Anxiety and Personality

The Concept of a Directing Object and its Applications

Karl Koenig

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9781782200406
• eBook ISBN: 9780429910869
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

The concept of a "directing object" is based on extensive clinical observations linked to a combination of ego psychology and object relations theory in the tradition of Otto Kernberg and Anne Marie and Joseph Sandler. People with a phobic disposition are those who were not, during childhood, permitted to learn by trial and error and thus gain confidence in their actions. They did not learn to direct their own actions and did not develop confidence in their capability to act successfully. In their inner world, they did not establish an internal directing object. Thus, they now need an external directing object, who watches over them. This has considerable influence on interpersonal relationships and on work. Phobic persons can work without difficulty when there is a external directing object, but they will not be able to work without such a companion. In therapy, they use their therapist as a directing object, which can create the illusion that the phobic patient is already much better. However the patient will fall back into phobic symptomatology when the therapist is no longer available as a directing object. Applying the concept of a directing object helps to understand a phobic person's psychodynamics. This will improve the results of therapy, and also help phobic persons to compensate difficulties arising from the lack of a companion, and deal with difficulties in finding and keeping one. Therapy can help them to develop their own internal directing object.

CHAPTER ONE

Psychoanalysis of phobia

Making the first contact

When meeting a phobic patient for the first time, a therapist may observe specific ways of behaving. Some phobics will talk a lot. There are different ways of doing this: an “anal” flow of words is usually experienced as aggressive and overwhelming and will cause irritation in a listener, while an “urethral”, perhaps elegant, flow of words may, if well executed, cause envy or feelings of rivalry, but it may also make a listener depreciate the content of what is being said. By contrast, a phobic’s flow of words is often experienced as interesting and pleasant. It makes for easy listening. However, a psychotherapist may find that she is being kept at a distance, making it difficult to get a word in. A phobic flow of words also seems to retain the listener, keeping her from leaving. This corresponds to what a child may have wanted to achieve: namely to keep his mother at a certain distance without losing contact, which would be the case of a child with a restrictive mother or with a mother who demanded more than the child was capable of. Such behaviour in a patient may irritate the therapist, since she may thus be prevented from asking for specific information, or from confronting the patient when he is circumventing particular topics.

Phobics have often learnt how to make people like them and feel obliged to help them. When a phobic patient enters the consulting room, he may—with slight, discreet signals—cause the therapist to do things she would not otherwise do. The therapist may then fell the need to direct the patient to the seat provided for patients, explaining the seating arrangement, perhaps explaining what she wants to find out, instead of just letting things develop. The little details involved in this first contact can be most revealing. For instance, one consulting room in a house where I received patients in my private practice, had a double door. The outer door had a magnet which kept it closed. You could open it in the way you might open the door of a fridge. When patients came for a first consultation, I would receive them at the door of the house and accompany them to my consulting room. When a patient left, I would take leave in the consulting room and open the inner door. Most patients, who did not have a phobic personality structure, would try to turn the knob on the outer door and, when they noticed that it could not be turned, would push it open. Phobic patients, after trying to turn the door knob, stopped and looked back at me for instructions. Patients with social phobia only behaved like this if the phobic part of the personality was stronger than the narcissistic part, which is usually the case in social phobias. Counterphobic patients they just pushed. And finally, according to Richter and Beckmann (1969), patients with cardiac neurosis type A, who are very dependent on parental figures, produced very strong signals. They suddenly looked anxious and in urgent need of help.

A phobic patient in classical psychoanalysis

The analyst sitting behind a phobic patient who is lying on a couch will comment on what the patient is saying or keeping back. The patient may experience this as being similar to what he experienced during childhood. The analyst pays attention to what a patient is doing or not doing, like the mother of a toddler who is quietly attentive to the child in his endeavours. The analyst may do this in different ways, according to how she experiences the relationship with the patient at any given moment. When an analyst addresses conflicts, a patient may assume that he is being criticised for not doing things in the right way, for not being able to do what is expected or for not wanting to do so. Thus the patient may experience the analyst’s activities as a repetition of the childhood experience of being criticised by the mother for ineptitude, which can lead to the failure of an analysis if the analyst does not bring this up for discussion and reflection.

The phobic patient feels very dependent on the analyst, at least as long as aggressive and distancing impulses do not reach consciousness. Protests over the behaviour of the analyst in dealing with the patient will not at first be consciously experienced but unconscious protest may prevent the patient from accepting interpretations and using them productively. If an analyst takes into account what effect the psychoanalytic setting itself can have on a phobic patient, she can interpret this and thus prevent the analysis from becoming unproductive.

Most phobics have negative opinions of themselves with regard to what they are capable of doing but, whereas a depressive patient will feel “no good” or worthless based on the experience of never having been nursed or fed in a caring way as a very young child, a phobic patient will have developed a negative self-image because he was made to feel incapable of competent behaviour. In addition, phobic people have not previously had sufficient opportunities to learn by trial and error. This results in a real lack of competence, which is a fact that has to be addressed and worked through.

Phobic patients often induce an analyst to treat them with special care and caution and to demand less of them than they can, in fact, handle or tolerate. They have learned to convince others that they should not demand too much of them, since they are very sensitive and ought to be protected from all kinds of demands. This often shows on first contact with them. If the analyst does not confront this in time then long and unproductive analyses may result.

Phobic patients may have learned to motivate other people to do things for them. For example, they will not finish a sentence, leaving it to somebody else to complete it, or when they feel confused about a particular subject they simply wait for clarification, or they confine themselves to hints instead of saying clearly what they want to communicate. They can manage to make the analyst complete their sentences for them, clarify confused communications, or interpret what their hints may mean. In this way a situation from their childhood is repeated. Like the mother, the analyst takes things in hand and acts in place of the patient. To a certain extent it may be necessary to do this at the beginning of the therapy, but with due caution and restraint, since an overdose of this behaviour will prevent change. For many phobic patients free association is difficult. “Moving around” in their own psyche without knowing what they, or what the analyst, may discover is not something they wish to do. Some patients just keep repeating similar ideas, regardless of what they are free-associating to. They remain, so to speak, within an area they know well. When they reach the borders of the territory they are already familiar with, free association comes to a halt. One patient, at this point, always said: “Today I can’t find anything new”. Many phobic patients do not free-associate to dreams or dream elements, thus preventing the latent contents of the dream from being linked to consciousness and to everyday life. Some leave it to the analyst to take the last few steps. They want the analyst to take responsibility for the contents of the dream as regards any influence it may have on the patient’s future actions. Infantile impulses of which the patient is afraid may lose some of their anxiety-provoking potential if they are described by the analyst. This is part of the work of containing in every analysis, but phobic patients may want more of it than others do.

Those phobic patients whose mothers have behaved intrusively may reject every “move” on the analyst’s part. This kind of resistance can be very difficult to dissolve. To succeed, the analyst needs to confront it directly, taking great care to let the patient know that the analyst understands and accepts the fact that the patient needs to show this resistance at the present stage of treatment (and mentioning that this may become unnecessary in the future). The flow of speech characteristic of phobic people often ceases when the patient lies down on the couch, begins to lack orientation, and therefore feels in danger. Patients then try, either verbally or by remaining silent, to make the analyst take the active part, in order to gain more orientation.

Analysts with a phobic personality structure

As mentioned before, an analyst in his consulting room is separated from the outer world. Since most analysts sit behind the patient, the visual contact between patient and analyst is avoided. To a certain extent, this protects the analyst from allowing exhibitionistic tendencies exert an influence. Greenson (1967) mentions that many analysts tend to suffer from “stage fright” and are relieved when they can take a seat behind the patient. The analyst’s professional role can serve as a directing object. The analyst follows the patient, who is supposed to start speaking and thus initiate a theme which will determine the direction that work may take in the session. Kohut (1977) suggests that one of the reasons why Freud chose the now classic setting was that he had not been able to work through some exhibitionistic tendencies in his self-analysis. This cannot, of course, be used as an argument against the classic setting. The personal reasons Freud may have had for creating it do not detract from the value of the analytic setting itself. After all, Columbus’ discovery of America was no less an historic achievement because he had, in fact, set out to find a sea route to India.

The fact that an analyst has a phobic personality structure does not predetermine her to be manipulated by the patient into behaving like a phobic’s mother. However, a phobic disposition in the analyst may make it easier for a phobic patient to manipulate her, and the analyst may, as a result, wish to retain a patient longer than necessary, or become anxious when the patient wants to choose his own way. In Freud’s time, patients were often asked not to take decisions of central importance in their lives while in analysis. Analyses did not last as long as they do in our day. Nowadays most analysts ask the patient to bring up any such decisions in analysis. An anxious analyst may then prevent a patient from taking a decision at all, keeping the patient from taking this step until it is no longer possible, because the situation has by then changed.

An analyst in the position of a phobic mother may carry out tasks that properly belong to the patient. On the other hand, if the analyst has slipped into the role of the phobic child—a position often taken by analysts who have a phobic personality structure—she may do quite the opposite and show reluctance to take on the analytical work required. This can lead some analysts to overemphasise the importance of free association and be unwilling to interrupt it by interpreting the material a patient brings up, with the result that this material may remain unused.

An analyst with phobic traits may ward them off with counterphobic behaviour and will then tend to be very active, overtaxing the patient and directly or indirectly asking him to take risks. This in a way resembles the behaviour of the distancing mother (type D), and shows an expectation of behaviour that the patient has not yet had the opportunity to become familiar with and to learn. In cases where the patient describes his mother as clinging (type A), analysts may try to behave differently from this type. They then find themselves falling into the pattern of counterphobic behaviour described above and, therefore, also overtaxing the patient. Equally, analysts who are trying hard to avoid behaving like a type D mother may fall into the trap of behaving in an intrusive manner. This can cause the patient to resist the analyst’s efforts.

Phobic analysts observe a patient keenly in order to keep the relationship stable and harmonious. They may then limit themselves to doing what the patient will like. This can lead to an avoidance of necessary confrontations or of interpretations that a patient will not like, since they cause anxiety, shame, or guilt. As in all fields of work, a phobic person in the working role of an analyst may lack initiative. Initiative is not blocked, as it is in depressive people, but it causes anxiety and may therefore be avoided. Some phobic analysts limit themselves to non-verbal interventions, such as “hmm”, to show that they are listening, and not do much else.

Counterphobic analysts may want patients to find things out by themselves, when they are not yet able to do so, whereas phobic analysts often use too much clarification, explaining to their patients what they mean by an interpretation, although the patients could find this out by themselves. In this respect, counterphobic therapists may explain too little. Phobic analysts may behave in an anxiously protective way, trying to prevent the patient from acting dangerously outside the session, while counterphobic therapists may provoke risk-taking behaviour in a patient, often by their tone of voice or by non-verbal interventions such as “hmm”.

Projective identification can make phobic therapists allow themselves to be projectively identified with good objects but not so readily with bad ones. In this respect they resemble a depressive therapist. Counterphobic therapists can resist identification with a helping object, preventing themselves from helping even when offering help is indicated. In phobic therapists, resistance on the part of a patient is usually met with patience. Longer than others, phobic therapists may try to understand why a patient resists, and will hesitate to confront resistance, thinking that the patients may still need their resistance. This can be useful but it can also make a therapy take longer than necessary. A counterphobic therapist may tackle a resistance head on, thereby making it increase.

Working through takes place both inside and outside the session (Greenson, 1967). During the session, phobic therapists may take more time for working through, since they want to make sure that the patient has been sufficiently prepared. Outside the session, phobic therapists expect a patient to move cautiously, not risking too much and taking the needs and wishes of people he deals with well into account. Counterphobic therapists do the reverse, wanting their patients to take risks, and this may lead to discouraging failures.

Phobic therapists like a patient to report on what he has done and experienced outside the session. They usually work less in the here and now than others, preferring to work on the relationships a patient has outside the analytic dyad, keeping conflicts out of the analytic relationship. They want to help a patient to deal with external interpersonal conflicts. Counterphobic therapists work more in the here and now than phobic therapists, but they may overtax patients in expecting them to tolerate conflicts with the therapist when they are not yet able to do this. Some phobic therapists may prevent a patient from learning by trial and error, just as phobic mothers of type A do. In a way, they would prefer to accompany patients in their lives outside the session, watching over them and helping them when they do something risky. Counterphobic therapists will want patients to rely on themselves.

In deciding whether to take on a patient or not, phobic therapists may wonder whether a patient will accept them as a directing object or rather take this role himself. Some patients will show reasonable self-reliance and competence and so seem suitable to take a companion’s role, doing much of the work themselves, and not overtaxing the directing capacity of the therapist. The phobic therapist may then prefer a patient of this kind to one who requires more help. Counterphobic therapists will act in a similar fashion, requiring, however, courage and self-reliance more than competence. This may lead to their choosing a type of therapy that overtaxes the patient.

Phobic therapists often adapt more than others to what they feel a patient wants or needs. This can prove useful. However, this may also make them avoid confronting the patient when it is necessary. When a phobic therapist has taken the patient as a directing object, the therapist remains passive while the patient is active. This may be a sensible thing to do, but it may also be done in the service of avoidance.

In summary, some phobic therapists seem to avoid all interventions that could make the patient angry. Counterphobic therapists, by contrast, risk interventions that prove “too much” for the patient, too much to tolerate. They also expect their patients to take risks in their daily lives. This may at times be useful, but if a patient fails in some undertaking, this can cause him to lose the self-confidence which is necessary to make further progress.

A phobic therapist in the role of a directing object may want to give more directions as to the patient’s behaviour outside the session than the patient can take. During the hour, she may give long explanations. In this, she resembles obsessive-compulsive therapists, but the motives are different. Obsessive-compulsive therapists want their patients to behave in the way the therapist considers to be right. A phobic therapist wants to prevent the patient from suffering “accidents” in the area of social relationships.

Confronting patients, as conceptualised by Greenson (1967), means asking them to turn their attention to certain aspects of what they have said or done, or avoided saying and doing. In confronting a patient, the therapist takes the lead. A phobic therapist may want to avoid this and, by avoiding confrontation, may by-pass important material, whereas a counterphobic therapist is likely to employ risky confrontations that traumatise the patient or increase resistance.

In offering an interpretation a therapist takes responsibility, establishing links the patient has not thought of before. Phobic patients often want the therapist to do this. A phobic therapist may feel anxious when taking this responsibility. A phobic therapist may also try to ignore a patient’s aggressiveness, instead of confronting it, or may interpret it very early on, thus preventing it from reaching the level of intensity needed for an interpretation to produce change.

To sum up: a phobic therapist will avoid taking the lead, confronting a patient, or naming links a patient may not like to learn about, while a counterphobic therapist may be too active, overcompensating for her own latent or manifest anxiousness.

CHAPTER TWO

Various types of phobia

In this part of the book I wish to compare what I have presented so far to what other authors have had to say about various types of phobia. I shall start with agoraphobia, because of its clinical and theoretical relevance. Then I turn to the role of a companion, which I would call an external directing object and which I first mentioned in papers on agoraphobia in various different theoretical contexts. I shall then discuss claustrophobia, animal phobia, school phobia, acrophobia, and cardiac neurosis.

Agoraphobia

What is warded off in agoraphobia?

Most authors mention libidinous and aggressive impulses stemming from the oedipal phase of development. Thus, Abraham (1913, 1914, 1921, 1922), Helene Deutsch (1928), Alexander (1930), and Bergler (1951), as well as Freud himself (1926) interpret the street as a place where a person may meet sexual temptation. Deutsch also takes aggressive, exhibitionistic, or scoptophilic impulses into consideration, as does Fenichel (1946). Anny Katan-Angel (1937) takes street traffic as a symbol f...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• ABOUT THE AUTHOR
• PREFACE
• INTRODUCTION
• CHAPTER ONE Psychoanalysis of phobia
• CHAPTER TWO Various types of phobia
• CHAPTER THREE Further applications
• APPENDIX
• REFERENCES
• INDEX