1. Self Psychology: A Relational Psychodynamic Model

2. Self Psychology as a Theoretical Framework
Heinz Kohut (1971, 1977) evolved self psychology concepts
Self-esteem and sense of self dependent on quality or relationships with parental figures
Self-object: person who is experienced intrapsychically
Self-object must be availability to the infant for its development of Self

3. Three Self Object Relationships
Mirroring self-object: recognizes a child’s capabilities and talents
Idealizing self-object: links a child with admired caregivers
Twinship self-object: provides a sense of being the same

4. Internalization of Self-objects
Self-objects perform adaptive functions of soothing and tension regulation
Transmuting internalization: child is gradually able to perform soothing and tension regulation functions in absence of original self-object

5. Impairments with Internalization of Self Objects
Without positive self-object experiences internalization of a “healthy self” cannot occur
Shame, humiliation, helplessness the result of self-object failure
True Self development hindered when child sacrifices expressing needs because self-object support is perceived as unavailable
Person complies with needs of other at expense of her/his True Self development (merger bond)
Failure to bond with caregiver leaves individual feeling isolated and depressed

6. Impairments with Internalization of Self Objects (cont.)
When early narcissistic needs unmet, child (adult) is continually searching for nurturing and validating self-object experiences
If self becomes strengthened through self-object responsiveness (i.e. through treatment) person will feel less shameful about needs for vulnerability and nurturing
Will be able to give to others, emotionally, without feeling anxiety about another’s needs

7. Maturity: Self Psychology Perspective
Maturity ability to evoke and engage in mutually enriching self-object relationships
Emotionally healthy individual has ability to choose self-objects based on adult development levels, not early narcissistic needs

8. Empathy
Kohut (1959): Psychological development evolves from attunement between self and self-objects
Experiencing attunement allows self to evolve from early, narcissistic needs to capacity for empathic attunement to others
Empathy as “vicarious introspection: ability of therapist to investigate inner world of client
Empathy as tool through which therapist gathers psychological information
Defense and resistance viewed as normal ways to protect oneself from pain or injury
Therapist seeks to understand what client fears in life and in the worker client relationship
Empathy frames the working alliance

9. Role of the Therapist in Self Psychology
Experience of therapist by client NOT solely based on past “representations
Client's feelings about worker based on her past experiences, current behaviors with others and with therapist
Therapist needs to share her experience of client with that person
Through “transmuting internalization” of the therapist as calming (mirroring) and competent (idealizing) client can learn to self-soothe, self-comfort and self-empathize
Therapist becomes a new “self-object”
This process enables client to find more mature self-object relationships in her life

10. Role of the Therapist in Self Psychology
Empathic failure: when the client does not feel the worker has been attuned to his self-object needs
Perfect empathic attunement is not always possible
Not problematic as long as therapist communicated to client the impact of empathic failure on the person
Client learns to tolerate frustration in the same way a young child is helped by parents who do not gratify every need
Learning to deal with frustration, through an empathic relationship with therapist, allows client to choose more emotionally sustaining self-objects and to experience empathy for others

11. Self Psychology: Treating Children
Rage, depression, clinging, lack of impulse control, inhibition in social skills and learning can result from lack of caregiver responses to appropriate childhood needs and wishes
Driven, repetitious behaviors seen as desperate attempts to achieve recognition and response to vital needs
Mirroring self-objects: to be affirmed
Idealizing self-objects: to merge with strength and wisdom
Therapist’s needs are to understand the self-object needs presented by the child
With children, don’t interpret their behavior, just respond to their needs
Self Psychology: Treating Children

12. Self Psychology: Treating Adolescents
Adolescent brings “turmoil” through loosening of ties to primary self-objects
Parental self-objects compared to peers in values and ideals
Ongoing process of “the experience of the self and other in parents and children”
Requires strength and flexibility

13. Self Psychology and Learning Disorders in Children and Adolescents
Palombo (1995): Disorders of the self do not cause learning disorders since they are neurologically based
However, neurological weaknesses can give rise to disorders of the self
Child’s thoughts and behaviors are neurologically based and not motivated by psychological factors
When child cannot make sense of her experiences and she receives negative feedback from family or educators, child can have problems with self esteem and self concept

14. Ideal self-object relationships for learning disabled youth:
Self Psychology and Learning Disorders in Children and Adolescents (cont.)
Ideal self-object relationships for learning disabled youth:
Direct verbal explanations to clarify confusion
Soothing guidance on how to deal with problems
Emotionally calm presence to reduce anxiety
Therapist must be a self-object for both child and the caregiver

15. Self Psychology and the Elderly
Integrity vs. despair ( developmental ask of last life cycle): maintaining self esteem in the wake of biological, psychological and social stressors
Symptoms of disorders of self in seniors:
Sensitivity to slights and insults
Reactive anger and withdrawal in response to rejection or disappointment
Hypochondriasis
Overdependence on others for approval
Viewing others not as separate but as extensions of self
Over-emphasis on psychical appearance, possessions and past accomplishments to cope with diminished self esteem
Major goal of therapy with elderly is restoration of self esteem
Reminiscence about past
Mourning loss of self-object relationships
Listening to past narcissistic injuries

16. Self Psychology and Brief Treatment
Self-psychology is applicable to brief treatment
Clients seek treatment because of a loss of meaningful self-object experiences
Causes loss of sense of self
Goal: enhance client’s self esteem and restore her to pre-crisis functioning
Therapeutic process of “empathic investigation," through mirroring, idealizing and twinship functions
Understanding client’s subjective experiences, providing “self-object responsiveness” restores self-cohesion and decreases symptom logy
Tasks of therapist:
Helps patient appreciate the legitimacy of her needs and feelings
Promotes self awareness, understanding and acceptance

17. Self Psychology and Group Treatment
Self psychology has been effective in group treatment with clients having self esteem problems
The group can provide affirming self-object relationships
12 Step meetings:
Mirroring transference through sharing others with same experiences
Idealizing transference through “sponsors” and subscribing to the “Steps”
Twinship transference through the “we” experience of mutual aid and peer support

18. Self Psychology and Practice Evaluation
“Success” would be client's ability to identify and seek out positive self-objects within her surroundings
Treatment provides a “reparative emotional experience” of being empathically understood and nontraumatically frustrated in a way that promotes self-identity and self-esteem
Kohut: the “internal world” should only be studies through the therapist’s empathy

19. Self Psychology and Practice Evaluation (cont.)
Qualitative research designs focusing on validity of meaning (comparing therapist and client responses)
Quantitative assessment of change in self esteem could be assessed by measures addressing that concept ( i.e. Rosenberg Self Esteem scale)

20. Ending in Self Psychology: the Therapist Experience
At end of treatment, therapist may experience:
“ loss of the therapy as a self-object experience that may have provided mastery, growth and professional stability”

21. Self Psychology: Summary
Kohut pioneered the term empathy as a clinical concept plus an important component of the healing process
Empathy more than “feeling for the client”
Empathy as the “scientific tool” of psychotherapy
Practitioner has only one tool; that tool is herself
“Empathy is means by which psychological observer gathers information about the inner world of the human experience”
Empathy is active listening through:
Hearing the client’s story
Communicating understanding of that story and its impact on the client’s life
Being understood by the therapist gives the client an affirming experience vital for establishing other meaningful relationships