Self-psychological Approach Research Articles

Analysis of Kohut’s Self-Psychological Approach to the Heroine ‘Dong-baek’ in the Drama「When the Camellia Blooms」and Study on Counseling Model

Analysis of Kohut’s Self-Psychological Approach to the Heroine ‘Dong-baek’ in the Drama「When the Camellia Blooms」and Study on Counseling Model

The Treatment of Adult Patients with an Inner Critic - Self-Psychological, Integrative Relational, and Modern Psychoanalytic Approaches

An enduring state of self-criticism characterized by self-attack and feelings of worthlessness and shame has been conceptualized as an inner critic in the object relations literature. Fairbairnian object relations theory has described the inner critic as an internalized bad object often representative of an abusive or rejecting parental figure with treatment focused on helping the patient to separate from this internal bad object and the actual external object. We propose three alternative psychoanalytically oriented treatment approaches which might be more applicable for certain patients. The first is a self-psychological approach which aims to neutralize the inner critic by meeting the patient’s needs for mirroring and idealization. The second is an integrative relational approach which helps the patient to realize and accept both good and bad aspects of the bad object. The third is a modern psychological approach in which the therapist helps the patient to express their anger toward the bad object while maintaining the possibility of improving the actual relationship. Clinical case material is presented in support of these approaches.

Becoming the Little Prince: Autism Within a Psychoanalytic Environment

ABSTRACT This article will describe a long-term psychoanalysis using a self-psychology approach with a child who was diagnosed with ASD (age 4 at the beginning of the analysis). The analytic process, accompanied by deep empathy for the child’s enclosed and different world, relies and builds on the child’s own inner resources. Together the therapist and patient creatively learn about each other so that the analyst can join the child’s world in his own unique way. The analysis raises questions about the potential of psychoanalysis and the psychoanalyst’s role for the autistic patient, who has his own vision of the outside world from within his particular inner world. Can we take his suffering and difference upon ourselves and let him experience belonging and inclusion, thus aiding his developmental process of integrating the fragments of his existence into a living, adaptive, creative person thriving within relationships?

The role of long-term psychodynamic psychotherapy in improving attachment patterns, defense styles, and alexithymia in patients with depressive/anxiety disorders.

Long-term psychodynamic psychotherapy (LTPP) emphasizes the centrality of intrapsychic and unconscious conflicts and their relation to development. Although there is evidence supporting the efficacy of LTPP in mental disorders, little research has been published on the efficacy of LTPP for depressive and anxiety disorders. To examine whether patients with anxiety and depressive disorders demonstrate improvement in their attachment styles, defense styles, psychiatric symptoms, anxiety/depressive symptoms, and alexithymia with LTPP. In this retrospective, descriptive study, the psychological outcomes of patients who were treated at the psychoanalytic clinic of Babol University of Medical Sciences were assessed. Fourteen patients diagnosed with depressive or anxiety disorder participated in the study of LTPP using the self-psychology approach. The Beck Depression Inventory II, Beck Anxiety Inventory, Adult Attachment Scale, 40-item Defense Style Questionnaire, and the 20-item Toronto Alexithymia Scale were administered at pre-treatment, post-treatment, and 6-month follow-up. Generalized estimating equations were used to analyze changes in psychological outcomes after each of the three assessments. The mean scores of depression and anxiety and secure attachment improved significantly after LTPP with self-psychology approach from baseline to post-treatment and follow-up. Also, the mean scores of neurotic and immature defenses, difficulty in identifying feelings, difficulty in describing feelings, externally oriented thinking, and total alexithymia scores decreased significantly from baseline to post-treatment and follow-up. Symptoms of anxiety disorders, depressive disorders, insecure attachment styles, alexithymia, and neurotic/immature defense styles improved after the LTPP with self-psychology approach. Moreover, the improvements persisted at the 6-month follow-up.

An Integrative Approach to Conceptualizing and Treating Complex Trauma

ABSTRACTComplex trauma (CT) often presents with polymorphous symptoms (i.e., emotional dysregulation, dissociation, somatic distress) resulting from repeated and chronic exposure to traumatic stressors. While the public is increasingly aware of posttraumatic stress disorder (PTSD) and its accompanying symptoms, the phenomena of complex trauma is less recognized and understood. Since the trauma reactions with CT typically occur during childhood, and the symptoms go well beyond PTSD, the authors of this article assert that an integrative approach is needed that synthesizes the most effective elements of cognitive-behavioral therapy (CBT) while blending a self-psychological approach. A review of the literature addresses the definition of complex trauma, cognitive-behavioral conceptualizations and treatment approaches, self-psychological models, current theories of attachment, and advances in neuropsychoanalysis. An integrative model is then proposed, supported by clinicians in the trauma field, identifying three intertwined phases of treatment.

Addiction and Temporal Bandwidth

Psychoanalytic thinkers tend to conflate addiction with the use of substances. At any moment of use, a substance can have emotion-regulating qualities and may even appear to be a symbolic substitute for a person or a function (a theory at the heart of the self-psychological approach to compulsive substance use). However, addiction—as opposed to use—is a state that happens over time and represents a loss of choice. It is my belief that far from being a symbolic act, addiction is an anti-symbolic state, plucking an individual from a narrative mode of being, which requires a human context and a broad, dynamic sense of time, to a conditioned mode or a somatic feedback mode, which relies largely on positive and negative reinforcement and tends to narrow temporal horizons. A tenet of this article is that a rigidly narrow subjective sense of time, what I call “low temporal bandwidth,” is the most prominent feature in a person’s vulnerability to addiction, a feature linked to a conditioned mode of being, as opposed to a narrative mode. This article traces some of the early relational pathways to low temporal bandwidth and explores how a new human context in therapy, centered on the elaboration of emotional states into narratives, can allow for more flexible, dynamic temporal bandwidth that often dramatically loosens the pull of addiction.

A Self-Psychological Approach to the Study of Biography

This chapter is an exploration of the psychoanalytic aspects of biography and the biographical aspects of psychoanalysis. The narratives that emerge from biography and psychoanalytic treatment incorporate elements of empathy, ideology (theory), and transference/countertransference and are co-constructed within an intersubjective field involving the subjectivities of both participants, the biographer and her subject and the analyst and her analysand. I will provide examples that demonstrate the way in which these processes play out in the biographical realm. Correspondingly, I will illustrate the way in which the analyst's biography and analysand's autobiography change in the course of the psychoanalytic treatment. Salient differences between biographical and psychoanalytic endeavors are also discussed.

Anger, aggression and hate: Concepts influenced by infant research and attachment theory – an individual psychological perspective

SummaryIn this paper, I would like to describe how the clinical understanding of phenomena like anger, hate and aggression can be enriched by concepts derived from infant research and attachment theory. In doing so, I will draw on my own individual psychological and psychoanalytical point of view. In modern individual psychology, as it is understood in Germany, there are certainly psychoanalysts who tend to favour not just Adler’s theories, but also those of Melanie Klein or Wilfried Bion above all, just as there are those who favour the self-psychological approach (and, of course, there are other theories as well). Therefore, it goes without saying that I do not claim to represent the definitive perspective of individual psychology in my work: in individual psychology, as in psychoanalysis, there are, after all, different opinions, theories and preferences which sometimes may be predominant in specific countries. I believe that we essentially gain overall from this pluralism of theories, in spite of the dangers that may be associated with it (such as confusion of language, diffusion of identity of school-specific concepts, undifferentiated pragmatism, etc.). Openness is, in my opinion, a very important characteristic of individual psychological theory. On the other hand, pluralism of theories does not, after all, exclude the focal points of scientific interest and the understanding of clinical phenomena, and I would like to concentrate on some of these focal points in this paper.

Working With Men Who Please Too Much: Gaining Clinical Momentum

This paper outlines a self-psychological approach to working with men who please too much. These men feel stuck in enacting patterns of compliance and defiance. Because they feel required to please others, they resort to addictive acts of substance use and unfaithful sexuality to break out of their deadening accommodation and to express their disavowed rage and their thwarted ambition. Reviewing an illustrative case, the author demonstrates how empathizing with each side of these mens' “split selves” and reaching for their disavowed affect facilitates a process of self-integration that improves their ability to assert themselves. Here, the patient responded to the therapist's sustained empathic inquiry by experiencing this disavowed affect and better understanding the meanings of his addictive behavior. His increased self-understanding enabled the therapist to make a momentum-building interpretation that fostered the patient's integration and his willingness to depend on the therapist for self-regulation....

Couples in the Playspace

SUMMARY The present paper presents, and illustrates with clinical material, a self-psychological approach to the use of dreams in a couples session. The approach suggested stresses a playful, metaphorical, form of communication. Freud (1914, p. 154) used the term spielraum, orplayspace, as a metaphor for the analytic atmosphere that allows the unfolding of a transferential process. Play, in the sense of developing a spirit of freedom, curiosity, and exploration, is necessary to the “growth of a healthy self.” It is very similar to the serious play that Winnicott (1953) described as occurring in an “intermediate area of experience.” This sense of playspace, and the creation of safety for it, underlies the approach of the present paper. A self-psychological approach to dreams can lend itself extremely well to working in a couples setting. Dreams provide an excellent opportunity for the development of a playful and metaphorical communication both between therapist and patient and between the two partners in the couple. This can deepen the couple's relationship as well as the curative process in each patient.

Self Psychology, Dreams and Group Psychotherapy: Working in the Playspace

This paper presents one leadership style within a self-psychological approach to working with dreams in group psychotherapy. It stresses an empathic attunement, the creation of safety, and an experience-near playful relationship. “Playful” is not used lightly here. It is used in the spirit of Winnicott's intermediate space where a mother suspends questions of what is real or not real and what is me and not me. Freud's analogy to a playspace forms a metaphor for the creation of a special atmosphere in a group, or for that matter in individual work as well, that encourages exploration, risk taking, and vulnerability. Working with dreams in this playspace deepens the curative process, not only for the dreamer, but for the entire group.

Strength and Diversity through a Self-Psychology Approach to Art Therapy

This article describes the use of art therapy with the aging population. Emphasis is placed on the use of art therapy with the segment of the elderly population who have experienced severe mental or physical losses. The art process appeared especially useful with moderately to severely impaired elderly who had experienced severe anxiety in addition to dementia. Decision making was used as a means to empower the older adult to expand on existing self-awareness, self-esteem, and self-cohesion within their capabilities. While the moderately handicapped client could eventually initiate choices about colour, form and/or topic, the severely handicapped, regressed client required constant technical assistance and cueing to make decisions as to colour form and/or topic. Spontaneity with this client group was observed infrequently and was not emphasized. Perseveration of either colour, form and/or topic was observed with both the moderately and the severely regressed clients. Similarly group interaction occurred occasionally with this segment of clients while interaction with the art therapist occurred during each session.

The Concept of Promiscuity

The purpose of this paper is to demonstrate a self-psychological approach to the understanding of promiscuity. A patient is described who utilized sexual activities as an attempt to acquire affirming and mirroring responses to stabilize her fragile sense of self. A mirroring transference spontaneously unfolded in the treatment which subsequently became eroticized. The selfobject mirroring tie to the therapist gradually became internalized wilhin the patient as she was able to calm and soothe herself. A definition of promiscuity from within a self-psychological framework emerged from this treatment. Promiscuity is the subjective experience of the patient that sexual activities are being utilized primarily to restore and maintain self-cohesion.

The evolution of the self-psychological approach to depression.

This paper traces the evolution of the self-psychological view of depression from its roots in classical psychoanalytic theory and technique. Self psychology differs significantly from classical psychoanalysis in its theoretical understanding and its technical handling of the transferences and aggressive tendencies of depressed patients in psychotherapy or psychoanalysis.

Treatment of Alcoholism and Other Addictions: A Self-Psychology Approach

Treatment of Alcoholism and Other Addictions: A Self-Psychology Approach

Treatment of alcoholism and other addictions: a self-psychology approach

Treatment of alcoholism and other addictions: a self-psychology approach

Group therapy with bulimic women: A self-psychological approach

Long-term psychodynamic group therapy is an important tool in the process of engaging bulimic women in treatment and in helping them work through both the symptom and the underlying characterological problems of the disorder. The authors utilize concepts from self-psychology, particularly “selfobject” needs and the therapist's empathic stance, to explain some of the dynamics of bulimia and the ways in which group therapy addresses them. An example from one of the authors' groups demonstrates this. The multiple selfobject transferences that develop in a group, coupled with the therapist's empathic interpretations, fostered the development of internal structure that explains the bulimic's gradual ability to dispense with her symptoms. The authors believe that groups provide a setting in which that structure can be developed.

The relationship between physical disability and narcissism: A critique of the literature

This article critically examines some of the major psychoanalytic writings on the relationship between physical disability and narcissism. Tracing the evolution of thought about narcissism from Freud's original formulation to a self-psychological approach, it considers and contrasts pain, illness, and adult disability on the one hand and early onset disability on the other. The conclusion reached is that disability and narcissism are related in complex ways, depending on a variety of physical, developmental, and environmental factors. Thus, clinicians must avoid making a priori assumptions in work with disabled patients, for such assumptions may be countertransferential.