Self-object Differentiation Research Articles

Asperger's Disorder: Implications for Psychoanalysis

Although described only one year after Kanner's (1943) classic description of autism, Asperger's account of the condition that now carries his name (Asperger, 1944) has, until recently, received much less attention. Psychoanalytic attention has focused largely on infantile autism. and early work was concerned with the idea that experiential factors might be involved in pathogenesis. During the 1970s, a large body of work questioned this view noting, for example, the strong genetic and brain basis of autism (Volkmar, 2000). Work from other fields began to question some early theoretical notions, e.g., the normative existence of an autistic phase, but important questions that autism raised for understanding early ego development and capacities for self-object differentiation continue to be a concern of some theoretical and clinical interest (Volkmar, 2000). This article provides a summary of Asperger's as a diagnostic concept in terms of the history of the concept, aspects of clinical expression and co-morbidity as well as implications or intervention. The final section of the article focuses on implications that the condition may have for theory and practice.

Self-object differentiation in suicidal adolescents

Background Although problems in the differentiation between self and object are commonly encountered in clinical work with suicidal adolescents, empirical validation of this phenomenon is limited in the literature. The aim of this study was to use empirical methods to examine the differentiation between self and parental representations in suicidal inpatient adolescents. Methods Ninety-six adolescents participated in the study: 32 suicidal inpatients, 32 nonsuicidal inpatients, and 32 healthy controls. The 3 groups were matched for sex, age, and education. All participants completed scales on self-object differentiation and suicidal tendencies. Results Suicidal adolescents were found to be significantly different from both nonsuicidal psychiatric and healthy controls in negative self and parental descriptions ( P < .001) but did not differ from the other groups when describing positive traits. Moreover, suicidal adolescents described themselves as being significantly less differentiated from both their father ( P < .001) and mother ( P < .01) in negative traits but not in positive traits, when compared to the 2 other groups. Conclusions Suicidal adolescents have difficulties differentiating the negative aspects of the self from the negative aspects of their parents. These results emphasize the importance of object relations theory in understanding suicidal tendencies in adolescents. A model combining negative symbiosis and suicidal tendencies offers several therapeutic intervention strategies.

Tuning the Therapeutic Instrument: Affective Learning of Psychotherapy

JILL SAVAGE SCHARFF AND DAVID E. SCHARFF (EDS.): Tuning the Therapeutic Instrument: Affective Learning of Psychotherapy. Jason Aronson, Northvale, NJ, 2000, 438 pp., $60.00, ISBN: 0-765-702452. The authors engage us in an interesting foray that moves psychoanalytic theory further into the field of object relationships. In fact, their conceptual scheme goes beyond the dyad to discussions of family dynamics and the explorations of small and large groups as organizers of psychic development. This book is divided into four sections. The first concentrates on psychic development as occurs in individual and group interactions. The developmental process is also infused with the mathematical principles of chaos theory and fractal geometry, although the latter is considered primarily in phenomenological terms rather than as a unique type of geometry. The second section consists of interesting discussions of the psychodynamics of psychotherapy and supervision in small and large groups, as well as therapists in the student role. The latter is an enhancing experience for the therapist and the group. The remaining sections include extensive discussions of many different groups, pursuing the individual, group, and institutional elements of the learning matrix. This book covers many aspects of psychic development, the learning process, and the treatment relationship. Inasmuch as it spreads itself to include very difficult and complicated theoretical systems, such as chaos theory, it is remarkably lucid. This is further noteworthy because various chapters are written by different people, so I conclude that the Scharffs have carefully reviewed and edited the manuscripts presented to them. The central theme of the Scharffs' system concerning therapeutic strategy and learning is what they call affective learning. It is sufficiently important to them to include it in the subtitle. It is also part of their educational endeavor, a two-year program in which the therapist focuses on using the self, a key ingredient of successful treatment, as it is developed into a sensitive instrument for therapy. In spite of the constant references to affective learning, I am not quite certain as to what special significance they attribute to that term. They emphasize that affects are motivating and integrative factors for self-object differentiation, obviously a developmental achievement. Unconscious self-object relations are the organizers for external object relations. Freud made the same point when he wrote that the ego is a precipitate of past object relations. The Scharffs state that communication is largely unconscious. This applies mainly to learning experiences that relate to developmental progression. As with many psychic processes it is unwise to generalize. There are many types of learning that involve different levels of the psychic apparatus and much is acquired by ego and secondary-process activity, although in creative interactions the role of the unconscious is vital. …

The psychotherapy of a male anorectic

The author describes the way in which a male anorexic patient came to be understood in once‐weekly psychotherapy. The findings are similar to recent psychoanalytic ones about female anorectics, but add that he was preoccupied with display and that there was an erotised transference in the oral mode. Of two major themes, the first was a food obsession; the food was felt concretely to be the mother as in a symbolic equation, and the conflict about eating represented a wish for and fear of fusion with her. The second major theme concerned exhibition; the self, as seen in two screen memories, was felt to be uncomfortably on show. Meanwhile the patient was preoccupied with a self‐displaying maternal object, which was prominent in the transference. This perception of the object served as a defence against envy, although the defensive aspect may have been added to by an actual experience of a mother who functioned operatively, giving food rather than loving attention. The patient employed primary‐process thinking defensively against selfobject differentiation, which would have excited further awareness both of envy and of the real deficiencies of his primary objects. The author raises the possibility that the anorexia functioned as a perversion, binding and organising the core complex about fusion.

Understanding Autism Implications for Psychoanalysis

Several lines of evidence inform current psychoanalytic thinking about infantile autism. Although early psychoanalytic interest in autism centered around the notion that experience might play a role in pathogenesis a large body of data suggest this is not the case; rather the condition appears to be the result of genetic and other neurobiological factors. Studies of children with autism do, however, suggest basic problems in capacities for object relations and other aspects of ego development which must be understood in the context of autistic social dysfunction. The study of normally developing infants raises considerable questions about the validity of notions such as a normal autistic phase; rather than for the normally developing child interest in the social world appears to be an innate capacity and one which has considerable importance for our understanding of the nature of early ego development and capacities for self-object differentiation.

Shame and Psychopathology

The origins of the word "shame" recall the concept of the infraction of integrity both as scandal and as individualization. The human experience of shame stretches along a continuum from modesty to disabling interpersonal terror. Unlike other basic affects, its emergence is a fundamental moment in the process of self-awareness and self-object differentiation. Neglected by psychiatry because it was regarded as a moral concept, today it is possible to hypothesize that it has a biologic basis that one can attempt to describe in terms of corticothalamic pathways. In this respect, like other affects, it could be considered as a cognitive shortcut to activate specific and evolutionally useful behavioral patterns, such as concealment or a request for affiliation. It is fairly ubiquitous in psychopathology, but is clinically much more structured in its abnormal expressions in anxiety disorders, particularly social phobia, obsessive-compulsive disorder, eating disorders, body dysmorphic disorder, and even in bipolar mood disorder. In schizophrenia it has been described as being one stage in the construction of delusion. Its presence is connected to interpersonal relationship (altruism) though it seems absent in autism. The assessment of shame experiences in psychiatric patients could be useful for both pharmacological and psychotherapeutic strategies, and could provide a categorization of a new psychopathology based on abnormal affects.

Positive and Negative Self-Complexity: Patterns of Adjustment Following Traumatic Versus Non-Traumatic Life Experiences

The present research extended work on the buffering effects of self-complexity by exploring its implications for long-term adjustment following traumatic life events. Self-complexity for positive and negative self-representations were examined separately. Subjects were classified into two groups ― trauma and no-trauma ― based on their ratings of experienced negative life events. Positive self-complexity was strongly associated with better adjustment post-trauma, whereas it was unrelated to adjustment for those who had not experienced a traumatic life event. Negative self-complexity was associated with poorer adjustment in both groups

The Psychoanalytic View of Phobias

The psychoanalytic literature on infantile phobias, despite disclaimers by several of its prominent authors, seems to demonstrate a growth in knowledge of these conditions and an increasing respect for methodology. It is also noteworthy in its close adherence to the presentation of clinical material. Looking at phobia from this developmental viewpoint has caused us to modify our definition of phobia, adding independence from immediate, fear-provoking stimuli and requiring an inference on the part of the observer because of some integral mental process which is nontransparent. These additions are further specifications of the meaning of the term in general; they are not intended to be limited to infantile phobias. Phobic syndromes can certainly arise well before age four, well before there is any evidence of a child's having entered the oedipal phase of development. Nevertheless, because of the early genital phase, castration reactions, albeit with a somewhat different meaning, usually appear to be involved in the symptom formation. There is also a suggestion that all infantile phobias may begin to arise at this period of development. The symptom pictures in the cases of the children reported in the psychoanalytic literature are very similar. We seem to have described a disorder which, we can hypothesize, has its beginnings in the early genital phase, may emerge as a psychopathological condition at that time, or may reach proportions sufficient to interfere with function or development only several years later. The disorder appears to make use of inherited reflex-like patterns of response to certain stimuli as dangers. On the basis of the reported psychoanalytic experience, we cannot really generalize much about psychogenetics or psychodynamics. Psychoanalysts have applied their ideas about neurotic symptom formation in general to these cases. Just why the illnesses assume these particular forms in these particular children is unclear. The only steps toward specification have been hypotheses introduced by Anna Freud and Owen Renik. Anna Freud hypothesized that a major condensation occurs to focus infantile anxieties on a single symbol, thus causing sharply focused, rather than generalized, anxiety. Renik related self-object differentiation and cognitive development to such "symbolization" in infancy, explaining phobic object formation in terms of primary and secondary process representations and their interaction. Although we have descriptively defined a syndrome "phobia," it is not yet clear whether the disorders of infancy and childhood which fit that definition have significant similarities--descriptively or psychodynamically--with conditions which develop later in life and also appear to fit the descriptive parameters.(ABSTRACT TRUNCATED AT 400 WORDS)

Attachment and Separateness

The aims of attachment and of separateness, and their experiential counterparts within the overall sense of self identity, guide the individual throughout the life cycle. Multiple forms of relatedness, based on varying degrees of self-object differentiation and instinctual drive involvement, enable the individual to establish and consolidate a sense of self both as a cohesive and autonomous entity and as inherently attached to others through loving relationships. This theoretical orientation provides a context for integrating Kohut's major conceptual contribution with classical object relations theory. The essence of this integration requires resolution of the challenges that Kohut's concept of "self-object" poses to conventional understanding of the relationship between relatedness and self development.

Gender as an element in the intersubjective field: The female therapist and the male patient

Gender identity is a fundamental component of core identity and it lays the ground plan for the creation of the specifics of the individual's self representation through varied early self- and object experience. This paper seeks to illuminate some of the unconscious dynamics emerging out of profound developmental differences between women and men. The effects of these unconscious dynamics upon the relationship between the male patient and the female therapist are examined, drawing upon transferential and extratransferential phenomena. Illustrations are presented, demonstrating interpretive work directed toward resolution of conflicts around male identity and aimed at fostering self-object differentiation.

Dimensions of personality organization as predictors of teenage pregnancy risk.

Personality development as measured by Loevinger's Washington University Sentence Completion Test, The Friedman Developmental Level Scoring System for the Rorschach, The Urist Mutuality of Autonomy Scale, The Thematic Apperception Test, and indexes from a structured interview were able to discriminate between teenagers at high- and low-risk for pregnancy. In addition, these measures correlated significantly with each other and enabled a description and comparison of the personality characteristics of adolescents who are at risk for pregnancy and those who are not.

Undermedication for Pain on a Burn Unit

As the consultation-liaison psychiatrist for a large burn service, the author investigated the undermedication for pain. This phenomenon could not be adequately explained by the staff's insensitivity, by mistaken ideas about analgesics, or by fears of iatrogenic addiction. For both patients and staff, the pain served to maintain self-object differentiation and to provide reassurance that the patient was alive. Developmental observations and psychoanalytic theory support this unconscious need for pain.

Undermedication for pain on a burn unit

As the consultation-liaison psychiatrist for a large burn service, the author investigated the undermedication for pain. This phenomenon could not be adequately explained by the staff's insensitivity, by mistaken ideas about analgesics, or by fears of iatrogenic addiction. For both patients and staff, the pain served to maintain self-object differentiation and to provide reassurance that the patient was alive. Developmental observations and psychoanalytic theory support this unconscious need for pain.

The Urist Rorschach Mutuality of Autonomy Scale as an indicator of psychopathology.

The Urist Rorschach Mutuality of Autonomy Scale (MAS), which assesses development along a self-object differentiation and mutuality dimension, has shown considerable promise as an index of interpersonal relationship capacities. As such, MAS scores were predicted to correlate significantly with three measures of psychological pathology/health. The reliability of the scale was investigated with non-S Rorschachs and found to be satisfactory. Four-card Rorschachs from 60 previously hospitalized adults comprised the data source for the hypothesis test. Results suggest that the Mutuality Scale accurately reflects observed pathology severity at time of hospitalization and over a lifetime, but not at the time of assessment. Hence, the Urist MAS may indicate potential for pathology.

Therapeutic Mother-Child Groups: A Developmental Approach

Parents who were stalemated in their own emotional development have children who are at risk of being similarly thwarted. A group for mothers and young children helps the adults to achieve greater self-object differentiation and the children to establish object constancy and to move toward independence.

Narcissism and superego development.

To elucidate the role of the superego in th maintenance of narcissistic equilibrium, we reviewed Freud's ideas about narcissism and the superego as well as the relevant theories of Kohut, Kernberg, and certain ego psychologists. These latter authors offer an alternative mode of understanding narcissism more consistent with Freud's structural theory, one in which signal affects and superego functioning play a central role in normal development and in the pathogenesis of narcissistic disturbances. Early steps in superego formation were then examined schematically to elucidate the interaction of environmental influences and emerging psychic structure. We suggested that the first step in a developmental line toward superego formation is based on the affective qualities experienced in the course of self-object differentiation. Subsequent steps examined were introject and ego-ideal formation; compliance with th object; compliance with the introject; identification with the introject and the ego ideal; and finally, with oedipal resolution, the integration of superego nuclei into a progressively structuralized autonomous superego system. This system achieves growing independence from the drives and from pressures from early introjects during the course of latency, and functions to maintain the demands of the conscience and the standards of the ego ideal; rewards or punishments result when these demands and standards are or are not met. The final stage briefly considered here was the revision, modification, and elaboration of moral codes and the ego ideal as part of the adolescent process. Narcissistic vulnerabilities at various stages were pointed out in an attempt to stress that a particular clinical picture in later phases of development or adulthood may derive from any of several development points of origin and from one or more etiological factors.

Some Narcissistic Consequences of Object Loss: A Developmental View

This paper examines the effects of object loss on narcissistic equilibrium from a developmental perspective. Such effects vary, depending on when the loss occurs in relation to the process of self-object differentiation, as well as on other characteristics in the loss situation. An effort is made to clarify the particular narcissistic elements which may be identified as involved in the experience of psychic pain following a loss. To this end, a distinction is made between feelings of omnipotence, of self-constancy, and of self-esteem, and their different developmental bases illustrated with clinical examples.

An experimental study of psychoanalytic theories of depression.

This study involves an application of a new methodology, subliminal psychodynamic activation, which can be used to experimentally test psychoanalytic "dynamic" propositions. It was found that with a sample of neurotically depressed female patients, there was a significant decrease in depression-related responses following the stimulation of a symbiotic gratification fantasy ("Mommy and I are one"). Subliminal symbiotic stimulation had been shown previously in studies with different populations (schizophrenics, homosexuals, phobics, alcoholics and overeaters) to have similar ameliorative effects. The current results point to the importance of symbiotic dynamics and the relationship dependent on a dominant other, rather than to the retroflexion of aggression in neurotic depression. This is in keeping with the formulations of Arieti (1959), Bemporad (1953), Horowitz (1980), and the senior author (Slipp, 1977). Hypotheses regarding the effects of stimulating fantasies involving success were not supported by the primary data, although secondary data (from correlational analyses) did provide some indirect support for the senior author's hypothesis. The "Autonomous Succeed" message ("Succeed for myself") did not reverse the depressive mood, possibly because autonomy was equated with abandonment. Relatively differentiated depressives tended to respond to the "Exploitative Succeed" ("Succeed for Father or Mother") messages with a decrease in depression, while depressives with a low level of self-object differentiation tended to respond with an increase in depression. For more differentiated depressives, performing for and giving over a part of the self to another is an adaptive style that insures the dependent relationship and bolsters the patient's weak self-image. However, with poorly differentiated depressives, giving over to another raises the threat of total annihilation, since the self is already diminished. These secondary data can be viewed, however, as only suggestive and need to be pursued in future studies. The results on symbiosis in this study add to the growing literature (summarized in Silverman, 1976, 1980) indicating that subliminal psychodynamic activation is a useful technique for investigating psychoanalytic formulations in the laboratory. It was Freud's overriding hope that psychoanalysis be firmly rooted as a behavioral science and this technique seems most promising as contributing toward that end.

Dynamic and Developmental Issues in Borderline and Related “Spectrum” Disorders

Reactive and schizoaffective syndromes, primary affective disorder, paranoid (psychotic) disorders, borderline personality disorders, and narcissistic personalities have in common a number of developmental and psychodynamic features which are expressions of failure of separation-individuation. Recent and current literature supports the concept of two subspectra, the subspectrum of psychotic disorders and the subspectrum of personality or characterologic disorders, the latter comprising an array of syndromes, the common developmental psychodynamics of which center on partial self-object differentiation; these are here subsumed under the borderline rubric. Patients with spectrum disorders have remained to variable degrees symbiotic, and the degree of psychopathology relates to the degree of self-object differentiation.

First Scribbles: The Emergence of an Ego Function

Abstract This paper presents a developmental analysis of some early stages of prerepresentational graphic functioning based on the “scribbles” of normal children in the second year of life, studied in a research nursery. We also present case material from the therapeutic nursery treatment of an autistic boy, comparing the evolution of his drawing with the developmental sequence derived from the normal group, and correlating advances in this ego function with progress in self-object differentiation and object relatedness.