Saturday, March 9, 2013

Otto Kernberg - Implications of Object Relations Theory for Psychoanalytic Technique

"An object relations focus is not geared exclusively to the understanding and treatment of patients with severe regression in the transference; it has applications for the standard psychoanalytic technique, many of which have long been integrated into that technique.

Within an object relations framework, unconscious intrapsychic conflicts always involve self- and object representations, or rather, conflicts between certain units of self- and object representations under the impact of a determined drive derivative (clinically, a certain affect disposition) and other, contradictory or opposing, units of self- and object representations and their respective affect dispositions reflecting the defensive structure. Unconscious intrapsychic conflicts are never simple conflicts between impulse and defense; rather, the drive derivative finds expression through a certain primitive object relation (a certain unit of self- and object representation); and the defense, too, is reflected by a certain internalized object relation. The conflict is between these intrapsychic structures. Thus, all character defenses really reflect the activation of a defensive constellation of self- and object representations directed against an opposite and dreaded, repressed self- and obect constellation. For example, in obsessive, characterological submissiveness, a chronically submissive self-image in relating to a powerful and protective parental image may defend the patient against the repressed, violently rebellious self relating to a sadistic and castrating parental image. Thus, clinically, both characterdefense and repressed impulse involve mutually opposed internal object relations.

While, therefore, the consolidation of the overall intrapsychic structures (ego, superego, and id) results in an integration of internalized object relations that obscures the constituent units within the overall structures, in the course of psychoanalysis one observes the gradual redissolution of pathogenic superego and ego structures, and, in this context, the activation and clarification of the constituent internalized object relations in the transference. In this regard, Glover's (1955) classical formulation of the transference as reflecting an impulse and an identification may easily be translated into the transference as always reflecting an object relation under the impact of a certain drive derivative.

In other words, the unconscious intrapsychic conflicts reflected in neurotic symptoms and pathological character traits are always dynamically structured, that is, they reflect a relatively permanent intrapsychic organization consisting of opposite, contradictory, or conflictual internalized object relations. At severe levels of psychopathology where psychoanalysis is usually contraindicated (certain types of severe character pathology and borderline conditions) dissociative mechanisms stabilize such dynamic structures within an ego-id matrix and permit the contradictory aspects of these conflicts to remain — at least partially — in consciousness.

On the other hand, with patients presenting less severe character pathology and psychoneurosis, the dynamically structured intrapsychic conflicts are truly unconscious, and are predominantly intersystemic conflicts involving ego, superego, and id and their advanced, high-level or "neurotic" defense mechanisms. Here, in the course of the psychoanalytic process, the development of a regressive transference neurosis will gradually activate in the transference the constituent units of internalized object relations that form part of ego and superego structures, and of the repressed units of internalized object relations that have become part of the id. At first, rather global expressions of ego and superego functions make their appearance, such as generalized guilt feelings about unacceptable impulses, or broadly rationalized ego-syntoniccharacter traits. Eventually, however, the transference is expressed more and more directly by means of a certain object relation which is used defensively against an opposng one reflecting the repressed drive derivatives. In the case of both defense- and impulse-determined object relations, the patient may re-enact the self-representation of that unit while projecting the object representation onto the analyst, or, at other times, project his self-representation onto the analyst while identifying with the object representation of the unit.

The fact that in the ordinary psychoanalytic case these transitory identifications emerge in the context of a well-integrated tripartite structure and a consolidated ego identity,

with integration of both the patient's self-concept and his concepts of significant others — including the psychoanalyst — permits the patient to maintain a certain distance from, or perspective on, this momentary activation of a certain distortion of self- and object representation without losing, at least potentially, the capacity for reality testing in the transference. This permits the analyst to deal with the regressive transference neurosis from a position of technical neutrality, by interpretive means; and it permits the patient to deal with interpretations introspectively, searching for further self-understanding in the light of the analyst's interpretive comments. In spite of temporary weakening of reality testing during affect storms and transferenceacting out, this quality of the psychoanalytc process is one of its outstanding, specific features.

The analyst, while empathizing by means of a transitory or trial identification with the patient's experience of himself and his object representations, also explores empathically the object relation that is currently predominant in the interactional or nonverbal aspects of the transference, and, in this context, the nature of the self- or object representation that the patient is projecting onto him. The analyst's subjective experience, at that point, may include either a transitory identification with the patient's self-experience — as is the case in concordant identification — or with the patient's currently dissociated or projected self- or object representation — as is the case in complementary identification (where the analyst, rather than identifying with the patient's self or ego, identifies with his object representation or the superego in global terms (Racker, 1968).

Throughout this process, the analyst first transforms his empathic understanding into intuitive formulations; he later ventures into a more restrictive formulation that incorporates a general understanding in the light of all available information (Beres and Arlow, 1974). The empathy with, the intuitive understanding, and the integrative formulation of the patient's affect states during this process clarifies the nature of the drive derivative activated and defended against in the object relation predominating in the transference.

It needs to be stressed that what I have just outlined is a focus, from an object relations standpoint, upon the theory of psychoanalytic technique that permits us to maintain this same theory for varying technical approaches. This theory of technique takes into consideration the structural characteristics, defensive operations, object relations, and transference developments of patients who are fixated at or have regressed to a structural organization that antedates the integration of the intrapsychic structures, as well as of patients whose tripartite structure has been consolidated, that is, the standard psychoanalytic case that we have examined in detail. I am suggesting that this focus upon the theory of psychoanalytic technique for the entire spectrum of patients for which a psychoanalytic approach may be considered the treatment of choice facilitates the application of a nonmodified psychoanalytic technique to some patients with severe psychopathology, clarifies certain modifications of the standad psychoanalytic technique for cases where psychoanalysis is contraindicated for individual reasons, and, most importantly, implies a reconfirmation of standard psychoanalytic technique for the well-organized patient with solid integration of the tripartite structure. I shall now attempt to illustrate this approach by means of a clinical vignette from a standard psychoanalytic treatment.
" (pp. 209-212)

Otto Kernberg (1979). Some Implications Of Object Relations Theory For Psychoanalytic Technique. Journal of the American Psychoanalytic Association., Vol. 27S, pp. 207-239

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