Tag: Object Relations Theory

What is Schema Therapy?

Published on by Andrew Marshall2 Comments

Introduction

Schema therapy was developed by Jeffrey E. Young for use in treatment of personality disorders and chronic DSM Axis I disorders, such as when patients fail to respond or relapse after having been through other therapies (for example, traditional cognitive behavioural therapy (CBT)). Schema therapy is an integrative psychotherapy combining theory and techniques from previously existing therapies, including CBT, psychoanalytic object relations theory, attachment theory, and Gestalt therapy.

Background

Four main theoretical concepts in schema therapy are early maladaptive schemas (or simply schemas), coping styles, modes, and basic emotional needs:

  1. In cognitive psychology, a schema is an organised pattern of thought and behaviour. It can also be described as a mental structure of preconceived ideas, a framework representing some aspect of the world, or a system of organizing and perceiving new information. In schema therapy, a schema specifically refers to an early maladaptive schema, defined as a pervasive self-defeating or dysfunctional theme or pattern of memories, emotions, and physical sensations, developed during childhood or adolescence and elaborated throughout one’s lifetime. Often they have the form of a belief about the self or the world. For instance, a person with an Abandonment schema could be hypersensitive (have an “emotional button” or “trigger”) about their perceived value to others, which in turn could make them feel sad and panicky in their interpersonal relationships.
  2. Coping styles are a person’s behavioural responses to schemas. There are three potential coping styles. In “avoidance” the person tries to avoid situations that activate the schema. In “surrender” the person gives into the schema, doesn’t try to fight against it, and changes their behavior in expectation that the feared outcome is inevitable. In “counterattack”, also called “overcompensation”, the person puts extra work into not allowing the schema’s feared outcome to happen. These maladaptive coping styles (overcompensation, avoidance, or surrender) very often wind up reinforcing the schemas. Continuing the Abandonment example: having imagined a threat of abandonment in a relationship and feeling sad and panicky, a person using an avoidance coping style might then behave in ways to limit the closeness in the relationship to try to protect themself from being abandoned. The resulting loneliness or even actual loss of the relationship could easily reinforce the person’s Abandonment schema. Another example can be given for the Defectiveness schema: A person using an avoidance coping style might avoid situations that make them feel defective, or might try to numb the feeling with addictions or distractions. A person using a surrender coping style might tolerate unfair criticism without defending themself. A person using the counterattack/overcompensation coping style might put extra effort into being superhuman.
  3. Modes are mind states that cluster schemas and coping styles into a temporary “way of being” that a person can shift into occasionally or more frequently. For example, a Vulnerable Child mode might be a state of mind encompassing schemas of Abandonment, Defectiveness, Mistrust/Abuse and a coping style of surrendering (to the schemas).
  4. If a patient’s basic emotional needs are not met in childhood, then schemas, coping styles, and modes can develop. Some basic needs that have been identified are: connection, mutuality, reciprocity, flow, and autonomy. For example, a child with unmet needs around connection—perhaps due to parental loss to death, divorce, or addiction—might develop an Abandonment schema.

The goal of schema therapy is to help patients meet their basic emotional needs by helping the patient learn how to:

  • Heal schemas by diminishing the intensity of emotional memories comprising the schema and the intensity of bodily sensations, and by changing the cognitive patterns connected to the schema; and
  • Replace maladaptive coping styles and responses with adaptive patterns of behaviour.

Techniques used in schema therapy including limited reparenting and Gestalt therapy psychodrama techniques such as imagery re-scripting and empty chair dialogues. See § Techniques in schema therapy, below.

Early Maladaptive Schemas

Early maladaptive schemas are self-defeating emotional and cognitive patterns established from childhood and repeated throughout life. They may be made up of emotional memories of past hurt, tragedy, fear, abuse, neglect, unmet safety needs, abandonment, or lack of normal human affection in general. Early maladaptive schemas can also include bodily sensations associated with such emotional memories. Early maladaptive schemas can have different levels of severity and pervasiveness: the more severe the schema, the more intense the negative emotion when the schema is triggered and the longer it lasts; the more pervasive the schema, the greater the number of situations that trigger it.

Schema Domains

Schema domains are five broad categories of unmet needs into which are grouped 18 early maladaptive schemas identified by Young, Klosko & Weishaar (2003):

  1. Disconnection/Rejection includes 5 schemas:
    • Abandonment/Instability
    • Mistrust/Abuse
    • Emotional Deprivation
    • Defectiveness/Shame
    • Social Isolation/Alienation
  2. Impaired Autonomy and/or Performance includes 4 schemas:
    • Dependence/Incompetence
    • Vulnerability to Harm or Illness
    • Enmeshment/Undeveloped Self
    • Failure
  3. Impaired Limits includes 2 schemas:
    • Entitlement/Grandiosity
    • Insufficient Self-Control and/or Self-Discipline
  4. Other-Directedness includes 3 schemas:
    • Subjugation
    • Self-Sacrifice
    • Approval-Seeking/Recognition-Seeking
  5. Overvigilance/Inhibition includes 4 schemas:
    • Negativity/Pessimism
    • Emotional Inhibition
    • Unrelenting Standards/Hypercriticalness
    • Punitiveness

Yalcin, Lee & Correia (2020) did a primary and a higher-order factor analysis of data from a large clinical sample and smaller non-clinical population. The higher-order factor analysis indicated four schema domains—Emotional Dysregulation, Disconnection, Impaired Autonomy/Underdeveloped Self, and Excessive Responsibility/Overcontrol—that overlap with the five domains (listed above) proposed earlier by Young, Klosko & Weishaar (2003). The primary factor analysis indicated that the Emotional Inhibition schema could be split into Emotional Constriction and Fear of Losing Control, and the Punitiveness schema could be split into Punitiveness (Self) and Punitiveness (Other).

Schema Modes

Schema modes are momentary mind states which every human being experiences at one time or another. A schema mode consists of a cluster of schemas and coping styles. Life situations that a person finds disturbing or offensive, or arouse bad memories, are referred to as “triggers” that tend to activate schema modes. In psychologically healthy persons, schema modes are mild, flexible mind states that are easily pacified by the rest of their personality. In patients with personality disorders, schema modes are more severe, rigid mind states that may seem split off from the rest of their personality.

Identified Schema Modes

Young, Klosko & Weishaar (2003) identified 10 schema modes, further described by Jacob, Genderen & Seebauer (2015), and grouped into four categories. The four categories are: Child modes, Dysfunctional Coping modes, Dysfunctional Parent modes, and the Healthy Adult mode. The four Child modes are: Vulnerable Child, Angry Child, Impulsive/Undisciplined Child, and Happy Child. The three Dysfunctional Coping modes are: Compliant Surrenderer, Detached Protector, and Overcompensator. The two Dysfunctional Parent modes are: Punitive Parent and Demanding Parent.

  • Vulnerable Child is the mode in which a patient may feel defective in some way, thrown aside, unloved, obviously alone, or may be in a “me against the world” mindset. The patient may feel as though peers, friends, family, and even the entire world have abandoned them. Behaviours of patients in Vulnerable Child mode may include (but are not limited to) falling into major depression, pessimism, feeling unwanted, feeling unworthy of love, and perceiving personality traits as irredeemable flaws. Rarely, a patient’s self-perceived flaws may be intentionally withheld on the inside; when this occurs, instead of showing one’s true self, the patient may appear to others as “egotistical”, “attention-seeking”, selfish, distant, and may exhibit behaviours unlike their true nature. The patient might create a narcissistic alter-ego/persona in order to escape or hide the insecurity from others. Due to fear of rejection, of feeling disconnected from their true self and poor self-image, these patients, who truly desire companionship/affection, may instead end up pushing others away.
  • Angry Child is fuelled mainly by feelings of victimization or bitterness, leading towards negativity, pessimism, jealousy, and rage. While experiencing this schema mode, a patient may have urges to yell, scream, throw/break things, or possibly even injure themself or harm others. The Angry Child schema mode is enraged, anxious, frustrated, self-doubting, feels unsupported in ideas and vulnerable.
  • Impulsive Child is the mode where anything goes. Behaviours of the Impulsive Child schema mode may include reckless driving, substance abuse, cutting oneself, suicidal thoughts, gambling, or fits of rage, such as punching a wall when “triggered” or laying blame of circumstantial difficulties upon innocent people. Unsafe sex, rash decisions to run away from a situation without resolution, tantrums perceived by peers as infantile, and so forth are a mere few of the behaviours which a patient in this schema mode might display. Impulsive Child is the rebellious and careless schema mode.
  • Happy Child occurs when one feels like their needs are being met. When people experience the Happy Child mode, they feel safe, loved, and content. They experience a joyful sense of wonder and playfulness about the world. This mode is healthy as it represents the absence of activation of maladaptive schemas. While healthy adults spend most of their time in the Healthy Adult mode, they also cultivate their Happy Child to balance the demands of life with a sense of lightheartedness.
  • Compliant Surrenderer is a coping mode where one experiences the schema that triggered it as true. This in turn leads to feelings such as helplessness, sadness, guilt, or anger about the situation. People in this mode often believe it is pointless to challenge their schema, and that it must simply be accepted. They also often adopt an interpersonally passive and dependent style, seeking to please people in their lives, to minimize conflict, and therefore avoid further harm or abuse.
  • Detached Protector is based in escape. Patients in Detached Protector schema mode withdraw, dissociate, alienate, or hide in some way. This may be triggered by numerous stress factors or feelings of being overwhelmed. When a patient with insufficient skills is in a situation involving excessive demands, it can trigger a Detached Protector response mode. Stated simply, patients become numb in order to protect themselves from the harm or stress of what they fear is to come, or to protect themselves from fear of the unknown in general.
  • Overcompensator is marked by attempts to fight off schemas in a way that is rigid and extreme. It often involves aggressiveness, rebelliousness, violating the rights of other people, and an attempt to dominate them. In this mode, a person who feels emotionally deprived demands affection from others, while a person who believes others cannot be trusted will try to preemptively hurt them before they do. It may also involve obsessiveness in an excessive attempt to control the environment, or forced behaviors, such as extreme forgiveness for someone with a Punitiveness schema.
  • Punitive Parent is identified by beliefs of a patient that they should be harshly punished, perhaps due to feeling “defective”, or making a simple mistake. The patient may feel that they should be punished for even existing. Sadness, anger, impatience, and judgment are directed to the patient and from the patient. The Punitive Parent has great difficulty in forgiving themself even under average circumstances in which anyone could fall short of their standards. The Punitive Parent does not wish to allow for human error or imperfection, thus punishment is what this mode seeks.
  • Demanding Parent is associated with a strong sense of pressure to achieve. When experiencing this mode, people often feel like their performance is inadequate, no matter how well they do or how much effort they make. Common beliefs also involve the idea that rest, fun, and relaxation are not acceptable and that one’s attention should remain focused on achieving more. It is important to note that while this mode is often accompanied by Punitive Parent, this is not always the case. Clients with the Demanding Parent mode feel pressure and dissatisfaction with their achievements, but not necessarily guilt, shame or feelings of worthlessness.
  • Healthy Adult is the mode that schema therapy aims to help a patient achieve as the long-lasting state of well-being. The Healthy Adult is comfortable making decisions, is a problem-solver, thinks before acting, is appropriately ambitious, sets limits and boundaries, nurtures self and others, forms healthy relationships, takes on all responsibility, sees things through, and enjoys/partakes in enjoyable adult activities and interests with boundaries enforced, takes care of their physical health, and values themself. In this schema mode the patient focuses on the present day with hope and strives toward the best tomorrow possible. The Healthy Adult forgives the past, no longer sees themself as a victim (but as a survivor), and expresses all emotions in ways which are healthy and cause no harm.

Techniques in Schema Therapy

Treatment plans in schema therapy generally encompass three basic classes of techniques: cognitive, experiential, and behavioural (in addition to the basic healing components of the therapeutic relationship). Cognitive strategies expand on standard cognitive behavioural therapy techniques such as listing pros and cons of a schema, testing the validity of a schema, or conducting a dialogue between the “schema side” and the “healthy side”. Experiential and emotion focused strategies expand on standard Gestalt therapy psychodrama and imagery techniques. Behavioural pattern-breaking strategies expand on standard behaviour therapy techniques, such as role playing an interaction and then assigning the interaction as homework. One of the most central techniques in schema therapy is the use of the therapeutic relationship, specifically through a process called “limited reparenting”.

Specific techniques often used in schema therapy include flash cards with important therapeutic messages, created in session and used by the patient between sessions, and the schema diary – a template or workbook that is filled out by the patient between sessions and that records the patient’s progress in relation to all the theoretical concepts in schema therapy.

Schema Therapy and Psychoanalysis

From an integrative psychotherapy perspective, limited reparenting and the experiential techniques, particularly around changing modes, could be seen as actively changing what psychoanalysis has described as object relations. Historically, mainstream psychoanalysis tended to reject active techniques—such as Fritz Perls’ Gestalt therapy work or Franz Alexander’s “corrective emotional experience” – but contemporary relational psychoanalysis (led by analysts such as Lewis Aron, and building on the ideas of earlier unorthodox analysts such as Sándor Ferenczi) is more open to active techniques. It is notable that in a head-to-head comparison of a psychoanalytic object relations treatment (Otto F. Kernberg’s transference focused psychotherapy) and schema therapy, the latter has been demonstrated to be more effective in treating Borderline Personality Disorder.

Outcome Studies on Schema Therapy

Schema Therapy vs Transference Focused Psychotherapy Outcomes

Dutch investigators, including Josephine Giesen-Bloo and Arnoud Arntz (the project leader), compared schema therapy (also known as schema focused therapy or SFT) with transference focused psychotherapy (TFP) in the treatment of borderline personality disorder. 86 patients were recruited from four mental health institutes in the Netherlands. Patients in the study received two sessions per week of SFT or TFP for three years. After three years, full recovery was achieved in 45% of the patients in the SFT condition, and in 24% of those receiving TFP. One year later, the percentage fully recovered increased to 52% in the SFT condition and 29% in the TFP condition, with 70% of the patients in the SFT group achieving “clinically significant and relevant improvement”. Moreover, the dropout rate was only 27% for SFT, compared with 50% for TFP.

Patients began to feel and function significantly better after the first year, with improvement occurring more rapidly in the SFT group. There was continuing improvement in subsequent years. Thus investigators concluded that both treatments had positive effects, with schema therapy clearly more successful.

Less Intensive Outpatient, Individual Schema Therapy

Dutch investigators, including Marjon Nadort and Arnoud Arntz, assessed the effectiveness of schema therapy in the treatment of borderline personality disorder when utilised in regular mental health care settings. A total of 62 patients were treated in eight mental health centres located in the Netherlands. The treatment was less intensive along a number of dimensions including a shift from twice weekly to once weekly sessions during the second year. Despite this, there was no lessening of effectiveness with recovery rates that were at least as high and similarly low dropout rates.

Pilot Study of Group Schema Therapy for Borderline Personality Disorder

Investigators Joan Farrell, Ida Shaw and Michael Webber at the Indiana University School of Medicine Centre for BPD Treatment & Research tested the effectiveness of adding an eight-month, 30-session schema therapy group to treatment-as-usual (TAU) for borderline personality disorder (BPD) with 32 patients. The dropout rate was 0% for those patients who received group schema therapy in addition to TAU and 25% for those who received TAU alone. At the end of treatment, 94% of the patients who received group schema therapy in addition to TAU compared to 16% of the patients receiving TAU alone no longer met BPD diagnostic criteria. The schema therapy group treatment led to significant reductions in symptoms and global improvement in functioning. The large positive treatment effects found in the group schema therapy study suggest that the group modality may augment or catalyse the active ingredients of the treatment for BPD patients. As of 2014, a collaborative randomised controlled trial is under way at 14 sites in six countries to further explore this interaction between groups and schema therapy.

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What is Narcissistic Withdrawal?

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Introduction

In children, narcissistic withdrawal may be described as ‘a form of omnipotent narcissism characterised by the turning away from parental figures and by the fantasy that essential needs can be satisfied by the individual alone’.

For adults, ‘in the contemporary literature the term narcissistic withdrawal is instead reserved for an ego defence in pathological personalities’. Such narcissists may feel obliged to withdraw from any relationship that threatens to be more than short-term.

Psychoanalysis

Freud used the term ‘to describe the turning back of the individual’s libido from the object onto themselves….as the equivalent of narcissistic regression’. On Narcissism saw him explore the idea through an examination of such everyday events as illness or sleep: ‘the condition of sleep, too, resembles illness in implying a narcissistic withdrawal of the positions of the libido on to the subject’s own self’. A few years later, in ‘”Mourning and Melancholia”…Freud’s most profound contribution to object relations theory’, he examined how ‘a withdrawal of the libido…on a narcissistic basis’ in depression could allow both a freezing and a preservation of affection: ‘by taking flight into the ego love escapes extinction’.

Otto Fenichel would extend his analysis to borderline conditions, demonstrating how ‘in a reactive withdrawal of libido…a regression to narcissism is also a regression to the primal narcissistic omnipotence which makes its reappearance in the form of megalomania’.

For Melanie Klein, however, a more positive element came to the fore: ‘frustration, which stimulates narcissistic withdrawal, is also…a fundamental factor in adaptation to reality’. Similarly, ‘Winnicott points out that there is an aspect of withdrawal that is healthy’, considering that it might be ‘”helpful to think of withdrawal as a condition in which the person concerned (child or adult) holds a regressed part of the self and nurses it, at the expense of external relationships”‘.

However, from the mid-20th century onwards, attention has increasingly focused on

‘the case in which the subject appeals to narcissistic withdrawal as a defensive solution…a precarious refuge that comes into being as a defense against a disappointing or untrustworthy object. This is found in studies of narcissistic personalities or borderline pathologies by authors such as Heinz Kohut or Otto Kernberg’.

Kohut considered that ‘the narcissistically vulnerable individual responds to actual (or anticipated) narcissistic injury either with shamefaced withdrawal or with narcissistic rage’. Kernberg saw the difference between normal narcissism and ‘ pathological narcissism…[as] withdrawal into “splendid isolation”‘ in the latter instance; while Herbert Rosenfeld was concerned with ‘states of withdrawal commonly seen in narcissistic patients in which death is idealised as superior to life’, as well as with ‘the alternation of states of narcissistic withdrawal and ego disintegration’.

Schizoid Withdrawal

Closely related to narcissistic withdrawal is ‘schizoid withdrawal: the escape from too great pressure by abolishing emotional relationships altogether’. All such ‘fantastic refuges from need are forms of emotional starvation, megalomanias and distortions of reality born of fear’.

Sociology

‘Narcissists will isolate themselves, leave their families, ignore others, do anything to preserve a special…sense of self’ Arguably, however, all such ‘narcissistic withdrawal is haunted by its alter ego: the ghost of a full social presence’ – with people living their lives ‘along a continuum which ranges from the maximal degree of social commitment…to a maximal degree of social withdrawal’.

If ‘of all modes of narcissistic withdrawal, depression is the most crippling’, a contributing factor may be that ‘depressed persons come to appreciate consciously how much social effort is in fact required in the normal course of keeping one’s usual place in undertakings’.

Therapy

Object relations theory would see the process of therapy as one whereby the therapist enabled his or her patient to have ‘resituated the object from the purely schizoid usage to the shared schizoid usage (initially) until eventually…the object relation – discussing, arguing, idealizing, hating, etc. – emerged’.

Fenichel considered that in patients where ‘their narcissistic regression is a reaction to narcissistic injuries; if they are shown this fact and given time to face the real injuries and to develop other types of reaction, they may be helped enormously’ Neville Symington however estimated that ‘often a kind of war develops between analyst and patient, with the analyst trying to haul the patient out of the cocoon…his narcissistic envelope…and the patient pulling for all his worth in the other direction’.

Cultural Analogues

  • In I Never Promised You a Rose Garden, the therapist of the protagonist wonders ‘”if there is a pattern….You give up a secret to our view and then you get so scared that you run for cover into your panic or into your secret world. To live there.”‘.
  • More generally, the 1920s have been described as a time of ‘changes in which women were channelled toward narcissistic withdrawal rather than developing strong egos’.

What is Narcissistic Mortification?

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Introduction

Narcissistic mortification is “the primitive terror of self dissolution, triggered by the sudden exposure of one’s sense of a defective self … it is death by embarrassment”.

Narcissistic mortification is a term first used by Sigmund Freud in his last book, Moses and Monotheism, with respect to early injuries to the ego/self. The concept has been widely employed in ego psychology and also contributed to the roots of self psychology.

When narcissistic mortification is experienced for the first time, it may be defined as a sudden loss of control over external or internal reality, or both. This produces strong emotions of terror while at the same time narcissistic libido (also known as ego-libido) or destrudo is built up. Narcissistic libido or ego-libido is the concentration of libido on the self. Destrudo is the opposite of libido and is the impulse to destroy oneself and everything associated with oneself.

Early Developments: Bergler, Anna Freud, and Eidelberg

Edmund Bergler developed the concept of narcissistic mortification in connection with early fantasies of omnipotence in the developing child, and with the fury provoked by the confrontations with reality that undermine his or her illusions. For Bergler, “the narcissistic mortification suffered in this very early period continues to act as a stimulus throughout his life”.

Anna Freud used the term in connection with her exploration of the defence mechanism of altruistic surrender, whereby an individual lives only through the lives of others – seeing at the root of such an abrogation of one’s own life an early experience of narcissistic mortification at a disappointment with one’s self.

Psychoanalyst and author Ludwig Eidelberg subsequently expanded on the concept in the fifties and sixties. Eidelberg defined narcissistic mortification as occurring when “a sudden loss of control over external or internal reality…produces the painful emotional experience of terror”. He also stressed that for many patients simply to have to accept themselves as having neurotic symptoms was itself a source of narcissistic mortification.

Kohut and Self Psychology

For Heinz Kohut, narcissistic injury – the root cause of what he termed narcissistic personality disorder – was broadly equivalent to the humiliation of mortification. Kohut considered that “if the grandiosity of the narcissistic self has been insufficiently modified…then the adult ego will tend to vacillate between an irrational overestimation of the self and feelings of inferiority and will react with narcissistic mortification to the thwarting of its ambitions”.

Object Relations Theory

Unlike ego psychologists, object relations theorists have traditionally used a rather different, post-Kleinian vocabulary to describe the early woundings of narcissistic mortification. Recently however such theorists have found analogies between Freud’s emphasis on the sensitivity of the ego to narcissistic humiliation and mortification, and the views of Bion on ‘nameless dread’ or Winnicott’s on the original agonies of the breakdown of childhood consciousness. At the same time ego psychologists have been increasingly prepared to see narcissistic mortification as occurring in the context of early relations to objects.

Physical Sensations and Psychological Perceptions

An individual’s experience of mortification may be accompanied by both physical and psychological sensations. Physical sensations such as: burning, painful tingling over the body, pain in the chest that slowly expands and spreads throughout the torso, dizziness, nausea, vomiting, sweating, blanching, coldness and numbness can be experienced by the individual suffering from mortification. The psychological sensations described are feeling shocked, exposed, and humiliated. Descriptions of this experience can be, for example: “It feels like I won’t survive” and “I have the absolute conviction that he or she hates me and it’s my fault”. These sensations are always followed by shock, although they may have happened on various occasions, they also prompt the need for the individual suffering to do something both internally and externally, to effect a positive self-image in the eyes of their narcissistic object. Narcissistic mortification is extreme in its intensity, global nature, and its lack of perspective, causing the anxiety associated with it to become traumatic.

Normal versus Pathological

In Eidelberg’s view, a normal individual would usually be able to avoid being overwhelmed by internal needs because they recognise these urges in time to bring about their partial discharge. However, Eidelberg does not view occasional outbursts of temper as a sign of disorder. An individual experiencing pathological narcissistic mortification is prone to become fixated on infantile objects, resulting in an infantile form of discharge. He or she cannot be satisfied by the partial discharge of this energy, which takes place on an unconscious level, and this in turn interferes with their well-being. According to Eidelberg, the denial of an infantile narcissistic mortification can be responsible for many defensive mechanisms.

Internal versus External

Narcissistic mortification can be:

InternalOccurs when an individual is overstimulated by their emotions. For example, while debating with classmates on the importance of stem cell research an outspoken student loses his temper causing an uproar. The student has just exhibited an overstimulation of his emotions and used this outburst to relieve internal tension.
ExternalOccurs when something out of one’s control influences a situation, for example, an individual who is held at gunpoint while having their wallet stolen. This individual does not hold any control over the scenario nor the actions of the gunman, but their reaction to being held at gunpoint influences the next scenario and what the gunman does next.

In Cult Leadership

To escape the narcissistic mortification of accepting their own dependency needs, cult leaders may resort to delusions of omnipotence. Their continuing shame and underlying guilt, and their repudiation of dependency, obliges such leaders to use seduction and manic defences to externalise and locate dependency needs in others, thus making their followers controllable through a displaced sense of shame.

Death, Anxiety, and Suicide

Because in Western culture death is sometimes seen as the ultimate loss of control, fear of it may produce death anxiety in the form of a sense of extreme shame or narcissistic mortification. The shame in this context is produced by the loss of stoicism, productivity, and control, aspects that are highly valued by society and aspects that are taken away as one ages. Death according to Darcy Harris:

‘is the ultimate narcissistic wound, bringing about not just the annihilation of self, but the annihilation of one’s entire existence, resulting in a form of existential shame for human beings, who possess the ability to ponder this dilemma with their higher functioning cognitive abilities.’

Individuals who hold this anxiety are ashamed of mortality and the frailty that comes along with it; and may attempt to overcome this reality through diversions and accomplishments, deflecting feelings of inferiority and shame through strategies like grandiosity in similar fashion to those with narcissistic personality traits.

Narcissistic mortification may also be produced by death of someone close. Such a loss of an essential object may even lead through narcissistic mortification to suicide.

Among the many motives behind suicidal activities in general are shame, loss of honour, and narcissistic mortification. Those who suffer from narcissistic mortification are more likely to participate in suicidal behaviours and those who do not receive the proper help more often than not succeed. Suicide related to narcissistic mortification is different from normal sorrow in that it is associated with deep rooted self-contempt and self-hatred.

Treatment

According to a paper presented by Mary Libbey, “On Narcissistic Mortification”, presented at the 2006 Shame Symposium, long-term goal of psychoanalytic treatment for those who suffer from narcissistic mortification is to transform the mortification into shame. She says by transforming it into shame it enables the sufferer to tolerate and use it as a signal; the process of transforming mortification into shame entails working through both the early mortifying traumas as well as the defences, often unstable, related to them. If an individual sufferer does not go through this transformation, he or she is left with two unstable narcissistic defences. Libbey says these defences are: self-damning, deflated states designed to appease and hold on to self-objects, and narcissistic conceit, which is designed to project the defective self experiences onto self-objects. Both of these defensive styles require a continuation of dependence on the self-object. Transforming the mortification into shame makes it possible for self-appraisal and self-tolerance, this ultimately leads to psychic separation and self-reliance without the need to sustain one’s mortification, according to Libbey’s paper.

In the 21st Century

Postmodern Freudians link narcissistic mortification to Winnicott’s theory of primitive mental states which lack the capacity for symbolisation, and their need for re-integration. Returning in the transference to the intolerable mortification underpinning such narcissistic defences can however also produce positive analytic change, by way of the (albeit mortifying) re-experience of overwhelming object loss within an intersubjective holding environment.

21st century American analysts are particularly concerned with the potential production of narcissistic mortification as a by-product of analytic interpretation, especially with regard to masochistic personality disorder.

Literary Uses

  • Narcissistic mortification at injuries to self-esteem has been seen as pervading Captain Ahab’s motivations in his confrontation with Moby-Dick.
  • Mortification at one’s self is seen in Mary Shelley’s Frankenstein when the Creature stares at his reflection in a pool of water. This is where he becomes convinced that he is in fact the Creature and becomes filled with despondence and mortification.

What is Narcissistic Injury?

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Introduction

Narcissistic injury, also known as “narcissistic wound” or “wounded ego” are emotional traumas that overwhelm an individual’s defence mechanisms and devastate their pride and self worth.

In some cases the shame or disgrace is so significant that the individual can never again truly feel good about who they are and this is sometimes referred to as a “narcissistic scar”.

Freud maintained that “losses in love” and “losses associated with failure” often leave behind injury to an individual’s self-regard.

Treatment

Adam Phillips has argued that, contrary to what common sense might expect, therapeutic cure involves the patient being encouraged to re-experience “a terrible narcissistic wound” – the child’s experience of exclusion by the parental alliance – in order to come to terms with, and learn again, the diminishing loss of omnipotence entailed by the basic “facts of life”.

Further Psychoanalytic Developments

Freud’s concept of what in his last book he called “early injuries to the self (injuries to narcissism)” was subsequently extended by a wide variety of psychoanalysts. Karl Abraham saw the key to adult depressions in the childhood experience of a blow to narcissism through the loss of narcissistic supply. Otto Fenichel confirmed the importance of narcissistic injury in depressives and expanded such analyses to include borderline personalities.

Edmund Bergler emphasized the importance of infantile omnipotence in narcissism, and the rage that follows any blow to that sense of narcissistic omnipotence; Annie Reich stressed how a feeling of shame-fuelled rage, when a blow to narcissism exposed the gap between one’s ego ideal and mundane reality; while Lacanians linked Freud on the narcissistic wound to Lacan on the narcissistic mirror stage.

Finally, object relations theory highlights rage against early environmental failures that left patients feeling bad about themselves when childhood omnipotence was too abruptly challenged.

Perfectionism

Narcissists are often pseudo-perfectionists and create situations in which they are the centre of attention. The narcissist’s attempts at being seen as perfect are necessary for their grandiose self-image. If a perceived state of perfection is not reached, it can lead to guilt, shame, anger or anxiety because the subject believes that they will lose the admiration and love of other people if they are imperfect.

Behind such perfectionism, self psychology would see earlier traumatic injuries to the grandiose self.

Criticism

Wide dissemination of Kohut’s concepts may at times have led to their trivialization. Neville Symington points out that “You will often hear people say, ‘Oh, I’m very narcissistic,’ or, ‘It was a wound to my narcissism.’ Such comments are not a true recognition of the condition; they are throw-away lines. To really recognise narcissism in oneself is profoundly distressing and often associated with denial.”

What is Love and Hate (Psychoanalysis)?

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Introduction

Love and hate as co-existing forces have been thoroughly explored within the literature of psychoanalysis, building on awareness of their co-existence in Western culture reaching back to the “odi et amo” of Catullus, and Plato’s Symposium.

Love and Hate in Freud’s Work

Ambivalence was the term borrowed by Sigmund Freud to indicate the simultaneous presence of love and hate towards the same object. While the roots of ambivalence can be traced back to breast-feeding in the oral stage, it was reinforced during toilet-training as well. Freudian followers such as Karl Abraham and Erik H. Erikson distinguished between an early sub-stage with no ambivalence at all towards the mother’s breast, and a later oral-sadistic sub-phase where the biting activity emerges and the phenomenon of ambivalence appears for the first time. The child is interested in both libidinal and aggressive gratifications, and the mother’s breast is at the same time loved and hated.

While during the pre-oedipal stages ambivalent feelings are expressed in a dyadic relationship between the mother and the child, during the oedipal conflict ambivalence is experienced for the first time within a triangular context which involves the child, the mother and the father. In this stage, both the boy and the girl develop negative feelings of jealousy, hostility and rivalry toward the parent of the same sex, but with different mechanisms for the two sexes. The boy’s attachment to his mother becomes stronger, and he starts developing negative feelings of rivalry and hostility toward the father. The boy wishes to destroy the father so that he can become his mother’s unique love object. On the other hand, the girl starts a love relationship with her father. The mother is seen by the girl as a competitor for the father’s love and so the girl starts feeling hostility and jealousy towards her. The negative feelings which arise in this phase coexist with love and affection toward the parent of the same sex and result in an ambivalence which is expressed in feelings, behaviour and fantasies. The negative feelings are a source of anxiety for the child who is afraid that the parent of the same sex would take revenge on him/her. In order to lessen the anxiety, the child activates the defence mechanism of identification, and identifies with the parent of the same sex. This process leads to the formation of the Super-Ego.

According to Freud, ambivalence is the precondition for melancholia, together with loss of a loved object, oral regression and discharge of the aggression toward the self. In this condition, the ambivalently loved object is introjected, and the libido is withdrawn into the self in order to establish identification with the loved object. The object loss then turns into an ego loss and the conflict between the Ego and the Super-Ego becomes manifested. The same ambivalence occurs in the obsessional neurosis, but there it remains related to the outside object.

In the Work of Melanie Klein

The object relations theory of Melanie Klein pivoted around the importance of love and hate, concern for and destruction of others, from infancy onwards. Klein stressed the importance of inborn aggression as a reflection of the death drive and talked about the battle of love and hatred throughout the life span. As life begins, the first object for the infant to relate with the external world is the mother. It is there that both good and bad aspects of the self are split and projected as love and hatred to the mother and the others around her later on: as analyst, she would find herself split similarly into a “nice” and a “bad” Mrs Klein.

During the paranoid-schizoid position, the infant sees objects around it either as good or bad, according to his/her experiences with them. They are felt to be loving and good when the infant’s wishes are gratified and happy feelings prevail. On the other hand, objects are seen as bad when the infant’s wishes are not met adequately and frustration prevails. In the child’s world there is not yet a distinction between fantasy and reality; loving and hating experiences towards the good and bad objects are believed to have an actual impact on the surrounding objects. Therefore, the infant must keep these loving and hating emotions as distinct as possible, because of the paranoid anxiety that the destructive force of the bad object will destroy the loving object from which the infant gains refuge against the bad objects. The mother must be either good or bad and the feeling experienced is either love or hate.

Emotions become integrated as a part of the development process. As the infant’s potential to tolerate ambivalent feelings with the depressive position, the infant starts forming a perception of the objects around it as both good and bad, thus tolerating the coexistence of these two opposite feelings for the same object where experience had previously been either idealised or dismissed as bad, the good object can be accepted as frustrating without losing its acceptable status. When this takes place, the previous paranoid anxiety (that the bad object will destroy everything) transforms into a depressive anxiety; this is the intense fear that the child’s own destructiveness (hate) will damage the beloved others. Subsequently, for the coexistence of love and hate to be attainable, the child must believe in her ability to contain hate, without letting it destroy the loving objects. He/she must believe in the prevalence of the loving feelings over his/her aggressiveness. Since this ambivalent state is hard to preserve, under difficult circumstances it is lost, and the person returns to the previous manner keeping love and hate distinct for a period of time until he/she is able to regain the capacity for ambivalence.

Refer to The Life and Death Instincts in Kleinian Object Relations Theory.

In the Work of Ian Suttie

Ian Dishart Suttie (1898-1935) wrote the book The Origins of Love and Hate, which was first published in 1935, a few days after his death. He was born in Glasgow and was the third of four children. His father was a general practitioner, and Ian Suttie and both of his brothers and his sister became doctors as well. He qualified from Glasgow University in 1914. After a year he went into psychiatry.

Although his work has been out of print in England for some years, it is still relevant today. It has been often cited and makes a contribution towards understanding the more difficult aspects of family relationships and friendships. He can be seen as one of the first significant object relations theorists and his ideas anticipated the concepts put forward by modern self psychologists.

Although Ian Suttie was working within the tradition set by Freud, there were a lot of concepts of Freud’s theory he disagreed with. First of all, Suttie saw sociability, the craving for companionship, the need to love and be loved, to exchange and to participate, to be as primary as sexuality itself. And in contrast with Freud he didn’t see sociability and love simply as a derivative from sexuality. Secondly, Ian Suttie explained anxiety and neurotic maladjustment, as a reaction on the failure of finding a response for this sociability; when primary social love and tenderness fails to find the response it seeks, the arisen frustration will produce a kind of separation anxiety. This view is more clearly illustrated by a piece of writing of Suttie himself: ‘Instead of an armament of instincts, latent or otherwise, the child is born with a simple attachment-to-mother who is the sole source of food and protection… the need for a mother is primarily presented to the child mind as a need for company and as a discomfort in isolation’.

Ian Suttie saw the infant as striving from the first to relate to his mother, and future mental health would depend on the success or failure of this first relationship (object relations). Another advocate of the object relations paradigm is Melanie Klein. Object relations was in contrast with Freud’s psychoanalysis. The advocates of this object relations paradigm all, in exception of Melanie Klein, held the opinion that most differences in individual development that are of importance for mental health could be traced to differences in the way children were treated by their parents or to the loss or separation of parent-figures. In the explanation of the love and hate relationship by Ian Suttie, the focus, not surprisingly, lies in relations and the social environment. According to Suttie, Freud saw love and hate as two distinct instincts. Hate had to be overcome with love, and because both terms are seen as two different instincts, this means repression. In Suttie’s view however, this is incompatible with the other Freudian view that life is a struggle to attain peace by the release of the impulse. These inconsistencies would be caused by leaving out the social situations and motives. Suttie saw hate as the frustration aspect of love. “The greater the love, the greater the hate or jealousy caused by its frustration and the greater the ambivalence or guilt that may arise in relation to it.” Hate has to be overcome with love by the child removing the cause of the anxiety and hate by restoring harmonious relationships. The feeling of anxiety and hate can then change back into the feeling of love and security. This counts for the situation between mother and child and later for following relationships.

In Suttie’s view, the beginning of the relationship between mother and child is a happy and symbiotic one as well. This happy symbiotic relationship between mother and baby can be disrupted by for example a second baby or the mother returning to work. This makes the infant feel irritable, insecure and anxious. This would be the start of the feeling of ambivalence: feelings of love and hate towards the mother. The child attempts to remove the cause of the anxiety and hate to restore the relationship (retransforming). This retransforming is necessary, because hate of a loved object (ambivalence) is intolerable.

In the Work of Edith Jacobson

The newborn baby is not able to distinguish the self from others and the relationship with the mother is symbiotic, with the two individuals forming a unique object. In this period, the child generates two different images of the mother. On one hand there is the loving mother, whose image derives from experiences of love and satisfaction in the relationship with her. On the other hand, there is the bad mother, whose image derives from frustrating and upsetting experiences in the relationship. Since the child at this stage is unable to distinguish the self from the other, those two opposite images are often fused and confused, rather than distinguished. At about six months of age, the child becomes able to distinguish the self from the others. He now understands that his mother can be both gratifying and frustrating, and he starts experiencing himself as being able to feel both love and anger.

This ambivalence results in a vacillation between attitudes of passive dependency on the omnipotent mother and aggressive strivings for self expansion and control over the love object. The passive-submissive and active-aggressive behaviour of the child during the pre-oedipal and the early oedipal period is determined by his ambivalent emotional fluctuations between loving and trusting admirations of his parents and disappointed depreciation of the loved objects. The ego can use this ambivalence conflicts to distinguish between the self and the object. At the beginning, the child tends to turn aggression toward the frustrating objects and libido towards the self. Hence, frustration, demands and restrictions imposed by parents within normal bounds, reinforce the process of discovery and distinction of the object and the self. When early experiences of severe disappointment and abandonment have prevented the building up of un-ambivalent object relations and stable identifications and weakened the child’s self-esteem, they may result in ambivalence conflict in adulthood, which in turn causes depressive states.

Who was Melanie Klein?

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Introduction

Melanie Klein (née Reizes; 30 March 1882 to 22 September 1960) was an Austrian-British author and psychoanalyst known for her work in child analysis.

She was the primary figure in the development of object relations theory. Klein suggested that pre-verbal existential anxiety in infancy catalysed the formation of the unconscious, resulting in the unconscious splitting of the world into good and bad idealisations. In her theory, how the child resolves that split depends on the constitution of the child and the character of nurturing the child experiences; the quality of resolution can inform the presence, absence, and/or type of distresses a person experiences later in life.

Life

Melanie Klein, 1952
Melanie Klein in 1952.

Melanie Klein was born into a Jewish family and spent most of her early life in Vienna. She was the fourth and final child of parents Moriz, a doctor, and Libussa Reizes. Educated at the Gymnasium, Klein planned to study medicine. Her family’s loss of wealth caused her to change her plans.

At the age of 21 she married an industrial chemist, Arthur Klein, and soon after gave birth to their first child, Melitta. Her son Hans followed in 1907 and her second son Erich was born in 1914. While she would go on to bear two additional children, Klein suffered from clinical depression, with these pregnancies taking quite a toll on her. This and her unhappy marriage soon led Klein to seek treatment. Shortly after her family moved to Budapest in 1910, Klein began a course of therapy with psychoanalyst Sándor Ferenczi. It was during their time together that Klein expressed interest in the study of psychoanalysis.

Encouraged by Ferenczi, Klein began her studies by observing her own children. Until this time, only minimal documentation existed on the topic of psychoanalysis in children, Klein took advantage of this by developing her “play technique”. Similar to that of free association in adult psychoanalysis, Klein’s play technique sought to interpret the unconscious meaning behind the play and interaction of children.

During 1921, with her marriage failing, Klein moved to Berlin where she joined the Berlin Psycho-Analytic Society under the tutelage of Karl Abraham. Although Abraham supported her pioneering work with children, neither Klein nor her ideas received much support in Berlin. As a divorced woman whose academic qualifications did not even include a bachelor’s degree, Klein was a visible iconoclast within a profession dominated by male physicians. Nevertheless, Klein’s early work had a strong influence on the developing theories and techniques of psychoanalysis, particularly in the UK.

Her theories on human development and defence mechanisms were a source of controversy, as they conflicted with Freud’s theories on development, and caused much discussion in the world of developmental psychology. Around the same time Klein presented her ideas, Anna Freud was doing the very same. The two became unofficial rivals of sorts, amid the protracted debates between the followers of Klein and the followers of Freud. Amid these so-called ‘controversial discussions’, the British Psychoanalytical Society split into three separate training divisions:

  • Kleinian;
  • Freudian; and
  • Independent.

These debates finally ceased with an agreement on a dual approach to instruction in the field of child analysis.

Contributions to Psychoanalysis

Klein was one of the first to use traditional psychoanalysis with young children. She was innovative in both her techniques (such as working with children using toys) and her theories on infant development. Gaining the respect of those in the academic community, Klein established a highly influential training programme in psychoanalysis.

By observing and analysing the play and interactions of children, Klein built onto the work of Freud’s unconscious mind. Her dive into the unconscious mind of the infant yielded the findings of the early Oedipus complex, as well as the developmental roots of the superego.

Klein’s theoretical work incorporates Freud’s belief in the existence of the death pulsation, reflecting the notion that all living organisms are inherently drawn toward an “inorganic” state, and therefore, somehow, towards death. In psychological terms, Eros (properly, the life pulsation), the postulated sustaining and uniting principle of life, is thereby presumed to have a companion force, Thanatos (death pulsation), which seeks to terminate and disintegrate life. Both Freud and Klein regarded these “biomental” forces as the foundations of the psyche. These primary unconscious forces, whose mental matrix is the id, spark the ego – the experiencing self – into activity. Id, ego and superego, to be sure, were merely shorthand terms (similar to the instincts) referring to highly complex and mostly uncharted psychodynamic operations.

Infant Observations

Klein’s work on the importance of observing infants began in 1935 with a public lecture on weaning.

Klein states that mother-infant relationships are built on more than feeding and developing the infant’s attachment; the mother’s attachment and bond with her baby is just as important, if not more. Klein came to this conclusion by using actual observations of herself and mothers that she knew. She described how infants show interest in their mothers’ face, the touch of their mothers’ hands, and the infants’ pleasure in touching their mothers’ breast. The relationship is built on affection that emerges very soon after birth. Klein says that as early as two months, infants show interest in the mother that goes beyond feeding. She observed that the infant will often smile up at the mother and cuddle against her chest. The way the infant reacts and responds to their mother’s attitude and feelings, the love and interest which the infant shows, accounts for an object relation.

Klein also goes on to say that infants recognise the joy that their achievements give their parents. These achievements include crawling and walking. In one observation, Klein says that the infant wishes to evoke love in their mother with their achievements. The infant wishes to give her pleasure. Klein says that the infant notices that their smile makes their mother happy and results in the attention of her. The infant also recognises that their smile may serve a better purpose than their cry.

Klein also talks about the “apathetic” baby. She says that it is easy to mistake a baby that does not particularly dislike their food and cries a little for a happy baby. Development later shows that some of these easy-going babies are not happy. Their lack of crying may be due to some kind of apathy. It is hard to assess a young person’s state of mind without allowing for a great complexity of emotions. When these babies are followed up on we see that a great deal of difficulty appears. These children are often shy of people, and their interest in the external world, play, and learning is inhibited. They are often slow at learning to crawl and walk because there seems to be little incentive. They are often showing signs of neurosis as their development goes on.

Child Analysis

While Freud’s ideas concerning children mostly came from working with adult patients, Klein was innovative in working directly with children, often as young as two years old. Klein saw children’s play as their primary mode of emotional communication. While observing children as they played with toys such as dolls, animals, plasticine or pencils and paper, Klein documented their activities and interactions. She then attempted to interpret the unconscious meaning behind their play. Following Freud, she emphasized the significant role that parental figures played in the child’s fantasy life and concluded that the timing of Freud’s Oedipus complex was incorrect. Contradicting Freud, she proposed that the superego was present from birth.

After exploring ultra-aggressive fantasies of hate, envy, and greed in very young and disturbed children, Melanie Klein proposed a model of the human psyche that linked significant oscillations of state, with the postulated Eros or Thanatos pulsations. She named the state of the mind in which the sustaining principle of life dominates the depressive position. A depressive position is the understanding that good and evil things are one. The fears and worries about the fate of the people destroyed in the child’s fantasy are all in the latter. The child tries to repair his mother through phantasm and behaviour therapy, overcoming his depression and anxiety. He employs phantasies representing love and restoration to restore the others he destroyed. Morality is based on the standpoint of depression. Klein named it the depressive position because the efforts to restore the integrity of the damaged object are accompanied by depression and despair. After all, the child doubts whether it can fix everything it hurts. Many consider this to be her most significant contribution to psychoanalytic philosophy. She later developed her ideas about an earlier developmental psychological state corresponding to the disintegrating tendency of life, which she called the paranoid-schizoid position. Klein coined the term “paranoid-schizoid defence” to emphasize how the child’s worries manifest as persecution fantasies and how he defends himself against persecution by separating. The paranoid-schizoid position develops at birth is a common psychotic condition.

Klein’s insistence on regarding aggression as an important force in its own right when analysing children brought her into conflict with Freud’s daughter Anna Freud, who was one of the other prominent child psychotherapists in continental Europe but who moved to London in 1938 where Klein had been working for several years. Many controversies arose from this conflict, and these are often referred to as the controversial discussions. Battles were played out between the two sides, each presenting scientific papers, working out their respective positions and where they differed, during war-time Britain. A compromise was eventually reached whereby three distinct training groups were formed within the British Psychoanalytical Society, with Anna Freud’s influence remaining largely predominant in the US.

Object Relation Theory

Klein is known to be one of the primary founders of object relations theory. This theory of psychoanalysis is based on the assumption that all individuals have within them an internalised, and primarily unconscious realm of relationships. These relationships refer not only to the world around the individual, but more specifically to other individuals surrounding the subject. Object relation theory focuses primarily on the interaction individuals have with others, how those interactions are internalized, and how these now internalised object relations affect one’s psychological framework. The term “object” refers to the potential embodiment of fear, desire, envy or other comparable emotions. The object and the subject are separated, allowing for a more simplistic approach to addressing the deprived areas of need when used in the clinical setting.

Klein’s approach differed from Anna Freuds ego-psychology approach. Klein explored the interpersonal aspect of the structural model. In the mid-1920s, she thought differently about the first mode of defence. Klein thought it was expulsion while Freud speculated it was repression (Stein, 1990). Klein suggested that the infant could relate – from birth – to its mother, who was deemed either “good” or “bad” and internalised as archaic part-object, thereby developing a phantasy life in the infant. Because of this supposition, Klein’s beliefs required her to proclaim that an ego exists from birth, enabling the infant to relate to others early in life (Likierman & Urban, 1999).

Influence on Feminism

In Dorothy Dinnerstein’s book The Mermaid and the Minotaur (1976) (also published in the UK as The Rocking of the Cradle and the Ruling of the World), drawing from elements of Sigmund Freud’s psychoanalysis, particularly as developed by Klein, Dinnerstein argued that sexism and aggression are both inevitable consequences of child rearing being left exclusively to women. As a solution, Dinnerstein proposed that men and women equally share infant and child care responsibilities. This book became a classic of US second-wave feminism and was later translated into seven languages.

Feminists critical of Klein’s work have drawn attention to an unwarranted assumption of a natural causality connecting sex, gender and desire, stereotypical gender descriptions and in general a prescriptive normative privileging of heterosexual dynamics.

In Popular Culture

  • Melanie Klein was the subject of a 1988 play by Nicholas Wright, entitled Mrs. Klein. Set in London in 1934, the play involves a conflict between Melanie Klein and her daughter Melitta Schmideberg, after the death of Melanie’s son Hans Klein. The depiction of Melanie Klein is quite unfavorable: the play suggests that Hans’ death was a suicide and also reveals that Klein had analysed these two children. In the original production at the Cottesloe Theatre in London, Gillian Barge played Melanie Klein, with Zoë Wanamaker and Francesca Annis playing the supporting roles. In the 1995 New York revival of the play, Melanie Klein was played by Uta Hagen, who described Melanie Klein as a role that she was meant to play. The play was broadcast on the British radio station BBC 4 in 2008 and revived at the Almeida Theatre in London in October 2009 with Clare Higgins as Melanie Klein.
  • The indie band Volcano Suns dedicated their first record “The Bright Orange Years” to Klein for her work on childhood aggression.
  • Scottish author Alexander McCall Smith makes extensive use of Melanie Klein and her theories in his 44 Scotland Street series. One of the characters, Irene, has an obsession with Kleinian theory, and uses it to “guide” her in the upbringing of her son, Bertie.

What is a Negative Therapeutic Reaction?

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Introduction

The negative therapeutic reaction in psychoanalysis is the paradoxical phenomenon whereby a plausible interpretation produces, rather than improvement, a worsening of the analysand’s condition.

Freud’s Formulations

Freud first named the negative therapeutic reaction in The Ego and the Id of 1923, seeing its cause, not merely in the analysand’s desire to be superior to their analyst, but (more deeply) in an underlying sense of guilt: “the obstacle of an unconscious sense of guilt….they get worse during the treatment instead of getting better”. The following year he offered the alternative formulation of a need for punishment instead; but in his thirties summation it was again unconscious guilt to which he attributed “the negative therapeutic reaction which is so disagreeable from the prognostic point of view”.

Precursors to the idea can be found in his own article Criminals from a sense of guilt, as well as in Karl Abraham’s 1919 article on envy and narcissism as enemies of the analytic work.

Later Developments

The negative therapeutic reaction is unusual in psychoanalytic history in never being the subject of major controversy, while still be steadily worked on and reformulated in later analytic phases. These have added additional motivations behind the reaction to that singled out by Freud. Joan Riviere pointed to the neurotic’s fear of any change in condition, even from worse to better, while the desire to spite the analyst may also be a motive. Lacan highlighted the role of amour propre in the hatred of being helped by any outside force. Object relations theory has also pointed to the way that underdoing defences means the patient experiencing their underlying conflicts more fully, and reacting negatively to that.

What is Working Through?

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Introduction

In psychodynamic psychotherapy, working through is seen as the process of repeating, elaborating, and amplifying interpretations. It is believed that such working through is critical towards the success of therapy.

The concept was introduced by Sigmund Freud in 1914, and assumed ever greater importance in psychoanalysis, in contrast to the immediacy of abreaction.

Interpretation and Resistance

Interpretations are made when the client comes up with some material, be it written, a piece of art, music, or verbal, and are intended to bring the material offered into connection with the unconscious mind. Because of the resistance to accepting the unconscious, interpretations, whether correct or partially incorrect, consciously accepted or rejected, will inevitably require amplifying and extending to other aspects of the client’s life.

In a process Sandor Rado compared to the labour of mourning, the unconscious content must be demonstrated repeatedly in all its various forms and linkages – the process of working through.

Because of the power of resistance, the client’s rational thought and conscious awareness may not be sufficient on their own to overcome the maladjustment, entailing further interpretation and further working through.

Rat Man

Before formulating the concept of working through, in his case study of the Rat Man, Freud wrote of his interpretations:

“It is never the aim of discussions like these to create convictions. They are only intended to bring the repressed complexes into consciousness…and to facilitate the emergence of fresh material from the unconscious. A sense of conviction is only attained after the patient has himself worked over the reclaimed material”.

Transference

The necessity of working through the transference is stressed in almost all forms of psychodynamic therapy, from object relations theory, through the openings offered for working through by transference disruption in self psychology, to the repetitive exploration of the transference in group therapy.

What is Paranoid Anxiety?

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Introduction

Paranoid anxiety is a term used in object relations theory, particularity in discussions about the Paranoid-schizoid and depressive positions.

The term was frequently used by Melanie Klein, especially to refer to a pre-depressive and persecutory sense of anxiety characterised by the psychological splitting of objects.

Further Developments

Donald Meltzer saw paranoid anxiety as linked not only to a loss of trust in the goodness of objects, but also to a confusion between feeling and thought.

For the extreme forms of such anxiety, he coined the term ‘terror’, to convey something of the qualitatively different intensity of their nature.

External Sources

Sigmund Freud considered that there was generally a small kernel of truth hidden in the exaggerated anxiety of the paranoid – what Hanns Sachs described as an amoeba about to become monster.

The anti-psychiatrist David Cooper argued indeed that “The therapist in working with people might far more often have to confirm the reality of paranoid fears than in any sense disconfirm or attempt to modify them”, but most family therapists would probably agree that this is an extreme and one-sided position.

Defensive Functions

Idealisation (as in the transference) can be used as a defence against deeper paranoid anxieties about the actual presence of a destructive, denigrating object.

Conversely, paranoid fears, especially when systematised, may themselves serve as a defence against a deeper, chaotic disintegration of the personality.

Persecutory Anxiety State (Panic Attack) and Persecutory Delusion

Paranoid anxiety may reach the level of a persecutory anxiety state (a form of panic attack), including various levels of persecutory delusions (the preferred term to paranoid delusions).

Heavy drinking is said to sometimes precipitate acute paranoid panic – the protagonist’s unconscious hostile impulses being projected onto all those around.

Literary Examples

Hamm in Endgame by Samuel Beckett has been singled out as a character driven by paranoid anxiety.

Noboru in The Sailor Who Fell from Grace with the Sea by Yukio Mishima is shown to have persecutory anxiety.

What is Splitting (Psychology)?

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Introduction

Splitting (also called black-and-white thinking or all-or-nothing thinking) is the failure in a person’s thinking to bring together the dichotomy of both positive and negative qualities of the self and others into a cohesive, realistic whole.

It is a common defence mechanism. The individual tends to think in extremes (i.e. an individual’s actions and motivations are all good or all bad with no middle ground).

Splitting was first described by Ronald Fairbairn in his formulation of object relations theory; it begins as the inability of the infant to combine the fulfilling aspects of the parents (the good object) and their unresponsive aspects (the unsatisfying object) into the same individuals, instead seeing the good and bad as separate. In psychoanalytic theory this functions as a defence mechanism.

Refer to Emotional Conflict and Psychological Projection.

Relationships

Splitting creates instability in relationships because one person can be viewed as either personified virtue or personified vice at different times, depending on whether they gratify the subject’s needs or frustrate them. This, along with similar oscillations in the experience and appraisal of the self, leads to chaotic and unstable relationship patterns, identity diffusion, and mood swings. The therapeutic process can be greatly impeded by these oscillations, because the therapist too can come to be seen as all good or all bad. To attempt to overcome the negative effects on treatment outcome, constant interpretations by the therapist are needed.

Splitting contributes to unstable relationships and intense emotional experiences. Splitting is common during adolescence, but is regarded as transient. Splitting has been noted especially with persons diagnosed with borderline personality disorder. Treatment strategies have been developed for individuals and groups based on dialectical behaviour therapy, and for couples. There are also self-help books on related topics such as mindfulness and emotional regulation that claim to be helpful for individuals who struggle with the consequences of splitting.

Borderline Personality Disorder

Refer to Borderline Personality Disorder.

Splitting is a relatively common defence mechanism for people with borderline personality disorder. One of the DSM IV-TR criteria for this disorder is a description of splitting: “a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation”. In psychoanalytic theory, people with borderline personality disorder are not able to integrate the good and bad images of both self and others, resulting in a bad representation which dominates the good representation.

Narcissistic Personality Disorder

Refer to Narcissistic Personality Disorder.

People matching the diagnostic criteria for narcissistic personality disorder also use splitting as a central defence mechanism. Most often narcissists do this as an attempt to stabilise their sense of self-positivity in order to preserve their self-esteem, by perceiving themselves as purely upright or admirable and others who do not conform to their will or values as purely wicked or contemptible.

The cognitive habit of splitting also implies the use of other related defence mechanisms, namely idealisation and devaluation, which are preventive attitudes or reactions to narcissistic rage and narcissistic injury.

Depression

In depression, exaggerated all-or-nothing thinking can form a self-reinforcing cycle: these thoughts might be called emotional amplifiers because, as they go around and around, they become more intense. Typical all-or-nothing thoughts:

  • My efforts are either a success or they are an abject failure.
  • Other people are either all good or all bad.
  • I am either all good or all bad.
  • If you’re not with us, you’re against us.

Janet, Bleuler and Freud

Refer to Pierre Janet, Eugen Bleuler, and Sigmund Freud.

Splitting of consciousness (“normal self” vs. “secondary self”) was first described by Pierre Janet in De l’automatisme psychologique (1889). His ideas were extended by Bleuler (who in 1908 coined the word schizofrenia from the Ancient Greek skhízō [σχῐ́ζω, “to split”] and phrḗn [φρήν, “mind”]) and Freud to explain the splitting (German: Spaltung) of consciousness – not (with Janet) as the product of innate weakness, but as the result of inner conflict. With the development of the idea of repression, splitting moved to the background of Freud’s thought for some years, being largely reserved for cases of double personality. However, his late work saw a renewed interest in how it was “possible for the ego to avoid a rupture… by effecting a cleavage or division of itself”, a theme which was extended in his Outline of Psycho-Analysis (1940a [1938]) beyond fetishism to the neurotic in general.

His daughter Anna Freud explored how, in healthy childhood development, a splitting of loving and aggressive instincts could be avoided.

Melanie Klein

Refer to Melanie Klein.

There was, however, from early on, another use of the term “splitting” in Freud, referring rather to resolving ambivalence “by splitting the contradictory feelings so that one person is only loved, another one only hated … the good mother and the wicked stepmother in fairy tales”. Or, with opposing feelings of love and hate, perhaps “the two opposites should have been split apart and one of them, usually the hatred, has been repressed”. Such splitting was closely linked to the defence of “isolation … The division of objects into congenial and uncongenial ones … making ‘disconnections’.”

It was the latter sense of the term that was predominantly adopted and exploited by Melanie Klein. After Freud, “the most important contribution has come from Melanie Klein, whose work enlightens the idea of ‘splitting of the object’ (Objektspaltung) (in terms of ‘good/bad’ objects)”. In her object relations theory, Klein argues that “the earliest experiences of the infant are split between wholly good ones with ‘good’ objects and wholly bad experiences with ‘bad’ objects”, as children struggle to integrate the two primary drives, love and hate, into constructive social interaction. An important step in childhood development is the gradual depolarization of these two drives.

At what Klein called the paranoid-schizoid position, there is a stark separation of the things the child loves (good, gratifying objects) and the things the child hates (bad, frustrating objects), “because everything is polarised into extremes of love and hate, just like what the baby seems to experience and young children are still very close to.” Klein refers to the good breast and the bad breast as split mental entities, resulting from the way “these primitive states tend to deconstruct objects into ‘good’ and ‘bad’ bits (called ‘part-objects’)”. The child sees the breasts as opposite in nature at different times, although they actually are the same, belonging to the same mother. As the child learns that people and objects can be good and bad at the same time, he or she progresses to the next phase, the depressive position, which “entails a steady, though painful, approximation towards the reality of oneself and others”: integrating the splits and “being able to balance [them] out … are tasks that continue into early childhood and indeed are never completely finished.”

However, Kleinians also utilize Freud’s first conception of splitting, to explain the way “In a related process of splitting, the person divides his own self. This is called ‘splitting of the ego’.” Indeed, Klein herself maintained that “the ego is incapable of splitting the object—internal or external—without a corresponding splitting taking place within the ego”. Arguably at least, by this point “the idea of splitting does not carry the same meaning for Freud and for Klein”: for the former, “the ego finds itself ‘passively’ split, as it were. For Klein and the post-Kleinians, on the other hand, splitting is an ‘active’ defence mechanism”. As a result, by the close of the century “four kinds of splitting can be clearly identified, among many other possibilities” for post-Kleinians: “a coherent split in the object, a coherent split in the ego, a fragmentation of the object, and a fragmentation of the ego.”

Otto Kernberg

Refer to Otto Kernberg.

In the developmental model of Otto Kernberg, the overcoming of splitting is also an important developmental task. The child has to learn to integrate feelings of love and hate. Kernberg distinguishes three different stages in the development of a child with respect to splitting:

  • The child does not experience the self and the object, nor the good and the bad as different entities.
  • Good and bad are viewed as different. Because the boundaries between the self and the other are not stable yet, the other as a person is viewed as either all good or all bad, depending on their actions. This also means that thinking about another person as bad implies that the self is bad as well, so it’s better to think about the caregiver as a good person, so the self is viewed as good too. “Bringing together extremely opposite loving and hateful images of the self and of significant others would trigger unbearable anxiety and guilt.”
  • Splitting – “the division of external objects into ‘all good’ or ‘all bad'” – begins to be resolved when the self and the other can be seen as possessing both good and bad qualities. Having hateful thoughts about the other does not mean that the self is all hateful and does not mean that the other person is all hateful either.

If a person fails to accomplish this developmental task satisfactorily, borderline pathology can emerge. “In the borderline personality organization”, Kernberg found ‘dissociated ego states that result from the use of “splitting” defences’. His therapeutic work then aimed at “the analysis of the repeated and oscillating projections of unwanted self and object representations onto the therapist” so as to produce “something more durable, complex and encompassing than the initial, split-off and polarized state of affairs”.

Horizontal and Vertical

Heinz Kohut has emphasized in his self psychology the distinction between horizontal and vertical forms of splitting. Traditional psychoanalysis saw repression as forming a horizontal barrier between different levels of the mind – so that for example an unpleasant truth might be accepted superficially but denied in a deeper part of the psyche. Kohut contrasted with this vertical fractures of the mind into two parts with incompatible attitudes separated by mutual disavowal.

Transference

Refer to Transference.

It has been suggested that interpretation of the transference “becomes effective through a sort of splitting of the ego into a reasonable, judging portion and an experiencing portion, the former recognizing the latter as not appropriate in the present and as coming from the past”. Clearly, “in this sense, splitting, so far from being a pathological phenomenon, is a manifestation of self-awareness”. Nevertheless, “it remains to be investigated how this desirable ‘splitting of the ego’ and ‘self-observation’ are to be differentiated from the pathological cleavage … directed at preserving isolations”.