{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T18:14:01Z","timestamp":1788545641581,"version":"build-2803163510"},"reference-count":11,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Palliative Medicine"],"abstract":"<jats:p>Serious illness threatens both the body and the self: the coherent, continuous sense of who one is, from bodily integrity to psychosocial identity. When illness disrupts identity and patients confront mortality and dependence, a range of responses may follow, including behaviors such as relentless demands, devaluation of clinicians, insistence on additional treatment, or rage at perceived care failures. These presentations are often labeled \u201cnarcissistic,\u201d yet such a formulation can foreclose clinical understanding. Heinz Kohut\u2019s self psychology offers a more generative framework: one that understands these behaviors as attempts to preserve self-cohesion when illness threatens identity, autonomy, competence, and roles. Because needs for recognition, connection, and reliable support persist throughout life, serious illness often exposes vulnerabilities that were previously stabilized through work, relationships, and social roles. Informed by self psychology\u2019s core concepts\u2014self-object needs, mirroring, idealizing, twinship, and empathic attunement\u2014this paper presents practical serious illness communication tools designed to reduce interpersonal conflict, strengthen therapeutic alliance, and support patients in maintaining a coherent sense of self as illness progressively reshapes what is possible.<\/jats:p>","DOI":"10.1177\/10966218261484373","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T07:10:41Z","timestamp":1788419441000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Threatened Identity: Self Psychology Informed Communication for Serious Illness Care"],"prefix":"10.1177","author":[{"given":"Daniel","family":"Shalev","sequence":"first","affiliation":[{"name":"Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9533-473X","authenticated-orcid":false,"given":"Indrany","family":"Datta-Barua","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of Palliative Medicine, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leah B.","family":"Rosenberg","sequence":"additional","affiliation":[{"name":"Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keri O.","family":"Brenner","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of Palliative Care, School of Medicine, Stanford University, Palo Alto, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore","family":"Scheel","sequence":"additional","affiliation":[{"name":"Department of Oncology Social Work, University of California San Francisco, San Francisco, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6219-7619","authenticated-orcid":false,"given":"Danielle","family":"Chammas","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Palliative Medicine, University of California San Francisco, San Francisco, California, USA."},{"name":"Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, 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