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대상관계이론의 역사
작성자  simonshin 작성일  2017.12.12 18:36 조회수 421 추천 0
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 신현근 박사 강의안: 대상관계이론에서의 임상적 개념의 진보 1부  
 

과목대상관계이론의 역사

주제대상관계이론에서의 임상적 개념의 진보 1

교수신현근 박사

내용강의안

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

_____________________________________________________________________________________________________________


Advances in Clinical Concepts 1

 

1)      James Grotstein’s Splitting and Projective Identification (1981)

a)       Overview

i)        James Grotstein is an American analyst profoundly steeped in the traditional British objet relations, especially the work of Fairbairn, Klein, and Bion.

ii)       He was in analysis with Bion during Bion’s years in Los Angeles.

iii)     The excerpt discusses the meaning and uses of splitting and projective identification.

iv)     It presents his original elaborations on these processes particularly his notion of the dual-track theory, in which he proposed that there is a facilitating split in the way therapists relate to patients by giving themselves over to a full unconscious relationship, and by paradoxically separating out their powers of observation and understanding at the same time.

b)      Normal splitting and projective identification

i)        They are the beneficent legacies of a series of self-objects which can now be seen as the harmonious cooperation of intrapsychic and interpersonal objects.

ii)       In infancy it takes three people to lead one life, the life of the infant; in adulthood, it takes twinship two – at least.

iii)     Mother and father are linked together in Siamese twinship with the infant who itself links up with these Siamese bond with its own background object of primary identification.

c)       Abnormal splitting and projective identification

i)        They emerge from infantile mental catastrophe, disappointment, dissolution, and despair.

ii)       The therapist must allow himself to become “pregnant” with his patient’s material not only so as to be able to be receptive to the patient’s preverbal, primitive communication, but also to be able to allow the patient the achievement of autistic relatedness guaranteed by a background object of primary identification, the achievement of symbiotic relatedness guaranteed by the interpersonal self-object, and the reasonable guarantee of the hope of a future by the reestablishment of a relationship with the object of destiny.

d)      Siamese bonding

i)        An epigenetically predetermined sequence of relationships which I called “Siamese bonding” includes autistic, symbiotic, and separated-individuated relatedness.

ii)       By this I mean that the therapist engages in a dual-track relationship with the patient and in the understanding of the person’s material insofar as the relationship is both real and phantasy components, and insofar as the patient is reporting his emphatic failures in present and past realities which have both real and phantasy components.

iii)     I consider it even more important to help establish an autistic and symbiotic bonding with the patient so that the contents of interpretations of splitting and projective identification can be seen as the “best possible solutions” that the patient could make under the circumstances.

e)      Object’s role

i)        The infant and the patient want their objects to be background objects which can be a backboard for the reflection of their thoughts and a transformative object who can “catch,”  sort out, and reflect upon the projections so as to give significance and meaning to the patient’s production.

ii)       The more emphatic the therapist object is with the patient’s projective identifications, the less projective and identifying they are and the more they become communications.

iii)     Projective identifications for which the patient is not ready for reflection must be contained within the domain of postponement by the therapist so that the patient does not have to resort to psychotic disavowal or eradication of his or her state of mind.

f)        Bipersonal field

i)        Infants and patients are keenly susceptible to the projections of their parents and their therapist.

ii)       Therapy is a bipersonal field with the possibility of projective identifications and splitting going across the network in both directions.

g)       Creation of internal objects

i)        Splitting and projective identification create the internal objects of the inner world as scaffoldings for the development of future psychic structures.

ii)       The design of the creation follows protocol of all the possible relationships between the parts of the infant’s subjective self (mouth, anus, genital, skin, sense organs, mind, etc.) and the corresponding anatomy of the object’s body.

iii)     The linkages follow instinctual motivations or, as I prefer to call, after Bion, L, H, K functions, where L stands for love, nurture, slumber, etc.; H stands for hate, aggression, defense, preparation, repairing, and taking care of; and K stands for knowledge, stimulation, curiosity, and the desire to transcend oneself.

iv)     By and large, the L, H, and K functions produce three normal internal objects: a nurturing object, a protective object, and a stimulating object. The pathological vicissitudes of these are many.

v)       Internal objects correspond to self-objects.

vi)     Object representations are not internal objects, but rather are the imaginative portraitures of external persons who are no longer possessed by omnipotent desire plus the shadow of the former presence of internal objects. They constitute permanent psychic structure. 

h)      Dual-track

i)        The dual-track bids that the therapist/parent extend safety and empathy to the infant/patient while at the same time encouraging the patient to extend amnesty toward him-/herself (self as object).

ii)       Empathy toward the struggling authentic self must be tempered by vigilance, discipline, and rigor in protecting it from the other split-off, malevolent, but hapless subpersonalities within the psyche whose imaginative births owe their origins to unbearable experience once upon a time.

i)        Epigenesis

i)        Splitting and projective identification have an epigenesis and eventually become sublimated functions within the mature psychic structure.

ii)       Whereas splitting is become discrimination and normal porous repression, projective identification not only participates in normal porous repression, but also becomes the means of communication between oneself and oneself and between oneself and the other.

iii)     In the depressive position of separation-individuation with rapprochement, the infant learns projectively to identify in its mother the feeling of subjectivity so that mother now becomes not only an object but also a co-subject.

j)        Thought without thinker

i)        Projective identification ultimately is the basis of thinking.

ii)       We first become aware of thoughts and feelings as they emerge and/or irrupt into our awareness.

iii)      Bion calls these “thought without thinker.”

iv)     Freud designated them as instinctual drive.

v)       In order for them to emerge, they must experience a projective trajectory onto the surface of objective representations which constitutes a table for thought, having been honed from experience with a containing mother who can reflect, “catch,” and sort out.

vi)     This is the basis for a “thinking couple.”

vii)   Ultimately, projective identification in its most basic communicative form is the cry of agony of the infant who must put its experience into the caregiving object so that object can know how the infant feels.

k)       Comparison to a spiritual experience

i)        The projective identification can be likened to a spiritual experience.

ii)       Every culture has practiced one form or another of ritual sacrifice.

iii)     The Christian Eucharist is currently the most well-known ceremony commemorating the mystical need for human sacrifice where one is chosen as a token to reflect and represent the sacrifices of the many.

iv)     It seems we are still in that stage of evolution where human sacrifice is needed.

v)       The infant may need its mother, father, or sibling to be its own token sacrifice where it can project its agony into those objects so that they “know” its agony and thereby relieve it.

vi)     By the same token, parents do likewise with each other and with their children.

vii)   It is as if all human beings are really children who wish someone to know their agony so that the tale can be told. The transmission of this message is projective identification.

viii)  The capacity to “know” that message is the ability to tolerate suffering through this “exchange transfusion” between the sacred and the profane.

 

2)      Jill Savege Scharff’s Projective and Introjective Identification and the Use of the Therapist’s Self (1992)

a)       Introduction

i)        Jill Savege Scharff was born in Scotland, and trained in Edinburgh with Sutherland and at the Tavistock Clinic in London before emigrating to the United States.

ii)       Her experience in family and couple as well as psychoanalysis spawned her investigation of projective and introjective identification.

iii)     Her writing emphasizes the neglected introjective arm of a cybernetic cycle of continuous projective and introjective identification, which forms a continuous cycle of communication in healthy development, in the maintenance of intimate relationships, in pathology, and in therapy.

b)      Introjection

i)        The introjector takes in a feeling, an idea, or a part of the self or object of another person, the introjectee.

ii)       Introjection may be simply a way of perceiving the outside world or it may be the first step in construction of an internal object in the realm of the ego or superego.

c)       Identification

i)        The introjector now identifies with the introject. The self becomes like the part that has been taken in from the introjectee.

ii)       The part taken in may be accurate or distorted by feeling about the person.

iii)     It will form an amalgam with other introjections to form an internal object with which self is in close relation and which represents both becoming like and reacting against the external object found in the introjectee.

iv)     Introjective identifications occurs in order to maintain a tie to the introjectee, to re-create a lost relationship, to possess something good that is admired or envied, to protect the other person from something bad, or displace and become the other person.

d)      Psychic structure formation

i)        Introjected identification leads to the formation of the ego and the superego.

ii)       Freud saw the superego as a superimposed censoring structure made up entirely of introjective identifications with the parents and reaction formations against them at the oedipal stage.

iii)     In Fairbairn’s object relations theory, in relation to objects experienced as bad, we see aggressively forbidding parts of the ego splitting off as subforamtions to preserve the central ego from intolerable aspects of its interaction with the parents. These ego parts are somewhat equivalent to superego structure described by Freud, but they develop long before the oedipal phase.

iv)     In Kleinian theory, the introjective identification contributes to the development of the superego in infancy.

e)      Reprojection and projective identification

i)        Projection

(1)    In projection, a part of the self – either a part of the ego or its internal object, or a feeling or an idea originally connected to the self or objects split from them – is expelled from the intrapsychic domain and displaced to an external object during an unconscious mental process.

(2)    The object is believed to be invested with qualities that it does not have.

(3)    It may be a delusion as in paranoia, a misperception in neurosis, or a normal momentary expulsion followed by reintrojection of an unaltered projection.  

ii)       Projective identification

(1)    Whether a projection remains a projection or becomes a projective identification depends on whether the second step of identifying the object with the projection occurs.

(2)    If the only object affected is the internal object, then the process remains an intrapsychic one.

(3)    If all the steps are completed, the process of projective identification goes beyond description as a one-body or two-body phenomenon to a multi-part-and-object phenomenon.

 

3)      Otto Kernberg’s “Transference and Countertransference in the Treatment of Borderline Patients” (1975)

a)       Introduction

i)        Otto Kernberg has introduced ideas from British object relations theory to the American audience and has produced notable development himself, most particularly in the areas of the treatment of the severely disturbed patients within the borderline and narcissistic classifications, as well as in exploring the application of object relations ideas to love relationships, groups, and institutions.

ii)       His work on the capacity for mature love integrates relational ideas with ego psychology, a trend that has remained a hallmark of the American object relations group.

iii)     This excerpt applies Kernberg’s general principles for treatment of patients with borderline personality, as elaborated in 1975.

iv)     Kernberg has continued to advance the treatment of the severely disturbed patient throughout his career, as well as inspiring adoption of object relational ideas in American psychoanalysis generally.

b)      Transference Interpretation limited by the deployment of special parameters of technique

i)        Negative transference interpretation

(1)    The predominantly negative transference of borderline patients should be systematically elaborated only in the “here and now,” without attempting to achieve full genetic reconstructions.

(2)    Full genetic reconstructions have to await advanced stages of treatment.

ii)       Interpretation of defensive constellations

(1)    The typical defensive constellations of these patients should be interpreted as they enter the transference.

(2)    The implication is that the interpretation of the predominant, primitive defensive operations strengthens the patient’s ego and brings about structural psychic change which contributes the resolution of the borderline personality organization. 

iii)     Limits to block acting out of the transference

(1)    Limits should be set in order to block acting out of the transference with as much structuring of the patient’s life outside the hours as necessary to protect the neutrality of the therapist.

(2)    The implications are that:

(a)    Although interventions in the patient’s external life may sometimes be needed, the technical neutrality is essential for the treatment.

(b)    It is important to avoid allowing the therapeutic relationship, with its gratifying and sheltered nature, to replace the ordinary life, lest primitive pathological needs be gratified in the acting out of the transference during and outside the hours

iv)     Positive transference interpretation

(1)    The less primitive, modulated aspects of the positive transference should not be interpreted because this fosters the gradual development of the therapeutic alliance.

(2)    The primitive idealizations need to be interpreted systematically as part of the effort to work through these primitive defenses.

v)       Formulation of interpretation

(1)    Interpretations should be formulated so that the patient’s distortions of the therapist’s interventions and of present reality (especially of the patient’s perceptions in the hour) can be systematically clarified.

(2)    One implication is that the patient’s magical utilization of the therapist’s interpretations needs to be interpreted.

vi)     Working through transferences

(1)    The highly distorted transferences (at times, of an almost psychotic nature), reflecting fantastic internal object relations related to early ego disturbances, should be worked through first in order to reach later the transferences related to actual childhood experiences.

(2)    All transferences, of course, recapitulate childhood fantasies, actual experiences, and defensive formations against them, and it is often difficult to sort out fantasies from rality.

(3)    The extreme nature the fantasied relationships reflecting very early object relations gives the transference of borderline patients special characteristics.

c)       Systematic resolution of the constellations of primitive object relations activated in the transference.

i)        Primitive transferences

(1)    A predominant characteristic of the transference of borderline patients, particularly in early stage of treatment, is the presence of overwhelming chaos, meaningless or emptiness, or conscious suppression or distortion.

(2)    The most general reason for this state of affairs is the predominance of “primitive transferences,” that is, the activation in the transference of part-object relations – units of self- and object-images and the primitive affects linking them.

(3)    The transference reflects a multitude of internal object relations of dissociated or split-off self aspects with dissociated or split-off object-representations of a highly fantastic and distorted nature.

ii)        Basic cause

(1)    The basic cause of the developments in borderline patients is their failure to integrate the libidinally and aggressively determined self- and object-images.

(2)    Primitive dissociation or splitting becomes a major defensive operation.

iii)     Strategic aim on treatment

(1)    The overall strategic aim in working through the transference developments of borderline patients is to resolve the primitive dissociations of the self- and object-representations and thus to transform primitive transferences – that is the primitive level of internalize object relations activated in the transferences – into the transference reactions related to real childhood experiences.

(2)    Obviously, this requires intensive, long-term treatment along the lines I have suggested – usually not less than three sessions a week over a number of years.

iv)     Three-step strategy of interpretation of transference

(1)    The first step

(a)    It consists in the psychotherapist’s efforts to reconstruct, on the basis of his gradual understanding of what is emotionally predominant in the chaotic, meaningless, empty, distorted, or suppressed material, the nature of the primitive or part-object relation that has activated in the transference.

(b)    The therapist by the interpretive efforts transforms the prevailing meaningless or futility in the transference (which dehumanize the therapeutic relationship) into an emotionally significant, highly distorted transference relationship.

(2)    The second step

(a)    The therapist must evaluate this crystallizing, predominant object relation in the transference in terms of the self-image and object-image involved and clarify the affect of the corresponding interaction of self and object.

(b)    The therapist may represent one as the patient’s dissociated self and/or one aspect of object-representation, and patient and therapist may interchange their enactment of self- and object-images.

(c)     These aspects of the self- and object-representations need to be interpreted and the respective internal object relations clarified in the transference.

(3)    The third step

(a)    The particular part-object relation activated in the transference has to be integrated with other, related and opposite, defensively dissociated part-object relations until the real self and his internal conception of objects can be integrated and consolidated.

v)       Integration

(1)    Integration of self and objects, and thus of the entire world of internalized object relations, is a major strategic aim in the treatment of patients with borderline personality organization.

(2)    Integration of affects with their related fantasied or real human relations involving the patient and the significant object is another aspect of this work.

(3)    The integration of split-off, fragmented affect states is a corollary of the integration of split-off, fragmented internalized object relations.


 
 
 
 
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