SOCW 674 Social Work and Families Lecture No. Seven

1
SOCW 674 Social Work and Families Lecture No.
Seven

• Psychodynamic Models
• Gender and cultural considerations as well as
  the interface between the family and the broader
  community in which it is embedded figure
  prominently in the thinking and clinical
  approaches of contemporary family therapists.
• The trend today is toward eclecticism and
  integration in family therapy ( Moultrop 1986
  Mikesell Lusterman McDaniel 1995 Lebow
  1997 ). In this postmodern age that emphasizes
  that all knowledge is inescapably relative and
  subjective there is less and less acceptance of
  the erstwhile belief in the endless possibilities
  of a single model universally applicable to all
  client problems and appropriate for all families
  regardless of cultural background or family type.
  The prevalence of a wide variety of family
  configurations (i.e. single families gay
  couples remarried couples) and culturally
  diverse groups reinforced the idea that no single
  theory or set of interventions is likely to fit
  all equally well.

2
Prochaska and Norcross

• Prochaska and Norcross ( 1999) contend that the
  modal orientation of family therapists today is
  eclecticism/integration. They note that the
  psychotherapy integration movement as it is now
  called is rapidly accelerating for the
  individual as well as family therapists as
  psychotherapy has matured and the ideological
  cold war between the theoretical systems has
  abated.

3
Eclecticism

• Eclecticism is usually pragmatic and case based.
  Examples of Eclecticism include
• -Functional family therapy for adolescent
  delinquents and substance abusers ( Alexander
  Waldon Newberry Liddle 1990 )
• -Family psycho educational treatment of severe
  psychiatric disorders ( McFarlane et. Al. 2003
  ).
• -Multisystemic therapy ( Henggeler Borduin
  1990 ) represents an empirically supported
  family based treatment program based on systems
  theory and Bronfenbrenners ( 1986 ) social
  ecology theory which has been directed at
  treating juvenile offenders and their families.
• ( 1998 ) Edward Goldners approach to treating
  violent couples represents still another effort
  aimed at a specific clinical problem.
• Integration more controversial
  represents a paradigm shift and calls for
  extensive combining of discrete parts of theories
  and treatment processes into a higher-level
  theory that crosses theoretical boundaries and
  uses

4
Intervention techniques in a unified fashion

• Intervention techniques in a unified fashion.
  While no integrative theory has yet emerged as
  predominant a number of efforts have appeared
  they include
• (1998) Datillos endeavor to combine systemic and
  cognitive approaches.
• ( 1995) Pinsofs attempt to synthesize family
  individual and biological therapies.
• ( 1997 ) Wachtels bid to integrate
  psychoanalysis behavior therapy and the
  relational world of family therapy..
• ( (1996) Integrative Couples Therapy ( Jacobsen
  Christiansen ) represents a successful
  combination of a humanistic outlook and
  communication training added to the problem
  solving techniques of behavioral therapy.
• ( 2003 ) Lebow contends that the practice models
  of most family therapists are now integrative and
  eclectic. No one school or therapeutic approach
  has a monopoly on effectiveness although efforts
  to establish evidence-based techniques are under
  way in some approaches especially emotionally
  focused couple therapy or cognitive-behavioral
  family therapy.

5
Psychodynamic Theory

• While there may no longer be slavish devotion in
  practice a therapists theory helps organize
  what information to seek and how to go about
  seeking it how to formulate a treatment plan
  make interventions and understands what
  transpires.
• Psychodynamic theory is concerned with
  insight motivation unconscious conflict early
  infant-caregiver attachments. It emphasizes the
  experiential-humanistic viewpoint emotional
  growth engagement self-growth self
  determination. Those that pay attention to a
  family as a system ( transaction patterns
  alliances boundaries )-the transgenerational
  structural strategic and systemic models and
  those that are cognitive-behavioral in their
  approach emphasizing learning skills and
  behavioral change.
• ( 1997 ) Patterson argues that a clear
  theoretical position provides the structural
  underpinnings for assessment and treatment
  planning to occur.

6
Psychodynamic Theory Con.

• He maintains that a therapist must accurately
  identify the major theoretical orientation from
  which he or she operates before utilizing
  congruent intervention methods within it.
• (1997) Grunebaum states that while techniques
  can be borrowed by an eclectic therapist there
  remains considerable controversy over whether an
  integrated super theory is ever likely to emerge
  Grunebaum points out that there are too many
  inherent incompatibilities in the central
  theoretical constructs of the major theories for
  such a conceptual integration to occur.

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What is the criteria for a solid theory

• - Is the theory comprehensive does it deal with
  family functioning without being trivial or
  oversimplified Is it generalizable to all
  families as they behave in all situations ( i.e.
  only to white middle-class families or only to
  ways families behave in special psychotherapeutic
  situations )
• - Is the theory parsimonious Does it make as few
  assumptions as necessary to account for the
  phenomena under study If two competing theories
  predict the same behavior is the theory chosen
  the one with fewer assumptions or constructs

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What is Solid Theory

• - Is the theory verifiable Does it generate
  predictions about behavior that can be confirmed
  when the relevant empirical data has been
  collected
• - Is the theory precise Does it define concepts
  explicitly and relate them to each other and to
  data (avoiding relying solely on figuarative
  metaphorical or analogical language)
• - Is it empirically valid Do systematic
  empirical tests of the predictions made by the
  theory confirm the theory
• - Is the theory stimulating Does it provoke
  response and further investigation to enhance the
  theory and even to demonstrate its inadequacies

9
Psychoanalysis

• Psychoanalysis both as theory and as a form of
  practice deserves recognition for playing the
  central role in establishing and defining the
  nature of psychotherapy ( Sander1998). It
  initially focused on treating neurotic
  individuals by examining and reconstructing
  childhood conflicts generated by the colliding
  forces of inner drives and external experiences
  psychoanalysis became the dominant ideology in
  American psychiatry after World War II. Erik
  Erikson and Erich Fromm were psychoanalytic in
  their orientation came to America to escape Nazi
  persecution.
• America became receptive to the ideas of Sigmund
  Freud and psychoanalysis became accepted by
  medical specialists academicians and
  clinicians. Indeed many of family therapys
  pioneers AckermanBowenLidzJackson Minuchin
  Wynne Boszormenyi-Nagy ( all men ) were
  psychoanalytically trained.

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Freuds Impact on Family Therapy

• Freud introduced the idea of defense mechanisms
  (such as displacement) and the unconscious ego
  that a person calls upon as protection against
  being overwhelmed by anxiety. He recognized that
  the family provided the early environment-or
  context-in which neurotic fears or anxieties
  developed. He did not go further to identify how
  current and ongoing family relationships helped
  maintain the maladaptive or problematic behavior.
  His therapeutic efforts concentrated on how the
  patient remembered it and not on how his family
  functioned.
• Freud opposed working with more than one
  family member at a time that his negative
  assessment virtually became unquestioned among
  psychoanalysts which for many years accepted the
  prohibition against analyzing members of the same
  family ( Broderick And Schrader 199!.

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(1975) Bowen

• (1975) Bowen noted that one psychoanalytic
  principle that may have retarded the earliest
  growth of the family therapy movement was the
  isolation of the therapist-patient relationship
  and the related concern that contact with the
  patients relatives would contaminate the
  therapist. Bowen reported that some hospitals had
  one therapist deal with the patients
  intrapsychic processes while another handled
  practical matters and administrative procedures
  and a third team member a social worker talked
  to relatives.. According to Bowens early
  experiences failure to respect these boundaries
  was considered inept psychotherapy.

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Adler and Sullivan

• Alfred Adler was an early associate of Freuds in
  Vienna. He helped found the Child Guidance
  movement in the 1900s. He was a physician
  initially trained in ophthalmology later
  specializing in neurology and psychiatry treating
  childhood disorders. . Adler invited by Freud
  joined the Vienna Psychoanalytic Society in 1902.
  Adler eventually developed divergent views from
  psychoanalytic theory emphasizing the importance
  of social and family factors as opposed to
  Freuds drive theory ( Scharf 2000 ).
• Adler particularly challenged Freuds lack of
  attention to social elements in personality
  formation. He offered in its place a theory
  rooted in social relationships. All behavior is
  purposeful and interactive and the basic social
  system is the family ( Carlson Sperry And Lewis
  1997). Adler broke with Freuds biological
  driven theory- substituting social purposeful
  and developmental determinants. Adler formed the
  Society For Individual Psychology in 1914. they
  emphasized the importance of the total
  individual in the therapeutic undertaking.

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Adler

• Adler insisted on an individuals conscious
  personal and social goals as well as subsequent
  goal-directed behavior could be understood only
  by comprehending the environment or the social
  context. especially the family in which the
  behavior originated and was displayed. Adlerian
  concepts such as sibling rivalry family
  constellation and style of life points to
  Adlers awareness of the key role of family
  experiences in influencing adult behavior. Hew
  had a holistic view of the human person as
  unpartitionable which has applicability to the
  systems outlook of many family therapists.
  Adlers direct family therapy connection can be
  seen in psycho educational efforts such as
  marriage enrichment programs parent education
  programs aimed at facilitating adult
  understanding and cooperation ( Dinkmeyer McKay
  Dinkmeyer McKay 1997).

14
Harry Stack Sullivan

• Harry Stack Sullivan an American Psychiatrist
  was psychoanalytically trained. He began his
  career in the 1920s and he stressed the role of
  interpersonal relationships with the family and
  with outsiders in personality development.
  Sullivan ( 1953) argued that people are
  essentially products of their social
  interactions to understand how people function
  he urged the study of their relatively enduring
  patterns of recurrent interpersonal situations.
• He stressed the importance of peer
  relationships in personal and social development
  believing that the seeds for later disturbance
  occurred in early dealings with others. He
  emphasized the importance of the mother-child
  dyad arguing that formative experiences lead to
  viewing parts of one self as the good me the
  bad me and the not me. He worked mostly with
  Schizophrenics at Sheppard Pratt Hospital in
  Baltimore MD.. He noted that the disturbance
  frequently manifested itself during adolescence
  leading him to speculate about the possibly
  critical effects of the patients ongoing family
  life in producing the confusion that might lead
  ultimately

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Schizophrenia

• Lead to schizophrenia ( Perry 1982 ). Sullivan
  ( 1940) described his way of engaging patients as
  acting as a participant observer anticipating by
  several decades the current second order
  cybernetic idea of the therapist being a part of
  the therapeutic system.

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Nathan Ackerman

• Nathan Ackerman- a psychoanalyst and child
  psychiatrist is generally credited with
  deliberately adapting psychoanalytic formulations
  to the study of the family. The first paper
  published on family therapy was in the Bulletin
  of the Kansas Mental Hygiene Society. Ackerman
  (1937) emphasized the influence of the family as
  a dynamic psychosocial unit in treating one of
  its emotionally disturbed members. The constant
  interaction between the biologically driven
  inner conflicted person (a psychoanalytic
  concept) the family and the social environment (
  a person-systems concept ) was to preoccupy for
  the next three decades as he struggled to apply
  an intrapsychic vocabulary to family diagnosis
  and treatment.

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The Psychodynamic Outlook

• -Psychoanalytic drive theory first introduced by
  Sigmund Freud
• -Object relations theory- revision of earlier
  psychoanalytic formulations
• With an emphasis on the search for satisfying
  human relationships.
• The self psychology theory of Heinz Kohut with
  its emphasis on
• The role of narcissism ( love of self ) as an
  organizing determinant of
• Personality development and a necessary
  precursor of loving others.

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The psychodynamic view

• The psychodynamic view of individual behavior is
  derived from Freuds psychoanalytic model this
  focuses on the interplay of opposing innate
  forces ( or drives ) within a person as the basis
  for understanding that persons motivation
  conflicts and symptomatology. Drives motivate
  behavior by way of bodily demands that take the
  form of unconscious wishes and impulses seeking
  satisfaction. Freud stated that each drive has
  four components
• an aim( the release of sexual or aggressive
  tension )
• - a source ( in the case of hunger for example
  the bodily need for nourishment )
• An impetus ( the pressure or urgency of the drive
  )
• An object ( person or thing or condition that
  will satisfy the drive
• i.e. food sexual intercourse etc. ). An object
  choice first stated by Freud can be a
  significant person or anything that is a target
  of another persons feelings or drives ( St.
  Clair 2000 ). It is important to note that it is
  not the real object per se nor how that object
  or person behaves in real life that is at issue
  but rather the fantasies about the object that
  the perceiver experiences. So falling in love
  with another person according to Freud
  primarily involves investing energy in ones
  inner thoughts or mental representations of that
  person.

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By the mid 1980s

• By the mid 1980s a more integrated view was
  being advocated by family therapists who urged
  that systems thinkers not neglect the individual
  family members personal conflicts and motivation
  ( Slipp 1984 Nichols1987 ). Presently the
  interlocking systems of the individual the
  family and the community are at the forefront
  many Freudian ideas about the needs and conflicts
  of individual members are being revisited
  alongside family relationship patterns and the
  impact of community life.

20
Bentovim and Kinston ( 1991 ) and Slipp ( 1991)

• Bentovim and Kinston ( 1991 ) and Slipp ( 1991)
  have developed a model that merges psychodynamic
  and family systems concepts. These British
  family therapists present a model called focal
  family therapy. In the United Kingdom family
  therapy developed out of the child guidance
  movement- this approach is developmentally
  oriented and looks for family disturbances
  especially traumatic events to family members
  that have led to intrapsychic and interpersonal
  disturbance within the family. I formulating a
  focal hypothesis about a familys conflict these
  therapists consider the familys response to the
  symptom in the identified patient the function
  of symptom in family functioning what keeps the
  family from facing their conflicts directly and
  any link to past trauma.

21
Samuel Slipp ( 1991)

• Samuel Slipp ( 1991) psychiatrist attends to any
  significant childhhod development of the
  participants while addressing ongoing family
  interaction using the framework of object
  relations theory. Both individual and family
  diagnoses are part of Slipps treatment plan in
  his effort to integrate psychoanalytic and
  systems concepts and therapeutic methods.

22
Nichols ( 1987 )

• Nichols ( 1987 ) Interactional psychodynamics
  remaining attentive to the circular nature of
  personal and family dynamics.
• Nichols argues for the restoration of individual
  dynamics into psychodynamic family therapy no
  matter how much attention is focused on the
  entire family system individual family members
  will remain separate persons with unique
  experiences private hopes ambitions outlooks
  expectations and potentials.
• Psychoanalytically oriented therapists practicing
  object relations therapy have become more
  focused instead of remaining a blank screen on
  which patients project their fantasies these
  therapists try to participate in a holding
  environment ( a safe nurturing setting ) caring
  for family members while remaining aware of
  transference processes. In the shared holding
  process the family is encouraged to feel free to
  interact safely in front of a trusted therapist.

23
Object Relations Theory

• Object Relations Theory (1950s ) first developed
  in Great Britain in the 1950s. It emphasizes
  that the fundamental need in people is for
  attachments and relationships. (Objects refer to
  the persons or things to which a person relates
  or otherwise gains gratification). In object
  relations family therapy ( Scharff Scharff
  1987 ) the interacting forces both within and
  between individuals are explored in the process
  of treatment. In particular efforts are directed
  at examining thwarted relationships experiences
  early in life particularly mother-child
  interactions that have become internalized and
  that shape a childs inner world and later adult
  relationships and experiences (St. Clair 2000 ).

24
Heinz Kohut

• Heinz Kohut ( 19711977) American psychiatrist
  born in Vienna was responsible for a major
  development in contemporary psychoanalysis.
  Kohut published a series of books that challenged
  some tenets of classical psychoanalysis such as
  drive theory. Kohut developed self psychology
  theory. Kohut analyzed patients with narcissistic
  personality disorder whom Freud thought to be
  unanalyzable because they were not able to invest
  or engage in a relationship with the analyst.
  Kohut argued that narcissistic personality
  difficulties ( as well as others ) result from a
  failure in childhood to develop confident
  feelings about oneself as a result of poor
  experiences with inadequate or unavailable
  parents As a result narcissists self-centered
  and with a powerful need for attention and
  admiration are likely to see themselves as the
  center of all relationships in which they engage.

25
St Clair ( 2000 ) Kohuts work

• St Clair ( 2000 ) Kohuts work helps explain why
  narcissistic persons do not necessarily withdraw
  interest from outside objects but rather are
  unable to rely on their own inner resources
  instead creating intense attachments with others.

26
Nathan Ackerman

• Nathan Ackerman then head of the Child
  Guidance Clinic at the Menniger Clinic in
  TopekaKS started to experiment and see families
  together. In order to obtain a complete picture
  of family functioning as he could especially
  among families suffering economic hardships
  during the Great Depression Ackerman had members
  of his staff make home visits with client
  families ( Guerin 1976 ).
• ( 1960 ) Nathan Ackerman opened The Family
  Institute in New York. (

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Grandfather Of Family Therapy

• 1970) Ackerman who is regarded as the
  grandfather of family therapy. He saw the
  family as a system of interacting personalities
  each individual is an important subsystem within
  the family just as the family is a subsystem
  within the community. He grasped early a full
  understanding of family functioning and
  acknowledged inputs from several sources
• -the unique personality of each member
• -the dynamics of family role adaptations
• - The familys commitment to a set of human
  values
• - the behavior of the family as a social unit

28
Ackerman

• Ackerman argued on the individual level the
  process of symptom formation came to be
  understood in terms of intrapsychic conflict.
• an unconscious defense against anxiety aroused
  by the conflict and the resulting development of
  a neurotic symptom ( psychoanalytic explanation
  ). At the family level the symptom is viewed as
  part of a reoccurring predictable interaction
  pattern intended to assure equilibrium for the
  individual but actually impairing family
  homeostatis by producing distortions in family
  role relationships. In family terms an
  individual symptoms becomes a unit of
  interpersonal behavior reflected within a context
  of shared family conflict anxiety and defenses.

29
A failure of complementarity

• A failure of complementarity- characterizes the
  roles played by various family members with
  respect to each other. Change and growth within
  the system becomes constricted. Roles become
  rigid narrowly defined stereotyped shifting
  rapidly causing confusion. For familys behavior
  to be stable flexibility and adaptability of
  roles are essential roles within the family
  which change over time must allow for nurturing
  children to gain an appropriate degree of
  autonomy.

30
Conflict

• Conflict occurs within an individual family
  member between members of the nuclear family
  between generations and extended family or
  between family and the surrounding community.
  Ackerman states that conflict at any level
  reverberates throughout the family system. A
  breakdown of role complementarity may lead to
  interpersonal conflict within the family and
  ultimately to intrapsychic conflict in one or
  more family members the individuals conflict
  deepens if the internalized family conflicts are
  persistent and pathogenic in form. Ackerman
  wanted to actively interrupt this sequence by
  extrapolating intrapsychic conflict to the
  broader area of family interaction.

31
Ackerman

• Ackerman argues that the process begins when one
  family member often noted to be different from
  the others- becomes the family scapegoat. As that
  individual is singled out and punished for
  causing family disunity various realignments of
  roles follow within the family. One member
  becomes persecutor while another takes the
  role of healer or rescuer of the victim
  of such prejudicial scapegoating

32
Ackerman

• Ackerman observed that family alliances and
  interpersonal conflict begin with a failure of
  complementarity within the marital dyad the
  family is precluded from functioning as a
  cooperative supportive integrated whole. In such
  cases as these Ackermans therapeutic mission
  was to shift familys concern from the
  scapegoated person to the basic disorder of the
  marital relationship.

33
Ackerman

• Ackerman was concerned about the impact of
  family environment on the development of
  childhood disorders. He was the first to note the
  constant interchange of unconscious processes
  taking place between family members as they are
  bound together in a particular interpersonal
  pattern. Any single members behavior can be a
  symptomatic reflection of confusion and
  distortion occurring in the entire family.

34
Interlocking pathology

• Interlocking pathology- as one family member
  gets better another family member gets worse. A
  patient improved in their treatment and as a
  result their marriage failed.

35
Ackerman

• Ackerman was always interested in how people
  define their roles ( What does it mean for you to
  be a father ) and what they expect from other
  family members ( How would you like you daughter
  to react to the situation). When family members
  delineate their roles more clearly family
  interactions proceed more smoothly.

36
Members

• Members can rework alignments engage in new
  family transactions and cultivate new levels of
  complementarity in their role relationships.

37
Ackerman

• Ackerman sees his role as family therapist as
  being the catalyst moving into the living
  space of the family stirs up interaction
  helps the family to have a meaningful emotional
  exchange and at the same time nurtures and
  encourages the members to understand themselves
  better through the contact with the therapist. As
  catalyst the therapist is also activator
  challenger confronter supporter interpreter
  integrator. Ackerman discerned patterns of role
  complementarity and tickled the defenses (
  gently provoking participants to openly and
  honestly express what they feel ) he caught
  members off guard and exposed their
  self-justifying rationalizations. Ackerman (
  1982) The Strength Of Family Therapy a
  collection of his papers. He was the first one to
  demonstrate his work with families before a
  professional audience breaking the
  psychoanalytic code of secrecy about what really
  went on in therapeutic sessions.

38
Object Relations Theory

• The structural conflict between the id impulses
  and those parts of the personality that Freud
  labeled the ego and the superego- is the soil
  from which psychopathology grows ( Slipp 1988 ).
  Acting out an impulse unconsciously becomes
  associated with the danger of reprisal- physical
  punishment loss of love from parents or other
  key parent figures in a childs life.. The
  combination attention to individual drives (
  motives ) the development of a sense of self (
  wishes fears internal conflicts ) and
  unconscious relationship seeking that object
  relations theory addresses.

39
Classic psychoanalysis

• Classic psychoanalysis is considered to be a
  drive theory.-inborn sexual and aggressive
  impulses emanate from the Id. Having created an
  excitation these impulses lead to unconscious
  fantasies as the individual endeavors to achieve
  gratification through the discharge of these
  drives. However the drives behavioral
  expression may lead to perceived danger or a fear
  of punishment. The resulting structural
  conflict- between the id impulses and those parts
  of the personality Fred labeled Ego and Superego-
  is the soil from which psychopathology grows (
  Slipp 1988 ). Acting out an impulse
  unconsciously becomes associated with the danger
  of reprisal-

40
Physical punishment loss of love

• Physical punishment loss of love from parents
  or other key parent figures in the childs life.
• It is precisely the combined attention to
  individual drives ( motives ) the development of
  a sense of self ( wishes fears internal
  conflicts ) and unconscious relationship seeking
  that object relations theory addresses and that
  helps explain the revived interest in
  psychoanalytic formulations by some family
  therapists.

41
Object Relations theory

• Object Relations theory views the infants
  experiences to the mother as the primary
  determinant of adult personality formation.
  According to the theory the infants need for
  attachment to the mother is the foundation for
  the development of the self- the unique psychic
  organization that creates a persons sense of
  identity ( Scharff Scharff 1992 ).
• Bowlby ( 1969 ) considers issues of attachment
  and loss to be central to functioning in humans
  and all higher mammals he argues that how people
  resolve these issues determines personality
  development and possible psychpathology.

42
Attachment

• Attachment refers to the early emotional bond
  that develops ( or fails to develop adequately )
  between infants and their caregivers. According
  to John Bowlby ( 1969) infants develop a secure
  attachment when certain core needs in the
  developmental process are met. When secure the
  infant who becomes frightened or feels
  threatened a normal occurrence will reach out
  to the caregiver ( usually but not necessarily
  the mother ) for responsiveness comfort and
  protection confident that it will be forthcoming.

43
Mary Ainsworth ( 1978 )

• Mary Ainsworth ( 1978 ) has described the complex
  interactive process by which mother and child
  communicate. According to Ainsworth most infants
  form secure attachments upset if the mother
  leaves but easily calmed when she returns. Others
  display an anxious-ambivalent attachment loudly
  protesting her departure and not particularly
  comforted by her return. And a third group
  demonstrate avoidant attachment seeking little
  connection to the mother not distressed when she
  leaves and often rejecting others of comfort.

44
Hazan And Shaver ( 1987

• Hazan And Shaver ( 1987 ) state that secure
  adults are able to trust others and not fear
  abandonment and avoidant adults fear rejection
  and abandonment and avoidant adults have
  difficulty establishing a close and confident
  connection to others.

45
Scharff Scharff ( 2003 )

• Scharff Scharff ( 2003 ) attachment styles in
  insecure adults that they may be insecure in
  various ways- preoccupied with and dependent on
  close relationships dismissive of the need for
  closeness and compulsively self-reliant or down
  right fearful of rejection.

46
Melanie Klein ( 1926)

• Melanie Klein ( 1926) British Psycho analyst who
  emigrated from Vienna in 1926 proved much of the
  foundation for object relations theory. Kleins
  contributions focused attention on the infants
  innate or instinctual make-up beginning at
  birth involves a world of fantasy he or she
  first experiences objects such as the mother
  through fantasies. It is the basis of such prior
  fantasies that the infant filters real life
  experiences. Klein was able to delve into the
  fantasies of young clients and to expand previous
  psychoanalytic formulations to cover the earliest
  phases of life.

47
British Middle School of Object Relations Theory

• British Middle School of Object Relations Theory
  ( Michael Balint Ronald Fairbairn Harry
  Guntrip Donald Winnicott).

48
W.R. D. Fairbairn ( 1952 )

• W.R. D. Fairbairn ( 1952 ) a psychiatrist in
  Edinburgh Scotland maintained that because the
  infant experiences different sets of encounters
  with a mothersometimes nurturing sometimes
  frustrating- and cannot control the circumstances
  or leave the relationship he or she creates a
  fantasy world to help reconcile the discrepant
  experiences. In the process called Splitting the
  child within the first year of life internalizes
  an image of the mother into a good object ( the
  satisfying and loving mother ) and a bad object (
  the inaccessible and frustrating mother )
  forming distinct internal
• Relationships with the separate objects. The
  former becomes an idealized object and allows the
  child to feel loved the latter a rejecting
  object that leads to anger a feeling of being
  unloved and a longing to regain that love.
• Fairbairn also talked about Introjects ( imprints
  of parents or other significant figures ) such as
  pleasing memories bad object introjects cause
  intrapsychic distress.

49
British Psychologist Henry Dicks ( 1967 )

• British Psychologist Henry Dicks ( 1967 )
  Family Psychiatric Unit of the Tavistock Clinic
  in LondonEngland talked about the defense
  mechanism of projective identification an
  interactive mental process in which marital
  partners unconsciously defend against anxiety by
  projecting or externalizing certain split-off or
  unwanted parts of themselves onto their partners.
• Object relations theorists believe that we
  relate to people in the present partly on the
  basis of expectations formed by early experiences
  ( Nichols 1987 ).

50
Object Relations And Family Of Origin Therapy (
James Framo )

• James Framo ( 1981) stressed the relationship
  between the intrapsychic and the interpersonal
  offering an amalgram of psychodynamic and systems
  concepts. Framo is particularly celebrated for
  his advocacy of couples groups. Framo believed
  that psychoanalytic theory did not pay sufficient
  attention to the social context of a persons
  life particularly the early crucial role played
  by family relationships in shaping individual
  behavior. Framo refused to polarize the
  intrapsychic and the interactional maintaining
  that both are essential to understanding the
  dynamic aspects of family life.. Framo worked at
  the Eastern Pennsylvania Psychiatric Institue (
  EPPI ) and had an academic career at Temple
  university. He also worked in San Diego as both
  teacher and practitioner until his death in 2001.

51
At EPPI Framo

• At EPPI Framo began to view family dysfunction
  as rooted in the extended family system. He
  developed a set of intervention techniques that
  helped couples in marital therapy deal with
  unresolved issues each partner brings to the
  marriage from his or her family of origin.
  Consistent with the view of Object Relation
  theorists Framo believed that the insoluble
  intrapsychic conflicts derived from ones family
  of origin continue to be acted out or replicated
  with current intimates such as a spouse or
  children.

52
Framo (1976)

• Framo (1976) theorized that a young child who
  interprets parental behavior as rejection
  desertion or persecution is in a dilemma this
  child cannot give up the sought-after object (the
  parents) nor can he or she change that object.
  Typically the ensuing frustration is dealt with
  by internalizing aspects of the loved-hated
  parents in order to control the objects in the
  childs inner world.

53
Framo (1992)

• Framo (1992) insisted that people usually do not
  select the partner they want they get the one
  they need. Therapeutically Framo began by
  treating the entire family especially when the
  presenting problem involved the children..
  However symptomatic behavior in a child may
  simply be a means of deflecting attention from a
  more basic marital conflict. In such cases once
  the childs role as an identified patient is made
  clear and the child is detriangulated from the
  parents Framo typically dismissed the children
  and proceeded to work with the marital dyad.

54
Framos unique contribution

• Framos unique contribution to family therapy
  was in the process of guiding a couple through
  several treatment stages conjoint therapy
  couples group therapy and finally
  family-of-origin (intergenerational)
• Conferences. The couples group in which many
  couples participate soon after beginning
  treatment allowed Framo to use many of the
  positive aspects of group therapy especially the
  therapeutic feedback from other couples to
  assist his therapeutic efforts.

55
In a daring therapeutic maneuver

• In a daring therapeutic maneuver Framo (1992)
  involved each individual (without the partner
  present) in sessions with his or her family of
  origin (parents brothers and sisters). Here
  instead of the customary working out of past or
  current problems with these family members via a
  relationship with the therapist Framos
  family-of-origin approach proved a direct
  opportunity for clearing up past
  misunderstandings or sources of chronic
  dissatisfaction.

56
Object Relations Family Therapy ( Scharff
Scharff )

• Object Relations Family Therapy ( Scharff
  Scharff )
• An object relations approach more faithful
  to orthodox psychoanalysis comes from the
  collaboration of David Scharff and Jill Savege
  Scharff husband and wife psychiatrists
  affiliated for many years with the Washington
  School Of Psychiatry and now directors of their
  own institute- The International Institute of
  Object Relations Therapy in Washington D.C.

57
In the Scharffs therapeutic approach

• In the Scharffs therapeutic approach
  unconscious themes expressed in dreams and
  fantasies are evoked and investigated family
  histories are explored as they relate to current
  relationships interpretations are made to the
  family insight is sought and transference and
  counter transference feelings are explored in an
  effort to arrive at greater understanding and
  growth. Consistent with drive theory the
  Scharffs attempt to aid the couple in overcoming
  resistance in order to become aware of repressed
  impulses.

58
According to the Scharffs interpretation

• According to the Scharffs interpretation by
  the therapist in order to provide insight is
  essential.. The Scharffs make use of
  transference which they view broadly as
  occurring between each family member and the
  therapist and particularly between the family as
  a group and the therapist.

59
Each partner

• Each partner is encouraged to examine his or her
  early nurturing or caring- what the Scharffs
  call holding experiences and how the images
  retained from those experiences affect the
  couples current marital relationship and their
  view of the therapist. The familys shared object
  relations are assessed as are the familys stage
  of psychosexual development and its use of
  various mechanisms of defense against anxiety.

60
Donald Winnicott ( 1965)

• Donald Winnicott ( 1965) British pediatrician a
  member of the British Middle School of Object
  Relation theorists describes the needs of the
  infant to avoid feeling abandoned or annihilated.
• Unlike Freud who was aware of parental figures
  but stressed the infants inner world and
  instinctual drives Wiinicott underscored the
  significance of the infants environmental needs
  especially for parents to provide sufficient care
  and attention for the infant to experience a good
  start in life.

61
Kohut And Self Psychology

• ( 1971 1977 ) Heinz Kohut retreated from
  Freuds drive theory and was more receptive to
  the idea of intrapsychic forces (gratifying the
  needs of the Self ) and interpersonal forces
  operate in a reciprocal fashion. These ideas are
  now at the forefront of todays practice for many
  clinicians wit psychoanalytic or object relations
  views.

62
Kohut

• Kohut a physician retired in Vienna spent most
  of his career at the Chicago Institute of
  Psychoanalysis. He formulate his influential
  ideas regarding self-psychology emphasizing the
  relationship between the self ( the persons
  personality core or center of initiatives ) and
  outside objects as the defining principle of
  human lives.

63
Kohut

• Kohut contends that initially the infant does
  not view its parents as separate persons or
  objects rather the parents are seen
  narcissistically as self-objects extensions of
  the infant represented by attention and praise
  from its environment. That is the infant makes no
  distinction between itself and its mothers
  praise (although it may not view her as a real
  object yet).

64
Kohut

• Kohut maintains that the infant does not yet
  have a self even if the parents think otherwise.
  That core self begins to emerge from interactions
  with and responses from self-objects. Ideally
  according to Kohut young children start to
  develop a core cohesive self when they experience
  two qualities from their attentive
  parents-empathy (validating how they feel ) and
  idealization of parents ( being proud to have
  good parents and to be part of them ). As a
  result of internalizing parental appreciation
  the child forms an autonomous self characterized
  by self-acceptance and self-esteem. Such
  fortunate children are said by Kohut to have
  needs mirrored by their parents and the
  idealization met by satisfying interaction with
  parents who themselves feel self-esteem. Less
  fortunate children- those whose parents fail to
  demonstrate sufficient appreciation or themselves
  have little self-esteem- continue to crave
  admiring attention throughout life.

65
Narcissism

• Narcissism then is ever present especially
  among infants and young children and represents a
  stage of development. All adults continue to have
  
• Narcissistic needs they wish to fulfill and
  continue to need the mirroring of the self by
  self-objects through out life ( St. Clair 2000 ).
  As Kohut ( 1971 ) seeking a connection with
  someone who is unresponsive or indifferent often
  makes us feel unloved with lowered self-esteem
  and in Kohuts view filled with narcissistic
  rage.

66
Based upon his work with patients

• Based upon his work with patients Kohut (1971)
  contended that the infants core self is likely
  to contain a self-centered grandiose-exhibitionist
  ic part especially if the parent offers
  unconditional admiration. Because the child will
  inevitably be frustrated at not receiving
  everything wished for the conflict at this early
  stage is often between doing what the child wants
  and believes he or she deserves ( the
  self-assertive grandiose self ) and what the
  child believes the idealized parent wants him or
  her to do ( the idealized self-object ) says
  Kohut ( 1977 ). Tantrums at being frustrated thus
  represent narcissistic rages- the removal of the
  mirroring self-object. Kohut considers such
  tantrums as a normal sequence in the development
  and precursor of object love. Such mature love is
  likely to involve mutual mirroring and
  idealization.

67
Working with patients with narcissistic
personality disorder

• Working with patients with narcissistic
  personality disorder Kohut contends that they
  are experiencing a defect in the structure of the
  self not having successfully completed the
  integration of the grandiose and idealized object
  into a reality-oriented self. He found that those
  who grew up feeling insufficiently admired or
  attended to will seek such acceptance in
  exaggerated narcissistic cravings experiencing
  others as self-objects. To the narcissistic
  adult then a self-object is a person
  undifferentiated from oneself who serves the
  needs of the self.