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 신현근 박사 강의안: 집단, 가족과 기관 치료  
 

과목대상관계이론의 역사

주제집단가족과 기관 치료

교수신현근 박사

내용강의안

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

_____________________________________________________________________________________________________________


Treating Groups, Families, and Institutions

 

1)      Introduction

a)       From the beginning, object relations theory has been applied well beyond psychoanalysis.

i)        Freud: group psychoanalysis, literature, and culture

ii)       Fairbairn: social policy, social movements such as communism, education, and the psychology of art.

iii)     Winnicott: child rearing and cultural questions

b)      Selections in this part of the book can only hint at the richness of this area of study.

 

2)      Henry Ezriel’s “A Psychoanalytic Approach to Group Treatment” (1950)

a)       Overview

i)        Henry Ezriel was a consultant psychiatrist at the Tavistock Clinic.

ii)       His work on groups developed after experience in on of Bion’s early therapy groups at the Tavistock Clinic.

iii)     His subsequent influence on group therapy movement was extensive because of his teaching.

b)      Interest in the group therapy

i)        I think the reason why psychoanalysts became interested in the application of their method to the groups of patients was the development of psychoanalytic theory and practice and reached a point where such step was a logical consequence.

c)       The transference situation 

i)        The “transference situation” occurs whenever one individual meets another.

ii)       A person’s manifest behavior contains (in addition to any consciously motivated pattern) feature which represent an attempt to solve any conscious tension arising from this person’s relations with unconscious phantasy objects in the residues of unresolved infantile conflicts.

d)      A common group tension

i)        When several people meet in a group each member projects his unconscious phantasy objects upon various other group members and tries to manipulate them accordingly.

ii)       The result of each member doing this (effort to twist discussions until the real group does correspond to his phantasy group) is that there will soon be established a “common denominator,” a common group tension, out of each member’s individual dominant unconscious tension.

iii)     Each member of the group adopts a particular role within the group, which corresponds to his or her specific way of defending himself or herself against unconscious fears set up by this group problem.

e)      Transference interpretations

i)        It seems more effective to adhere strictly to a technique which uses only transference interpretations, i.e., interpretations of what is going on in the group here and now.

ii)       In using such a technique it appears best to follow the practice instituted by many English analysts in recent years of leaving the patient free from rules and regulations.

iii)     I do not give any advice and I consider that every instance of reassurance or active interference in  his so-called real, outside problems arises from faulty techniques, due to my inadequacy in giving transference interpretations as consistently and as well as I should like to do.

iv)     I no longer ask any patient to tell me what comes to his mind in connection with any particular item but, on the contrary, take it for granted that all he displays are his “free” associations.

v)       Whenever I think he is holding back something I try to free his associations by means of interpretations.

f)        Target of interpretations

i)        Interpretations are directed primarily to the “common denominator,” the common group tension.

ii)       Any particular patient’s reactions are only referred to insofar as two things can be shown to him:

·         That his behavior represents his specific way of coping with this common group tension;

·         Why he acts in this way in preference to other ways of dealing with this group problem.

iii)     Examples

·         A patient in a group may, for instance, often try to obtain a “private interview” within the group session by offering tempting material to an analyst.

·         A female patient once reported an anxiety dream in which a train going through a tunnel had an accident.

·         A male patent who in proceeding sessions felt rejected by the woman of the group gave a long narrative of difficulties with his wife.

g)       Effectiveness of the technique

i)        From my experience I believe that as long as we strictly adhere to the rule only to interpret what becomes apparent in the interpersonal relations of group members in the here-and-now situation, it is not only safe but essential to make conscious the symbolic or otherwise veiled sexual meaning of the manifest material.


3)      Henry V. Dicks’ Marital Tensions: Clinical Studies Towards a Psychological Theory of interaction (1967)

a)       Overview

i)        Henry Dicks was one of the early pioneers of object relations who worked for many years at the Tavistock Clinic as well as chairing the Department of Psychiatry at the University of Leeds where he fostered the work of Harry Guntrip.

ii)       His 1967 book, Marital Tension established the application of object relations theory to the study of marriage, and by implication, to that of the family.

iii)     This excerpt summarizes his concept of the three subsystems that together constitute the overall psychological system of marriage.

b)      The first subsystem

i)        The first and most “public” subsystem is that of sociocultural values and norms.

ii)       There remain the traditional norms of selection on the basis (as well as the opportunities) of social homogeneity or “homogamy.”

iii)     Though of decreasing importance, homogamy at social level is a factor for initial cohesion in a certain proportion of marriage.

c)       The second subsystem

i)        It is that of the central egos, which operates at the level of the personal norms, conscious judgments, and expectations also derived from the developmental background of object relations and social learning preceding the marriage.

ii)       At this level the subculture element can be enriched or diluted by individual variances.

iii)     At this point the “heterogamy” of free choice become possible, and with it potential conflict in one or both partners between subculture pressures (now operating in intrapersonlly) and the individual’s contrary norms and role expectations.

iv)     The second subsystem, insofar as it works well, would correspond to Fairbairn’s mature dependence, “characterized by a capacity on the part of differentiated individuals for co-operative relationships with differentiated objects.”

d)      The third subsystem

i)        This is the area which I have called the unconscious forces flowing between the partners, forming bonds of a “positive” or “negative” kind, often referred to as transactions.

ii)       These are the “repressed” or “split-off” internal ego-object relations, as envisaged by object-relations theory.

iii)     I hold that it is the “mix” of the more or less unconscious interaction of object relations in this third subsystem which governs the longer-term quality of marriage.

e)      Dyadic adaptation or homeostasis

It depends on the two partner’s ability to deal with the pressures in the third subsystem in one of the following ways:

i)        By congruence of all three subsystems – including the perception of each by the other as a whole person with consequent “benign” conflict resolution.

ii)       By the successful use of shared cultural and personal-conscious norms and values as defences against the deeper impulsions from the libidinal or anti-libidinal primary object relation levels.

·         This is collusive defence by idealization, convention, rationality, moral consensus, etc.

·         Conflict is not allowed to arise.

·          The defences are effective for a greater or lesser time.

iii)     Contrariwise, by the collusive use of the cultural marital norms and values as a facade behind which to permit and act out the expression towards each other of elements in the primary libidinal and anti-libidinal object relational potentials by projective and introjective mechanisms, for which each partners share a need.

·         These may come into operation at once or replace the failures of defensive collusion after a time, and give rise to what the external observer might term paranoid or depressive dyadic systems, in which the satisfactions are mainly, or at least episodically, at primary, fiercely ambivalent object relational levels.

·         Here the “negative” or aggression-expressing bonds of the primary object relational attritions are often more emotionally rewarding than the “positive” or love-expressing bonds.

·         The first and second subsystems in this situation are maintained because in themselves supportive to the dyad, or as an arena sanctioned by the “outside world,” where the conflict (itself the satisfying feedback for the partners) can be conducted.

f)        A theoretical conjecture on the failed marriage ending in permanent separation or divorce

i)        Marriages may prove unviable at any of the three subsystem levels.

ii)       It would seem necessary for at least two of the three subsystems postulated to function with credit balances of satisfaction over dissatisfaction to both partners.

iii)     If reality testing proves to one or both partners the relation was based on nothing but social affinity or meeting ground, on nothing but some shared personal interests, or, on nothing but seeing a potential parent figure or an exciting libidinal object as a guarantee against essentially infantile loneliness, then it is only a question of time before the need for a broader-based merging of lives will become felt, and, in due course, acted upon in one way or another.

·         It is usually the case that, at this stage, the emotional content of the relationship is one of boredom, indifference, and withdrawal of investment.

·         Nothing of the self is any longer projected into the other.

·         The institutional aspects of cohabitation may be continued for rational or social advantages, but marriage as interpersonal relations will be dead.

g)       Love, hate, and indifference

i)        The opposite of love is not hate.

ii)       Love and hate always coexist as long as there is a live relationship.

iii)     The opposite to love is indifference.

 


4)      David E. Scharff and Jill Savege Scharff’s Object Relations Family Therapy (1987)

a)       Overview

i)        A complete object relations view of family development and pathology draws on a full view of the development and pathology of individuals, of the group, and of marriage as well as those qualities unique to the family as a special group in society and in the consulting room.

ii)       Techniques of psychodynamic treatment draw from all the modalities of individual and group treatment.

iii)     This excerpt outlines a theory of the therapy that contrasts individual therapy with that for families and couples.

b)       A model of individual therapy

i)        Communication

·         The internal object life of the patient is communicated to the therapist through conscious communication and through the medium of direct communication of the central ego.

·         What is communicated overtly contains all the material needed for the understanding of the unconscious, split-off, and repressed internal object life.

·         In the unconscious realm, the relationship between parts of the self and the object are out of awareness but are communicated indirectly along with what is intended to be consciously communicated.

·         The communication that we care about in any therapy that goes beyond purely supportive and problem-solving in the most limited sense, involves the patient’s capacity to communicate with the interior of the therapist.

·         The therapist has an internal object system whose organization corresponds to that of the patient, although we rely on its being less split, rigid, and less thoroughly repressed.

ii)       Mirroring

·         Therapist should have better access to these repressed areas that consists (just as patients’ do) of repressed objects and repressed parts of themselves.

·         Being more comfortable with them, the therapist can feel their activation when something happens with the patient, and being able to work with them, he or she can begin by first appreciating the patient’s experience.

·         The therapist can empathize and then can feed back a digested and metabolized internal experience to the patient.

·          In accepting the “projection” of the patient’s internal objects and acknowledging it, the therapist is performing the eye-to-eye function, like the mother who validates the baby’s experience. This has been broadly discussed as “mirroring” by several writers.

·         It is in this zone of centered and core relating that communication between aspects of repressed inner object relations of therapist and patient and occur.

·         It is in this zone that internal object relations can be modified by direct influence.

iii)     Differentiation of transference

·         The differentiation of transference into two distinct types deriving from the separate parts of primary relationships allows us to call the transference to the mother’s and father’s holding capacity the contextual transference and the transference to the mother’s centered relating the focused transference.

iv)     The contextual transference

·         It is directed at the therapist as the provider of a holding environment that contains the patient’s anxiety.

·         The contextual transference is the transference only to the contextual holding aspect of containment.

·         In the early part of a psychotherapy or an analysis, it is the contextual transference that is activated, as the patient tells the therapist or analyst about his life or travail.

·         Contextual holding is derived from the functions of Winnicott’s environmental mother.

v)       The focused transference

·         The moment that the therapist does become a permanent internal figure, the patient is hit with the realization that a major shift has occurred in the therapeutic relationship.

·         This shift does not ordinarily occur in psychotherapy, but in analytic work this is the moment of crystallization of the transference neurosis.

·         The focused transference emanates from the patient’s early experience of both centered holding and centered relating.

·         Centered relating and holding derive from those of object mother.

c)       A model of family therapy

i)        When family comes to the therapist, it brings its contextual transference, just as individual patients do.

ii)       The view of the family therapist is primary on the family as a group and on its capacity to offer holding to the family members.

iii)     The transference that corresponds to this perspective is the family’s shared transference to the therapist’s holding capacity for the family members as a group. This constitutes the family’s shared contextual transference.

d)      Shared family holding

i)        Overall family holding

·         The family’s overall holding corresponds most simply to the combination of the mother’s arms-around holding of her baby, the father’s support of that, and the parental marital relationship.

·         In the more complex situation of the family, the family-as-a-whole provides the envelope within which to foster the growth of multiple centered relationships – between all the children, parents, and any close grandparents or babysitters.

·         Within this space, the family members provide the material and experience for each other’s internal objects.

·         What makes a family a unique group is the ongoing process of both contributing to each other’s internal objects and living in intimate relation to them.

·         In treatment the family always brings these internal object relationship sets as many focused transferences.

ii)       Focused on contextual transference and combined holding capacity

·         While the family therapist understands the vitality and importance of the multiple focused transferences, they are too complex to be clear as clinical transferences that can be used in the early stage of family therapy.

·         The attitude the family shares toward the therapist is pooled in the contextual transference to the therapist or to the therapeutic situation.

·         As family therapists, we should primarily consider the transference from the family-as-a –whole because this the most powerful way of organizing our understanding and intervention.

·         The combined holding capacity can be sensed through the countertransference as we encounter the family at the boundary which is provided by the shared envelope.

iii)     Source of transference

·         While individual therapist gets information from the internal object world of the patient, the family therapist gets transference information from the interactions in the shared holding space of the family.

·         Family members in therapy interact mainly with each other, and their difficulties are understood as difficulties in the function they all contribute to, providing the holding for each other.

·         The source of transference that is the business part of family therapy is the contextual holding transference.

·         It is here that we become affectively aware the family’s difficulty in providing holding for its members and it is this failure that we consult to in doing family therapy.

·         At a practical level, this means that we should begin by emotionally equidistant from each of the family members, with an overall notion that we are really on the side of a family as a unit in its job of helping each of the members to grow, to love, and to work.

iv)     Therapist’s holding function

·         In organizing our understanding of the family at this level, we provide an envelope around the family and around its presumably flawed holding capacity.

·         Within the safety of the holding we provide, the family can begin to risk relaxing its own holding function in order to attempt new holding functions.

·         The building blocks for these new holding patterns are the daily minute transactions that occur among the individuals and influence the whole group.

·         In our therapeutic setting, we see samples of these within the container we provide.

·         When we do so, we absorb and try to understand the anxieties the family shares, and to feed back our understanding of these.

·         While we may do so by speaking to one individual, our primary focus is on the way that one individual speaks for the shared anxieties of the whole family group.

·         Our ability to help them with the shared difficulty will help them to hold each other and help each other.

·         Even if we speak momentarily to an individual family member or to a subgroup, any effect will immediately have consequences for the whole family.

 


5)       Elliott Jaques’ ‘Social Systems as Defence against Persecutory and Depressive Anxiety”

a)       Overview

i)        Elliott Jaques applied Klein’s concepts of deep anxiety and the paranoid-schizoid and depressive positions to adult development, social systems, and institutions.

ii)       Jaques also published a seminal work on adult development, “Death and Mid-Life Crisis” (1965).

iii)     This final article is the theoretical starting place for the widening scope of object to the institutions and social organizations in which all individuals function throughout life.

b)      Specific hypothesis

i)         The specific hypothesis I shall consider is that one of the primary cohesive element binding individuals into institutionalized human association is that of defence against psychotic anxiety.

ii)       In this sense individuals may be thought of as externalizing those impulses and internal objects that would otherwise give psychotic anxiety, and pooling them in the life of the social institutions in which they associate.

iii)     The reasons for the intractability of change of many social stresses and group tensions may be more clearly appreciated if seen as the “resistances” of groups of people unconsciously clinging to the institutions that they have, because changes in social relations threaten to disturb existing social defences against psychotic anxiety.

c)       Defence mechanism

i)        One of the primary dynamic forces pulling individuals into institutionalized human association is that of defence against paranoid and depressive anxiety.

ii)       All institutions are unconsciously used by their members as mechanisms of defence against their psychotic anxiety.

iii)     Societies provide the institutionalized roles whose occupants are sanctioned, or required, to take into themselves the projected objects or impulses of other members.

iv)     The occupants of such roles may absorb the objects and impulses – take them into themselves and become either the good or bad object with corresponding impulses; or they may deflect the objects and impulses – put them into an externally perceived ally, or enemy, who is then loved, or attacked.

v)       The gain for the individual in projecting objects and impulses and introjecting their careers in the external world, lies in the unconscious cooperation with other members of the institution or group who are using similar projective mechanisms.

vi)     Introjective identification then allows more than the return of the projected objects and impulses.

vii)   The other members are also taken inside, and legitimize and reinforce attacks upon internal persecutors, or support manic idealization of loved objects, thereby reinforcing the denial of destructive impulses against them.

d)      Phantasy social form and content of institutions

i)        The unconscious cooperation at the phantasy level among members of an institution is structured in terms of what is here called the phantasy social form and content of institutions.

ii)       The form and content of institutions may thus be considered from two distinct levels:

·         that of the manifest and consciously agreed form and content, and

·         that of the phantasy form and content, which are unconsciously avoided and denied, and, because they are totally unconscious, remain unidentified by members of institution.

e)      Dynamics of social change

i)        Change occurs when the phantasy social relations within the institution no longer serve to reinforce individual defences against psychotic anxiety.

ii)       Imposed social change which does not take into account of the use of institutions by individuals, to cope with unconscious psychotic anxieties, is likely to be resisted.

iii)     Effective social change is likely to require analysis of the common anxieties and unconscious collusions underlying the social defences determining phantasy social relationships.


 
 
 
 
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