Concept of Science
Classical theory (including Freud’s work from 1900 on and the concept of ego psychology) retained a 19th-century ideal of scientists as external observers who are to describe the forces and constraints that give rise to structure. All sciences are to be unified, sooner or later, into a single, coherent picture of the knowable universe. That which cannot be known by science in this way cannot be spoken of intelligibly. Unification also presupposes that truths in one science, such as math or physics, cannot be contradicted by claims in other sciences, especially in the less rigorous sciences such as biology and psychology. When Freud speaks of psychic energy, he does so within the constraints of the physics of his time. Hence psychic energy must obey the second law of thermodynamics and have all the tensor qualities that 19th-century scientists said were true of physical energies. Also, because physical energies are interchangeable with all forms of energy (ie, heat may be transformed into mechanical power), psychic energies are also interchangeable. Thus the psyche, too, should show similar transformations. For example, pregenital energies, genital energies, and the theory of sublimation reflect 19th-century physics.
Given this reductionistic ideal, psychic contents, such as ideas or dreams, must all be reducible in principle to states of a system that uses and binds psychic energy. In Freud’s terms, because science tells us that the “really real” is only blind elements running into other blind elements, our sense that we live in a world of color, not to mention intentions, wishes, and so on, is illusory. Object relations theorists have struggled against this notion of psychological science. ORT names a widely diverse group of theoreticians, not merely the so-called English School, which uses the term “object relations” explicitly. Beginning with Carl Jung’s strenuous rejection of Freud’s metapsychology, all ORT authors have felt constrained by Freud’s reductionistic ideals. Some, like Melanie Klein, have tried to remain true to Freud’s language. Hence Klein retains the dual-instinct theory Freud promulgates in his papers on ego psychology. Yet she too found it difficult to use energic terms to account for her clinical discoveries. Instead, she created new terms that seemed closer to her patients’ actual experience. A liability of wholesale rejection of Freud’s reductionism is a tendency toward sentimentalism. At this extreme, empathy merges into sympathy, and tenderness replaces insight. Consequently, patients can feel that the therapists are avoiding unconscious fantasies and therefore the patient’s anxiety increases. With sufficient “tenderness” patients will abandon therapy or choose some self-destructive mode to deal with their increasing sense of danger in the poorly maintained frame.
Klein and other ORT authors created new terms because they worked with a class of patients—children and infants—whom Freud had not seen, and they developed their clinical explanations using their patients’ categories. Freud listened to his patients; perhaps no one has ever listened better. Because he was committed to a theory of unconscious motivation, Freud refused to accept patients’ conscious self-understandings as sufficient. These manifest accounts could never be the ultimate target of analytic investigation, nor could they be the ultimate authority against which we can assess psychoanalytic claims. For example, a patient’s initial rage at the constraints of the “solid frame,” a firmly announced set of rules for the conduct of analysis, is not, by itself, an indicator that the therapist ought to abandon ordinary rules.
In this sense, Freud was both phenomenologic and antiphenomenologic. Prior to the fully developed metapsychology of 1900, Freud adopted some of the self-descriptions hysteric patients elaborated. For this reason, Fairbairn traced the notion of “splitting” to Freud’s early essays on hysteria. For example, the rule of free association not only requires the patient to speak freely about everything that passes through his or her mind but also permits the analyst to treat such data as thematically and causally related to one another. For example, in a male patient’s thoughts,"Competing with boss. . .fight. . .conflict with boss. . .blood. . .death. . .lack of sexual desire for wife,” one can conjecture the presence of castration anxiety and then seek clinical validation of this hypothesis. Do his recent assertive wishes to compete elicit a fixed, reflex-like pattern? Will competition yield shame around his genital functioning or elicit the fantasy that his father will try to hurt him? To remove that possibility does he deny the presence of sexual desire?
In all its forms, Freud’s metapsychology is radically antiphenomenologic: The dual-instinct theory is not derived from first-order patient narratives, nor is the structural theory of mind. ORT authors rely on classical theory and elaborate on it by adopting portions of the manifest content of their patients’ experience. This is most evident in the work of Fairbairn, whose ORT is “pure” because it uses only psychological terms and, then, only terms derived from first-order patient accounts. For example, sick patients often talk about feeling split or divided against themselves or about attacking themselves. It is also “pure” because Fairbairn does not seek to locate psycholog-ical theory within the grander schemata of the unified sciences, as did Freud and all who pursue biological reductionism.
Classical theory contains an account of pre-oedipal experience (eg, in 1895 Freud elaborated a condensed theory of the nursing infant), but it does not contain a theory of pre-oedipal subjectivity. Freud describes the infant’s behavior when frustrated and its (supposed) efforts to hallucinate the lost breast. Freud did not attempt to describe how the infant felt (thought or imagined) about that object relation. Certainly, Freud concerned himself with these issues. One can find passages in which he appears to describe infantile (preverbal) experience. But he does so always via deductive reasoning, based either on data derived from adult patients or on his metapsychological principles. When Freud reconstructs a patient’s past he does so to oedipal ages, for example,"You wanted to push your mother out of the bed and have daddy to yourself.” ORT authors wish to extend the range of psychoanalytic reconstructions and account for early infantile experience. Winnicott, for example, described early mother-infant interactions, using language that is, at one level, self-contradictory and unconstrained by formal, adult logic. ORT authors argue that this kind of language, full of seemingly crazy assertions, matches better the pre-oedipal child they seek to understand. Klein was explicit about this when she attempted to describe the “devouring breast” that the infant experiences.
Classical theory focused on neurotic patients. Only secondarily was it applied to other groups of patients. Classical theory and technique presumes the existence of a reasonable ego. No matter how much intrapsychic conflict it faces, this ego is strong enough to bring the patient to therapy and help the patient sustain the burdens of treatment. Those burdens include the rigors of analytic silence, the prohibitions against acting out, analytic neutrality, the primacy of interpretations rather than “support,” and other aspects of the rigorous frame designed to induce the transference neurosis, the automatic repetition of the patient’s earlier conflicted object relations.
ORT analysts focus on sicker groups of patients, for example, those who have schizoid, borderline, or severe personality disorders, especially those exhibiting narcissism, psychosis, or schizophrenia, or on patients who have less developed egos, especially infants and very young children. ORT authors seek to comprehend processes that precede the consolidation of the tripartite personality Freud described. Freud analyzed conflicts within a relatively consolidated personality; ORT authors analyze struggles to become a consolidated personality. When ORT analysts speak of therapeutic goals, they describe the patient’s struggles to become “a person,” or to “become real,” or a “true self.” For example, Winnicott wrote about a patient for whom dreaming replaced “living.” Winnicott wished to analyze away the patient’s schizoid use of dreams, not analyze the dreams themselves as representations of structural conflicts.
Technique & Intervention
Because they often work with nontraditional patient groups, ORT authors focus on nonverbal patient behaviors. Hence they may use play therapy with both children and adults, or drama, group process, patient art work, or mutually created artifacts that require a great deal of interaction with the therapist. In using these techniques, many ORT authors claim to be classical in that they retain an analytic style and regard interpretation of their patient’s behavior as the ultimate agent of therapeutic effectiveness.
What fantasies and bodily sensations arise in response to this patient? Upon reflection, what sudden impulses (eg, sexual, aggressive, protective) do we experience aimed at this patient? ORT is a theory of subjectivity and intersubjectivity, of the capacity to be alone (per Winnicott) and to be sustained by others. A crucial part of ORT and object relations technique is to recognize the therapist’s profound place in the patient’s emotional life.
A Sample Contemporary Developmental Theory
Otto Kernberg represents an especially creative, contemporary current in modern American psychoanalysis. He is known both for his brilliant attempts to integrate schools of psychoanalytic theory and for his specific concepts of borderline pathology and its treatment. Linking both tasks is the notion of integration. In his theoretical papers Kernberg seeks to integrate classical analytic theory with other orientations that appear to be incompatible with it.
Kernberg wishes to unite three schools: (1) Freud’s classic theory of the drives or set of instincts (sex and aggression), (2) the nondrive theories of British ORT, and (3) the American school of ego psychology. The concept that links these three schools together is the internal object and associated concepts, such as the internal object relationship.
Freud describes an internal object as that set of feelings, thoughts, images, and so on that a person associates with a particular entity (real or imagined) within a person’s mind. Table 4-4 lists some sample internal objects.
Internal objects are always tied to particular feelings (ie, affects, emotions), a particular thing from one’s past (whether real or imagined), and a sense of one’s relationship to that thing. All three components figure into each internal object. For example, a patient may remember with strong distaste a visit to the zoo (because his mother was depressed that day and seemed to avoid him), whereas another patient may remember with extreme pleasure a visit to a junkyard (because her father was happy that day and enjoyed being with her). The three components mean that each person’s internal object representation of zoos and junkyard are not identical to those of anyone else. Freud asserted that we can distinguish these two responses to object loss by noting the fate of internal objects in each. In mourning, the survivor realizes that a loved one is lost, and reality testing remains intact. For example, an adult woman’s mother dies. She slowly examines the internal objects linked to her dead mother and detaches herself from them by mourning. The daughter remembers her mother and feels anew the wish that she might return to her. The surviving daughter alters gradually her internal world to accommodate a change in the third component of the internal object: the linkage between representations of herself and her mother. Added to each memory of mother is the new information:"Mother is no longer with me in ordinary time and space.” This requires her to use the ego function of time sense at an adult level.
In melancholia—what we would call a severe depression precipitated by object loss—the work of mourning, of slowly altering the internal object relationship, does not take place. Rather, melancholic persons attack themselves, heaping abuse on their own heads. A key feature of such attacks is the absence of feelings of shame; there is an “insistent communicativeness which finds satisfaction in self-exposure” (Freud 1917, p. 247). Freud discovered that these complaints are really “plaints” against the lost person (ie, external object). Rather than mourn the loss of the object, the melancholic person has identified with the abandoned object. “Thus the shadow of the object fell upon the ego, and the latter could henceforth be judged by a special agency, as though it were an object, the forsaken object” (Freud 1917, p. 249).
Internal object relations refers to this form of division within the mind (ego, or self): One part of the personality attacks or praises (loves or hates) another part. The attacking part Freud called a “special agency.” Later, Freud called it the superego. How the superego, the agency responsible for shame and guilt, treats the ego defines one form of internal object relations. Given that older children and most adults show some form of ego and superego conflicts, we can say that most people show some degree of splitting of their psyches. For example, neurotic-level patients complain about guilt or shame or “feeling driven.” Each utterance expresses internal conflicts (eg,"I’m my own worst enemy.").
That human beings are divided against themselves has been a staple insight of eastern and western thought for many thousands of years. Freud’s insight was to study the development of such splits, both longitudinally—through the study of children and infants—and clinically—through the study of regression in deep psychotherapy. Both venues suggested that the adult patient’s “divided self” stemmed from infancy.
Kernberg argued that when we examine the developmental history of splitting, we find that it begins in an archaic period—perhaps 4 months after birth—and eventually develops into adult forms of ego versus superego. During the first stage of ego development, intense feelings of hate toward an external object (such as the mother) and intense feelings of love toward the same object are distinctly experienced and registered separately in the infantile psyche because the ego cannot integrate introjections activated by dissimilar valences. During the next stage of ego development, to prevent the “bad” from overwhelming the “good” (eg, to prevent the “bad internal mother” from obliterating memories of the “good internal mother"), the ego, in response to anxiety, retains a split between the two internalized object relationships. During the third stage—from 4 to 12 months—a three-part psyche is present: an ego built up of positive introjections, a sense of a positive external reality intimate with the self, and a sense of a bad external reality, made up of actually dangerous objects and projected contents of the self (eg, childish notions of “monsters” who threaten to eat mommy).
Finally, these split-off parts of the psyche consolidate up to and through the oedipal period."Bad" and “good” parts of the self are fused into a more complex sense of oneself, as are “bad” and “good” parts of the object. These fusions make possible normal psychic life, including the capacity for guilt, shame, and mourning (and the capacity to be alone, to feel that mother is with one even when she is not present). With fusion of negative and positive parts of the self comes also the dominance of a new form of defense: repression. Repression, when excessive, gives rise to neurotic suffering and is treated by forms of analytic psychotherapy, which aims to undo repressions and make possible new, more mature solutions to intrapsychic struggles (eg, to accept one’s sexual life and one’s assertiveness as elements in an adult life).
Antedating this relatively high-level form of conflict is primitive splitting. This form of splitting is prestructural, that is, it develops before the “structuralization” of the oedipal period (ages 3 to 5 years). When it dominates, it produces patients who manifest borderline personality disorder—what Kernberg terms borderline personality organization (BPO).
Splitting gives rise to BPO. Hence primitive defenses, such as projection, action discharge, denial, dissociation, primitive idealizations, and extreme narcissism predominate in these patients. Therapy with such patients must first deal with these primitive defenses and their structural consequences—identity diffusion and impaired reality testing—and the interpersonal chaos that accompanies BPO functioning. To treat BPO, the clinician must first confront, interpret, and undo the multiple splits that patients with BPO present. Then therapy can help the patient renew developmental processes stymied by intrapsychic and interpersonal failures. Because the patient comes to see how harmful primitive functioning has been, he or she also must mourn the time that cannot be recaptured and the love that has been lost.