Consideration of the issue of impulse versus control brings focus from a new perspective to the presenting behavior problem. This point of view provides an elaboration of the patient's dynamic forces through an analysis and discussion of the interplay between impulse and controls. Consequently, conclusions from the section on cognition and reality testing can be linked to broader aspects of the individual. For example, problems with issues of judgment, perception, and thinking can be related to strains in the relative balance between impulse expression and the extent of control over such expressions. Findings regarding the way in which anxiety operates in the functioning of the personality can now also be applied to the mechanisms that regulate impulses. Cognitive elements, anxiety, and control over impulses constitute an important sequence in understanding the struggle or conflict that underlies the more manifest behaviors and experiences of the patient.
Another major feature in analyzing and reporting the nature of the dynamic interplay between impulse and control concerns the level of maturation in the structure and makeup of the personality. For example, extremely poor controls that enable powerful impulses to initiate immediate behavior sequences reflect a relatively primitive maturational level. On the other hand, the presence of stronger inhibitions indicates other clinical implications. The relation of impulse-control features to maturational aspects of the personality also has a direct bearing on intrapsychic functioning and on diagnostic considerations. Because of the more detailed discussion permitted by analysis of issues stemming from impulse control findings, the initial broad, differential diagnostic concern with reality testing and the possibility of psychosis can be developed, and narrower categories of diagnostic possibilities can be established.
Thus, in the sequence of sections within the report, a refinement takes place in the communication about the meaningful details of the person's essential makeup, starting with the problem behavior and leading to a rich and clear elaboration of the framework in which this behavior is embedded. The problem behavior is gaining context and meaning. It is apparent that even the most bizarre behavior or experience can be clarified through these interpretive steps in the developing sequence of the report.
The dynamics of impulse control as they relate to behavior, cognition, reality testing, and anxiety can be further understood through an analysis of the specific, characteristic defense operations and defense mechanisms that permit such dynamics to operate.
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