Object relations theory attempts to explain the ups and downs of human relationships through a study of how internal representations of the self and others are organized. The clinical symptoms that suggest object relations problems typically developmental delays throughout life include disturbances in an individual's capacity to feel warmth, empathy, trust, sense of security, identity stability, consistent emotional closeness, and stability in relationships with significant others.
It is not suggested that one should trust everyone, for example. Concepts regarding internal representations also sometimes termed, "introspects", "self and object representations", or "internalization of self and other" although often attributed to Melanie Klein , were actually first mentioned by Sigmund Freud in his early concepts of drive theory Three Essays on the Theory of Sexuality , Freud's paper "Mourning and Melancholia", for example, hypothesized that unresolved grief was caused by the survivor's internalized image of the deceased becoming fused with that of the survivor, and then the survivor shifting unacceptable anger toward the deceased onto the now complex self-image.
Vamik Volkan , in "Linking Objects and Linking Phenomena", expanded on Freud's thoughts on this, describing the syndromes of "Established pathological mourning" vs. Margaret Mahler Mahler, Fine, and Bergman, The Psychological Birth of the Human Infant , and her group, first in New York, then in Philadelphia, described distinct phases and subphases of child development leading to "separation-individuation" during the first three years of life, stressing the importance of constancy of parental figures, in the face of the child's destructive aggression, to the child's internalizations, stability of affect management, and ability to develop healthy autonomy.
John Frosch, Otto Kernberg , Salman Akhtar and Sheldon Bach have developed the theory of self and object constancy as it affects adult psychiatric problems such as psychosis and borderline states. Peter Blos described in a book called On Adolescence , how similar separation-individuation struggles occur during adolescence, of course with a different outcome from the first three years of life: the teen usually, eventually, leaves the parents' house this varies with the culture.
During adolescence, Erik Erikson —s described the "identity crisis", that involves identity-diffusion anxiety. In order for an adult to be able to experience "Warm-ETHICS" warmth, empathy, trust, holding environment Winnicott , identity, closeness, and stability in relationships see Blackman, Defenses: How the Mind Shields Itself , , the teenager must resolve the problems with identity and redevelop self and object constancy.
Self psychology emphasizes the development of a stable and integrated sense of self through empathic contacts with other humans, primary significant others conceived of as "selfobjects". Selfobjects meet the developing self's needs for mirroring, idealization, and twinship, and thereby strengthen the developing self. The process of treatment proceeds through "transmuting internalizations" in which the patient gradually internalizes the selfobject functions provided by the therapist.
Lacanian psychoanalysis , which integrates psychoanalysis with structural linguistics and Hegelian philosophy, is especially popular in France and parts of Latin America. Lacanian psychoanalysis is a departure from the traditional British and American psychoanalysis, which is predominantly Ego psychology.
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Lacan's concepts concern the " mirror stage ", the "Real" , the "Imaginary" , and the "Symbolic" , and the claim that "the unconscious is structured as a language". Though a major influence on psychoanalysis in France and parts of Latin America, Lacan and his ideas have taken longer to be translated into English and he has thus had a lesser impact on psychoanalysis and psychotherapy in the English-speaking world. In the United Kingdom and the United States, his ideas are most widely used to analyze texts in literary theory. Interpersonal psychoanalysis accents the nuances of interpersonal interactions, particularly how individuals protect themselves from anxiety by establishing collusive interactions with others, and the relevance of actual experiences with other persons developmentally e.
This is contrasted with the primacy of intrapsychic forces, as in classical psychoanalysis. Some psychoanalysts have been labeled culturalist , because of the prominence they attributed culture in the genesis of behavior. Feminist theories of psychoanalysis emerged towards the second half of the 20th century, in an effort to articulate the feminine, the maternal and sexual difference and development from the point of view of female subjects. For Freud, male is subject and female is object. For Freud , Winnicott and the object relations theories, the mother is structured as the object of the infant's rejection Freud and destruction Winnicott.
For Lacan , the "woman" can either accept the phallic symbolic as an object or incarnate a lack in the symbolic dimension that informs the structure of the human subject. Feminist psychoanalysis is mainly post-Freudian and post-Lacanian with theorists like Toril Moi , Joan Copjec , Juliet Mitchell ,  Teresa Brennan  and Griselda Pollock ,  following French feminist psychoanalysis,  the gaze and sexual difference in, of and from the feminine.
The "adaptive paradigm of psychotherapy" develops out of the work of Robert Langs. The adaptive paradigm interprets psychic conflict primarily in terms of conscious and unconscious adaptation to reality. Relational psychoanalysis combines interpersonal psychoanalysis with object-relations theory and with inter-subjective theory as critical for mental health. It was introduced by Stephen Mitchell. Fonagy and Target, in London, have propounded their view of the necessity of helping certain detached, isolated patients, develop the capacity for "mentalization" associated with thinking about relationships and themselves.
Arietta Slade, Susan Coates , and Daniel Schechter in New York have additionally contributed to the application of relational psychoanalysis to treatment of the adult patient-as-parent, the clinical study of mentalization in parent-infant relationships, and the intergenerational transmission of attachment and trauma. The term interpersonal-relational psychoanalysis is often used as a professional identification. Psychoanalysts under this broader umbrella debate about what precisely are the differences between the two schools, without any current clear consensus.
The term " intersubjectivity " was introduced in psychoanalysis by George E. Atwood and Robert Stolorow Intersubjective approaches emphasize how both personality development and the therapeutic process are influenced by the interrelationship between the patient's subjective perspective and that of others. Fosshage, Donna M. Levenson, Jay Greenberg , Edward R. Ritvo, Beatrice Beebe, Frank M.
Lachmann, Herbert Rosenfeld and Daniel Stern. Interventions based on this approach are primarily intended to provide an emotional-maturational communication to the patient, rather than to promote intellectual insight. These interventions, beyond insight directed aims, are used to resolve resistances that are presented in the clinical setting. This school of psychoanalysis has fostered training opportunities for students in the United States and from countries worldwide.
Its journal Modern Psychoanalysis has been published since The various psychoses involve deficits in the autonomous ego functions see above of integration organization of thought, in abstraction ability, in relationship to reality and in reality testing. In depressions with psychotic features, the self-preservation function may also be damaged sometimes by overwhelming depressive affect. Because of the integrative deficits often causing what general psychiatrists call "loose associations", "blocking", " flight of ideas ", "verbigeration", and "thought withdrawal" , the development of self and object representations is also impaired.
In patients whose autonomous ego functions are more intact, but who still show problems with object relations, the diagnosis often falls into the category known as "borderline". Borderline patients also show deficits, often in controlling impulses, affects, or fantasies — but their ability to test reality remains more or less intact. Adults who do not experience guilt and shame, and who indulge in criminal behavior, are usually diagnosed as psychopaths, or, using DSM-IV-TR , antisocial personality disorder.
Panic, phobias, conversions, obsessions, compulsions and depressions analysts call these " neurotic symptoms " are not usually caused by deficits in functions. Instead, they are caused by intrapsychic conflicts. The conflicts are generally among sexual and hostile-aggressive wishes, guilt and shame, and reality factors. The conflicts may be conscious or unconscious, but create anxiety, depressive affect, and anger. Finally, the various elements are managed by defensive operations — essentially shut-off brain mechanisms that make people unaware of that element of conflict.
Neurotic symptoms may occur with or without deficits in ego functions, object relations, and ego strengths. Therefore, it is not uncommon to encounter obsessive-compulsive schizophrenics, panic patients who also suffer with borderline personality disorder , etc. This section above is partial to ego psychoanalytic theory "autonomous ego functions".
As the "autonomous ego functions" theory is only a theory, it may yet be proven incorrect. Freudian theories hold that adult problems can be traced to unresolved conflicts from certain phases of childhood and adolescence , caused by fantasy, stemming from their own drives. Freud, based on the data gathered from his patients early in his career, suspected that neurotic disturbances occurred when children were sexually abused in childhood the so-called seduction theory.
Later, Freud came to believe that, although child abuse occurs, neurotic symptoms were not associated with this. He believed that neurotic people often had unconscious conflicts that involved incestuous fantasies deriving from different stages of development. He found the stage from about three to six years of age preschool years, today called the "first genital stage" to be filled with fantasies of having romantic relationships with both parents. Arguments were quickly generated in early 20th-century Vienna about whether adult seduction of children, i.
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There still is no complete agreement, although nowadays professionals recognize the negative effects of child sexual abuse on mental health. Many psychoanalysts who work with children have studied the actual effects of child abuse, which include ego and object relations deficits and severe neurotic conflicts. Much research has been done on these types of trauma in childhood, and the adult sequelae of those.
In studying the childhood factors that start neurotic symptom development, Freud found a constellation of factors that, for literary reasons, he termed the Oedipus complex based on the play by Sophocles , Oedipus Rex , where the protagonist unwittingly kills his father Laius and marries his mother Jocasta. The validity of the Oedipus complex is now widely disputed and rejected. Sandler in "On the Concept Superego" and modified by Charles Brenner in The Mind in Conflict — refers to the powerful attachments that children make to their parents in the preschool years.
These attachments involve fantasies of sexual relationships with either or both parent, and, therefore, competitive fantasies toward either or both parents. Humberto Nagera has been particularly helpful in clarifying many of the complexities of the child through these years. Both seem to occur in development of most children. Eventually, the developing child's concessions to reality that they will neither marry one parent nor eliminate the other lead to identifications with parental values.
These identifications generally create a new set of mental operations regarding values and guilt, subsumed under the term "superego".
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Besides superego development, children "resolve" their preschool oedipal conflicts through channeling wishes into something their parents approve of "sublimation" and the development, during the school-age years "latency" of age-appropriate obsessive-compulsive defensive maneuvers rules, repetitive games. Using the various analytic and psychological techniques to assess mental problems, some believe that there are particular constellations of problems that are especially suited for analytic treatment see below whereas other problems might respond better to medicines and other interpersonal interventions.
To be treated with psychoanalysis, whatever the presenting problem, the person requesting help must demonstrate a desire to start an analysis. The person wishing to start an analysis must have some capacity for speech and communication. As well, they need to be able to have or develop trust and insight within the psychoanalytic session. Potential patients must undergo a preliminary stage of treatment to assess their amenability to psychoanalysis at that time, and also to enable the analyst to form a working psychological model, which the analyst will use to direct the treatment.
Psychoanalysts mainly work with neurosis and hysteria in particular; however, adapted forms of psychoanalysis are used in working with schizophrenia and other forms of psychosis or mental disorder. Finally, if a prospective patient is severely suicidal a longer preliminary stage may be employed, sometimes with sessions which have a twenty-minute break in the middle.
There are numerous modifications in technique under the heading of psychoanalysis due to the individualistic nature of personality in both analyst and patient. The most common problems treatable with psychoanalysis include: phobias , conversions , compulsions , obsessions , anxiety attacks , depressions , sexual dysfunctions , a wide variety of relationship problems such as dating and marital strife , and a wide variety of character problems for example, painful shyness, meanness, obnoxiousness, workaholism, hyperseductiveness, hyperemotionality, hyperfastidiousness.
The fact that many of such patients also demonstrate deficits above makes diagnosis and treatment selection difficult. Analytical organizations such as the IPA, APsaA and the European Federation for Psychoanalytic Psychotherapy have established procedures and models for the indication and practice of psychoanalytical therapy for trainees in analysis. The match between the analyst and the patient can be viewed as another contributing factor for the indication and contraindication for psychoanalytic treatment.
The analyst decides whether the patient is suitable for psychoanalysis. This decision made by the analyst, besides made on the usual indications and pathology, is also based to a certain degree by the "fit" between analyst and patient. A person's suitability for analysis at any particular time is based on their desire to know something about where their illness has come from. Someone who is not suitable for analysis expresses no desire to know more about the root causes of their illness.
An evaluation may include one or more other analysts' independent opinions and will include discussion of the patient's financial situation and insurances. The basic method of psychoanalysis is interpretation of the patient's unconscious conflicts that are interfering with current-day functioning — conflicts that are causing painful symptoms such as phobias, anxiety, depression, and compulsions. Strachey stressed that figuring out ways the patient distorted perceptions about the analyst led to understanding what may have been forgotten also see Freud's paper "Repeating, Remembering, and Working Through".
In particular, unconscious hostile feelings toward the analyst could be found in symbolic, negative reactions to what Robert Langs later called the "frame" of the therapy  — the setup that included times of the sessions, payment of fees, and necessity of talking. In patients who made mistakes, forgot, or showed other peculiarities regarding time, fees, and talking, the analyst can usually find various unconscious "resistances" to the flow of thoughts sometimes called free association.
When the patient reclines on a couch with the analyst out of view, the patient tends to remember more experiences, more resistance and transference, and is able to reorganize thoughts after the development of insight — through the interpretive work of the analyst. Although fantasy life can be understood through the examination of dreams , masturbation fantasies cf. Marcus, I. The analyst is interested in how the patient reacts to and avoids such fantasies cf.
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There is what is known among psychoanalysts as "classical technique", although Freud throughout his writings deviated from this considerably, depending on the problems of any given patient. Classical technique was summarized by Allan Compton, MD, as comprising instructions telling the patient to try to say what's on their mind, including interferences ; exploration asking questions ; and clarification rephrasing and summarizing what the patient has been describing.
As well, the analyst can also use confrontation to bringing an aspect of functioning, usually a defense, to the patient's attention.
The analyst then uses a variety of interpretation methods, such as dynamic interpretation explaining how being too nice guards against guilt, e. Analysts can also use reconstruction to estimate what may have happened in the past that created some current issue. These techniques are primarily based on conflict theory see above. As object relations theory evolved, supplemented by the work of John Bowlby and Mary Ainsworth , techniques with patients who had more severe problems with basic trust Erikson , and a history of maternal deprivation see the works of Augusta Alpert led to new techniques with adults.
These have sometimes been called interpersonal, intersubjective cf. Stolorow , relational, or corrective object relations techniques. These techniques include expressing an empathic attunement to the patient or warmth; exposing a bit of the analyst's personal life or attitudes to the patient; allowing the patient autonomy in the form of disagreement with the analyst cf. Paul, Letters to Simon ; and explaining the motivations of others which the patient misperceives.
Ego psychological concepts of deficit in functioning led to refinements in supportive therapy. These techniques are particularly applicable to psychotic and near-psychotic cf. These supportive therapy techniques include discussions of reality; encouragement to stay alive including hospitalization ; psychotropic medicines to relieve overwhelming depressive affect or overwhelming fantasies hallucinations and delusions ; and advice about the meanings of things to counter abstraction failures. The notion of the "silent analyst" has been criticized. Actually, the analyst listens using Arlow's approach as set out in "The Genesis of Interpretation", using active intervention to interpret resistances, defenses creating pathology, and fantasies.
Silence is not a technique of psychoanalysis also see the studies and opinion papers of Owen Renik, MD. It refers to the analyst's position of not taking sides in the internal struggles of the patient. For example, if a patient feels guilty, the analyst might explore what the patient has been doing or thinking that causes the guilt, but not reassure the patient not to feel guilty. The analyst might also explore the identifications with parents and others that led to the guilt. Interpersonal—relational psychoanalysts emphasize the notion that it is impossible to be neutral.
Sullivan introduced the term "participant-observer" to indicate the analyst inevitably interacts with the analysand, and suggested the detailed inquiry as an alternative to interpretation. The detailed inquiry involves noting where the analysand is leaving out important elements of an account and noting when the story is obfuscated, and asking careful questions to open up the dialogue.
Although single-client sessions remain the norm, psychoanalytic theory has been used to develop other types of psychological treatment.
Schilder, Samuel R. Slavson , Harry Stack Sullivan , and Wolfe. Child-centered counseling for parents was instituted early in analytic history by Freud, and was later further developed by Irwin Marcus, Edith Schulhofer, and Gilbert Kliman. Psychoanalytically based couples therapy has been promulgated and explicated by Fred Sander, MD.
Techniques and tools developed in the first decade of the 21st century have made psychoanalysis available to patients who were not treatable by earlier techniques. This meant that the analytic situation was modified so that it would be more suitable and more likely to be helpful for these patients.
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Eagle believes that psychoanalysis cannot be a self-contained discipline but instead must be open to influence from and integration with findings and theory from other disciplines. Psychoanalytic constructs have been adapted for use with children with treatments such as play therapy , art therapy , and storytelling. Throughout her career, from the s through the s, Anna Freud adapted psychoanalysis for children through play.
Using toys and games, children are able to demonstrate, symbolically, their fears, fantasies, and defenses; although not identical, this technique, in children, is analogous to the aim of free association in adults. Psychoanalytic play therapy allows the child and analyst to understand children's conflicts, particularly defenses such as disobedience and withdrawal, that have been guarding against various unpleasant feelings and hostile wishes. In art therapy, the counselor may have a child draw a portrait and then tell a story about the portrait. The counselor watches for recurring themes—regardless of whether it is with art or toys.
Psychoanalysis can be adapted to different cultures , as long as the therapist or counselor understands the client's culture. For example, Tori and Blimes found that defense mechanisms were valid in a normative sample of 2, Thais. The use of certain defense mechanisms was related to cultural values. For example, Thais value calmness and collectiveness because of Buddhist beliefs , so they were low on regressive emotionality.
Psychoanalysis also applies because Freud used techniques that allowed him to get the subjective perceptions of his patients. He takes an objective approach by not facing his clients during his talk therapy sessions. He met with his patients wherever they were, such as when he used free association — where clients would say whatever came to mind without self-censorship. His treatments had little to no structure for most cultures, especially Asian cultures. Therefore, it is more likely that Freudian constructs will be used in structured therapy Thompson, et al.
In addition, Corey postulates that it will be necessary for a therapist to help clients develop a cultural identity as well as an ego identity. The cost to the patient of psychoanalytic treatment ranges widely from place to place and between practitioners. Low-fee analysis is often available in a psychoanalytic training clinic and graduate schools. Otherwise, the fee set by each analyst varies with the analyst's training and experience.
Since, in most locations in the United States, unlike in Ontario and Germany, classical analysis which usually requires sessions three to five times per week is not covered by health insurance, many analysts may negotiate their fees with patients whom they feel they can help, but who have financial difficulties. The modifications of analysis, which include psychodynamic therapy, brief therapies, and certain types of group therapy cf.
Slavson, S. As a result of the defense mechanisms and the lack of access to the unfathomable elements of the unconscious, psychoanalysis can be an expansive process that involves 2 to 5 sessions per week for several years. This type of therapy relies on the belief that reducing the symptoms will not actually help with the root causes or irrational drives. The analyst typically is a 'blank screen', disclosing very little about themselves in order that the client can use the space in the relationship to work on their unconscious without interference from outside.
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