, Jeffrey R. Strawn2 and Ernest V. Pedapati3
(1)
Division of Psychiatry and Child Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
(2)
Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
(3)
Division of Psychiatry and Child Psychiatry Division of Child Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
There is no creation without tradition; the “new” is an inflection on a preceding form; novelty is always a variation on the past.
― Carlos Fuentes
In the last two chapters, we laid the groundwork to distinguish between traditional one-person and two-person relational psychologies. The astute reader will recognize that the terms that are used within each theoretical model may, in fact, ultimately complicate one’s ability to distinguish between the two psychologies. As Bornstein (2001) states, “Many psychoanalytic terms and concepts became so widely known that they evolved into colloquialisms, recognized even by persons with little or no formal exposure to psychology.” In fact, some of the two-person relational literature often retains the language of the traditional one-person model. Nonetheless, it is critical to clarify the differences in the meaning of the terms used in one-person psychology, which continue to prevail in the psychotherapeutic lexicon, as ultimately these terms evolved to represent two-person relational model constructs. In this regard, there are numerous everyday examples involving clinicians using traditional one-person psychology concepts to understand another person’s behaviors, as if the clinician clairvoyantly knew the nature of the patient’s unconscious. For example, a clinician may describe an adolescent girl who dates older men as having “father/daddy issues,” or a male adolescent who struggles with intense closeness and “neediness” in his relationships as having “mother/mommy issues.” These comments forestall a true understanding of the patient for several reasons. First, the clinician—in using these terms—assumes that the patient has unconscious intrapsychic conflicts (e.g., maladaptive behaviors represent ego defense mechanisms against the pressures from intrapsychic conflict). Second, the clinician fails to take into account the many aspects of the adolescent’s innate temperament , cognition, and internal working models of attachment that influenced his or her relational patterns. Third, in the case of the adolescent girl who dates older men, it is important to consider that in early childhood, she may have had the emotional availability and affective attunement needed provided by warm and caring men in her family (e.g., father, brothers, uncles, cousins, neighbors) and limited affective attunement from the women in her family. As such, her development occurred in an environment where older men may have represented, in a nonconscious way, implicit relational knowings, as safe and caring and likely adaptive. Herein, her wish for closeness to older men to provide the needed affective attunement may have been adaptive in spite of the age difference, as true compatibility is not a simple issue of biology or social construct. Fourth, this also forestalls the fact that for another adolescent, an older man may represent maladaptive childhood experiences of demanding and abusive men that provided some support to her, seen in disorganized forms of attachment. Thus, in the case of the adolescent with a disorganized attachment style, her choice of older men reflects a return to maladaptive implicit relational knowings during adolescence. For the adolescent boy, his clinginess to women may also represent cocreated experiences of safety when close to women and fearful being close to men as a child, stored in implicit nondeclarative memory . Further, both adolescents may have temperament or cognitive weakness that predisposed them to engage in maladaptive behaviors, and, as such, these behaviors may not be attributable to their parents or to their environment per se. Thus, a two-person relational model allows for teasing apart the complexities of nature and nurture through here-and-now experiences between patient and clinician.
Additionally, we have observed the use of traditional one-person psychology terms (e.g., unconscious, transference) during discussions of two-person relational approaches, which increases confusion among students, clinicians, and supervisors. This tendency is described by Fossage (2003), a relational theorist: “Each of us gravitates toward and develops a theory and practice that resonates deeply with our subjective experience. For this reason, it is difficult for all of us to really know, to have a ‘feel’ for psychoanalytic approaches other than the one we practice.” Thus, the ability to meaningfully discuss two-person relational approaches and apply its key concepts in a clinically meaningful way requires extensive reading, living, and breathing of this approach. In order to clarify why we, as authors and two-person relational clinicians, view the traditional one-person psychology terms as limiting, this chapter is written to juxtapose case-based conversations of traditional one-person and two-person relational psychotherapists that will highlight differences in context and terminology. As such, we provide a list of the common concepts in traditional one-person psychoanalytic theory and compare these terms with those from a two-person relational psychology model. We will also explore conceptual differences from the two psychologies in each of the clinical cases discussed in subsequent chapters.
At the most basic level, a traditional one-person psychology tenet is to help the patient understand, within the therapeutic encounter, his or her past intrapsychic conflicts and object relations (inner life) through his or her transference manifestations to the objective psychotherapist or by the autobiographic memories shared. Foangy and Target (2000) remind us that theories are shaped by what the clinician finds helpful and are intrinsically contaminated by technique and consequently run the risk of assuming that what is remembered by the patient is true and accurate. By contrast, two-person relational psychology focuses on both players (i.e., the psychotherapist and patient), although not symmetrically. That is, the psychotherapist, through bidirectional here-and-now experiences with the patient, will cocreate and model new and more adaptive patterns of interaction with others in the form of a new emotional experience (Hoffman 2009, see Chap. 5). A two-person relational psychotherapist is not neutral; rather, he or she makes implicit (nonconscious) or explicit self-disclosures and welcomes planned and well-thought-out enactments when believed to help the psychotherapeutic process of his or her patients (Delgado and Strawn 2014). Another contrast is that a traditional one-person model implies a conflicted unconscious, whereas two-person relational psychology implies that there is a dynamic, nonconflicted unconscious stored in nondeclarative memory systems. This nonconflicted unconscious provides the internal working models of “how to” implicitly engage in interactions with other people, known as “implicit relational knowing ” (Chaps. 3 and 5).
The reader may then wonder: Are the concepts of the unconscious, transference, and countertransference helpful? Does the two-person relational model of psychotherapy “throw the baby (i.e., traditional psychoanalytic concepts) out with the bathwater (i.e., traditional psychoanalytic technique)”? In order to answer these commonly posed questions, we provide a guide for the reader to navigate through the two models of psychotherapy and the semantic differences. As Aron (1990) states, “My aim is to extract fundamental clinical concepts from the quasi-biological drive theory that has dominated both our metapsychology and our clinical theory and to reexamine the value of these clinical concepts within a relational, contextual, and intersubjective framework.”
6.1 Two-Person Relational Psychodynamic Psychotherapy: A Historical Context
For more than a century, traditional one-person psychoanalytic theories dominated the psychotherapeutic landscape and were used to develop constructs about the frailties of the human mind, with the notion that unconscious instinctual drives exerted a role in shaping the introjected representations of the parents—as “objects”—that served as a relational template for an individual when interacting with others. A failure to master the instinctual drives would lead to psychological symptoms, thought to reflect the battle between the urges for gratification of infantile drives and wishes, and the pressures for the repression of these wishes to remain composed. In this model, common treatment interventions were akin to archaeological explorations: efforts to uncover deeply buried intrapsychic phenomena (e.g., unconscious developmental intrapsychic conflicts and object representations). The treatment was directed at mastering the pressures from the instinctual drives and conflicted object relations through the use of healthy ego defense mechanisms. The psychoanalytic concepts that evolved were used broadly to create diagnostic formulations about conditions such as anxiety neurosis (harsh superego formations), obsessive–compulsive symptoms (anal level conflicts), and depression (internalization of the lost loved object). These psychoanalytic concepts were also applied to the understanding of conditions and problems of children and adolescents, such as enuresis, night terrors, toilet-training difficulties, and oppositional and aggressive behaviors, all of which were believed to result from the compromise of unconsciously repressed intrapsychic conflicts, poorly integrated parental objects by the child, or poor ego functions.
Over the last 40 years, the emergence of a two-person relational psychology shifted the understanding of psychological and relational problems. In this regard, the two-person relational model proposes that a child’s problems result from difficulties of the interplay of multiple complex processes, including temperament, affective attunement, cognition, cognitive flexibility, internal working models of attachment, and intersubjectivity —the complex interactions of the relational self, influenced by other people. This shift fostered the development of treatment interventions that differed from traditional archaeological inquiries—which focused on the discovery of a conflicted and buried past—and instead focused on open, bidirectional, here-and-now subjectivities (i.e., the experience of each other’s mental states, in the context of treatment, that are continually modified by both the patient and the psychotherapist).
Herein, we provide the background of what have been historically viewed as conflicting approaches and theoretical orientations, and we attempt to clarify the reason for the seeming persistence of the conflict that exists between the traditional drive-based, conflict-based, object relations , one-person psychology theories and the contemporary relational , intersubjective, co-constructive, two-person relational psychology theories. Although both theories provide—implicitly or explicitly—a foundation for shared concepts for communication among psychodynamically oriented psychotherapists within their respective theoretical paradigms, their differences render them discordant with one another (Delgado and Strawn 2014). In this regard, while many psychotherapists are more familiar with the traditional one-person theory and terminology that they learned during their child and adolescent psychiatric training, and that is routinely used in understanding patients and families, they recently developed interventions are more aligned with and guided by contemporary two-person relational approaches and family systems. These contemporary theories give importance to both patient and psychotherapist, as well as to “the contextual model of psychotherapy focusing on common factors instead of treatment techniques, and actual trends in psychodynamic therapy, which accentuate critical moments of interpersonal experiences transforming the procedural knowledge of patients on attachment patterns” (Schiepek et al. 2013).
6.2 Clinically Relevant Concepts from Traditional One-Person Psychology: A Two-Person Relational Perspective
While it would be beyond the scope of this book to comprehensively define all of the terms relevant in working with children and adolescents from a traditional one-person model, we have chosen to focus on the concepts that are most relevant and frequently used in the clinical work of a psychodynamic psychotherapist. Moreover, the terms used in traditional one-person psychologies have been ingrained in our implicit nondeclarative memory and are ubiquitous in the psychotherapeutic vernacular. Thus, as we discuss two-person relational concepts herein, we do not intend to portray Freud and the traditional one-person model as the straw man to be devalued; rather, we hope to provide a broad perspective with regard to these competing concepts from both approaches and provide the information needed, in a succinct manner, for the reader to arrive at his or her own conclusion. Accordingly, we—as relationalists—seek to provide the reader a chapter that allows him or her to understand the differences in common terminology of psychodynamic practice and to have the tools to discuss these terms and concepts, given that he or she will invariably need to contend with skeptics and critics (Table 6.1).
Table 6.1
Two-person relational psychotherapy
Relational | Traditional |
|---|---|
Implicit and nonconscious | Unconscious |
We-go | Ego |
Intersubjectivity and cocreation | Neutrality |
Implicit relational knowing | Transference |
Emotional availability and social referencing | Countertransference |
Regulatory schemas and Intersubjectivity | Object relations |
Enactments and self-disclosures | Boundaries |
New and corrective emotional experiences | Insight |
6.3 Traditional Unconscious in Traditional One-Person Psychology and Two-Person Relational Psychology
Unconscious in Traditional One-Person Psychology
Freud believed that the unconscious was a hypothetical region of the mind. Further, he posited that the pressure from the instinctual drives resided in the unconscious, as they were repressed and only evident when the drives became conscious if acceptable to the superego or in the form of neurotic symptoms or maladaptive ego defense mechanisms. In traditional psychoanalytic theory, these drives reflect a conflicted unconscious, which is hidden behind defenses derived from the ego and superego. In traditional psychoanalytic treatment, the primary goal is to make the “unconscious” conscious, a process best captured by Freud’s now famous maxim of psychoanalytic work: “Where id is, there shall ego be” (Freud 1916–1917). In making the “unconscious” conscious, Freud suggested that insight is achieved and, thus, maladaptive defenses are relinquished in favor of more adaptive defenses (Delgado et al. 2011), and clinical improvement ensues. Accordingly, traditional psychoanalytic treatment focuses on the replacement of maladaptive ego defenses with mature ego defenses.
Unconscious in Two-Person Relational Psychology
In two-person relational psychology , the unconscious phenomena are dynamic and nonconflicted and are commonly referred to as the nonconscious . Additionally, the nonconscious processes consist of (1) meaning-making processes and (2) internal regulatory and interpersonal schemas within nondeclarative memory systems in the form of implicit relational memory:
An everyday example of the relational nonconscious
A young physician was walking from his office to his car when he received a call on his smartphone from his 4-year-old daughter, who had just returned home from the zoo. The father implicitly knew which tone of voice to use when talking to his daughter, who was sharing her excitement about the trip to the zoo she had taken with her mother. As his daughter exclaimed, “Daddy, I saw two big elephants and one baby elephant!” the father, without explicitly thinking about the tone of voice, cadence, etc., responded to his daughter in a manner that allowed her to know that he shared her excitement and was curious about her trip—affective attunement. As the father was about to enter the stairwell of the parking garage, he encountered a colleague who asked him about the location of tomorrow’s staff meeting. The father covered the smartphone with his hand and, as he answered his colleague’s question, changed his tone of voice accordingly. This shift in tone of voice, between both conversations, was unrelated to the traditional ways of thinking about the unconscious (e.g., id, ego, or superego conflict models); rather, this shift in tone of voice was a result of information stored in nondeclarative memory systems that was nonconsciously accessed when needed to move along the interactions in present moments (see Chap. 5).
From a two-person relational perspective, the physician’s tone of voice implicitly communicates to his daughter and to his colleague that he is affectively and intersubjectively attuned to them at a nonconscious level. In a traditional one-person model, the decision to shift speech pattern, tone of voice, and affect reflects a function of the ego, either as a compromise of instinctual drives or as a shift in internal object representations that are influenced by the superego. The view of a nonconflicted, relational nonconscious thus creates contentious discussion in that slips of the tongue (i.e., Freudian slips), dreams, and oedipal conflicts have limited relevance in understanding the human mind by two-person relational psychology.
6.4 Psychic Determinism in Traditional One-Person Psychology and Two-Person Relational Psychology
Psychic Determinism in Traditional One-Person Psychology
The unconscious and psychic determinism are concepts at the heart of Freud’s psychoanalytic theories. They are the precursors to Freud’s universal Oedipus complex. Brenner (1974) describes psychic determinism as a concept that Freud adhered to and assumes that nothing in everyday life happens by chance or in a random manner, “Each psychic event is determined by the ones which preceded it. Events in our mental lives that may seem to be random and unrelated to what went on before are only apparently so. In fact, mental phenomena are no more capable of such a lack of casual connection with what preceded them than our physical ones. Discontinuity in this sense does not exist in mental life.” Freud’s concept of psychic determinism in its narrow view placed in doubt matters of free will. As such, Freud believed that if the analyst had unlimited access to an individual’s unconscious (e.g., free associations, parapraxes, and dreams), it would confirm that all psychic phenomena had meaning and did not occur by accident.
Psychic determinism in a 15-year-old adolescent
John, a 15-year-old adolescent, appeared anxious in his weekly psychotherapy appointment and shared with his psychotherapist that he forgot to place a lock on his bike, which was in the front of the psychotherapist’s office. From a psychic determinism standpoint, the psychotherapist might ask for associations of why this may have happened, believing that this “forgetting” represented unconscious conflict due to the fact that it happened within the context of his psychotherapy appointment and may have been evidence of possible transference manifestations. With the patient’s associations, the psychotherapist can then decipher the “meaning” of such act and may choose to explore further or interpret it.
Thus, it seems that the concept of psychic determinism attributes individuals to not being free to make decisions based on contextual circumstances and needs.
Psychic Determinism in Two-Person Relational Psychology
Psychic determinism and free associations , by virtue of the assumption that all psychic phenomena have unconscious meaning, cannot exist in true two-person relational psychology. Hoffman (2006) states, “Free association is still one of the sacred cows of the psychoanalytic tradition; it is a term one tampers with at peril of his or her psychoanalytic identity. Can you claim to be a psychoanalyst if you do not ‘believe in’ free association?” The two-person relation model of psychodynamic psychotherapy relies on here-and-now subjective experiences between patient and psychotherapist that are shaped and unique to the dyad. It is through moments of meeting cocreated by the dyad that change occurs, at the implicit level. Holland and Kensinger (2010) conclude that when memories are reconstructed at the time of retrieval, they are prone to memory biases and inconsistencies. The affective characteristics of the event can influence how a memory is encoded, stored, and retrieved. They add that emotional memories are never perfect representations of the past and are recalled through a distorted lens. They eloquently state how positive here-and-now experiences can help patients, “remembering our past experiences and behaviors as more positive than they actually were may allow us to maintain a coherent, positive sense of self and to forge positive social relationships. Similarly, the flexibility in the construction of events at retrieval may enable us to direct our future behavior and to regulate our emotions.”
In returning to the example of the adolescent who forgot to lock his bike, a psychotherapist utilizing a two-person relational model would see a variety of possibilities as to why this occurred. First, the adolescent may have simply forgotten to lock the bicycle due to other thoughts having taken priority. In this regard, he may have been preoccupied with other thoughts, such as thinking about being on time for his appointment, reflecting on his girlfriend’s basketball game, planning his homework strategy for his evening assignments after the appointment, etc. In other words, the reasons that underlie his “forgetting” are many and may have not been related to the psychotherapist. Second, the adolescent having shared that he forgot to lock his bike may be a result of his feeling safe, in the intersubjective sense, with his psychotherapist, with whom he is able to share his dilemma, hoping that the psychotherapist recognizes his wanting to go out lock his bike and keep it safe.
In two-person relational psychology , one cannot infer that the adolescent “forgetting” to lock his bike represents a repressed unconscious mental process, derived from a conflict that can only be discovered through an archaeological excavation in which the psychotherapist seeks to uncover a hidden truth. Instead, the two-person relational psychotherapist will attend to the patient’s tone of voice and affect and, in parallel, will attune to his or her own experience as it is cocreated in intersubjectivity. These elements will direct the psychotherapist to determine the type of new emotional experience that would be most helpful for the adolescent. To return to our example, one might imagine a scenario in which the adolescent patient wanted to go and lock the bike in order not to risk losing it, although he waited for his appointment to start in order to not offend his psychotherapist. In this scenario, in a nonconscious manner, the adolescent relates in what is familiar to him—internal working models through implicit relational knowing —given that, for him, respecting adults is more important than asserting himself. The psychotherapist notices intersubjectively that he feels like telling the adolescent: “You don’t need to be so polite. Go ahead and lock it; I can wait a few minutes.” With this experience, he is reminded about the adolescent’s pattern of not asserting himself in most situations. This allows the psychotherapist to feel that one possible intervention, which could serve as a new and corrective emotional experience and cocreate more adaptive neuronal pathways, was, to say, “I know how much you value your bike and I am glad that you told me about not locking it. How about I wait here while you go lock it?” In a different scenario, the psychotherapist intersubjectively notes that the adolescent is anxious knowing that his bike is not locked, and his anxiety prevents him from feeling comfortable in the appointment, a similar pattern his parents had noted—their son struggled and was easily overwhelmed with anxiety when problem solving. In knowing this, the psychotherapist may say: “You know, at your age, my bike was very important to me. I see that your bike is very important to you, and I think we should not have to worry about this. Let’s go and make sure it is locked.” We are aware that the reader may think of many other possible scenarios that incorporate a two-person relational model of intervention. In summary, the devil is in the intersubjectivity.
6.5 Drive Theory in Traditional One-Person Psychology and Two-Person Relational Psychology
Drives in Traditional One-Person Psychology
Freud postulated that instincts or drives innately formed to eliminate any state of tension from the body. Accordingly, Freud believed that bodily tensions were aggressive and sexual in nature and were developmentally determined by the organ of predominant interest to the infant for pleasure. For Freud, the origin of the drive was a biological stimulus, although the drive itself was a psychic representation. In this model, he proposed that, “from a biological point of view, an ‘instinct’ appears to us as a concept on the frontier between the mental and the somatic, as the psychic representation of the stimuli originating for within the organism and reaching the mind” (Freud 1915). Freud stated about the infant: “From the very start, the infant exploration of the external world is invested with libido. The drive towards taking things into his mind, towards looking, touching, listening and exploring, satisfies some of the wishes frustrated by the original objects.” Accordingly, intrapsychic conflicts are considered a normal occurrence in the development of a child, which is why Smirnoff (1971) and others consider child psychoanalysis as essential for symptomatic children to reduce their anxiety through the dissolution the maladaptive ego defenses, which ultimately permits an outlet for the instinctual drives.
Drives in Two-Person Relational Psychology
Two-person relational psychology does not adhere to Freud’s drive theory. Rather, two-person relational psychology proposes an innate relational matrix, the forerunner for which was theorized by Bowlby. In this regard, Bowlby distanced himself from the classical drive theory, as he believed that infants had innate prosocial “wishes” to be with and to get along with others. This has been supported by a wealth of infant developmental research (Emde and Hewitt 2001; Tronick and Beeghly 2011), with strong evidence of complex prosocial processes occurring throughout the life span: meaning making , social referencing , affective attunement , internal working model schemas, mentalization, dynamic nonconscious, and implicit relational knowing . We remind the reader of Tronick’s remarkable still-face experiments in 1975 (Weinberg et al. 2008, Chap. 5) that capture the many efforts an infant can resort to in reengaging with their caregiver. Additionally, a brief clip of Tronick’s still-face experiment is available at www.YouTube.com.
6.6 Id in Traditional One-Person Psychology and Two-Person Relational Psychology
Id in Traditional One-Person Psychology
Laplanche and Pontalis (1974) in the classic text The Language of Psycho–Analysis, a dictionary of psychoanalytic concepts, define the id as “the prime reservoir of psychical energy, [which] from the dynamic point of view, conflicts with the ego and the super-ego—which, generally speaking, are diversifications of the id.” Thus, in the simplest terms, the id is the agent of the bodily instinctual needs, desires, and impulses, particularly of sexual and aggressive nature without respect to reality or moral issues. The id embodies the instinctual sexual and aggressive drives and seeks for immediate gratification (Freud 1920).
Id in Two-Person Relational Psychology
Two-person relational psychology does not adopt Freud’s structural theory and therefore does not consider the id as a necessary concept, which presupposes the need for an ego and superego. Instead, two-person relational psychology proposes an innate strong process in which infants seek to engage with other humans for comfort and survival and not for gratification of sexual or aggressive needs and desires. That is, the attachment system is a “hardwired” motivational system in the brain. The experience the infant has with his or her caregivers activates and encodes meaning-making processes that will directly shape the organization of the motivational system in nondeclarative memory (Siegel 2001). As such, the concept of the id is limiting, as it does not account for the active bidirectional mode of interaction that shapes neuronal pathways, as occurs in two-person relational psychotherapy. Additionally, genetically encoded information and neuronal activation can lead to the activation of genes that shape the structure of the brain (Kandel 1999).
6.7 Ego in Traditional One-Person Psychology and Two-Person Relational Psychology
Ego in Traditional One-Person Psychology
The ego , which has historically been viewed as the intrapsychic agency that negotiates between the superego, the drives, and the id, is noted by Laplanche and Pontalis (1974) to be “above all the expression of the defensive pole of the personality in neurotic conflict; it brings a set of defensive mechanisms into play which are motivated by the perception of an unpleasurable affect (signal of anxiety).” Further, “the ego is an agency of adaptation which differentiates itself from the id on contact with external reality. It is also described as the product of identifications in the formation of a cathected love-object by the id.” In short, the ego is the mediator of conflicts between the id and the superego. In traditional one-person psychology, the psychotherapist helps the patient work through the pressures from the id: “Where id is, there shall ego be” (Freud 1916–1917). Anna Freud focused on the ego’s unconscious defensive mechanisms that originated during the child’s stages of psychosexual development. She systematically classified these ego defenses, compiling a comprehensive catalog in her classic work The Ego and the Mechanisms of Defense (Freud 1937/1966), which later led to the school of ego psychology.
Ego in Two-Person Relational Psychology
As two-person relational psychology does not support Freud’s structural theory, the ego, which presupposes the need for an id and superego, is not a useful construct. Interestingly though, with regard to “ego functions,” the psychoanalyst Heinz Hartman , who is often described as one of Freud’s favorite students, held that the ego had a biological substrate that includes perception, memory, concentration, motor coordination, and learning. He believed these innate ego capacities had autonomy from the sexual and aggressive drives of the id and were not products of frustration or conflict. Hartman coined the term “autonomous ego functions” (Hartman 1958), and his ideas share much with recent concepts concerning implicit memory systems and internal working relational schemas stored in nondeclarative memory systems (Mancia 2006, also see Chaps. 5 and 7).
Further, two-person relational theory relies on the “we-go,” an intersubjective, mutually adaptive process—as opposed to structure (i.e., the ego)—that exists at a prereflective level and encompasses both “we” and “me” (Emde 2009; Iacoboni 2008, 2009; Iacoboni and Dapretto 2006). Freud’s ego as a concept fails to account for the intersubjectivities of the person and those of the person they are interacting with; these intersubjectivities ultimately subserve self-regulatory functions. The psychoanalyst and developmental researcher Emde (2009) captured this failure of the established Freudian school as follows: “We came to the realization that these children had developed an executive sense of ‘we’ of the significant other being with them, giving them an increased sense of power and control,” adding, “The self is a social self.” Moreover, over the course of development, there are substantial gains in the neurostructural foundations of social reciprocity and the development of “we-ness.” It is through we-ness of the nondeclarative memory systems that internal working models of attachment with self-regulatory functions are formed.
6.8 Superego in Traditional One-Person Psychology and Two-Person Relational Psychology
Superego in Traditional One-Person Psychology
The superego , an intrapsychic agency that limits the drives of the id, has been referred to as “the heir of the Oedipus complex in that it is constituted through the internalisation of parental prohibitions and demands” (Laplanche and Pontalis 1974). Further, the superego seeks to obey cultural and societal norms that have been incorporated into the person’s psyche. Returning to our example of the adolescent who had forgotten to lock his bike, a psychotherapist who utilizes the traditional one-person model notes that the adolescent experiences harsh superego pressures, feeling he has done something wrong and believes that his psychotherapist will confirm this. In turn, the psychotherapist would consider the adolescent having forgotten to lock his bike as a transference manifestation with regard to the patient’s relationship with his parents. From a Kleinian standpoint, superego formation occurs before the age of 2 and is a requisite component of the infant’s foray into the depressive position, wherein “the child proceeds to develop a capacity of concern for others and guilt about one’s actions and thoughts about others, with desire for reparation” (Winnicott 1965).
Further, Johnson and Szurek (1952) developed this concept of “superego lacunae” (gaps in ego and superego functioning) when working with a 6-year-old boy who chronically would run away. The authors understood the child’s running away as a result of his father unconsciously encouraging him to run away, seeking vicarious gratification from his son’s behavior. This led the boy to have a weakened superego with lacunae or gaps in functioning. Johnson and Szurek concluded that serious antisocial behavior, such as stealing, fire setting, and damage to property, in children and adolescents, as the result of acting out unresolved intrapsychic conflicts through parent-induced superego lacunae.
An everyday example thought to be due to pressures from superego lacunae is when ostensibly bright children or adolescent do not complete school assignments. This is considered a form of acting out of unconscious conflicts.
Superego in Two-Person Relational Psychology
Just as we have seen for the ego and for the id, the two-person relational psychology does not adhere to Freud’s structural theory, and therefore the notion of a superego does not live in this theory. Rather, in two-person relational psychology, an implicit nonconscious social sense of morality develops as early as 9 months old as infants interpret the different expectations and intents of others, which suggest that infants (and adults) do not learn morality per se, but rather that morality is innate (Bloom 2013). The early development of self was not only fundamentally social but moral (Emde et al. 1991). This model developed from the work of the developmental psychologist Kohlberg, who in turn based his explorations of morality on Piaget’s work. Kohlberg proposed a set of six developmental stages in moral development, which served as the basis for ethical behavior (Kohlberg 1973); however, these stages were extended by Buchsbaum and Emde (1990), who found that “children as young as 36 months represent a considerable amount of moral development in narrative form. Children were able to articulate coherent stories about rules, reciprocity, empathy, and internalized prohibitions. Most remarkable was their ability to deal with alternative outcomes in order to resolve a moral dilemma.” Much is yet to be known about moral development, particularly in regard to cultural differences.
6.9 Psychosexual Stages in Traditional One-Person Psychology and Two-Person Relational Psychology
Psychosexual Stages in Traditional One-Person Psychology
Freud proposed that children progressed through several psychosexual developmental phases that were determined by the organ of predominant interest to the infant/child for pleasure (e.g., oral , anal, and phallic). For Freud, unresolved conflicts in a particular phase manifested themselves as a regression to the ego functions and behaviors of the phase that they were fixated in. For example, it was believed that conflicts in the oral phase can result in eating problems or alcoholism, whereas unresolved conflicts in the anal phase can yield obsessional and anal-sadistic behaviors indicating pleasure in controlling and exercising power. As an aside, anal erotism was thought to reflect sadistic forms of behavior by children with wishes to destroy the object or to possess it. Finally, regarding conflicts in the phallic phase, symptoms relate to masturbation, fantasies about pregnancy, and sadistic conception of parental intercourse. Importantly, Freud’s theories about psychosexual stages were formulated based on his observations of very few European Caucasian children.
Psychosexual Stages in Two-Person Relational Psychology
The notion that psychosexual stages occur in a linear manner and are punctuated by the resolution of stage-specific conflicts is antithetical to the two-person relational psychology. In the contemporary two-person relational model, development occurs in a multilayered and continuous manner in which a person may be in different layers simultaneously. For example, in the two-person relational model, the development of a meaning-making process occurs in parallel with the development of affective attunement and social referencing, independent of zone-based interests and fixations (e.g., oral, anal, phallic). In essence, in a two-person relational model, “the search for a theoretical structure that neatly places psychological disorders and character traits along a continuum of purported developmental levels does not do justice to what we know about the complex ways in which development proceeds as a continuing interplay between evolving personal characteristics and the environments encountered and, over time, created by the evolving personality” (Wachtel 2003). Importantly, Erikson was the first theorist to offer a model of development that extended over the entire life span, proposing that psychosocial stages of development are influenced by the social context and relate to an epigenetic principle: “Anything that grows has a ground plan, and…out of this ground plan the parts arise, each having its time of special ascendancy, until all parts have arisen to form a functioning whole” (Erikson 1968). Developmental research has now begun to reveal the complex processes involved in the scaffold building of physical and psychological competencies over time, which are not derived from instinctual drives but rather from a genetically influenced developmental blueprint. Recent cross-cultural research suggests that it is difficult to delineate the transition from one developmental phase to another. Thus, the description of development in phases (i.e., preoedipal, oedipal, latency, and adolescence) is somewhat artificial. More likely, children have a developmental blueprint that is influenced by genetic, family, and environmental factors, which promotes development (Delgado et al. 2011).
For example, walking as a developmental milestone is typically attained between the ages of 9 and 15 months in a securely attached environment, wherein the infant has been provided ample opportunity for motor development as well as balance and gross motor coordination. The child that grows in an unpredictable and chaotic environment (e.g., an environment in which disorganized attachment styles predominate) may learn to walk at earlier ages for survival and, in doing so, will be able to access food or use mobility to distance themselves from violent situations. As such, both children will have different cognitive and environmental pressures that implicitly determine which developmental path promotes survival, rather than this being influenced by the resolution of stage-specific conflicts.
Clinically, the two-person relational psychodynamic psychotherapist will need to be familiar with cognitive, psychological, and social milestones (see Appendix A), as a knowledge (and application) of these milestones provides clues as to whether developmental or psychological discontinuities may be due to neurodevelopmental (e.g., learning disorders) or environmental factors (e.g., deprivation). Such an understanding will aid the psychotherapist in being realistic in his or her expectations of the psychotherapeutic process. Additionally, it will be important for the two-person relational psychotherapist to have an awareness of variations in these milestones among non-Caucasian and minority populations, although we concede that, at present, the academic understanding of the development of cognitive, psychological, and social milestones in these populations is lacking.
Finally, it is clear that we are in era that recognizes that sexual development comprises biological, psychological, and social aspects of experience that Freud did not consider as important during his time. Herein, sexuality in children and adolescents remains a complex subject, as it also pertains to children who live with lesbian, gay, bisexual, and transgender parents. This complex process is described in the AACAP Practice Parameter on Gay, Lesbian, or Bisexual Sexual Orientation, Gender Nonconformity, and Gender Discordance in Children and Adolescents (Adelson et al. 2012): “Much of what has been learned scientifically about sexual orientation and gender development in the last generation has occurred in parallel with societal changes in attitudes toward sexual orientation and gender roles.” This is in alignment with the two-person relational model’s view of development.
6.10 The Oedipus Complex in Traditional One-Person Psychology and Two-Person Relational Psychology
Freud’s Oedipus Complex
In traditional one-person psychoanalytic theory, the Oedipus complex is the cornerstone of understanding a person’s personality structures (e.g., id, ego, superego, and ego ideal) and their psychopathology. This universal conflict in Freudian theory involves the child’s development of unconscious aggressive wishes toward the same-sex parent in order to possess the opposite-sex parent. According to Freud, the importance of the Oedipus complex came to him while viewing Sophocles’ play, Oedipus Rex, in Vienna. In a letter to Fliess he wrote, “The Greek legend seizes on a compulsion which everyone recognizes because he feels its existence within himself” (Freud 1897). He later added, “Every new arrival on this planet is faced with the task of mastering the Oedipus complex” (Freud 1905). In psychoanalytic theory, the Oedipus complex is at its peak between the ages of 3 and 5 years old, the phallic stage.
Freud (1924) wrote of the Oedipus complex:
A little boy will exhibit special interest in his father; he would like to grow like him, and be like him and take his place everywhere…. He takes his father as his ideal…. At the same time as the identification with his father, or a little later, the boy has begun to develop a true object-cathexis towards his mother according to the attachment type…. The little boy notices that his father stands in the way with his mother. His identification with his father then takes on a hostile coluoring and becomes identical with the wish to replace his father in regard to his mother as well.
In traditional one-person child psychoanalytic literature, the understanding and, at times, interpretation of oedipal conflicts were considered essential for the child to achieve a healthy love object choice and to overcome castration fears typically seen in the form of ego inhibitions (e.g., poor performance at school, eating difficulties, or self-defeating behaviors due to unacceptable wishes within the triangular relationship to parents). This position has been attenuated although not ignored.
In writing about the Oedipus complex , Freud believed that a successful resolution led to a healthy love object choice by repressing incestuous wishes. The concept of object choice sets the stage for Klein’s object relations theory .
The Kleinian school of object relations proposes that most of the child’s conflicts occur in the early stages of life, thus emphasizing early superego formation leading to the preoedipal conflicts based on split objects—the breast and penis—during the paranoid position. When the paranoid position is resolved, the child moved to the depressive position. The oedipal conflict was thought as part of the depressive position, in which the child accepts the loved object as a whole object that can be loved and forgiven for the hated aspects.
Jung’s Electra Complex
Jung (1961) proposed the Electra complex, a negative Oedipus complex that affected girls and that emerged between 3 and 5 years old (in parallel with Freud’s phallic stage). Freud was reluctant to accept this concept, as he did not see the usefulness and did not believe girls experienced the castration complex as intensely as boys due to their preoedipal attachment to their mother. Freud believed that in girls, the “Oedipal complex culminates in a desire, which is long retained, to receive a baby from her father as a gift—to bear him a child” (Freud 1924).
The Oedipus and Electra Complexes in Two-Person Relational Psychology
Both two-person relational psychology and current neuroscientific data refute the Oedipus and Electra complexes. In fact, Kandel, , an American neuropsychiatrist and recipient of the 2000 Nobel Prize in Physiology or Medicine for his research on the neurobiologic basis of memory consolidation, recognized the complexities in the area of infantile sexuality and questioned the relevance of the oedipal conflict: “This is a complex area, because genotypic gender, phenotypic gender, gender identification, and sexual orientation are distinct from one another but interrelated. Indeed, the recognition of this complexity can render standard terms such as male, female, masculine, and feminine imprecise and in need of qualification. These are all early findings, and their consistency over groups of people, both heterosexual and homosexual, is still being questioned.” He further added, “The methods at hand for establishing whether there are reliable anatomical differences between people with different sexual orientations…. [These] should greatly influence psychoanalytic thinking about the dynamics of sexual orientation” (1999). Thus, in a two-person relational model, what is considered to shape a child’s interaction with others regardless of their gender is set in motion early in life through meaning-making processes that provide the affective attunement and social reciprocity needed for present moments of intersubjectivity with others unique to the dyad throughout their life (Emde 1992).
The infant’s interaction with caregivers is singularly the most important task to ensure survival and adaptation to the world. As such, developmental research reveals that early interactions between child and caregiver are stored in nondeclarative memory systems and become part of declarative memory systems later. Thus, infantile memories from early childhood are not accessible to verbal or symbolic recall, but rather are encoded within the nondeclarative memory system machinery that is unique to each child and is driven by their innate cognitive abilities (or limitations). Therefore, it is well documented that securely attached infants can learn to elicit soothing experiences from their caregivers (both females and males), which are stored in implicit relational memory systems. For instance, the child can implicitly know that teachers who, regardless of their gender, are encouraging and warm are trustworthy and those that are critical and intrusive are worth maintaining distance—implicit relational knowing. In contrast, in a traditional one-person model, the psychodynamic psychotherapist may consider, in knowing that the child’s parents are critical and intrusive, that the child’s experience of a critical teacher is a displacement or projection of parental conflicts, when in reality, the teacher is critical like the child’s parents. As Emde (1992) aptly states, “Freud’s portrayal of the child’s experience during the family oedipal drama is oversimplified. We know today that fathers do not appear later on the stage to interrupt an earlier affectionate relationship with mother when the child becomes 3 or 4.” He adds, “Research has shown that fathers, under normative conditions, develop early and qualitatively separate affectionate relationships with both young boys and girls.”
6.11 Latency in Traditional One-Person Psychology and Two-Person Relational Psychology
Latency in Traditional One-Person Psychology
In traditional one-person psychoanalytic theory, latency is the period that begins with the dissolution of the Oedipus complex and extends to the onset of puberty, typically between the ages of 6 and 12 years old. It is believed that during this period, repression intensifies and brings with it amnesia of the early conflicts, as well as the development of sublimation, moral values (including shame), and aspirations for future activities. This phase was thought to be of relative stability. Anna Freud argued that what fostered children in the latency period to shift their attention from their parents to their peers was diminished drive pressures (e.g., the pleasure principle) in favor or the reality principle. Surprisingly, during the last 50 years, in The Psychoanalytic Study of the Child, many of the clinical cases reviewed are of children in child psychoanalysis or psychotherapy who became symptomatic during the latency period, suggesting that this phase is thought of as lacking stability. This notion is consistent with Bornstein (1951), who believed that children, in the early phase of latency, struggle with increased incestuous wishes and masturbatory fantasies as a consequence of harsh superego pressures and rigid ego defenses (i.e., the externalization of superego pressures due to incomplete mastery of the oedipal phase). During the latency phase, ego functions acquire greater stability.
Latency in Two-Person Relational Psychology
Unlike in traditional one-person models wherein development occurs in a linear fashion involving distinct phases with discrete beginnings and endings, current research suggests that the maturation of physical and psychological competencies occurs in parallel. This is to say that the interrelated processes of temperament, cognition, cognitive flexibility, internal working models of attachment, and culture—which are unique to each individual—serve as a scaffold for biological development (Delgado et al. 2011). Thus, the traditional one-person conceptualization of latency as a psychosexual phase is artificial. Children have a unique genetic developmental blueprint that is strongly influenced by family and environmental factors, which when interwoven can act synergistically (Delgado et al. 2011). As such, one does not have to look far to appreciate these complexities in personality formation of school age children. For example, consider the situation of two school age siblings: In the case of the first child, good affective attunement and social referencing were present early in life and laid the groundwork for interpersonal success as a school age child. The second child, as a toddler, also had ample emotional availability, affective attunement and social referencing from his or her parents. Moreover, this second child exhibited receptive language deficits and attention deficit hyperactivity disorder (ADHD), as well as a difficult/feisty temperament, which collectively resulted in difficulties engaging with peers due to his incapacity for social reciprocity. These deficits in the second child resulted in episodes of verbal or physical aggression, which ultimately confirmed, at an implicit level, that he was different. Thus, both children had secure attachment environments, and there was no suggestion of indolent, unresolved intrapsychic conflict. However, one child struggled in making sense of the world as a result of his deficits, and his “advancing” chronologically to the next developmental stage (i.e., adolescence) is unlikely to result in symptomatic improvement. Finally, it is worth noting that during the elementary school years, the developmental milestones are complex (see Appendix A). Among the most salient developmental tasks are competition in games, enjoyment of group activities, enjoyment of conversation with others, increased interest in the opposite gender, and increased respect for parents. Returning to our example of the two siblings, we might expect that the first child would readily play with peers, compete with classmates, and might play baseball in the neighborhood, whereas the second child would—as a result of his difficulty to read the intent of others—chronically feel misunderstood and struggle to participate in similar activities. As such, the concept of latency is limiting as it does not account for the multifactorial complexities of development.
6.12 Adolescence in Traditional One-Person Psychology and Two-Person Relational Psychology
Adolescence in Traditional One-Person Psychology
In traditional one-person psychology, adolescence follows latency. The study of adolescent psychological development was based on patients with significant psychopathology (Delgado et al. 2012). In his Three Essays on Sexuality (1905), Freud stated that the beginning of adolescence is heralded by the reawakening of the oedipal conflicts and asserted that the adolescent’s developmental tasks were “painful psychical achievements” to find a nonincestuous sexual object. Freud’s daughter, Anna Freud , was among the first to describe the adolescence period as a state of disequilibrium, or “turmoil” (1958). Subsequently, Blos (1968) introduced the notion of a second individuation process during adolescence based on Mahler’s (1974) separation–individuation phase of the infant. Blos believed that the adolescent’s break from the internalized objects made possible the quest for “extrafamilial love and hate objects” (Blos 1967). Upon completing this process, the object relations of the adolescent become stable, with clear boundaries, and the adolescent becomes more “resistant to cathectic shifts” (Blos 1968). In parallel, Erik Erikson asserted that adolescence was not “an affliction but a normative crisis, a normal phase of increased conflict characterized by a seeming fluctuation in ego strength, and yet also by a high growth potential” (Erikson 1956). Taken together, the traditional psychodynamic understandings of adolescence posits four key intrapsychic developmental tasks: (1) loosening of infantile ties, (2) de-idealization of the parents and overcoming castration anxieties, and (3) character formation and the second individuation, all of which are dependent on the preceding process (Fig. 6.1).
Fig. 6.1
Key tasks of adolescent development in classical theory (Adapted from Delgado et al. (2012))
The traditional one-person form of psychoanalysis and psychotherapy of adolescents focused on helping the patient overcome the regressive pull of the parental ties, which accordingly led to the self-defeating and maladaptive behaviors of the adolescent. Barrett (2008) views the adolescent’s self-defeating behavior as a manic defense: “The loneliness results from the adolescent’s need to transfer love from primary objects to new adult relationships not yet available to him. The resultant emptiness may be defended against by overuse of the Internet, alcohol, cigarettes, drugs, and food. These defenses are manic in quality in that they suggest an orally based regressive attempt to ‘take in’ and ‘expel out,’ preserving the felt ‘lost’ object and converting the loneliness into elation.”
Importantly, however, these theories that are focused on ego functions fail to account for the influence of family factors and have been aptly critiqued by the family psychotherapist Murray Bowen , who notes that psychoanalytic theory lacks the theoretical formulation for the individuation that occurs within the context of family triangles (Bowen 1972). Finally, a significant limitation of the traditional one-person psychodynamic model is that it does not provide a theoretical understanding of gay and lesbian adolescents or the physically, mentally, and learning disabled, areas where further research is necessary.
Adolescence in Two-Person Relational Psychology
The twentieth century saw substantial advances in understanding the biological, psychological, and sociological aspects of adolescent development. In two-person relational psychology, adolescence is a period in which the developmental complexities are viewed as having been built on the lifelong maturation genetic blueprint within the context of innate temperamental and cognitive abilities—nature—as well as environmental factors, including the availability of affective and social referencing and implicit relational knowing, nurture. That is, adolescence is not considered a distinct phase of a linear process as in the traditional one-person model. Accumulating data supports the notion that adolescent behavior cannot be reduced to purely psychological or biological phenomena. Imaging studies of adolescent brains show that during adolescence, the area of the brain responsible for organization, planning, and strategizing is not fully developed, as the gray matter continues to thicken, confirming aspects of fluidity in decision making and a number of other cognitive capacities (Giedd 1999).
Offer and colleagues’ empirical research occurred with adolescents in the “real world” (rather than in clinical populations) and suggests that the majority (80 %) of adolescents managed the transition from childhood to adulthood quite well. Specifically, these longitudinal studies of adolescence (Offer and Offer 1975) suggest that most adolescents either progress “steadily” or with a sequence of developmental spurts, which are punctuated by episodic conflict, whereas 20 % of adolescents appeared to take a more tumultuous route through adolescence.
Contemporary psychodynamic understanding of the adolescent is strongly influenced by attachment theory, developmental psychology, and intersubjectivity, the implicit nondeclarative memories of the interactions between self and others. The typical adolescent develops the ability to regulate the shifts of affective states and judges how to convey, within reason, autonomous opinion without compromising relationships—the use of an abstract self within the backdrop of early secure attachment patterns (Delgado et al. 2012).
Further, even with the advances in developmental psychology, the understanding of gay, lesbian, bisexual, and transgender adolescents is challenging and an area that requires further research. Additionally, in regard to physically, mentally, and learning disabled adolescents, although challenging, their psychological needs must be determined, and their treatment recommendations must be made after a careful assessment of the four pillars in a contemporary diagnostic interview (Chap. 8). This will lead to a better grasp of their cognitive strengths and weakness to tailor treatment of these individuals with realistic expectations, regardless of their chronological developmental phase.
As a note, an area that is of interest to sociological adolescent research is the impact that YouTube®, Facebook® instant messaging, text messaging, Instagram®, and Twitter® will have on matters of intersubjectivity , which typically depends on face-to-face interactions to discern intent of others through the tone of voice and facial expressions. This has become an issue too complex for psychodynamic theories alone.
6.13 Defense Mechanisms in Traditional One-Person Psychology and Two-Person Relational Psychology
Defense Mechanisms in Traditional One-Person Psychology
The concept of defense mechanisms is part and parcel of the everyday lexicon of child and adolescent psychiatry trainees, their supervisor, and experienced clinicians. It is the “go to” manner of understanding a patient’s and their family’s psychological symptoms and behaviors. The concept is at the heart of the traditional one-person model in understanding others, with broad statements of “that patient is splitting,” “the patient is using reaction formation to deal with their anger about being diagnosed with diabetes,” “I like the patient because she sublimates and is able to get along with her parents,” etc. In essence, it involves understanding the patient’s inner life through their ego defense mechanisms, while excluding the clinician’s contribution to the patient’s discourse.
In traditional one-person psychology, the ego generates defense mechanisms to psychologically mediate conflict among the id (drives) and the superego (urging civility). Also, this theory contends that “the window into…[the] personality [derives from an] understanding of the ego’s defense mechanisms that an individual employs in coping with daily-life anxiety and threats to self-esteem from intrapsychic conflicts” (Delgado and Strawn 2014).
While Sigmund Freud was the first to describe defense mechanisms, much of our understanding of these processes comes from his daughter, Anna Freud . She compiled a comprehensive catalog of these defenses in The Ego and the Mechanisms of Defense (Freud 1937/1966). Anna Freud further believed that defenses would be best assessed through the understanding of the child’s play and that this was the equivalent of free associations. She believed that the goal of a child’s psychoanalytic treatment was to improve their ego functions by interpreting their ego defenses, and she provided reassurance and gave suggestions to the parents on how to interact with their child (Freud 1937/1966). More recently, however, there have been subtle changes in our understanding of defenses, with a distinction being made between mature and immature levels and then being hierarchically categorized as mature, neurotic, immature, or pathological, as conceptualized in George Valiant’s seminal work, Ego Mechanisms of Defense: A Guide for Clinicians and Researchers (1992).
Delgado and Strawn (2014) further state, “Sometimes we might consciously know which defense mechanisms we use in relation to others—as in humor to manage family conflict, or denying or overlooking a colleague’s negative comments—but in most cases they occur unconsciously. Defense mechanisms usually are adaptive and can have a salutary effect, allowing an individual to function normally. Importantly, however, when used in a repetitive fashion, defense mechanisms can become maladaptive and induce further anxiety.”
Defense Mechanisms in Two-Person Relational Psychology
Two-person relational psychology does not endorse the existence of instinctual drives, which imply the need for the use of defense mechanisms against pressures from the id and superego. Two-person relational psychology posits that a person is not defending from intrapsychic pressures from the id or superego; rather, they defend against experiences that are unfamiliar and subjectively provoke anxiety. An example that occurred to one of the authors when supervising a child and adolescent psychiatric trainee happened when the trainee stated: “The patient missed their psychotherapy appointment. Last week I was on vacation, and I think she is mad at me and is resisting coming because she is afraid at expressing her anger at me.” Unfortunately, this is familiar to most of us; we all have had experiences of traditional one-person competency, when we firmly believed we clairvoyantly knew the reasons for our patient’s actions. In this case, the author suggested viewing the patient’s absence within the context of the patient having improved with healthier adaptive patterns of interaction with others that had occurred through a two-person relational approach, which provides new emotional experiences through moments of meeting (see Chap. 5). Although the trainee was reluctant in tolerating the ubiquitous uncertainty of a two-person relational model, she was able to consider several scenarios for the patient’s missed appointments. The following supervisory hour, the trainee was outwardly in a jovial mood. She stated: “Wow, it is so important to think about context. The patient missed because she interviewed for a really good job that morning, and they asked her to stay that afternoon to complete her paperwork. She was so excited that she forgot to call and cancel, and when she noticed she hadn’t called, she knew I would understand. She is so much better.” A note to the reader: Context is not only about the realities noted in verbal form; it also includes the intersubjective experiences with the patient, which will be different with each dyad. In this example, the intersubjective experience of the previous session set up the feelings experienced in the missed session: the patient felt the trainee would understand, while the trainee initially worried that the patient was resisting, but then was able to tolerate the uncertainty when taking into account her positive intersubjective experience of the earlier session. We also will not ignore that the reader may have noticed the comment by the patient “forgot to call,” which from a traditional one-person model may also be considered as resistance, and—depending on the psychotherapist’s school of thought—may be viewed as fear of sharing her success; fear in not receiving the mirroring needed for such an achievement, as had previously occurred with her parents; fear in destroying the relationship due to the psychotherapist’s vacation; etc. In a two-person relational model, the patient’s forgetting to call may genuinely be due to her excitement about employment, which is reasonable to have been a step forward in her well-being.
Therefore, given that two-person relational psychology conceptualizes a patient’s behavior as influenced by nonconscious relational schemas initially set in implicit nondeclarative memory systems by interactions with the many people they had a relationship with, it is natural for the trainee or newly minted psychotherapist to have a certain degree of discomfort in their quest to understand the reasons for their patient’s behaviors. As we have stated throughout this book, tolerating uncertainty and relying on change to occur in here-and-now interaction at the implicit nondeclarative local level may be a new concept to the reader that we hope to instill.
Attachment and developmental researchers demonstrate that implicit schematic patterns of relatedness (i.e., internal relational knowing) are sensitive to the deletions and distortions that occur during interactions. For example, the child attending kindergarten who displays oppositional behavior when the teacher encourages him or her to participate during the story reading time may be avoiding participating in something that is not familiar to him or her if he or she has never been exposed to reading by caregivers. Thus, the child’s oppositional behavior occurs at an implicit level, likely having seen a caregiver also refuse to participate in an activity they did not master, perhaps also reading. In short, in a relational model, “all that happens in interactive and affective life…replace[s] the idea of conflict between tripartite structures with this more dyadic view of complex patterns of conflict between the intentional directions of the self and the intentional directions of important others that are represented at the implicit level” (BCPSG 2002; 2005; 2007).
6.14 Object Relations Theory in Traditional One-Person Psychology and Two-Person Relational Psychology
Object Relations Theory in Traditional One-Person Psychology
More than half a century ago, a natural transition from ego psychology to object relations theory occurred. Melanie Klein (1882–1960), a student of Sigmund Freud, was the first object relations theorist and postulated that object relations were at the center of a person’s emotional life (Klein 1932). In the simplest terms, object relations refers to the capacity to have stable and rewarding relationships based on the internalization (a process closely related to introjection ) of the early childhood representations of others in the form of “objects.” However, internalization of these objects is not a mere imitation. Filtered by the child’s wishes and needs, individualized significance is attributed to these “objects” (Delgado and Songer 2009). Additionally, Klein proposes a paranoid position of the child when internalized representations of caregivers are experienced as part objects that the mind splits into “good” and “bad” objects (e.g., the loving, nurturing mother and the depriving mother). In the early years, the child maintains the self-object split and, in doing so, avoids the distress associated with recognizing that there are aggressive and depriving aspects of the self as well as of the other. Then, as development progresses, from 4 to 12 months old, the child learns to integrate and tolerate that a person has both “good” and “bad” parts and enters a healthy phase that Klein describes as the depressive position (Klein 1932). Having psychologically achieved the depressive position, the child proceeds to develop a capacity of concern for others and guilt about one’s actions and thoughts about others, with a desire for reparation (Winnicott 1965). For Klein, psychoanalysis in children alleviated the primitive anxieties from the harsh internalized objects and inner persecutors (i.e., paranoid position), and modified this through transference interpretations that removed a blockage from the artery to the child achieving a depressive position. The object relations theorist and psychoanalyst Otto Kernberg, MD (1928–), suggested that when the patient’s internal representation of others remains “split,” they primarily use low-level defense mechanisms, including splitting , projection , and projective identification (Kernberg 1976). According to Kernberg, these patients are best understood as exhibiting a borderline level of organization, with poor capacity for affect regulation, and are prone to impulsive actions, including suicide (Kernberg 2000; see Defense Mechanisms, this chapter).
Paulina Kernberg was the first to study the early signs of personality disorders in children and adolescents from an object relations point of view. She wrote, “The potential for psychological change comes through the activation of dissociated or repressed internalized object relations and through the empathic and shared interchange with the analyst. This patient could discern more clearly what belonged to the present from what belonged to the past and what was being distorted in both present and past.” She goes on to state, “It is more relevant to the patient to understand the determinants of her object relationships than to determine what is intrapsychic or interpersonal” (Kernberg 1988).
Object Relations Theory in Two-Person Relational Psychology
An infant’s temperament, cognition, cognitive flexibility, and internal working models of attachment that allow him or her to cocreate experiences of the self with others do not originate from Freud’s instinctual drives or Klein’s objects; rather, these relational processes are derived from complex nonconscious meaning-making processes stored in implicit nondeclarative memory systems (Chap. 5). The infant elicits and shapes experiences within the context of others and cocreates self-regulatory schemas based on the opportunities for affective attunement and social referencing in his or her environment. As eloquently described by Emde (2009), “We are dealing with human relations, not objects—‘we-ness’ introduces an important new domain that has not been encompassed. The mirror neurons research indicates that our neurobiology commits us to others at a basic prereflective level, and that there is a primary sense of ‘we’ as well as ‘us’” (Emde 2009; Iacoboni 2008, 2009; Iacoboni and Dapretto 2006). Importantly, two-person relational theory emphasizes knowledge of a child’s or adolescent’s family and social systems and posits that this is essential to contextualizing to the developmental processes, accounting for cultural and social norms. Similarly, as with drive theory, object relations fails to attend to family and social systems in which the child lives and often fails to integrate the importance of multiple caregiving figures in the form of parents, aunts, uncles, and grandparents relating with the infant in early life, contributing to the infant’s developmental processes. Thus, object relations theory also limits the importance of cultural and social norms in the development of the child and adolescent. Finally, many object relations concepts (e.g., introjection , projection , projective identification, and splitting) fail to account for the psychodynamic psychotherapist’s proclivities as a contribution to the cocreated moments of meeting in the therapeutic relationship (i.e., the psychotherapist’s own internal relational knowing when interacting with the patient, intersubjective experiences).
Stated differently, the study of a nonsymbolically based representational system has become the central contribution from infant research (Beebe and Lachmann 2002; Tronick 1998). Thus, the older term, “internalized object relations,” connotes the “taking in from the outside,” rather than the “taking in” of the here-and-now implicit and nonconscious subjectivity that is inherent in two-person relational psychology (Tronick 1989). The older term is also more identified with the literature on pathological rather than adaptive relatedness and is more often used to refer to past relationships and their activation in the transference rather than with more general representational models that are constantly accessed and updated in day-to-day encounters.
6.15 Transitional Objects in Traditional One-Person Psychology and Two-Person Relational Psychology
Transitional Objects in Traditional One-Person Psychology
Coined by the pediatrician and psychoanalyst Donald Winnicott , the transitional object (1953) refers to any material object, typically something soft (e.g., a blanket or stuffed animal), that serves as the infant’s first intrapsychic “not-me” possession. Winnicott believed that the infant’s reliance on the transitional objects was a normal phenomenon that allowed the child to transition from the first oral relationship with the mother’s breast to a true “object relationship” (Laplanche and Pontalis 1974). Conceptually, Winnicott (1965, 1971) was clearly referring to both drive and object relations theories as demonstrated in his comments:
I have introduced the terms “transitional objects” and “transitional phenomena” for designation of the intermediate area of experience, between the thumb and the teddy bear, between the oral erotism and the true object-relationship, between primary creative activity and projection of what has already been interjected, between primary unawareness of indebtedness and the acknowledgement of indebtedness (“Say: ‘ta’”). By this definition an infant’s babbling and the way in which an older child goes over a repertory of songs and tunes while preparing for sleep come within the intermediate-area as transitional phenomena, along with the use made of objects that are not part of the infant’s body yet are not fully recognized as belonging to external reality.
Winnicott noted that the transitional phenomena occur between the ages of 4 and 12 months, and he postulated that these phenomena served as a defense against the feelings of depression and the separation anxiety that results from times when the mother is absent. Further, he believed that the overuse of transitional phenomena gave rise to psychopathology, if the projected object was of a persecutory nature, as it would have a fetish quality and could ultimately lead to drug addiction, pathological lying, and theft (Winnicott 1953). Not surprisingly, many Kleinian analysts criticized Winnicott’s concept of the transitional object, as it was an inanimate object that could not represent pathological manifestations of object introjections.
The concept of a transitional object has found a home in the general and psychotherapy lexicon, although not necessarily in the way that Winnicott had conceptualized it. It is common to refer to “binkies,” stuffed animals, or “blankies,” as transitional objects, although, in reality, these objects are likely a soothing object rather than the transitional object in the Winnicottian sense: not-me possession, an intrapsychic representation of mother’s breast.
Related posts:
Two-Person Relational Psychotherapy: Infants and Preschool Age Children
Two-Person Relational Psychotherapy: High School Age Adolescents
Two-Person Relational Psychotherapy: Middle School Age Youth
Supervision
Setting the Frame
Putting It All Together: The Four Pillars of the Contemporary Diagnostic Interview
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