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Family & Couple Therapy -
Psychodynamic and Object relations
Couple and Family Therapy
Introduction - ✔• This therapy is derived from *principles of object relations and Freudian theory. *
- The goal for psychodynamic family therapy, as with individual psychodynamic therapy, is *more self-awareness, which is created by bringing unconscious material into conscious thought. *
- At the heart of this practice is the notion that *current family problems are due to unresolved issues with the previous generation. *
- Interpersonal function is distorted by attachments to past figures and by the *handing down of secrets from one generation to the next. *
- The psychodynamic ally oriented family therapist wants to free the family from excessive attachment to the previous generation and wants to help family members disclose secrets and express concomitant feelings (e.g., of anger or grief).
- Change is created through insight that is often revealed in one individual at a time, in a serial fashion, as others look on.
- In order to loosen the grip of the past on the present, the therapist uses several tools (including interpretation of transferential objects in the room, interpretation of projective identification, and the use of the genogram to make sense of generational transmission of issues).
- In family therapy, transferential interpretations are made among family members, rather than between the patient and the therapist, as occurs in individual therapy.
- For example, when Mr. Bean says "I guess I am not an expert when it comes to female problems," the therapist may have asked, "Who made you feel that way in your family of origin?" When he reveals that he has felt this way since his sister's suicide, he comes to understand how an old lens distorts his current vision (i.e., he still feels so guilty about his sister's death that he does not feel entitled to weigh in with opinions about his daughter's anorexia). Introduction The Metaphor - ✔This therapist is like a lead-testing scientist who tests for levels of lead in one's garden to assess the legacy of toxins from previous homeowners. Only when the true
condition of the soil has been revealed is the current homeowner free to make decisions about whether the soil is clean enough to plant root vegetables; somewhat contaminated, so that only fruit-bearing bushes will be safe; or so toxic that only flowers can be grown without hauling in truckloads of clean, fresh soil Examination of the past enables the current gardener, and, by analogy, parents, to make informed choices about how the current environment needs to be adjusted and what kind of growth is allowable. Psychodynamic & Bowen Family Therapy - ✔• Shared belief that the past is active in the present
- Initial experiences with attachment and connection are particularly relevant
- Focus on how interpersonal and intrapersonal dynamics influence one another
- Each approach has coined terms to describe phenomena in family systems Leading Figures - ✔James Framo invites parents and adult siblings to come to an adult child's session; this tactic allows the past to be revisited in the present. This "family of origin" work is usually brief and intensive, and consists of two lengthy sessions on 2 consecutive days. The meetings may focus on unresolved issues or on disclosure of secrets; it allows the adult child to become less reactive to his or her parents. Norman Paul believes that most current symptoms in a family can be connected to a previous loss that has been insufficiently mourned. In family therapy, each member mourns an important loss while other members bear witness and consequently develop new stores of empathy. Ivan Boszormenyi-Nagy introduced the idea of the "family ledger," a multigenerational accounting system of obligations incurred and debts repaid over time. Symptoms are understood in terms of an individual's making sacrifices in his or her own life in order to repay an injustice from the past. Adelaide Johnson 's notion of superego lacunae: gaps in personal morality passes on by parents Erik Erikson: sociology and ego psychology John Bowlby Nathan Ackerman: The Psychodynamics of Family Life (1958) - the first book dealing strictly with diagnosis and treatment of families. Nathan Ackerman - ✔• Nathan Ackerman largely credited as the father of psychodynamic approaches to family therapy -Traditionally trained as an analyst
Nagy believes that trust, loyalty, and mutual support are the key elements that underlie family relationships and hold families together, and that symptoms develop when a lack of caring and liability result in a breakdown of trust in relationships. The therapists' role is to help the family work through avoided emotional conflicts and to develop a sense of fairness among family members. The contextual model proposes relational ethics - the ethical or "justice" dimension of close relationships - as an overarching integrative conceptual and methodological principle. Relational ethics focuses in particular on the nature and roles of connectedness, caring, reciprocity, loyalty, guilt, fairness, accountability, and trustworthiness - within and between generations. Ivan Boszormenyi-Nagy 2 - ✔The contextual model, in its most well-known formulation, proposes four dimensions of relational reality, both as a guide for conducting therapy and for conceptualizing relational reality in general: (1) Facts (e.g., genetic input, physical health, ethnic-cultural background, socioeconomic status, basic historical facts, events in a person's life cycle, etc) (2) Individual psychology (the domain of most individual psychotherapies) (3) Systemic transactions (the domain covered by classical systemic family therapy: e.g., rules, power, alignments, triangles, feedback, etc) (4) Relational ethics. These dimensions are taken to be inter-linked. Nagy 3 - ✔Multidirected partiality is the main methodological principle of contextual therapy. Its aim is to evoke a dialogue of responsible mutual position-taking among family members. It consists of a sequential, empathic turning towards member after member (even absent members), in which both acknowledgement and expectation are directed at them. It is an alternative to the more common 'neutrality' or unilateral partiality of other approaches. It requires an appreciation of the 'ledger' from each person's point of view, even that of the current victimizer. For example, a family comes into therapy desiring to fix their son's outbursts and oppositional defiant behavior.
The therapist (and possibly a co-therapist where appropriate) would firstly seek basic information (including any relevant clinical or medical information), construct a genogram if possible, and have each family member explain their side of the story (either conjointly or in individual sessions as appropriate), in order to begin to understand the problem in terms of background facts, the relational context (i.e., intergenerational, interpersonal, and systemic), and deeper motivational factors (e.g., psychological processes, hidden loyalties and legacies, ledger imbalances, destructive entitlement resulting from real or perceived injustices, scapegoating, parentificationof the child, etc.), and not simply (as is commonly done in some other approaches) in terms of the 'behaviour', 'systemic interactions', or 'narratives' of the family and the son. Having gained this preliminary understanding of the situation, the therapist would firstly address any issues requiring urgent attention (e.g., physical welfare, prevention of violence, etc.), especially in relation to the interests of the most vulnerable member(s), whether or not they are present at the the Normal Family Development - ✔1. Healthy psychological development based on good early environment - parents
- Positive attachment with mother
- Separation/individuation - provision of reliable support from mother is necessary
- Parents need to be empathetic and model idealization
- Nagy: "loyalty and trust provide the glue that holds families together" Development of Dysfunction - ✔While non-psychoanalytic family therapists look at problems in interactions between people, psychoanalytic therapists look at problems in the actual people in the family. Symptoms come from attempting to cope with unconscious conflicts and the anxiety that signals the emergence of repressed impulses. Some problems can occur with parents not accepting children's separation Kohut: mirroring and idealization - when these needs aren't met from parents, children go on to be showy and seek admiration Fixation and regression in families - after marriage, people can go back to behaviors seen when they were younger Nagy: symptoms occur when trust breaks down in relationships - individuals feel the effects Kernberg: blurred boundaries between family members
Focus is on the first three years of life and their emphasis on the experience of the mother-infant relationship as a major component of psychic structure formation. The character structure organized by this time provides a sense of personal identity that endures and remains relatively constant over time. The Internal Object - ✔• Object Relations theory and therapy focus on internal objects. An internal object is a piece of psychic structure that formed from the person's experiences with the important caretakers in earlier life.
- It is captured in the personality through the process of internalization, so that the personality thereafter bears the trace of that earlier relationship.
- The internal object is neither a memory nor a representation, but is rather an integral part of the self's being. Internal objects become expressed in the individual's choice of, and interactions with, other people (i.e., external objects) in their present life.
- Internal objects may also be modified through relationships with present external objects (such as the therapist). The Self - ✔Internal objects are just one component of the self. In brief, the self comprises: (1) the old-fashioned concept of the ego as an executive mechanism that modulates self-control through its control of motility, sphincters, and affect states, and that mediates relations with the outside world, (2) the internal objects, and (3) objects and parts of the ego bound together by the affects (feelings) appropriate to the child's experiences of those object relationships. The self, then, refers to the combination of ego and internal objects in a unique, dynamic relation that comprises The Self in Relation with Others - ✔• Object Relations is an inclusive technical term that spans the intrapsychic and interpersonal dimensions.
- It refers to the system of interactions and inter-relationships between the various elements of the self, which are then expressed in the arena of current relationships with other people.
- Internal objects and other parts of the self are reciprocal with outer objects so that, in any relationship, the personalities are mutually influenced by each other.
- That is, external relationships are in constant interaction with internal psychic structures.
Object Relations Psychotherapy - ✔Object relations theory puts the relationship between the therapist and the patient at the center of the way of working. While the therapist and patient join together in the task of examining the patient's internal world and its effect on the patient's relationships, at the same time the patient and therapist are in a relationship themselves. This therapeutic relationship forms the laboratory in which the therapist learns most centrally about the patient's ways of relating and the difficulties they include. As the therapist processes the experience of this current relationship, he or she is able to inform the patient about this experience. In this way, patient and therapist have a current shared relationship that both can study and learn from. The patient (or couple, family or group) establishes a current relationship with the therapist that reflects the internal object relations set that is brought to all of their relationships. The therapist's task is to experience these current expressions of object relationships by making himself or herself available to the fantasies, feelings, etc. that arise within them specifically in response to the patient.
- This way of working is characterized by the use of what Freud termed transference and countertransference.
- Object relations theory views the patient's transference as the expression of their internal object relationships within the therapeutic relationship itself.
- Countertransference, on the other hand, is seen as the basis for the therapist's ability to understand and fully interpret the patient. The set of countertransference feelings and attitudes that are stirred up in the therapist during a course of therapy form a model of what happens inside the people with whom the patient is in relationship. Providing that therapists have been well trained and A Main Focus in ORFT - ✔Choices that families make, including partner choices, are based on unresolved internal object relations issues .... patterns repeat themselves until awareness increases and choices are made to differentiate from past objects. The Family is a System of Relationships .... - ✔Which function in ways unique to that family during developmental phases of the individuals and family. Which can be noted by the family therapist who attends to the family system as its members relate to each other and as a group relate to the therapist
The Scharffs Works - ✔Scharff, D. E. and Scharff, J. S. (1987). Object Relations Family Therapy. Northvale, NJ: Jason Aronson Scharff, D. E. and Scharff, J. S. (1991). Object Relations Couple Therapy. Northvale, NJ: Jason Aronson Scharff, J. S. and Scharff, D. E. (In Press). The Primer of Object Relations Therapy, New, Expanded Edition. Northvale, NJ: Jason Aronson Scharff, J. S. and Scharff, D. E. (1994). Object Relations Therapy of Physical and Sexual Trauma. Northvale, NJ: Jason Aronson. Scharff, J. S. and Scharff, D. E. (1998). Object Relations Individual Therapy. Northvale, NJ: Jason Aronson. Object Relations Couple Therapy (ORCT) - ✔Internal psychic structure is built from the attachment relationship When the mother is unresponsive an infant experiences her as rejecting and then "introjects" the experiencing of the mother as a rejecting object The self deals with this by *splitting this introject off from the image of the ideal mother *and pushing that into the unconscious This rejected object is then further split off into the "need exciting" (associated with longing) and "need rejecting" aspects (associated with rage) The personality now consists of the: Central self: attached to feelings of satisfaction and security to an ideal internal object Craving self: longlingly but unhappily attached to an exciting internal object Rejecting self: angrily attached to a rejecting internal object Fairburn would identify that the rejecting object relationship system further suppresses the exciting object relationship system *Couples therefore unconsciously look for lost parts of self in their partner*********** Longevity in marriage is then influenced by the goodness of fit between their lost parts of self and the de-repression of repressed parts of self (or another way of saying this: each partner holds the potential to re-traumatize and potentially heal the other). Klein would highlight the role of projective identification in marriage (or "induction")
Induction or PI arises from infancy as a mental process of unconscious communication that functions along a continuum of defense to mature empathy Dr. Tobin's Model of Attraction and Marriage is Object Relational and Will Illustrate the Complex Jargon of the Next Few Slides - ✔ The Steps of Projective and Introjective Identification in a Couple - ✔Projection: expel a part of self that is denied (or overvalued) and sees the spouse as if he/she were imbued with these qualities -If the projection fits then the spouse has valency Projective Identification: the spouse may or may not identify with the projection. In an ideal situation the spouse transforms the projection in a way that allows the individual to introject a modified version of self (containment and introjective identification) Mutual projective and introjective identificatory processes: while this process is occurring with one spouse the same is true for the other. Together the couple is containing and modifying each other's internal versions of self and object. -This governs mate selection -Falling in love -Quality of the sexual relationship -Level of intimacy -The nature of the marriage in general Dysfunction - ✔Projective and introjective identificatory processes are not mutually gratifying Containment of the spouse's projections is not possible Cementing of the object relations set happens instead of its modification ORCT: The Process - ✔Setting the Frame-includes the number & length of sessions, the fee, management of the beginning & end of session, and establishment of the way of working Creating Psychological Space for Understanding-dealing with the couple relationship rather than the individuals Listening to the Unconscious-be free of the need to get information and to make sense of things. Listen to the communication from the couple as a system. Listen for unconscious communication. Following themes, noting the meaning of silence, and working with fantasy and dream material. Following the affect-moments of emotion in sessions, in which projections and PI's become apparent. Goal Setting -
✔Assists couples in unveiling their unconscious components (the Imago) that determine their choice of mate. This therapy combines spiritual and behavioral techniques and marries them with western psychological methodologies. It arms the couple with the tools necessary to relate to each other and themselves in a positive and caring way, and reveals the emotional pathway formed in childhood that led them to their current situation. Imago relationship therapy involves viewing a conflict between a couple as the answer to the situation, not the cause of the disharmony. By examining the conflict itself, a couple can unlock the key to the solution. Conflict often arises as a result of an underlying emotional discontent felt within the context of the relationship. Outwardly it is expressed through criticism, anger, and dissatisfaction. When this situation presents itself, many couples choose to turn to others for comfort and love. Imago Relationship Therapy helps a couple explore the root of the emotional hurt or need and determines what elements causes those issues to manifest as strenuous and negative comments, feelings, and behaviors. Communication is often severed or non-existent when couples first seek therapy. By understanding that both parties of the couple are communicating from different sources of needs fulfillment, the dialogue becomes deciphered in a manner that is accepted and empathized by both parties. Couples who engage in conflicting behavior learn to realize that although the disagreements are not a threat to self-preservation on the conscious level, they are on the unconscious level because they attack very real emotional perceptions. Our primitive selves revert to innate beliefs that in order to be adequately protected we must be outwardly loved. T Review Template - ✔Nathan Ackerman largely credited as the father of psychodynamic approaches to family therapy; traditionally trained as an analyst; Ackerman connected family context and the unconscious to pathology Theoretical Rationale for Intervention Approach:
- Based on Freudian ideas
- Mental conflict arises when children learn and mis-learn that expressing basic impulses will lead to punishment
- Conflict is signaled by unpleasant affect: anxiety or depression
- In order for conflict to be resolved there must be a strengthening of defenses against a conflicted wish or defenses must be relaxed sufficiently to permit some gratification Major Therapeutic Goals : - ✔To reduce conflict in the family through understanding the interplay between the intrapsychic and interpsychic dynamics at work within the family. Major goal is to free the family of unconscious restrictions. Often accomplished through interpretations of events and insight on the part of family members regarding these events. Differentiation-Outcome is that family members are able to interact with one another without being weighted by unconscious processes of the past. Crisis resolution-focus is more on symptom reduction and fortification of defenses Therapeutic Techniques: - ✔Transference-in family therapy is utilized to understand dominant feelings within a family unit and delineate what emotions are being directed toward which people. Important to not personalize and utilize these interactions as a platform for dealing with unproductive emotions and styles of interaction with one another Dream and Daydream Analysis-Identification and analysis of needs not being met within the family Confrontation Interpretation-bringing unconscious conflicts into consciousness. Is insight oriented in that by bringing these issues to light they can be critically examined and somewhat resolved. Focusing on Strengths Life History-helps you reflect with the family on present and past patterns of interactions Role of the Therapist: - ✔Good enough mother/father Catalyst for change-work to generate interactions and facilitate the processing of ongoing problems Mechanisms of Change: - ✔Often accomplished through interpretations of events and insight on the part of family members regarding these events.
