Object Relations Theories and Psychopathology

A Comprehensive Text

Frank Summers

• Editorial: Routledge
• Año: 2014
• ISBN:
  9781317771401
• Edición: 1
• Categoría: Psychology
• Categoría: Psychopathology

In Object Relations Theories and Psychopathology: A Comprehensive Text, Frank Summers provides thorough, lucid, and critically informed accounts of the work of major object relations theorists: Fairbairn, Guntrip, Klein, Winnicott, Kernberg, and Kohut. His expositions achieve distinction on two counts. First, the work of each object relations theorist is presented as a comprehensive whole, with separate sections expounding the theorist's ideas and assumptions about metapsychology, development, psychopathology, and treatment, with a critical evaluation of the strengths and limitations of the theory in question. Second, the emphasis in each chapter is on issues of clinical understanding and technique. Making extensive use of case material provided by each of the theorists, he shows how each object relations theory yields specific clinical approaches to a variety of syndromes, and how these approaches entail specific modifications in clinical technique.Beyond his detailed attention to the theoretical and technical differences among object relations theories, Summers' penultimate chapter discusses the similarities and differences of object relations and interpersonal theories. And his concluding chapter outlines a pragmatic object relations approach to development, psychopathology, and technique that combines elements of all object relations theories without opting for any single theory. Object Relations Theories and Psychopathology is that rare event in psychoanalytic publishing: a substantial, readable text that surveys a broad expanse of theoretical and clinical landscape with erudition, sympathy, and critical perspective. It will be essential reading for all analysts, psychologists, psychiatrists, and social workers who wish to familiarize themselves with object relations theories in general, sharpen their understanding of the work of specific object relations theorists, or enhance their ability to employ these theories in their clinical work.

CHAPTER 1

The Origins of Object Relations Theories

OBJECT RELATIONS THEORIES HAVE BEEN WIDELY READ AND DISCUSSED IN recent years as psychoanalytic theorists, and clinicians who have begun to question traditional psychoanalytic theory have turned increasingly to object relations theories to broaden or even supplant their theoretical and clinical understanding. Nonetheless, there is a great deal of confusion regarding the nature of many object relational theories and their clinical application. Object relations theories differ widely with respect to key concepts, assumptions, and principles and are often confusing and difficult to digest.

In addition, the general trend of object relations theories has been subject to widely different interpretations. Greenberg and Mitchell (1983) view object relations theories as part of a wider movement to supplant drive theory with a relational model of psychoanalysis; Kernberg (1984) and Winnicott (1960a) tend to see object relations concepts as an addition to drive theory applicable to more primitive emotional disorders; and Bacal and Newman (1990) view object relations theories as a bridge to self psychology. An object relations theory as defined here and used throughout the text signifies any systematic effort to account for personality development and pathology on the basis of the internalization of relationships with others. This model is contrasted with the drive-ego model, according to which the drives and their vicissitudes (however disguised, sublimated, or neutralized), along with ego mechanisms, account for personality development.

In an attempt to consolidate knowledge of object relations theories, Greenberg and Mitchell (1983) presented the first comprehensive review of each of the major theories. Serving the critical purpose of familiarizing clinicians with the major concepts of these theories, their text has probably made the single most significant contribution to the dissemination of information about object relations. Despite the invaluable contributions of their discussion of object relations theories, however, there are two key drawbacks to their work. First, Greenberg and Mitchell do not present each theory as an integrated whole; they discuss the various ideas of each theory in isolation without full appreciation of the unifying principles on which the individual ideas are based. Thus, the reader fails to obtain a sense of the overall thrust of each theory. Second, Greenberg and Mitchell pursue the discussion of each theory primarily in terms of its proximity to either the drive/structure or the relational/structure model. While this issue is pivotal theoretically, their focus on thus categorizing each theory gives short shrift to its clinical implications. Nor is it clear from their theoretical discussions how drive/structure and relational/structure models differ clinically.

Since the publication of their book, both Mitchell (1988) and Greenberg (1991) have offered clinical theories that involve relational concepts. These theories, which will be discussed in chapter 7, do not, however, address the clinical implications of the major object relations theories.

The contributions of the various object relations theories to the psychoanalytic process remain unclear. This obfuscation may be due partly to the cumbersome and difficult language often used by theorists. A large share of the difficulty, however, is due to the fact that object relations theories were developed by clinicians dissatisfied with the clinical and theoretical limitations of the classical psychoanalytic models. We will see in our discussion of the various theorists that they differ on whether their ideas are an addition to the classical viewpoint or a replacement of it, and at times, the theorist is unclear about the relationship between his or her ideas and the classical model. Each object relations theory breaks away from the major tenets of the model of endogenous drives to some degree, but, because of this confusion, the clinical implications of this theoretical shift are not readily apparent. It is a major task of this book to show the connection between theory and clinical intervention in each major object relations theory.

Because each object relations theory is a reaction to the classical theory, one cannot grasp the meaning and importance of its concepts without an appreciation of the history of the psychoanalytic ideas which preceded them. Object relations theories developed because each theorist found some limitation in the drive-ego model that pushed his or her thinking to new concepts and, ultimately, ways of practicing psychoanalytic therapy. Consequently, to understand the contributions of the object relational theorists, one must first grasp the major trends in psychoanalytic theory. Therefore, we shall review in detail the major developments in ego psychology so as to clarify the ego-psychological view of psychic structure, development, pathology, and treatment. From this conceptual clarification, we can see the growth of object relations theories from their roots in ego psychology to the critical step of separation from it in the development of new theorizing. As we will see, some object relations theorists take this step more dramatically than others—hence the differences among them in their degree of adherence to the classical model.

This chapter describes the shift from drive to ego psychology and presents the major theoretical and clinical developments within the ego psychology tradition. It highlights the major theoretical bridges from ego psychology to object relations theories. This discussion sets the context for the presentation of object relations theories in subsequent chapters.

THE ORIGINS OF EGO PSYCHOLOGY

When Freud abandoned the theory of sexual trauma as the etiology of neurosis in favor of endogenous drives, psychoanalytic theory shifted to consideration of the internal workings of the mind. Freud (1915a) began to focus on inborn drives as the motivating force of psychopathology and eventually extended this focus to personality development in general. As drives and their vicissitudes came to be considered the critical factor in development, psychoanalytic theory made a decisive move away from external events, including trauma, toward the functioning of the mind, now conceived as a product of the drives, or biological tension states, that aim for gratification through tension reduction. According to this drive model, human motivation originates in the press of biological drives that gain psychological expression in the form of wishes that power psychological functioning. Psychopathology, in this model, is caused by the repression of wishes, not of memories of external trauma (Freud, 1915b). The pathogenic conflict is between preconscious censorship of conscious thoughts and unconscious wishes for instinctual gratification (Freud, 1915c). When the repression barrier is broken through by disguised expressions of unconscious wishes, symptoms result. The clinical implication of this shift from the trauma theory to the drive model is that the goal of the analytic process becomes the uncovering of unconscious wishes, the repression of which is considered the cause of neurosis.

The study of unconscious wishes and their manifestation in psychopathology dominated psychoanalytic theory and practice from 1897 to 1923. This situation began to change when Freud (1923) pointed out in The Ego and the Id that the unconscious cannot be equated with wishes, nor the conscious with the forces of repression because the mechanism of repression is unconscious. These facts led Freud to superimpose his structural model of ego-id-superego upon the topographic model of unconscious-preconscious-conscious: the ego, consisting of repressive mechanisms, is largely unconscious; and the superego, which is the moral system motivating the repression of unacceptable wishes, has a conscious component, the conscience, as well as an unconscious component in the form of unconscious guilt. From the viewpoint of this structural model, psychological conflict takes place not between the unconscious and the conscious, but between the unconscious components of the ego or superego and the id. Psychopathology is a compromise formation between an id content, such as a sexual wish, that is otherwise blocked from consciousness, owing to its unacceptability to the moral system, or superego, and an ego defense mechanism, such as repression. Psychopathology is, therefore, a result of conflict between competing psychological structures. This shift in Freud’s theoretical thinking marked a change in psychoanalytic theory and practice away from the exclusive focus on drives to an equal emphasis on the forces opposing it (Freud, 1937).

With this theoretical shift, the ego now assumed the central role in the functioning of the psyche. The degree of health or pathology of the personality, from this viewpoint, is a function of the ability of the ego to manage the press of drive-based wishes for discharge as well as the constraints of reality on such gratification. The ego must also change the moral constraints from within (in the form of the superego), which constitutes an additional counterpressure to drive discharge. Ego strength, or the capacity of the ego to handle the conflicting demands of id, reality, and superego, now assumes the pivotal role in the well-being of the personality. To the degree that the ego is not able to accomplish a functional balance, the personality will fall ill. For example, if the ego is forced to use excess repression, wishes will seek substitute expressions of discharge and hysterical symptoms will result. To the extent that the ego displaces unacceptable wishes onto the environment, phobic fears ensue. Thus does ego psychology include the functioning of the ego in all psychopathology, with every symptom implying a failure of the ego to balance effectively the need for drive discharge with the constraints of superego strictures and reality (Fenichel, 1945).

Freud (1926) changed his concept of anxiety in accordance with the structural model. Whereas he had originally viewed anxiety as the result of dammed up libido due to repression, he now reconceptualized anxiety as a warning signal to the ego. When the ego senses danger from unacceptable wishes, it experiences anxiety; it then employs a defense mechanism to ward off the threatening affect and restore balance, sometimes at the price of a symptom outbreak. From the viewpoint of the structural model, anxiety is not a product of repression, rather, it motivates repression and other defenses. This reconcep-tualization of anxiety reflects the central role of the ego in balancing the various pressures to which the psyche is subject.

The structural model resulted in the concept of psychological organization: the ego is not simply a group of mechanisms but a coherent organization whose task is to master the competing pressures of the id, superego, and relations with reality. This concept led Freud to question how such mastery is possible given the biological origins of the psyche. He had to account for the establishment of a psychological organization, the structured ego, that opposes the gratification of the drives, from which all human motivation originates.

Freud’s answer was that the ego develops from drive frustration. Simple drive gratification is never all the child wants, even in the best of circumstances; eventually, the preoedipal tie to the mother is given up, and later the oedipal object must be relinquished (Freud, 1923). The loss of these early objects, according to Freud, forces the child to set up a substitute: an internal psychological representation of the parents to replace the abandoned objects of childhood longings. As the early attachment to the mother is given up in reality, she is taken in psychologically. The object cathexis of the mother is replaced by identification with her. In the oedipal phase, which Freud considered decisive for identifications, the longing for the parent of the opposite sex is given up and the child either intensifies identification with the same sex parent or identifies with the opposite sex parent in response to the loss. These identifications will determine the gender identification of the personality and concomitantly form the superego-ego ideal complex. Each relinquishment of a childhood object results in an identification that helps form the ego structure:

When it happens that a person has to give up a sexual object, there quite often ensues an alteration of his ego which can only be described as a setting up of the object inside the ego…. the process, especially in the early phases of development, is a very frequent one, and it makes it possible to suppose that the character of the ego is a precipitate of abandoned object-cathexes and that it contains the history of those object-choices [Freud, 1923, p. 29].

In Freud’s formulation, the id drives the organism to seek object contact to achieve instinctual gratification. When reality forces the relinquishment of these objects, they are taken in through identification and form the basis of the ego. Thus, the ego develops out of the frustration of id wishes and is formed by becoming like the objects reality forces the id to relinquish. Likewise, the superego is a “precipitate of abandoned object-cathexes of the id,” but it is also a reaction formation against those choices in the form of moral objection. Thus, both the ego and the superego are formed from the internalization of previously cathected objects.

THE CLASSICAL EGO PSYCHOLOGISTS

Freud’s pioneering suggestions regarding the importance of the ego and the mechanisms of its development became the basis for ego psychology, which extended the concept of the ego even further than Freud did. Anna Freud (1936) enumerated a variety of defensive mechanisms used by the ego to keep wishes unconscious. She pointed out that the various defenses used by the ego become resistances in the analytic process; thus, psychoanalytic treatment is focused equally on ego mechanisms and id wishes. She drew further implications from the structural model by pointing out that psychoanalytic assessment of development and psychopathology must include the functioning of the ego.

Subsequent ego psychologists have extended further the concept of the ego’s autonomy from the id. Hartmann (1939) pointed out that some of the mechanisms used by the ego, such as perception, motility, and memory, do not develop from frustration but are autonomously developed functions, which he termed “apparatuses of primary ego autonomy,” which later become integrated and are necessary for the functioning of the ego. Hartmann pointed out that since these ego functions exist from birth and originate outside of conflict, one cannot properly speak of the ego as developing “out of” the id; rather, both ego and id gradually develop from an undifferentiated matrix and become separate systems. This concept removes the original dependence of the ego on the id that characterized Freud’s formulation. Hartmann referred to that part of ego functioning which is not in conflict at any given time as the “conflict-free ego sphere.” For example, while fantasy is at times a product of frustrated wishes and conflict, it is also a useful means for the consideration of alternatives in solving problems.

The concept of autonomous ego apparatuses does not mean that Hartmann disputed Freud’s view that drive frustration leads to the structuralization of the ego. Indeed, in Hartmann’s view there are two sources of ego development: the motivation of inborn apparatuses of primary autonomy and the frustration of drives, which results in secondary autonomy. With regard to the second source, Hartmann agreed with Freud that energy from libidinal frustration is used for the organized ego; however, in his view aggression, rather than libido, is a more significant factor in ego structuralization. (Hartmann, Kris, and Lowenstein, 1949). Hartmann pointed out that since the intent of the aggressive drive is to destroy the object, its discharge is more dangerous than that of the libidinal drive and, consequently, its neutralization is more critical. For the same reason, in the view of Hartmann and his colleagues, permanent object relations are more dependent on the sublimation of the aggressive than of the libidinal drive. Neutralized aggression leads to structuralization of the ego, which allows for good object relationships and object constancy and which, in turn, make possible the further neutralization of aggression. Unneutralized aggression, on the other hand, is accorded a primary role in much of psychopathology (for example, when unneutralized aggression attacks an organ, psychosomatic illness results). According to Hartmann (1953) when aggression is not neutralized, no counter-cathexis is possible, aggression erupts over the organism, object relations are not possible, and a schizophrenic process results.

In Hartmann’s view, the ego is a group of functions, including defenses and adaptive mechanisms. These functions are organized into a system Hartmann called the “synthetic function” of the ego. This system is not simply an outgrowth of the id but an organized, adaptive capacity that controls healthy functioning and has its own sources of growth in addition to frustration of wishes. Nonetheless, complete ego autonomy is not possible, in Hartmann’s view, because the ego uses energy from the drives, especially the aggressive drive. Thus, the organized ego is always linked to the id and achieves only relative autonomy from it.

Rapaport (1951, 1957) viewed the id as a constitutionally given and the ego as the created personality. Although he agreed with Hartmann that the ego develops from an undifferentiated ego-id matrix, Rapaport pointed out that in healthy development the emergent ego organization obeys its own laws, distinct from and independent of the elements from which it emerged. To the extent that the ego is independent of the id, it is better adapted to reality and more capable of functioning; the extent to which the ego is unable to achieve autonomy from the id is the degree to which it will be a slave to it, with a resultant inability to adapt to the demands of reality. The health of the personality, in Rapaport’s view, is a function of ego autonomy, that is, the ability of the ego to manage id pressures. The actual content of id wishes and the conflicts to which they give rise are of little moment to Rapaport, as the same wishes and conflicts may exist in healthy and pathological personalities; the difference lies in the ability of the healthy ego to achieve autonomy from the id so that it can manage its conflicts without symptomatic outcome.

Arlow and Brenner (1964) extended Hartmann’s concept of ego autonomy by pointing out that the topographic model was not modified by the structural model but replaced by it. In contrast to the common ego-psychological view, as represented by Hartmann and Anna Freud, that the topographic model can be used along with the structural model, the view held by Arlow and Brenner is that the two models are, in fact, contradictory because anti-instinctual forces are unconscious. With the introduction of the structural model, conflicts were no longer considered to be between the preconscious and unconscious; both instinctual wish and the force that opposes it are seen as unconscious. The concept of the preconscious had been obviated by the central role of the ego in psychic conflict; because the preconscious could not determine the nature of the psychic content with which the instinctual wish is in conflict, it was replaced by the ego.

In agreement with Rapaport, Brenner (1981) endorses Hartmann’s view that the ego and id develop from an undifferentiated matrix. He points out, however, that since all mental phenomena include some degree of compromise between ego and id, the two are not separable except under conditions of conflict. The ego as executant of the id must find a way to help it achieve instinctual gratification. To accomplish this goal, the ego must negotiate the dangers to which all id wishes give rise. Therefore, according to Brenner (1976), mental phenomena are products of a compromise formation including wish, guilt, anxiety, and defense. The id wish conflicts with feelings of guilt, creating anxiety that is warded off by defense. The task for the ego is to find a way to allow instinctual gratification within the limits set by guilt feelings and anxiety.

To perform this task, the ego uses a variety of mental mechanisms, such as fantasy, perception, cognition, and the functions typically labeled “defense mechanisms” (Brenner, 1981). In this view of mental functioning, defenses are not a specialized group of mechanisms, as conceptualized by Anna Freud (1936) and Hartmann (1939); that is, one cannot label any particular ego function as a “defense” since all ego functions have both defensive and adaptive value (Brenner, 1981). Healthy, socially acceptable behavior is no less a compromise formation than is a symptom. When instinctual gratification is excessively compromised to satisfy the demands of guilt and anxiety, symptoms or pathological character traits result. The decisive factor in health or illness for Brenner (1976) and Arlow (1963) is the ability of the ego to execute a compromise formation that allows instinctual gratification without symptoms.

White (1963) took the final step in the theoretical movement toward the concept of the autonomous ego with his view that the ego has its own in...

Índice

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Acknowledgments
• Preface
• 1 - The Origins of Object Relations Theories
• 2 - The Work of W. R. D. Fairbairn and Harry Guntrip
• 3 - The Work of Melanie Klein
• 4 - The Work of D. W. Winnicott
• 5 - The Work of Otto Kernberg
• 6 - The Work of Heinz Kohut
• 7 - The Interpersonalists
• 8 - An Object Relations Paradigm for Psychoanalysis
• References
• Index