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PubMed1985

Early object-relations conflicts in marital interaction.

In this paper I have tried to show how certain early object-relations conflicts in marital interaction had their principal source in the rapprochement phase of the separation-individuation process. The clinical material suggested that only a tenuous separation from the early mother had been achieved, and now the spouse (be it husband or wife) had become the new maternal representation; the early mother-child interaction was being recapitulated once again between husband and wife. It was the conflicts and vicissitudes of the rapprochement crisis which were instrumental in shaping the patient's infantile neurosis and not just the oedipal struggle of the infantile neurosis prototype. The clinical material furthers confirmation of marriage as a viable developmental phase. Considering such marital interaction from the point of view of our analytic technique, it provided a unique occurrence where the infantile neurosis, the adult neurosis (i.e., the pathological marital union) and the transference neurosis came together. Two issues were thrown into clearer focus by this confluence: first, the repetition compulsion principle was distinctly demonstrated; and second, support for recovery of experience from preverbal and semiverbal stages of early object relations was forthcoming.

Adult↗
PubMed2000

Contributions of object relations theory and self psychology to relational psychology and group psychotherapy.

Object relations theory and self psychology are psychoanalytic perspectives that are especially concerned with interpersonal relations and their mental representations. Object relations theory began as an intrapsychic "singleton" psychology with the work of Freud and Melanie Klein. It subsequently evolved into a multi-person psychology with the work of Bion on groups, as well as the clinical and theoretical contributions of Winnicott and Fairbairn. Kohutian self psychology, which emerged later, has been interested in the relations between the self and significant others as mirroring and idealizing "self-objects." Stolorow's "inter-subjective perspective" emerged from self psychology as a full-fledged multi-person point of view. This article considers the significance of contemporary object relations theory and self psychology as relational, multi-person perspectives in terms of their application to group psychotherapy, focusing upon the group-as-a-whole, projective identification, transitional space and object, and self/self-object relations as particularly useful constructs. A clinical vignette is provided.

Humans↗
PubMed1994

Parental representation in suicidal adolescents: a controlled study.

One hundred and eighty-seven adolescents referred to outpatient and residential services in three Canadian cities were assessed for lifetime suicidal ideation and attempt, and administered the Parental Bonding Instrument (PBI). Suicidal adolescents of both genders reported lower care and higher over-protection in relation to their mothers than non-suicidal subjects, and female subjects reported this pattern for their fathers as well. Male subjects did not show clear differentiation between groups on PBI ratings for their fathers. Mean PBI scores for female subjects indicated subjects with no suicidal ideation, those with suicidal ideation only, and those having made suicide attempts to be on a continuum, but findings for males did not. The findings extend previous reports of higher "affectionless control" in suicidal adults, but suggest that this pattern may be stronger in females than males, and that maternal influences may be stronger than paternal influences.

Adolescent↗
PubMed1976

Masochism, the ego ideal, and the psychology of women.

Psychoanalytic advances have led to refinement and reformulation of early models of female personality development. Masochism was taken as a point of departure for a study of the psychology of women and earlier hypotheses of a masochistic and inferior female psychic structure. Masochism is a residue of unresolved infantile conflict and is neither essentially feminine nor a valuable component of mature female function and character. Though the female might be more predisposed to masochism, there is no evidence of particular female pleasure in pain. It is important to distinguish between masochistic suffering as a goal in itself, and tolerance for a discomfort or deprivation in the service of the ego or ego ideal. Initial hypotheses of a diminished female libido, ego tendencies toward arrest and rigidity, relative inability to sublimate, and a deficient superego are incomplete and obsolete theoretical propositions. The female ego and superego are different from but not inferior to the male. Female development cannot be described in a simple reductionism and overgeneralization. Femininity cannot be predominantly derived from a primary masculinity, disappointed maleness, masochistic resignation to fantasied inferiority, or compensation for fantasied castration and narcissistic injury. Castration reactions and penis envy contribute to feminine character, but penis envy is not the major determinant of femininity. Penis envy variously impedes and fosters femininity but penis envy is more closely related to the girl's bisexual masculinity. The female Oedipus complex is central to feminine development, but has significant normative roots in primary and positive feminine identifications and individuation. Contemporary contributions to the psychology of women have emphasized concepts of gender and sexual identity, body image and self-representation, psychosexual response and empathic motherliness, etc. The female superego includes an ego ideal with feminine ideals and values and regulates feminine interests. The maternal ego ideal consolidates overdetermined maternal attitudes, guides the formation and integration of maternal attitudes, and directs the developmental achievement of "the ordinary devoted mother." Conflicts between the maternal ego ideal and infanticidal impulses are ubiquitous and clinically significant. Current theoretical amendments conceptualize mature female autonomy, pride, and self-esteem. Female creativity may be exemplified in many and new forms in addition to motherhood. The capacity to sublimate and to foster sublimation in children is a prerequisite for normal motherhood. Femininity evolves under the influence of parents and culture, with unique developmental challenges and transformations, and a universal psychobiological core linked to functions and roles that should be neither idealized nor devalued.

Ego↗
PubMed1976

Some suggested revisions concerning early female development.

In our view, Freud's original position that sexual drive organization exerts a special and exemplary role during the various psychosexual stages remains a valid one, although drive organization is in turn consistently and extensively influenced by events in the sphere of object relations. Very early genital-zone experiences during the first sixteen months of life contribute to a vague sense of sexual identity, and undoubtedly exert an influence over many ego functions. Some genital sensations probably occur consistently in conjunction with feeding, as well as during many other interactions of the mother and her young infant. With ongoing separation and individuation, the genital zone emerges as a distinct and differentiated source of endogenous pleasure somewhere between sixteen and nineteen months of age, exerting a new and crucial influence upon the sense of sexual identity, object relations, basic mood, and many aspects of ego functioning, such as the elaboration of fantasy and graphic representation in girls and the increased use of the motor apparatus in boys-the latter probably in the service of denial. This era constitutes an early genital phase, preceding that of the oedipal period, and the later oedipal constellation will inevitably be shaped by the preoedipal developments we have described. The discovery of the sexual difference and the new genital sensations of this early genital phase should not be considered merely as several of many variables that influence the growing sense of identity; they are unique, exemplary, and of equal importance to the oral and anal aspects of psychosexual development which have preceded them. Furthermore, the preoedipal castration reaction rapidly reactivates and becomes fused with earlier fears of both object and anal loss, and is therefore particularly threatening to the child's still unstable sense of self and object. In other publications, we have presented data from direct observational research indicating that the little girl's early relation with her mother, as well as her early bodily experiences, are important in determining the effect upon her when she discovers the sexual anatomical difference at about sixteen to eighteen months of age. At this juncture, depending upon the nature of her earlier experiences, as well as the availability of the father, she may either turn more definitively to the father, or she may remain even more ambivalently attached to the mother, a choice having fateful consequences for the oedipal constellation shortly to emerge.(ABSTRACT TRUNCATED AT 400 WORDS)

Body Image↗
PubMed1999

[Wish and reality in installation of a clinic-wide system for image and documentation access].

PROBLEM: This report describes the problems that can occur in the representation of the radiological workplace in a digital environment. On one hand the radiologist can sometimes access good equipment in "stand-alone" surroundings (CT, laser printer, workstations,...); on the other hand, the existing insufficient communication between different components is only rarely qualified to support the radiological workflow. This unsatisfactory framework handicaps the required clinic-wide distribution of radiological information. METHODS: From the beginning we defined user groups requiring different radiological data closely associated with specific hard- and software: The radiological workstation in the department for reporting and image processing. The demonstration workstation in wards/outpatient departments for clinicians involved in treatment. Standard PCs with access to the digital medical document for clinicians involved in treatment. At all workstations the medical as well as the legal unity of digital radiological images and the corresponding report is ensured. RESULTS: Only the first two user groups have unrestricted access to the RIS database and to the PACS archive. We have decided that the RIS should be the master of the RIS/PACS-System. For an effective master/slave relationship between RIS and PACS archive and PACS workstations we suggest to mark images and/or series of images. CONCLUSION: The third user group depends on the information exported by the radiologist from PACS. After the report is written and signed by the radiologist, the digital report is transferred from the RIS to the HIS. The report is automatically attached to these images. Authorized personnel at the wards and outpatient are able to read the combination of validated report and exported radiological images as part of the digital medical record with an intranet browser on standard PCs.

Computer Systems↗
PubMed1996

The Splitting Index: construction of a scale measuring the defense mechanism of splitting.

The Splitting Index (SI), a self-report scale based on the writings of Kernberg (e.g., 1976) on self and object representations and the defense mechanism of splitting, was constructed. After development over the course of 6 pilot studies, the SI was validated through 2 further studies. Factor analyses revealed a 24-item scale with three 8-item subscales, measuring the splitting of self, family, and others' images. The SI and its subscales were demonstrated to be internally consistent and stable over a 4-week period. Convergent validity was supported by significant correlations with measures of borderline and narcissistic personality disorders, self-image stability, self-esteem, depression, and negative affectivity. Discriminant validity was demonstrated by near-zero correlations with two measures of cognitive complexity. Contrary to predictions, the SI was significantly correlated with the Dogmatism Scale (Rokeach, 1960), a third measure of cognitive complexity. Research and clinical applications of the SI are discussed.

Adult↗
PubMed1987

On the early formation of the mind. I: Differentiation.

This is the first of three papers, in which the early structuralization of the mind is investigated. The main themes dealt with in this paper are the following: The earliest ways of experiencing are discussed and two successive levels of psychological experiencing are distinguished. The undifferentiated mind is conceptualized as a pure pleasure formation. Undifferentiation is regarded as especially susceptible to adultomorphic misinterpretations. The part object concept and the ways to conceptualize symbiosis are examples. Undifferentiated representations of gratifications are examined both as primary structures with a regulatory function and as raw material for the emerging self and object. The birth of self-experience, initiating differentiation, is proposed to originate from the first mentally represented pain. Self and object are seen to emerge as 'all good' and are therefore constantly threatened by frustration-aggression, made possible by the differentiation. Drive theory is briefly considered. Drive is defined as a purely energic concept without qualities of its own. Aggression is not regarded as an independent drive but as the way frustration originally becomes mentally represented. Anxiety is defined and discussed as a primary affective experience of the self when its existence is threatened. Finally, after questioning the so-called symbiotic longings, the earliest ways of protecting the primary differentiation are discussed.

Aggression↗
PubMed2001

The obscure object of desire: 'nearly, but clearly not, like me': contingency preference in normal children versus children with autism.

The author describes the central role of contingency detection in early socioemotional development. It has been proposed (Gergely & Watson, 1999) that infants are innately equipped with a complex perceptual mechanism, the "contingency detection module," which functions to establish the primary representation of the bodily self as well as the later orientation toward reactive social objects. According to the "contingency switch" model, the target value of the module that is initially genetically set to preferentially explore perfectly response-contingent stimulation is "switched" at around 3 months toward a preference for less-than-perfect social contingencies. It is hypothesized that the primary cause of childhood autism is a genetic defect, due to which the normal process of switching contingency preference at around 3 months does not take place. Preliminary results from an experimental study to test this model are reported. The study contrasts the preferential reactions of normal children and children with autism to perfect versus imitative (high-but-imperfect) contingencies. The results provide support for the contingency switch hypothesis of the etiology of childhood autism.

Autistic Disorder↗
PubMed1997

[Internal representation of diseased organs and symbolic disguise of conflictual object relations].

Psychoanalytic-psychosomatic hypotheses assume, among other things, that patients with psychosomatic diseases tend to represent conflict-laden object relationship experiences symbolically in the diseased organ of the body. This assertion was tested on 139 patients having inflammatory and irritable bowel diseases with the help of the repertory grid technique. Univariate analysis showed that this hypothesis not only applies to the primary object, but is also valid for the partner relationship. Neither gender nor illness behaviour affect the connections observed here. Although patients with irritable bowel diseases as well as those suffering from Crohn's disease or colitis ulcerosa, have differing pathogeneses, there is a comparable tendency in all three diagnostic groups to represent object relationships leaded with conflict symbolically in the diseased organ of the body. The finding that the physical and psychological condition of the moment in the sense of a reactive component like-wise has to intervening influence, leads to the supposition that, in accordance with theoretical assumptions, this is a general factor.

Adult↗
PubMed1997

[Image-guided surgery].

Initially, stereotactic surgery was developed to treat functional brain diseases only. The localisation of targets was based on stereotactic atlases and radiographs. The introduction of computer based imaging techniques, such as CT and MRI, have offered the possibility to "see" anomalies and to approach them stereotactically. The working principle of such a procedure consists of three steps. It is assumed that brain tissue does not move with respect to the skull. 1. Acquisition of the images and their registration with the patient, usually based on a series of reference points (fiducials) that belong to a stereotactic localizer attached to the base ring of the stereotactic frame, 2. planning and simulation of the surgical intervention, mostly based on two-dimensional (2D) images resliced along arbitrary directions, and 3. intra-operative guidance of the instruments mounted onto the stereotactic frame. This procedure has continuously been updated by new image acquisition techniques, 3D visualization and frameless stereotaxy. 1. PET, MRI and angiography (DSA, MRA) have been used in addition to CT. Moreover, such images of different modalities can automatically be fused without using a stereotactic frame or other artificial fiducials. 2. 3D images for surgery planning have become available, a feature that has proved to be very useful for the cerebral blood vessels. 3. The stereotactic frame can be replaced by a robot arm or an optical guidance system. Registration of the instruments with the patient is then performed by using markers in the cranial bone or on the scalp, or by means of intra-operative images such as radiographs or video images. Recently the use of registered video images has resulted in a number of experiments with "improved reality" and telesurgery. The same working principle has shown to be useful for bone and bone related surgery. As in brain surgery, the prerequisites of rigidity and immobility with respect to a reference are satisfied. Because bone structures are rigid and can easily be outlined in CT images, 3D graphical as well as stereolithographic representations can be produced for the purpose of planning and even for navigation. Unfortunately, for most organs or soft tissue the above conditions of inflexibility and fixed position with respect to a reference are not fulfilled. Real time imaging, partly due to the introduction of the "open" MR scanner, may offer a solution. It can be expected that interventional diagnostic imaging will become increasingly important in the future, also for neurosurgery.

Humans↗
PubMed1989

[Psychogenic pain as a representation of the maternal object].

Since Freud, psychoanalysis has approached psychogenic pain from two points of view: conversion, and narcissistic hurt through loss of an object (pain of separation). In an early developmental phase concerning the first differentiation of self, body-self and external objects, representatives of physical and psychical pain as well as representatives of frustrating experiences with external objects (emotional deprivation, overstimulation) are able to take the place of each other reciprocally. This means, as Deutsch (1959) has elaborated, the extension of the concept of conversion to pregenital stages and its connection with object-relation-theories. The author suggests an idea of a two phase conversion, by which the primarily acquired defence of conversion is followed by later traumatization, which introduces subsequent conflicts of later developmental stages, for example oedipal ones. In the case of psychogenic pain, where physical and sexual abuse as well as the inherent guilt dynamics are frequently found, they can be integrated by using this hypothetical model. The relation to the conceptualizations of archaic hysterization (McDougall) and secondary hysterization (Mentzos) respectively symbolization (Engel) is discussed; case studies are illustrating the theoretical conception.

Humans↗
PubMed1993

The context of transference interpretations in analytical group psychotherapy.

Transference interpretation varies with the underlying understanding of the concept of transference. We view the phenomena of transference in its multiple connections; its relationship to countertransference, its relationship to a particular kind of remembering that unfolds in sequence rather than in representation and its relationship to working through. The transference is expressed in the context of a "total situation" and in order to unfold, requires a time-space frame which variation will modify the nature of the transference available for interpretation. The analytical frame applied to a group situation creates an environment that promotes rapid and sometimes massive regression. We have introduced the notion of levels of transference to account for the state of self/object differentiation present in the group. This varies with the amount of regression, and depends on the severity of splitting, projection and projective identification. In terms of transferential objects available in the group, we recognize the analyst, other members and the group as a whole. The latter carries the more primitive transference and the underlying phantasy structure of the group transactions. We briefly described some possible errors in the interpretation of transference and their potential consequences.

Countertransference↗
PubMed1980

Adaptive functions of affect and their implications for therapy.

The adaptive functions of affects are formulated in relation to hierarchical conception of ego organization based on object-relations theory. Ego states are defined as relationship paradigms, consisting of particular self- and object representations and associated affective qualities of relatedness. Affect that is integrated in a conscious ego state as part of an experience of relatedness is distinguished from affect that occurs as an isolated mental content at the structurally subordinate level of cognition. In the latter form, affect may function as a signal of disequilibrium to the ego, potentially resulting in consolidation of the ego state in consciousness and awareness of the associated relationship. The potential signal properties of the wide range of affects are best understood on the basis of the associated object-relations paradigms. Affect provides especially useful interpretive material for both therapist and patient because of its intrinsic association to ego states and object relations. However, the fashion in many current therapies of encouraging affect expression for its own sake is often misdirected; it is better to orient the work more directly toward understanding and altering object relations.

Adaptation, Psychological↗
PubMed2002

Object-related knowledge and the production of gestures with imagined objects by preschool children.

Previous research suggests that the gestural representation of preschool age children has a symbolic quality in the absence of real objects. It has shown a developmental progression from use of concrete body parts to more abstract imaginary-object gestural representations during the preschool years. The present study examined whether object-related knowledge is involved in the production of imaginary-object gestures. 35 children (12 3-, 11 4-, and 12 5-yr.-olds) performed gestural tasks in which they were asked to pretend to use common objects, e.g., "pretend to brush your teeth with a toothbrush." In addition, they were asked to describe the relationship between the performed gesture and object when they were pretending. Analysis indicated that, when an imaginary-object gesture was performed, it was through an evoked prior knowledge of the function and context of the use of objects. This may suggest that object-related knowledge is a key factor involved in developmental changes from body part to imaginary-object gestures and that it is involved in freeing preschool children from object substitution, which is prescribed by perceptual support.

Child, Preschool↗
PubMed1996

Modeling of polypeptide chains as C alpha chains, C alpha chains with C beta, and C alpha chains with ellipsoidal lateral chains.

In an effort to reduce the number of degrees of freedom necessary to describe a polypeptide chain we analyze the statistical behavior of polypeptide chains when represented as C alpha chains, C alpha chains with C beta atoms attached, and C alpha chains with rotational ellipsoids as models of side chains. A statistical analysis on a restricted data set of 75 unrelated protein structures is performed. The comparison of the database distributions with those obtained by model calculation on very short polypeptide stretches allows the dissection of local versus nonlocal features of the distributions. The database distribution of the bend angles of polypeptide chains of pseudo bonded C alpha atoms spans a restricted range of values and shows a bimodal structure. On the other hand, the torsion angles of the C alpha chain may assume almost all possible values. The distribution is bimodal, but with a much broader probability distribution than for bend angles. The C alpha - C beta vectors may be taken as representative of the orientation of the lateral chain, as the direction of the bond is close to the direction of the vector joining C alpha to the ad hoc defined center of the "steric mass" of the side chain. Interestingly, both the bend angle defined by C alpha i-C alpha i+1-C beta i+1 and the torsional angle offset of the pseudo-dihedral C alpha i-C alpha i+1-C alpha i+2-C beta i+2 with respect to C alpha i-C alpha i+1-C alpha i+2-C alpha i+3 span a limited range of values. The latter results show that it is possible to give a more realistic representation of polypeptide chains without introducing additional degrees of freedom, i.e., by just adding to the C alpha chain a C beta with given side-chain properties. However, a more realistic description of side chains may be attained by modeling side chains as rotational ellipsoids that have roughly the same orientation and steric hindrance. To this end, we define the steric mass of an atom as proportional to its van der Waals volume and we calculate the side-chain inertia ellipsoid assuming that the steric mass of each atom is uniformly distributed within its van der Waals volume. Finally, we define the rotational ellipsoid representing the side chain as the uniform density ellipsoid possessing the same rotationally averaged inertia tensor of the side chain. The statistics of ellipsoid parameters support the possibility of representing a side chain via an ellipsoid, independently of the local conformation. To make this description useful for molecular modeling we describe ellipsoid-ellipsoid interactions via a Lennard-Jones potential that preserves the repulsive core of the interacting ellipsoids and takes into account their mutual orientation. Tests are performed for two different forms of the interaction potential on a set of high-resolution protein structures. Results are encouraging, in view of the drastic simplifications that were introduced.

Amino Acids↗
PubMed1997

Clinical and developmental dimensions of hate.

Bridging concepts of aggression, affect, and attitude, hate emerges during the process of separation-individuation concurrent with ego development and persisting intrapsychic conflict and fantasy. Rage precedes hate developmentally, though later the two are amalgamated both developmentally and clinically. Hate is the negative pole of ambivalence and is a component of all self- and object representations and object relationships. When excessive and unmodulated, hate interferes with object relations and personality development. Paradoxically, hate may also subserve adaptation and personality organization. Transference hate is often a greater problem for the psychoanalyst or psychotherapist than is transference love. Transference hate threatens the analyst's narcissism and neutrality and tests the analyst's tolerance and patience. The patient's intense hate is often experienced as a direct assault on the analytic relationship and the analytic process. Countertransference hate and the need to defend against it are of great clinical importance. Because it runs counter to analytic ideals and values, the analyst's hatred of the patient may be denied, minimized, rationalized, enacted, or vicariously gratified and may occasion great resistance to analytic self-scrutiny. Countertransference hate is often an unrecognized determinant in cases of analytic and therapeutic impasse. A classic contribution by D.W. Winnicott to the recognition and elucidation of countertransference hate is reevaluated.

Adult↗
PubMedDate not supplied

The analytic introject and ego development.

A discussion of "Introjection and the Idealizing Transference" by Theodore L. Dorpat, M.D. Ego defects during analysis can be converted into defensive adaptations and then become legitimate analytic material. Two clinical vignettes of patients suffering from an inability to maintain mental representations without reinforcement from external percepts are presented. These patients suffered from an inability to internalize experiences with the outer world and external objects. The resulting ego impoverishment was experienced as tormenting feelings of inadequacy and helpless vulnerability. In treatment, these feelings caused the analyst to feel the same hopelessness the patient did. The analyst, once he regained the analytic composure to view all of the patient's productions in terms of their transference potential and adaptive significance, became a synthesizing force. His presence, in essence, held the patient together. The patient gradually was enable to internalize the analyst as a unifying modality and form an analytic introject. The formation of analytic introject is the outcome of specific clinical interactions. The author discusses the interplay of counter-transference frustration and structuralizing interpretations, even what might be considered wrong interpretations, and stresses the various factors during treatment involved in the acquisition of psychic structure in a particular clinical context.

Attitude of Health Personnel↗