ABSTRACT
We want to thank Bill Coburn for his careful and sympathetic reading of our study and for his clarifying summary of its essential points. He raises one specific question about whether our singleminded focus on the patient’s sense of agency might have led us to deemphasize other important aspects of the patient’s self experience, including especially self-cohesion, self-efficacy, and self-esteem. With regard to the question of self-efficacy, and self-esteem, we think of these aspects of self experience as presupposing a sense of agency, which is irreducibly a part of the very existence of the self. The loss of the sense of agency is essentially an annihilation state, and this is the danger that we came to understand as the central one in Adam’s subjective world. Efficacy has to do with effectiveness, with having an impact on one’s surroundings. Agency, on the other hand, pertains to the existence of will, to the experience of oneself as an abiding center of initiative. Self-esteem, similarly, presupposes the presence of a consolidated sense of self, which is then positively or negatively valued. Self-cohesion was not an issue in this patient’s experience in that he did not report feelings in which fragmentation or cohesion were salient. Our specific focus on agency arose from the clinical process, because it was only when the therapist spoke of this theme that any constructive effect on Adam could be seen.
