Object relations theory and therapeutic applications

Object Relations Theory

Development of behavior disorders and object relations theory

Object relations (or) theory revolves around the internalization and externalization of good and bad "objects," especially the mother and breast, beginning in infancy. The infant is not yet able to reconcile good and bad feelings for mother and breast, so therefore keeps the good and bad versions separate and distinct. In addition, the infant attempts to control the scary feelings of aggression and anger toward mother by internalizing them as part of the self; this also occurs with positive emotion (Murdock, 2009). Or theorists believe that these good and bad internalized objects become the basis for the self and determine how the infant will grow to relate to others later in life. A healthy child who was raised by a "good enough mother" will be able to integrate the good and bad objects into a whole person and develop healthy, empathic relationships based on genuine intimacy and realistic expectations (Murdock, 2009). On the other hand, if mother is not "good enough" (she doesn't provide a "safe holding environment" in which the infant can learn to contain emotions and integrate internal and external realities through quiet time), the infant will remain at least partially "stuck" in an immature, schizoid, split-off sense of self and others (Murdock, 2009). Or theorists believe it is this failure to properly integrate good and bad, internal and external, that leads to behavior disorders and destructive relationships.

Put another way, Fairbairn, one of the fathers of or theory, believed that psychopathology and behavior disorders develop as a result of disturbed object relationships. These object relations are the most primitive constructs in an infant's psyche, and unlike Freud who believed sexual and aggressive drives lay at the heart of the self, the or theorist believes the primary goal of creating object relations is to develop a sense of consistent emotional support (Buckley, an Object Relations Perspective on the Nature of Resistance and Therapeutic Change, 1996). When an infant is unable to actualize this sense of support both internally and externally, he will develop maladaptive thinking, emotion, and behavior patterns that manifest as disorders later in life (Buckley, an Object Relations Perspective on the Nature of Resistance and Therapeutic Change, 1996). In an extreme case, for example, the male infant may learn to view his smothering or neglectful mother as a hated object; this hatred is then projected onto all women. At the same time, the bad-mother-object is internalized; therefore, the abused becomes an abuser himself. If not resolved, this internalized and externalized hatred and aggression toward women can eventually lead the grown man to abuse or even kill women in an attempt to destroy that hated internalized object that "haunts" him (Knight, 2006). He is also trying to replace frightening feelings from infancy of being unable to control his mother with comforting feelings and object relations based on a newfound sense of omnipotence and control over women by way of abuse (Knight, 2006). The notorious serial killer Ted Bundy, for example, experienced rejection at birth from his mother (for whom he was a bastard), and later after experiencing rejection again at the hands of a girlfriend, lashed out at the uncontrollable, rejecting objects women represented to him through the ultimate act of control -- murder. In less extreme cases, the infant with unhealthy object relations may cope with these confusing and painful constructs later in life through a personality disorder, depressive disorder, or anxiety disorder (Hamilton & al, 1994). For example, an infant whose instinctual desires for an intimate, stable, secure, and loving mother-object were never satisfied may grow up to live with a chronic emotional emptiness that either results in depression and anxiety, and/or he constantly attempts to fill the void with addictions to drugs, alcohol, food, sex, money, power, etc. (Stewart, Elder, & Gosling, 1996). In addition, he will likely feel compelled to chronically relive that first dysfunctional relationship with mother, playing out the same pattern of desire, hope, and disappointment over and over.

During adolescence, when the self's inner schema of object relations is once again upset as dramatic developmental changes are taking place, any underlying issues will likely surface (Kelly, 1997). This is why so many behavior disorders become apparent during the teenage years. This is also why therapy during these critical years can help to alter and redefine object relations for a healthier, more cohesive and integrated personality (Kelly, 1997).

Goals of object relations therapy

or therapy is an offshoot of psychoanalysis. Beginning with Melanie Klein in the 1920s, Freudian philosophy split off into two groups: the Kleinian London group -- who recognized the importance of an infant's desire to establish supportive relationships as internalized and externalized "objects," on top of Freud's drive theory; and the Freudian Viennese school -- still centered around the ego, superego, id, aggressive and sexual drives, and the release of tensions (Murdock, 2009). Later, Fairbairn, Winnicott, and Kernberg would take over the field of object relations in Europe and America. Fairbairn was the most radical, believing that some object relationships could in fact be formed with inanimate objects such as stuffed toys or blankets (Murdock, 2009). In Kernberg's own words:

"When, as children, we relate to important people in our lives, we internalize the memory of intense emotional states we experienced during our interactions with them, and these intense emotional states get organized in two parallel series of loving and hateful emotions. These emotions are imbedded in the relationship between representations of the self and representations of significant others. In fact, the concept of basic, dyadic units (of self representation-object representation-affect state linking them) as "building blocks" of the supraordinate structure of the ego, superego, and id is the central concept of contemporary psychoanalytic object relations theory." Otto Kernberg, 1998 (McGinn, 1998, p. 192)

The ultimate goal of or therapy is to recreate a healthy, integrated self by interpreting and redefining a person's object relations and attendant emotions, stemming back to infancy. This healthy self can then relate to other people in mutually-beneficial ways, rather than repeating self-destructive or dysfunctional behavior patterns based on disturbed object relations. The or therapist is tasked with interpreting the patient's inner world and negative, aggressive emotions, and providing a basis for proper integration by serving as a new good object for the patient (Buckley, an Object Relations Perspective on the Nature of Resistance and Therapeutic Change, 1996).

The process of change in object relations theory

or therapy has three major phases. In the first phase, the therapist must "diagnose the dominant unconscious object relationship from the past that is repeated" in the present transference to the therapist (McGinn, 1998, p. 192). In other words, the interpretation of primitive object relations constructs can occur when a patient begins relating to the therapist in the same maladaptive ways he relates to others (transference) (McGinn, 1998).

The second phase begins after this projection of dysfunctional object relations onto the therapist takes place and can be analyzed. During this stage, the therapist must be aware of the primitive defense mechanisms at play during the transference, such as projective identification, dissociation, or introjection, and the therapist's own countertransference emotional stance (McGinn, 1998). It is critical that rather than being reactive, the or therapist maintains "technical neutrality" toward the patient, expressing adequate empathy but otherwise remaining objective and informative (McGinn, 1998; Scharff & Scharff, 1997). At this point, transformation can begin to take place because rather than responding the way a "normal" person would to the dysfunctional behaviors, the therapist attempts to analyze and understand the behavior from an object-relations perspective, and passes this understanding along to the patient so that it becomes conscious and controllable (McGinn, 1998).

In the third and final phase of or therapy, healthy integration takes place between the painful, guilt-inducing, split-off hatred for the object or objects, and the equally compelling love for those same objects (McGinn, 1998). As a result of early trauma or abuse, the patient has dissociated from reality, creating a tendency to see the world and its people (objects) as either "all- good or all-bad" (McGinn, 1998, p. 192). This habit can be overcome if the therapist knows how to direct the patient to see his maladaptive stance for what it truly is: an attempt to avoid cognitive dissonance in critical relationships, and an attempt to avoid conflict and pain by creating one relationship that is all-good and another that acts as a scapegoat for all the bad (McGinn, 1998). According to Buckley (1996): "The greatest source of resistance is postulated to be patient's fear of the terrifying world that would be faced if such repressed internal objects enter consciousness. He further posits that such bad objects can only be safely released if the analyst has become established as a good object for the patient." The patient must learn that the target of their love and hate is one and the same; only then can they relate to that object with empathy from their authentic, whole self.

Therapeutic techniques

Two prominent techniques used in or therapy are interpretation and transference analysis. Interpretation itself has several phases, corresponding to the beginning phase of therapy. During interpretation, patient and therapist work to understand the nature of the patient's disturbed object relationships by the "unconscious meanings of their behavior in their transferential relationship with the therapist" (McGinn, 1998, p. 192) the first phase of interpretation is a time for exploration and free association; at this point, the patient is expressing and the therapist is formulating the meanings of those expressions in terms of object relations. This is followed by an "empathic confrontation," in which the therapist gently guides the patient's maladaptive unconscious object relations into consciousness. Once the patient is conscious of his behaviors, the final phase of interpretation can take place, which is sometimes called a "genetic interpretation" (McGinn, 1998, p. 192). This is when the therapist "uses his interpretations of the current relationship between himself and the patient and links it to unconscious meanings from the patient's past" (McGinn, 1998, p. 192). The purpose of interpretation is to provide the background information and understanding necessary for successful transference work.

The present relationship between therapist and patient is the basis for a second technique common to or therapy -- transference analysis -- corresponding roughly to the middle stage of therapy. It is assumed that all patients will begin to "transfer" pathological relationship patterns (object relations) from their past onto the therapist, allowing the therapist to analyze what is going wrong outside of therapy based on what occurs in-session (McGinn, 1998). This is somewhat overlapping with interpretation, but at this point the therapist needs to gradually take on a stable role as a "good-object" for the patient. Then, using his prior interpretation, the therapist can tie the patient's symptoms and treatment goals to one or more overriding themes of abnormal relating (McGinn, 1998). The trustworthy, good-object stance of the therapist will then allow patient and therapist to bring these abnormal behavior patterns into consciousness, where they can hopefully be redefined and reworked into healthier object relations during the final phases of therapy.

The role of the therapist

The role of the or therapist is different from traditional psychoanalysts in that he is expected to show a degree of empathy for the patient's traumatic past and dysfunctional patterns of relating. The patient is likely very frightened, on a primitive level, of bringing his "split-off" object relations into consciousness where they can be confronted and transformed; the therapist needs to be gentle and understanding in order to facilitate successful transference and conscious integration of the self. In addition, the or therapist must work to keep his own countertransference emotions (the reactions and emotions he experiences as a result of being the target of the patient's transference), conscious and in check (McGinn, 1998). If the therapist doesn't successfully maintain his stance as an objective, neutral transference object, he may become just another "all-bad" object relation to the patient, and therapeutic efforts will be thwarted.