Title: SOCW 674 Social Work and Families Lecture No. Seven
1SOCW 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.
2Prochaska 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
4Intervention 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.
5Psychodynamic 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.
6Psychodynamic 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?
8What 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.
10Freuds 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.
12Adler 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).
14Harry 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
15Schizophrenia
- 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.
16Nathan 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.
17The 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.
20Bentovim 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.
21Samuel 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.
22Nichols ( 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.
23Object 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 ).
24Heinz 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.
25St 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. (
27Grandfather 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.
30Conflict
- 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.
33Ackerman
- 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.
36Members
- 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. -
38Object 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-
40Physical 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.
41Object 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.
43Mary 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.
44Hazan 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.
45Scharff 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 ).
50Object 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.
61Kohut 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. -