FT DQ10

This presentation will explore several concepts and techniques within the Object Relations theory  of family therapy which,  if understood, provides a framework for looking at couples and families. Before talking about this approach to family therapy, I would like to explain what object relations theory is all about.Object Relations Theory was originated in England by a group of British psychoanalysts, including Klein, Balint, Fairburn, Winnicott, and Guntrip.  Object relations theory was a break from Freud’s drive model, and differs from it as follows:Freud’s  model  held  that  a  newborn  infant  is  driven  by  animal instincts, such as hunger, thirst, and pleasure, but cannot relate to others. Relationships with others only develop later in the course of satisfying  those  needs. In this sense, Freud’s model considers relationships to be secondary.In  contrast, object relations theory maintains that the infant  can relate to others at a very early age and  that  relationships  with others  are,  therefore,  primary.  The drive to attach oneself to  an object is considered to be the major motivating force.Since we are talking about object relations theory, this is a good time to ask what an object is.  In object relations theory, the word object is used with a very specific meaning. It’s not  literally  a physical  person, but an internal mental structure that is formed throughout early development.   This mental structure is built through a series of experiences with significant others  through a psychic process called introjection.  Because an infant’s earliest experiences are usually with its mother,  she is usually the first internal object formed  by the infant.   Eventually,  the father and other significant people also become internalized objects.Introjection, the process of creating internal mental objects, leads to another process called splitting.   Splitting occurs because  the infant  cannot  tolerate certain feelings such as  rage  and  longing, which occur in all normal development.  As a result, the infant has to split  off  parts of itself and repress them.  What happens  to  those repressed  split-off  parts?  They  are  dealt  with  through  another important process, called projective identification.   Projective  identification  itself  is a very specific part of object relations theory.  It is a defense mechanism which was conceptualized by Melanie Klein in 1946,  having evolved from her extensive study and work  with children.   According to Klein,  projective  identification consists  of  splitting off parts of the self,  projecting  them  into another person, and then identifying with them in the other person.For example,  the earliest relationship the infant  has with its mother is  feeding and touching, but the mother is not always able to  respond quickly enough to the infant’s need.  Since the natural rage and longing the infant feels at such times are intolerable,  to survive these feelings the  infant   “splits   them  off” and  represses  them   from   its consciousness.  The  “split off”feelings can be thought of as  other parts of the self (ego).When  such splitting takes place,  the infant is free of the rage but has placed that part of itself inside the mother. To make itself whole again  it  must identify with the mother.  The mother may or  may  not allow herself to become the container for the infant’s negative feelings.  Even if she doesn’t, the projective identification still occurs.The above process begins in the first half year of life,  known as the paranoid-schizoid  position.  It  is characterized by  an  ability  to distinguish  good feelings from bad,  but an inability to  distinguish the mother from the self. Depending on how consistent the mothering is, the infant may or  may not  progress to a higher level of development known as the depressive position.  In  the depressive position,  which starts at  about  eight months of age,  the child takes back its bad feelings from the mother and separates from her.  The mother is now seen as a separate  object, with both good and bad feelings of her own. The infant is aware of its own good and bad feelings.For a child to reach this level of development,  the earlier mothering must be consistent. The mother must have accepted most of the child’s projected feelings.  A child who reaches the depressive position will, in adulthood,  be capable of experiencing,  at best, such feelings as empathy, or will at least become neurotic.In contrast,  if the mothering is not consistent, the child can’t take back  its  projected feelings and splitting continues both inside  and outside the child. It remains in the paranoid-schizoid position or, at best, a precarious  form of the depressive position.  This type of development is associated with borderline personalities.In the above infant-mother example, the repressed parts of the self, if unresolved, will remain repressed into adulthood.  Those parts will govern the choice of marital partner and the nature of marital relationships, and by extension the nature of relationships with children. By  the  time  the couple or family come to  therapy  the  projective identification  process  has likely progressed to the point  of  being obvious to the therapist, and will be seen in the members’  behavior toward each other.   This is usually not so in individual therapy because it often takes time to build the  transference relationship with the therapist. So what does this mean for the therapist?   What does a therapist have to  know   in order to work with a family, using the object  relations  approach?   The therapist needs to be trained in individual  developmental theory from infancy to aging  and  to understand that the internal object world is built  up  in  a child,  modified in an adult and  re-enacted  in  the family.  The family has a developmental life cycle of its own,  and as it  goes  through its series of tasks from early nurturing of its  new members,  to  emancipation of its adolescents,  to taking care of  its aging members,  the family’s adaptation is challenged at every  stage by unresolved issues in the adult members’ early life cycle. Conflicts  within any of its individual family members may threaten to disrupt the adaption previously achieved.  If any member is unable  to adapt to new development,  pathology,  like projective identification, becomes a stumbling block to future healthy development.The clinical approach is to develop, with the family, an understanding of the nature and origins of their current interactional difficulties, starting  from their experience in the here-and-now of the therapeutic sessions, and exploring the unconscious intrapsychic and interpersonal conflicts   that   are   preventing   further   healthy   development.  Interpretation  and insight are thus the agents of family  change.  By uncovering the projective identifications that take place among family members, and  having  individuals take back  their  split-off  parts, members  can  be  freed to continue healthy  development.  If  further therapy  is indicated,  individual therapy would be a  recommendation.  Symptom reduction in individuals is not necessarily a goal here. In  fact,  individual  family members may become  more symptomatic  as projective  identifications are taken back and the members become more anxious.To do this, the therapist needs the following four capabilities:1. The ability to provide a “holding environment”for the family – a place  which  is consistent – so that eventually the family comes  to feel  comfortable  enough  to be themselves in  the  presence  of  the therapist.2.  An  ability to understand the “theme”of each session,  so that  a broad theme can be identified over the course of treatment.3.  An  ability to interpret the latent content of patients’  manifest statements.4.   An  understanding of unconscious processes like transference and countertransference.Given those tools,  it is the therapist’s job to uncover the projective identifications in the family that prevent the children from having  a healthy  development.  Once these projections are uncovered,  and  the split-off  parts  given  back to the family members  they  belong  to, children are freer to continue healthy development. Having introduced projective identification, I’d like to show how this process  operates  later  in life-in couples and families-and  is  a framework  for doing couple and family therapy.  I’m going to  present two cases-one of a couple and one of a family-to show how projective identification works.A male patient of mine with little ambition fell in love with a  woman who subsequently pushed him to be ambitious. As it turned out, the woman had been repressing her own ambition under pressure  from  a father who didn’t believe women should  work.   This woman  was quite intelligent and obtained a professional  degree,  yet she chose to stifle her ambition in order to please her  father.   She remained dependent on her father, both emotionally and financially.The  husband,  my patient,  was a professional but quite  unambitious.  His  family’s  philosophy was that one is lucky to have a job and  pay the  bills.   His father had held the same low paying job  for  twenty years although he, too, had a professional degree. So why did these two people get married?   Since it was  unacceptable for  her  to be ambitious,  the wife needed someone to  contain  those feelings for her.   My patient was the ideal object because,  although he  had  an  inner  ambition,  he had no parental  support  for  these strivings.  Therefore, he was predisposed to accept and collude in his wife’s projection. What  is  the  effect of projective identification when a  couple  has children?   The following example shows how parents use their children as objects.Fern  was a woman in her second marriage with two adolescent children.  When Fern was a child,  her mother favored her brother.   The  message she received from her mother was that men were important and had to be taken care of, while women were stupid and born to serve men.  Both of Fern’s  husbands  agreed with her mother’s philosophy,  so Fern spent most of her married life serving them.When  the family came to see me,  both children were having  emotional problems.   The  son was a heavy user of pot and cocaine.   His sister had emotional and learning problems in school. Fern had projected into her son that males were special and needed  to be taken care of. It’s not hard to see why the son colluded with his mother.  The rewards of accepting her projected feelings were too hard to  resist,  so when he reached adolescence he satisfied his excessive dependency needs with drugs. The  message Fern’s daughter received was that she was unimportant and stupid.   Why did Fern project these feelings onto her daughter?  Fern grew  up  unable to develop her own career goals  because  her  other ignored  her wishes to go to college.   For Fern to feel  sufficiently competent  and  achieve  some career success,  she had to get  rid  of feelings that she was stupid and unimportant.   So she projected those feelings  on  to  her  daughter and was then able  to  start  a  small business.  To avoid being totally rejected by her mother, the daughter colluded by remaining stupid and unimportant to herself.Fern’s reenactment with her daughter of her mother’s relationship with her is a form of projective identification called “identification with the aggressor,”because Fern is acting as if she is her own mother and her daughter is her (when she was a child). Fern’s relationship to her son  is also similar to the relationship Fern’s mother had  to  Fern’s brother.  Because  Fern is treating her children so differently,  when they grow up they will have very different views of this family.  This explains why,  in therapy,  siblings often talk about the same  family very differently.Notice  how unresolved feelings from childhood,  which Fern split  off and repressed,greatly affected her relationship with both  children.  What do you think is going on in her second marriage?Now  I  will  present  an actual transcript of part  of  a  session  I recently  had with this family.   As you will see,  it illustrates the process  of  projective identification and will serve as a  basis  for further discussion.T:  Fern, I wonder, when Donald was talking about being like Roberta and John asked him a question how did you feel?F:  What do you mean how did I feel?T:  When John asked Donald when he figured out that he was like Roberta and Donald said just now.J:  How do you feel about him saying just now.T:  And you changed the subject and I wondered what you were feeling.F:  I don’t know.  IT:  Donald owned up to some feelings that he was like his father and that part of what he saw in Roberta was like himself.F:  Donald is definitely part ofD:  No but what she’s saying is that you changed the subject.  That is why she’s wondering if you have some feelings about that.T:  Exactly.  You seemed to have moved away from what was going on here.  John was talking to DonaldR:  She doesn’t want us to be like our father.T:  Maybe that was upsetting to you?R:  He wasn’t good to her.D:  Subconsciously maybe.  It’s deep but it’s there.F:  Well, I don’t like Martin, naturally.  It’s true.  I don’t like him – I don’t think he’s a nice person.R:  You don’t like him at all?D:  She loves him but doesn’t like himF:  I loved him but I never liked him as a person. I never thought he was a good person;  that he really cared about me, that he took care of me, that he was ever concerned with me.  I remember a couple of things that – I remember having a bloody nose one night when I was pregnant and he went out to play racketball and left me alone.  Things like that – He was mean to me – he had no compassion for me.D:  That’s one thing, I’m not like my father.F:  I’m not saying – I’m trying to say I see certain characteristics of their father in them.T:  How does that make you feel?F:  How does that make me feel?  I don’t know.  I guess part of it, not too good because I would rather them be above that, that is, above that anger, why can’t they rise above that anger.  I don’t want them to be like that because it didn’t get Martin anyplace in life.J:  I have a very deep question.F:  I don’t know if I want to answer it.J:  You may not but how can you find that with Roberta and Donald being so much alike in personality, like Martin, how do you separate Donald’s being like Martin and accepting it from Roberta and saying Roberta is just like her father and not accepting it?F:  Because Donald never directed his anger at me as a person, as a human being.  In other words he never – he might have been angry but he never said to me – he never was mean to me, whereas Roberta has been mean to me, attacked me as a person, Donald never attacked me as a person.T:  Donald attacked himself as a person.D:  Hmm.T:  By taking drugs.F:  But he never attacked me as a person.D:  Never, I’m not a mean person.  I don’t have that mean streak in me.T:  You sure?F:   You may have it in youD:  I don’t have a mean streak.F:  Sure, everyoneT:  Who did you direct that meanness to? Roberta directs it out to her mother and who did you direct it to?D:  I direct it to her.T:  NoR:  No you directed it at yourself.D:  Myself, yeah – I’m mean to myself.F:  You were destructive to yourself.T:  So whatD:  But that’s different from being destructive to other human beings.F:  No, maybe you would have been better off being mean to me or somebody else.  Or to your father.R:  Let’s get back to Uncle John’s question.J:  No this is part of the answer.D:  Yeah – I’m mean to myself.  I still am.  But I don’t destroy myself with anything – with any kind of substances, but I still am.R:  What do you mean, you still are?D:  I’m hard on myself, critical of myself.R:  See, you would never think that of Donald because he walks around like he’s above the world.  He does.T:  But why would somebody walk -D:  But I’ve been working on that very heavily nowT:  But why would someoneD:  That’s the way I am; it’s the way I am.T:  Why would someone walk around like that.D:  It’s very basic – when I was on drugs and everything like that and I’m fully aware of it, aware that I’m conceited and like I have that air about me – I’m fully aware of it.  When I was on drugs I had that part to me but it wasn’t as strong as it is now.T:  You weren’t aware of it then?D:  I wasn’t really in control of the fact that I control my conceitedness now – I choose to put that on because I have nothing, I have nothing else now.T:  RightD:  It seems it’s like my only defense, to be arrogant and to be conceited because I don’t have anything else to back me up so I figure that wall.R:  Why do you need – I don’t need anything.D:  Roberta – because when I was on the drugs and everything like that, it was a great wall  for me to keep everybody out.  Now I want everybody to think big things.Respond to that lecture….Now  let’s  look at the latent content of this  session and identify the projective identifications.