Object Relations

Question 1

How did object relations theory develop?

Answer 1

-Klein tried to integrate drive theory with internal object relations. Subsequent thinkers such as Fairbairn (1941) and Winnicott (1951) developed what is known as British Independent Perspective which argued that the primary motivation of the child is object seeking rather than drive gratification

Question 2

Object relations theorists place an emphasis on:

McWilliams (1994)

Answer 2

“what the main objects in the child’s world had been like, how they had been experienced, how they and felt aspects of them had been internalized, and how internal images and representations of them lived on in the unconscious lives of adults.”

Question 3

Bowlby (1969) and Fonagy (1998) also stressed

Answer 3

importance of attachment as a primary motivational force and how internal working models or mental representations of self and other are formed through repetitive childhood experiences.

Question 4

Transference

Answer 4

patient experiences the therapist as an old, bad object

Question 5

Basic assumptions and prototypes of human connections are established _____

Answer 5

in the past and presented in internal object relations shape the experience with the therapist

Question 6

What imprisons the patient?

Answer 6

neurosis is the only form of relation the patient believes in

Question 7

How does patient feel connected to others?

Answer 7

only through painful states of mind and self defeating behaviors, patient believes getting rid of these states would lead to abandonment and isolation
-patient must believe in new, less constrained patterns of relatedness to renounce old forms of connections

Question 8

Pathological ties to old objects

Answer 8

-will be highlighted in the work and held in contrast against new and more adaptive relationships

Question 9

Patient will develop:

Answer 9

• more complex self and other representations and a sense that vision and meaning involve choice and agency
• therapist helps patient achieve this by striving to create an atmosphere of neutrality in behavior and attitude

Question 10

Therapist neutrality

Answer 10

-intended to communicate a supportive stance without an expressed preference for a particular aspect of the patients personality

Question 11

Pine (1990)

Answer 11

• Each individual shapes their relationships according to the patterns of relatedness that are internalized from the earliest significant relationships.
• The modes of connection with these early objects become the preferred and expected ways of relating to new people……we choose new love objects for their similarity to past satisfying or unsatisfying objects and interactions with new partners trigger and are processed by old expectations and behaviors

Question 12

Key concepts

Answer 12

• People enact for various reasons: to master them, to turn passive experiences into active ones, or because the dramas are pleasurable
• Early objects are internalized and become introjects as manifested by repetitions, relational patterns, and transference
• Emphasis on relational patterns (fusion, dyadic space, separate), patient doesn’t suffer from symptoms but from contact disturbances= inability to engage meaningfully with others in a sustaining or gratifying way (Kaiser, 1965)
• Emphasis on separation/individuation rather than oedipal theme
• Use of countertransference data useful in clinical understanding of patients’ experiences (Winnicott, 1969)

Question 13

View of pathology

Answer 13

-Place emphasis on relational pathology – contact disturbances not symptoms- Kaiser
-Instead of suffering from an inability to reconcile inner impulses, patient has an inability to meaningfully engage others in sustained and/or gratifying relations
-The meaning of psychiatric symptoms, such as depression and anxiety, is that the patient’s relationships are deteriorating or threshing in the patient’s sense of self (Cashdan, 1988)
-The relationships with others constitute the basic motivational force in humans
-Pine (1990)
The individual is seen in terms of an internal drama, derived from early childhood, that is carried around within as a memory (conscious or unconscious) and in which the individual enacts one or more (or all) of the roles. These internal images, loosely based on childhood experiences, also put their stamp on a new experience in that they are assimilated to the old dramas rather than being experienced fully in their contemporary form.
The greater the level of enactment the greater the pathology.

Question 14

Goals

Answer 14

 Pine (1990) - Emphasis is on what the main objects in the child’s world had been like, how they had been experienced, how aspects of them had been internalized (introject) and how internal images and representations of them had lived on in the unconscious lives of adults.

Question 15

Curative factors

Answer 15

• Emphasis on the emotional connection between the therapist and the patient, therapeutic relationship heals, come to see how old dramas are enacted via therapists transference interpretations, patient can have new experiences instead of repeating old ones
• It is the changed capacity for relatedness where analytic change occurs
• Progress is the result of changed capacity to relate to others
• Identifying and modifying harsh introjects though identifying relational patterns, transference patterns, countertransference information, and historical data, interpret transference
• Winnicott-holding environment, safety

Question 16

Fairbairn’s (1952) curative factors

Answer 16

• emphasis on emotional connection between therapist and patient… the relationship heals, not the interpretation of intrapsychic conflict
• Patient comes to see how old dramas are enacted via therapists transference interpretations.
• Patient can then have new experiences instead of repeating old experiences.
• They see how the old dramas are enacted via the therapist’s transference interpretations. Patient learns new ways of relating, and gives up old introjects.
• Patient learns to recognize what is me and what is not me (Steiner, 1989)
• Fairbairn located analytic change in a changed capacity for relatedness to renounce old forms of connections and ability to connect with therapist in new ways

Question 17

For Fairbairn, insight is

Curative factors (Fairbairn, 1952)

Answer 17

• not enough
• Patients can’t give up powerful addictive ties to old objects unless they believe that new objects are possible, that there is another way to relate to others in which they will feel fulfilled and touched. Mere insight is not enough.
• For the patient to renounce the old, transferrential forms of connection to the therapist, they must begin to believe in new, less constrained patterns of relatedness.

Question 18

-Fairbairn located analytic change in a changed capacity for

Answer 18

relatedness, an ability to connect with the therapist in new ways

Question 19

Curative factors (Fairbairn, 1951) related to when the patient’s early relational patterns are reenacted within the analytic treatment

Answer 19

• adhesive, pathological ties to old objects will be highlighted and held in stark contrast against the new and more adaptive, flexible relationship that the patient and therapist struggle to negotiate in the present.
• Through the process of contrasting, integrating, and appreciating the nuances of alternative perceptions other than one’s own, the patient will develop more complex self and other representation, and a sense that vision and meaning involve choice and agency.
• Therapist helps the patient achieve this by striving to create an atmosphere of neutrality in both behavior and attitude.
• Therapist’s neutrality is intended to communicate a supportive stance without an expressed preference for a particular aspect of the patient’s personality, the therapist’s presence and ability to provide certain holding, soothing, containing functions highlight the boundaries between old and new relational experiences.

Question 20

Fairbairn’s conceptualization of presenting problem

Answer 20

• Places emphasis on relational pathology. Patient doesn’t suffer from symptoms, but from contact disturbances (Kaiser, 19650)
• Instead of suffering from an inability to reconcile inner impulses, patient has an inability to meaningfully engage others in sustained and/or gratifying relationships.
• The meaning of psychiatric symptoms, such as depression and anxiety, is that the patient’s relationships are deteriorating or threshing the patient’s sense of self (Cashdan, 1988)

Question 21

Winnicott’s ideas on pathology

1949, 1951, 1958, 1960, 1965, 1969, 1971

Answer 21

• result of maternal deprivation. This is the result of the mother not being “good enough” and not providing an adequate holding environment.
• Focused on the importance of personal meaning and the image of oneself as a distinct and creative center of one’s life

Question 22

How do patient’s shape the therapeutic relationship according to Winnicott (1949, 1951)

Answer 22

• Patients are powerfully self-restorative and shape the therapeutic relationship to provide the environmental experiences missed in childhood
• The experience of the self in relation to them is what’s most curative

Question 23

Winnicott’s holding environment

Answer 23

– psychic and physical space with in which the infant or pt. is protected. It is an environment in which the individual is free to move and learn.
-Too much stimulation or impingement means not providing adequate holding environment – this can be traumatizing for child

Question 24

Winnicott’s good enough mothering

Answer 24

• physical and emotional attunement to baby, allowing for optimal environment to facilitate establishment of secure attachments.
• Deprivation leads the child to develop a false self, which aims to appease the impinging forces of the objects in their environment.
• In working with patients, therapists attempt to figure out which internal parent or other important early object is being activated at any give time (introjects).
• Patients can’t give up addictive ties to old objects unless they believe and trust that new ways of relating are possible.

Question 25

Winnicott was interested in themes of

Answer 25

• separation and individuation rather than Oedipal themes
• Focused on the importance of personal meaning and of the image of oneself as a distinct and creative center of one’s life.
• Patient’s are powerfully self-restorative and shape the therapeutic relationship to provide the environmental experiences missed in childhood.

Question 26

Winnicott’s curative factors

Answer 26

• Search for truth – guided by Winnicott’s true self/false self dichotomy, patients begin to take a look at who they really are, not who they want to be.
• The outcome of therapy is feeling comfortable in one’s own skin, of being authentic. –attempting to help the client develop an authentic self!
• **By providing holding environment, the person has the opportunity to discover who they are without impingements of old objects- therapist provides the holding environment for the client in the therapeutic relationship!

Question 27

The meaning of psychiatric symptoms in object relationship is that

Answer 27

the patient’s relationships are deteriorating or thrashing the patient’s sense of self (Cashdan, 1988)

Question 28

Pathology of depression

• McWilliams (1994)
• Furman (1982)

Answer 28

• McWilliams (1994) often relates to the early loss of an important love object.
• Furman (1982): the separation-individuation process results in depressive dynamics when the mother’s pain about her child’s growth and separation is so great that she either clings and induces guilt or pushes the child away counterphobically. When this happens, the child is left feeling that normal wishes to be aggressive and independent are hurtful, or they learn to hate their natural dependent strivings. Either way a part of their self is experienced as bad

Question 29

Pathology of anxiety

- Winnicott (1969)

Answer 29

-Winnicott (1969) chronic nurtural failure (mother fails to provide the good enough environment) causes radical split in the self between genuine strivings (true self) and compliant self (false self) from a history of premature, forced necessity for dealing with the external world. Anxious adults are seen as in search of crucial, missing experiences, spontaneous excitement is met with fear and anxiety.