From Inner Sources - New Directions in Object Relations Psychotherapy

From Inner Sources - New Directions in Object Relations Psychotherapy

* Object relations theory --- How individuals develop in relation to the people around them

* Internalizing & Externalizing Relationships, Attachment & Separation, Introjection & Projection, Transmuting Internalization

* Freud (1905) - the infant as having drives that have an aim and are directed toward an object. According to this model, psychological growth takes place as impulses are frustrated and the organism seeks increasingly efficient avenues for discharge of energy. The needs of the object are accommodated only as a compromise. In this model, pathology arises when the drives are excessively frustrated or gratified, leading to symptomatic inhibitions, renewed attempts to gratify impulses through convoluted channels, or impulse control problems.

* Anna Freud (1936) - concentrated on the ego's attempts to protect its integrity through an increasingly elaborate series of defense mechanisms, which contribute both to growth, when managed well, and to pathology, when managed poorly.

* Freud (1917) - following a loss, people seek to continue receiving gratification from the lost person by internalizing the person's image and relating to this now internal object as if it were the actual person. People not only internalize lost objects but identify with them; they make the object-image a part of themselves and thereby develop their identity.

* Melanie Klein (1975) - infants are object related from birth. Since infants are in a relationship from the beginning, they attempt to protect their integrity as an organism and that of the primary object of attachment (which they experience as a part of themselves) by projecting their innate destructiveness onto the environment and introjecting its good aspects or, reciprocally, by projecting the good aspects of themselves onto the good object and experiencing themselves removed from discomfort or danger. Thus, they split their self-and-object world into all-good and all-bad camps.

* Pruyser (1975) - the lack of clarity in "splitting" terminology which suggests that what is divided - the ego - is also the agent which does the dividing. More recent work has attempted to address this issue by distinguishing the self from the ego (Hamilton, 1988).

* Klein (1975) - As splitting resolves, whole object relations become central to mature functioning in normal development. The maturing child learns that his loving wishes are directed toward the same object as his destructiveness. The mother whom he hates and wishes to destroy for depriving him is the same mother he loves for nurturing him. The child then develops romorse and guilt and wishes to restore or repair the object he had previously wanted to diminish. As he works through his guilt, he comes to recognize his loving and destructive impulses as his own and his mother's nurturing and depriving qualities as her own. The self is loving and also somewhat destructive. The object is loving and also a bit destructive. The self and object are separate, yet related. This is whole object relatedness (Mahler et al., 1975).

* The primary problem - how to maintain continuity of relationships in the presence of contradictory loving and hating feelings - love being associated with gratification-attachment and hate being associated with deprivation-abandonment.

* Klein (1946) - Projective identification, whereby a person attributes an aspect of the self to the object and reidentifies with the projected element in the other, attempting to control it.

* Fairbairn (1954) & Guntrip (1969) - the need to seek objects and attach meaningfully to other people as the central elements in personality development; a divided self or ego - libidinal ego, antilibidinal ego, and central ego.

* Bion (1962) - the metaphor of the container and the contained to show how infants overcome the isolation and fragmentation of their split internal world.Children have strong affects that threaten to overwhelm them. They externalize their distress and project it onto the parent, who takes in the projected feeling, contains it, modulates and alters it, and gives the transformed affect back to the child in the form of holding behavior or a meaningful comment. The child can now accept the metabolized affect and self-image as his own. He eventually identifies with the containing process itself and learns to contain his own affects.

* Winnicott - the holding environment (1960) and the transitional object (1953). The holding environment describes the good enough mother's function of providing the child with optimal closeness while allowing adequate room for development of autonomy. It emphasizes the need for closeness and separateness. Eventually, the child can internalize the holding functions so that he can self-soothe (Tolpin, 1971) and separate from the parent. An important step in this process is development of a transitional object, which is neither self nor object and yet may be treated as if it were the beloved parent and simultaneously the self.

* Kernberg (1976) - infants develop through phases of a split internal world and gradually shift toward whole object relatedness; infants as being born with an undifferentiated energy and responsiveness. This energy becomes organized into the traditional two drives of sex and aggression by polar effects experienced in the split all-good, all-bad world of the infant.

* Mahler (1975) - autism (birth), symbiosis (2 months), separation-individuation (6 months; 10-16 months - new mobility, 16-24 months - increased cognitive awareness of his vulnerability & separateness --> uneasy return to the mother, rapprochment subphase of separation- individuation), and whole object relations (24-36 months; infant and parent are separate yet related, the relationship being primarily good but also having some less than optimal qualities).

* Kohut (1971) - denies inherent human aggression; infants as being born with needs; They need self-cohesion and self-regulation, functions that the parent originally performs for the child. Through empathic attunement the parent integrates and modulates for the baby. Splitting as a fragmentation product resulting from inadequate empathic attunement. Since the parent performs a self-modulation function for the infant and is still an object, the parent serves as a "selfobject." Through what Kohut called transmuting internalization, that is, introjecting and identifying with the sustaining selfobject, the child learns to self-soothe and develop self-esteem and a cohesive sense of self, although even adults continue to need sustaining objects to some degree.

* Diagnosis - Object relations theorists classify mental disorders according to the degree of separation-indivduation and development of whole object relations achieved by the patient. The psychoses display a severe degree of self-object confusion and fragmentation; they are placed at the presymbiotic or symbiotic level of development described by Mahler. Borderline disorders, in which splitting all-good and all-bad experience is predominant, are placed at the rapprochement level. Narcissistic idealizing and devaluing are seen as associated with the late rapprochement subphase or the early phase in developing whole object relations. Neurotic disorders with greater tolerance of ambivalence are considered whole object relations issues. Kohut's schema (1971) is based on the degree of self-cohesion as manifested in merger, mirroring, and idealizing transferences.

* Object-relations-oriented developmental diagnosis is most useful in planning psychotherapies and less useful for choosing somatic interventions.

* Kohut (1971) - narcissistic disorders ~ inadequate parental empathic attunement, defective self-soothing and an ongoing desperate search for external sources of self-esteem.

* Masterson & Rinsley (1975) - borderline splitting ~ maternal behavior that alternately rewards clinging symbiosis and punishes appropriate individuation by emotional abandonment.

* Kernberg (1975) - borderline splitting ~ an attempt to keep overwhelming aggression from annihilating feeble good internal objects. While he emphasized a constitutional excess of aggression as central, he acknowledged that extreme environmental frustration in early life could lead to increased internal aggression.

* Because object relations theory is an intrapsychic and interpersonal construct focusing on emotional interactions, cognitive and perceptual-motor factors have been relatively ignored.

* Splitting, envy, negative transference, acting out, abandonment depression, +/- self- and other-images, self-other boundaries, mirroring (narcissistic DOs), idealizing transferences (narcissistic DOs), a holding environment, containment, empathic attunement, sustaining relatedness.

* Elucidation of how projective identification stimulates powerful and primitive countertransference reactions had made it possible for therapists to work with many patients previously considered untreatable.