1. Self Psychology: A Relational Psychodynamic Model SOW6425 Assessment and Planning Professor Nan Van Den Bergh, PhD, LCSW

2. Self Psychology as a Theoretical Framework Heinz Kohut (1971, 1977) evolved self psychology concepts –In order for the core self to emerge and evolve into a cohesive structure, the self needs others –Individual never outgrows the need for others’ confirmation –Self exists in rudimentary way from birth but evolves from interplay between infant’s innate potential and an emphatically attuned and responsive caretaking environment Individual never outgrows the need for others’ admiration

3. Self Psychology Concepts Self-object: person from external environment who is experienced intra-psychically –Early self-objects are empathic caregivers who perform vital functions for infant, i.e. soothing –Self-objects must be available to the infant for its development of SELF –Ego function impact: Sense of Identity Self-objects perform adaptive functions of soothing and tension regulation Transmuting internalization: person develops the capacity to perform self-soothing and tension self- regulation previously done by self-objects

4. Three Self Object Needs Mirroring self-object : confirms the child’s sense of vigor, greatness and perfection –Recognizes the child’s capabilities, talents and responds to the child’s needs/feelings Idealizing self-object: offers strength and calmness to soothe the child –Someone to admire, idealize and from whom the child gains strength “ to bask in the glow of …….” –Pride and strength by association Twinship self-object: provides a sense of humanness, likeness to and partnership with others –“All in the same boat…”

5. Impairments with Internalization of Self Objects Without positive self-object experiences internalization of a “healthy self” cannot occur –Shame, humiliation, helplessness the result of ongoing self-object failure –Conflicts arise when individual fears her own expression of needs will diminish whatever self-object experiences are available –Failure to bond with caregiver leaves individual feeling isolated and depressed –Individual, anxious for support of the self-object, may falsely comply with the needs of the other at the expense of the development of a “true self”

6. Impairments with Internalization of Self Objects (cont.) When early narcissistic needs unmet, child (then adult) is continually searching for nurturing and validating self- object experiences If SELF becomes strengthened through self-object responsiveness (i.e. through treatment) person will feel less shame about their need and desire to be vulnerable and to be nurtured –Outcome will be ability to give to others, emotionally, without feeling anxiety about responding to another’s needs

7. Maturity: Self Psychology Perspective Maturity is the ability to evoke and engage in mutually enriching self-object relationships Emotionally healthy individual has ability to choose self-objects based on adult development levels, not early narcissistic needs –Early narcissistic needs are “feed me, see me, praise me….” etc.

8. Empathy Kohut (1959): Psychological development evolves from attunement between self and self- objects –Experiencing attunement allows self to evolve from early, narcissistic needs to capacity for empathic attunement to others Empathy,“vicarious introspection:” –ability of therapist to investigate inner world of client Empathy as tool through which therapist gathers psychological information Empathy frames the working alliance

9. Empathy (cont.) Defense and resistance viewed as normal ways to protect oneself from pain or injury –Therapist seeks to understand what the client fears in life and in the worker/client relationship –Worker reflects back, empathically, client’s efforts to “defend” against focusing on anxiety-related topics “ It is painful to talk about the circumstances that led to your separation and divorce from your wife…..”

10. Role of the Therapist in Self Psychology Attunement to transference and countertransference are central Client’s transference response to the therapist not only based on past “representations or others” Client's transference could ALSO be based on current behaviors with others and with therapist (totalistic transference) Therapist needs to share her experience of the client with the client “Transmuting internalization:” –Experinece of therapist as calming (mirroring) and competent (idealizing) allows client to learn how to self-soothe, self-comfort and self-empathize Therapist becomes a new “self-object” This process enables client to find more mature self-object relationships in her life

11. Role of the Therapist in Self Psychology (cont.) Empathic failure: when the client does not feel the worker has been attuned to his or her self-object needs –Perfect empathic attunement is not always possible –Empathic failure not problematic as long as therapist offers an interpretation, to the client, of the failure’s’ impact on the client Therapist may need to apologize and admit an error/mistake –Client gradually learns to tolerate frustration in the same way a young child is helped by parents who do not gratify every need Learning to deal with frustration, through an empathic relationship with therapist, allows client to choose more emotionally sustaining self-objects and to experience empathy for others

12. Self Psychology: Assessment Assessment: –What is level of self-esteem? –Transference/countertransference awareness: Client involved with therapist or self-absorbed? “Piece of furniture counter-transference?” –Capacity to be available to others? –Narcissistic personality characteristics: Grandiose sense of self-importance Preoccupied with fantasies of unlimited success, brilliance, beauty, etc. Believes s/he is ‘special,’ unique, understood only by other ‘special” people Requires excessive admiration Sense of entitlement and expects especially favorable treatment Interpersonally exploitative Lacks empathy Arrogant, haughty behaviors or attitudes Envious of others or believes others are envious of her/him

13. Self Psychology: Interventions Interventions: –Monitor transference responses and provide empathically for client’s self-object needs: Mirroring: validating and empathizing Idealizing: calming and soothing when anxious/fearful Twinship: offering collaboration to address client's concerns –Offer person-situation and developmental reflections plus interpretations as to relational dynamics in therapeutic relationship and with others

14. Self Psychology: Treating Children Rage, depression, clinging, lack of impulse control, inhibition in social skills and learning can result from lack of caregiver responses to appropriate childhood needs and wishes Driven, repetitious behaviors seen as desperate attempts to achieve recognition and response to vital needs –Mirroring self-objects: being affirmed by another –Idealizing self-objects: merging with strength and wisdom of another Therapist’s needs to understand the self-object needs presented by the child With children, don’t interpret their behavior, just respond to their needs (typically through play)

15. Self Psychology: Treating Adolescents Adolescent brings “turmoil” through loosening of ties to primary self-objects Parental self-objects are compared to peers in terms of values and ideals Ongoing process of “the experience of the self through parents and other youth” –Requires strength and flexibility –This ongoing “re-experiencing of selves” between parents and children occurs throughout the life cycle Self-object needs: –Mirror empathy needs: strengths, capabilites, competencies –Clarify concern with risky behaviors and consequences –Serve as “ally” in seeking resolution to challenges/problems

16. Self Psychology and the Elderly Integrity vs. despair ( developmental task of last life cycle): maintaining self esteem in the wake of biological, psychological and social stressors Symptoms of disorders of self in seniors: –Sensitivity to slights and insults –Reactive anger and withdrawal in response to rejection or disappointment –Hypochondriasis –Overdependence on others for approval –Viewing others not as separate but as extensions of self –Over-emphasis on physical appearance, possessions and past accomplishments to cope with diminished self esteem Major goal of therapy with elderly is restoration of self esteem –Reminiscence about past –Mourning loss of self-object relationships –Listening to past narcissistic injuries

17. Self Psychology and Learning Disorders in Children and Adolescents Palombo (1995): Disorders of the self do not cause learning disorders since they are neurologically based –However, neurological weaknesses can give rise to disorders of the self –Child’s thoughts and behaviors are neurologically based and not motivated by psychological factors When child cannot make sense of her experiences and she receives negative feedback from family or educators, child can have problems with self esteem and self concept

18. Self Psychology and Learning Disorders in Children and Adolescents (cont.) Ideal self-object relationships for learning- disabled youth: –Direct verbal explanations to clarify confusion –Soothing guidance on how to deal with problems –Emotionally calm presence to reduce anxiety Therapist must be a self-object for both child and the caregiver

19. Self Psychology and Brief Treatment Self-psychology is applicable to brief treatment Clients seek treatment because of a loss of meaningful selfobject experiences (source of most adjustment disorders, DSM IV) –Causes loss of sense of self Goal: –Enhance client’s self esteem and restore her to pre-crisis functioning Therapeutic process of “empathic investigation," through mirroring, idealizing and twinship functions Understanding client’s subjective experiences, providing “self-object responsiveness” restores self-cohesion and decreases symptom logy Tasks of therapist: –Helps patient appreciate the legitimacy of her needs and feelings –Promotes self awareness, understanding and acceptance

20. Self Psychology and Group Treatment Self psychology has been effective in group treatment with clients having self-esteem problems The group can provide affirming self-object relationships 12 Step meetings: –Mirroring transference through sharing and listening to others with same experiences –Idealizing transference through “sponsors” and subscribing to the “Steps” –Twinship transference through the “we” experience of mutual aid and peer support

21. Self Psychology and Practice Evaluation “Success” would be client's ability to identify and seek out positive self-objects within her surroundings Treatment provides a “reparative emotional experience” of being empathically understood and non-traumatically frustrated in a way that promotes self-identity and self-esteem Kohut: the “internal world” should only be studied through the therapist’s empathy

22. Self Psychology and Practice Evaluation (cont.) Qualitative research designs focusing on validity of meaning (comparing therapist and client responses) Quantitative assessment of change in self- esteem could be assessed by measures addressing that concept ( i.e. Rosenberg Self Esteem scale) Scaling experiences in external world and in relationships with others

23. Ending in Self Psychology: the Therapist Experience At end of treatment, therapist may experience: –“ loss of the therapy as a self-object experience” that may have provided mastery, growth and professional stability”

24. Self Psychology: Summary Kohut pioneered the term empathy as a clinical concept plus an important component of the healing process Empathy more than “feeling for the client” –Empathy as the “scientific tool” of psychotherapy –Practitioner has only one tool; that tool is herself/himself –“Empathy is means by which psychological observer gathers information about the inner world of the human experience” Empathy is active listening through: – Hearing the client’s story –Communicating understanding of that story and its impact on the client’s life Being understood by the therapist gives the client an affirming experience vital for establishing other meaningful relationships