1. 1 Psychodynamic Approaches Object Relations Theory

2. 2 Psychodynamic Approaches Neo-Freudian Tradition Alfred Adler, Wilhelm Reich, Carl Jung, Otto Rank, and Sullivan Ego-Analytic Tradition Self-Psychology and Object Relations Theories Originated with Anna Freud and Melanie Klein’s observation of infants in the 1930’sd 1940’s Winicott, Erikson, Mahler, Fairbarn

3. 3 Neo-Freudian Tradition Objected to Freud’s emphasis on instinct theory, infantile sexuality and his view of the Oedipus complex More concerned than Freud with: The nature of conscious experience: cognition and will – human’s ability to choose Psychological health and normal development Socio-cultural determinants of behavior

4. 4 Ego-Analytic Tradition Based on work with young children Interested in understanding severely disturbed adults (psychosis, narcissistic, borderline disorders) Emphasizes Ego’s functioning in adaptation, coping, and mastery Interpersonal experiences

5. 5 Psychodynamic Approaches Agree with Freud in The importance of early life The importance of the unconscious The role of defense mechanisms The use of transference, counter transference, interpretation, insight, resistance and catharsis in therapy Abandon the couch and pay attention to the therapeutic alliance based on a real therapist – client relationship in the here and now

6. 6 Object Relations Theory 1. Concerned with the formation of the self before the Oedipal stage 2. Major drive of humans is the drive to relate 3. Ego’s role is to seek relationships rather than to control an unruly ID (Fairbarn) 4. The self is formed in the context of early relationships

7. 7 Objects Object Relations Interpersonal relations External Objects Significant persons that are the target of a person’s feelings, desires, needs Internal Objects Internalized images of the external person, which may differ from the real person

8. 8 Inner and Outer World of Objects

9. 9 Psychological Function of Infants Splitting (normal and defensive process) Keeping apart contradictory feelings about others- good mother vs. frustrating mother Internalization of “Others”– “Experiences” An aspect of the external world* is introjected and becomes part of the child’s internal world *Emotional experiences & characteristics of relationships Internal objects carry out functions performed by the external object: trust, self-worth, condemnation. Lead to the formation of self-representations

10. 10 Self-Representations How the infant perceives him/herself in relation to significant others in their lives Initially, external objects and self are not differentiated Pleasurable feelings are internalized as “good me” Frustration is internalized as “bad me” which is painful – and often repressed Self-representations and internalized objects shape how one relates to oneself and to others

11. 11 Development of the Self Crucial early development task : move from a state of fusion and dependence on care- giver to a state of increased independence and differentiation (attachment-individuation processes) Adequate, positive relations in the early stages lead to good feelings about self Negative relations and neglect leave the child feeling empty, deficient, frustrated

12. 12 Development of the Self - Mahler Normal Autism First 3 to 4 weeks Objectless period of primary narcissism Responses based on physiological tensions Normal Symbiosis 2-3 to 8 months Dim awareness of mother as separate Differentiates pleasurable ( bliss, reaching out ) from frustrating experiences ( aggression ) Investment in the relationship with caretaker is the crucial point from which all subsequent relationships form

13. Harry Harlow: On the Nature of Love – American Psychologist -- 1958 13

14. Harry Harlow After 8 months of total isolation, damage to the ability to form bonds was permanent Less than 3 months, damage was reversible Food, cuddling, warmth, movement and few hours of play

15. 15 Development of the Self - Mahler Separation Individuation 10 months to 21/2 years “No” period - disengagement from symbiotic relationship – emergence of the Ego Caretaker: balance between letting go and being emotionally available Neglect or enmeshment will hamper exploration of environment. Neglect: child will focus energy on getting attention May revert to earlier splitting mechanisms that may lead to narcissistic or borderline disorders

16. Attachment -- Autonomy 16

17. 17 Development of the Self - Mahler Emotional Object Constancy and Individuality 3 years old on Internalization of a positive image of caretaker comforts child in caretaker’s absence and allows for individuation Ability integrate “good” and “bad” aspects of the internalized object (caretaker) Development of a unified self-image: cohesive self Development of complex cognitive functions & language Increased reality testing and curbing of aggressive feelings

18. 18 Psychopathology Deficits in the early relations: Generate feelings of aggression and anger Hinder the development of a cohesive self Result in disintegrated internalized objects or psychic structures- splitting May lead to serious difficulties in adult relationships: Narcissistic Personality Disorder Borderline Personality Disorder

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20. Narcissistic Personality Disorder Grandiose sense of self-importance - Lacks empathy Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love Believes that he or she is “special” and unique Requires excessive admiration, praise Has a very strong sense of entitlement, e.g., unreasonable expectations or wants automatic compliance with expectations Exploitative of others -- hostility Often envious of others or believes others are envious of them Regularly shows arrogant, haughty behaviors or attitudes 20

21. Borderline Personality Disorder Frantic efforts to avoid real or imagined abandonment A pattern of unstable and intense interpersonal relationships extremes idealization and devaluation Identity disturbance: unstable self-image or sense of self Impulsivity in at least two areas (e.g., spending, sex, substance abuse, reckless driving, binge eating) Recurrent suicidal behavior, threats, or self-mutilating beh. Emotional instability due to significant reactivity of mood Chronic feelings of emptiness Inappropriate, intense anger or difficulty controlling anger Transient, stress-related paranoid thoughts or severe dissociative symptoms 21

22. 22 ] Example Early Conflict Client has difficulty relating to others: Child receives inadequate, inconsistent care in infancy, experiences: Frustration and anger Perception of needs as bad, self as bad Fear of abandonment from caretaker To some extent the negative feelings will be repressed or denied

23. 23 In adulthood, situations that elicit desire to be close to others, to have others take care of her needs, elicit Anxiety related to the repressed feelings of: Frustration and anger Perception of needs as bad, self as bad Fear of abandonment Symptom: Difficulties in interpersonal relations – Problem : Extensive use mechanisms of defense (e.g. denial, reaction formation, projection, displacement, sublimation) to avoid the anxiety generated by these negative feelings

24. Psychodynamic Perspective Potential Defense Mechanisms Displacement: anger, frustration towards parental figures and self is directed towards significant others Projection/Sublimation: projects on others repressed desires of being taken care of- becomes supreme caretaker Reaction formation: develop a super-independent person Conflict between conscious desire (to be close to others, be taken care of) and repressed aspects of the Ego (sense of self as bad; fear of rejection/abandonment) 24

25. 25 Psychodynamic Therapy Enable client to re-experience conflicts related to early stages of development: Explore repressed negative experiences Emotionally: Catharsis, Corrective Em. Exp. Explore how current conflicts repeat patterns of behaviors and feelings about self and others established earlier Cognitive: Interpretation-Insight Parallel Process: In relation to therapist Examination/Confrontation of defenses

26. Therapy (continued) to achieve a more positive level of functioning (object relations): The therapist provides some of the functions that client lacked in childhood Therapist serves as an auxiliary ego to help client cope with painful, overwhelming emotions Modeling – positive intimacy Foster process of integration and synthesis of self- cohesive self with less reliance on defenses 26

27. Limitations Lack of direct attention to behavior change Limited number of specific interventions Reliance on exploring the past Does not lead to quick results 27

28. Markers Ego Resiliency vs. Brittleness Confidence Optimism Has social poise and presence Responds to humor Calm, relaxed in manner Feels a lack of personal meaning Basically anxious Vulnerable, fearful Tends to ruminate Feels cheated, victimized by life Maladaptive under stress Is self-defeating Productive and Autonomous Activity Is productive; gets things done Values own independence Gives up; withdraws from adversity 28

29. Markers Ego Resiliency vs. Brittleness Interpersonal Warmth and Insight Has warmth; is compassionate Insight into own motives and behaviors Arouses liking and acceptance Perceptive of interpersonal cues Sees to heart of problems Dependable and responsible Denies unpleasant experiences Over-reactive to frustrations Skilled Expressiveness Skilled in social techniques Initiates humor Is emotionally bland Does not vary roles Uncomfortable with uncertainty 29