Assessing clinical progress: A case study of Daryl

In this single case study, the authors conceptually framed their understanding of dissociation and splitting as defensive/adaptive coping mechanisms through which children respond to abusive/neglectful environments and the developmental deficits of abused/neglected children as related to failure in separation/individuation. Case study methodology with a nested experimental research design employed content analysis of process recordings to identify targeted defenses and developmental themes and then to assess therapeutic effectiveness during the first six months of psychodynamic play therapy with Daryl. In-session cliniial progress was assessed through charting changes in defenses and developmental themes, identifying degree of goal achievement, and clinically observing treatment stage progression. Visual analysis of the frequency charts identified a slight cyclical decline in use of splitting and guarding against dissociation and a somewhat uneven increase in the developmental theme of coexistence/integration. While these changes in targeted outcome variables were not statistically significant, the amount of change did exceed the predetermined outcome goals for decreased splitting and increased coexistence but not the goal of decreased guarding against dissociation. Review of the process recordings also identified clear markers of treatment progression through two therapeutic stages in the first six months of long term psychodynamic play therapy and further supported the clinical meaningfulness of the observed changes.     

The effects of maternal depression on children

The importance of identifying children at risk because of parental pathology such as schizophrenia has been well established. It is recommended that a systematic investigation of children of depressed mothers be made. An object relations developmental model is presented as a conceptual framework for understanding the consequences to children of being cared for by depressed mothers.     

The Tango of Loving Hate: Couple Dynamics in High-Conflict Divorce

This article explores the dynamics of couples embroiled in high-conflict divorce through the theoretical prism of British object relations theory. Such couples are often characterized by primitive object relations, and use splitting and projection as a way of “being in the world.” The fear of the ex-spouse’s retaliation is accompanied by fear of their own destructiveness and a desire to make reparation; however, attempts at reparation at this level of relational functioning rarely achieve reconciliation. In fact, such dynamics create a cycle of terror, retaliation, and failed reparation attempts that in turn leads to further terror, splitting and projection, with the resulting outcome often a high-conflict divorce.     

The impact of cumulative trauma in infancy: Some treatment techniques

Children who have had major disruptions and traumas in early developmental phases come to the attention of child mental health specialists frequently. These children present a complex and often puzzling picture due to the early deficits. Without skilled intervention further development will be hampered. Particular focus is placed on the individuation process in the first two years of life and its impact on early development of affects and object relations. Theoretical considerations and specific intervention techniques applying this model are delineated in two case reports.     

PROJECTIVE IDENTIFICATION IN COMMON COUPLE DANCES

This paper integrates the object relations concept of projective identification and the systemic concept of marital dances to develop a more powerful model for working with more difficult and distressed couples. This integrated model explains how some couples use the defenses of splitting and projective identification to externalize and transpose internal conflicts into interpersonal conflicts in five common marital dances. The author suggests how object relations techniques can be used to interrupt the projective identifications, help clients to reown their disowned and projected affects and resolve the conflict on the intrapsychic level so that the marital dance is no longer necessary to resolve the intrapsychic issues.     

Case management with borderline children: Theory and practice

Case management with borderline children requires collaborative work with parents and teachers in which the focus is on the child's needs and relationships with others. Understanding of borderline pathology from the perspectives of developmental psychology and object relations theory can be used implicitly in management planning and explicitly in enabling parents and teachers to comprehend the issues and goals of the child's therapy.     

Sexual identity: Conflict and confusion in a male adolescent

This paper presents a conceptual formulation, derived from developmental object relations theory and ego psychology, of the passage in male adolescence that culminates with the achievement of a masculine heterosexual identity. Themes of psychosexuality, male gender attributes, masculinity and object preference, and sexual orientation are discussed with reference to the adolescent stage. Finally, the critical tasks, core conflicts, and internalizations of prior developmental stages, as well as the integration that is required of adolescence proper relative to a sexual identity as heterosexual and masculine, are highlighted through an extensive case illustration of an adolescent male with sexual identity confusion.a clinical social worker in private practive in Palatine, Illinois. The author gratefully acknowledges that the writing of this paper was supported by a research leave granted him by Loyola University Chicago.     

The Teasing Syndrome in Facially Deformed Children

Teasing is a common occurrence in children and teenagers attending the Australian Cranio-Facial Clinic (maybe as high as 40%). A pilot project was developed to obtain more information about teasing and its effect on children attending the Cranio-Facial Clinic. From this work an hypothesis was developed about the dynamics of teasing at school and the consequences for the children in the form of sequential symptom development, which can evolve into a teasing syndrome. The syndrome begins with the child being upset, angry and miserable and evolves through social withdrawal, emergence of various psychosomatic symptoms and then proceeds to school failure and eventually to school refusal. At this point the child presents a clinical picture of being depressed and maybe suicidal. An innovative treatment method was used to teach the children to make an imaginary forcefield which they could use to beat teasing and this was evaluated using a single case design method. Further studies need to be done to ascertain the epidemiology of teasing in normal and handicapped children in schools and to further elucidate aspects of “The Teasing Syndrome”.     

Emotionally Focused Family Therapy and Play Therapy for Young Children Whose Parents Are Divorced

ABSTRACT

Divorce is common and can pose risks to those involved. Although divorce affects all parts of the family system, young children face extraneous challenges due to their unique developmental stage and limited cognitive ability. Emotionally focused family therapy (EFFT) works to enhance attachment bonds by restructuring a family’s negative interaction cycle and can be useful for repairing relationships between parents and their children who are suffering negative effects of parental divorce. Whereas adults have the skills to express themselves verbally, young children often use imaginary play to convey their emotional experiences and unmet attachment needs. By using play therapy techniques within an EFFT framework, adults and children can better communicate their perspectives concerning difficult life events such as parental divorce.     

Resistance and preoedipal object relations

This paper attempts to elaborate on the distinction between resistance stemming from underlying well working defensive processes in neurotic conflict, and resistancelike behavior denoting a progressive development thrust and adaptive solutions in the understructured personality. A case is used to illustrate how preoedipal object relations can be embedded in resistant-like behavior. Within the case illustration there is an attempt to show how interpretations directed to developmental need and preoedipal object relation conflicts facilitate higher levels of ego organization.     

In pursuit of potential: A discussion of developmental delay,structuralization, and one child's efforts at mastery

This article presents a discussion of the effects of a developmental delay, cerebral palsy, upon the structuralization and consequent object relationships of a 6-year-old child. A review of the concept of normative development, together with a theoretical exploration of object constancy is made in conjuction with the underlying contention that symptomatology requires selective interpretation depending upon the developmental context within which it appears. A case is presented highlighting these constructs as they affect actual functioning. Finally, it is suggested that the use of a developmental conceptual framework will yield a more growth-inducing approach to treatment.     

The road to conventional tool use: Developmental changes in children's material engagement with artifacts in nursery school

The development of tool use in early childhood is a topic of continuing interest in developmental psychology. However, the lack of studies in ecological settings results in many unknowns about how children come to use artifacts according to their cultural function. We report a longitudinal study with 17 sociodemographically diverse children (8 female) attending a nursery school in Madrid (Spain) and their two adult female teachers. Using mixed-effects models and Granger causality analysis, we measured changes in the frequency and duration of children's object uses between 7 and 17 months of age and in the directional influences among pairs of behaviors performed by teachers and children. Results show a clear shift in how children use artifacts. As early as 12 months of age, the frequency of conventional uses outweighs that of all other types of object use. In addition, object uses become shorter in duration with age, irrespective of their type. Moreover, certain teachers' nonlinguistic communicative strategies (e.g., demonstrations of canonical use and placing gestures) significantly influence and promote children's conventional tool use. Findings shed light on how children become increasingly proficient in conventional tool use through interactions with artifacts and others in nursery school.     

OBJECT RELATIONS AND THE FAMILY SYSTEM IN BULIMIA: A THEORETICAL INTEGRATION

This paper presents an integration of object relations theory and family systems theory in the conceptualization of bulimia. It is based primarily on Winnicott's construct of the maternal "holding environment," and Klein's formulation of ego deficits at the level of part-object relations, as they apply to the family as a whole. We propose that in bulimic families there are transgenerational developmental deficits and adaptations which determine the level and quality of intrapsychic experience within individuals, as well as the interpersonal relationships and dynamic functioning of the larger family system.     

Emancipating play: dis/abled children,development and deconstruction

This paper reflects critically on the meaning of play, especially as it relates to disabled children and their experiences. We explore the close alliance of play to cognitive and social development, particularly in the case of psychologies of development, and reveal a dominant discourse of the disabled child as a non‐playing object that requires professional therapeutic intervention. We argue that this pathologisation of play on the part of disabled children is closely tied to normalisation of childhood, in which non‐normal bodies are increasingly expected to be governed and corrected not only by professionals but also by parents/carers. In order to rescue more enabling visions of the disabled child and their play we turn to three perspectives – the new sociology of childhood; social oppression theories of disability; critical developmental psychology. These resources, we suggest, allow us to reconfigure what we mean by play and disability in a contemporary climate that celebrates competition and marketisation over the intrinsic potentialities of all children. We argue that how we conceive play will per se undermine or promote forms of inclusive research, policy and practice.     

Three Object Relations Models of Couple Treatment

This article describes three different approaches to the treatment of couples, all based on different versions of object relations theories. Object relations as a term has various meanings embodying different theoretical assumptions. It is used differentially to highlight certain aspects of clinical phenomena, to connote certain developmental paradigms, and to signal the importance of real, interactional aspects of human behavior. The three therapeutic approaches to work with couples illustrate some of the ways that the greater conceptual complexity of object relations theories affects how love is explained, couple conflicts defined, and what makes for change in couples treatment. Understanding the basic assumptions of a given theory will enable us to increase our informed consent to the use of theory in our practices.     

Promoting object constancy. Writing as a nursing intervention

1. Object constancy is an important developmental milestone that many psychiatric patients have not achieved. 2. Asking patients to write down thoughts and feelings will assist the nurse in reinforcing a continuous experience of self as a necessary antecedent to self and object constancy. 3. Object constancy allows the patient to be more autonomous in relationships. Writing will help the patient become more independent in managing thoughts and feelings. 4. Using an object relations framework for this commonly prescribed nursing intervention will assist nurses in providing a focus and goal for the use of writing.     

Making the most of your time: Clinical social work with a borderline patient

If the therapist is to avoid feeling helpless bewildered, and disorganized in response to patients with Borderline Personality Disorder, it is essential that he or she understand as fully as possible the behavior, defenses, and developmental history commonly associated with this syndrome. This paper examines both the diagnostic and the treatment issues from an object relations perspective, including the contributions of social work concepts. A case example is offered.This paper was delivered at the 23rd Annual Meeting of the International Conference for the Advancement of Private Practice, August 1984, in Banff, Alberta, Canada.     

Factitious Illness by Proxy: Understanding Underlying Psychological Processes and Motivations

Children are put at risk of emotional and physical harm when parents seek unnecessary medical care. Understanding why parents seek medical interventions that create risk for their children requires us to consider how past experiences, and the mental representations of these experiences influence current behaviour. Past experiences of danger affect how parents interpret ‘dangerous’ situations in the present and how they organise protection of their child. This article demonstrates how the notion of mental representations (that dispose parents to act in particular ways) can assist in engaging, assessing and treating parents who display factitious illness by proxy behaviour. When classified using the Dynamic‐Maturational Method, the Adult Attachment Interview (AAI) allows both assessment of implicit and explicit representations and also understanding of the developmental process through which parents have learnt to attribute meaning to information and to organise their behaviour. In this case study, psychosocial assessment of the family included an AAI with each parent. The use of this assessment tool both aided the therapy team in the process of case formulation and intervention planning, and had therapeutic value in and of itself. We argue that treatment is more likely to be effective if the parents and professionals have a shared understanding of the parents' intentions and the developmental process that led to unsafe behaviour, which requires change.     

Transitional relationships: Clinical observations on a form of peer parenting

Adolescents may form quasi-parental/quasi-marital couples to compensate for insufficient access to parental objects at this crucial developmental stage. These relationships constitute a form of peer parenting which can facilitate transition to adulthood. Object relations theory provides a theoretical framework for assessing and responding to critical developmental needs that these young couples present in the clinical setting. An object-relations assessment of a transitional relationship couple is presented, and treatment strategies discussed.     

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.