Self Psychology and Diagnostic Assessment

Identifying Selfobject Functions Through Psychological Testing

Marshall L. Silverstein

• Publisher: Routledge
• Year: 1999
• Print ISBN: 9780805822809
• eBook ISBN: 9781135690359
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

The self psychology of Heinz Kohut has been an important force in contemporary psychoanalytic thought and its ramifications for therapy have been extensively explored. Now, Marshall Silverstein offers the first analysis of the application of self psychology to projective diagnostic assessment. Differentiating the self psychological approach from an ego psychological interpretation of classical drive theory, he clearly outlines the principal contributions of Kohut, including the concepts of selfobject functions, empathy, transmuting internalization, and compensatory structure. Providing numerous clinical examples, he shows how the major selfobject functions of mirroring, idealization, and twinship can be identified on projective tests. Silverstein then demonstrates how conventional assessment approaches to grandiosity, self-esteem, and idealization can be reconceptualized within the framework of self psychology, and he also contrasts ego psychological interpretations with self psychological interpretations.

This book makes a strong case for the importance of the clinical identification of self states. It will help practitioners understand their patients' varied attempts to repair an injury to the self to restore self-esteem (compensatory structure) and the clinical consequences of self-disorders, including disintegration products such as narcissistic rage and affect states characterized by empty depression, chronic boredom, and lack of zest.

Part I
Psychoanalytic Self Psychology

1	The Shift From Classical Drive Theory To Self Psychology

In the introduction to the final installment of The Search for the Self, the definitive collection of Heinz Kohut’s papers and letters, Ornstein (1990) succinctly captured one of Kohut’s principal contributions. He wrote: “Kohut maintained from early on that there were areas of human experience that could not be adequately explored with the aid of drive psychology and ego psychology and considered this fact as one of the most compelling reasons for introducing self psychology” (p. 9).

In this statement, Ornstein conveyed that self psychology had evolved to become a theory in its own right, one that was more than an expansion or development of classical drive theory. Nevertheless, it is difficult to think of another conceptual system in psychoanalysis that is as incompletely understood as is the psychology of the self. Nevertheless, self psychology has achieved a position of importance despite criticisms of its most central features. This chapter and the two chapters that follow outline the progression of self psychology.

In the present chapter, I describe the development of Kohut’s thinking, beginning with his initial formulations about narcissism and the clinical phenomena that gave rise to his ideas about the selfobject functions of mirroring, idealization, and twinship. In Chapter 2, I discuss Kohut’s formulations of the crucial concepts of empathy, compensatory structure, and transmuting internalization. Chapter 2 also includes Kohut’s reformulated understanding of dreams and the oedipal situation and his attempt to define the self and its properties as a mental structure. Finally, the third and final chapter on the central principles of self psychology is entirely devoted to a comprehensive description of the selfobject functions, which represent the conceptual anchor for the self psychological approach to diagnostic psychological testing, the chief focus of the remainder of this book.

THEORETICAL ORIGINS OF SELF PSYCHOLOGY

In his initial formulation of narcissism, a formulation that he subsequently developed into an expanded psychology of the self by 1977, Kohut (1971) viewed his ideas as an extension of the predominant drive (id) and ego psychology of the day. This view was particularly prominent in his earliest writings on narcissism, beginning in 1966 and culminating in The Analysis of the Self (1971). The 1971 book was Kohut’s first comprehensive statement about the analytic understanding and treatment of narcissistic personality and behavior disorders although Kohut’s important 1959 paper on the empathic-introspective method of obtaining analytic data and on their clinical understanding foreshadowed the book.

In several respects, the impetus for Kohut’s views came from shortcomings in classical analytic treatment, which Kohut believed was limited in its ability to reach major areas of patients’ distress and internal experience. (Ornstein’s [1990] statement, quoted previously, addressed exactly this point.) Kohut thus discovered that an enfeebled self needed to be acknowledged or responded to in a way that was more accepting of people’s discomfort and that did not leave patients feeling undermined by analytic treatment, including analysts’ interpretations that patients perceived as assaults or criticisms.

Kohut (1977) believed that although clinical improvement occurred, at least from the patients’ viewpoint, many people often felt unfulfilled or dissatisfied with their lives so that some aspects of the experience of the self were left essentially untouched. His well-known paper The Two Analyses of Mr. Z. (1979) is an excellent illustration of exactly this problem. In this paper, Kohut described in detail the outcome of an analysis, conducted in a traditional manner, followed 5 years later by a second period of analysis informed by a self psychological viewpoint. Despite an otherwise successful treatment that produced substantial amelioration of symptoms, Kohut maintained that the first analysis could not have produced the results that the second analysis had.

Kohut’s (1971) early thinking about the self emphasized clinical description of narcissistic personality disorders and the ways that psychoanalysts treated these conditions. The description of the transferences that emerged in treating such patients became the centerpiece of Kohut’s attempt to understand this form of psychopathology. His theorizing extended the idea of separate lines of development from classical drive theory to include a developmental line for the self based on his new view of narcissism. Kohut saw his views as a natural extension of drive theory, an “adjacent territory” as Ornstein (1978, p. 98) put it, rather than a variant of the object relations schools.

Kohut maintained this position throughout his career, although he substantially broadened his views about the differences between self psychology and ego psychology. As he increasingly came to realize, his contributions came into focus as an independent theoretical system, often at variance with some of the central tenets of mainstream psychoanalysis. Kohut recognized the inevitability of his views’ standing apart from drive theory formulations, notably that of the oedipal conflict.

Other therapeutic advances, such as that pioneered by Melanie Klein (1935/1975), laid the groundwork for contemporary British object relations theory. Kohut considered, however, that using these theories did not help analysts to effectively mobilize patients’ needs for self-cohesion or self-esteem. In his view of the self, people crucially needed an empathically attuned responsiveness to provide the basis for feeling psychologically invigorated and energetic. Whereas Kohut considered Klein’s emphasis on aggression as extreme (“Klein’s essential attitude is that the baby is evil … a powder keg of envy, rage, and destructiveness” [Kohut, 1996, p. 104]), he preferred to think of aggression as an understandable reaction to unresponded-to “rightfully expressed wishes” (Kohut, 1996, p. 104).

One criticism of self psychology has been that Kohut failed to account sufficiently for the clinical and theoretical importance of aggression. This criticism is related to another—that Kohut ignored the viewpoints of major object relations theorists such as Fairbairn (1941), Balint (1968), and Winnicott (1953). Kohut dissociated his views from object relations theories, as well as from Mahler’s (1968) and Bowlby’s (1969) work, not because he ignored these theorists’ work but rather because his own views were at a variance with the object relations and instinctual drive emphases of some of these theories, including their views about aggression.

According to Kohut’s view of how self-cohesion is interrupted, ego psychology could not sufficiently account for a weakened or unresponded-to self. Kohut (1977, 1984) came to believe with increasing conviction that analysts who emphasized drives had only limited success in treating disorders of the self. Because Kohut regarded drives as secondary to a fundamental disturbance of cohesion of the self, his view was that injury to the self was more crucial than were libidinal or aggressive impulses. Kohut departed from the structural theory formulation of the drive (impulse) that produced anxiety, which then gave rise to defenses resulting in symptom formation. Instead, he considered disruptions of self-cohesion and diminished self-esteem as the primary psychopathology, which appears clinically in disorders of the self. He saw ego deficits or weaknesses as defensive reactions to destabilization of self-cohesion (Kohut, 1977, p. 74).

In Kohut’s view, the self disorders resulted from chronic or pronounced failures to respond to a person’s need for mirroring or idealization. These failures predisposed people to depression, anxiety, rage reactions, and a variety of behavior disorders that attempt to relieve intolerable tension states associated with compromised self-cohesion. In this interpretation of symptom formation, the threat to the cohesiveness of the self, not unacceptable drive states or impulses, is the fundamental core of psychopathology.

Kohut began with the problem of analytically treating people with disorders that did not respond well to interpretations based on standard theoretical principles. He referred to such conditions as narcissistic personality disorders and the narcissistic behavior disorders. He described two transference patterns, mirroring and idealization, which originated from different sectors of the self, the grandiose-exhibitionistic and the idealized parent imago poles (the bipolar self). This view permitted a comprehensive clinical understanding of the psychopathology on the basis of his new understanding of these narcissistic disturbances. From this formulation, Kohut (1971) established a basis of therapeutic action for disorders of the self.

Kohut’s psychology of the self continued to develop beyond the scope of narcissistic pathology; Kohut first set forth this enlarged view in The Restoration of the Self (1977) and crystallized it in How Does Analysis Cure? (1984). Self psychology came to constitute, in Ornstein’s (1990) phrase, “a new continent.” Kohut himself wrote in the 1984 book:

Self psychology is now attempting to demonstrate, for example, that all forms of psychopathology are based either on defects in the structure of the self, on distortions of the self, or on weakness of the self.

… Self psychology holds that pathogenic conflicts in the object-instinctual realm—that is, pathogenic conflicts in the realm of object love and object hate and in particular the set of conflicts called the Oedipus complex—are not the primary cause of psychopathology but its result. (p. 53)

Kohut understood that oedipal dynamics could masquerade as disturbances of a self state. He was careful not to confine his understanding of clinical observations to one or the other position in isolation. Kohut stressed the importance of careful listening to the appearance of oscillations in clinical material. Thus, he commented in a lecture:

The more one knows, the more you have a grasp of the totality of the life histories and of the basic disturbance in the personality, the more you will be able, with a variety of configurations in your mind, to watch and see and find out what area the pathology finally falls into. All these variants do occur. If I have contributed something to analysis, it is not just to have replaced one conceptual thing with another. … Such individuals do sometimes secondarily retreat from these oedipal positions into narcissistic vulnerability. That is perfectly true. But the secondary narcissistic vulnerabilities or the secondary oral dependency attitudes you see in some individuals are a defense against the deeper going, more deeply situated anxieties of the oedipal period. (Kohut, 1996, pp. 118–119)

In reference to development, Kohut did not argue against the presence of in-phase drives to assert oral, anal, or phallic-oedipal wishes or urges. He did consider these drives as secondary, however, to mothers’ responses to these stages in development. For example, mothers might welcome and encourage or display out-of-step rejection or unawareness of their children during the various stages of psychological development. Mothers might show a depressive incapacity to respond encouragingly to such steps and might display outright thwarting of children’s expressions of autonomy and accomplishment. Rage reactions to these and similar kinds of empathic unattunement did not represent, therefore, primary aggressive or hostile wishes. Instead, rage or withdrawal or devitalization-depletion reactions by children reflected disappointment over mothers’ faulty, unempathic responsiveness. This situation provides a good illustration of selfobject failure.

In Kohut’s view, children at each developmental stage endeavored to “show their stuff’ and sought to produce a “gleam” in their mothers’ eye. Normal children seem to say “look at me” or “look at what I can do”; they act in ways that seek only to be regarded as lovable, worthwhile, or competent. It is a normal expectation that mothers respond in keeping with their children’s needs. It is also normal that children respond with anger when their legitimate needs go unmet, in the same way that it is normal for children to feel injured when told that healthy urges are unwelcome or should be inhibited.

Referring to the remobilization of drive derivatives in transference, Kohut said:

The patient’s rage is not the manifestation of aggressions directed outward against the analyst who by his correct interpretations seems to be on the side of the dangerous drives and has to be defended against. The patient’s rage is “narcissistic rage.”

… Concretely speaking, whenever a patient reacts with rage to the analyst’s interpretations, he has experienced him, from the point of view of the archaic self that has been activated in analysis, as a nonempathic attacker of the integrity of the self. The analyst does not witness the emergence of a primary primitive-aggressive drive, he witnesses the disintegration of the preceding primary configuration, the breakup of the primary self-experience in which, in the child’s perception, the child and the empathic self-object are one. (Kohut, 1977, pp. 90, 91)

It is not difficult to see that this view represents a significant reformulation of the childhood experiences crucial for sustaining a vigorous and cohesive self. Self psychologically informed analysts or psychotherapists attempt to understand that there has been an injury to the self and then to explain this circumstance to their patients. This understanding also influences techniques of interpretation. It is one thing to tell patients that they are angry; it is something else to explain to patients that they are angry because a need has been misunderstood. Treatment proceeds more efficaciously if therapists do not interpret patients’ wishes as defensive derivatives of infantile drives that should be abandoned or rechanneled.

Kohut also believed that patients perceived the excessive reserve or underresponsiveness of traditional analysis, based on preventing contamination of transference, as unempathic unless tempered with “emotional undertones and overtones, which, arising from the depths of the analyst’s psyche, make themselves heard despite the analyst’s conscious theoretical convictions” (Kohut, 1977, p. 258). Treatment, however, need not necessarily be amicable or friendly, although casual observers may sometimes misinterpret treatment in this way. On the importance of empathy, Kohut maintained that “man can no more survive psychologically in a psychological milieu that does not respond empathically to him, than he can survive physically in an atmosphere that contains no oxygen” (Kohut, 1977, p. 253).

One consequence of therapists’ customary reserved stance is the remobilization of patients’ disappointment, rage, or withdrawal in the face of what they frequently perceive as unempathic responsiveness. This experience can re-expose patients to the very conditions that produced the problems for which they sought help in the first place. Such a reaction can be particularly pronounced in patients who experienced a chronically under-responsive or understimulating parental environment. Thus, an overly reserved therapeutic stance can iatrogenically provoke rage or withdrawal reactions. If these reactions are incorrectly interpreted as manifestations of drive derivatives, patients can continue to feel misunderstood, and treatment is often undermined. It was Kohut’s impression that therapists whose treatment approach was influenced by a conflict-defense model only imperfectly understood pathological self-esteem and the causes of the self disorder. Thus, they rarely interpreted this disorder to therapeutic advantage.

SELF PSYCHOLOGY: EARLY CLINICAL CONSIDERATIONS

Selfobject Functions and Mirroring

Kohut’s (1971) reformulations took shape in his attempts to understand why conventional transference interpretations seemed to be particularly inappropriate for several of his patients. He reported the analysis of a female patient, Miss F., who maintained a long period of intensely angry refusal to hear anything other than a repetition of her own statements about herself. Treatment centered on interpreting unyielding resistances. Eventually, Kohut reconsidered the transference meaning of his function for this patient and decided that he had become an impersonal function rather than an object of love and hate in her transference.

In modifying his understanding of the genetics of her anger, Kohut could explain to his patient how her re-enactment with him revived an attempt to cope with an unresponsive, depressed mother. Thus, Kohut discovered that her stubborn resistance was not fundamentally a negative therapeutic reaction or a defense. Instead, he reconceptualized what at first appeared to resemble a defense as an attempt to obtain an echoing or approving response from the analyst. Genetically, this attempt represented a transference revival of parental failure to respond to the patient’s desire to simply be heard or listened to. This function of being attentive as an echoing presence, of affirming and admiring, is what people need to sustain a cohesive self. It is the mirroring selfobject function; its mobilization in treatment becomes the mirroring transference (described in greater detail in chap. 3).

Kohut realized that many patients’ internal experiences of the self and the ensuing self-esteem problems that these gave rise to were not understood accurately or in depth in traditional analytic or psychodynamic treatment. Unable to effect a genuine therapeutic result in patients like Miss F., Kohut realized that the principal reason for treatment failure resulted from misinterpreting mirroring by using a conceptual framework based on regressions from oedipal conflicts and libidinal and aggressive drives. He discovered that a revival of mirroring in treatment fulfilled the usual criteria for a genuine transference: inappropriateness to the ongoing work, its function as a resistance, and its genetic basis. Accordingly, Kohut believed that mirroring represented a transference reaction that could be analyzed without modifying standard technique. The meaning of the transference reaction, of course, had to be broadened to include a mirroring need rather than what was formerly considered a transference revival of libidinal or aggressive wishes.

From clinical material such as his work with Miss F. and his observations in other analyses, Kohut formulated the concept of the selfobject function. The transference represented the way that selfobject functions appear clinically; thus, he proposed the term selfobject transference. An analyst or psychotherapist had to perform a particular function for the patient’s weakened self that could not carry out this function. The selfobject function is first and foremost a mental representation of what the undermined self requires to restore optimal functioning. This function is perceived and responded to as a needed or vital extension of the pat...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Dedication
• Contents
• Preface
• Psychoanalytic Self Psychology
• The Shift From Classical Drive Theory To Self Psychology
• Self Psychology: Major Concepts
• The Central Role of Selfobject Functions
• Selfobject Functions: Psychodiagnostic Indications
• Content Analysis of Psychodiagnostic Testing: A Pathway to Understanding Self States
• Clinical Indications of Selfobject Functions: Mirroring
• Clinical Indications of Selfobject Functions: Idealization and Twinship
• MS. T.: Mirroring
• Mr. L.: Idealization and Twinship
• Postscript: Summary and Reflections
• References
• Author Index
• Subject Index