Introduction_to_Psychodynamic_Therapies

UNDERSTANDINGTHE DYNAMICS OF OBJECT RELATIONS WITH KLEIN and WINNICOT Zeynep Yildirim Fricker The unexamined life is not worth living. Socrates  Introduction   This is an introductory work to Psychodynamic Approaches. It aims to develop some understanding of the dynamics of the object relations, by presenting elements of both Klein and Winnicot’s approaches. Considering the size and the complexity of the subject, this essay should be considered as a summary of the summary. Every theory is born from assumptions and these assumptions became core principles of that theory. I therefore found it useful to explain the core assumptions of Psychodynamic/Psychoanalytic Theories in part 1. There are a few approaches to psychodynamic theory such as object relations, self psychology, inter-subjective approaches and brief psychodynamic theories. Each of these psychodynamic approaches bring us different perspectives in our understanding of human functioning. My main focus will be on object relations. Whilst many great names of the object relations school have put their signature to, and influenced, the therapeutic world (Melaine Klein, Winnicot, Bowlby, Fairbain, Kohut, Bion and many others) my focus will be on Klein (as the starter of the object relationship) and Winnicot whose work I find meaningful in my personal development. Their spectrum of object relations, and therapeutic materials will be explained through my own personal and professional experience in part 2. The conclusion uses short comparisons between the two clinician’s approaches. I allow myself reflections here, as I am permitting these influences to happen in the here and now, whilst working through the subject and evaluating my experiences in this essay. Part 1 Basic core Assumption of Psychoanalytic / Psychodynamic Theory Psychoanalytic Theory is the most influential, traditional and long lived theory in the understanding of human dilemma and behaviour. As a result of evolution in the Applications of Psychoanalytic Theory, different schools and techniques were established. The emphasis has shifted from instinctual drive theory, to more relational drive theories and the understanding of the mind became less static and more dynamic as the phenomena of psychodynamic approaches emerged following WW2.These approaches have gained popularity in the last 40 years. According to Noy (1977), there are seven assumptions in the root of Psychoanalytic/Psychodynamic Theories: 1st Assumption: Psychological determinism; this explains that our behaviours, thoughts and feelings are not random; they have a cause (usually unconscious). Every formation in the mind is determined by the previous formations. Our dreams, slips of the tongue, jokes, choice of occupation-partner, important life decisions, and in some circumstances even accidents, are symptoms of neurosis and were pre-determined. (Ardali and Erten 1999). 2nd Assumption: Our behaviour and feelings are powerfully affected by unconscious motives. This term was introduced for the first time by Freud. Being aware of what we are currently feeling and thinking is described as consciousness, some mental material which is not conscious but can easily and readily be triggered and recalled to the conscious is called preconscious. The Unconscious is called Instinctual representatives by Freud and is not present in the field of consciousness at a given moment. (Laplanche and Pontalis, 1988). We do not fully know our hearts and minds, and important things take place outside of our awareness, staying hidden unknowingly. In particular, data that triggers anxiety and disturbs the balance is kept in this ‘unknowing’ area. It can however be understood by a person’s expressions (transferences), affections and dreams, in relation to the other. It is a useful concept for conceptualising the structure of the mind and its dynamics. (Jacobs, 2010) A Therapeutic aim could be to bring unconscious material to the conscious. 3rd Assumption: Behaviour is motivated by instinctual drives: Eros (the sex drive & life instinct) and Thanatos (the aggressive drive & death instinct). These drives come from the “id”, seeking satisfaction and avoiding suffering. Object relations emphasise the drive of seeking a relationship in addition to other drives. Fairbairn says that Libido is an object seeking impulse, rather than pleasure seeking (Grant and Crawley, 1999). 4th Assumption Epigenetic Development, in this the emphasis is on developmental stages, from womb to adolescence. In ageing human growth follows stages of development; experiences are accumulated in a particular order and each contributing to the structuring of personality. Every stage of development has its own duties to complete, hesitations and conflicts in the completion of these duties can cause fixations and stoppage, in the development of the personality. Psychodynamic therapy aims to start the process of resolving these conflicts and stoppages, and repairing stuck parts in order to achieve full development. In this process encouraging regression is a useful tool. 5th Assumption The mind is structured in 3 parts (i.e. tripartite). The id, ego and Super-ego., this was Freud’s idea and he suggested it in his Structure Theory. The Id is the primitive, unchangeable and unconscious part of the mind it‘s drives are the most powerful in those of us that are seeking immediate gratification without any assessment, qualification or time boundaries. In psychodynamics, the id conflicts with other parts of the mind. (Laplanche and Pontalis, 1988) The ego is the most organised part of the mind; it is in a dependant relationship with the claims of the id as well as imperatives of the super-ego, its role as a mediator is to be responsible for the interest of the person as a whole. Ego is a fragile structure of the mind in dynamics, it may become overridden by the other parts of the mind and could be for instance submerged by, or re absorbed into the id. It may lose its reality testing, making judgement functions consciously or unconsciously. If there is any perceived signal of anxiety the ego brings a set of defensive mechanisms into play, for self preservation. (Laplanche and Pontalis, 1988). In this context strengthening the ego could be a therapeutic aim in psychodynamic work. Super-ego is mostly unconscious, and the last developed part of the mind, it represents society’s formation of ideals, traditions, prohibitions, law and internalised morals. In the embodiment of superego the forbidden voice of the parents gets internalised and turns into a capacity for inner control in a person’s mind as part of the resolution of the Oedipus complex. (Laplanche and Pontalis, 1988). 6th Assumption emphasises the adaptability of the ego. Ego can make realistic plans, judgements and develop strategies that give the most adaptive answers to the social environment in order to survive. 7th Assumption emphasises the psychosocial part of human existence. Not only instinctual drives, but also the seeking of relationships is a motive of human behaviour. An influence of the relational concept on the mind is not only experienced at the impulsive level; the mind can also structured by the mechanisms of internalization and introjections. According to this if we want to understand our self image, self structure and our sense of self, we need to understand our past and present relationships. In psychodynamic work the therapeutic relationship, in the here and now needs to be given a great deal of attention. The relational aspect of the mind can be understood in detail by the Object Relations. Part 2 Object Relations Theory with Klein and Winnicots Object Relations focuses on a person’s relationship and interaction with the significant others (usually parents) and how they are represented in the person’s internal world, at both conscious and unconscious level. The term ‘object’ does not represent an inanimate thing, it may represent whole person, or a part object (part or aspects of a person). There is philosophical distinction between subject and object. In our early relations (Infantile) we may relate to our mother as whole person or we may relate to the generosity of her breast. We might relate to aspects of the person, as the ‘powerful person’ or the ‘weak person’ or ‘a rescuer from my troubles’. The person’s relationships and interactions with significant others facilitate a process of introjections, internalizations, identification and ego identity. In this development process, the dynamics of the projections and identifications look like a tennis ball that moving back and forwards between a person’s internal and external world. (Erten and Ardali, 1999) I shall explain my understanding of this with a personal example: One of my previous clients, who was in her early 40 s was a very moody mother and had a violent father in her childhood. She was physically abused many times. As an adult whenever she felt a slight threat or the fear of somebody or something, she would become violent. Once, in an argument with her partner, she grabbed a knife and stabbed him without even realising it. Many similar events followed and she became a serial offender. She internalised her father’s violence (part object) and overcame her fear of him, allowing herself to feel powerful in the face of any internal or external threat. She also internalised and interjected the guilt of ‘being naughty’ (This was projected onto her throughout child hood.) as a part of her personality. She created or found herself in situations which resulted in her feeling guilty. Her mother and father might not have been capable of owning their feelings of not coping with the demands of life, they blamed her for being a naughty child, projecting the parts of self (own guilt) to her unconsciously. Melanie Klein discusses this as projective identification, which I shall explore later. The Object Relations School starts with Melanie Klein, who focuses on the infant’s internal world and it’s interaction with the external world. Klein talks about the infant’s mental life in two positions. These occur in the first year of the infant’s life; The Paranoid schizoid position and the depressive position. These positions start during the first three months of life, but can occur throughout life in times of anxiety and stress. The paranoid schizoid position occurs when the baby is coping with the anxieties of life outside of the womb by splitting bad and good experiences. Perceiving good and bad as a whole is very overwhelming for the baby which is the reason that there is big split between bad and good, with no common ground. The infant’s curiosity about mother’s body turns into a want to control and demolish it (fantasy attack) followed by persecutory anxiety because the breast might attack back or stop supplying milk. The baby experiences people as part objects ‘as a breast’ that can be very generous or deny satisfaction by withholding milk. A person regresses to this position at moment of stress. According to Klein the depressive position occurs between 6 and12 months of age. The baby has a more accurate picture of the external world and can hold the mother as a bad and good object in its internal world. This realisation might result in feelings of guilt such as ‘what have I done to my mother’' In the depressive position holding the object as a whole is a painful process, and requires that they come face to face with depressive fear and guilt before reparation starts. The Infant starts to believe that they are unable to damage the object with what comes from their inside and won’t be persecuted but loved as a whole. They can then complete the depressive process by grieving (restoring). In this way a child develops the capacity of ambivalence, ‘you can love and hate parts of the same object without being defeated by associated guilt. We are thrown into these positions unconsciously or sometimes consciously throughout the life. I have recently been observing people’s reaction to Margaret Thatcher’s death. How she was perceived in the paranoid schizoid position is interesting and I believe illustrates Klein’s Theory. Some people saw in her only negative aspects, blaming her for what they perceived as the destruction of their country, even rejoicing her death. At the other end others perceived her as a purely good person, at the centre of all that is good, a great strong Politician and amazing person. I also observed a leading opposition politician who mentioned her as responsible for the current problems of the country. He explained that whilst he did not agree with her political ideas, he felt sadness that a powerful leader and historically significant person had passed away. This politician shows a capacity for ambivalence which may have been gained by the power of the loss (maybe remembrance of mortality)' I have had ambivalent feelings towards my parents for years. I was not ok with these feelings in the past. Freeing me from guilt and allowing me to stop feeling like their rescuer took a lot of therapy sessions. I now accept my ambivalent feelings and I am also able to receive ambivalence from my own child. I have been working with early age children for 6 years in the child care sector and I often eyewitness situations where the negative feelings of a child are not accepted in a healthy way. The child’s negative feelings are often answered in a negative way as “silliness or naughtiness”. If the child is given enough space to express their negative feelings, the chance can be taken to learn from their expressions, as they may identify the needs or confusion in the child. Encouraging them to suppress or not feel them will not be helpful in their adult life, especially in developing their capacity for ambivalence, which is essential in developing intimacy with others. My sensitivity in this subject is based on my own childhood, with experience of being punished for expressing my negative feelings. In my cultural context you were not allowed to feel those feelings towards people who were older than you. This leaves you with not being you. Searching out and voicing my own opinions has been a long journey. The foundation of my journey started with Winnicot who is the most influential theorist and clinician for me. His concerns about the quality of subjective experience in terms of developing a self and sense of self strike a chord for me. He considered that the self is not integrated at the beginning; but that the integration of self develops in relation to the mother and in a holding environment which is supplied by the mother. His term “good enough” mothering is important for the child in developing a consistent sense of self. When the child’s needs are met without delay by a tuned in mother, the child would feel them self the author of their own satisfaction. The child is experiencing his ‘subjective omnipotence’. Another important point for Winnicott is the capacity of being alone. This requires that the mother does not disturb the quietness of the child whilst being tuned into their needs. The mother accompanies the child’s aloneness without requiring anything from them. This moment of Illusion starts to fail slowly when the mother begins to pay attention to her own needs. This is necessary, but also a very powerful and painful experience for the child. The child meets with ‘objective reality’ as it becomes aware that it is not able to answer its own needs. It realises that there is a difficult external world that needs to be negotiated with, in order that it can find the object it requires to meet its needs. The process of separation and differentiating from mother occurs.If the child did not receive empathic mothering in this process then impingement occurs. In these circumstances the child develops “false self”. The child would comprise to survive, giving up from being its original self (spontaneity), acting according to the expectation and enforcements of the external world. The Child will scan itself and its environment constantly, evaluating reality with increased mental activity and heading towards a superficial adaptation. The real self will be at the undeveloped core, surrounded and protected by the false self. The real self is the source of spontaneous needs and expressions whereas the false self is on a continuous search for the positive ambience missing from the earlier experience. Winnicot’s phenomenon of Transition is offered in this context. In order to understand the phenomena of transition we first need to consider the transitional object. A Child Who experiences the phenomenon of transition usually builds a relationship with an inanimate object. This object is sometimes a teddy bear, comfort blanket or something used in the house. The child takes this object under their control and carries it everywhere for a while. The child wishes to possess and retain control of this object. Winnicot suggests that this symbolises healthy development. As a mother I found personal reassurance in this idea. ‘Mouse’ is my 2. 5 years old daughter’s comforter, she exerts a great deal of omnipotent control over it. She places boundaries on it, gives it advice, hurting and comforting it, playing with it as well as receiving comfort from it. He is well respected member of our family! She asks us to animate it but are reminded that she retains ownership. Introducing the boundaries to 2 years old is a challenging concept; it can go wrong very easily in different ways. So having mouse or transitional object helps us introduce and maintain boundaries in a non harsh way. I sometimes feel mirrored by my daughter’s relationship with this transitional object. It is experienced in a mutually beneficial way in our household and I would thank to Winnicot for that. Transitional experience shows itself in child’s play allowing a child to develop creativity and the function of playing with their fantasy and thoughts. My one year play therapy experience with 4-5 years old children is aimed at providing that transitional experience for them. My work with one young boy in particular remains unforgettable. With no age / gender appropriate toys at home he had no experience of play in the presence of any ‘good enough’ care giver. His was lost in his quietness and a state of compliance with everything which struck me very much. Until meeting him I had never known a child who did not know what to do with toys. The empathetic and affectionate environment (without intrusion into his play) enabled him to show some colour and begin to find his voice, exploring issues around his father and his abrupt disappearance. Therapeutic Material in Winnicot This model emphasises the exploration and regeneration of personal subjectivity, the counsellor like the ‘good enough’ mother, provides a ‘safe enough’ holding environment by putting her subjectivity on hold. The client can experience a powerful self restorative situation where experiencing self in relation to the other is crucial. This helps the client to reach an “alone but not lonely state”. Realising the repeating patterns of the relationship, and bringing back hidden affects, encourages them to experience and express them in the safe holding space, whilst gaining insight. This enables the client to re discover their capacity to imagine and fantasise, generating a deeply real experience, both personal and meaningful. Therapuetic Materials in Klein: The Primitive form of early object relations, the pain that comes with fantasies of the object (and defences against the pain) are the basic ingredients of this therapy. The client’s unconscious fantasies can be understood via transferences in Klein’s therapy. Projection, Projective Identification and Splitting are some of the defences against the pain. Splitting involves exploring the client’s bad and good aspects of self, what is owned what is not owned, or what is projected. Transference has become very important in psychodynamic work; transference means the conscious, but also unconscious expression, of past and present experiences, relationships, thoughts, fantasies and feelings, both positive and negative, in relation to the therapist/counsellor. Transference patterns are formed in early childhood and enacted in adulthood relationships. (Grant and Crawley, pg48-49).Interpretation of the transference involves linking the client’s current feelings and attitudes towards the counsellor with experienced and fantasized early object relations. Counsellor could be experienced as a punitive parent, an unreliable sibling or a neglectful care giver. Working through the transference relationship via interpretations creates some changes in the client internally. The client might then become available to an internalised healthy relationship with the therapist. Other useful material is the use of counter transference as a source of information about the client. (after Klein). Counter -transference an unconscious reaction of the counsellor/therapist to the individual client’s transference. This is a form of psychodynamic communication, from unconscious to unconscious between client and counsellor. An awareness and usage of it as an effective tool can help the client to understand what is going on in their relational dynamics. Projective Identification a very powerful concept introduced by Klein, primitive form of object relations, unacceptable internal object’s parts (experiences, feelings, fantasies and functions) get projected onto the external object by entering into it. The external object is pushed into accepting what is projected when the projective identification was overridden in a person’s mind. This means that the person perceives the external world as more powerful than him/her unconsciously; this indicates poor sense of self. The person would feel paranoid about being controlled by others, and in this way may act out this situation. Working through the projective identifications of clients, requires handling and containment of the client’s deeply disturbing feelings that had previously been disowned. One of the important functions of that is the capacity to transform the ‘distressed’ into an ‘experience of severely depressed’ state. This might have disturbing effect on the counsellor. (Grant and Crawley, 2002) Conclusion In this essay I have tried to introduce two influential clinician’s models. If I draw some conclusions from this, I would say that whilst they are different concepts, they share certain common characteristics such as the emphasises on the different aspects of the object relations. I outline some of these below: The complex interplay between the world of internal subjective experience in the external world is a fundemental focus in both. The approach to splitting is also used in both, such as bad or good object/parts versus true self false self, internal / external world versus subjective omnipotance / objective realitiy. The transitional space / object is however only discussed by Winnicot and is a creative concept that helps to understand the child’s inner world, in the sense of reaching emotional maturity. Klien however talks of the importance of the depressive position in the sense of developing a capacity for ambivilance. Aggression in the child is seen as a natural part of development and is an accepted concept by both but named differently, for example an infant experiencing a fantasy attack towards its mother’s breast in Klein, Winnicot talks about the moment of illusion, subjective omnipotence in the child, the child manipulates the object for its gratification. The difference between them: With Winnicot the relationship between a mother and her child and its quality, (being good enough) is central. This quality could be created in the session to achieve restoration. Klein however seems to put unconscious fantasies of the object, anxiety and defences against this anxiety, hearing the anxiety and articulating it to the client is central to the therapy. I am using these approaches in my work and I am gaining confidence in them. Despite their abstraction and the degree of ambivalence I feel towards them, I feel supported by the structure of psychodynamic theory. I know that to become familiar with my unconscious is an important responsibility for me and my past experience of being the object of projective identifications overwhelmed me. I have visited this experience during this essay and have connected with them. I believe that I shall be able to offer a ‘good enough’ holding space and positive object relation for my client’s reparation. Resources Ardali C., And Erten Y. From Psychoanalysis to Dynamic Theories, Istanbul: Alfa; 1999 Brenner C., An Elementary Textbook of Psychoanalysis, Ankara: HYB; 1998 Davies D. And Dinesh Bhugra, Models of Psychopathology, Maidenhead: Open University Press;2004 Grant J. AND Crawley J., Transference and Projection, Maidenhead: Open University Press;2002 (pg 48-49) Jacobs M., Psychodynamic Counselling in Action (4th Edition), London: Sage; 2010 Kernberg O. F.,Selzer Michael A.,Koenigsberg W. Harold, Carr C. A.,Appelbaum A.H., Psychodynamic Psychotherapy of Borderline Patients, New York: Basic Books, Inc., Publishers 1989 Laplanche J. And Pontalis J.B., The Language of Psycho-analysis , London: Karnac Books andThe Institude of Psycho-analysis;1998 Weddel M., Inside Lives Psychoanalyses and Growth of The Personality, The Tavistoc Clinic Series, London &New York ; 2002 Winnicot D.W., Playing and Reality, Istanbul: Metis Publication; 1997 Noy P., Metapsychology as a Multimodal System. Inernational Review of Psychoanalysis , 4, 1-12