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concepts and techniques within the Object Relations theory of family therapy which, if understood, provides a framework for looking at couples and families. FT DQ10

concepts and techniques within the Object Relations theory of family therapy which, if understood, provides a framework for looking at couples and families.

This presentation will explore several concepts and techniques within the Object Relations theory of family therapy which, if understood, provides a framework for looking at couples and families. Before talking about this approach to family therapy, I would like to explain what object relations theory is all about.

Object Relations Theory was originated in England by a group of British psychoanalysts, including Klein, Balint, Fairburn, Winnicott, and Guntrip. Object relations theory was a break from Freud’s drive model, and differs from it as follows:

Freud’s model held that a newborn infant is driven by animal instincts, such as hunger, thirst, and pleasure, but cannot relate to others. Relationships with others only develop later in the course of satisfying those needs. In this sense, Freud’s model considers relationships to be secondary.

In contrast, object relations theory maintains that the infant can relate to others at a very early age and that relationships with others are, therefore, primary. The drive to attach oneself to an object is considered to be the major motivating force.

Since we are talking about object relations theory, this is a good time to ask what an object is. In object relations theory, the word object is used with a very specific meaning. It’s not literally a physical person, but an internal mental structure that is formed throughout early development. This mental structure is built through a series of experiences with significant others through a psychic process called introjection. Because an infant’s earliest experiences are usually with its mother, she is usually the first internal object formed by the infant. Eventually, the father and other significant people also become internalized objects.

Introjection, the process of creating internal mental objects, leads to another process called splitting. Splitting occurs because the infant cannot tolerate certain feelings such as rage and longing, which occur in all normal development. As a result, the infant has to split off parts of itself and repress them. What happens to those repressed split-off parts They are dealt with through another important process, called projective identification.

Projective identification itself is a very specific part of object relations theory. It is a defense mechanism which was conceptualized by Melanie Klein in 1946, having evolved from her extensive study and work with children. According to Klein, projective identification consists of splitting off parts of the self, projecting them into another person, and then identifying with them in the other person.

For example, the earliest relationship the infant has with its mother is feeding and touching, but the mother is not always able to respond quickly enough to the infant’s need. Since the natural rage and longing the infant feels at such times are intolerable, to survive these feelings the infant “splits them off” and represses them from its consciousness. The “split off”feelings can be thought of as other parts of the self (ego).When such splitting takes place, the infant is free of the rage but has placed that part of itself inside the mother. To make itself whole again it must identify with the mother. The mother may or may not allow herself to become the container for the infant’s negative feelings. Even if she doesn’t, the projective identification still occurs.

The above process begins in the first half year of life, known as the paranoid-schizoid position. It is characterized by an ability to distinguish good feelings from bad, but an inability to distinguish the mother from the self. Depending on how consistent the mothering is, the infant may or may not progress to a higher level of development known as the depressive position. In the depressive position, which starts at about eight months of age, the child takes back its bad feelings from the mother and separates from her. The mother is now seen as a separate object, with both good and bad feelings of her own. The infant is aware of its own good and bad feelings.

For a child to reach this level of development, the earlier mothering must be consistent. The mother must have accepted most of the child’s projected feelings. A child who reaches the depressive position will, in adulthood, be capable of experiencing, at best, such feelings as empathy, or will at least become neurotic.

In contrast, if the mothering is not consistent, the child can’t take back its projected feelings and splitting continues both inside and outside the child. It remains in the paranoid-schizoid position or, at best, a precarious form of the depressive position. This type of development is associated with borderline personalities.

In the above infant-mother example, the repressed parts of the self, if unresolved, will remain repressed into adulthood. Those parts will govern the choice of marital partner and the nature of marital relationships, and by extension the nature of relationships with children. By the time the couple or family come to therapy the projective identification process has likely progressed to the point of being obvious to the therapist, and will be seen in the members’ behavior toward each other. This is usually not so in individual therapy because it often takes time to build the transference relationship with the therapist.

So what does this mean for the therapist What does a therapist have to know in order to work with a family, using the object relations approach The therapist needs to be trained in individual developmental theory from infancy to aging and to understand that the internal object world is built up in a child, modified in an adult and re-enacted in the family. The family has a developmental life cycle of its own, and as it goes through its series of tasks from early nurturing of its new members, to emancipation of its adolescents, to taking care of its aging members, the family’s adaptation is challenged at every stage by unresolved issues in the adult members’ early life cycle. Conflicts within any of its individual family members may threaten to disrupt the adaption previously achieved. If any member is unable to adapt to new development, pathology, like projective identification, becomes a stumbling block to future healthy development.

The clinical approach is to develop, with the family, an understanding of the nature and origins of their current interactional difficulties, starting from their experience in the here-and-now of the therapeutic sessions, and exploring the unconscious intrapsychic and interpersonal conflicts that are preventing further healthy development. Interpretation and insight are thus the agents of family change. By uncovering the projective identifications that take place among family members, and having individuals take back their split-off parts, members can be freed to continue healthy development. If further therapy is indicated, individual therapy would be a recommendation. Symptom reduction in individuals is not necessarily a goal here. In fact, individual family members may become more symptomatic as projective identifications are taken back and the members become more anxious.

To do this, the therapist needs the following four capabilities:

1. The ability to provide a “holding environment”for the family – a place which is consistent – so that eventually the family comes to feel comfortable enough to be themselves in the presence of the therapist.

2. An ability to understand the “theme”of each session, so that a broad theme can be identified over the course of treatment.

3. An ability to interpret the latent content of patients’ manifest statements.

4. An understanding of unconscious processes like transference and countertransference.
Given those tools, it is the therapist’s job to uncover the projective identifications in the family that prevent the children from having a healthy development. Once these projections are uncovered, and the split-off parts given back to the family members they belong to, children are freer to continue healthy development. Having introduced projective identification, I’d like to show how this process operates later in life-in couples and families-and is a framework for doing couple and family therapy. I’m going to present two cases-one of a couple and one of a family-to show how projective identification works.

A male patient of mine with little ambition fell in love with a woman who subsequently pushed him to be ambitious. As it turned out, the woman had been repressing her own ambition under pressure from a father who didn’t believe women should work. This woman was quite intelligent and obtained a professional degree, yet she chose to stifle her ambition in order to please her father. She remained dependent on her father, both emotionally and financially.

The husband, my patient, was a professional but quite unambitious. His family’s philosophy was that one is lucky to have a job and pay the bills. His father had held the same low paying job for twenty years although he, too, had a professional degree. So why did these two people get married Since it was unacceptable for her to be ambitious, the wife needed someone to contain those feelings for her. My patient was the ideal object because, although he had an inner ambition, he had no parental support for these strivings. Therefore, he was predisposed to accept and collude in his wife’s projection.

What is the effect of projective identification when a couple has children The following example shows how parents use their children as objects.

Fern was a woman in her second marriage with two adolescent children. When Fern was a child, her mother favored her brother. The message she received from her mother was that men were important and had to be taken care of, while women were stupid and born to serve men. Both of Fern’s husbands agreed with her mother’s philosophy, so Fern spent most of her married life serving them.When the family came to see me, both children were having emotional problems. The son was a heavy user of pot and cocaine. His sister had emotional and learning problems in school.

Fern had projected into her son that males were special and needed to be taken care of. It’s not hard to see why the son colluded with his mother. The rewards of accepting her projected feelings were too hard to resist, so when he reached adolescence he satisfied his excessive dependency needs with drugs. The message Fern’s daughter received was that she was unimportant and stupid. Why did Fern project these feelings onto her daughter Fern grew up unable to develop her own career goals because her other ignored her wishes to go to college. For Fern to feel sufficiently competent and achieve some career success, she had to get rid of feelings that she was stupid and unimportant. So she projected those feelings on to her daughter and was then able to start a small business. To avoid being totally rejected by her mother, the daughter colluded by remaining stupid and unimportant to herself.

Fern’s reenactment with her daughter of her mother’s relationship with her is a form of projective identification called “identification with the aggressor,”because Fern is acting as if she is her own mother and her daughter is her (when she was a child). Fern’s relationship to her son is also similar to the relationship Fern’s mother had to Fern’s brother. Because Fern is treating her children so differently, when they grow up they will have very different views of this family. This explains why, in therapy, siblings often talk about the same family very differently.

Notice how unresolved feelings from childhood, which Fern split off and repressed,greatly affected her relationship with both children. What do you think is going on in her second marriage

Now I will present an actual transcript of part of a session I recently had with this family. As you will see, it illustrates the process of projective identification and will serve as a basis for further discussion.

T: Fern, I wonder, when Donald was talking about being like Roberta and John asked him a question how did you feel

F: What do you mean how did I feel

T: When John asked Donald when he figured out that he was like Roberta and Donald said just now.

J: How do you feel about him saying just now.

T: And you changed the subject and I wondered what you were feeling.

F: I don’t know. I

T: Donald owned up to some feelings that he was like his father and that part of what he saw in Roberta was like himself.

F: Donald is definitely part of

D: No but what she’s saying is that you changed the subject. That is why she’s wondering if you have some feelings about that.

T: Exactly. You seemed to have moved away from what was going on here. John was talking to Donald

R: She doesn’t want us to be like our father.

T: Maybe that was upsetting to you

R: He wasn’t good to her.

D: Subconsciously maybe. It’s deep but it’s there.

F: Well, I don’t like Martin, naturally. It’s true. I don’t like him – I don’t think he’s a nice person.

R: You don’t like him at all

D: She loves him but doesn’t like him

F: I loved him but I never liked him as a person. I never thought he was a good person; that he really cared about me, that he took care of me, that he was ever concerned with me. I remember a couple of things that – I remember having a bloody nose one night when I was pregnant and he went out to play racketball and left me alone. Things like that – He was mean to me – he had no compassion for me.

D: That’s one thing, I’m not like my father.

F: I’m not saying – I’m trying to say I see certain characteristics of their father in them.

T: How does that make you feel

F: How does that make me feel I don’t know. I guess part of it, not too good because I would rather them be above that, that is, above that anger, why can’t they rise above that anger. I don’t want them to be like that because it didn’t get Martin anyplace in life.

J: I have a very deep question.

F: I don’t know if I want to answer it.

J: You may not but how can you find that with Roberta and Donald being so much alike in personality, like Martin, how do you separate Donald’s being like Martin and accepting it from Roberta and saying Roberta is just like her father and not accepting it

F: Because Donald never directed his anger at me as a person, as a human being. In other words he never – he might have been angry but he never said to me – he never was mean to me, whereas Roberta has been mean to me, attacked me as a person, Donald never attacked me as a person.

T: Donald attacked himself as a person.

D: Hmm.

T: By taking drugs.

F: But he never attacked me as a person.

D: Never, I’m not a mean person. I don’t have that mean streak in me.

T: You sure

F: You may have it in you

D: I don’t have a mean streak.

F: Sure, everyone

T: Who did you direct that meanness to Roberta directs it out to her mother and who did you direct it to

D: I direct it to her.

T: No

R: No you directed it at yourself.

D: Myself, yeah – I’m mean to myself.

F: You were destructive to yourself.

T: So what

D: But that’s different from being destructive to other human beings.

F: No, maybe you would have been better off being mean to me or somebody else. Or to your father.

R: Let’s get back to Uncle John’s question.

J: No this is part of the answer.

D: Yeah – I’m mean to myself. I still am. But I don’t destroy myself with anything – with any kind of substances, but I still am.

R: What do you mean, you still are

D: I’m hard on myself, critical of myself.

R: See, you would never think that of Donald because he walks around like he’s above the world. He does.

T: But why would somebody walk –

D: But I’ve been working on that very heavily now

T: But why would someone

D: That’s the way I am; it’s the way I am.

T: Why would someone walk around like that.

D: It’s very basic – when I was on drugs and everything like that and I’m fully aware of it, aware that I’m conceited and like I have that air about me – I’m fully aware of it. When I was on drugs I had that part to me but it wasn’t as strong as it is now.

T: You weren’t aware of it then

D: I wasn’t really in control of the fact that I control my conceitedness now – I choose to put that on because I have nothing, I have nothing else now.

T: Right

D: It seems it’s like my only defense, to be arrogant and to be conceited because I don’t have anything else to back me up so I figure that wall.

R: Why do you need – I don’t need anything.

D: Roberta – because when I was on the drugs and everything like that, it was a great wall for me to keep everybody out. Now I want everybody to think big things.

Respond to that lecture….

Now let’s look at the latent content of this session and identify the projective identifications.

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