Psychodynamic Approaches

1. Psychodynamic Approaches Object Relations Theory

2. Psychodynamic Approaches • Neo-Freudian Tradition • Alfred Adler, Wilhelm Reich, Carl Jung, Otto Rank, and Sullivan • Ego-Analytic Tradition • Self-Psychology andObject Relations Theories • Originated with Anna Freud and Melanie Klein’s observation of infants in the 1930’sd 1940’s • Winicott, Erikson, Mahler, Fairbarn

3. Neo-Freudian Tradition • Objected to Freud’s emphasis oninstinct theory, infantile sexualityand his view of theOedipus complex • More concerned than Freud with: • The nature of conscious experience: cognition and will – human’s ability to choose • Psychological health and normal development • Socio-cultural determinants of behavior • External sources of conflict

4. Ego-Analytic Tradition • Based on work with young children and severely disturbed adults • Emphasizes Ego’s functioning in adaptation, coping, and masteryunrelated to instinctual forces • Development of self and psychological characteristics are explained in terms of theinternalization of psychosocial experiences • Views personality and motivation in terms ofinterpersonal transactionsand not instincts

5. Psychodynamic Approaches • Agree with Freud in • The importance of early life • The importance of the unconscious • The role of defense mechanisms • The use of transference, counter transference, interpretation, insight, resistance and catharsis in therapy • Abandon the couch and pay attention to the therapeutic alliance based on a real therapist – client relationship.

6. Object Relations Theory • Concerned with the formation of the self before the Oedipal stage • Major drive of humans is thedrive to relate • Ego’s role is toseek relationshipsrather than to control an unruly ID (Fairbarn) • The self is formed in the context ofearly relationships

7. Objects • Object Relations • Interpersonal relations • External Objects • Significant persons that are the target of a person’s feelings, desires, needs • Internal Objects • Internalized images of the external person, which may differ from the real person

8. Psychological Function of Infants • Splitting (normal and defensive process) • Keeping apart contradictory feelings about others- good mother vs. frustrating mother • Internalization of “Others”– “Experiences” • An aspect of the external world* is introjected and becomes part of the child’s internal world • *Emotional experiences & characteristics of relationships • Internal objects carry out functions performed by the external object: trust, self-worth, condemnation. • Lead to the formation of self-representations

9. Self-Representations • How the infant perceives him/herself in relation to significant others in their lives • Initially, external objects and self are not differentiated • Pleasurable feelings are internalized as “good me” • Frustration is internalized as “bad me” which is painful – and often repressed • Self-representations and internalized objects shape how one relates to others in the world

10. Inner and Outer World of Objects

11. Development of the Self • Crucial early development task : move from • a state offusion and dependence on care-giver to • a state ofincreased independence anddifferentiation (attachment-individuation processes) • Adequate, positive relations in the early stages lead to good feelings about self • Disruptions leave the child feeling empty, deficient, frustrated

12. Development of the Self - Mahler • Normal Autism First 3 to 4 weeks • Objectless period of primary narcissism • Responses based on physiological tensions • Normal Symbiosis 2-3 to 8 months • Dim awareness of mother as separate • Differentiates pleasurable (bliss, reaching out) from frustrating experiences (aggression) • Investment in the relationship with caretaker is the crucial point from which all subsequent relationships form

13. Harry Harlow: On the Nature of Love – American Psychologist -- 1958

14. Harry Harlow • After 8 months of total isolation, damage to the ability to form bonds was permanent • Less than 3 months, damage was reversible • Food, cuddling, warmth, movement and few hours of play

15. Development of the Self - Mahler • Separation Individuation10 months to 21/2 years • “No” period - disengagement from symbiotic relationship – emergence of the Ego • Caretaker: balance betweenletting go and being emotionally available • Neglect or enmeshmentwill hamper exploration of environment. • Neglect: child will focus energy on getting attention • May revert to earlier splitting mechanisms thatmay lead tonarcissistic or borderlinedisorders

16. Attachment -- Autonomy

17. Development of the Self - Mahler • Emotional Object Constancy and Individuality 3 years old on • Internalization of a positive image of caretaker • comforts child in caretaker’s absence and • allows for individuation • Ability integrate “good” and “bad” aspects of the internalized object (caretaker) • Development of a unified self-image: cohesive self • Development of complex cognitive functions & language • Increased reality testing and curbing of aggressive feelings

18. Psychopathology • Deficits in the early relations: • Generate feelings of aggression and anger • Hinder the development of acohesive self • Result in disintegrated internalized objects or psychic structures- splitting • May lead to serious difficulties in adult relationships: • Narcissistic Personality Disorder • Borderline Personality Disorder

19. Narcissistic Personality Disorder Grandiose sense of self-importance Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love Believes that he or she is “special” and unique Requires excessive admiration, praise Has a very strong sense of entitlement, e.g., unreasonable expectations or automatic compliance with expectations Exploitative of others -- hostility Lacks empathy Often envious of others or believes others are envious of them Regularly shows arrogant, haughty behaviors or attitudes

20. Borderline Personality Disorder Frantic efforts to avoid real or imagined abandonment A pattern of unstable and intense interpersonal relationshipsextremes idealization and devaluation Identity disturbance, unstable self-image or sense of self Impulsivity in at least two areas (e.g., spending, sex, substance abuse, reckless driving, binge eating) Recurrent suicidal behavior, threats, or self-mutilating beh. Emotional instability due to significant reactivity of mood Chronic feelings of emptiness Inappropriate, intense anger or difficulty controlling anger Transient, stress-related paranoid thoughts or severe dissociative symptoms

21. Therapy • Enable client to re-experience early stages of development: • Explore repressed negative experiences • Cognitively and emotionally • Explore how current conflicts repeat patterns of behaviors and feelings about self and others established earlier – including in relation with therapist –

22. Therapy (continued) • and achieve a more positive level of functioning (object relations): • The therapist provides some of the functions that client lacked in childhood • Therapist serves as an auxiliary ego to help client cope with painful, overwhelming emotions • Foster process of integration and synthesis of self

23. Case Conceptualization: Richard • Examine Richard’s current and early relationships as they relate to issues of attachment and autonomy. • Describe ideas and feelings about self that Richard might have developed during his upbringing • Discuss how ideas and feelings about self may influence Richard’s current problems; identify patterns (adaptive or maladaptive) from early relationships that Richard may be repeating in current life. .

24. Case Conceptualization: Richard • Describe counseling goals: changes in Richard’s feelings and/or behaviors • Describe specific interventions

25. Ainsworth Strange Situation Research Laboratory procedure used to assess infant attachment style. (Connell & Goldsmith, 1982; Ainsworth, Blehar, Waters, & Wall, 1978) • Mother and baby introduced into room • Mother and baby alone, baby free to explore (3 minutes) • Stranger enters, sits down, talks to mother and then tries to engage the baby in play (3 minutes) • Mother leaves.  Stranger and baby alone (up to 3 minutes) • First reunion.  Mother returns and stranger leaves unobtrusively.  Mother settles baby if necessary, and tries to withdraw to her chair (3 minutes) • Mother leaves.  Baby alone (up to 3 minutes) • Stranger returns and tries to settle the baby if necessary, and then withdraw to her chair (up to 3 minutes) • Second reunion.  Mother returns and stranger leaves unobtrusively.  Mother settles baby and tries to withdraw to her chair (3 minutes)

26. Two aspects of the child's behavior are observed: • The amount of exploration (e.g. playing with new toys) the child engages in throughout, and • The child's reactions to the departure and return of its caregiver (mother)

27. Insecure-avoidant attachment • Child’s Behavior (22% in original study) • Child will avoid or ignore the mother - showing little emotion when the mother departs or returns. • Will not explore very much regardless of who is there. Strangers will not be treated much differently from the mother. • Avoided the stranger, but not as strongly as they avoided the mother on her return • There is not much emotional range displayed regardless of who is in the room or if it is empty. • This attachment style develops from a mothering style which is more disengaged. The child's needs are frequently not met and the child comes to believe that communication of needs has no influence on the mother.

28. Insecure-ambivalent attachment •   Child’s Behavior (12% in original study) • Child is anxious of exploration and of strangers, even when the mother is present. • When the mother departs, the child is extremely distressed. • Child will be ambivalent when mother returns, seeking to remain close to the mother but resentful, and also resistant when the mother initiates attention. Child may scream and rage, rather than be pacified when the mother returns. • Child shows ambivalent behavior towards the stranger, similar to the pattern of resistance and interest shown to the mother • This style develops from a mothering style which is engaged but on the mother's own terms. That is, sometimes the child's needs are ignored until some other activity is completed; attention is sometimes given to the child but more to meet the parents’ needs than from the child's initiation.

29. Secure attachment • Child’s Behavior (66% in original study) • This style represents a balance between over-involvement with the environment or with the mother. • Child explores freely while the mother is present, • Child shows moderate avoidance of the stranger, although is friendly when the mother is present. • is visibly upset when the mother departs, and • is happy to see the mother return.

30. Attachment in intimate relationships • Securely attachedpeople are able to place trust in their partner which, in turn, means they can confidently spend time apart. • People with an anxious ambivalent attachment style may have difficulties because their way of behaving in relationships can be seen as needy or clingy by their partner. They are prone to worry about whether their partner loves them or whether they are valued by their partner. • People with an avoidant attachment style are uncomfortable being close to others. They have difficulties in trusting other people and do not like to depend on others. • Such patterns are believed to be working models that develop in infancy, but can be modified as people enter into new relationships. Phillip Shaver, Cindy Hazan, and others