Tuesday, August 24, 2004

An Object Relations Approach to Understanding Unusual Behaviors and Disturbances
By Dr. Varkin
Excerpt of article full article here:
http://www.toddlertime.com/general/disturbances.htm

Symbiotic Magnetic Pull (SMP)
Matterson found that treating certain patients was difficult because there “is still a strong internal regressive pull to maintain the old familiar rewarding object relations unit” [11]. The Symbiotic Magnetic Pull (SMP) derives from the unconscious attraction to the symbiotic orbit of the mother-infant dyad that was experienced when mother was conceptualize as an extension of the self (symbiotic phase), as a container that resolved and metabolized anxiety through her affect modulation. The strength of the SMP is a regressive force, an energy, a ‘pull”. SMP is conceptualized as a nexuses, a oneness with creation, a completeness. For example, this force to return, to regress is exemplified with the rival of baby into the family unit in the face of an older child.

Here we see “another form of attempted adaptation was identification with the rival baby. Matthew showed signs of wanting to be a baby himself; like this baby brother, of instance, he would climb into the playpen [4]. Mother was intolerant of his regressive behavior and Matthew; the happy radiant child began to adapt aggressive conduct by throwing objects out of frustration. It was observed that Matthew had lost his spark for life in service of the mother, the influence of the false-self, “all of which on superficial observation seemed to be in compliance with mother’s wishes that he be independent and remain her happy little “big” boy [4].

The influence of the SMP will vary depending on the progress on the separation – individualization phase. The greater the symbolic pull, the more likely the individual is developmentally conflicted with unsatisfactory object constancy. If the individual’s development is static and held in abeyance because insufficient maternal reserves are absent or not fully integrated, the individual may become fixated and employ primitive defensive mechanisms (regressions, splitting and etc.) to relieve anxiety.

SMP, Anxiety and Defense Mechanisms
To simplify, anxiety derives from three sources (pressures) of conflict. To simplify, they are (1) pleasure seeking (impulsive) and the aspects needed to survive, (2) morals and perfection, formed out of punishment and rewards, and (3) the external world (reality). Depending on the source of conflict, defense mechanisms are automatically activated to prevent the individual from the harshness of reality. Defense mechanisms distort or distract an individual from the full impact of reality. If the defense mechanism(s) is successful, a compromise has been reached between the opposing forces toward a decision that enables the discharge or displacement of anxiety. However, when defensives are primitive or ridged, and the personality is rendered with inflexibility, then there is likely a disturbance in the Separation – Individualization phase that is yielding to the SMP. In other words, the inability to defuse anxiety renders the individual prey to the regressive, symbiotic magnetic pull of oneness with creation. Primitive defenses closely orbit the SMP due to its greater gravitational pull, then the more distant orbits of sophisticated defenses.

Brief Discussion on Defense Mechanisms.
At birth, the infant has no need for defense mechanisms because the ego has not evolved out of the autistic orbit into an awareness that requires a defense. Defense mechanisms protect the ego (self) from anxiety by distorting reality. Defense mechanisms are largely unconscious. Lets run through several of them.

Primitive Defenses (Close orbit to the SMP)
Regression: Return to an earlier developmental level of functioning prompt by anxiety. For example, an individual overtaken with losses collapsed into a fetal position. An adult clutches a stuffed bunny (transitional object) to ease anxiety. A child temporarily reverts to dependence as a relief from the new responsibilities of independence.

Splitting: Separation of internal objects that create anxiety. For example individuals that cannot tolerate ambivalence (shades of gray) will split a person as ‘all-good’ or ‘all-bad.’ It creates less anxiety to completely hate a person that is ‘all bad.’

Projection: Decrease anxiety by deferring responsibility onto others. It is easier to tolerate ‘You made me do it’ rather then ‘I did it.”

Projection Identification: Projection with intense pressure. There is a decrease in anxiety when pushing an individual into a role to preserve perception. Altering perception would create a mass upheaval within the mind. It is easier to tolerate “He is a liar” by massive projection. This defense creates a target to deposit the hate that resides within the self. In other words, “If I treat you like the bad object long enough, you will become the bad object, and then I have a ‘right’ to hate you.” We could say the treater became the bad object through projective identification.

Denial: Stops anxiety dead in its tracks. “How can I be upset if it didn’t happen?”

Sophisticated Defenses (Distant orbit to the SMP)
Rationalization: Excusing the behavior through an internal debate. “So what? I would have happened sooner or later anyway.” Rationalization defends against internalized moral and cultural conflicts.

Intellectualization: The use of abstract thought to advert or minimize troublesome emotions (anxiety). For example, a man avoids the emotional grief from the loss of his wife by intellectualizing she had a long life in spite of her illness.

Repression: Evading unwanted anxiety through avoidance. Usually repression is the source from which other defense mechanisms operate. For example the repression of early trauma protects the psych from anxiety.

Sublimation: The release of anxiety through more appropriate and ‘acceptable’ channels. For example, an individual may release his rage in a sport such as boxing.

Reaction Formation: Behaving the complete opposite of one’s true desires to avoid anxiety. For example, a pedophile becomes a priest to advert unacceptable impulses. An employee is extra nice to her boss whom she hates to save her job.

Identification: Identification with a role model, parent, teacher etc to avoid anxiety within the self. For example, identification with a committee, a wining team, or organization can deflect anxiety through absorption and participation.

Maturity vs. Fixation and Object Constancy
After separation – individualization has been sufficiently resolved; a more mature defense against the SMP has evolved. The child is able to internalize a consistent, available image and the essence of mother though repeated satisfactory (good enough) interactions with her. The child’s integrated conceptualization of mother satisfies the demands of the SMP and helps regulate anxiety. We call this object constancy.

As the child matures and the SMP is adequately satisfied with the constant internalized mother object, a new dynamic begins to take shape reaching into youth and adulthood. The constant object within the youth/adult reverberates with the SMP to form a more integrated sense of self, a new dual unit. The self becomes integrated within the self, no longer seeking the maternal nurturing though the original symbolic mother - infant dyad. What has emerged is an individual that has separated from the unconscious nexuses of mother. The individual is now ready to enter into a more mature libidinous relationship with ‘other’, a life partner.

In the absence of the more mature (integrated) sense of self due to disturbance in the separation individualization phase, manifestations to recreate and replay a failed situation in hopes of a better outcome can become chronically and compulsively intrinsic with the individual’s pathology. Treaters find this especially difficulty according to Matterson and Chathan “They bring nothing into the treatment that will disrupt the symbiotic fantasized relationship with the therapist and thus activate depression [11].

V. Symbiotic Magnetic Pull (SMP) and Manifestations
Because SMP is a regressive force, its vicissitudes may become apparent though the manifestation of unusual behaviors. These behaviors are the result of mechanisms that were created to satisfy the unconscious demands for emotional equilibrium.

Transitional Object Revisited
The transitional object is a defense against the demands of the SMP. The cathected object may enable functioning and impede regression. The transitional object represents a compromise for the unconscious need of maternal supply. In this vignette temporary relief was intermediately attained though contact with the transitional object. An example:

A forty-year-old patient reported that in times of anxiety or insecurity her ‘center’ would ‘pull.’ At times the patient would appear crunched over with her hands pressing on her stomach to hold her ‘insides in’ because the pull was so pervasive. To access relief she would carry a transitional object to establish emotional equilibrium (homeostasis). This worked quite well for her most of the time. Other times her transitional object failed when her ‘center’ pulled with an enormous tension. At those times she would regress and not be able to function.

In preceding vignette the transitional object was the first line of defense against regression. Another example of a transitional object is medication. The patient emotionally refueled when taking her pills that represented the nurturing care of her idealized doctor. Perhaps the placebo effect can be explained in the transitional phenomena. In other words, the (fake) pill worked because it was cathected as transitional object.

We can also see the comforting influence of the transitional object in this case:
“Blanck and Blanck (1979,pp. 156-157) have discussed the use of the transitional objects when the therapist cannot meet with the patients. For example, when they went on vacation, they have one severely disturbed woman their phone number on a piece of paper so that she could have it as a transitional object. The woman never telephoned them, but she felt secure just having the number [11].

The author makes the point clear that the transitional object can help maintain the object image of the treater to soothe anxiety.

Transvestite Manifestation
Disturbance during the rapprochement crisis though sudden, unexpected and prolonged separations with mother can affect the structure building process of the internalized constant object representing mother (The forth subphase). Because there is a disturbance with the libidinous internalized representation of mother, the symbiotic magnetic pull (SMP) manifests in child’s behavior in an unconscious attempt to preserve the relationship. In this example the child does not understand ‘why’ he behaves the why he does, only that is satisfies the demand of the SMP through manifestation of symbiotic representation.
Settlage Case [1]
A 3-year-old boy became preoccupied with girlish activities and insisted on dressing up in mother’s clothes, wearing her jewelry, putting on her perfume and cosmetics, and carrying a purse. At the same time, he showed little or no interest in boyish activities and pursuits.

Beginning at age 18 months, the boy experienced repeated disruptions of his relationship with his mother. She reported that she felt compelled to leave the house. Having made arrangements for a caregiver, she did so, sometimes several times a day. His attempting to become like or identical with mother severed to nullify the threat of separation.

Here we see the genesis of pathology in transvestitism. I suggest that transvestitism occurs more often in the male gender because it is mother who gave birth and the separation individualization process is more difficult based on alignment of gender identity differences the cultural demands on males (big boys don’t cry, etc…).

Infantilism Manifestation
In true infantilism the individual’s pathology is centered on the transitional object. Depending upon the strength of the SMP from disturbances in the separation individualization phase, an individual may have a neurotic compulsion to regress because the individual is seeking a component of maternal satisfaction from the cathected transitional object rather then in ‘other.’ Usually in infantilism there is object fragmentation (splitting) and the internalized representation of the maternal object is not integrated into a continuing sense of self. During these times ‘significant other’ is not seen as a whole cohesive individual to in their own right, but rather as maternal supply for fusion to satisfy the primitive symbiotic orbit of oneness with creation – mother.

In relationships, coping with fragmentation may be problematic since the fragmented individual oscillates between the need to emotionally refuel with maternal supplies (symbiotic orbit) AND the need to express intimacy in age appropriate manner. The spouse however, is usually an integrated individual that has developmentally matured and cannot understand the significance of the transitional object. For example the significant other may reason, “I should be able to libidinally satisfy all your needs. Toss the transitional object.” However, because the individual is fragmented, and the split-off infantile object (part-self) is developmentally fixated, the resonating transitional object and its concomitants remain as a source for maternal supplies. It is almost as though there is a dual personality (fragmented) in which the individual seeks ‘balance.’

Reparenting
This is a difficult decision and can open up a can of worms. Reparenting if not done correctly can come off as a reintroduction to the SMP abyss. The formation of a malignant regression can be dangerous when it shifts into a realm of impossibility. However, a benign regression can be most helpful and therapeutic.

The benign regressions are carried out as goals focused through excises to progress through developmental fixation. For example, a patient is regressed when old unresolved hurts (transferences / distortions) resurface and are directed toward the treater. For the more fragmented individual, integration takes place through the taking in of (introjection) positive interactions with the treater. Lets say old wounds are resurrected, amplified (unresolved rage) and projected onto the treater, (the treater is the target of transferences), it is the treater’s function to empathetically acknowledged the rage (projected object in the transference), and handle resurrected dynamics of the rage by taking it in, detoxifying the rage, and offer it back in a less threatening form. In other words, the patients close core structures are modified when the treater acknowledges the rage first, and then helps defuse the situation as a new role model (identification). For example the regressed patient may say, “I HATE you! You are just like my mother! You always twist things around!” The treater responds, “I can see you are angry, really mad. I would be mad too if my mother twisted everything around. I bet being misunderstood would be crazy making. So if things appear as twisted around, lets figure out what happened because I wouldn’t be doing my part to let you go on thinking that.” Here we see the treater has accepted the rage, contained it, and is now aligning a positive and corrective stance with the patient, (the patient has split off the bad object in the transference, projected into the treater, and the treater as contained, detoxified the bad object, now modified, and offered it back in a more harmless form to the patient). What the treater has done in effect, has reparented the patient and built a stronger trust, with means, strengthen the therapeutic alliance. Once this alliance has become stronger, and the bad objects in the patient has been modified through repeated interactions with the treater, which after a time, will bring us to the next step.

Be forewarned, this usually works only for the more integrated individual. Through clarification, confrontation and interpretation, the regression in transference promotes growth through insight and self-awareness and especially through the cathartic release, (great pain released in tears).
The malignant and dangerous regressions into reparenting would be the sinking of self, fused with the powerful SMP. Rule of thumb, regressions are benign and helpful when they promote growth to a period of moving on. Regressions are malignant when they become the object of fusion and static with the symbiotic magnetic pull, and there is no relief, but more of a demand for unreasonable entitlement. The task of reparenting should take place in the framework of structured holding environment because it can act as the safety net from the abyss of the SMP.

Borderline Personality Manifestation
The hallmark traits of borderline personality disorder (BPD) are a lack of identity, pervasive emptiness, excessive anger and the inability to regulate emotion. The sources of these symptoms were caused by the dynamic, ambivalent and powerful struggle between the SMP vs. individualization during the rapprochement subphase. “The rapprochement subphase is where the fixation becomes apparent, with the point of origin in the symbiotic phase [11]. Here we see dependence vs. independence.

Emptiness – lack of a maternal constant object
Since the subphase of object constancy has not developed within the borderline individual, he resides predominately within the rapprochement subphase. There is a constant reverberation of the push-pull behavior. A sort of “I hate you, don’t leave me’ or ‘I run away, come rescue me’ dynamic. We see this because a borderline individual has not internalized the ‘all-good nurturing maternal object’ (emptiness) and when his fleeting maternal supplies diminish, there is a run-away behavior to prompt the chase. We can sum it up in this way, “If you catch me, you love me, if you don’t catch me, you hate me.” When ‘captured’ the borderline individual’s maternal supplies are replenished for a time. We can see this clearly when the borderline patient tries to woo and extract maternal attention from the treater. If the treater fails, like the toddler, the borderline patient will up-the-stakes, sort of speak. Note this observation in the toddler. “It is quite impressive to observe the extent to which the normal infant-toddler is intent upon extracting, and in usually able to extract, contact supplies and participation from the mother, sometimes against considerable odds; how he tries to incorporate every bit of these supplies into libidinal channels for progressive personality organization [9]. Here we see that the borderline individual is behaving as the normal toddler through rapprochement with his treater. The problem a treater faces is that active approaching (rapprochement) and the ‘catch’ appears as chronic, and therefore draining on the reserves of the therapeutic relationship. Sooner or later the therapeutic relationship with the borderline individual will take the normal course into a rapprochement crisis that is age appropriate with the toddler. What may appear to a treater as ‘regression’ is actually a resuming course of development that was fixated in childhood.

Rage
The hallmark of the borderline individual is rage. Rage from the separation of the maternal symbiotic orbit without the compensation of the internalized maternal constant object because the resolution of the rapprochement subphase has failed. Rage derived from the repeated failure of environment’s attunement with the infant’s inborn ego endowment. In other words, the child has failed to get what he needs because of problems from attunement with the primary love object or from abuse. The oscillation of rage is directly in sync with the borderline’s fluctuation of maternal supplies from his environment. Since a constant object does not exist within the borderline individual, then the constant modulation to defuse rage does not exist either. The containment of rage is much like the containment of maternal effect. Neither are subject to containment without external attention. To say it another way, the borderline individual is able to contain his rage as well as he is able to contain the constant object, which is to say, not very well. Note this observation. “Rage tends to wipe out positive experience in relationships and maintain a predominance of angry over loving feelings. Good experience fails to “stick to the ribs” of psychic structure” [1]. This is why in borderline individuals we see the rollercoaster affect. Their moods are fluid and can begin or end abruptly in direct relation to the success of the rapprochement catch.

Treatment
The goal of the treater is to experiment and develop an attunement with the borderline individual. Through validation and positive mirroring a strong therapeutic alliance can be constructed. One of the signs of a strong alliance is the resumption of the rapprochement subphase that will move forward into the rapprochement crisis. Here we see the flare up of rage, which seems puzzling because things were going so well as the alliance developed. We use the analogy in which rage is like nuclear fusion and if not contained can be a bomb. However, nuclear fusion can be contained in specially built nuclear power plants (holding environment) and the energy (rage) can be modified. It is important to note that without fusion (rage-heat) there is nothing to modify (structural change). The negative affects that were repressed due to failed attunement or abuse are resurrected in the holding environment. If the treater is successful, rage from the negative affects is modified into the formation of the internalized constant object.

Treaters face problems when they ‘are afraid to upset the patient’ and employ all sorts of tactics to maintain a positive affect in the patient. The holding environment that was constructed for fusion is not utilized. Sessions are uneventful, boring and dead. Some treaters take the low road to pass the time in chitchat. This would be much like a blacksmith attempting to shape a cold chuck of metal without heat. However, with the application of heat, and the skillful use of development tools, the blacksmith is able to modify the metal.

Working with the borderline individual is an art and similar to the navigation of a vehicle because there must be balance of acceleration and breaking to get someplace. Breaking (speed regulation in dangerous areas) is akin to the establishment and promotion of positive affects (positive transferences) to maintain the holding environment that is needed for treatment compliance. In other words, the strength of the alliance and the ability to get something done is based on the positive emotion toward the treater. Acceleration (working through – going somewhere) is the application of negative affects (negative transferences) that generate anger and rage. The treater’s employment of developmental skills can reshape the psychic structures while contained within the holding environment. However, the treater must be prudent not to pervasively overwhelm the patient with negative affect since to do so would equate to a car going over a cliff (the therapeutic alliance has severally deteriorated and cannot be repaired). During these times breaking (use of positive affects), and backing off on acceleration (shelving negative affects) can preserve the alliance. This will give the client a chance to fall back and regroup. This attunement carries the rapprochement crisis forward through regressions – progressions, unavailability – availability, and rage – soothing. It is the successful reverberation of comings and goings with the treater that produces useful derivatives in the formation of the constant object.

The Holding Environment
This term, coined by Winnicott suggested the treater create a holding space, which can provide a safe place for experimentation and change with the patient. Winnicott emphasized that the critical element of the holding environment was its framework, or operating boundaries. To help prevent unnecessary treatment failures Winnicott suggested explaining to the patient at the onset of treatment an agreement between the therapist and patient. For example, lateness is handled this way, or missed sessions in this way, or dangerous behaviors in this way. Be consistent! How can the patient internalize a constant object if the treater does not model one?! Action should take place as matter-of-factly without irritation (countertransference reaction). This is especially important with personalities that are prone to feel slighted without perfect mirroring. In other words, a treater that changes the rules as he goes can have a deadly effect. It may come off as the ‘rejecting mirror’ and validate beliefs, and destroy months carefully constructed introjects that modified the patients poor objects relations. The treater that changes the rules as he goes may come off as a cheater, weak, passive, aggressive or a whole range of affects. And, the patient with a ridged and unforgiving personality (rightly so in many cases) will walk or act out dangerously and then, treatment has failed. It is important to discuss with the patient the difference between ‘acting out’ (physical aggression, missed or late appointments, dangerous behaviors) and ‘working through.’ Working though is the verbalization of feelings, emotions and affect. Acting out on the other hand must confronted using a preset framework of consequences. For example, consequences (other then the execution boundary) can strengthen the therapeutic alliance. In some cases consequences will validate the rapprochement-patient that he as been ‘caught’ in the unconscious compulsion to ‘shadow and dart away.’ Much in the same way as the rapprochement-toddler, object constancy will progress for the patient through testing, the comings and goings of the treater.

Transitional Space
Once the holding environment is constructed it can provide a safe place for transition. Winnicott viewed the transitional space (the transitional phenomena) as an intermediate space to invite experimentation and exploration. It was modeled from the mother-infant transitional space during the separation-individualization phase. It is sort of a playground, a place to assign roles that are resurrected from the past (transferences) and played out. As these roles take shape, a distorted reverberation based in the past (transferences – countertransferences) will take place between the treater and the patient. For example a treater may kindle an exaggerated rage in the patient from slight rejections. In other words the joint assigned roles between the treater and the patient has stirred emotions of the over critical and rejecting parent. Once the roles are in motion in a safe place (activated transferences of the bad object in the transitional space) the treater guides the treatment course with skillful tools. The skillful treater may apply more ‘heat’ to ambiguous transitions to bring clarity, to help the situation become more obvious. Usually, during a return to baseline there is a cathartic release within the patient from repressed emotions. Guidance from the treater in the form of clarification, confrontation and interpretation can crystallize the flooding of emotions into a meaningful experience. This is similar to our analogy of the blacksmith that quenches the carefully shaped metal in the water. The modified metal is crystallized as the steam escapes, much as the patient is modified as the repressed emotions escape the cold labyrinths of confusion…. all while in Winnicott’s transitional space within the framework of the holding environment.

VI. Conclusion
We have learned that objectifying the psych into object relations can provide powerful tools to deconstruct (reverse engineer) the end product of pathology that originated in childhood. In other words, the end product of present day behaviors (i.e. neurotic, ridged, obsessive, object attachment or failure to attach) that originated in childhood can be reexamined and identified to provide insight into that which was unknown (unconscious). We have learned that fixation or arrest in a critical phase(s) during the first three years of life can have lasting implications. In some cases we have learned that ‘knowing’ and ‘insight’ is at times not enough. Treatment is necessary when a disturbed individual’s quality of life is severely undermined by their pathology. “The process of structural change involves the undoing of pathology and the resumption of development.” [1] Sometimes relief can only come from working-through with a skilled professional that has a solid foundation in developmental knowledge. There are times the professional can assist with validation (a supportive stance of benign behaviors that provide relief), or a system of working through. Working through tackles developmental obstacles with a balance of treatment stances. Some stances are educational, supportive, confronting, or a delicate mixture of complex stances that lead (they own it) the patient to self-discovery. A treater must know when to guide, when to carry, when to support and when to intermittently let go.

We have learned about defense mechanisms. The closer their orbit to the symbiotic magnetic pull, the more primitive they are.

We have learned that change is intrinsic of the life cycle, either through re-validation (i.e. strengthen self-esteem or strengthen “I am bad”) or modification (a corrective, harmful, or educative experience). We have seen how disturbances in the rapprochement subphase manifests into borderline personality organization or fixation in the practicing subphase can manifest into narcissist personality organization. Depending on the period of arrestment, developmental manifestations are amplified at the point of fixation. In other words, the infant will to proceed at the drop-off-point, much like a seed that fell out of the planter’s pouch. Rather then grow at the planter’s destination in rich soil; the seed took root where it fell. Perhaps the soil was bare (abandonment), or perhaps it was saturated (engulfment). The end result may be a stunted or distorted tree. However, the knowledgeable nurturing caretaker (treater) can prune the limbs to encourage redirection and enrich the ground with the necessary ingredients to correct and promote growth.