2.4 On Middle School and Attachment Theory
作者: 張凱理 / 4811次阅读 时间: 2010年6月19日
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2.4 On Middle School and Attachment Theory

On Middle School and Attachment Theory
Nov 10, 2004 

The Legacy of Fairbairn and Sutherland: Psychotherapeutic Applications, ed. by Jill Scharff and David Scharff, Routledge, 2005

An Introduction to Object Relations, by Lavinia Gomez, FA, 1997 p54-176.


(1) Ronald Fairbairn: The Dynamic Structure of the Self

Life:
Born in Edinburgh, Scotland, 1889 … remained in Edinburgh to study philosophy, going on to study theology and Hellenic studies in London, Manchester and abroad till WWI … studied medicine 1919 … did not have access to a training analyst, supervision or formal training … in analysis for 2 years with Ernest Connell, an Edinburgh psychiatrist who had been psychoanalysed by Jones … by 1925 seeing his own patients for analysis … despite several attempts to move to London, he remained in Edinburgh for the rest of his life … married 1926 (37 y/o) … most active and original work done in 1930s & 1940s

We get a picture of Fairbairn as isolated and with little support, the butt of hostility and ridicule, which no doubt increased his tendency to turn inwards rather than outwards. It is not surprising that in 1934, when his personal and work circumstances were at a very low ebb, he developed the same neurotic symptom from which his father had suffered: an inhibition which increased to an inability to urinate when others were nearby. 

… first wife Mary More Gordon died in 1952 … began to suffer increasing ill-health (several near-fatal bouts of influenza and developed parkinson’s disease) … Guntrip was in analysis with Fairbairn during 1950s … married his secretary Marian Mackintosh in 1959 … It is touching to learn that despite his poor health and his difficulties with traveling, he made the journey to London for Melanie Klein’s funeral in 1960. … died 1964 

Theory:
1. Overview
… thorough and critical reading of Freud … his training in philosophy enabled him to pick out of the assumptions and structures underlying Freudian theory … concluded that the scientific foundations on which Freud’s work rested were out of date … the distinction between matter and energy, structure and instinct, should be abandoned … the person is structured energy, or dynamic structure …saw the person as the libidinal ‘I’ with the overarching aim of relating to another ‘I’. … libido, or the person in her libidinal capacity, is primarily not pleasure-seeking but object-seeking … our most basic anxiety, therefore, is separation anxiety … saw aggression as a reactive rather than a fundamental phenomenon, arising when libidinal contact is blocked or frustrated …the id is redundant in Fairbiarn’s structure too … 

2. The Schizoid Position
… at birth, our hypothetical beginning, we are whole and undivided, through the traumas and stresses of post-natal life our primary unity is broken along predictable lines, and we become divided within ourselves and against ourselves. … He termed this primary division the schizoid position … He is suggesting not that we are all schizoid personalities but that we are all split and conflicted, and that these inner splits and conflicts structure the self. … What is the nature of the primary trauma leading to this internal rupture? …if the baby is not convinced that her object loves her for herself, and if the baby is not convinced that her object accepts her love as love … 

ideal object --- central ego
exciting object --- libidinal ego
rejecting object --- anti-libidinal ego (internal saboteur)(anti-wanting I) 

Fig 3.5 (p64)
By taking the burden of badness within, we can continue to see the needed external person as good enough, and can therefore continue trusting them and relating to them. We maintain an outward sense of security at the price of inward insecurity and conflict. Fiarbairn calls this relocation of badness the ‘moral defence’ … 

3. The Schizoid State
The hallmark of the extreme schizoid position, the schizoid state, is a sense of emptiness, deadness and futility. … Fairbairn suggests that all psychotic and neurotic states relate to these two basic human positions. People usually tend more towards one than the other, depending on whether their greatest problems arose in the primitive experience of need, leading to the schizoid position, or the later experience of hating the person they needed, leading to the depressive position. 

4. Emotional Development
Infantile dependence --- transitional stage --- mature dependence 

Infantile dependence … a libidinal (wanting) connection based on primary identification … the baby experiences the other more as an aspect of herself than as another person … perceives little difference between self and other … (mature dependence, by contrast, is a libidinal connection based on the recognition of the other person’s separateness; mature attachment means wishing to give as well as take) … 

Transitional stage and transitional techniques … the transitional stage is thus a process of emotional separation between self and other …the transitional techniques are not the result of fixation, but different methods which we use in the struggle to move from infantile to mature dependence … Fairbiarn places the neuroses in the transitional stage, suggesting that they are based on paranoid, phobic, obsessional or hysterical techniques. … Neuroses represents both the achievement of going beyond infantile dependence and the failure to reach mature dependence. … All of us who have moved beyond gross infantile dependence will tend to favour one or more of the transitional techniques and distort our perceptions accordingly. 

Fairbairn did not examine the process of moving from the transitional stage of relating to that of mature dependence. 

*He sees that intense, painful, crisis-ridden Oedipus Complex of Freudian theory as the outcome of earlier deprivation and inner splitting. Where relationships have been more fulfilling, the Oedipal stage is less difficult and less important. 

5. Therapy
Prior to Fairbairn’s influence, psychoanalysts believed that technique was what made psychoanalysis effective. … He believed the single most important factor in helping the patient to change was the real relationship --- not the transference relationship --- with the analyst. …He offered the option for patients to sit in a chair, half-facing himself; he put himself, however, behind a large desk. … His empathy seems to have been greater than his ability to communicate it … He believed the greatest resistance to change lay in the patient’s loyalty to her internal objects. … Fairbairn’s psychotherapeutic aim is to help the patient to give up her closed system of internal ego/object structures and come to rely instead on undistorted relationships with real people. 

6. Commentary
He was not interested in creating a large body of written work and must have reworked each paper painstakingly until he was satisfied with it. … many of his papers remained unpublished until 1994 … retiring personality … 




(2) Donald Winnicott: The Emerging Self

It is a paradox that the accessibility which is such an attractive feature of his writing is limited to his professional style. His personal life has tended o be presented in an idealized fashion by himself, his widow Clare Winnicott and other advocates of his work. It is therefore difficult to make an appraisal of his personal life and its relationship with his work. 

Life:
Born in Plymouth, England 1896 … surrounded mainly by women … decided he was “too nice” at age 9 …sent to boarding school at 13 by his father because he said “drat” …married Alice Taylor in 1922 at age 27 … first marriage (childless) seldom mentioned … a disturbed and difficult 9 y/o boy who lived with them for 3 months during the war and Winnicott hoped to treat, “… it was really a whole-time job for the two of us together, and when I was out the worst episodes took place” …this boy was not the only patient to be taken into their home. Another regressed and needy schizoid patient “Susan”. Winnicott had in fact asked Marion Milner to work with Susan and paid for her treatment, and Susan lived with the Winnicotts for 6 years. … Winnicott clearly saw himself as a carer, and in other cases too he seems to have become highly involved and perhaps entangled with some of his regressed patients …Perhaps they also had the need for a vulnerable other into whom they could project their own feelings of dependency, creating a buffer between them in the process. …eventually separated with Alice in 1949 … maintained contact with Alice even after he remarried 2 years later to Clare Britton … sank into a depressed state and suffered his first of his coronaries when his first marriage ended … first personal analysis with James Strachey for 10 yrs, paid his bills late … second analysis with Joan Riviere for 5 years … thus had early and full experience of both Freudian and Kleinian psychoanalysis … held a clinic at Paddington Green Children’s Hospital in London for over 40 years, also worked at The Queen Elizabeth Hospital for Children in the East End of London … seen over sixty thousand cases in his working life …commonly described as playful, spontaneous, sparkling and deeply empathic, yet some people saw him as a loner, for all his apparent sociability …died peacefully in 1971

Winnicott distinguished between management and treatment in his psychoanalytic work with borderline patients, whom he considered were often unable to benefit from the therapeutic distance suitable for the less disturbed. His view of regression as a therapeutic opportunity rather than a defence led him to experiment with different ways of facilitating psychic growth in highly dependent patients who had regressed to early stages of development. His responses to such patients included open-ended sessions of sometimes several hours in length, physical holding, sessions on demand and support outside sessions. These experiments have been welcomed as bringing a new humanity to psychoanalysis, but Winnicott has also been criticized for holding an arrogant attitude of omnipotence and failing to learn from previous similar experiments which had mostly turned out badly. 

Again, the truth is likely to be complex rather than simple. Many of Winnicott’s patients must have benefited from his genuine care and concern, and his efforts to meet even the extreme needs of his patients in an imaginative and flexible way are impressive. Other patients, however, must have suffered from his keenness to provide all the care himself. This led to propose irregular treatment with him rather than referring patients to colleagues who could have offered them more consistency. 


Theory:
1. Overview
… first and foremost a clinician, and unlike Fairbairn, “more revolutionary in practice than in theory” (Guntrip, 1975) … focuses on paradox, transition and ambiguilty … charts the emergency and vicissitudes of the self in early development, in disturbance, in delinquency and in psychosis … his arena is the borderline between inner and outer, self and other, the subjective and the objective …In his optimistic fashion, he made a plea for Klein’s depressive position to be renamed “the stage of concern”. Unusually for a psychoanalyst, he saw human beings as on the whole healthy. … 

2. Privation and Psychosis
… described psychosis as an “environmental deficiency disease” … He termed this deficiency “privation”: the absence of factors which were needed for the child to develop and mature in a straightforward way. … What is the nature of the relationship between the infant and mother before the infant is aware of anyone separate to relate to? … the baby as a person who is perpetually “on the brink of unthinkable anxiety” … the threat or actuality of falling into an unbearable state called “annihilation” … the primitive agonies of going to pieces, falling forever, having no relation to the body, having no orientation in the world and complete isolation with no means of communication … These are horrors which surface in later life as psychotic or borderline-state anxieties in which one’s very being seems threatened … 3 ways in which the mother protects her baby from these experiences: holding / handling / object presenting … 

Holding is both physical and emotional … her protective holding is expressed through the way she carries, moves, feeds, speaks to and responds to her baby, and in her understanding of his needs and experience … the baby is able to remain in a state of “unintegration”, a relaxed and undefended openness in which his different experiences can join together in an unbroken stream. … mother’s holding enables the baby’s “true self”, the spontaneous experience of being, to develop coherence and continuity … 

… the second aspect of this early, pre-differentiated relationship arises from the mother’s handling … her sensitive touch and responsive care of the baby’s body … 

Object-presenting … the third aspect of mothering … the way in which the mother brings the outside world to the baby … Winnicott often describes object-presenting in terms of feeding … The sensitive mother allows the baby to actively find and feed from the breast or bottle, rather than thrusting the nipple in his mouth before he knows it is there or keeping him waiting for longer than he can manage … the baby feels as though he is actually creating the world … he seems to be living in a world of “subjective objects”, at once part of him and yet novel, which are under his magical control … the mother helps him build a primitive conviction of omnipotence and “dual unity” which is an essential prelude to disillusion … at it worst, failure in the area of object-presenting results in the conviction that people are not only separate, but isolated. This is the primitive agony of not being able to communicate because there seems to be no way of connecting with anyone, even oneself. … a sense of distrust, futility and loneliness … If there seems to be little point in trying to relate to others, the person may elevate self-sufficiency from a necessity to an ideal … 

Privation of attuned holding, handling or object-presenting will not feel like an external failure to the baby who has not yet become aware of separateness. Rather, he will be overwhelmed by stimuli from internal or external sources which he cannot manage, at an intensity that breaks up his peaceful state of simply being. Winnicott termed these traumatic experiences “impingements”, fractures in the wholeness of being which the baby has no option but to accommodate. … 

Winnicott was acutely sensitive to the hazards of this early stage of life and the kind of suffering that arose from it. This made him highly empathic to his psychotic and borderline child and adult patients, whom he thought of in terms of the baby at the stage of absolute dependence. … under the threat of psychotic anxieties (the primitive agonies), we do not need the analysis of our problems, but rather the kind of sensitive, involved and unsentimental care that the “good-enough” mother gives naturally to her young baby … If both therapist and patient can tolerate this regression to early dependence, the patient can perhaps be helped to repair some of the gaps and fragmentation in his being through experiencing more empathic care. A distant professionalism feels false and evasive: only a real person will do. … 

3. Transitional Phenomena
… perhaps his most widely known idea … belongs to the border between the child’s early fusion with mother and his dawning realization of separateness, in the area of transition between absolute and relative dependency … in this transitional zone, the baby finds he can use particular object, sound, ritual or other happening as a way of managing his fears of being separate or alone …is the emblem of the child’s internal unity with a giving, accepting, nurturing mother … is the outward sign of the early blissful fusion between mother and child … the separateness of the transitional object signified the limits of the child’s omnipotence: the rag or blanket is real rather than imaginary … through his transitional object, the child creates a resting place between the comforting illusion of oneness and the separateness that he can no longer deny … it both stand for is not the mother … it is the beginning of symbol-making, of fantasy, play and thought … “from four to six to eight to twelve months” … 

Winnicott outlines the transitional object’s essential features. It must belong to the child, and the child must be able to treat it as he likes; but at the same time, it must not be so malleable that the child feels he has magical control over it. The child’s relationship with the object may range from identification to love and hate, and the object must survive the rough treatment of primitive relating. It must seem to have a substance and a life of its own to contribute to the relationship, whether through sound, texture, movement or warmth. It must therefore be an external object or phenomenon --- a blanket, toy, the sound of a musical box, shifting patterns on a rug --- yet it cannot by copied or replaced. It carried its symbolic power only through the meaning with which the child infuses it. … Gradually, the child ceases to need a concrete embodiment of the transitional state as he becomes able to take both connectedness and autonomy for granted. … The transitional object is not consciously given up, lost or mourned, but is slowly relegated to the margins, dropped behind a bed or left in a cupboard. … The world now offers the child opportunities for broader transitional experience. … even as adults we retain “special” objects … the therapeutic setting as supremely transitional … the therapist offers himself and the therapeutic space explicitly for transitional experience … without play, there can be no therapy; when the patient is enabled to play, growth and development naturally follow …

4. Deprivation and Delinquency
The child who has not experienced stable and continuous care will thus have far greater difficulty in building a coherent sense of self and integrating the different aspects of relating and relationship. He will have had neither the necessity nor the opportunity to realize the effects of both his anger and his love on the same person, and will not therefore appreciate their different nor bring them together to develop an attitude of concern. He will not feel a part of the family, group or society around him, and will not feel the obligation towards others that arises from this sense of belonging. … 

… specific failure in relationship at the stage when the child is able to perceive his own separateness leads to a fault or gap in the development of the capacity for concern. Winnicott terms this failure “deprivation”, as opposed to “privation”. It leads to an “anti-social tendency”, arising in the stage of relative rather than absolute dependency. … the anti-social act or tendency emerges when the child becomes hopeful of a positive response from the world once more … his hope leads him to protest against his deprivation and try to put matters right. He may seek unconsciously to take back what has been “stolen” from him in some form of stealing. He is reclaiming his right to take unreservedly from the other, as he did in the unconstrained good relationship he had before its traumatic break, and he is demanding that the other acknowledges his loss and makes amends in symbolic form as part of the re-establishment of a relationship of trust. … may also expressed through destructiveness … the destructive act expresses not only anger but also a plea for strong parenting from an adult who can contain and control the child without hate or vengeance … 

… a different matter when the child or adult has become anti-social as a way of life … management should be differentiated from treatment in the area of delinquency and criminality … 

5. Commentary
… he brought an imaginative and creative optimism to the oppressive and pathologised Kleinian scenario … He did not revise the theoretical structures of Freud or the conceptual developments of Klein, but he used their work as a background for a new emphasis on the role of the environment in emotional development. … Greenbergand Mitchell suggest that Winnicott’s unwillingness to oppose Freud and Klein results in muddled theoretical premises … his detractors point to the lack of rigour in his theoretical structure, suggesting that this was paralleled by an overly indulgent attitude to patients … neglects to go through the literature or acknowledge his sources … “It is no use, Masud, asking me to read anything! If it bores me I shall fall asleep in the middle of the first page, and if it interests me I will start rewriting it by the end of that page.” … particularly anxious about reading the work of Ferenczi … he might lack confidence in himself as a thinker …” Not brilliant, but will do” … a way of reading him: in a Winnicott-Klein conjunction … 


(3) Michael Balint: The Harmonious Interpenetrating Mix-Up

His contribution to psychoanalysis is seldom fully acknowledged. … the only one of the early Object Relations pioneers who has not yet been the main subject of a biographical and theoretical study. … 

Life:
Born 1896 … little is publicly known about Balint’s family life … he studied medicine, he half-joked later, to please his general practitioner father … first wife Alice Szekely-Kovacs … moved to Berlin 1919 …Balint was one of the few analysts to express sympathy for Klein’s plight … found their analyst Hanns Sachs dogmatic and domineering, and returned to Budapest to train with Ferenczi … moved to Britain 1939 with their son John … Jones arranged for the Balints to live in Manchester … criticized Jones’ sneering portrayal of Ferenczi … Alice died of a ruptured aneurysm a few months after their arrival at Britain … his parents committed suicide 1945 on the point of being arrested by the Nazis … second marriage 1944 lasted only a short time … at the Tavistock Clinic 1948-1961, developing work with grups and couples and a form of brief therapy … here met his 3rd wife, End Eichholz (who had founded the Family Discussion Bureau, later the Institute of Marital Studies) … idyllic relationships with Alice and Enid … together they developed “Balint groups” … independent rather than partisan, seems to have had mixed relations with his colleagues … closest friend and colleague, after Enid, was John Rickman … died 1970 … Enid died 1994 … his relative marginalization probably stems from his cross-professional work, his anti-partisan stance and his association with the neglected and unfortunate Ferenczi … 


Theory:
… Balint brought the Hungarian tradition to Britain and Object Relations … deeply influenced by Ferenczi … Ferenczi broke new ground in his work with those patients whom Freud deemed too narcissistic for psychoanalytic treatment. Ferenczi believed that they were traumatized through a lack of love rather than innate instinctual conflict, proposing an object relations hypothesis startlingly early. He spent his professional life following up the implications for practice of this reorientation. … Like Ferenczi, Balint’s main focus was the effect of theory on practice rather than the creation of a new theoretical structure … similar to Winnicott, he thinks that in their instinctual lives human beings are both pleasure-oriented and object-seeking … 

1. The Harmonious Interpenetrating Mix-Up
… Freud suggested both that object relationship is primary and leads on to narcissism, and elsewhere that narcissism or auto-erotism are primary and lead to later object relationship. The unfinished “Outline of Psychoanalysis” (Freud, 1938) holds that primary narcissism precedes object relationship. This became the “official version”, and Freud’s earlier ponderings were forgotten. … Balint coined the terms “primary love”, “primary object relationship” and finally “harmonious interpenetrating mix-up” in his attempts to articulate this first form of relatedness … likens it to the fish’s relation with water, or our own with air … in this state the other is experienced neither as the self nor as a distinct object but as matter, a word which he points out has the same root as “mother” … 

2. The Development of Object Relationship
… object relationship as an attempt to re-create the archaic harmonious mix-up, replaced after birth with a dual track of self-attachment and object-attachment … 

3. Ocnophils and Philobats
In the ocnophilic reaction, we identify the substance of objects as safe and the space between them as threatening; we try to re-find harmony through attaching ourselves to the solid objects which we equate with primary matter. … Bowlby’s attachment theory is a study of the ocnophilic tendency … The philobat, by contrast, finds enclosure claustrophobic. It is the expanse between objects that feels safe and trustable, while solid objects appear treacherous. … the philobatic mode as coming together at a later stage than the ocnophilic … 

4. Three-body, Two-body and One-body Modes
The major difficulty for therapist and patient working together arsies from the breakdown of the three-body, or Oedipal level of functioning. This is the level on which the smooth running of everyday life depends … The two-body mode is more primitive. There is little space for anything apart from the self and the other … all kinds of misapprehensions can then occur … symbolization is not possible … 
There is also a one-term mode of being which, intriguingly, arises from rather than preceding the basic two-term harmonious mix-up … the “area of creation” … 

5. The Basic Fault
… a metaphor for a geological fault, a fissure embedded beneath the surface of a continuous structure. Even if the superficial layers appear intact, it is a weak point which particular stresses may expose as an obscure sense of disconnectedness or outbursts of desperate anxiety and primitive defences … a residue of trauma at the two-term stage … the catastrophe happened before the establishment of the sense of self and other as distinct entities … People express their “basic fault” in terms of damage at the ground of their being: “I’m not a proper person”, “I’m only half a person”, “The thing that ‘s wrong with me.” …

6. Malignant and Benign Regression
…benign regression where a gently harmonious relationship leads to new beginning, and malignant regression where a spiral of demand sets in … Malignant regression is a frustrating and destructive process which most people in the helping professions will recognize. It arises from an extreme ocnophilic or hysterical reaction to anxiety and need. It may develop, Balint suggests, through the therapist feeling that his normal working frame is too rigid and depriving for his acutely dependent and hysterically-inclined patient to bear. He may offer or agree to longer or more frequent sessions, contact between sessions, gifts, reassurance or touch. At first, these extras seem to help and the patient becomes calmer, which encourages the therapist to continue. Shortly, however, the demands increase, and an addiction-like spiral develops with both patient and therapist feeling that neither the patient nor the therapeutic relationship can survive without her increasingly disruptive demands being met. In this truly malignant escalation, the patient’s frightened search for a powerfully gratifying figure to latch on to combines with the therapist’s potential for grandiosity. … few professionals speak openly about their ordeals with such patients … 
It would be interesting to research how frequently malignant regression, a creation of both therapist and patient, is a factor in the culmination omnipotence of sexual activity with a patient or client, where responsibility lies with the therapist. 

Malignant regression of the kind Balint describes arises from a hysterical defence against emotional contact; the schizoid’s frozen avoidance of relation, equally malignant, is the converse regressed mode. 

… the implications of any change of frame are complex … humility is the main quality which helps practitioners avoid setting up a malignant spiral, through guarding against an easy falling-in with patient’s assumptions of their powerfulness. The humble therapist will be more able to resist the responsibility for “curing” the patient, whose experience will be seen as her own rather than something the therapist should give. He will put himself across as simply another person, without ultimate answers or solutions, who is willing to be alongside the client or patient without needing gratitude, attention or accommodation. Then tangles have a better chance of untangling, and being vulnerable does not mean losing autonomy. The patient can come to accept, perhaps with regret, that the therapist can never be more than a therapist to her. Like the child in the Oedipal dram, she becomes free to want only what is possible with him, turning to other people for fuller life with them. …

… in benign regression, a step towards a new life rather than a perpetually vicious circle … Instead of the endless substitutive search for gratification which can only ever be partial, the patient can sink into a relaxed being-with the therapist, experiencing him as “someone like me” who will not judge or criticize, who easily tunes in, and whose failures can be tolerated because he does not expect to be perfect. The patient’s need is not for instinctual gratification but for personal recognition. While this may involve some relaxing of the therapeutic frame, the purpose is not to allay suffering but to facilitate an atmosphere of openness and trust. … Benign regression is the modus operandi of the new beginning. …

7. Touch
… it can be the entrance to a minefield. Many practitioners know from bitter experience how touch can induce or intensify a regression taking a malignant turn. … Yet Balint did not believe a fixed rule to be the answer. … It will be a low key rather than highly charged touch --- holding the therapist’s finger, for example. … 

8. Therapeutic cultures
… Balint suggests that classical psychoanalysis was based on interpretation leading to insight, rather than relationship leading to maturation. It was developed for those patients with an intact sense of self and an ability to make use of communications as ideas rather than experiencing them as actions. The patient was assumed to lives experientially as a separate, whole person in relationship with other separate, whole people, interacting reliably through words. This approach worked well with carefully selected patients, who confirmed the centrality of the Oedipus Complex and the usefulness of the interpretational approach. However, as Freud discovered, it stumbled with the narcissistic, borderline and psychotic patients for whom these assumptions were invalid because they could not function at the level the therapy required. …

Balint’s critique of Kleinian analysis suggests a similar induction of its own conceptual frame. The immediate interpretation of primitive impulses presents the analyst as a powerful and controversial figure. Idealisation, envy and hate become not only understandable but expected in the early Kleinian climate, possibly telling us more about the approach than about the patient or the primitive human being. The expression of pre-symbolic processes in adult communicational forms beings inevitably misunderstanding and confusion, and the specialized early Kleinian language sounded mad to outsiders. … the Kleinian tendency to interpret all the patient’s communications in terms of transference left little space for the patient’s own creative discoveries …

9. Commentary
… his positioning of himself at the point of divergence between Freud and Ferenczi … he suggests that in the increasingly relational emphasis of current psychoanalytic practice, technique was forging ahead of theory (Balint, 1949) … 


(4) Harry Guntrip: The Schizoid Experience
… his aim was to being together Fairbairn’s theory and Winnicott’s practice, which with his own specific contributions he believed could create a fully object-relational psychotherapy … even his theoretical studies are emotional rather than dry …he lived a painful and driven life …Guntrip, Fairbairn, Winnicott and Balint represent the purest form of early Object Relations. 

Life
… born 1901 … father Henry, mother Harriet …Percy was born in 1903 … Guntrip was said to have been devoted to his baby brother, and the trauma of Percy’s death when Guntrip was three became the symbol of his own psychological fragility for the rest of his life …the start of lifelong psychosomatic illness and emotional distress …Harriet seems to have given Guntrip intermittent and often insensitive care in his early years, taking him into the shop with her when he was unhappy, but using him to model girls’ clothes until customers protested that this would not do … his psychosomatic symptoms ranged from chronic constipation to insomnia and severe sinusitis, punctuated by periodic collapses when a “brother-figure” disappeared or when he was in danger of being alone with his mother for too long … married Bertha Kind … settled in Ipswich, then Leeds, as Minister … turned to psychoanalysis in 1936 at Tavistock Clinic, by Hugh Crichton-Miller, or his student Clifford Allen, for 6 years …started the dream and analysis records which he hoped can be turned into a psychoanalytic autobiography (Hazell, 1996) … Harriet lived with Guntrip, Bertha and Gwen, from 1944 till 1953 when she died … it is not surprising that Guntrip felt trapped, fraught and inadequate at this time … went to analysis with Fairbairn for 10 years … spent two nights a week in Edinburgh and worked up to12 hours a day on the remaining days of the week … he must have been a trying patient … described his work with Fairbairn as ultimately disappointing … felt that Fairbairn’s therapeutic approach was more traditionally Freudian than was his theory … felt that their most fruitful collaborations took place in post-session theoretical discussions … then went to Winnicott for another 10 years … periodic rather than regular … Hazell found that during his analysis with Winnicott Guntrip became quieter and more peaceful, reaching correspondingly greater depths with his patients … his lifelong quest for a memory of Percy was fulfilled in a series of dreams which began after Winnicott died, culminating in two dreams … in one, Percy was in a pram, with himself as a 3-year-old close by; in the other, Percy appeared as an unhappy baby on the lap of a mother withut a face, arms or breast, and he was trying to make Percy smile … this seems to have been his journey’s end … Guntrip reveals himself as a generous, good-hearted man with a tormented inner world … He was painfully aware of the compulsive over-activity which he was convinced was a cover for his “non-existent sense of basic being”. … “to care for people is more important than to care for ideas” (Guntrip, 1977) …died 1974 

Theory
1. From Freud to Object Relations
… his first psychoanalytic book, “Personality Structure and Human Interaction” (1961) … a historical survey 

2. The Schizoid and Depressive Positions
… depressive anxiety is “love grown angry” … the schizoid stats is “love grown hungry” … he quotes an anorexic patient, who said, “I can’t make moderate demands on people so I don’t make any at all” … 

3. The Regressed Ego
Guntrip suggests an amendment to Fairbairn’s diagram (Fig 6.1) … the kernel of the traumatized person may withdraw even from internal relationship …a symbolic return to the womb, away from activity, responsibility or even consciousness … consciously experienced as a pull to non-being, to passive giving up, even to suicide … a longing to sink back into effortless oblivion … Guntrip’s regressed ego has withdrawn from the external and internal object relations of post-natal life to an imagined return to the womb and what Guntrip conceived as the most basic form of relationship: a vague sense of being “safe inside” something indeterminate. … he implies that the “safe inside” feeling reaches back before birth, and endures beneath more ordinary experiences of being … The person who has returned to the level of the regressed ego has thus retreated from present reality further than either the depressed or the schizoid person. … 

4. Therapy
… as the womb is there is for the unborn baby … Regression to this level is a profound collapse which would be disastrous without someone there to provide the protection and support that were previously carried by the defences. Regression can only be fruitful “if there is a real person to regress with and to.” (Guntrip, 1968) … the total breakdown potentially demanded by this approach may be too much for some people … Comparatively few patients of clients would need or want to undertake this risky journey, which may also conflict irreconcilably with the responsibilities of everyday life. Therapists, too, will vary in their desire and their capacity to manage the extreme and unpredictable needs of a patient who has regressed to this level of dependency; and even those who are willing to work in this strenuous and hazardous area would not be able to manage the breakdown of more than the occasional person. … What Guntrip describes, therefore, is at the extreme end of need …

5. Commentary
…No one has written as passionately as Guntrip on behalf of the regressed patient and his need --- almost his right --- to the personal understanding and support through which he can gain or regain his wholeness. … his review of the development of psychoanalytic theory is broad-brush rather than exact … unequalled in his capacity to communicate warmth and empathy; but on the theoretical side, much of his work is repetitive and rambling, sometimes grandiose, often imprecise of partisan, and narrowly focused on the therapy of a specific regressed state … thanks to Jeremy Hazell, it is heartening that Guntrip’s work is now being published and discussed more fully …


(5) John Bowlby: Attachment Theory

Life
… born 1907 … father (Sir Anthony) died when he was 21 … spent a year working in an unorthodox progressive school for disturbed children … analysed by Joan Riviere … 1937 qualified as a psychiatrist and psychoanalyst … began training with Melanie Klein while working in the newly established London Child Guidance Clinic … here began to gather evidence for his conviction that environmental causes of neurosis were underrated …married Ursula Longstaff 1938 … 4 children … seems to have replicated his father’s distance … from the end of WWII till 1972, worked at the Tavistock Clinic … with Esther Bick set up the child psychotherapy training program … with James Roberston, Mary Ainsworth and Mary Boston developed Attachment Theory … with Colin Murray Parkes worked on the mourning process …majority of his time spent on research … during 1960s withdrew from the psychoanalytic society and concentrated on his definitive trilogy, Attachment, Separation and Loss, published between 1969 and 1980 … influenced social policy too … died 1990 … a biography of Darwin was published just before he died … an intriguing mixture of pompousness and sensitivity, shyness and arrogance, protocol and idiosyncrasy … more at home with procedures than patients, he nevertheless had an influence on psychotherapy that has grown over the years … There was a temperamental and cultural chasm between the upper-class Englishman and the traumatized, European Jewish contingent who, together with the British Independents, were more at home with art, emotion and imagination than science, facts and statistics.

Theory
1. Overview
… stressed that while the early work of Freud had made full use of the scientific methods and ideas then available, this had ceased to be the case … reading King Solomon’s Ring (Lorenz, 1952) introduced him to the new science of ethology … the films made by Bolwby’s colleagues James and Joyce Roberston (1952, 1976), unrepeateable historical documents which graphically record the agony young children go through when ripped away from home and family … the actual experiences people have in relationship contribute to an “internal working model” of the world which includes cognitive, emotional and behavioral representations of self and other and of the relationship which mediates their connection … 

2. Attachment Theory
… takes as its premise that human beings are born with inbuilt patterns of behavior which promote and maintain relationship, unfolding in an orderly sequence in interaction with the environment … no human social group is smaller than two families or larger than about 200 people … attachment behavior is designed to form and maintain this kind of stable community … “All of us, from the cradle to the grave, are happiest when life is organized as a series of excursions, long or short, from the secure base provided by our attachment figures” (Bowlby, 1969) … 

3. Developmental Stages
… the baby is born with a preference for human voices and a fascination for the human face … crying, sucking, smiling, clinging and following are all instinctive rather than learned behaviors: even blind babies smile … babies younger than 4-6 months usually show a general rather than individual attachment … after 6th months the baby has normally developed an intense attachment to her main carer, together with secondary attachments to specific others … this is the time of “stranger anxiety” … intriguingly this matches the stage at which the baby is likely to become mobile … Bowlby describes an observation of 2-year-old children in a park, where practically all stayed within a 200-feet radius of their mother, who remained in one place … from 6th months to 3 years-old children have a strong need to remain physically close to their primary carer, they can tolerate separation for limited periods only, preferably with another familiar person. Prolonged separation during these years is a major trauma and is exacerbated if the child cannot build a new attachment … IT IS AS THOUGH THE YEARS UP TO THE AGE OF FOUR CONSTITUTE THE HUMAN “CRITICAL PERIOD” FOR LAYING DOWN HOW AND HOW MUCH WE RELATE TO OTHERS, PATTERNS WHICH ARE NOT EASY TO CHANGE LATER, AS ALL PSYCHOTHERAPY PATIENTS KNOW … a threshold occurs at about 3 years … sometimes with surprising suddenness, the child becomes able to tolerate not actually seeing mother, provided she knows where she is or when she will return … three years is the age at which children become able to benefit from regular periods as one of a group of children, such as at nursery school … The child’s area of potential exploration enlarges insorfar as her internal model allows, depending both on the maturity of her attachment behavioral systems and the security of her external, and therefore internal, base. … interesting that a child with several subsidiary attachment figures rather than just one or two is more, rather than less, attached to her main figure … home and family, whether the parental home or one’s own adult home, remain fundamentally important throughout life, enabling rather than restricting exploration and direction … 

4. The Strange Situation
… Mary Ainsworth … an observational procedure for one-year-old babies and their mothers … secure group, while usually upset by the separation, demanded and received care from mother when she returned and then continued happily with their explorative play … insecure-avoidant group, were not overtly upset when mother left and ignored her on her return, but watched her acutely and were unable to play freely … insecure-ambivalent group, were panicked by the separation and simultaneously clung to mother and fought her off when returned, and were also unable to return to their own activity … insecure-disorganized group, were confused and chaotic, with bizarre patterns of repetitive movements or frozen paralysis expressing their bewilderment … 

… the kind of attachment shown by the babies was linked closely with their mothers’ responsiveness to them during their first year … the mothers of the secure group were the most attuned to their babies, interacting with them freely and with enjoyment, picking up their signals accurately responding to their distress promptly … the insecure-avoidant babies were likely to have mothers who interacted with them less and held a practical rather than personal attitude towards them … the mothers of the insecure-ambivalent group tended to respond unpredictably and were rather insensitive to their babies’ signals … the insecure-disorganized children generally came from profoundly disturbed backgrounds involving abuse, severe neglect or psychosis … 

… moreover, the attachment shown by the one-year-old child predicts future development … the secure child has an inner representation of a lovable self and responsive other, with enjoyable interactions alternating with exciting explorations in an interesting world … the insecure-avoidant child has an internal model of a self which is not worthy of care and an other who does not care, forcing the child to repress her longing and her anger in order not to drive the other even further away … the insecure-ambivalent child has a picture of a self which is not lovable and an unpredictable other who has to be manipulated or coerced into caring … in the insecure attachment patterns, the child disowns her anger, need and anxiety and the awareness of her carer’s rejection in “defensive exclusion” … those systems of perception, feeling and incipient behavior which involve unbearable pain are “deactivated” into dissociated frozen blocks of cognition and emotion … as long as they remain deactivated, these systems cannot be revised or integrated and so lead to a partial, distorted or fragmented internal working model of relationship … 

Where much is excluded, gaps in the inner model show up as emotional detachment and a difficulty in giving a clear and integrated account of experience, revealing a fragmented and incoherent sense of self … where there is little defensive exclusion, the secure child or adult relates to others easily and can articulate a coherent and continuous account of her life …

5. Reactions to Separation
… lengthy separation is particularly damaging for a child between 6th months and 3 years … typical reactions to separation in this age group can be divided into 3 phases … protest (can last up to 1 week) …younger children cry in angry distress, looking for the parents where they last saw them; older children demand the parents’ return, cry and search for them …/ despair (can last for 9-10 days) … may mistakenly be seen as “settling down” …/ detachment …Bowlby recounts heartrending stories of children, who, after prolonged separation, remained politely aloof from the parents they had missed so much, or even failed to recognize them … rebuilding the relationship is a painful process … some degree of detachment occurs when a child is separated from her main attachment figure for a week or more in this critical early period, although the degree and reversibility of detachment vary with the quality of substitute care and the situation to which the child returns … the destructiveness which accompany their detachment may paradoxically be a hopeful sign: a spark of protest in the shreds of their capacity for attachment …destructiveness is more extreme in those children who lost attachment figures, and less of a feature in children who never developed attachments in the first place …

6. Therapy
… negative patterns need not dominate if we have been able to come to terms with what has happened to us … the integration of past experience and the resolution of conflicting and painful emotions makes defensive exclusion unnecessary …if we can bear our past, we can see it in perspective … 

The purpose of psychotherapy are to diagnose the attachment pattern of patient or client, largely through monitoring the ways in which she relates to the therapist, to discover what were the major events and influences which gave rise to her particular internal working model, and to revise and modify patterns which are now limiting or self-defeating. These aims can only be achieved if the therapeutic relationship itself is one of security and trust. The role of the therapist has much in common with the role of the mother towards the child, from the earliest stages of relationship through to separation. … Because attachment is an essential part of life, the therapeutic relationship is important in its own right rather than predominantly as indicator of transference issues … 

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