Object Relations Theory and Self Psychology in Soc

Eda Goldstein

• Publisher: Free Press
• Year: 2010
• ISBN:
  9781451603187
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Object Relations and Self Psychology are two leading schools of psychological thought discussed in social work classrooms and applied by practitioners to a variety of social work populations. Yet both groups have lacked a basic manual for teaching and reference -- until now. For them, Dr. Eda G. Goldstein's book fills a void on two fronts: Part I provides a readable, systematic, and comprehensive review of object relations and self psychology, while Part II gives readers a friendly, step-by-step description and illustration of basic treatment techniques. For educators, this textbook offers a learned and accessible discussion of the major concepts and terminology, treatment principles, and the relationship of object relations and self psychology to classic Freudian theory. Practitioners find within these pages treatment guidelines for such varied problems as illness and disability, the loss of a significant other, and such special problems as substance abuse, child maltreatment, and couple and family disruptions. In a single volume, Dr. Goldstein has met the complex challenges of education and clinical practice.

PART I

HISTORICAL, THEORETICAL, AND CLINICAL PERSPECTIVES

1

OBJECT RELATIONS THEORY AND SELF PSYCHOLOGY

THEIR SCOPE AND SIGNIFICANCE

A person-in-situation perspective has been a defining characteristic of social work practice historically. The social work profession has relied on numerous distinctive theoretical frameworks that help to explain the nature of person-environmental transactions during the lifelong developmental process (Goldstein, 1983). Psychodynamic theory has occupied a prominent position in this knowledge base. Although its place as an underpinning to social work practice has waxed and waned over the years (Goldstein, 1996; Specht & Courtney, 1994; Strean, 1993), it has provided practitioners with important insights into human motivation, needs, capacities, and problems and has played a major role in shaping social work practice from the 1920s to the present.

As we begin the twenty-first century, psychodynamic theory is by no means the only theoretical paradigm that is available to social workers, but it continues to have significance for social work practice. It has moved far beyond its Freudian and ego psychological base, however, and reflects newer and more diverse views of personality development and the nature of human problems. Psychodynamic thinking and treatment principles are applicable to a broad range of clients, in both short-term and long-term intervention, and across a variety of treatment modalities. This broad and varied framework can be used to complement other formulations that inform social work practice, such as ecological, cognitive-behavioral, family systems, and group theories. Evidence that psychodynamic theory has stood the test of time can be found in a study of practitioners drawn from the 1991 National Association of Social Workers Register of Clinical Social Workers. Respondents said they utilized 4.2 theoretical bases in their work, but 83 percent reported using psychodynamic or psychoanalytic theory (Strom, 1994: 80-81). Additionally, it is common for social work students and practitioners to seek to advance their knowledge of psychodynamic theory and treatment principles by taking academic courses, participating in in-service training programs, enrolling in psychotherapy institutes, and attending professional workshops and conferences.

THE ASSIMILATION OF PSYCHODYNAMIC THEORY INTO SOCIAL WORK

Sigmund Freud’s classical psychoanalytic, or drive, theory was the first psychodynamic framework that was introduced into social work during a period called “the Psychiatric Deluge” in the 1920s (Woodroofe, 1971: 118-51). Throughout the next several decades, Freud’s writings had a dramatic impact on social workers, particularly on the East Coast, who belonged to the diagnostic school associated with Mary Richmond, Gordon Hamilton, Lucille Austin, Annette Garrett, Florence Hollis, and others (Goldstein, 1995a: 31-33). Many social work practitioners underwent psychoanalysis and sought supervision from psychoanalysts, some of whom had recently emigrated from Europe. Enthusiastic about their own treatment and educational experiences, social workers began to employ Freudian theory and psychoanalytic treatment principles in their practice (Hamilton, 1958). The only competing psychodynamic framework at this time was Rankian theory, which provided the theoretical underpinnings to the functional school associated with Jessie Taft and Virginia Robinson and the Pennsylvania School of Social Work (Brandell & Perlman, 1997; Goldstein, 1995b).

THE EXPANSION OF PSYCHODYNAMIC THEORY

Beginning in the late 1930s and especially after World War II, Freudian theory underwent major modifications and transformations as social workers began to become familiar with ego psychological writings. Throughout the 1950s to the 1970s, ego psychology, which focused on the more autonomous and rational aspects of the ego, led to major changes in the diagnostic approach and its successor, the psychosocial model. It also contributed to Perlman’s problem-solving approach, crisis intervention, the task-centered approach, and the life model (Brandell & Perlman, 1997; Goldstein, 1995a & b; and Strean, 1973).

In the last several decades, psychodynamic frameworks and treatment models that present alternatives to Freudian theory and ego psychology have captured the attention of social workers and other mental health professionals. Among the most significant of these formulations in today’s practice arena are object relations theory and self psychology, which arose in reaction to and have a different philosophical base from Freudian drive theory and ego psychology. They have expanded psychoanalytic thinking to encompass the whole person rather than the drives or ego functions alone, a person’s here-and-now functioning as well as childhood fantasies and experiences, the strengths and resilience of people alongside or in addition to their areas of pathology or weakness, and the impact of interpersonal, social, and cultural as well as intrapsychic factors on development and personality functioning.

Object relations and self psychological treatment approaches have moved traditional psychoanalytically informed treatment beyond its earlier rigidity and narrowness of focus and in some ways, they have provided a theoretical basis for many of the tried and true principles that have been characteristic of clinical social work practice. These newer frameworks have led to ten important changes in the ways in which psychodynamically oriented treatment is carried out.

1. Treatment has moved away from the traditional psychoanalytic stance that requires that the therapist be neutral in his or her interventions, abstinent with respect to gratifying patients’ needs, and anonymous in terms of revealing personal information. Therapists are encouraged to be more empathic, involved, real, and genuine in their responses.
2. The treatment structure is more flexible and individualized.
3. The use of the therapist’s self in engaging the patient and in providing a safe and accepting therapeutic holding environment and a reparative and facilitating relationship that offers opportunities for participation in new, more positive interactions is a crucial component of treatment.
4. The repertoire of treatment interventions has expanded beyond the use of insight-oriented techniques to encompass a broad range of developmentally attuned interventions that include active efforts to meet some of the patient’s developmental needs, to facilitate and support the patient’s growth, and to provide environmental supports. It is recognized that insight-oriented techniques, such as confrontation and interpretation, too early in treatment are not suited to work with many patients.
5. The therapist pays greater attention to the patient’s subjective experience and personal narrative than previously and is advised to adopt a collaborative rather than authoritarian stance in the treatment relationship.
6. Treatment is based on revisions and expansions of personality theory so that it considers the impact of early relationships and self-development in influencing the nature of a patient’s strengths and pathology.
7. The concept of transference has been expanded to include more recent views on the type of relational patterns and selfobject needs that patients bring into the treatment relationship.
8. The concept of resistance has been broadened to encompass the fact that many factors may be influencing what appear to be patients’ difficulties in using treatment. These may stem from their efforts to maintain safety in the face of fear, hold on to coping mechanisms that have seemed to work for them in the past, sustain their attachment to internalized relations with others, and deal with what they feel to be realistic threats to their well-being. Moreover, impasses in the treatment may reflect a therapist’s lack of correct attunement and responsiveness to the patient’s concerns.
9. The concept of countertransference has been reconceptualized to encompass not only the therapist’s reactions that stem from unresolved unconscious conflicts and other developmental issues but also those that stem from the impact of the patient’s personality on the therapist. Additionally, there is recognition that the therapist always brings his or her own personality and organizing principles to the treatment relationship and this affects how he or she perceives and interacts with the patient.
10. There is greater appreciation of the need to understand patients’ total biopsychosocial situation, which includes the nature of their cultural and other types of diversity, the effects of oppression, and the impact of the difficult and sometimes traumatic and tragic circumstances of life that patients have experienced.

OBJECT RELATIONS THEORY AND SELF PSYCHOLOGY DEFINED

Like Freudian theory and ego psychology, object relations theory and self psychology are developmental in nature and view adult personality characteristics as dependent upon early childhood experiences. In contrast, however, to Freud’s emphasis on biological instincts as the driving force behind personality development, all object relations formulations are relational—that is, they share the view that human beings are social animals and that interpersonal relationships have a major impact on development (Aron, 1996). They describe the process by which the infant takes in (internalizes) the outside world, thereby acquiring basic perceptions of and attitudes toward the self and others that become structuralized within the person. Many object relations theorists have put forth somewhat different formulations, so that there is not a fully unified set of concepts.

Although the term object relations originally referred to the quality of a person’s actual or external interpersonal relationships (Bellak, Hurvich, & Gediman, 1973), it was later used to describe the internal images or representations of the self and others (objects) that a person acquires in the course of early development. As noted by Greenberg and Mitchell (1983: 10), “people react to and interact with not only an actual other but also an internal other, a psychic representation of a person which in itself has the power to influence both the individual’s affective states and his overt behavioral reactions.”

The following six propositions characterize object relations theory’s view of human development, psychopathology, and treatment.

1. Early infant-caretaker interactions lead to the person internalizing basic attitudes toward the self and others, characteristic relational patterns, and a repertoire of defenses and internal capacities. Important developmental processes involve attachment, separation-individuation, early object loss, experiences with frustrating or bad objects, and the move from dependence to independence.
2. Characteristic underlying problems that result from early object relations pathology include maladaptive attachment styles, separation-individuation subphase difficulties, borderline, narcissistic, paranoid, and schizoid disorders, severe and chronic depressive reactions, and false self disturbances. These difficulties also may present in clients who show a variety of clinical symptoms and syndromes.
3. Patients bring their pathological internalized object relations, primitive defenses, developmental deficits, as well as their capacities and strengths to the treatment situation.
4. Treatment can modify pathological internal structures or create facilitative and reparative experiences in which new and stronger structures are acquired.
5. Change processes in treatment result from both reparative and new experiences within the treatment relationship itself and from insight into and modification of entrenched object relations pathology.
6. Providing a therapeutic holding environment, pointing out dysfunctional relational patterns and defenses, engaging in a range of developmentally attuned techniques, and focusing on transference-countertransference dynamics, particularly with respect to what the client “induces” in the therapist or is “enacting” in the relationship are important components of treatment.

In contrast to object relations theory, self psychology places the self rather than internalized interpersonal relationships at the center of development. Whereas object relations theories tend to view the self as reflecting what the child takes in or internalizes from the outside, self psychology defines the self as an innate and enduring structure of the personality that has its own developmental track. It views the self as possessing organization, initiative, and potentialities, regulating self-esteem, and giving purpose and meaning to the person’s life (Wolf, 1988:182).

The following six propositions characterize self psychology’s view of human development, psychopathology, and treatment.

1. Infants are born with innate potentialities for self development but require the responsiveness of the caretaking environment in order to develop a strong, cohesive self. The individual needs to have idealizable caretakers, experiences of validation, affirmation, a sense of feeling like others, and other forms of empathic selfobject responsiveness.
2. When the self-structure is weak and vulnerable as a result of unattuned, neglectful, or traumatic caretaking, both the self-concept and self-esteem regulation become impaired. The person may be at risk for developing self disorders and narcissistic vulnerability that lead to chronic problems or to periods of acute disruption later in life.
3. Clients bring their early unmet or thwarted selfobject needs to treatment, which provides them with a second chance to complete their development.
4. Treatment aims at strengthening self-structures, creating greater self-cohesion and self-esteem regulation, and enabling increased self-actualization and enjoyment of life.
5. Change results from the worker’s empathic attunement to the client’s subjective experience, optimal responsiveness to the client’s needs, and empathic interpretations of the link between the client’s current needs and problems and his or her early experiences with unattuned caretakers.
6. Engaging in empathic attunement and responsiveness, helping the client to develop and maintain a selfobject transference, exploring past caretaker failures and their sequelae, and removing obstacles to the worker’s ability to be empathic to the client’s selfobject needs and their manifestations, even when they appear to be demanding or unreasonable, are important components of the treatment.

Because both object relations and self psychological theories address the impact of interpersonal relationships on personality development, there are those who do not view these two frameworks as fundamentally different from one another (Greenberg & Mitchell, 1983; Bacal, 1991). Nevertheless, Kohut, who originated self psychology, saw his formulations as distinctive from those of object relations theory, and many of his followers have continued to hold to his position (Ornstein, 1991). Throughout the book, however, I shall strive to show how both theories can contribute to understanding and working with particular individuals.

Object relations theory and self psychology are not unitary frameworks. Object relations theory is a broad term that encompasses diverse concepts, and it has generated different and sometimes conflicting treatment approaches. For many years, the American object relations theorists such as Edith Jacobson and Margaret Mahler—who showed loyalty to Freud and his daughter, Anna—were highly critical of the writings of the British object relations theorists such as Melanie Klein, W. R. D. Fairbairn, D. W. Winnicott, and Harry Guntrip for rejecting many Freudian tenets. More recently, other theorists such as Otto Kernberg and Stephen Mitchell have attempted to put forth integrative models. Likewise, since the death of Heinz Kohut, who originated self psychology, some of his associates and followers, including Daniel Stern, Michael Basch, Arnold Goldberg, Howard Bacal, Joseph Lichtenberg, Robert Stolorow, Frank Lachmann, Beatrice Beebe, and Morton and Estelle Shane, have extended his ideas, and others have branched into different directions that have led to refinements and modifications of his views on development and the nature of treatment.

SIGNIFICANCE FOR SOCIAL WORK PRACTICE

Object relations theory and self psychology are holistic frameworks that are consistent with the humanistic stance, values, and person-environmental focus of the social work profession and fit well with the existing body of clinical social work theory and practice.

1. They are biopsychosocial theories that address the interplay among a person’s innate endowment and interpersonal, familial, environmental, and cultural factors in shaping behavior.
2. They focus on a person’s here-and-now functioning as well as on how past development has contributed to a person’s capacities, talents, ambitions, values, patterns of relating, and sense of self.
3. They recognize the strengths and resilience of people and their push for growth as well as what goes wrong in the course of development.
4. The treatment approaches that stem from object relations theory and self psychology require a more human therapeutic environment and are optimistic about the reparative and facilitating role of the treatment relationship. They emphasize the importance of an individual’s subjective experience the therapist’s need to be where the client is, and the mutual and reciprocal impact of client and worker.
5. Object relations and self psychological concepts apply to a broad range of problems, including life crises and transitions, the effects of physical and sexual abuse and other types of trauma, emotional disorders, substance abuse, physical illness, disability, loss of loved ones, violence, parenting and family problems, and work issues. They have implications not only for individual long-term treatment but also for crisis and short-term intervention and work with couples, families, and groups.

Along with Freudian drive theory and ego psychology, object relations theory and self psychology comprise the contemporary psychodynamic base of social work practice. Because of their divergent elements and emphases, no simple theoretical integration of these four frameworks is possible at present (Phillips, 1993; Pine, 1988). Yet, it is likely that each formulation has some value and no one particular perspective constitutes the only truth about human behavior. Consequently, it is important for practitioners to be competent in their understanding and use of diverse theoretical formulations and treatment models so that they can utilize them differentially depending on the needs of a given client. This eclecticism is necessary because it is likely that clients have difficulties at multiple and diff...

Table of contents

• Cover
• Title Page
• CONTENTS
• ACKNOWLEDGMENTS
• PART I: HISTORICAL, THEORETICAL, AND CLINICAL PERSPECTIVES
• PART II: SOCIAL WORK TREATMENT: PRINCIPLES AND APPLICATIONS
• REFERENCES
• INDEX