THERAPEUTIC ACTION IN SELF PSYCHOLOGY, WITH SPECIAL FOCUS ON

TWO DIMENSIONS OF SELFOBJECT FAILURE

Kenneth Newman, M.D.

Introduction

            Kohut’s theory, which placed disturbances in the development of the self as central to the formation of pathology, evolved gradually from his clinical practice.  What became clear to him was that many of his patients (and those of his supervisees), heretofore understood from a drive-defense model, were communicating pathological characterology through their symptoms and, most especially, through their unique transference presentations which were the result of environmental traumata that related to issues involving the establishment of a cohesive self.  When Kohut began to look at his patient’s symptomatic complaints, compromised relatedness, and vulnerability to fragmentation anxiety from the perspective of a self disturbance, he came to recognize the importance of the early environmental caretakers, whom he called selfobjects.

            The term selfobject is meant to describe persons in the external world who are experienced psychologically as a necessary part of our selves.  Selfobjects are needed throughout life; the functions they serve change with shifting developmental demands.  While they continue to be important at all times, when they appear more noisily, or as part of a “hunger,” we may say they represent the need for a set of functions (idealizing, mirroring, twinship) that had not been acquired in early life.  By locating the pathognomic point of fixation at the time when the child’s self and its relationship to selfobjects is primary, Kohut could argue that the failures in these bonds lead to arrests  in development that would emerge in treatment as psychological needs and residual infantile wishes.  In other words, the major disturbances occurred at a time when selfobjects were be crucial in establishing self-cohesion, self-enhancement, and validation.  Remediation in analysis included mobilization and reactivation of those selfobject transferences that continued to be necessary for internal reorganization and structure building.

            Like Winnicott, Balint, and others, but in a more systematic way, Kohut saw that patients whose traumatic development resulted from the empathic failures of parental figures would require in the clinical situation that there be new opportunities to reconnect with the analyst as selfobject, in order to reactivate derailed developmental processes, and integrate a frozen or split-off emotional life.  Since the locus of pathology was shifted from infantile drives in conflict with a critical superego-ego system to developmental failure, the patient’s inability to “outgrow” the need for objects was seen from a different perspective.  In short, if the original foundations of a cohesive self were still in flux, then the search for the objects (in however distorted a way this was manifested) to complete the self was seen as related to legitimate needs.  However inappropriately archaic the character pathology, symptomatic expressions, and ways of relating to others and themselves might seem, they reflected and expressed thwarted strivings whose therapy require a new kind of emotional experience.  Ultimately the hope was that this could occur through finding a “usable object” as mediated in the transference by the analyst.

            “Usability” (Winnicott) refers to an achievement in object relations that represents the subject’s ability to place the object outside the realm of omnipotent or selfobject control.  It denotes a capacity for a relationship that can allow for some separateness of the other.  It has a point of confluence with all psychoanalytic models in that it implies that the subject does not experience or necessarily require the other for defensive purposes.  The major yield of reaching “usability” is that the object (selfobject) is now available for new emotional exchanges, structure building, and the opportunity to analytically rework old transferences.

Kohut’s Model:  Healthy and Pathological Outcomes:

            Kohut’s model of the developmental stage of self formation, aided by experiences with the needed selfobjects, aims to describe healthy as well as pathological outcomes.  He emphasizes the role of the parental caretakers as crucial in facilitating cohesion and self-enhancement, leading to higher levels of integration as their selfobject function becomes internalized.  If, however, the environmental parents are inadequate to the task, the process of internalization will be faulty, and significant fixations will occur.  These will be manifested in an intensified and often pathological search for objects to complete the self.  This prolonged need, as well as characterological defenses against it, will appear in the complex narcissistic configurations emerging in the analytic situation.

            Kohut originally stated that, under optimal conditions, the exhibitionism and grandiosity which are phase appropriate for the infant self, gradually become modulated and integrated, fueling ego syntonic ambitions and aims, and serving as a continued source of self-esteem.  Similarly, the idealized parental imago will undergo transformations (including expectable disillusionment), and become a vital component of the psychic structure serving as a guiding ideal and a source of internal validation of meaningful activities.

            But if the child suffers severe narcissistic traumata, then the grandiose self remains in a fixated, unaltered form, walled-off or split-off, in continual need (“hunger”) of responsiveness.  Similarly, if the child experiences too great a disappointment in the idealized parent (either as an early self-model for tension and affect regulation, or later as the bearer of admired standards), this configuration will fail to become seamlessly integrated into the self as a tension regulating and ego guiding structure.  It will remain in an archaic form.  The result of these failures leaves the child seeking restitutional means to maintain homeostasis, often assuming addictive forms of drives, or perversions, or delinquency, to effect comfort or self-esteem regulation.  Additionally, the child may form pathological bonds of attachment, which serve to compensate for the lack of wholesome and “usable” ties.  While the injured child employs a variety of ways (often forged from innate talents and abilities) to protect the vulnerable, anxiety-prone self, the deep-seated yearning for selfobjects to aid him in rehabilitating a developmentally derailed self, and reconnecting with split-off or unintegrated affects, continues unabated.

How Kohut’s Model Effected a Change in the Analytic Situation:

            By positing the point of pathognomic fixation at a stage in development prior to the consolidation of the self, Kohut legitimized the patient’s claims, however disguised, for responsiveness.  Emphasizing that as analysts we are being deployed in the transference to fill in uncompleted psychological structure and to validate the significance of emotional requirements, relieves us from taking a role that patients can experience as adversarial.  We become focused on illuminating and accessing the patients’ needs, rather than discovering and interpreting hidden and “illegitimate” infantile wishes.

            A further extension of the shift away from the experientially adversarial position is seen in the attitude toward “resistance.”   Like Winnicott, Kohut reconceptualized what had been deemed resistance, formerly considered as the patient’s attempt to evade the superego, or even defeat the analyst, as now constituting a response to impingements or empathic failures on the part of the analyst.  Kohut further elaborated this when he observed that his patients’ regressive expression of archaic self states was based on ruptures in the self-selfobject transference, rather than on intrapsychic defensive operations designed to ward off deeper analytic involvement.  This meant that the analytic focus shifted to understanding the causes of disruption, both in the context of their genetic roots, and in empathic breaks within the analytic situation.

            However, the most dramatic change in the analytic climate emerged from Kohut’s construction of transferences now  seen as carriers of needs linked to fixations caused by environmental trauma.  These narcissistic configurations (variously referred to as the grandiose self and the idealized imago), as they became elaborated, appeared as admixtures in rigidified form of the original needs, as well as the adaptive/maladaptive defensive solutions.

            Kohut described several major forms of selfobject transferences.  The broadest of these relates to the grandiose self, with its complementary selfobject needs, as they pertain to distinct variations that include the mirroring, the alter-ego, and the twinship selfobject.  We also have needs for idealized selfobjects.  The requirement for this parental selfobject begins with mother’s earliest function as an omnipotent figure capable of aiding the infant with tension and affect regulation.  It continues as part of the spectrum emerging in later developmental stages, where the idealizing object provides paradigms for the fulfilling of ideals and ambitions.

            While Kohut offered a differential classification of these narcissistic transferences, it is clear that such sharp demarcations  may not always occur.  Further, it should be noted that the establishment of these self-selfobject transferences in the analytic situation usually points to the fact that earlier editions of these needs had been frustrated and therefore have become intensified.  Often the appearance of these needs in the external world—usually in some split-off or derivative (or symptomatic) form—will be considered an expression of selfobject hunger.  Thus, as we encounter a form of the mirror transference in treatment, we will surmise that, as a result of insufficient early responsiveness, the patient will deploy into the analysis the yearning for confirmation and acceptance.  Similarly, alter-ego or twinship transferences may appear.  These manifest as seeking a selfobject who conforms to the self in appearance, values, or opinions, in order to provide a confirming reality and a validation for the existence of the self.

            One further point Kohut made was that all of these transferences, when established in analysis, were anchored in and emerged from a solid core of repressed need.  He meant to distinguish between fleeting manifestations and those more abiding, analyzable configurations representing specific self-selfobject transferences.

            It is important to distinguish between archaic narcissistic presentations that represent the way the self has attempted solutions, or defensive restitutions, and the emergence of an expanded grandiosity that can be liberated from behind a wall of repression in the analytic situation.  For example, Citizen Kane, as portrayed by Orson Welles, is a study of a restitutive position forged out of early trauma that, while a derivative of the original need for mirroring and confirming, represents grandiosity in its more archaic and defensive form.  In treatment, the aim would be to address the needs of the child, linked associatively to the sled, the “Rosebud” image and the deeper, heretofore walled-off needs for an insufficiently mirrored self.

Of greatest importance was the analyst’s awareness that these “transferences,” while they might express defenses against retraumatization were, for the most part, the leading edge of the perceived expressions of narcissistic needs.  This perspective was quite different from the prevailing school of thought (as illustrated by Kernberg [      ]) that viewed narcissistic presentations as a defense erected to protect against conflict with “bad” internal objects. 

For Kohut, the task of the analyst was to accept these narcissistic transferences and allow them to unfold—not to challenge them as defenses against primitive drive-superego conflicts.  For the analyst, an additional problem was how to manage his own countertransference in the face of so little evidence of “traditional” libidinal transferences.  The analyst’s appreciation of the possibility that these presentations were carriers of need for missing developmental experiences made a great deal of difference in his attitude toward his patients.

Therapeutic Action

            Kohut’s view of the essential aspects in the psychoanalytic cure of patients with analyzable narcissistic disorders centers around the accretion of structure via optimal frustration of the analysand’s needs, aided by an empathic surround, and mediated through the analyst’s optimal use of interpretation.  This can be maximally achieved through a two-step process that begins with an understanding phase and then is followed by an explanatory stage.

            The first stage involves the analyst’s grasping and communicating to the patient his understanding of the core of the patient’s subjective states.  This will include acknowledging recognition of the needs imbedded in the patient’s associations, dreams, and so forth.  For example, fairly early in the work with a 40 year old woman who suffered from bouts of lethargy and depression, and an inability to work effectively, the following dream occurred.   She had finished school but felt there were crucial courses she had missed.  Back in school, she tried to find the right teacher to help her complete a particular course.  The analyst interpreted that the patient sensed that certain psychological needs had never been fully met, hampering her in acquiring necessary emotional skills.  The analyst wondered if the dream reflected a hope that, with the help of the analyst, these missing experiences could be revisited and hopefully relived in a more useful way.

Of course, this dream could have been interpreted with a different emphasis.  The sense that the patient had not accomplished enough could be an internal criticism coming from a critical superego, or the focus might be on the failure of her teachers (parents), and be the harbinger of specific negative transferences.  But in this instance the analyst was addressing the patient’s sense that there was something she had not internalized, something missing, which spoke to a developmental arrest and the need for psychological assistance.  The analyst inferred, also, that this need would become linked to the transference.  The patient responded warmly to this interpretative line, and brought into the analysis further evidence to support the relative accuracy of her analyst’s response.

            As the analysis proceeds and transferences become more consolidated, the analyst’s response will include legitimizing the patient’s distress upon the reactivation of old unfulfilled needs and temporary failures, or inevitable breaks in empathy within the current transference.

            Kohut spoke of structure building within the context of optimal frustration.  Later, other self psychologists (e.g., Bacal,   ) would challenge this tenet, but Kohut explained his position as follows:  The analyst frustrates in that the emerging needs are identified but not acted upon.  It is an “optimal” frustration because he offers the patient an empathic surround through an attitude of acceptance and confirmation of the legitimacy of these mobilized needs.  It is also considered optimal because the attuned understanding enhances the development of an empathic bond, which facilitates strengthening of a cohesive self and expands the capacity for an analytic alliance.

            The second step (note that this two-step process is usually not so well demarcated) includes well designed verbal interpretations that identify more accurately the nature of the unfolding transferences and the patient’s psychological reactions to them.  This will lead to deepening insight into the meaning of the current transferences and their genetic antecedents.

            Of even greater significance in the evolution of the self psychological theory of curative action are explanations that take up the process of disruption and repair within the analytic self-selfobject bond.

            Through the provision of an empathic milieu there is created a greater sense of safety and a rising expectation that selfobject needs will be heard and accepted.  Within this context, the specific transferences associated with earlier repressed or split-off needs can be revived and illuminated.  As part of this process, transference disruptions will occur, both because of inevitable circumstances (e.g., weekend breaks or vacations), and due to relative “failures” in empathy.  Through the analyst’s appropriate responsiveness, the impact and meanings of these disruptions can be identified, and linked to both the current state of the transference and to genetic antecedents.

            Again the analyst’s major tool is the use of insight in order to increase depth of understanding and help give a sense of conviction to the patient.  Kohut saw this particular interpretative activity as contributing further to the strengthening of the self, but also as being a phase in what he called “transmuting internalization.”  The repeated process whereby the patient’s current injury is understood as imbedded in the continuing need for selfobjects, now frustrated by a break with the analyst, provides an opportunity for the patient not only to feel a sense of repair, but to gradually internalize this experience.  In this manner  patients can begin to help themselves as they take over the analyst’s function.

            While Kohut saw the work with disruption and repair as part of the analytic process, later writers, like Wolf, take this up in a more detailed way.  Wolf’s explanations for the curative action began to refer to affect integration.   His emphasis on affect management and integration, as mediated by the analysis of rupture and repair, is a paradigm for addressing what I consider to be a second dimension of selfobject need.  While Wolf seems to describing a holding function activity, intensified by inevitable “breaks” in the treatment, the analyst’s capacity to bear the heightened affect states in fact addresses a need of the patient theretofore often unmet.  Just as being available for the deployment of narcissistic transferences in the sphere of the mirroring and idealizing needs is essential, the patient also requires a selfobject to help regulate unmanageable affect states.  I will develop this theme of the second dimension of need and deficit in the succeeding sections.

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