Self psychology and the psychotherapy of psychotic patients: A case study

Self psychology has previously been employed in describing the treatment of narcissistic personality disorders. This article discusses the clinical application of concepts of self psychology to the psychotherapy of a psychotic patient. Empathy and the concept of empathic failure were very helpful in conceptualizing the therapeutic process. The two selfobject transferences of mirroring and idealization were both present in this case, and the recognition and interpretation of these transferences were critical in understanding the therapeutic process. The patient's delusional experiences receded and began to be less disruptive as the selfobject transferences emerged and remained in place. The resurgence of delusional material was usually indicative of a failure of empathy and a disruption of the selfobject transference. This patient's ability to regulate his anxiety and calm himself was considerably enhanced during the course of treatment. Self psychology and the understanding it provides proved to be of great value in the treatment of this patient and has wide applicability to the psychotherapy of psychosis.     

Toward a More Optimal Selfobject Milieu: Family Psychotherapy from the Perspective of Self Psychology

This paper applies the theory of self psychology to the understanding and treatment of families. The healthy family is viewed as a reliable source of selfobject experience for its members, while problems in or between family members are seen as due to a lack of adequate selfobject experience for one or more members. Causes of selfobject failures or misattunements in the family are examined, with an emphasis on the influence of previous relational experiences on current needs, capacities, and experiences of others. Curative factors in this form of family therapy are then outlined, and a treatment approach designed to help family members become better able to provide empathically attuned responses to each other is described, with a case example used to illustrate key points.     

Panic Disorder and Self States: Clinical and Research Illustrations

Patients who suffer from panic attacks are often deeply distressed by the symptoms of panic and their aftermath. Alarming physiological symptoms (i.e., dizziness, shakiness, and abdominal distress) are typically accompanied by a sense of imminent doom. This article presents a formulation of panic disorder that assumes that panic results from selfobject failures, leading to fragmentation and disorganizing experiences. Early selfobject responses to panic set the stage for the meanings of panic in subsequent development. A single clinical case, along with examples from research, illustrates the benefit of focusing on developmental processes and unconscious and preconscious fantasies.     

Selfobject functions of the family: Implications for family therapy

The application of Self-Psychology theory to family functioning adds to our models of understanding and intervention in family therapy. This article develops a theory of the family as a supraordinate selfobject and explores diverse clinical applications of the theory. The family as a selfobject matrix enhances the self development of the child by the provision of continuity through the maintenance of proximity over time, and by an enhanced quality and quantity of selfobject responsiveness for the individual. This application of Self Psychology theory has wide implications for family therapy with children in foster care, family therapy with elderly couples coping with dementia in one spouse, and family therapy as a component of treatment with suicidal adolescents.     

Extending Kohut’s Concept of Selfobject: The Undifferentiated Selfobject

This paper highlights and adds to the understanding of the undifferentiated selfobject, an extension of Kohut’s contributions of mirror, twinship and idealizing selfobjects. Introduced by Rowe in (2005), the undifferentiated selfobject follows Kohut’s teaching that there are still selfobjects that have not been discovered and which, therefore, have remained unanalyzed. This paper offers an understanding of the importance of the undifferentiated selfobject in the treatment of a depressed and potentially suicidal woman.     

Development from archaic to mature selfobject transferences

Heinz Kohut has contributed a new understanding of altered states as fixations on aspects of early developmental forms of selfobjects. Fixations can occur as a result of inadequate empathic relatedness necessary for the internalization of anxiety relieving functions. Fixations on aspects of archaic forms of the idealized selfobject may take the form of ecstatic, trance-like religious feelings. These altered states provide needed sensations that substitute for missing psychic structure. Understanding the self sustaining function that these altered states provide is crucial to the treatment. The author shares moment to moment steps in the treatment of a highly successful professional who is addicted to heightened sensation states. The development of new editions of the selfobject transferences are followed in the treatment—from primitive idealization to more mature forms of selfobject transferences.Presented at the Third National Clinical Conference of the Committee on Psychoanalysis, National Federation of Societies for Clinical Social Work.     

Supervision of trainees: Tending the professional self

This article seeks to demonstrage how self psychological concepts can be applied to the process of training psychotherapists in a variety of clinical and community settings. The author examines the role of clinical supervision in the development, consolidation, and maintenance of a cohesive professional self. The role of selfobject experience, needs, transference, and countertransference as manifested in the supervisory relationship is elaborated. Supervisor and supervisee form a self-selfobject unit, through which the trainee's anxieties and vulnerabilities can be managed. This selfobject matrix enables maintenance of self-esteem, expansion of cognitive understanding, and structure building in the arena of the professional self. To achieve these ends, the supervisor forms an empathic alliance with the internal, subjective experience of the therapist. The importance of focusing on the self experience and selfobject needs of the therapist in training via an empathic mode of observation is illustrated by several examples and vignettes. The application of theory to practice is emphasized, with examples chosen from a variety of clinical settings and modalities.     

A self psychological study of dehumanization in Eugene O'Neill'sThe Hairy Ape

Experiences of isolation, alienation, and self-fragmentation have been expressed by literary artists throughout this century. Many of the plays of Eugene O'Neill depict human suffering in these terms. Applying the constructs of self psychology, particularly those relating to selfobjects and the selfobject milieu, these experiences in O'Neill's plays can be described as shifts in self-cohesiveness. O'Neill'sThe Hairy Ape depicts a man with a fragile sense of self who suffers a disruption of the selfobject milieu which had sustained him. As a consequence of this change in his social embeddedness, the character Yank experiences a sense of fragmentation and ultimately feels that he does not belong to the human race. The play depicts in a powerful way the necessity of a selfobject milieu in sustaining one's sense of self.     

God as Selfobject and the Therapeutic Potential of Divine Failure

Although early psychoanalytic theorists took a disapproving stance towards religious belief, later theorists recognized the critical support that a relationship with God provides the believer. This shift has allowed social workers to continue utilizing psychodynamic theory without taking a condescending attitude towards their clients’ religious beliefs. Kohut’s articulation of selfobject needs that persist throughout adulthood provided a prism through which to understand the support for the underlying structures of the self that a connection with the divine offers. However, Kohut’s identification of God as a selfobject limits itself to only its supportive element. This article explores the potential for psychological growth inherent in a relationship with God. The ability to acknowledge and mentally process divine failure—those moments where for the believer God does not offer sought after support—seem to be the primary catalyst for exercising this potential growth. Clinical examples are provided to demonstrate how a relationship with God can be addressed in a therapeutic context.     

The Desomatizing Selfobject Transference: Analysis of an Eating Disorder

This article documents the manner in which psychological treatment, with its attentiveness to the vicissitudes of the unfolding selfobject transference, gradually enabled a patient to contain and articulate painful affect states. The patient's passionate relationship with food, strikingly illustrated in the clinical material, including her dreams, endowed eating with the functions of an idealized selfobject. Over the course of treatment, she seemed to traverse a psychic bridge that took her from an isolated reliance on food through a more focal awareness of her body and her feelings, to an investment in, and capacity for, deepened relationships with other people.     

Depletion states and selfobject disorders

The subjective experience of depression is reviewed. The dynamics of that experience are then explicated from the perspective of self psychology. It is proposed that some depressions may best be understood as reflective of the patient's feeling of depletion. This feeling may be related to the loss of a selfobject, or may be reflective of a deficit in the self, which gives rise to unsatisfiable yearnings.     

Selfobject intervention in brief treatment with patients inappropriate for traditional brief psychotherapy models

This article discusses brief psychodynamic intervention with patients who are likely not to benefit from a primarily verbal, insight-oriented or explorational treatment. The major models of brief psychodynamic psychotherapy and their range of effective applicability are discussed. The function of selfobjects throughout the life-cycle are explored. Interventions designed around these selfobject functions are presented for patients unlikely to benefit from a more traditional approach. These interventions are developed through a thorough assessment of the patient's difficulties and include the setting of time limits for treatment (i.e. both within sessions and for the treatment as a whole). Interventions specifically directed toward reestablishing effective selfobject functioning in the mirroring, idealizing and twinship/alterego spheres are also presented. Vignettes are used to illustrate such interventions.     

Chronic Fatigue Syndrome: A self psychological perspective

Chronic Fatigue Syndrome, an illness with debilitating effects on both the body and mind, has received increased attention in the last several years. Yet there has been hardly any documentation of the psychotherapy of afflicted individuals. The author suggests that self psychology is a useful approach in such cases, not only in addressing the effects of the illness, but in facilitating the patient's maintenance of much needed selfobject ties and the ability to follow the complex and difficult medical treatment program. A case illustration demonstrates these dynamics. Self experience of such individuals is then explored with specific reference to nuclear vs. peripheral selves. The author catalogues disruptions in selfobject ties as a result of the illness and offers treatment recommendations.I wish to thank Susan Sands, Ph.D., and Karen Rogers, MFCC, for their support and editorial contributions.     

A self psychological approach to the treatment of gay men with AIDS

This paper applies the concepts and techniques of the self psychological approach to the treatment of gay men with AIDS. The psychosocial impact of AIDS on the maintenance of self and identity for gay men is explored with an emphasis on the implications for selfobject needs being met. The author illustrates through four case vignettes attempts at satisfying the mirroring, idealizing, and alterego selfobject needs of such clients. Individual, relational, and family-focused clinical concerns are addressed.     

Severe borderlines and self psychology

This paper will discuss work with a woman diagnosed as having borderline personality disorder because of classic symptoms of intense unstable affect, recurrent suicidality, self-mutilation, and primitive defensive organization. Once a selfobject transference tie was established, the borderline symptoms remitted. Discussion of this case will focus on the clinical application of concepts from the field of psychoanalytic self psychology, particularly the concepts of self-object functions and intersubjectivity, in work with patients diagnosed as borderline.     

“Losers” and “Winners” Within an Intertwin Dyad: A Case of a Twinship Selfobject Relationship of a Twin

This paper reports on and discusses a relationship involving the selfobject function of twinship in the case of an adult patient who is a twin. This study shows that the intense twinship the patient formed with her sister when they were children, although providing positive functions, also contributed to developmental problems regarding differentiation and the formation of secure self-boundaries.     

The “risky” intervention: Twinship selfobject impasses and therapist self-disclosure in psychodynamic psychotherapy

This article examines therapist self-disclosure from the perspective of self psychology. Resistance to therapist self-disclosure in the traditional psychodynamic literature is reviewed and recent research pertaining to therapist self-disclosure is discussed. Twinship selfobject needs and the impasses resulting from these in psychotherapy are examined. Therapist self-disclosure is proposed as an appropriate intervention for such impasses. Two cases are presented to illustrate such interventions and the potential dangers and gains inherent in therapist self-disclosure are discussed.     

Ageing and Transageing: Transgenerational Hauntings of the Self

In this article, I examine the dissonant experience of ageing in the context of two different but related models of the psyche: a vertical model to which repression is central and a horizontal model that emphasizes dissociation. I compare the structure of Freud's melancholic self, as Abraham and Torok (1994 Abraham , N. & Torok , M. ( 1994 ), Mourning or melancholia: Introjection vs. incorporation . In: The Shell and the Kernel: Renewals of Psychoanalysis , Vol. 1 , ed. and trans. N. Rand . Chicago : University of Chicago Press , pp. 125 – 138 . [Google Scholar]) have revised it, with the postmodern, poststructuralist, and post-Freudian self, which is characterized by dissociation and emphasized by relational psychoanalytic theorists. I argue that dissociation is the more capacious model for the consideration of the experience of ageing because it can serve an incorporative or an introjective function. In its defensive, incorporative role, it maintains ghostly specters of youth as consuming objects of loss and desire. In its creative introjective role, dissociation initiates a dynamic and creative process in which multiple self-states of past and present are available for recognition and enactment. In this latter form of the dissociative state, the melancholic longings of ageing are transformed into a productive process, which I call transageing. In the final section of the article, I compare the complexities and contradictions of transageing with those of other projects of category crossing, specifically to those that pertain to sex and gender.     

A role-reversal in the mother-daughter relationship

Psychoanalytic theorists have noted a particular dynamic in the mother-infant relationship in which the emotional needs of the mother predominate. When this situation occurs, the emotional needs of the infant may go unmet, resulting in impaired self-development. Through an integration of the ideas of mainstream psychoanalytic theorists and feminist psychoanalytic thinkers, this paper proposes the idea that, because of the intensity of the mother-daughter relationship, this dynamic may be more prevalent between mothers and daughters than between mothers and sons. A mother-daughter relationship is described in which the mother comes to depend on her daughter for emotional attunement and response, and the mother's selfobject needs predominate. As a consequence, the daughter is unable to develop a cohesive sense of self and experiences difficulty in achieving separation. Two clinical reports are presented to illustrate the way in which this mother-daughter dynamic manifests itself in the patient's life and in the therapeutic relationship. A negative transference dynamic is described resulting from these patient's fear of duplicating their relationship with their mothers in the therapeutic relationship by having to meet the selfobject needs of the therapist.     

Returning to psychotherapy with the same therapist: A self psychological perspective

Terminations or interruptions of psychotherapy which have been followed by a patient's resuming therapy with the same therapist at a later time have often been viewed as premature with the implication that the initial therapy has been inadequate or deficient. This paper suggests, however, that a patient returns to the same therapist because the selfobject bond established in the initial treatment is still intact, and that the hiatus between treatments can be a time of further development and strengthening of self structure. Two clinical cases are described which illustrate these ideas.