Object relations 2 Balint and Winnicott

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'Object relations' is a broad church containing disparate thinkers, united mainly by their common membership of the British Psychoanalytic Society, which managed to avoid the splits typical of some psychoanalytic societies by its 'gentleman's agreement' that created a structure in which different theoretical tendencies could coexist within the one society—a good example, perhaps, of 'depressive position thinking' outlined above.

Klein's view of the mind and of psychopathology was essentially a conflictual model: defensiveness and difficulty arise out of the inherent conflict in an immature mind between love and hate, and attempts to avoid the inevitability of loss. For her, such conflict was characteristic of normal development, and pathology merely an exaggeration of normal conflict in which the environment has failed to mitigate its potentially destructive effects (thus Kleinian psychoanalysis might be seen as a secularized version of the doctrine of original sin). By contrast, the non-Kleinian members of the 'object relations' school tend to espouse some variety of a deficit model, in which normal and abnormal development are more sharply differentiated, and the basis for psychopathology is a failure of the environment to provide the conditions needed for healthy psychic growth.

Michael Balint(12) is perhaps best known for his work in raising psychological awareness among general practitioners through the use of 'Balint groups', but he was also a significant figure in psychoanalysis, introducing a number of key terms and concepts. In contrast to Klein, who saw the newborn infant as wracked with fear and conflict, Balint proposed a state of primary love characterizing the early mother-infant relationship—which he described as a 'harmonious interpenetrative mixup'. Where parenting was inadequate, due to neglect, overintrusiveness, aggression, or abuse he claimed that the child would be permanently scarred at the level of the 'basic fault'. He emphasized the importance of regression in the therapy of such cases, and argued that therapy could only be effective if it reached the level of the basic fault. His model of therapy implied a remedial, rather than purely interpretative, experience with the therapist, including both quiet acceptance, and on occasion therapeutic 'acting in': Balint would sometimes gently hold the patient's hand, and, famously, once encouraged a patient who stated that she had never had the courage to do a somersault to try one out in the consulting room then and there (behaviour therapy meets psychoanalysis!). Freud originally identified two fundamental defences against anxiety: schizoid withdrawal, seen in obsessive-compulsive disorders and psychosis, and the dependent clinging characteristic of hysteria. Balint developed this theme, dividing patients into those who are frightened of the spaces between people, and so tend to cling to their objects, while others find close contact with people threatening and use avoidance as a way of controlling anxiety. Attachment theory (see below) has provided some experimental evidence to support this dichotomy.

Donald Winnicott,(13) after Klein perhaps the best known of the British psychoanalysts, was a maverick figure combining exceptional clinical sensitivity with great theoretical originality. His work bridges Klein and the independent group, and like Bowlby (see below) reached a wide audience through his writings and broadcasts on child development. A number of his phrases and concepts have passed into the vernacular, especially that of the good-enough mother and transitional object. Winnicott's central focus was on the interaction between mother and baby, like most of the object relations school; unlike Freud, he had relatively little to say about fathers, whose main role he saw as protecting the mother-baby couple from outside interference, including their own.

Winnicott visualized an intermediate zone in the early years of life that was neither the realm of pure phantasy (as described by Klein), nor that of reality (to which adaptation by the ego was required, as described by Freud), although it partakes of both. In this intermediate, or transitional, zone the infant learns, with the help of the mother, to play (another key Winnicottian theme). Here phantasies can become reality, at least for the duration of the interactive play. In this transitional space Winnicott saw the origins of creativity and culture generally, and of a nascent sense of self. He suggested that the mother's face is a kind of mirror in which the child sees his own feelings reflected, and through this recognition begins to gain a sense of who he is. This process is disrupted if the mother is depressed or abusive, and here perhaps are the germs of borderline personality disorder, characterized by a deficient sense of self, and feelings of inner emptiness and sterility. Winnicott saw 'learning to play' as a key task in therapy in helping patients to regain their sense of self.

A related phenomenon is that of the transitional object—the special handkerchiefs, teddy bears, and precious playthings that toddlers often need for comfort and to help them sleep. Winnicott saw these as buffers against loss, objects that are invested with the properties of the primary object (the mother and her breast) but remain under the control of the child. They are 'transitional' in the sense that they lie between the ideal object of phantasy and the real, but potentially unreliable, objects of external reality.

The subtlety of Winnicott's thought is exemplified by his notion of the good-enough mother. Unlike some psychoanalytical writers he did not attribute all the evils of mankind to parental failure. Just as Freud saw phantasy as a reaction to loss (there is no need to imagine/phantasize a breast if you are in proximity to one), so Winnicott realized that a 'perfect' mother, who is always and intrusively in tune with her infant's needs could inhibit rather than foster the development of a sense of oneself as a separate and autonomous being. Mothers (and presumably fathers) should be 'good enough', not perfect, not least because through healthy protest about parental failure the child learns his own strength and finds limits which reassure him that his parents can withstand his aggression and still love him. Transitional objects can help children negotiate such conflict, as representatives of an intact inner world of loving objects, while external relationships are stormy.

Winnicott realized that developmental deficit does not always take the form of neglect or overt violence. He was particularly concerned with the ways that parents, driven by their own unconscious needs, may subtly impose their will on a compliant child, thereby inhibiting the growth of a robust and distinct sense of self. The false-self-real-self distinction tries to capture the ways in which children, and later personality disordered adults, may present an acceptable face to the world that is radically at variance with inner feelings of terror, emptiness, or rage. In his seminal, but today largely forgotten, classic The Divided Self R.D. Laing(14) took Winnicott's false-self-real-self distinction as a central theme in his psychodynamic account of schizophrenia, seeing delusions as representing a way of holding together, albeit 'falsely', a disintegrating 'real' self and its inner world.

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Do Not Panic

Do Not Panic

This guide Don't Panic has tips and additional information on what you should do when you are experiencing an anxiety or panic attack. With so much going on in the world today with taking care of your family, working full time, dealing with office politics and other things, you could experience a serious meltdown. All of these things could at one point cause you to stress out and snap.

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