Psychodynamic Thought In Relation to Group Theory and Practice Today’s Agenda Psychodynamic Lecture Part A / B (2hrs hour) Solowoniuk, 2007

Setting the Context Why do we need to understand psychodynamic theory with respect to conducting group therapy… For better of for worse psychodynamic theory is the most influential and comprehensive theory of human psychological development and functioning to date. – Flores (1997). Solowoniuk, 2007

A prelude: Psychodynamic Theory and Addiction Addiction occurs in and amongst psychological development (ego or self development). First and foremost the self or “I” is created through the desire to be with others as oneself, with all its imperfections and its shortcomings, while recognizing that others are independent, separate and not just there to serve one’s own needs and desires…. OBJECT RELATIONS THEORY Solowoniuk, 2007

Psychodynamic Theory: A Neo-Freudian Object Related Theory Freud held that behavior is determined by biological drive states that are tempered by social expectation (superego) and through a evolving rational self (ego). However; His successors (e.g., Kernberg, Mahler, Kohut, and Winnicott’s) work over 60 years holds that our sense of self is defined by the way we are perceived by others and how we perceive or distort our perceptions of others. Solowoniuk, 2007

Neo-Freudian Philosophical Underpinnings Development of “Self” primary goal of human being. Thus, we become what we are in order to be able to develop authentic real relationships… And we remain inauthentic or false until we are able to engage another in true dialogue. The hook or problem is however… Solowoniuk, 2007

Developmental Impasses We must first be autonomous and independent before we can fully engage each other. However, if we do not know our boundaries, we can lose ourselves in our relationships and confuse that which is ours with that which is not ours. Hence, “can I be close to another without losing myself and can I really tolerate being alone”? Solowoniuk, 2007

Enter Addiction This is an important theme in the treatment of addiction because many persons for whom addiction is a problem feel at their core that: They don’t know who they are; Their history displays a rash of failed relationships or none all; They present as unworthy, unlovable, and; They either have rigid boundaries or none not at all Solowoniuk, 2007

Enter Addiction (contd). Ultimately, a persons’ use of a drug or a behaviour is a way t0 combat their feelings of worthlessness while also burying a sense of emptiness that intermittently permeates their consciousness. And yet through extended use these phenomena only become more hauntingly real; leading to further escape via a false-self schema. Solowoniuk, 2007

Song Interlude Solowoniuk, 2007

Enter Addiction (contd) Thus, addiction can represent or take the form of Yearning for praise and approval or a merger with an idealized other in order to self-sooth; or it can… Take the form sexual acting out with persons, figures, or symbols so as to feel wanted, real, alive, or powerful; or it can be … An escape through drugs into a fantasy world to keep the void and meaningless at bay. Yet whatever the means, according to… Solowoniuk, 2007

Psychodynamic theory… All these behaviors are a substitute for a self-object which failed the infant/child when they should still have had the feeling of omnipotently controlling its responses in accordance with his or her needs as if it were part of themselves. Solowoniuk, 2007

Object Relations Theory Mentalistic psychology aimed at understanding how an individuals’ external functioning is / was a representation of their internal perceptions The term object signifies an individual’s ability to carry around an accurate mental representation of another person in his or her mind The internal world acts, reacts, and is reactivated with actual interpersonal relationships Solowoniuk, 2007

What does this have to do with addiction? Addiction is about arrested self-development! Thus… Before one can understand the implications that alcohol and drugs use have in relation to an individual’s developmental fixation, one must understand the different stages of typical development. Solowoniuk, 2007

Towards An Object-Related Developmental Understanding of Addiction Self-Object: mental representations of others that we experience as part of ourselves; there are two types. Mirroring self-object: is an object that responds to and confirms the child’s innate sense of vigor, greatness, and perfection. For example: it is the gleam in the mother/father’s eye that is in tune with the infant/child’s achievements. It is this pole that the child’s basic strivings for power and success emanate. Solowoniuk, 2007

Mirroring Self-Object Therefore if the parents/caregiver/or other mirror these feelings to the ICA he or she develops a healthy sense of self with an appropriate sense of assertiveness and ambition. Failure of the self-object to optimally gratify the ICA’s hungry needs results in an individual who needs constant admiration, confirmation, and recognition from others because they feel empty and cannot give this to themselves. Solowoniuk, 2007

Idealizing Self-Object Idealizing self-objects are objects with whom a child can merge as an image of calmness, infallibility, and omnipotence. If the child is presented with a strong , soothing self-object who allows idealization, he or she develops a capacity for healthy ideals, values, and principles. In contrast, children who do not have idealizing self-objects available are forever attempting to achieve a union with an idealized object . Solowoniuk, 2007

Failure to achieve Union: Addiction in Adulthood Solowoniuk, 2007

Margaret Mahler’s Theory of Ego Development If one is to truly elucidate how ego development affects later life toward understanding addiction as relational (i.e., cure through ingesting objects/drugs or others)… Which leaves no psychic structure in place to appease a false-self schema, we must understand how a viable ego is formed or deformed. Consequently to begin investigating how an ego or “I” is birthed, we are brought to the work of Margaret Mahler and her theory of ego development. Solowoniuk, 2007

Introducing: Margaret Mahler’s Theory of Ego Development After having spent most of her professional career studying severely disturbed children, Mahler began to investigate the psychological development of children (o – 3 years ). She eventually drew a picture of the psychological birth of the child, which stressed that the ego purposefully sought relations. Whereas Freud, believed the ego’s primary drive was to reduce biological urges. Solowoniuk, 2007

Introducing: Margaret Mahler’s Theory of Ego Development (contd). Essentially, her work revealed the interpersonal relations of the ego and how these relations determined the building of future intrapsychic structures and in turn… How these structures preserve, modify, and reactive past relations throughout the lifespan. Most importantly, Mahler was able to delineate the birth and evolving births of important psychic structures from 0 to 3 toward the creation of a cohesive self/real self/true-self. Solowoniuk, 2007

Solowoniuk, 2007

Stage I: Normal Autism (birth to 4 weeks) During the first month of life, the infant is encapsulated in a psychic orbit that serves as a stimulus barrier protecting the child from excessive outside intrusions. It is considered normal because of its adaptive function, allowing the child to purposefully use the mother/father caregiver (MFC) as an auxiliary ego. If however, the environment is grossly pathological the early development of ego does not begin and fusion or less than optimal differentiation between MFC, world, and child may result. Solowoniuk, 2007

Normal Symbiosis – Attachment By the second month of life, the infant becomes aware of the (MFC) as an external object. During these early months the infant internalizes the (MFC) and uses it as a beacon of orientation, engendering a basic sense of: Security Safety, and; Trust Solowoniuk, 2007

Splitting the Good and the Bad The crude differentiation between object and self, good and bad, and pleasure and pain allows the symbiotic infant to deal with painful experiences in the only way his/her limited cognitive defenses permit… **By splitting the good and the bad, and projecting the bad outside of the symbiotic partnership. Eventually this splitting will have to be reconciled… Solowoniuk, 2007

Splitting the Good and the Bad (contd). Crucial to this development phase is the infant’s ability to attach itself to an eternal object. However, the failure of the attachment carries several deficits in the early organization of the self. However, we must keep in mind it’s not just the MFC’s that lead to attachment failure as both biology, personality, and environment play a role here. Solowoniuk, 2007

Failure to Attach to External Other Failure here may lead to a ego or I that is Affectionless Withdrawn from interest in the world, self/other (engendering a basic mistrust) personality, or ; failure may lend its self to the… Creation of a False-Self Solowoniuk, 2007

False Self / True-Self – Ala’ “Winnicott” In the event that the infant/child’s ego or I is threatened, defensive compensatory structures (false-self) are established to prevent further injury. Such an individual develops an as if personality bolstered by a pomposity that hides their “true self” from further fragmentation. But this defensive process prevents them from further nourishing their true self because each success is attributed to the way they “acted” rather than “who they are”. Solowoniuk, 2007

False Self / True-Self – Ala’ “Winnicott” (contd) Consequently, they feel like “imposters” who sub-consciously ruminate about being discovered and exposed for what they really are. However, the therapist must understand that this false-self creation is a defense mechanism designed to hide and protect the true-self that lies within. Winnicott holds that false-self is not conceived as malevolent, on the contrary it is a caretaker self that energetically manages life so that an inner self might not experience the threat of annihilation resulting from excessive pressure on it to develop according to the internal logic of an another person (MFC). Solowoniuk, 2007

Winnicott’s False/True-self Primary Tenets "With the care that it receives from its mother each infant is able to have a personal existence, and so begins to build up what might be called a continuity of being. On the basis of this continuity of being the inherited potential gradually develops into an individual infant. If maternal care is not good enough then the infant does not really come into existence, since there is no continuity of being; instead the personality becomes built on the basis of reactions to environmental impingement.“ "The first ego organization comes from the experience of threats of annihilation which do not lead to annihilation and from which, repeatedly, there is recovery."  "(1) Subject relates to object. (2) Object is in process of being found instead of being placed by the subject in the world. (3) Subject destroys object.  (4) Object survives destruction. (5) Subject can use object."  Solowoniuk, 2007

Winncottian Therapy For Winnicott, the therapist's task is to provide a holding environment for the client so they have the opportunity to meet neglected ego needs and allow their true self to emerge. One of the most important attributes of the therapist is simple patience. "If only we can wait, the patient arrives at understanding creatively and with immense joy...The principle is that it is the patient and only the patient who has the answers." Solowoniuk, 2007

Returning to Mahler/Stage II: Separation Individuation Differentiation and Hatching (5 to 10 months) As strong as the childs’ yearnings for attachment are, the infant gradually begins to experience even more powerful urges to move away from his/her MFC’s. - Hatching Such a phase marks the beginning of the child’s emergence as a separate individual free from the symbiotic attachment to his/her MFC’s. Failure to negotiate this developmental process results in an adult who becomes disorganized and suffers dissolution of the self when faced with object loss. Solowoniuk, 2007

Failure of Differentiation When severe, the individual is unable to discern inner experiences from outer experiences, leading to confusion regarding what is me and what is not me. In extremer cases, internal stimuli become confused with external reality, which may be the breeding ground for hallucinations and delusions. These individuals may have an infinity for hallucinogen type drugs or similar behaviors. Solowoniuk, 2007

Practicing From approximately 10 – to 15 months, the child’s focus shifts from the MFC’s to autonomous functioning. He/she begin to stand, walk, climb, jump, etc… He or she truly believes they are the center of the universe (primary narcissism). However, if the child is not given boundaries, or if the boundaries are too rigid or diffuse, or the child’s process of development is impaired by unavailable, intrusive, or uncaring self-objects… Solowoniuk, 2007

Grandiose Self A grandiose self may take shape; especially when these qualities are not assimilated into the ego or they or not challenged throughout maturation!!! Such a self is often found in individuals with addictions and because such a self can be recalled it will used be used as a defense against loss of self-esteem and or loss of control. This defensiveness comes out usually at the beginning of the treatment process or is revealed when a significant other tells their partner … “Go to treatment or where done.” Solowoniuk, 2007

Rapprochement (15 to 24 months) Toward the end of the toddler’s practicing sub-phase, he/she becomes increasing aware of his separateness from his/her MFC. Thus there will inevitably be moments when the toddler will become acutely aware of his/her complete vulnerability (falls, bumps, bruises, child becomes lost in department store, abuse at the hands of another, etc). Hence, he/she will become distressed and these frustrations and other feelings will become internalized bringing one’s omnipotence into question…. Solowoniuk, 2007

Rapprochement (15 to 24 months) Here the developing self begins to understand (clearly) that causes and events exist outside of oneself, independent of his or her needs and wishes. Thus he or she suffers a loss of omnipotence and wishes to return to the safety of his/her MFC. This is a period or phase of contradictions known by the parent as a terrible two’s. Solowoniuk, 2007

The Reemergence of Splitting : Good vs. Bad While the MFC’s will be confused by trying to understand the child's frustration , the rapprochement phase is critical to the child’s ability to internalize conflict and to reconcile clashes between an: “All Good” MFC and an “All Bad” MFC Solowoniuk, 2007

The Reemergence of Splitting : Good vs. Bad (Contd) While in the symbiotic phase the MFC’s were considered “good love objects” and viewed as part of the self, they now come in conflict with the child’s new emerging sense of “I”. However, our child love objects unavoidably have their dark sides. Sometimes they are need frustraters , or pain inflictors, or indifferent distracted caretakers, or are absent altogether. For the child’s newly developing ego, the “good MFC’s” and “bad MFC’s” can not be one and the same love object. Solowoniuk, 2007

Splitting the Ego For instance, the MFC who was once so long ago apart of me, can not be bad; yet, undeniably, MFC’s are not always good. If the good MFC and the bad MFC are one person, then I, too must harbor some bad within me… That is not possible, for I’m all good. Solowoniuk, 2007

Stage III Object Constancy: Reconciling the Split Within Essentially, object constancy involves the emotional and cognitive acceptance of the idea that we are neither saints nor demons but whole people capable of both love and hate. Secondly, we also understand and realize that other people are both capable of love and hate, and being able to unite and integrate such insights, individuals confirm their sense of personal wholeness. This occurs between 24 and 36 months and the degree with negotiate this stage can impact the use projection and projective identification in later life. Solowoniuk, 2007

Stage III Object Constancy: Reconciling the Split Within (Contd). When object constancy is weak, the only way to protect the good, cherished parts of the self from the negative or undesirable aspects of the self is to force or split this off. Destructively, it becomes impossible to appreciate the wholeness of the self or other. Thus, the individual will simply get rid of others like unwanted objects if those others disappoint them. In addition, they will also fail to see the other’s *history of goodness and will only be able to recall the badness of the latest experience. Solowoniuk, 2007

Object Constancy Achieved However, when achieved: The child can hold onto both positive and negative images of the MFC’s and function as a separate self, even if angry, frustrated, and alone(separation and individuation is achieved). There is also an enduring developing of the psychic structure; individuals are able to calm and sooth themselves and will not have to rely on external self-objects or external sources of gratification (i.e., alcohol, drugs, sex, food, and gambling, be dependent on relationships) to ward off painful affective states. Solowoniuk, 2007

Addiction and Defensive Posturing Even after developing a cohesive self, the fact that a person is addicted indicates that his or her primary defenses have been weakened on one level, yet strengthened on another level. Drugs and alcohol or similar behaviors become a substitute for a person whose psychic apparatus has lost its adaptive power. And while drugs and alcohol provide temporary relief from psychic pain, deteriorating chemical effects on the mind/body result in the use of more primary defense operations like: Denial Splitting Projective identification, and: Grandiosity Solowoniuk, 2007

Toward Treatment Conceptualizations While these defensive operations are attempts to shield the individual from the intolerable affects produced by the loss of self worth and other behaviors that destroy the individuals world, or… The defenses arise because of an ego that was never viable… Treatment from the psychodynamic perspective for ego related pathologies and addictions , nevertheless, follow well thought steps and time honored procedures. Solowoniuk, 2007

Kernberg’s Supportive Psychodynamic Therapy Three Principles Clarification of individuals behavior “this is what you are doing with me.” Distortions are confronted in a supportive, firm, and caring manner. After the individual is completely aware of what they have done, gain consensual validation from group and point out how they do this with others. Encourage individuals to act differently with others outside therapy. Solowoniuk, 2007

Inter-Group Dynamic Corrective Emotional Process Goals Ego Strengthening ego Strengthening ego defenses for adaptive response to real life situations Examining idealized views of parents and other objects and the impact of self-absorption (who in the group remind the self of past object relations and what is being triggered). Solowoniuk, 2007

Inter-Group Dynamic Corrective Emotional Process Object relations Creating a new relationship template from which alternative interpretations can be made and new relationship options entertained Self-in-relations Creating a new template for mutual empathy Balancing autonomy and connection Alternative definitions of self-in-relationships Solowoniuk, 2007

General Therapist Tasks and Functions Establish trust in a therapeutic Encourage a transference relationship Interpret clients and groups: And then reflexively bridge, cycle, challenge, and offer insights derived from interpretations with the goal of group members completing a second cycle on their own. Early relationship templates Adaptive coping with real life Critical relationships Inadequate parenting Disconnections Defenses Counter transference Developmental fixations Resistance Solowoniuk, 2007

A Brief Review of Object Related Psychodynamics Understanding relationships as specific influence in development of self Libido is object seeking Object: the target of a need or that which will satisfy a need Basic motive is to relate Focus on ego development through object relations Solowoniuk, 2007

A Transference Interlude The shapes we buried, dwell about, Familiar, in the Rooms – Untarnished by the Sepulcher The Modlering Playmate comes – In just the jacket that he wore – Long buttoned in the Mold Since we – old mornings – Children – played... The Grave yields back her Robberies – The years our pilfered things... (Emily Dickinson)

Common Clues to Transference Stronger feelings than seem to fit the circumstance Instant reactions Obsession Defending others when it’s your issue Unexplainable attractions / repulsions Personalizing others actions, and ; A similarity in the characteristics of our partners and acquaintances Ultimately, transference shows us that other people are not out there as totally other. They are reflections/projections/ of our own story and how it played out. Instead of seeking need fulfilment in an adult way, we add on expectations and entitlements that belong to the child/parent relationship. Solowoniuk, 2007

A Brief Review of Object Related Psychodynamics Initial relationships Single most important factor in development Constitute a template upon which others are patterned Early formation and differentiation of psychological structures that comprise images of self and others Dependency results in lack of differentiation or fusion Development moves toward independence and autonomy by means of support Problems result from developmental arrests in relationship experiences Solowoniuk, 2007

The Gift of Transference and Finding the True Self When love is my only defence, I am invincible... - Tao Te Ching Solowoniuk, 2007

Guntrip and Fairbairn: Model of Self and Pathology Self is present from birth Earliest form of anxiety is separation anxiety triggered by abandonment or failure of attunement Internalize objects is defensive and happens because of frustrating and unsatisfactory aspects of early MFC’s Degree of frustration leads to introjection not mere internalization Introjection involves three components: object representation (OR); self representation (SR), and affect states related to (OR)and (SR) Solowoniuk, 2007

WHEN FRUSTRATION HAPPENS SPLITTING OCCURS – A GOOD OBJECT AND BAD OBJECT A GOOD SELF AND A BAD SELF MAIN CORE WHICH IS NOT SPLIT OR REPRESSED BECOMES EGO IDEAL The person is left with 3 part ego Solowoniuk, 2007

Central Ego attached to Repressed Good Self attached to Ego Ideal Good Object Repressed Bad Self attached to Bad Object Solowoniuk, 2007

Hostile Attitude toward all objects Bad Self Internal Saboteur Hostile Attitude toward all objects Including good self Solowoniuk, 2007

Internal Saboteur Distrusts all promise of hope Especially hope coming from good objects and sometimes therapist Believes / thinks it will be tricked into promises that things can change, get better, trust is possible, etc. Can and will attack good self for being gullible, stupid, that love, change, and trust is possible Solowoniuk, 2007

Un-cohesive Self World is dominated by internal world of self and object representations leaving little psychic energy for authentic relationships This false-self (FS) configuration rules interactions with others The person is either rebellious or compliant or oscillates between the two Individuals in external world are coerced or forced to comply with the internal reality of FS inner experiences and expectations Solowoniuk, 2007

Repressed Good Self in Relationship With: Internal Reality Tends to idealize or fantasize others Can feel unworthy, shameful, that their needs are sick and that their love can destroy Believe they are too needy Solowoniuk, 2007

Repressed Bad Self in Relationship With: Internal Reality Feels rejected and held in contempt by others Turns anger inward, attacks self and those that promise they care Threatened by the possibility of hope Solowoniuk, 2007

Repressed Good Self and the Exciting Object Internal Reality This needy part can be a bottomless pit – never satisfied, and the tantalizing good object can never fulfill it promise of perfect love, acceptance, and complete nurturance without any limits or disappointments Craving self Solowoniuk, 2007

Some Useful Terms Self-object Optimal Frustration Refueling Transmuting Internalization (process of developing psychic structure – mirroring and idealization completed) False-Self Good enough mother / mothering Self-care Affect regulation Transitional object Adversarial Solowoniuk, 2007

Dependency and the Self Defects in the self lead to failures in ego-ideal formation Failure to be admired, admire, be encouraged, valued, suffer from chronic feelings of self-worth/esteem Inability to accurately evaluate oneself plays significant role in one’s ability to see the relative health of “love object” Alcohol/drugs, and other behaviors then attempt to refuel grandiose self and activate the all good-self and object images Solowoniuk, 2007

Archaic and Mature Mirroring / Idealization Early recovery typically centers around archaic mirroring Kohut believed that we never outgrow our need for self-objects Therapy is only complete when the person can form healthy attachments outside of the therapeutic milieu Solowoniuk, 2007

Alexithymia Inability to name and use one’s own emotions – to verbalize them Instead the addict may experience sensations and experience somatization of feelings Use then become a way to stave of waves of sensations Thinking becomes mundane, operative, and boring Solowoniuk, 2007

Anhedonia The inability to experience joy, pleasure, or happiness Alcohol, drugs, and behaviors become the only way to feel or distract from feeling distressful states Return of the unbearable (keep my self stimulated) These is seen in all types of addicted sufferers, especially the work alcoholic Solowoniuk, 2007

Let’s talk about NARCISSISM Solowoniuk, 2007

Narcissism Revisited: Kohut Redefining The old view – selfishness or self-centeredness, a driven stubbornness insisted by a immature individual who wants to get his or her own way Kohut instead views narcissism as misguided attempts at seeking for relatedness – disturbances in the self and in most important interpersonal relationships where mirroring and validation failed Looking for a balance in the valuation of others and ourselves, our importance and our potential Solowoniuk, 2007

The Psychodynamics of Narcissism One down - idealize the other One up – need mirroring to confirm their special Once mirroring is received the other is often discarded Usually brought on by some real or imagined hurt Holding contempt, being shameful of oneself, one cannot tolerate similar qualities in the other Solowoniuk, 2007

Absence of Self-Worth And the Role of Shame Pain of feeling shameful Leads to defenses of grandiosity, superiority, and self-sufficiency All the while the self is thought to be flawed and imperfect – which generates the need for narcissistic defense Solowoniuk, 2007

Shame Types Narcissistic shame type: experience vulnerabilities, shortcoming, and failures that must be denied and avoided at all costs Masochistic Type – defend against shame to the degree that they are guiltless Both types have inability or serious difficulties in understanding internal signals, setting boundaries, or respecting other person’s boundaries Can be prone to exhibitionistic, voyeuristic, and sexually fixated behaviors Solowoniuk, 2007

Shame Prone People in Society Often excruciatingly ambitious Success driven Shame is contained by constant achievements, grandiosity, or addictive-compulsive acting out There is a need to be seen as powerful, independent, beautiful, and successful All that activity can be seen as a defense to distract others from what is hidden Solowoniuk, 2007

Interpersonal Relationships and Recovery 1. DENIAL OF NEED FOR THERS (“I don’t need anyone.”) 2. DENIAL OF NEED FOR ALCOHOL AND DRUGS (“I am not addicted to alcohol and drugs.”) 1. ACCEPTANCE OF NEED FOR ALCOHOL AND DRUGS (“I am alcoholic or addict.”) 2. ACCEPTANCE AND NEED FOR OTHERS Addiction 1st Step Recovery (“I need other people.”) Solowoniuk, 2007