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대상관계이론의 역사
작성자  simonshin 작성일  2017.12.12 18:30 조회수 476 추천 0
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 신현근 박사 강의안:대상관계적 이론의 다양한 발달  
 

과목대상관계이론의 역사

주제대상관계적 이론의 다양한 발달

교수신현근 박사

내용강의안

교재Scharff, D. E. (1996). Object relations theory and practice: An introduction. Northvale, New Jersey: Jason, Inc.

_____________________________________________________________________________________________________________


Advances in Theory

 

1)      John Steiner’s “A Theory of Psychic Retreats” (1993)

a)       Overview

i)        John Steiner is a consultant medical psychotherapist at the Tavistock Clinic, a leading modern Kleinian.

ii)       His book Psychic Retreat brings together the main currents of the developments in the concepts of pathological organizations or psychic retreats.

iii)     These organizations of the personality are lodged in an uneasy but staunchly defended equilibrium between the paranoid-schizoid and depressive positions, blocking further maturation.

b)      A psychic  retreat

i)        A psychic retreat provides the patient with an area of relative peace and protection from strain when meaningful contact with the analyst is experienced as threatening.

ii)       In some analyses, particularly with borderline and psychotic patients, a more or less permanent residence in the retreat may be taken up and it is then that obstacles to development and growth arise.

c)       Pathological organization

i)        Obstacles to contact and obstacles to progress and development are related, and that they both arise from the deployment of a particular type of defensive organization by means of which the patient hopes to avoid intolerable anxiety.

ii)       I call such systems of defences pathological organizations of the personality and use this term to denote a family of defensive systems which are characterized by extremely unyielding defences and which function to help the patient to avoid anxiety by avoiding contact with other people and with reality.

d)      Borderline position

i)        The retreat may be thought of as a position with its own grouping of anxieties, its pattern of defences, its typical object relations and character structure.

ii)       I have referred to it as a “borderline position” because of its place on the border between the two basic positions.

iii)     It is clear that not only the basic two positions but also the borderline position occur in all patients, and the notion can help the analyst to consider where the patient is located at t any particular time.  

iv)     The patient can withdraw to a retreat at a borderline position where he is under the protection of a pathological organization from either of the two positions.

v)       When the analyst is stuck there is very little, if any, movement discernable in this equilibrium, and the patient become firmly established in retreat protected by the pathological organization  and only rarely emerges to face either depressive or paranoid-schizoid anxieties.

e)      A particular type of retreat (perversion)

i)        Adoption of perverse stance

(1)    Freud, in his discussion of fetishism, described how the patient adopts a stance in which reality is neither fully accepted nor fully disavowed, so that contradictory views are held simultaneously and are reconciled in a variety of ways.

(2)    A central aspect of the perverse attitude is reflected in this kind relation to reality.

(3)    It is important in sexual perversions, where some of the basic “facts of life,” such as the difference between the sexes and between the generations, are simultaneously accepted and disavowed, but it has a more general applicability to any aspect of reality which is difficult to accept.

(4)    In particular, it is prominent in the difficult task of facing the reality of age and death to which similarly perverse stance is often taken.

ii)       Two aspects of perversion

(1)    A perverse pseudo-acceptance of reality is one of the factors which makes the retreat so attractive for the patient who can keep sufficient contact with reality to appear “normal” while at the same time evading its most painful aspects.

(2)    A second aspect of perversion is seen when the object relations which make up the organization is examined.

(a)    The links which bind the organization together are often sadomasochistic and involve a cruel type of tyranny in which objects and the patient himself are controlled and bullied in a ruthless way.

(b)    Sometimes sadism is obvious, but often the tyranny is idealized and develops a seductive hold on the patient, who appears to become addicted to it, often gaining a masochistic gratification in the process.

iii)     Recovering process

(1)    It is only with long and painful work that the patient begins to feel he has the capacity to say “no” to the attractive pull of the perversion as alternative source of help become available.

(2)    As the addictive properties lessen he is able to free himself more and face psychic reality.

(3)    If perversion is recognized for what it is – namely, an area where perverse relationships and perverse thinking are sanctioned – the patient may accept an occasional need to adopt these methods without idealizing it.

(4)    The protection of the retreat is then seen to offer a temporary respite from anxiety but no security and no opportunity for development. It then can be viewed more realistically and the patient can come to terms with it.

2)      Elizabeth Bott Spillius’s “Varieties of Envious Experiences” (1993)

a)       Overview

i)        Elizabeth Spillius is the editor of the New Library of Psychoanalysis.

ii)       Like Sutherland, she is a consummate editor with a thorough knowledge of analytic theory beyond the constraints of a single tradition

iii)     She carefully traces Klein’s concept of envy and its role in development and pathology in the paper.

iv)     In the excerpt here, she defines its scope and then expands the concept to include the interpersonal field.

b)      Observation on envy

i)        I used to think that envy was only destructive to the individual and to those around him when it was unconscious and split off, and that in analysis it would become conscious, arouse guilt, and gradually become integrated with more positive dispositions.

ii)       However, in some patients envy appears to be very obvious, certainly to outsiders, and sometimes it appears to be conscious in some form or other to the envious person, but without arousing his guilt or remorse.

c)       When envy is felt

i)        Envy may be felt, according to the Oxford English Dictionary, when the individual compares himself with someone superior in happiness, reputation, or in possession of anything desirable.

ii)       In my view, envy is especially likely to be felt when an individual has to depend on someone who is felt to be this sort of superior person, and all envious patient defend themselves to some extent against being aware of such dependence.

d)      Ego-dystonic envy

i)        The person whose envy is ego-dystonic directs defences against becoming aware that envy may be the basis of his behavior, especially his various forms of attack on good object.

ii)       The definition of this sort of envy is a destructive attack on a good object.

e)      Impenitent envy

i)        Defensive feature

(1)    The person whose envy is impenitent does not suffer from conscious guilt and a sense of responsibility for his envy.

(2)    His defences are used to maintain and enhance what he regards as a legitimate grievance.

ii)       Projective mechanism

(1)    A frequent aspect of the defensive arrangements of the person who suffers from impenitent envy is that he feels unconsciously that he is profoundly unlovable and inferior, qualities which he projects on to those towards whom he feels superior.

(2)    Thus the person with impenitent envy and a persistent sense of grievance tends to find himself in a world in which some people are unfairly superior to him while others are justifiably inferior.

iii)     Character perversion

(1)    In such a person character perversion is likely to play an important role – sadism and masochism are sometimes pronounced, and frequently there is a preoccupation with the issue of power.

(2)    Such a person reminds one of Milton’s Satan, with his abandoning of hope, good, and remorse, and his welcoming of evil and power.

iv)     Double uses of defenses

(1)    I have found that in cases of grievances and impenitent experiencing of envy, defences are used not only to maintain and enhance the sense of grievance, but also to evade acknowledging the acute pain and sense of loss, sometimes fear of psychotic collapse, that would come from realising that one wants a good object but really feel that one does not or has not had it.

(2)    Having perpetual grievance and blame, however miserable, is less painful than mourning the loss of the relationship one wished one had had.

(3)    “Envy and narcissism” as Segal said, “can be regarded as two sides of the same coin.” 

v)       Forming pathological organization

(1)    Defences against envy are multiple, and frequently reinforce one another to form what John Steiner has called a “pathological organization.”

(2)    This is especially likely in cases of impenitent envy, but is also found in severe cases of ego-dystonic envy.

vi)     Spillius’s model

(1)    My model centers on the perceived relation between giver and receiver, because it is this relation that we see especially clearly in analysis, as in infancy, but also because it is the relation in which envy is particularly likely to be aroused. 

(2)    One crucial factor seems to me to be conscious and unconscious feelings of the giver about giving, and the way these feeling s are perceived or misperceived, consciously and unconsciously, by the receiver.

(3)    Presumably there is some “factual reality” about the nature of the giving and receiving, but this reality is complicated enormously by the conscious and unconscious feelings and perceptions of both giver and receiver, and it is these psychic realities that are especially important in the experience of envy.

(4)    Although my basic model of giving/receiving has become very complicated, I have found it essential to include the conscious and unconscious feelings, perceptions, and misperceptions of both giver and receiver.

(5)    I have found the model and its many variations useful in making a first step towards understanding the connections between giving, receiving, and envy in the inner worlds of my patients and in understanding their expectations of me and my reactions to them.

(6)    I use my model to achieve more accurate descriptions of envious reactions.

(7)    When it comes to attempts at causal explanations, I think one must be very cautious.

 

3)      Esther Bick’s “The Experience of the Skin in Early Object Relations” (1968)

a)       Overview

i)        The next four selections form a group in their emphasis on the move to early integration from the non-integration which Klein ad Winnicott stated, and which elaborate on Fairbairn’s idea of pristine, unsplit ego.

ii)       Bick and Ogden also develop aspects of the notion of pathological organizations of the personality outlined by Rosenfeld and Steiner, as they move toward a third position which is in dynamic relationship to the two developmental positions described by Klein.

iii)     Esther Bick’s paper can be seen to echo the themes of an early state of unintegration, which also concerned Winnicott.

iv)     Her contribution is grounded in close observation of infant and their mother.

b)      Central theme

i)        The central theme of this brief communication is concerned with the primal function of the skin of the baby and of its primal objects in relation to the most primitive binding together of parts of the personality not as yet differentiated from parts of the body.

c)       Thesis

i)        The thesis is that in its most primitive form the parts of the personality are felt to have no binding force amongst themselves and must therefore be held together in a way that is experienced by them passively, by the skin functioning as boundary.

ii)       But this internal function of containing the parts of the self is dependent initially on the introjection of an external object, experienced as capable of fulfilling the function.

iii)     Later, identification with this function of the object supersedes the unintegrated state and gives rise to the fantasy of internal and external spaces.

iv)      Only then the stage is set for the operation of primal splitting and idealization of self and objects as described by Melanie Klein.

v)       Lack of an internal space

(1)    Until the containing functions have been introjected, the concept of a space within the self cannot arise.

(2)    Introjection, i.e., construction of an object in an internal space is impaired.

(3)    In its absence, the function of projective identification will necessarily continue unabated and all the confusions of identity attending it will manifest.

d)      Fluctuations in the primal state

i)        The stage of primal splitting and idealization of the self and object can now be seen to rest on the earlier process of containment of self and object by their respective skins.

ii)       The fluctuations in this primal state show the difference between unintegration as a passive experience of total helplessness, and disintegration through splitting processes as an active defensive operation in the service of development.

iii)     We are dealing with situations conducive to catastrophic anxieties in the unintegrated state as compared with the more limited and specific persecutory and depressive ones.

e)      Need for a containing object

i)        The need for a containing object would seem, in the infantile unintegrated state, to produce a frantic search for an object – a light, a voice, a smell, or other sensual object – which can hold the attention and thereby be experienced, momentarily at least, as holding the parts of the personality together.

ii)       The optimal object is the nipple in the mouth, together with the holding and talking and familiar-smelling mother. 

f)        Primal skin function

i)        The containing object is experienced concretely as a skin.

ii)       Faulty development of this primal skin function can be seen to result either from defects in the adequacy of the actual object or fantasy attacks on it, which impair introjection.

iii)     Disturbance in the primal skin function can lead to a development of a “second-skin” formation through which dependence on the object is replaced by a pseudo-independence, by the inappropriate use of certain mental functions, or perhaps innate talents, for the purpose of creating a substitute for this skin container function.

g)       Cases

i)        Infant observation: Baby Alice

ii)       Analysis of a schizophrenic girl: Mary

iii)     Analysis of an adult neurotic patient

iv)     Analysis of a child: Jill

h)      Summary

i)        In all patients with disturbed first-skin formation, severe disturbance of the feeding period is indicated by analytic reconstruction.

ii)       This faulty skin-formation produces a general fragility in later integration and organizations. It manifest itself in states of unintegration as distinct from regression involving the most basic types of partial or total, unintegration of the body, posture, motility, and corresponding functions of the mind, particularly communication.

iii)     The “second skin’ phenomenon which replaces the first skin integration, manifest itself as either partial or total type of muscular shell or a corresponding verbal muscularity.

iv)     Analytic investigation of eh second skin phenomenon tends to produce transitory states of unintegration.

v)       The containing aspect of the analytic situation resides especially in the setting and is therefore an area where firmness of technique is crucial.

 

4)      Thomas Ogden’s “On the Concept of an Autistic-Contiguous Positions” (1989)

a)       Overview

i)        Ogden used Bick’s work along with that of others in proposing a new developmental position analogous to Klein’s paranoid-schizoid and depressive positions.

ii)       He followed developments presented in papers presented by Esther Bick (1968), Frances Tustin (1980, 1984) and Donald Meltzer and his colleagues (Meltzer 1975, Meltzer et al. 1975) on the development of the self in relationship to the mother through experiences at the level of the skin.

iii)     He believes that autistic-contiguous position begins earlier and is more fundamental than the other two, in that it involves the initial formation and maintenance of the body self and its extensions into the integration and coherence of an internal sense of self throughout life.

iv)     Once each position has entered the child’s development, it is in continuous interplay with the other positions throughout life.

b)      Primitive organization of experience

c)       The nature of the sensation-dominated experience

d)      Autistic-contiguous experience and pathological autism

e)      The nature of autistic-contiguous anxiety

f)        Autistic-contiguous modes of defence

g)       Summary

i)        The development of British object relations theory over the past twenty years can be viewed as containing the beginnings of a realm of experience that lies outside of the states being addressed by Klein, Winnicott, Fairbairn, and Bion.

ii)       In this paper, the idea of an autistic-contiguous position is proposed as a way of conceptualizing a psychological organization more primitive than either the paranoid-schizoid or the depressive modes: each creates, preserves, and negates the others.

iii)     The autistic-contiguous mode is a sensory-dominated, presymbolic mode of generating experience which provides a good measure of boundedness of human experience and beginnings of a sense of the place where one’s experience occurs.

iv)     Anxiety in this mode consists of an unspeakable terror of the dissolution of boundedness resulting in feelings of leaking, falling or dissolving into endless, shapeless space.

 

5)      John D. Sutherland’s “The Autonomous Self” (1993)

a)       Overview

i)        John Sutherland, who, along with Guntrip, was the major disciple of Fairbairn, became a towering figure in the psychoanalytic world in his own right.

ii)        He was director of Tavistock Clinic for 21 years of its heyday, and founded the Scottish Institute of Human Relation.

iii)     He was editor of many of the major analytic journals.

iv)     He acquired a comprehensive understanding of the major currents and issues in psychoanalysis.

v)       He wrote a critical biography of Fairbairn (Sutherland 1989).

vi)     He followed Guntrip’s lead in exploring the formation and function of the self throughout life.

vii)   Sutherland brought to this study an unusual capacity to look at the growth of the self in relationship with the family and the wider society.

viii)  The contribution excepted here continues the theme of Ogden’s paper on the conditions for the development of the self, but also considers the social conditions and consequences of growth of an autonomous self.

b)      Early development of the self

i)        The first preoccupying activity of the self is how to effectively relate to mother.

ii)       The growth of self-awareness must begin early to develop the capacity to be alert to the attitudes of others by recognizing their emotional states.

iii)     The clinical evidence from disorders in the self strongly suggests that effective development of self rests on joyful, empathic responsiveness from the mother.

iv)     Good-enough mothering gives the first “layering” in the structuring of the self as a person.

v)       The next structuring is for the person to become more specifically a male or female. Relationship with the father now becomes of critical importance. The growing assertiveness of the boy must be responded to as before by the mother’s joyful acceptance, but father’s acceptance now needs to be available as well for both the girl and boy infant.

vi)     For the eventual integration of the self, the relationship between the parents and their joint attitudes toward the child are almost as critically important as that of each parent separately.

vii)   In the earliest months – the traditional oral stage – there seems to be no question that orality represents a more general incorporative need for which alimentary function is the prototype.

viii)  The question of how much the infant is differentiated from the mother has tended to be regarded as settled by the assumption that there is a phase of nondifferentiation.

ix)     From what we have stressed about the operation of an organizing principal, it would entail from the start in any organism a powerful assertion and maintenance of autonomy and of the integrity of its wholeness.

 

c)       Intentionality

i)        The existence of a subjective sense of self and its conscious intentionality is strongly suggested by the observation data on infants approaching the end of the first year.

ii)       Intersubjective sharing is the means through which individuals can relate with rapid appraisals of intentions and affects in others.

iii)     The concept of an innate dynamic gestalt underlying the formation of the person resembles Lichtenstein’s organizing principle, which constitutes the potential self that is personalized by the earliest relationship with the mother.

iv)     This potential being personalized by this specific experience becomes the unique identity of the person.

v)       I have suggested that this potential be conceptualized as an inherited gestalt that seeks to become a person by finding the “expected” encounters.

 

 
 
 
 
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