1. Heinz Kohut

2. Attachment theory & Psychoanalysis Heinz Kohut: Empathic immersion
Kohut dealt with narcissistic PDs and discovered
in the transference things which led him to a new
view of the development of narcissism.
Kohut saw himself as challenging theory from an
empirical perspective rather than from a competing theoretical one.
He thought theory was getting in the way of
Practice.
He took a stance of empathic immersion or
vicarious introspection in the psychic world of his
patients

3. Kohut
To Kohut, it is the construction of the self and its role in human affairs that dictates what is normal and abnormal – psychopathology is viewed as a disturbance of the self, with very severe
disorders rooted in very early disturbances of the mother-infant relationship.

4. Kohut
The child is born into a social milieu, and relatedness with others forms a basic prerequisite for psychological survival. The child needs adults not only to fulfill physical requirements, but also to fulfill psychological needs. Perhaps the most important of these is support for a vague and undifferentiated sense of self. In the beginning, that sense of self amounts to little more than a set of reflexes and an innate potential, but through parental expectations and encouragement, it quickly becomes transformed into a central organizing force in the psyche.

5. Kohut
The significance of selfobjects lies in the psychological functions they contribute to the child’s developing self. Selfobject responses such as praise or the induction of shame are “taken in” by the child and experienced as pride or guilt. the concrete, observable communications that make up the mother-child interaction form the building blocks of what ultimately comes to be known as the self.

6. Kohut
There are two basic narcissistic needs that the child seeks to satisfy through early selfobject relations: one is the need to show off developing capabilities and to be admired for them: “if others see me as good, then I must be good.” The other is to form an idealized image of one of the parents, usually the mother, so as to experience a sense of merger. Both needs are normal; the first, a healthy omnipotence, and the second, a healthy desire for connectedness.

7. Kohut
The significance of these tendencies is that they become incorporated in one’s representational world. By means of “transmuting internalization” the two types of external object relations are transformed into two inner relational configurations. The first, comprised of grandiose, exhibitionistic self-images, is the result of interchanges with “mirroring selfobjects” “I am perfect and you must admire me.” The second, consisting of self-images involving fusion, evolves out of interchanges with “idealized selfobjects.” “You are perfect and I am part of you.”

8. Kohut
Psychopathology represents an inability to transcend the narcissistic internalizations of infancy. In the course of treatment, the patient develops either a mirroring or idealized transference - or both. Mirroring - the patient casts the analyst into the role of admiring audience. Idealizing - the patients view of the therapist is extraordinarily inflated.

9. Attachment theory & Psychoanalysis
Freudian theory would insist upon interpretation of
these various transferences, seeing them as
resistances to ego growth
Kohut found patients needed to experience these
transferences as a way of recouping missing
developmental inputs
Change takes place by transmuting internalization
in which gentle and repetitive narcissistic failures
on the part of the selfobject build up the patient’s
capacity for narcissistic self-regulation.

10. Kohut
The beginning of therapy is marked by the analyst’s willingness to allow the patient to dwell in the infantile aspects of the relationship. As the therapy progresses, the patient outgrows the narcissistic, infantile aspects of the transference and moves on to more mature ways of relating. Resolution of the transference (relating to the analyst as a positive and healthy selfobject) provides for a positive transmuting internalization. Psychoanalysis is seen as providing the patient with an opportunity for a developmental second chance. Selfobject failures early in life lead to deficiencies in the self.

11. Narcissistic Personality Disorders
Understimulated Self – feel bored, empty. Parents failed to respond empathically to mirroring/idealizing needs. Typically engage in various stimulating, but dangerous behaviors.
Fragmenting Self – Feels uncoordinated, slow, awkward

12. Narcissistic Personality Disorders
Overstimulated Self – Excessive responsiveness. No optimal frustrations. Discrepancy between primitive grandiose self and weak nuclear self – leads to avoidance of becoming the center of attention
Overburdened Self – views the world as hostile and dangerous – results from inability to merge with the calmness of omnipotent selfobjects

13. Narcissistic Behavior Disorders
Mirror-Hungry Personalities – look for people to admire them
Ideal-Hungry Personalities – look for people to admire. Eventually become disillusioned and move on the the next one.
Alter-ego Personalities – need someone like themselves – opinions, values, etc.
Merger-Hungry Personalities – lose themselves in others
Contact-shunning Personalities – Same needs as merger-hungry, but keep their distance to prevent losing themselves

14. Object Relations Theory
Emphasized the role of interpersonal, pre-Oedipal experiences in the development of personality and psychopathology
Freud (1923): “the character of the ego is a precipitate of abandoned object cathexes and it contains the history of those object choices.”
Melanie Klein, W.R.D. Fairbairn

15. Margaret Mahler
Utilized systematic observation to identify the stages of the separation-individuation process
Autism (birth – 2 months)
Symbiosis (2 – 6 months)
Separation-Individuation
Hatching (6 – 10 months)
Practicing (10 – 16 months)
Rapproachment (16 – 24 months)
Object Constancy

16. Separation-Individuation Theory of child development
Normal Autistic Phase - First few weeks of life. The infant is detached and self absorbed. Spends most of his/her time sleeping. Mahler later abandoned this phase, based on new findings from her infant research.

17. Separation-Individuation Theory of child development
Normal Symbiotic Phase - Lasts until about 5 months of age. The child is now aware of his/her mother but there is not a sense of individuality. The infant and the mother are one, and there is a barrier between them and the rest of the world.

18. Separation-Individuation Theory of child development
Separation-Individuation Phase - The arrival of this phase marks the end of the Normal Symbiotic Phase. Separation refers to the development of limits, the differentiation between the infant and the mother, whereas individuation refers to the development of the infant's ego , sense of identity, and cognitive abilities. This process, labeled separation-individuation, is divided into subphases, each with its own onset, outcomes and risks.

19. Separation-Individuation Theory of child development
Hatching – first months. The infant ceases to be ignorant of the differentiation between him/her and the mother. "Rupture of the shell". Increased alertness and interest for the outside world. Using the mother as a point of orientation.
Practicing – 9-about 16 months. Brought about by the infant's ability to crawl and then walk freely, the infant begins to explore actively and becomes more distant from the mother. The child experiences himself still as one with his mother.

20. Separation-Individuation Theory of child development
Rapprochement –15-24 months. In this subphase, the infant once again becomes close to the mother. The child realizes that his physical mobility demonstrates psychic separateness from his mother. The toddler may become tentative, wanting his mother to be in sight so that, through eye contact and action, he can explore his world. The risk is that the mother will misread this need and respond with impatience or unavailability. This can lead to an anxious fear of abandonment in the toddler. A basic ‘mood predisposition’ may be established at this point. Rapprochement is divided into a few sub phases:

21. Separation-Individuation Theory of child development
Beginning - Motivated by a desire to share discoveries with the mother.
Crisis - Between staying with the mother, being emotionally close and being more independent and exploring.
Solution - Individual solutions are enabled by the development of language and the superego.
Disruptions in the fundamental process of separation-individuation can result in a disturbance in the ability to maintain a reliable sense of individual identity in adulthood.

22. Separation-Individuation Theory of child development
Object Constancy - The phase when the child understands that the mother has a separate identity and is truly a separate individual. This leads to the formation of Internalization, which the internal representation that the child has formed of the mother. This Internalization is what provides the child with an image that helps supply them with an unconscious level of guiding support and comfort from their mothers. Deficiencies in positive Internalization could possibly lead to a sense of insecurity and low self esteem issues in adulthood.