeed, many psychological factors have been identified as contributing to procrastination, such as task avoidance, fear of failure, low self-efficacy, impulsivity, and poor organization.
However, in recent years, researchers have also begun to investigate the biological and neuropsychological basis of procrastination. Findings from genetics and neuroscience suggest that procrastination may have measurable biological components—for example, inherited personality traits and specific brain circuits involved in our tendency to procrastinate.
Below, we provide an overview of the mechanisms of procrastination from both a biological and psychological perspective. We first examine the biological mechanisms of procrastination, including genetic predispositions and neural processes that contribute to procrastination behavior. We then discuss psychological mechanisms, such as cognitive, emotional, and personality factors that drive the habit of procrastination.
Finally, in the discussion, we will integrate these perspectives to show how biological and psychological factors interact to contribute to procrastination, and we will evaluate evidence-based interventions that leverage these insights. Finally, the conclusion summarizes key points and highlights possible strategies for reducing procrastination based on the mechanisms discussed. From here, we will move on to understanding procrastination in light of the model of the “self” that we are developing.
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By Prof. Levine & Dr. Salganik
Greetings to our readers,
Paranoid (delusional) disorder is a serious mental condition characterized by persistent delusions – strong beliefs about things that are not based on reality.
Unlike other psychotic disorders such as schizophrenia, people with paranoid disorder often function normally in many aspects of life, except for the influence of their delusions. According to DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Revised), paranoid disorder is classified as a distinct psychiatric condition that requires specific diagnostic criteria. Understanding the definition, symptoms and treatment options for paranoid disorder is essential for effective management and improving the quality of life of those affected.
How does the DSM-5-TR define paranoid disorder?
Paranoid disorder, as defined by the DSM-5-TR, is a psychotic disorder characterized by the presence of one or more paranoid thoughts lasting at least one month. These paranoid thoughts, which are permanent false beliefs, stand out because they persist despite clear evidence to the contrary.
Unlike other psychotic disorders, people with paranoid disorder usually do not exhibit other prominent psychotic symptoms such as disorganized thinking, hallucinations, or severe dysfunction.
Their behavior outside of the psychotic context often appears normal, allowing them to maintain daily activities and relationships.
The DSM-5-TR establishes specific criteria to differentiate delusions from related conditions such as schizophrenia, in which the delusions are usually accompanied by more severe cognitive and functional impairments. Understanding this disorder requires a clear distinction between the types of false thoughts experienced and how they affect the individual's perception of reality.
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By Prof. Levine & Dr. Salganik
Hello to our readers,
In our model, the self includes the elements of the human mental apparatus. The model first assumes the existence of the "primary self", which is in fact the basic biological core consisting of several innate structures and subject to increasing development during life, this self includes the instinctive emotional and cognitive parts of the person. The primary self uses the reservoirs and mechanisms of emotion, memory and cognitive abilities and it contains primary nuclei for the future development of other mental structures.
Let's first refer to the primary self (Biological Predestined Core): the primary self consists of innate biological structures and instincts that form the innate basis of the parts of the personality and it also included the cognitive processes and the emotional processes.
This primary self has its own dynamics during a person's life and is subject to changes with age, following diseases, traumas, drug consumption, addiction, etc.
Both the instincts and the basic needs in each and every person change according to different periods of development and aging – (hence their effect on behavior) and may change through drugs, trauma, diseases and more. Within the primary self there is the potential for instrumental abilities that are innate, but they can also be promoted, or on the contrary, suppressed through the influence of the reference groups.
The primary self also has cognitive abilities that are partly innate and partly dependent on interactions with the environment during the first years of life. In addition, it includes the temperament and emotional intelligence that are partly innate and partly dependent on interactions with the environment in the first years of life.
And finally, it includes an energy charge that is mostly innate but can be suppressed through the influence of the reference groups, as well as through various situational factors.
The primary self also includes the seven personal sensitivity channels: Individual Sensitivity Channels (ISC) which reflect our individual reactivity in response to stressors (both external and internal). So far we have identified seven sensitivity channels:
1. Sensitivity regarding a person's status and location (status channel)
2. Sensitivity to changes in norms (norms channel)
3. Sensitivity in relation to emotional attachment to others (attachment channel)
4. Sensitivity to threat of any kind – physical, economical, etc., (threat channel)
5. Sensitivity to routine changes (routine channel)
6. Sensitivity to a drop in energy level and the ability to act derived from it (energy channel)
7. Sensitivity to proprioceptive stimuli coming from the body (proprioceptive channel)
From the primary self, a number of superstructures continue to develop from innate nuclei that constitute a basis for the development of the infant and later the person throughout his life with the characters around him: three structures that together make up the secondary self or the social self, these include:
A] The group of the collection of internalized characters that we will metaphorically call the Board of Internalized Characters,
B] The group of internalized enemies
C] The group of the internalized self-representations.
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By Prof. Levine & Dr. Salganik
Hello to our readers,
Dissociative Identity Disorder, which was previously known as "Multiple Personality Disorder", is one of the most controversial topics in psychiatry and psychology. In recent years, there has been an increase in awareness of complex dissociation situations, along with an in-depth discussion of the validity of the disorder, its prevalence and how to treat it.
In this article we will examine dissociative identity disorder through a theoretical model for the "Self" which consists of three main components: (1) the "primary self" (2) the "directorate of internalized characters", and (3) the "internalized enemies’ group ".
We will also discuss therapeutic options derived from the model, referring to the individual sensitivity channels, to the influence of positive (mostly within the “directorate of characters”) and negative internalized figures (enemies) on the mental structure, and to the role of the inner leader in the board of internalized figures in the rehabilitation process.
AI-assisted illustration of the dissociative identity disorder
Dissociative identity disorder is defined as a mental condition in which two or more identities exist in the same person, where each identity is characterized by a different self-concept, behavior style, and even different memories (American Psychiatric Association [APA], 2013). In many cases, there are significant gaps in the autobiographical memory, feelings of disconnection (derealization/depersonalization) and loss of time (Putnam, 1989).
Various studies indicate that dissociative identity disorder often develops as a response to complex or persistent trauma in childhood, such as physical, emotional or sexual abuse.
There are researchers and clinicians who question the reported prevalence rate of dissociative identity disorder and claim that many cases may be mistakenly labeled as a result of incorrect use of hypnotic techniques or overidentification. On the other hand, there is clinical and empirical evidence that quite a few patients with dissociative identity disorder are not properly diagnosed.
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By Prof. Levine & Dr. Salganik
Greetings to our readers,
Our model of mental life first assumes the existence of the "primary self", which is in fact the basic biological nucleus consisting of a number of innate structures and subject to increasing development during life, this self includes the instinctive emotional and cognitive parts of the person.
The primary self uses the reservoirs and mechanisms of emotion, memory and cognitive abilities and it contains primary nuclei for the future development of other mental structures.
Let's first refer to the primary self (biological predestined core): the primary self consists of innate biological structures and instincts that form the innate basis of the parts of the personality and it also included the cognitive processes and the emotional processes.
This primary self has its own dynamics during a person's life and is subject to changes with age, following illnesses, traumas, drug consumption, addiction, etc.
Both the instincts and the basic needs in each and every person change according to different periods of development and aging – (hence their effect on behavior) and may change through drugs, trauma, diseases and more.
Within the primary self is the potential for instrumental abilities that are innate, but they can also be promoted, or on the contrary, suppressed through the influence of the reference groups.
The primary self also has cognitive abilities that are partly innate and partly dependent on interactions with the environment during the first years of life.
In addition, it includes the temperament and emotional intelligence that are partly innate and partly dependent on interactions with the environment in the first years of life.
And finally, it includes an energy charge that is mostly innate but can be suppressed through the influence of the reference groups, as well as through various situational factors.
he primary self also includes the seven personal sensitivity channels: Individual Sensitivity Channels (ISC) which reflect our individual reactivity in response to stressors (both external and internal). So far we have identified seven channels of sensitivity:
1. Sensitivity regarding a person's status and position (the status channel).
2. Sensitivity to changes in norms (the norms channel).
3. Sensitivity in relation to emotional attachment to others (the attachment channel).
4. Sensitivity to threat (the threat channel).
5. Sensitivity to routine changes (the routine channel).
6. Sensitivity to a drop in the energy level and the ability to act derived from it (the energy channel).
7. Sensitivity to a variety of sensory proprioceptive aspects arising from the body (the proprioceptive channel).
The less sensitive the person is in these channels, the healthier he is mentally. Great sensitivity in one or more channels may demonstrate mental pathology.
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Prof. Joseph Levine, M.D. is an emeritus associate professor in the Division of Psychiatry, Faculty of Health Sciences, Ben Gurion University in Israel. Prof. Levine is a certified psychiatrist with clinical experience in controlled trials of adult psychiatric disorders and in psychotherapy. He was awarded a NRSAD independent investigator grant for the study of Creatine Monohydrate in psychiatric disorders -- mainly Schizophrenia. He resides and treats patients in Tel Aviv and all of central Israel.
