Psychodynamic Thought In Relation to Group Theory and Practice

Solowoniuk, 2007Psychodynamic Thought In Relation to Group Theory and PracticeTodays AgendaPsychodynamic Lecture Part A (1.2o hour) Break 15 Psychodynamic Lecture Part B (1.15 hour)) 1Solowoniuk, 2007Setting the ContextFor better of for worse psychodynamic theory is the most influential and comprehensive theory of human psychological development and functioning to date. Flores (1997).Why do we need to understand psychodynamic theory with respect to conducting group therapy2Solowoniuk, 2007A 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 ones own needs and desires.

OBJECT RELATIONS THEORY3Solowoniuk, 2007Psychodynamic 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 Winnicotts) work over 60 years suggests 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.

4Solowoniuk, 2007Neo-Freudian Philosophical UnderpinningsDevelopment 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

5Solowoniuk, 2007Developmental ImpassesWe 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?

6Solowoniuk, 2007Enter AddictionThis is an important theme in the treatment of addiction because many persons for whom addiction is a problem feel at their core that:

They dont 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 all7Solowoniuk, 2007Enter Addiction (contd).Ultimately, a persons use of a drug or a behaviour is a way to 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.

8Solowoniuk, 2007Enter Addiction (contd)Thus, addiction can represent or take the form of

Yearning for praise, 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 9Solowoniuk, 2007Psychodynamic theoryAll 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.

The drug or behavior then becomes the self-object and

The addicted sufferer symbolically compels a mirroring self-object to self-sooth it or compels the idealized object to submit to his or merging into it 10Solowoniuk, 2007Merging and Compelling Behaviors11Solowoniuk, 2007Object 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 individuals ability to carry around an accurate mental representation of another person in his or her mind

The internal world and how it acts, reacts, is reactivated with actual interpersonal relationships12INNER LIVESSolowoniuk, 2007What does this have to do with addiction?Addiction is about arrested self-development! ThusBefore one can understand the implications that alcohol and drugs use have in relation to an individuals developmental fixation, one must understand the different stages of self development.13Solowoniuk, 2007Psychodynamic Theory, Becoming Real and AuthenticHelp addicted sufferer :

1) Realize that they will not be rejected or unloved for who they really are

2) See that its their behavior and actions that lead them to be rejected or unloved

3) Recognize that they are separate, alone, and responsible for their condition in life 14Solowoniuk, 2007Towards An Object-Related Developmental Understanding of Addiction Self-Object: mental representations of others that we experience as part of ourselves; there are two types: 1) mirroring, 2 idealizing

Mirroring self-object: is a 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/fathers eye that is tune with the infant/child's achievements.

It is this pole that the selfs basic strivings for power and success emanate.15Solowoniuk, 2007Mirroring Self-ObjectTherefore if the parents/caregiver/or other mirror these feelings to the Infant/Child/Adolescent (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 ICAs needs may result in an individual who needs constant admiration, confirmation, and recognition from others because they are empty and cannot give this to themselves. 16

Solowoniuk, 20072) Idealizing Self-ObjectIdealizing 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 / she 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 . 17

Solowoniuk, 2007Here is an example of a Mirroring Self-Object18Solowoniuk, 2007Margaret Mahlers Theory of Ego DevelopmentIf 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. 19

Solowoniuk, 2007Introducing: Margaret Mahlers Theory of Ego DevelopmentAfter 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. 20Solowoniuk, 2007Introducing: Margaret Mahlers Theory of Ego Development (cont.)Essentially, her work revealed the interpersonal relations of the I and how these relations determined the building of future intra-psychic structures and in turn

How these structures preserve, modify, and reactivate past relations throughout the lifespan.

Mahler was able to delineate the birth and evolving psychic structures from 0 to 3 toward the creation of a cohesive self/real self/true-self.21Solowoniuk, 2007

22Solowoniuk, 2007Stage 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 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 mother/father/caregiver (MFC) world, and child may result.

23Solowoniuk, 2007Normal Symbiosis Attachment (1 to 4 Months)By the second month of life, the infant becomes aware of (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; Trust24Solowoniuk, 2007Splitting the Good and the BadMFC is a beacon of orientation, infant cannot comprehend separateness

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. 25Solowoniuk, 2007Failure to Attach to External OtherFailure here may lead to an ego or I that is

Affectionless, lack capacity to experience guilt,

Withdrawn (schizoid) from interest in the world, self/other, engendering a basic mistrust, defense against object relatedness

Creation of a False-Self 26Solowoniuk, 2007False Self / True-Self Ala WinnicottIn the event that the infant/childs 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. 27Solowoniuk, 2007False 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).28Solowoniuk, 2007Winnicotts 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." 29Solowoniuk, 2007Winncottian TherapyFor 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."

30Solowoniuk, 2007Returning 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 MFCs. - Hatching

Such a phase marks the beginning of the childs emergence as a separate individual free from the symbiotic attachment to his/her MFCs.

Failure to negotiate this developmental process results in an adult who becomes disorganized and suffers dissolution of the self when faced with object loss. 31Solowoniuk, 2007Failure 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 extreme 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. 32Solowoniuk, 2007PracticingFrom approximately 10 to 15 months, the childs focus shifts from the MFCs 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 boundaries are too rigid or diffuse, or the childs process of development is impaired by unavailable, intrusive, or uncaring self-objects 33Solowoniuk, 2007Grandiose SelfA 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

The omnipotent mental representation can be recalled (at least in vigor)

Used to defend against the danger of loss of self-esteem / threat of shame

34Solowoniuk, 2007Rapprochement (15 to 24 months)Toward the end of the toddlers practicing sub-phase, he/she becomes increasing aware of his separateness from his/her MFCs.

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 ones omnipotence into question.

The birth of shame may begin here 35Solowoniuk, 2007Rapprochement (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 lost 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 twos.

36Solowoniuk, 2007The Reemergence of Splitting : Good vs. Bad While the MFCs can be confused by trying to understand the child's frustration , the rapprochement phase is critical to the childs ability to internalize conflict and to reconcile clashes between:

All Good MFCs and All Bad MFCs37Solowoniuk, 2007The Reemergence of Splitting : Good vs. Bad (Cont.).While in the symbiotic phase, the MFCs were considered good love objects and viewed as part of the self, they now come in conflict with the childs 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 childs newly developing ego, the good MFCs and bad MFCs can not be one and the same love object. 38Solowoniuk, 2007Splitting the EgoFor instance, the MFC who was once so long ago apart of me, can not be bad; yet, undeniably, MFCs are not always good.

If the good MFC and the bad MFC are one person, then I, too must harbour some bad within me That is not possible, for Im all good.

39Solowoniuk, 2007Stage 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, negotiation of this stage can impact the use projective identification in later life. 40Solowoniuk, 2007 Stage III Object Constancy: Reconciling the Split Within (cont.). 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 others *history of goodness and will only be able to recall the badness of the latest experience. 41Solowoniuk, 2007Object Constancy Achieved However, when achieved:

The child can hold onto both positive and negative images of the MFCs 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, or be dependent on relationships) to ward off painful affective states. 42Solowoniuk, 2007According to Psychodynamic TheoristsFailure of the facilitating environment can make psychic apparatus vulnerable to:

0 to 4-5 months (psychosis)

5 months to 2 years (character disorders)

3 years and greater (neurosis; e.g.., - depression, anxiety, obsessive behaviour) 43Solowoniuk, 2007Addiction and Defensive PosturingEven 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 SplittingProjective identification, and: Grandiosity44Solowoniuk, 2007Toward Treatment Conceptualizations45Solowoniuk, 2007Kernbergs Supportive Psychodynamic TherapyThree 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.46Solowoniuk, 2007Inter-Group Dynamic Corrective Emotional ProcessGoals

Ego

Strengthening ego

Strengthening ego defenses for adaptive response to real life situations (e.g., empathy, compassion, sublimation, altruism, repression, humour)

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).47Solowoniuk, 2007Object 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 empathyBalancing autonomy and connectionAlternative definitions of self-in-relationships Inter-Group Dynamic Corrective Emotional Process48Solowoniuk, 2007General Therapist Tasks and FunctionsEstablish trust

Encourage a transference relationships

Interpret client 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.

DefensesCounter transferenceDevelopmental fixationsResistance

Early relationship templatesAdaptive coping with real lifeCritical relationshipsInadequate parentingDisconnections49Solowoniuk, 2007 A Brief Review of Object Related Psychodynamics Initial relationships

Single most important factor in developmentConstitute a template upon which others are patternedEarly 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 experiences50Solowoniuk, 2007A Brief Review of Object Related Psychodynamics (cont.). 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

51A Transference InterludeThe 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 MoldSince we old mornings Children played... The Grave yields back her Robberies The years our pilfered things... (Emily Dickinson) 52Solowoniuk, 2007Common Clues to TransferenceStronger feelings than seem to fit the circumstance Instant reactions ObsessionDefending others when it isnt 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.53Solowoniuk, 2007The Gift of Transference and Finding the True SelfWhen love is my only defence, I am invincible...

- Tao Te Ching54Solowoniuk, 2007 Guntrip and Fairbairn: Model of Self and PathologySelf is present from birth Earliest form of anxiety is separation anxiety triggered by abandonment or failure of attunement Internalized objects are defensive and happen because of frustrating and unsatisfactory aspects of early MFCs 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) 55Solowoniuk, 2007WHEN FRUSTRATION HAPPENSSPLITTING 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 56Solowoniuk, 200757Central Ego attached toEgo IdealRepressed Bad Self attached to Repressed Good Self attached toBad ObjectGood ObjectSolowoniuk, 200758Bad Self Hostile Attitude toward all objects

Including good self Internal SaboteurSolowoniuk, 2007Internal SaboteurDistrusts 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 59A dialogue with the internal SaboteurLove or Love me Not: Measuring therapist Personal Eros Dont misinterpret the transference (hate in)Interpreting the transference what is our client trying to make us feelTherapist must have room for despair in themselves and be loyal to that despair1(vessel of despair)Preventing nowhere we make possible the clients experience of abysmal emptiness1

Solowoniuk, 2007Un-cohesive SelfWorld 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 62Solowoniuk, 200763Tends to idealize or fantasize others

Can feel unworthy, shameful, that their needs are sick and that their love can destroy

Believe they are too needyRepressed Good Self in Relationship With:Internal RealitySolowoniuk, 200764Feels rejected and held in contempt by others

Turns anger inward, attacks self and those that make promises

Threatened by the possibility of hope Repressed Bad Self in Relationship With:Internal RealitySolowoniuk, 200765This 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 Repressed Good Self and the Exciting ObjectInternal RealityTechniques: Toward Surrender

1) Face Symptoms2) Willingly accept 3) Float 4) Let time Pass 5) No-separation

Solowoniuk, 2007Some Useful TermsOptimal Frustration Refuelling Transmuting Internalization (process of developing psychic structure mirroring and idealization)False-Self Good enough mother / mothering Affect regulation Alexithymia (inability to name and use ones emotions) Anhedonia incapability to experience pleasure)67