Psychoanalytic Psychotherapy in the Kleinian Tradition

Stanley Ruszczynski, Sue Johnson, Stanley Ruszczynski, Sue Johnson

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9780429918032
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This set of papers, from members of the British Association of Psychotherapists, demonstrates the vitality of the 'Kleinian tradition' in work with adult patients. It is a picture of work from outside the inner circle of Kleinians in London. And it thus indicates how the concepts have fared in their transport into everyday psychotherapy.

Chapter One
Recollection and historical reconstruction

Philip Roys

Writing in 1937, Freud commented that “the work of analysis aims at inducing the patient to give up the repressions … belonging to his early development and to replace them with reactions of a sort that would correspond to a psychically mature condition. With this purpose in view, he must be brought to recollect certain experiences and the affective impulses up called by them which he has for the time being forgotten” (Freud, 1937, pp. 257-258).

That such recollection is central to psychoanalytic psychotherapy there can be no dispute, but there are different points of view about what precisely might be recalled and how this should be achieved; in particular, historical reconstruction tends to be approached differently by contemporary Kleinians and those of other orientations.

In this chapter, I intend to explore contemporary Kleinian technique in psychoanalytic psychotherapy, with particular reference to the question of historical reconstruction. I shall suggest that it is possible to delineate a distinctively Kleinian approach to historical reconstruction which follows from the Kleinian account of the development of mind and of its functioning.

Kleinian thought seems to have acquired the reputation of being difficult to understand. In part, this may result from the fact that much of its concern is with primitive experience that, by its very nature, is remote from adult experience and thought. But I think that, in addition to this, there may be something in the nature of the account that is provided—a dynamic, constantly moving picture—which can make it complex and troubling. I shall, therefore, begin by attempting to clarify some basic concepts, in the hope that this will facilitate clearer understanding of what follows.

Unconscious phantasy

A central concern of Kleinians is with the internal world. Melanie Klein “created a revolutionary addition to the model of the mind; namely, that we do not live in one world but in two—that we live in an internal world which is as real a place to live as the outside world” (Meltzer, 1981, p. 178).

Now, the important point here is not that as an outside observer it is possible to describe the contents of the mind of another objectively, but that we all have an awareness (albeit unconscious) of important things going on inside us.

At the deepest level of the mind, this awareness exists as unconscious phantasy. “An unconscious phantasy is a belief in the activity of concretely felt ‘internal’ objects” (Hinshelwood, 1989, p. 34). Hinshelwood provides a clear illustration: Take, for example, the infant who is hungry. His bodily sensations given by his physiology are also experienced subjectively and psychologically. The discomfort is attributed to the motivation of a malevolent object actually located in his tummy that intends to cause the discomfort of hunger. A good internal object is experienced when the infant is fed and feels the warm milk giving satisfying sensations in his tummy (Hinshelwood, 1989, pp. 34-35).

The concept of unconscious phantasy, then, “being the mental representation of instinctual impulses is the nearest psychological phenomenon to the biological nature of the human being” (Hinshelwood, 1989, p. 34) and thus provides a link between biology and psychology. At the most primitive levels, unconscious phantasy is experienced by the individual in terms of objects that are felt to be concrete (as having a real existence inside or outside) and are believed to have good and bad motivations (towards the subject).

But there is much more to unconscious phantasy than the recognition of good and bad objects. “In the mental development of the infant… phantasy soon becomes also a means of defence against anxieties, a means of inhibiting and controlling instinctual urges and an expression of negative wishes as well” (Isaacs, 1952, p. 83).

Over time, this phantasy world of objects and of the relationships between them develops. “Growth and evolution of an individual are due not only to physiological growth and the maturation of the perceptual apparatus—memory, and so on—but also to accumulated experience and learning from reality. Learning from reality is, in turn, connected with the evolution and changes in phantasy life. Phantasies evolve. There is a constant struggle between the infant’s omnipotent phantasies and the encounter of realities, good and bad” (Segal, 1991, p. 26).

In many ways, the concept of the internal world with its unconscious phantasy life and objects is rather mysterious and difficult to grasp. Everyday expressions such as being “gnawed by hunger” or having “butterflies in the tummy” may be suggestive of an internal world of live objects, but in themselves these expressions are probably not convincing.

The evidence for the existence of this world of phantasy came initially from Melanie Klein’s play technique, in which the play of a child was regarded in the same way as the free associations of the adult in analysis—that is, as demonstrating the unconscious phantasies active in the patient’s mind.

Klein says:

Take, for instance, the case of Ruth who, as an infant, had gone hungry for some time because her mother had little milk to give her. At the age of four years and three months, when playing with the wash basin, she called the water tap a milk tap. She declared that the milk was running into mouths (the holes in the waste pipe), but that only a very little was flowing. This unsatisfied oral desire made its appearance in countless games and dramatizations and showed itself in her whole attitude. For instance, she asserted that she was poor, that she only had one coat and that she had very little to eat—none of these statements being in the least in accordance with reality. [Klein, 1926, pp. 135-136]

But it is a long way from the unconscious phantasy life of the infant to that of the adult. It is to the development of the individual and the interaction between internal and external worlds that I now wish to turn.

The concept of position

In contrast to Freud, Klein held that from birth the infant has a rudimentary ego that experiences anxiety and takes measures to deal with this. This primitive ego utilizes defence mechanisms and forms internal and external object relations.

In considering the question of the development of the infant, Melanie Klein eventually moved away from Freud’s scheme of libidinal stages (oral, anal, genital, etc.) and utilized instead a model that, via the concept of “position”, emphasized the fluctuations and the dynamic quality of psychic functioning and development. The term “position” refers to a particular constellation of impulses, anxieties, and defences. Melanie Klein described two positions: the paranoid-schizoid and the depressive. These refer to two types of anxieties and the characteristic defences and object relationships that the ego employs to deal with these.

In one sense, these two positions could be seen as phases of development, the paranoid-schizoid position occupying the first three to four months of the infant’s life and gradually being superseded by the depressive position. But this would be very misleading, for the depressive position never completely replaces the paranoid-schizoid position. As Segal argues: “the integration achieved is never complete, and defences against the depressive conflict bring about regression to paranoid-schizoid phenomena, so that the individual at all times may oscillate between the two” (Segal, 1964, p. ix).

In utilizing the concept of position, therefore, Klein was not just describing infantile development; she was outlining two characteristic groups of anxieties and defences that persist throughout life. There is “a continuous movement between the two positions … so that neither dominates with any degree of completeness or permanence … we observe periods of integration leading to the depressive position functioning or disintegration and fragmentation resulting in a paranoid-schizoid state” (Steiner, 1992, p. 48).

What, then, are the characteristics of these positions, which form such an important part of the Kleinian model of the mind?

The paranoid-schizoid position

The paranoid-schizoid position refers to a group of anxieties and defences associated with an immature ego preoccupied with the question of its own survival. The infant is assailed by anxieties from within and without, which are felt to threaten its very existence. These anxieties and defences are experienced in terms of concrete unconscious phantasies such as those described above.

The immature ego takes steps to rid itself of bad experiences and to maintain good experiences by splitting itself and its objects into two parts, good and bad. The bad experience is projected outwards. But although the infant may have succeeded in diminishing a bad and threatening internal experience, a price has been paid. It is now faced with a persecuting external object as well as with whatever is felt to remain of the bad internal experience. This is the prototype of the persecuting object relationship.

At the same time, in an effort to foster good experiences, good parts of the self are projected to create an ideal object relationship.

The separation of good from bad and the desperate attempt to hold on to the good and get rid of the bad is one of the characteristic features of paranoid-schizoid functioning. The central anxiety is paranoid—a fear of being attacked and overwhelmed by hostile internal and external forces. The primitive defences employed to deal with this (splitting, projective identification, and idealization) aim to keep the bad as far away as possible from the good. But although moments of idealization may be created, the sense of persecution will be in the background, ready at any moment to return to centre stage.

The paranoid-schizoid position is, then, characterized by a desperate struggle for survival and the complex phantasy world that is elaborated as the infant deals with primitive anxieties.

The external world

So far, the focus has been on the phantasies that the infant has about its impulses and objects and of its relationships with them. But what of the real external world? Does this have any impact, or, as is sometimes suggested, does the external environment have little significance in Kleinian thinking?

While it is certainly the case that a major preoccupation is with the internal world, it would be misleading to conclude that the external world has no importance in Kleinian thought. Rather, it is suggested that there is an interaction between the two, with the state of the internal world affecting the perception of the external world, but with the real external world shaping the state of the internal world. Thus, phantasies, which are projected, can either be confirmed and reinforced by the external world, or the external world can lead to their modification. Cycles of projection and introjection can move in a negative or in a positive direction.

To take a simple illustration, let us return to the example of the hungry infant. In an attempt to deal with the bad object felt to be inside him, he will tend to project this outside. He will then be faced with a persecuting outside world.

This begins a process, the outcome of which will depend upon the strength of the infant’s rage and the qualities of the real object (in this case, the breast) in terms of its capacity to satisfy his hunger. If the infant’s rage is not too great and the mother responds sensitively and soon enough, the bad object felt to be attacking the infant will be modified by the good object that has been presented to him. His phantasy will be changed in a positive direction.

If, however, his rage and therefore his persecutory phantasies are very strong and/or his mother fails to respond in time, then the outside world will tend to confirm his internal phantasies. The perception of a bad and persecuting world will be perpetuated. The screaming, hungry infant who turns away when the breast is offered may be seen as having had his persecutory phantasies reinforced. He has been faced with a breast that is terrifying rather than a good object capable of satisfying his needs.

The illustration above enormously oversimplifies the phantasy life of the infant and his efforts to deal with internal anxieties, instinctual urges, and the frustrations of external reality. What I hope it does convey, however, is something of the complicated interaction between internal phantasy and the external world, of how phantasy colours the perception of reality, and of how reality can lead either to its modification or to its reinforcement and confirmation.

The depressive position

How, then, does the infant move forward from the paranoid-schizoid position? The key issue is whether good experiences have sufficiently outweighed bad experiences. Under favourable internal and external conditions, at the age of about four to five months, the infant will gradually become convinced of the resilience of his good object and his libidinal impulses in the face of his bad object and his destructive impulses. There will therefore be less need to project bad parts outside, and the external world will therefore be less dangerous and persecuting. With a more benign internal and external environment, the need to split and project diminishes, resulting in a push towards integration.

The infant is now at the frontier of the depressive position, in which he comes to recognize that the same object that is capable of meeting his needs and wishes can also frustrate them and that he can feel both love and hate towards it. “This is not simply an enlargement of awareness and knowledge, but the disruption of the existing psychic world of the infant. What had previously been separate worlds of timeless bliss in one ideal universe of experience, and terror and persecution in another alternative universe, now turn out to be one world. And they come, these contrasting experiences, from one source… “(Britton, 1992b, pp. 38-39).

In the depressive position, there is a shift from concern about the survival of the self to include concern for the internal and external good object. Feelings of guilt and of genuine concern for the object (and not merely for the gratification that it gives), if tolerable and tolerated, lead to a hope that all might not be lost after all, that some repair or reparation might be possible. “This is based on the sense of an internal world in which some goodness survives, whatever paroxysm of bad feelings sweep across it” (Hinshelwood, 1989, p. 148).

The working-through of the depressive position represents a major developmental milestone. If the painful “sense of distinction between self and object and between the real and the ideal object” (Britton, 1992b, p. 40) can be borne, the infant gradually enters a psychic universe in which he is able to accept reality (which can be painful and frustrating) and engage in symbolic thinking.

But the intense conflict engendered in the depressive position may be too much to bear. In this case, the experiences that cannot be faced will be avoided. Briefly, there are two main groups of defences that might be called upon—paranoid and manic. The use of paranoid defences involves a retreat from the threshold of the depressive position back to the paranoid-schizoid position. The reinstitution of splitting and projective identification and other primitive defences ensures that good and bad are separated, omnipotent control is maintained, and depressive reality and its associated anxiety and conflicts are thereby avoided.

Manic defences are a particular group of primitive defences distinguished by their aim of denying depressive anxiety and guilt. “In this state the source of conflict is that the ego is unwilling and unable to renounce its good internal objects and yet endeavours to escape from the perils of dependence on them as well as from its bad objects and id” (Klein, 1935, p. 227). Segal argues that “the manic relation is characterized by a triad of feelings … control, triumph and contempt” (Segal, 1964, p. 83).

With the advent of the depressive position, there is the possibility of love and goodness becoming integrated with and prevailing over hate and badness. There is a question, however, of whether this love and goodness will survive the knowledge of the Oedipus situation. Britton suggests that “just as in the depressive position the idea of permanent possession has to be given up, so in confronting the parental relationship the idea of one’s sole possession of the desired parent has to be relinquished” (Britton, 1992b, p. 40).

For some, however, relinquishing the idea of being the special one proves impossible, and “life, instead of being lived, can become the vehicle for the reinstatement of… defensive illusions, and the relationships of the external world are used only as stage props for an insistent internal drama whose function is to deny the psychic reality of the depressive position and the real Oedipus situation” (Britton, 1992, p. 45).

Kleinian technique

What, then, are the implications of the above point of view for therapeutic technique?

Specifically, it is the view of unco...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• ACKNOWLEDGEMENTS
• CONTENTS
• CONTRIBUTORS
• Introduction
• 1 Recollection and historical reconstruction
• 2 On the persistence of early loss and unresolved mourning
• 3 Interrelationships between internal and external factors in early development: current Kleinian thinking and implications for technique
• 4 “Turning a blind eye”: misrepresentation and the denial of life events
• 5 Tolerating emotional knowledge
• 6 Psychoanalytic psychotherapy for chronic depression
• 7 Notes on a case of paedophilia
• 8 When is enough enough? The process of termination with an older patient
• REFERENCES AND BIBLIOGRAPHY
• INDEX