Self Psychology: A Relational Psychodynamic Model

Self Psychology as a Theoretical Framework Heinz Kohut (1971, 1977) evolved self psychology concepts Self-esteem and sense of self dependent on quality or relationships with parental figures Self-object: person who is experienced intrapsychically Self-object must be availability to the infant for its development of Self

Three Self Object Relationships Mirroring self-object: recognizes a child’s capabilities and talents Idealizing self-object: links a child with admired caregivers Twinship self-object: provides a sense of being the same

Internalization of Self-objects Self-objects perform adaptive functions of soothing and tension regulation Transmuting internalization: child is gradually able to perform soothing and tension regulation functions in absence of original self-object

Impairments with Internalization of Self Objects Without positive self-object experiences internalization of a “healthy self” cannot occur Shame, humiliation, helplessness the result of self-object failure True Self development hindered when child sacrifices expressing needs because self-object support is perceived as unavailable Person complies with needs of other at expense of her/his True Self development (merger bond) Failure to bond with caregiver leaves individual feeling isolated and depressed

Impairments with Internalization of Self Objects (cont.) When early narcissistic needs unmet, child (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 shameful about needs for vulnerability and nurturing Will be able to give to others, emotionally, without feeling anxiety about another’s needs

Maturity: Self Psychology Perspective Maturity 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

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 as “vicarious introspection: ability of therapist to investigate inner world of client Empathy as tool through which therapist gathers psychological information Defense and resistance viewed as normal ways to protect oneself from pain or injury Therapist seeks to understand what client fears in life and in the worker client relationship Empathy frames the working alliance

Role of the Therapist in Self Psychology Experience of therapist by client NOT solely based on past “representations Client's feelings about worker based on her past experiences, current behaviors with others and with therapist Therapist needs to share her experience of client with that person Through “transmuting internalization” of the therapist as calming (mirroring) and competent (idealizing) client can learn 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

Role of the Therapist in Self Psychology Empathic failure: when the client does not feel the worker has been attuned to his self-object needs Perfect empathic attunement is not always possible Not problematic as long as therapist communicated to client the impact of empathic failure on the person Client 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

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: to be affirmed Idealizing self-objects: to merge with strength and wisdom Therapist’s needs are to understand the self-object needs presented by the child With children, don’t interpret their behavior, just respond to their needs Self Psychology: Treating Children

Self Psychology: Treating Adolescents Adolescent brings “turmoil” through loosening of ties to primary self-objects Parental self-objects compared to peers in values and ideals Ongoing process of “the experience of the self and other in parents and children” Requires strength and flexibility

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

Ideal self-object relationships for learning disabled youth: 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

Self Psychology and the Elderly Integrity vs. despair ( developmental ask 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 psychical 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

Self Psychology and Brief Treatment Self-psychology is applicable to brief treatment Clients seek treatment because of a loss of meaningful self-object experiences 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

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 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

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 nontraumatically frustrated in a way that promotes self-identity and self-esteem Kohut: the “internal world” should only be studies through the therapist’s empathy

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)

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”

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 “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