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Title: 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.

7
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?

8
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 ( Sander,1998). 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 Ackerman,Bowen,Lidz,Jackson, Minuchin,
    Wynne, Boszormenyi-Nagy ( all men ) were
    psychoanalytically trained.

10
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!.

11
(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.

12
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.

13
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

15
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.

16
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.

17
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.

18
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.

19
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 Nichols,1987 ). 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 ( 1971,1977) 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
    Topeka,KS 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. (

27
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 London,England 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.
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