I had a testy session with
my psychiatrist on Monday June 18, 2012. I complained to him that he seemed to ignore the fact that I suffered from a severe mental illness, Schizoid Personality Disorder. He suggested that perhaps I used my disorder as an excuse not to move on in life and cited the fact that I had been in therapy for the past 20 years. Implicit in my psychiatrist's comments and questions was the view that perhaps psychotherapy was not the answer to my problems and that I should look into volunteer work or employment.
I responded that I did not believe that my work with my psychiatrist constituted psychotherapy. Indeed, I asserted that I had not in fact not been in psychotherapy for the past 20 years. I said that I considered the last twenty years to be nothing more than weekly conversations with psychiatry residents. I pointed out that psychotherapy involved insight, interpretation, analysis, synthesis and a relationship between patient and therapist. I said that all those factors were missing in my work with all the psychiatry residents I had seen in the last 20 years.
I believe that the treatment of schizoid disorder involves specialized knowledge about the dynamics of the disorder and specialized knowledge about the handling or treatment of schizoid patients. All of the therapists I have seen in the last two decades seem to lack any specialized knowledge that is essential for the treatment of schizoid disorder.
I recently came across a useful article that talks about the essential features of schizoid disorder and discusses the specific steps that need to be undertaken in the treatment of the disorder.
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Schizoid Processes: Working with the Defenses of the Withdrawn Child Ego State
Ray Little
Abstract
This
article examines the defenses of the withdrawn Child ego state as described
by both transactional analysis and British object relations theory. The
process of withdrawal is considered, and the principles of therapy from
a relational perspective are explored.
______
Theoretical Views on Schizoid Processes
I will start by examining
several theoretical descriptions of schizoid processes that have influenced
my thinking in my work with the withdrawn Child Ego State.
The term “schizoid” has
been used in the psychotherapy literature to describe both a personality
structure and psychological processes.
Melanie Klein (1946/1986),
from the British object relations school, employed the term both to refer
to the splitting mechanism used by the infant to organize his or her experience
and to describe a developmental position. In discussing what she saw as “the
violent splitting of the self,” she highlighted the “excessive
projection” (p. 187) that resulted in the other being experienced as
a persecutor. She thus described the terror that some clients experience
when they feel the whole world is about to attack them.
Fairbairn’s
(1940/1952c) paper “Schizoid Factors in the Personality” described
three prominent characteristics of schizoid personalities: (1) an attitude
of omnipotence, (2) an attitude of detachment, and (3) a preoccupation
with fantasy and inner reality. In a later
paper, “Endopsychic Structure Considered
in Terms of Object-Relationships” (1944/1952a), he went on to describe
an intrapsychic structure that consisted of the splitting of the ego and repression
as a defense. He also pointed out that schizoid personalities may appear to
fulfill a social role with others with what seems to be appropriate emotion
and contact while in actuality remaining detached.
Guntrip (1968/1992) developed
Fairbairn’s endopsychic ideas further and listed characteristics of
the schizoid personality. He also elaborated on Fairbairn’s concept
of the schizoid’s dilemma and spoke of the compromise that people engage
in to manage that dilemma. He described a further split in the ego that he
called “the passive regressed ego” (p. 144), which he saw as
a retreat to an objectless world.
Ralph Klein (1995) built
on the work of Fairbairn and Guntrip, and from the perspective of the Masterson
(1988) approach, he used the term “schizoid” to describe another
disorder of the self (in addition to borderline and narcissistic personality
disorders). In taking an object relations view, Klein saw the schizoid as
either in a self-object relations unit as a slave attached to a master or
as a self-in-exile fearful of a sadistic object.
Horney (1945) described
three “neurotic trends” (p. 42): moving toward people, moving
against people, or moving away from people in a way that involves withdrawal
from contact. She saw people who manifested these trends as estranged from
themselves and others.
In
Principles of Group
Treatment Eric Berne (1966) used the term “schizoid” to
describe one of the four life positions, which he called a “futile
and schizoid” position (p. 270). A game typical of that position
would be “Look What They Did To Me.” In describing clients
who occupy this position and who are at the limit of their endurance, Berne
wrote that the schizoid position “leads ultimately to the choice of
aesthetic or spiteful suicide” (p. 271).
Paul Ware (1983) developed
a classification of personality types or adaptations that described psychopathology
and maladjustment and listed various driver behaviors and injunctions that
were typical of each type. He described the schizoid adaptation as characterized
by withdrawn passivity, daydreaming, avoidance, and detachment and people
who exhibit these characteristics as shy, overly sensitive, and eccentric.
Their driver behavior is “Be strong,” “Try hard,” or
“Please others.” Vann Joines (1985), further developing Ware’s
work, viewed individuals with the schizoid adaptation as creative daydreamers,
referring to their highly developed capacity to think internally.
In talking about three styles
of the Adapted Child—compliance, rebellion, and withdrawal—Vallejo
(1986) described withdrawal as “the adaptive behavior that accompanies
despair and resignation after loss, deprivation, destruction, abandonment,
or the failure of something, whether it be a person, thing, or situation” (p.
116).
The schizoid character is
a defensive position that results in a detached interpersonal style. Johnson
(1994) viewed character structure as existing on a continuum. At one end
is the personality disorder and at the other is a higher level of functioning
that he calls a “character style” (p. 11). He saw schizoid personality
at the disorder end and avoidant personality at the style end (p. 11) of
this continuum.
The
Diagnostic and Statistical
Manual of Mental Disorders (DSM-IV) (American Psychiatric Association,
1994) lists the diagnostic criteria for the schizoid personality disorder:
A pervasive pattern of detachment from social
relationships and a restricted range of expression of emotions in interpersonal
settings, beginning by early adulthood and present in a variety of contexts,
as indicated by four (or more) of the following:
- neither desires nor enjoys close relationships, including being part of
a family
- almost always chooses solitary activities
- has little, if any, interest in having sexual experiences with another
person
- takes pleasure in few, if any, activities
- lacks close friends or confidants other than first-degree relatives
- appears indifferent to the praise or criticism of others
- shows emotional coldness, detachment, or flattened affectivity. (p. 641)
The DSM-IV focuses on behavioral
manifestations, whereas Fairbairn and the British object relations theorists
focus more on intrapsychic dynamics. In my view, the various behavioral and
descriptive elements of the DSM-IV need to be supported by a developmental
and intrapsychic perspective.
Defenses and Processes
In my reading of the aforementioned
authors, it became clear that certain defensive processes are common in relation
to schizoid phenomena. One of these is splitting, a “process by which
a mental structure loses its integrity and becomes replaced by two or more
part-structures” (Rycroft, 1968, p. 156). Several writers also speak
of repression or the process of rendering something unconscious. A further
defense, projection, is highlighted by a number of authors; it consists of
“viewing a mental image as objective REALITY” (Rycroft, 1968, p.
125). Withdrawal and detachment from the world, coupled with self-reliance,
may create an impression of aloofness. This may be seen as a defense against
the perceived dangers and anxieties that inevitably accompany reliance on others
and is supported by a lack of affect and coldness (noted by several writers).
Regression, a further defensive process, is characterized by a flight inward
and backward, even to the point of contemplating suicide. Schizoid personalities
are often introverted and live primarily in an internal world. They may experience
themselves as lonely, which may be felt as a longing for contact and love.
In contrast to this longing, a common feature is terror of destroying others
and of being destroyed by others. Often these people may appear outwardly contactful
but are, in fact, emotionally withdrawn. Overall, there is a sense of futility
and emptiness and a lack of integration (J. Klein, 1987, pp. 171-172).
Case Example: Some
of these processes are demonstrated by Sebastian, who usually starts the session
by feeding me something that we can talk about or “chew” on but
that does not reveal his vulnerability. In so doing he is checking to see
whether he recognizes and can trust me this hour. Sessions seem to be isolated
experiences for him, without continuity. He often seems to have forgotten
the previous session and to have wiped out his experience of connecting with
me.
During sessions, Sebastian
often withdraws and seems to be watching me. It is as if he is on the inside
of his head looking out of his eyes watching my every move. He has described
having retreated into a castle, in the dungeon where he feels safe. He leaves
a guard on duty. The drawbridge is down but can be raised at any time. If
I see an expression of emotion on his face and respond, he is moved at having
been seen but feels he cannot call out. He feels it would be dangerous and
frightening to do so.
Sebastian has retreated
from the world and is detached from interpersonal relations. He has numbed
his emotional responses to people and events. Initially, when we explored
his feelings about our breaks, they did not mean anything to him. Now he
seems to have some feeling about our endings, and more recently when we spoke
of my going away, he acknowledged that he will miss me. This indicates that
he is beginning to emerge from hiding into a contactful relationship with
me.
The Process of Withdrawal
Attachment: Various
authors have described our need for others (Bowlby, 1969; Erskine, 1989;
Fairbairn, 1952b; Guntrip, 1968/1992) and suggested that we are relationship-
and attachment-seeking from birth. Berne (1966) referred to this need for
others as “recognition hunger” (p. 230) (for a detailed overview,
see Erskine, 1989).
The helpless infant needs
a holding, containing environment to make sense of his or her experience
as well as an attuned response to his or her feelings and relational needs.
An attuned holding environment enables the infant to emotionally attach to
the other (Bowlby, 1969; Fairbairn, 1952b). A bond forms between the unitary
ego of the infant and the attachment figure, and these fulfilling experiences
of contact become memories.
Johnson (1994) described
research that shows that the infant is “ ‘hardwired’ at
birth for social interaction” (p. 21) and is attuned to the social
responses he or she will encounter. He suggested that the infant “will
be able to track the affective tone with which he is handled and the attunements,
or lack of it [sic], to his needs, emotional states, etc.” (p. 22).
Chamberlain (1987, p. 58) cited experiments in which the mothers of infants
were asked to be silent and “still faced” for just three minutes.
The infants tried to influence the mother within 15 seconds, as if to elicit
a normal response. If they were unsuccessful, they withdrew. D. Stern (1985,
p. 73) also found that when a parent does not respond appropriately, a baby
can become disturbed or withdrawn.
Disruption and Withdrawal: A
contactful attachment to another is the basis of the development of the self
for the growing infant (Kohut, 1977; D. Stern, 1985). When the infant experiences
neglect, impingement, or lack of attunement accompanied by a lack of reparation,
the child may go into hiding with his or her feelings and relational needs.
This painful disruption in the relationship may halt or slow the process
of integration (J. Klein, 1987, p. 171) and the ego may fragment. Fairbairn
described the infant’s response to this disruption as taking the relationship
inside where she or he divides the experience into tolerable and intolerable
elements (Fairbairn as cited in Gomez, 1997, p. 61). The tolerable self-object
experiences are projected out onto the world and the intolerable are kept
inside. This is the first phase of withdrawal and splitting. A coping/everyday
self is left to maintain a relationship with the world while the withdrawn,
vulnerable self goes into hiding (Figure 1).
To provide a sense of well-being and safety,
the infant’s coping/everyday self attempts to maintain a tolerable
relationship with the external object. To achieve this the infant must abolish
negative experiences, which it does by splitting and later repressing the
bad experiences so that he or she can control them. Tolerable experiences
of the everyday self are repeated and internalized; this reinforces the repression
of the vulnerable self. The infant thus upholds his or her sense of security
by maintaining a relationship with the external object. However, this relationship
is now impoverished. The vulnerable infant part of the ego is now split off
and will be repressed and hidden from that part of the ego that maintains
contact with the world. This coping/everyday self is similar to Winnicott’s
(1965) false self as well as to the
adapted Child described by Berne (1961, p. 69).
The withdrawn self splits
further to create the internal saboteur (Fairbairn, 1952b), which turns against
the vulnerable self. The internal saboteur serves to keep the vulnerable
self hidden and repressed. It is the anti-wanting self that is contemptuous
and despising of neediness and ensures we neither seek nor get what we want
(J. Klein, 1987). The vulnerable self is repressed further and splits off
from the coping/everyday self that maintains a relationship with the external
world (Figure 2). As a defense against an attack from the external world
or an attacking and rejecting object, the internal saboteur may launch a
preemptive strike against the vulnerable self to forestall such an attack.
This has the effect of shutting down the vulnerable self to prevent an attack.
This process of withdrawal
describes a defensive retreat from the world of rejecting objects and painful
experiences, with a subsequent withdrawal from contact and taking inside
the important and precious parts of the self to protect them from the unresponsive
world.
Fairbairn (1944/1952a) described
a psychic structure that he saw evolving out of this disruption to the early
relationship with the primary caretaker (Figure 3); he called it the
“endopsychic structure” (p. 82). In this structure, each aspect
of the self is attached to an object by affect. Thus we have three basic self-object
representations. First, the coping/everyday self was described by Fairbairn
as the central ego, which is attached to the idealized object. I prefer to
call this the “preserved object” to distinguish it from Kohut’s
(1977) idealized selfobject and because it is more descriptive of the everyday
self’s attempt to maintain and preserve the nature of the relationship.
Often the countertransferential response to this representation is feeling
controlled and limited by the attempt to preserve the relationship. Second,
the vulnerable self/libidinal ego is attached to the exciting object, which
is inevitably disappointing; therefore, I call it the “exciting/disappointing
object.” J. Klein (1987, p. 161) described it as the frustrating exciting object for
similar reasons.
Third, the internal saboteur, which Fairbairn
later called the antilibidinal ego, is attached to the rejecting object,
which may also be experienced as an attacking object. The coping/everyday
self uses aggression to keep the rest of the structure out of conscious awareness,
and further aggression from the rejecting/attacking object and the internal
saboteur maintains the repression of the vulnerable self. Although the structure
is repressed, it is there all the time, overhearing the process of therapy
even if it is not active or manifest in the therapeutic relationship.
Ego States: In Blackstone’s
(1993) excellent article, “The Dynamic Child: Integration of Second-Order
Structure, Object Relations, and Self Psychology,” she suggested that
the introjected object of Fairbairn’s theory is analogous to the Parent
ego state. She quoted Berne (1972) as stating that “Fairbairn is one
of the best heuristic bridges between transactional analysis and psychoanalysis” (p.
134). One of the points Fairbairn made is how the self is bonded to the object/Parent
ego state by affect, and it is the affect that keeps the two glued together
to form a self-object representational unit.
Therefore, the three self-object units of Fairbairn’s
psychic structure represent three introjected units in the second order of
the Child ego state. These units are archaic states of the Child ego state
resulting from “developmental arrest which occurred when critical early
childhood needs for contact were not met” (Erskine, 1988, p. 17). When
the contact is need fulfilling, the experience becomes integrated and assimilated
as memory (R. Erskine, personal communication, August 1999). These self-object
representational units may simply be relics of a relationship that once existed.
However, if, for example, the infant projected onto the other his or her
rage at not being met, then the other is imbued with that rage in addition
to whatever anger the person was expressing toward the infant. The self will
then be depleted and impoverished, and it is this relationship that will
be introjected in the Child ego state.
In Exile: In developing
Fairbairn’s theory, Guntrip (1968/1992) suggested that the infant may
feel so persecuted by internal objects that there is a further split in the
ego that results in the infant making a second retreat deeper into his or
her mind to avoid the internalized world of self-object representations (Figure
4). The repressed vulnerable infant self is thus further split as it once
again leaves part of itself to deal with the internal bad objects while the
rest retreats into its “citadel.” This is a fantasy of a retreat
to an antenatal existence in a symbolic womb. Security is, therefore, established
through fantasies of enclosure in a womb-like state. “Womb fantasies
cancel postnatal object relations” (p. 53) and represent a flight from
life. As mentioned earlier, Guntrip described this aspect of the ego as the “passive
regressed ego” (p. 144), which I describe as the “hidden vulnerable
self.” At each stage of the withdrawal, defenses are employed to protect
the self from further humiliation, attack, or injury. The regression may
also be the self’s flight from its own murderous rage and hatred of
the object; therefore, the self is retreating not only from the aggression
of the internal objects, but also from its own aggression. Repression and
withdrawal prevent further normal development of the self.
R. Klein (1995) described
this position as being in exile—a retreat from being in prison with
others to being in an objectless world. While being with others entails a
loss of self, being in exile entails a loss of others. Therefore, the retreat
may represent safety, but it also encompasses the fear of objectlessness.
The womb-like state may be described by clients as a citadel, a castle, a
fortress, or even a freezer. The state of being in exile has been described
as being adrift in a boat without a rudder or a sail on an ocean a long way
from land with no wind. However, as several theorists have observed (Scharff & Fairbairn-Birtles,
1994; Seinfeld, 1996), describing this womb-like state as objectless may
be confusing. The retreat is not to an objectless state but to an antenatal
state where there are no demands or attacks and there is no need to adapt. “An
objectless state remains something the individual dreads” (Seinfeld,
1996, p. 14).
In addition to a client
presenting as having gone into hiding, Seinfeld (1993) also described a retreat
and regression in therapy as the client relaxes his or her defenses. This
retreat is in response to a holding relationship and the seeking of a psychological
rebirth. As the client relinquishes his or her defenses, he or she may allow
regression to an earlier self-object relationship.
Schizoid Dilemma: Retreating
from contact leaves the individual isolated, lonely, and in pain. In some
cases the longing for contact will reemerge and the person may move toward
others; however, such movement also brings with it the anxiety of being close.
Guntrip (1968/1992) described this as the “in and out program” (p.
36), an expression of the hunger for and terror of contact and closeness.
Some individuals manage this dilemma by establishing what Guntrip called
the
“schizoid compromise” (p. 58), which is a way of keeping others
around but preventing them from getting too close or becoming endangered. This
may be achieved by keeping contact at an intellectual level, by being present
physically but absent emotionally, or by looking away when expressing emotions.
Therapeutic Principles: Reaching the
Withdrawn Child Ego State
Working relationally with
these processes entails working in the here and now with the client, working
with the transference (both the needed and repeated relationship [S. Stern,
1994]), and working with the various defenses used to protect the vulnerable
self from further pain. It entails the therapist being involved, being available
to be impacted and affected by the client (Erskine, Moursund, &
Trautmann, 1999), and offering a reparative experience.
Creating a Safety Zone: Therapeutic
goals include creating a safe, holding environment that is both not wounding
and unobtrusive and that will enable the hidden vulnerable self to reemerge.
The therapist needs to understand why the client went into hiding and what
his or her terror is about. In addition, it is important to comprehend how
attempts at contact may be experienced by the client as intrusive. The schizoid
compromise is the individual’s attempt to create safety and to manage
the tension between isolation and being trapped or enslaved. The therapist
needs to demonstrate an understanding of the schizoid dilemma and compromise
(R. Klein, 1995) and offer an attuned interpretation. Ware (1983) adjured
us to go slowly: “It must be remembered that the cure of Schizoids
is a slow, painstaking process, taking only small steps at a time” (p.
15).
The therapist must track
the relationship, noticing and responding to the vulnerable self as it reveals
itself as well as monitoring the defensive interruptions to contact. The
therapist needs to listen to and notice when the client withdraws or dissociates
and to explore what behavior in the therapist prompted the client’s
retreat from contact. In supporting the relaxation of defenses and the reemergence
of the self, the therapist will enable the self to come out of hiding and
to leave its fortress or castle. The therapist thus takes on the function
of the defense. For example, with someone who uses intellectualization as
a defense, the therapist might offer, “May I do the thinking, while
you feel?”
As therapists working with
these clients, we need to be available for connection by responding to the
withdrawn Child ego state (R. Klein, 1995) and by offering an attuned empathic
relationship (Erskine & Trautmann, 1996). We must also be available as
an object, creating a space in which the client can use us until he or she
feels safe enough to let us into the “citadel.” Then we can help
the client out of hiding. This entails the client emerging into a relationship
with the therapist through forming an attachment with him or her. The therapist
then eventually supports the client’s separation by pointing out the
client’s anger and thus disillusioning him or her. At times, we need
to be as still as possible, to sit quietly and be willing to
not know what
is happening. We need to allow ourselves to wonder silently about them and
about our countertransference responses. We need to shift between centering
on the client and noticing our own feelings, thoughts, and fantasies. We
need to be curious and offer reverie (Bion, 1962), and as we begin to understand,
show them what they feel or want and create a space in which they can experience
love and hate. Speaking of the schizoid personality, Joines (1985) wrote
of the need to go “in after them and bring them out” (p. 48).
Rather than “going in,” perhaps it might be more appropriate to
wait to be invited so as to avoid a reenactment as the intrusive object.
Defenses: In working
with the schizoid’s defenses, the goal is for the client and therapist
to discover the function of the defensive process and to move through the
defenses to the repressed and hidden elements of the vulnerable self. Fixated
defenses are an attempt to take care of the self in the absence of a reparative
relationship but at the expense of some capacities, which results in the
self being impoverished in some way. Manfield (1992) described defenses as
follows:
“Defenses are patterns of behavior or thoughts that people use to protect
themselves from emotional pain or discomfort arising from present life situations
usually linked to painful childhood memories” (p. 32). In his article
on defense mechanisms, Erskine (1988) wrote, “It is because of the fixation
of defense mechanisms that the archaic (Child) or introjected (Parent) aspects
of the ego remain separate states and do not become integrated into the neopsychic
(Adult) awareness” (p. 18). These defenses, therefore, keep the vulnerable
self with its feelings and relational needs repressed. In addition to repression,
splitting, and regression, other early defenses include avoidance, freezing,
fighting, the transformation of affect, and reversal of aggression (Fraiberg,
1987). When talking about the defense of avoidance, Fraiberg cited Kaufman’s
description of how an infant, when faced with danger, will feel helpless and “employ(s)
a ‘flight-fight’ response(s), followed by conservation-withdrawal” (p.
191) to defend and sustain himself or herself.
The appropriate therapeutic
response to such processes is to acknowledge, name, validate, and normalize
the defenses and to understand their function, pacing movement through the
defenses to the vulnerable self in such a way that the client can accommodate
the change. The role of the therapist is to take on the function of the defense,
thus leaving the client free to express vulnerability. Since defenses serve
to offer the individual stability, consistency, identity, and predictability
(Erskine, Moursund, & Trautmann, 1999), all these functions need to be
taken over by the therapist. However, care must be taken in working with defenses
so that the client and therapist can handle the underlying affect. Offering
a contactful relationship in which the therapist is inquiring and attuned
may trigger memories for the client of not being met in the past and may
be a challenge to his or her script. The client may therefore defend against
the current contact to avoid emotional memories.
When working in an attuned
manner with clients, they may begin to relax their defenses and cathect a
part of their mind in which they feel terrified; they may then experience
what M. Klein (1986/1946) described as “persecutory anxiety” (p.
182). The whole world becomes a dangerous place, and even the therapist becomes
an attacking object. When this happens the client has cathected an early
defensive split in the ego, and rather than the therapist being a helpful
person, he or she becomes unhelpful and even dangerous or attacking. The
client may feel he or she is in a torture chamber, and the therapist may
be seen as the sadistic torturer or jailer.
Working within the Transference: Working
therapeutically within the transference relationship with the withdrawn Child
ego state involves creating an opportunity for the client to relive, in the
present with the therapist, the emotions, conflicts, and relational longings
of the past. The feelings must be reexperienced and expressed in the present
toward the therapist, who becomes the focus for the old feelings. He or she
must be willing to respond nondefensively (Gill, 1982) by offering a validating,
attuned empathic response. Working within the transference allows the intrapsychic
conflict to be expressed within the therapeutic relationship (Erskine, 1993).
For the withdrawn Child ego state this means possibly experiencing both the
fear of and the hunger for contact as well as the fear of isolation.
As the work develops, the
focus may shift to decisive archaic scenes. The therapist then functions
as the
“secondarily longed-for, receptive, and understanding” (Stolorow,
1994, p. 51) other, who, through attuned responsiveness, offers a reparative
relationship. For example, in the case of inhibited aggression, the therapist
might support the undoing of the inhibition and the expression of fighting
back.
The Needed and Repeated
Relationship: In the transference relationship clients will invite
the therapist to repeat old experiences, but they are also longing to be
exposed to new experiences. For therapy to be effective, the therapist
needs to be experienced as both someone new as well as someone from the
past (Cooper
& Levit, 1998). If the therapist tends to focus exclusively on repetitions
of the past in the form of games (Berne, 1966), he or she may overlook how
new capacities for relating are emerging out of the old. On the other hand,
the therapist using a relational model may too quickly offer a new relationship,
therefore defensively welcoming aspects of the new while seeking relief from
the old, repetitive, problematic relationship with its games. We need to balance
staying with the old while offering the new so that the new may emerge out
of the old. Therapy is the search for the transformational experience (Bollas,
1987) that enables the repeated relationship to be understood and the needed
relationship to be experienced.
Negative Therapeutic
Reaction: As the therapist attunes to the client’s withdrawn
vulnerable self, the latter will probably relax his or her defenses, and
in doing so, the endopsychic structure will be disrupted. Attunement mobilizes
the withdrawn self’s relational needs, particularly if the therapist
takes on some of the functions of the defenses, thus leaving the client
to experience the vulnerable self. In other words, this process disturbs
the equilibrium of the psychic structure, and elements of that structure
will probably react against the disturbance. The “gang” of
the rejecting object, the coping/everyday self, and the internal saboteur
will attack the previously repressed self. This is the essence of the negative
therapeutic reaction.
This defensive process was
described by Freud (1923) as the most serious obstacle to psychotherapy.
It comprises the client’s lack of “receptivity to an alien, unfamiliar
positive experience” (Seinfeld, 1990, p. 13) with a therapist, reinforced
by the client’s active rejection of the need for the experience “in
identification with the original external rejecting object” (p. 13).
The negative therapeutic reaction describes the mechanics of juxtaposition
as identified by Erskine and Trautmann (1996), and the internal saboteur
is similar to Erskine’s (1988, p. 17) self-generated ego state.
Activation of the internal
saboteur and the rejecting object serves to protect against the emergence
in the relationship of the vulnerable self’s relational needs. Attacks
from members of the “gang” may result in the client shutting
down, annihilating self or other, and forgetting. More serious attacks may
lead to drug abuse and self-harm. I think this is similar to Bion’s
(1967) observation that psychotic clients attack the link between self and
object. The “gang” may attack the link the therapist forms with
the repressed self and its relational needs. The therapist must work with
the attacks on the link between self and other, exploring the aggressive
denial of need. The client must also experience the therapist as the exciting
object in order to separate and individuate. The client’s inevitable
frustrations and disappointments with the therapeutic relationship require
a nondefensive response from the therapist. In fact, therapeutic efforts
by either the client or the therapist to avoid regression and dependence
in the transference may be an avoidance of the exciting object transference.
The hidden vulnerable self
may be experienced as deadened, and an attuned, understanding attitude from
the therapist may lead the client to feel like the deadened self is being
brought back to life. It is as if the therapist is giving mouth-to-mouth
resuscitation to the client, who may fear an attack if he or she does come
back to life. These individuals may also be frightened of their own aggression
and hatred of the other, which in the past may have been projected onto the
attacking object so that the other became a terrifying monster. At one time,
survival may have depended on being dead to the world, so the therapist’s
attempts at resuscitation may be resisted because the client fears what might
happen if he or she came alive. A lively infant may have not been welcome
in the client’s family of origin, and the infant’s angry reaction
to the unwelcoming response may also be experienced as a danger to existence.
If the rejecting object
and internal saboteur are activated in the transference, the therapist has
the option of interpreting the attack (Seinfeld, 1993), thus differentiating
these two parts from the vulnerable self. For example, the therapist may
say, “What we’re seeing right now is how, as we form a bond,
the attacking part of you becomes critical.” Therapist and client can
then work to understand the reason that an aspect of the person would reject
efforts to activate the self and to invite the rejecting object/Parent ego
state (Erskine & Moursund, 1988) to express itself directly to the therapist.
The therapist can also interpose himself or herself between the rejecting
object and the vulnerable self (p. 191). Therapy with the internal saboteur,
however, may consist of echoing its statements in order to mobilize the energy
of the vulnerable self so that it can emerge and fight back.
Therapy needs to combine
an attuned, empathic, involved relationship; a holding, containing environment;
and interpretation and transformation of the bad objects. Attuned interpretations
that breach the closed system allow clients to incorporate a good object
relationship with the therapist (Seinfeld, 1993).
Conclusion
The purpose of the type
of therapy described in this article is to create an opportunity for the
client to reown his or her repressed, disavowed, hidden capacities and to
integrate these into here-and-now functioning. Further, it is an opportunity
for the client to reemerge from withdrawal, to integrate the split and fragmented
ego, and to resolve the conflicting pulls between a self that seeks predictability,
continuity, and safety and a self that seeks spontaneity, authenticity, and
contact.
The capacity for growth
and development may be hampered by the prior reinforcement of the closed
system, and, like a muscle that is underused, it may have become wasted and
will require exercise and support to rebuild it. This involves rebuilding
the attachment-seeking behavior that may have atrophied over time as a result
of not being sustained in earlier relationship (Sutherland, 1994).
Therapy needs to combine
an attuned, empathic, involved relationship; a holding and containing environment;
and interpretation and transformation of the bad objects. Attuned interpretations
that breach the closed system allow clients to incorporate a good object
relationship with the therapist (Seinfeld, 1993).
Ray Little is a Certified
Transactional Analyst working as a psychotherapist in private practice
in London. Please send reprint requests to Enderby Psychotherapy &
Counselling Associates, 16 Hatfield Road, London W4 1AF, United Kingdom.
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