Object relation therapy

OBJECT RELATION THERAPY

ARATHI VI JAYANGRACE JOCHAN

ANJANA THATTILJOEL JOHN

REJ IN D

ORIGIN

• Object relations theory is an offshoot of psychoanalytic theory that emphasizes interpersonal relations, primarily in the family and especially between mother and child.

FREUD ‘S WORK

• Initially Freud felt that suppressed childhood memories were the reason for hysteria. • Later corrected saying the oedipal complex that

existed between children and its repression was what caused pathology.• Sexual longing causes a tension that is required

to be release and as a way of this release, children form attachments with certain figues or objects.

FAIRBAIRN’S CONTRIBUTION

• Children did not seek sexual satisfaction but are inclined towards forming relationships. • Humans are not primarily pleasure seeking. • ORT sees internalisation as motivated by the

needs for self development and a guide to navigate the interpersonal world.

DEVELOPMENTAL AND ETHOLOGICAL EVIDENCE

• Harlow’s experiment on rhesus monkeys.• Bowbly – attachment towards care giving figures.• Beebe and Stern – child prewired for relationship

with caregiver.

CLINICAL & THEORETICAL BASIS

• Human organism as autonomously motivated to form object relationships and personality formation as a product of the object relationships internalized in the developmental process.

• Object relationships are interpersonal relationships seen from the participant view point . They differ from interpersonal relationships seen from the viewpoint of a third person.

• Example: while an observer might say two people have a “bad” relationship, one person might experience the self as trying to please an implacable other whom this person regards as possessing exceptional qualities. That is the object relationship.

• Because of the overriding importance of the attachment to the caretaker, the child will do whatever is necessary to secure this attachment.

• If the relationship requires the suppression of aspects of the self, those potential components of the self are arrested, thus crippling self-development.

• Example: if the caretaker will not tolerate aggressive feelings the child will learn not to feel or act in an aggressive manner. The aggressive component of the personality will be arrested, thus crippling all areas that rely on aggression such as self-assertion, ambition, and competitiveness.

• Development of crucial components of the self, such as excitement, interest, enjoyment, aggression, and sexuality, the self will be fundamentally split in a way that arrests the development of essential components of the self.

• Winnicott called this division the split between the “true self” and the “false self.”

• From the object-relations viewpoint, all psychogenic pathology is a function of self-arrest induced by anxiety-driven object attachments.

• According to Winnicott, each infant is born with potential that cannot be changed, but can be either facilitated or interfered with by caretakers.

• When the early caretakers do not meet the child’s needs well, the child will experience the caretaking figure as traumatizing, the child will internalize the figure as a “bad object.”

Object Relations Model of Psychotherapy

Goal Uncover early relations internalized in

childhood and early life Relinquish them Create new object relations structure that

foster self-development

Traditional psychoanalysis focus on discrete affects;

Object relations psychotherapy focus on the structure of self; symptom considered as an outgrowth of an anxiety driven object relationship

A. Resistance Patient’s current relational patterns reflect

underlying object relations structure

The ‘more painful early relationships, stronger is clinching to the object.’ (Fairbairn)

i.e; abused child more attached to abusive parent

Early relationships Object relations structure Self structure

Resistance- even after awareness of problem and underlying motivations, behavior persists, continues to be out of control.

Object relations theory considers patient’s attachment to patterns as a reflection of the underlying object relation patterns that are interwoven with the structure of self.

Patterns of behavior becomes unmanageable because a. Focus is primarily on understanding

affects and impulses without considering self-structure

b. There is over-reliance on interpretation

B. Patient- Therapist Relationship Awareness about the maladaptive pattern

does not solve the pattern

Therapeutic relationship – where patient creates new, adaptive, authentic, meaningful object relationships for a healthier psychological structure

Winnicott- psychotherapeutic relationship – ‘transitional space’- similar to a transitional object for a child like teddy bear or blanket.

Success of relationship depends on how it facilitates development of true self. Patient uses analytic relationship to create new object relationship.

Patients use of the therapist more important than therapist’s understanding

Role of therapist – adapt to patient’s needs, rather than understanding unconscious.

Transference- more broadened concept ;

beyond the projection of one’s own past relationships

Transference in object relations therapy is a complex blend of past images and present adaptations.

• T H E T H E RA P I S T I N T E R P R E T S T H E T RA N S F E R E N C E

• D O E S N O T R E D U C E E V E RY A S P E C T O F T H E R E L AT I O N S H I P T O PA S T E X P E R I E N C E ’ S

• T H E RA P I S T S E A RC H E S F O R R O O T S O F T H E R E L AT I O N S H I P I N T H E PAT I E N T ’ S PA S T

• M O R E I M P O RTA N T LY T H E A DA P T I V E F U N C T I O N O F T H E R E L AT I O N S H I P I N T H E P R E S E N T

CREATION OF A NEW OBJECT RELATIONSHIP

• Patient idealises therapist- Because an idealised OR provides the security lacking in early caretaker relationship

• So therapist, interprets not just lack of security, but also the safety provided by an idealised therapeutic relationship.

Not just interpretation alone • Interpret idealising transference. • Help patient develop a new relationship without repeating

patterns of the past• The new relationship will replace the internalized bad

object.

PURPOSE OF THE RELATIONSHIP

• Adapt to the patient so an opportunity to create a more positive benevolent object than the object it replaces.

• The active provision of a new different relationship is the difference between OR model pf psychotherapy and classical psychoanalytic viewpoint.

• In psychoanalytic viewpoint it is wrong because with OR strategy there is gratification of patients wishes.

• Therapist must not become the new object BUT interpret the patients desire fro the therapist to become such an object.

• By contrast – OR model sees personality as consisting of internalized object and health or pathology as a product of the nature of these objects.

• Therefore anything done to facilitate the relinquishing of old objects and replacing with new objects is beneficial to the therapeutic process and its goals.

• The old OR structure is deeply ingrained and will not be easily given up meaning a new relationship will rarely affect change.

• Unless, the OR pattern is interpreted and patient is aware of the origins and damaging consequences of it.

• Before, the therapists influence as a new Object can be experienced

SUMMARY• Principle: Child’s relationship with early figures are autonomously

motivated.

• This parental relationship is internalized as object relationships that form the character structure.• The articulation of a personal idiom is arrested where there are

impingements that interfere with the child’s maturational process.• Now, when the significant aspects of the self are blocked, the

buried self will seek veiled expression as a symptom.• Therefore, object relations therapy is directed both to

understanding the defensive constellation and facilitating the articulation of buried affective dispositions that lie beneath it. • Emphasis is on insight into the transference and the patient’s

creation of a new object relationship with the therapist.• This model widens the scope of psychoanalytic treatment beyond

neurotic conditions to characterological disturbances.

RESEARCH• Quality of object relations and security of attachment as predictors of

early therapeutic alliance.

• Security of attachment and quality of object relations were measured as predictors of initial impressions of the therapeutic alliance as well as dropout.

• 55 individual psychotherapy clients were administered the Revised Adult Attachment Scale and the Bell Object Relations and Reality Testing Inventory prior to their initial therapy session.

• 30 of these participants completed the Working Alliance Inventory following their 1st, 2nd, and 3rd sessions.

• Security of attachment and quality of object relations were strongly related. • Security of attachment and quality of object relations showed relations to

early alliance that decreased over time. • Attachment and object relations were not related to dropout.