Family treatment of a borderline personality

This article discusses family therapy as a complementary treatment modality with the adult borderline patient. According to theory, the separation-individuation process is the underlying conflict of the pathological adaptation of the adult borderline patient and the goal of therapy is often considered to be separation of the patient from the family. Family treatment can facilitate the process of separation-individuation as it allows for the concomitant enhancement of the separateness of the parents. Family treatment can also reduce anxiety about separation, minimize the development of a premature intense transference, and prevent the battle for control between the therapist and the parents. Moreover, the process of the family treatment itself, described in this article, reflects the developmental phase of symbiosis, followed by the subphases of the separation-individuation process, i.e., differentiation, practicing and rapprochement, with the groundwork being laid for moving into object constancy. The ego functioning of all family members has the potential of being enhanced and strengthened through this process.     

Transitional phenomena in adolescence: Tools for negotiating the second individuation

The purpose of this article is to heighten clinicians awareness of the integrative potential of transitional phenomena in adolescent ego development. A review of the literature and presentation of clinical examples support the author's contention that adolescents may employ transitional phenomena to assist them through developmental turbulence reminiscent of original rap-prochement crises in early separation-individuation. An understanding of how adolescent clients may use transitional phenomena provides clinicians with an expanded perspective for differential assessment and intervention.     

The experience of divorce for the psychotherapy patient—A developmental perspective

In this article the dynamics of divorce are discussed from the perspective of psychoanalytic developmental psychology. This theoretical framework is used to highlight and to explain some typical internal and external responses of psychotherapy patients for whom divorce is an issue. A therapeutic stance is suggested that enables the patient to understand the connection between his or her marital situation, early life experience, and past developmental problems. The patient's preoccupation with the unsatisfactory marital relationship can serve as a catalyst for the strengthening of the patient's overall ego functioning. This article demonstrates Kris' (1951) concept that the material at the psychic surface-in this case divorce-needs to be explored in such a way that the patient's ego is enlisted in his or her total growth.     

The growth of psychoanalytic developmental psychology and the application of technique

The growth of ego psychology theory from Freud to the present has stimulated interest in the development of special techniques of a psychotherapy based on that theory—techniques that have evolved from but are different than those of psychoanalysis proper. Modifications in technical procedures address themselves to developmental failures rather than the resolution of the oedipal conflict. The newer concept of the borderline diagnostic category is understood in terms of the contributions of Kernberg and the Blancks, particularly as it is integrated with Mahler's developmental theory. Clinical examples are presented of some specific techniques of what is now called psychoanalytic developmental psychology.     

The therapist as a catalyst in promoting separation-individuation

This paper describes a therapeutic approach to patients fixated at or regressed to a developmental point in the separation-individuation phase. The normal developmental sequence from autism and symbiosis to the achievement of a position of on-the-way-to object constancy as elaborated by Mahler and her colleagues is summarized. Though the original experience cannot be replicated, a precise understanding of what has been missed in the early dyad between mother and child enables the therapist to help repair lesions and promote growth through the patient-therapist relationship and carefully designed interventions. A case illustration is offered of treatment of a patient with profound difficulties at the symbiotic phase which impede negotiation of separation-individuation.     

Winning a Race: Narratives of Healing and Psychotherapy in Children and Adolescents Who Have Been Sexually Abused

This article explores the process of recovering from sexual abuse according to children and adolescents who have been sexually abused and have successfully completed psychotherapy. In this qualitative study, interviews were conducted with 20 participants from 8 to 18 years of age and then subject to narrative analysis. Results show that participants’ narratives of recovery involve an improvement of psychological well-being. Moreover, they feel better equipped to overcome future challenges, feeling empowered and able to retake control of their lives. Factors that support and inhibit recovery are examined, as are developmental differences. Discussion underlines the valuable role of psychotherapy in helping children and adolescents in their healing process, changing the meaning of the abusive experience, and developing new capacities.     

Loss of mate—A third individuation process

Summary and Conclusions The concept of a third individuation process following the loss of a mate focuses on the structural psychological dynamics which may impede or foster a successful adaptation to such a loss. When adequate individuation has been impaired during adolescence, marriage may serve as an ego support which impedes further development. With the death of the mate, there exists the possibility of a third chance at individuation. This understanding of the underlying dynamics suggests a treatment focus with an emphasis upon structural rather than behavioral change. The bereaved mate must be helped to dissolve the tie to the internalized infantile object and so gain a more advanced level of separation-individuation.While this paper has focused on the loss of a mate through death, the concepts would seem to be equally applicable for some divorcees. For some, divorce may represent a self-initiated third individuation process.This paper was presented at the Spring 1975 Educational Institute of the New York Society for Clinical Social Work.     

Out from under: Countertransference in the treatment of the masochistic youngster

The masochistic youngster tends to evoke in the treatment situation precisely the responses which impede progress. This article discusses countertransference issues and the dynamics of masochism, understood as a protection for a frightened ego rather than merely a willful manipulation. Difficulties in and approaches to dealing with the environment of children in residential treatment are presented.Ms. Smaldino is currently in private practice and supervisor of psychotherapy for the New Hope Guild.     

An early intervention program for developmentally at-risk toddlers and their mothers

This study explores a program devised to enhance the normal development of toddlers whose psychological development was jeopardized by their mothers' emotional difficulties. Theory about separation-individuation suggests that mothers who are depressed or narcissistically preoccupied will be unable to participate in required ways in their toddlers' development. It was hoped that as the mothers' concerns about separation-individuation were addressed within a time-limited group, the mothers would be enabled to handle more adequately their toddlers' separation and individuation. A six-month course of weekly meetings with five mother-toddler dyads brought about significant changes in the developmental progress of the toddlers and enhanced the mothers' participation in the separation-individuation process.This paper is based on a dissertation project with Roger R. Miller as the advisor and submitted in partial fulfillment of the requirements for, the Doctor of Social Work degree, Smith College School for Social Work, 1977.     

BOOK REVIEWS

Book reviewed in this article:
Ambert, A-M. (1997). Parents, children, and adolescents: Interactive relationships and developmental context .
Simon, L., & Drantell, J. J. (1998). A music I no longer heard: The early death of a parent .
Coale, Heen W. (1998). The vulnerable therapist: Practicing psychotherapy in an age of anxiety .
Friedman, Steven. (1997). Time-effective psychotherapy: Maximizing outtcomes in an era of minimized resources .     

Disruptions in the Separation-Individuation Process of Domestically Violent Men

ABSTRACT

In the past twenty-five years, domestic violence has emerged as a significant social issue for research and theory development. This paper proposes an examination of domestic violence through the lens of Margaret Mahler's separation-individuation theory of development. This paper examines the existing empirical literature of domestically violent men using Mahler's theory of development. The paper then discusses the results from an empirical examination of the hypothesis that men who batter evidence disruptions in the separation-individuation process. This study has implications for treatment of domestically violent men, and suggests that interventions should include models that develop insight into the effects from developmental ruptures.     

Thomas Szasz' “critical reflections on child psychiatry”: An alternative view through a systemic lens

In “Critical Reflections on Child Psychiatry,” Thomas Szasz (1979) argues that children are without the rights afforded adults, that children are often coerced into therapy, and that most children do not appear to benefit from psychotherapy. Szasz raises many pertinent questions for mental health professionals working with children. However, his arguments appear to be based on literature limited to traditional psychodynamic approaches. His position also neglects to consider literature in the developmental psychology and legal fields. This paper, written from the cognitive developmental and the family systems perspective, provides another examination of the important issues raised by Thomas Szasz.     

Repairing ego deficits in children with developmental disorders

Children with developmental disorders have ego deficits which must be addressed before one is able to work with them in traditional dynamic clinical treatment. A review of the literature explores the distortions in personality structure which accompany developmental disorders, a conceptual paradigm for integration of psychodynamic and social learning theory models for understanding this problem, and suggestions for working with these children and their families. Three specific ego functions must be repaired in the initial stages of treatment: control of drive activity, reality testing, and the capacity for identification. Two case examples are used to illustrate how the worker may repair deficits in these ego functions.     

Ambiguity of gender identity fantasies and aspects of normality and pathology in hypopituitary dwarfism and Turner's syndrome: Three cases

Three cases of short stature females are presented, two with, gonadal dysgenesis and one with hypopituitarism, all about the same age, social class, and intelligence. One of the subjects with gonadal dysgenesis was normally functional; the other depressed, but she became functional after psychotherapy. The patient with hypopituitarism was poorly adapted and failed to change on brief effort at psychotherapy, discontinuing treatment. Evidence is drawn from transference and observational material that disturbances in the mother‐child relationship may lead to persistence of unreasonable wishes to grow physically. This leads to a split in the ego which prevents adaptation to small stature because it is not acceptable to the patient. In the case which was successfully treated, it is shown that the acceptance of the defective self led to restoration of ego functions adaptive to small stature.     

Mahler and Stern: Irreconcilable differences?

Recent observational research on infants, particularly that reported by Daniel Stern, challenges some of the basic assumptions of traditional psychodynamic developmental theory. Specifically, Stern takes issue with Margaret Mahler's formulation of separation-individuation and proposes an alternative conceptual framework for charting early development. The purpose of this article is to compare Mahler's and Stern's theories in terms of their epistemology and assumptions, research methods, and developmental schemata. This comparison suggests that, although they appear polarized, the two researchers' ideas can be integrated in ways that enrich social work theory-building and practice.     

A child's imaginary companion: A transitional self

The article explores the use of the imaginary companion by normal children, two to five years of age. Some existing literature on the imaginary companion is reviewed. Three case presentations demonstrate the use of the imaginary companion and its effect on ego development.Major findings are the prevalence of the mechanism of splitting and the use of the imaginary companion as transitional phenomenon by the children. An ensuing discussion relates an object relations understanding of the normal developmental use of splitting and transitional phenomena to the case presentations. The imaginary companion is viewed as a transitional self on the developmental lines of narcissism and object relations.     

Alone together: An application of separation-individuation theory to conjoint marital therapy

Mahler's principle of separation-individuation, widely recognized as a useful tool for understanding couples' difficulties, has been applied traditionally in one-to-one psychotherapy with individual partners. In this article, the author illustrates the use of Mahler's schema in conjoint marital therapy. Following a theoretical elaboration, the author uses excerpts from case process notes to trace a couple's development in treatment from a level dominated by symbiotic longings and related ambivalence to one reflective of increased object constancy and empathic mutuality.     

A qualitative analysis of child protective services practice with children with developmental disabilities

The purpose of this study was to examine Child Protection System (CPS) practice with children with developmental disabilities. This study used an emergent design, ethnographic interviews, purposive sampling, inductive data analysis, and grounded theory building. Ethnographic interviews were conducted with foster families, administrators, intake screeners, special investigators, and workers in one local CPS office. Participants expressed concern about the ability to identify disabilities, placement options, services to meet complex needs of children with disabilities, training and support for families, collaborative arrangements with other agencies, and disability training for CPS workers. Findings suggest strategies for improving CPS practice for children with developmental disabilities.     

The differential use of metaphor in psychotherapy

Metaphor is seen to play a significant role in psychoanalytic theory and technique. While acknowledging this view, this paper examines the differences in which individuals of varying developmental profiles, experience, comprehend and use metaphor in the context of psychotherapy. Differences in the capacity to play, adaptively regress, regulate affect, maintain ego boundaries, and symbolize, are found to affect capacities to employ those figures of speech in words or phrases literally denoting one type of object or idea but used in place of others by suggesting likenesses or analogies. A rationale for differential use of interventions involving metaphor is offered.     

Reflections on repeated abortions: The meanings and motivations

Abstract

This paper is an attempt to answer three questions concerning women who have repeated abortions -Why do they do it?, What is being aborted?, and why do they need to repeat it? By exploring developmental factors in relation to clinical cases, ideas are formulated about the type of women who might be using abortion to act out problems of separation-individuation. I speculate that for some women abortion may act as a rite de passage from one self-image to another or from dependency toward independence. The act of abortion may be an unconscious way to touch or repair infantile developmental failure and to find a 'good enough' resolution.