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Learning Objectives

After reading this chapter, you should be able to:

• Describe the basic elements of object-relations theory, and describe the process of form- ing internalized objects and how they shape personality.

• Explain how attachment theory expanded our understanding of how personality develops.

• Discuss the main features of Kohut’s self psy- chology and how it adds to our understand- ing of narcissism.

• Explain Winnicott’s concept of the good- enough mother and why he thought infants could not be studied by themselves.

• Explain the purpose of defenses and what makes them functional or pathological.

• Describe Erickson’s contributions to identity development and personality theory.

• Explain how normal personality development is undermined by narcissism, according to the contemporary psychodynamic approach.

Contemporary Psychodynamic Models of Personality 3

Chapter Outline Introduction

3.1 Early Development of Contemporary Psychodynamic Approaches: Object Relations • Primacy of Attachment • Attachment in Nonhuman Species • The Good-Enough Mother • The Experience of Emptiness • Psychoneurosis and Normal Development

3.2 Early Development of Contemporary Psychodynamic Approaches: Self Psychology • Mirroring • Identity Development • The Significance of Identity and

Identity Crisis • Development of Narcissism • Core Effects of Narcissism: Shame and Rage

• Use Malan’s triangle of conflict to describe how emotion-anxiety-defenses depict intrapsychic processes.

• Use Malan’s triangle of persons to describe how patterns from our past attachments are reenacted in our current relationships.

• Know the assessment strategies and tools for contemporary psychodynamic models.

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CHAPTER 3

Introduction We love attention, and it seems that our penchant for self-attention is growing (at least on a societal level). There are now companies you can hire to provide you with the same paparazzi experience lavished upon Hollywood celebrities; you can actually be a “celebrity for a day” and have throngs of media taking photos of you as you go out ( http://www.celeb4aday.com/Home.html). The most popular TV shows are reality shows that essentially detail and expose our private lives. There are even companies that will help you develop a more effective personal Face- book page to help boost your personal image and appear more popular to others. Although some self-love and attention seeking can be normal and even healthy, in more extreme manifestations (especially when combined with grandiosity and selfishness) it is neither healthy nor normal and would be labeled as narcissism.

In psychodynamic terms, narcissism is a personality disorder characterized by extreme, pathological self-love. In their 2001 book, The Narcissism Epidemic, psychologists Jean M. Twenge and W. Keith Campbell discuss how narcissism in American culture is on the rise, and they suggest that this will result in problems such as aggression, materialism, and shallow values. Even primary research has weighed in on this topic, suggesting that the use of social media can be related to narcissistic tendencies (e.g., Carpenter, 2012) and can have implications for self-worth (Stefanone, Lackaff, & Rosen, 2011). For example, greater narcissism is seen in those who use Facebook the most. Research also suggests that certain behaviors associated with Facebook use are related to narcissism. Consider the following questions:

• Do you frequently update your Facebook status? • When you do post, are the posts self-promoting in nature? • Do you spend more than an hour per day on Facebook? • Do you tag yourself in photos? • Do you have a large number of virtual friends relative to non-virtual

friends, and are you focused on growing that number? • Do you enhance photos of yourself?

Introduction

3.3 Early Development of Contemporary Psychodynamic Approaches: Ego Psychology • Modes of Normal Functioning • Interpersonal Functioning • Making Sense of the World and

Using Defenses

3.4 Malan’s Psychodynamic Model of Integrative Theory • Malan’s Triangle of Conflict • Malan’s Triangle of Persons: The Inter-

personal Matrix • Using the Triangles to Explain Personal-

ity Development and Organization

3.5 Assessment Strategies and Tools for Contemporary Psychodynamic Models • The Clinical Interview • Projective Tests

Summary

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CHAPTER 3 3.1 Early Development of Contemporary Psychodynamic Approaches: Object Relations

These are just some sample questions, but the more often you answer “yes” to these questions, the more likely you have more narcissistic traits (and lower self-esteem), at least according to some survey research of Facebook users (e.g., Carpenter, 2012).

Of course, we are interested in doing more than just measuring narcissism; we want to know its causes and consequences, and from a clinical standpoint, we want to know if such behavior can be modified (i.e., treated). With over one billion users worldwide, it’s obviously not the case the case that all Facebook users are narcissists (so don’t close your account just yet). However, even individuals with no clinical training appear able to identify the Facebook pages of those higher in narcissism (Buffardi & Campbell, 2008), and it is typically easier to identify nar- cissistic behavior in others than it is to see it in ourselves. Indeed, our innermost motivations are not always self-apparent (see the study in Section 3.2 in “Devel- opment of Narcissism,” which examines narcissism and self-awareness).

In this chapter, we will explore some of the contemporary psychodynamic models that emerged around the second half of the 20th century and continue to evolve today. These theoretical systems advanced new concepts that seemed to more fully characterize the modern human condition. For example, they looked at the influence of sociocultural factors—an area that was largely overlooked by Freud— and how these affect the self.

Pine (1990) suggests that there are four basic orientations in psychoanalytic the- ory. The first, referred to as drive theory, was forwarded by Freud. Drive theory refers to the instincts that motivate behavior, and as noted in Chapter 2, those were the defined in terms of sex (life) and aggression (death). The three remaining orientations—object relations, self psychology, and ego psychology—are grouped within the contemporary psychodynamic approaches, and are the primary focus of the current chapter, along with Malan’s psychodynamic model.

3.1 Early Development of Contemporary Psychodynamic Approaches: Object Relations

An important development in contemporary psychoanalytic theory is object- relations theory—the notion that each of us carries around in our minds certain well-established ideas (referred to as objects), often based on our early relationships with our mothers or fathers. The theory is founded on the notion that important aspects of how we relate to people are programmed into us by our early relationships. Thus, object relations refer to the study of how our minds evolve and grow in the context of our relationships to our early caregivers or primary attachment figures (for an overview, see Williams, 2012).

Objects are our internalized representations of important aspects of these relationships. For exam- ple, the mental representation of your mother is the object, and object-relations theory suggests that the way we relate to people reflects these objects. The theory might suggest that a man who is immediately suspicious of all the women he meets may be viewing women through an object that is based on experiences he had with his mother when he was an infant. Perhaps she had to leave him every day for a brief period of time and his (unconscious) perception might be that

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CHAPTER 3 3.1 Early Development of Contemporary Psychodynamic Approaches: Object Relations

she intentionally abandoned him (note how reality is less relevant than the individual’s perception of reality; the object relation is a subjective mental representa- tion). The resulting object, based on that early relationship, now guides how he interprets rela- tionships with other women. This example could likewise be extended to paternal objects, as well as any other relationship the infant can represent internally.

Among the many psychoanalysts who contributed to the development of object-relations theory are Otto Rank (who first introduced the concept), Melanie Klein, W. R. D. Fairbairn, Margaret Mahler, Annie Reich (Buckley, 1986), Ivan Boszormenyi-Nagy, Harry Guntrip, and of course, D. W. Winnicott, who played the most significant role in expanding the concept of object relations.

Winnicott was a pediatrician who, after exposure to the work of Melanie Klein and Anna Freud, became a child analyst, although he also worked with adult psychotic patients (D. W. Winnicott, 1988). He believed he could learn much about the psychology of early infancy by studying adult patients who had been made to regress (go back to their childhoods and even infancies).

Object-relations theory was an impor- tant departure from Freud’s structural drive theory, in which aggression was assumed to be a normal human instinct. Instead, Winnicott viewed aggression as a result of attachment disruption. Thus, for Freud, the presence of aggression would be normal, whereas for Winnicott aggression would indicate a problem related to attachment. Object-relations theory is based on two main assump- tions: (1) the development of self occurs in our relationships with significant oth- ers and (2) interactions with attachment figures form internalized templates that serve as working models for future rela- tionships (Benedict & Hastings, 2002).

The object-relations movement was stimulated in part by attachment theo- rists who were beginning to recognize the importance of relationships in both psychotherapy and individual development. The move- ment also focused on the processes of symbiosis and individuation and their essential role in iden- tity development (Mahler, Pine, & Bergman, 1975). Symbiosis refers to the mother–infant unit, of which the child is initially an undifferentiated part; individuation is the process by which the infant becomes increasingly separate and self-sufficient (Note: Although traditional object-relations

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Object-relations theory suggests that there is a delicate balance between the mother and child being integrated as one unit (symbiosis) and the developmental process of the infant forming his or her own identity (individuation).

Beyond the Text: Classic Writings

In this 1958 paper, “The Nature of Love,” Harry Harlow, who did pioneering work in the field of maternal attachment in nonhuman species, describes maternal “love.” Read it at http://psychclassics.yorku.ca/Harlow/love.htm.

Reference: Harlow, H. F. (1958). The nature of love. Ameri- can Psychologist, 13, 673–685.

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CHAPTER 3 3.1 Early Development of Contemporary Psychodynamic Approaches: Object Relations

theorists referred to the mother-infant unit, with this language being echoed in this chapter, a more modern view would refer to the parent–infant unit, as the former may be more tied to the traditional gender roles of the time. In fact, the absence of fathers—paternal separation—can also have a toll on the infant; see, for example, Phares & Compas, 1992). Object-relations theory assumes that separation that is too rapid causes excessive anxiety and can lead to a disruption in the normal separation-individuation phase, which can then result in more longstanding problems in later life. Some research provides general support for this association, as children who have experienced various forms of abuse (e.g., sexual, physical, or emotional) have a heightened risk for a range of psychiatric conditions, including depression and posttraumatic stress (Felitti et al., 1998; Gibb, Chelminski, & Zimmerman, 2007). See “Putting Object-Relations Theory to the Test: Part 1,” in this chapter, for a description of one such study.

In addition to associating early maternal (and in parallel, paternal) separation to problematic behavior later in life, researchers have also tried to associate it with biological consequences, such as hormonal changes and other biological markers associated with a stress response. More recently, the term allostatic load has been introduced into the literature to refer to the biologi- cal and physiological consequences that result from chronic stress. Importantly, the body has a physiological threat response that occurs following stress exposure, and although it is adaptive to respond to the acute stressor, the frequent activation of this system can be harmful to organs and tissues. Allostatic load is a cumulative account of these strains on the organs and tissues and can be used to predict later life problems (McEwen & Seeman, 2003). In “Putting Object-Relations Theory to the Test: Part 2,” in this chapter, we will examine whether the early experience of mater- nal separation can manifest in terms of physiological or biological outcomes.

Primacy of Attachment Many of Winnicott’s theoretical constructs developed after World War II and were influenced by his experience with children separated from their parents during the bombing of England. He came to believe that the main challenges we deal with have to do with how to maintain balance in our relationships. This requires balancing the polarities involved in, for example, being autono- mous but not feeling isolated; cooperating and giving without allowing ourselves to be used; and both receiving and giving, without being engulfed by the needs of others (Cushman, 1992).

Winnicott’s ideas are very similar to Freud’s with respect to his view of the unconscious, the importance of early childhood development, and transference. What is unique to Winnicott is that he did not believe that infants could be viewed outside the context of the maternal–infant dyad. He thought of the beginning of the child’s life as a mother–infant unit, such that the infant exists only in the mother–infant dyad (Rayner, 1991). Accordingly, he believed that the self develops in the context of relationships between child and parent, and that there is a core struggle between the infant’s need for intimacy and the urge for separation. Some of the theoretical concepts to be defined next highlight his emphasis on this maternal–child dyad and any disruptions to this dyad.

Attachment in Nonhuman Species The importance of early attachment was also being explored in other fields. For example, the animal studies of Harlow (1958; for an overview see Suomi & Leroy, 1982) demonstrated that attachment involved more than simple feeding, as infant monkeys who had been separated from their mothers at birth (referred to as “orphaned monkeys”) were exposed to surrogate mothers, some of which provided warmth and a soft touch (they were made of cloth), while others were physically uncomfortable (made of wire), but they provided food (i.e., a bottle to mimic breast

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CHAPTER 3 3.1 Early Development of Contemporary Psychodynamic Approaches: Object Relations

feeding). Harlow found that the cloth surrogates were preferred over the wire feeding surrogates. However, all forms of early separation (i.e., regardless as to whether the orphaned monkeys had no or simply limited opportunities for attachment) resulted in problematic behavior as they aged, including, most notably, aggression (Harlow & Zimmerman, 1959). For a more detailed look at Harlow’s work, see the “Beyond the Text: Classic Writings” box in this section. Subtler forms of separation have also been shown to result in greater timidity and decreased willingness to explore one’s environment (Suomi, 1991).

Similarly, the work of developmental psychologists also informed our understanding of attachment and separation, emphasizing the role of these experiences in personality development (Davidson, Scherer, & Goldsmith, 2003; Nadel & Muir, 2005; Panksepp, 1998). Especially influential was the work of John Bowlby (1988) who studied early attachment in primates and forwarded a theory of attachment, separation, and loss (for a review, see Bretherton, 1992). Bowlby postulated that there are a number of behavioral systems that function to tie the infant to the mother and keep her in close proximity. He describes how attachment develops: “The behavioural systems them- selves are believed to develop within the infant as a result of his interaction with his environment, of evolutionary adaptedness, and especially of his interaction with the principal figure in that environment, namely his mother” (pp. 179–180). Bowlby believed that clinging and sucking drive attachment. Eating, he explained, is only a minor element in the process of attachment, a finding that was consistent with Harlow’s work, as well (see van der Horst, LeRoy, & van der Veer, 2008).

The aim of attachment behavior, claims Bowlby, is to keep the attachment object close to ensure protection and food, both of which are essential for survival. Proximity-maintaining behavior can be seen when a mother leaves the room and the infant cries. Bowlby also studied the experience of separation and threats of separation, both of which were thought to arouse feelings of anxiety, anger, and even grief. Bowlby suggested that children are protected from overly painful experi- ences of loss because they experience a form of amnesia that serves to defend against the pain/ loss, and he suggested that separation does not affect all children in the same way.

Thus, it appears that attachment and the process of separation are both experiences that are some- what universal, and not limited to humans or just those experiencing problematic functioning.

The Good-Enough Mother One of Winnicott’s best-known concepts is that of the good-enough mother, which is a very use- ful concept in understanding the development of healthy and unhealthy selves. This concept refers to the fact that the mother must be healthy and responsive enough to meet the infant’s minute-to-minute needs as they occur (Winnicott, Shepherd, & Davis, 1989). It does not mean that the mother has to be a “perfect” parent to have healthy children, but that it is important to be available at a critical level of parental functioning in order to fulfill the basic needs of uncom- plicated developmental progression. Good-enough mothering, then, provides what is necessary for healthy development.

What is important is not a precise measurement of what is good enough, but rather the idea that at a certain level of maternal insufficiency, development will be compromised. For example, imag- ine a chronically depressed mother who is unable to respond emotionally to her infant. In this case, a sufficiently good attachment or object relationship will not have been established. Accord- ing to object-relations theory, the infant will then internalize the mother as a distant and nonre- sponsive object, and this may become a fixed internal representation applied to future relation- ships. In this case, the mother was not “good enough.” Now take an instance in which a mother

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CHAPTER 3 3.1 Early Development of Contemporary Psychodynamic Approaches: Object Relations

suffers from the “baby blues” or even postpartum depression in the weeks following her child’s birth. She isn’t perhaps as responsive as she would like to be to her baby’s needs, but with medi- cation and strong support from family and spouse, she is soon feeling better and able to handle most of the demands her child poses. Ultimately, the object relation her child will form will be a positive one. In this case, then, the mother wasn’t perfect, but she was certainly “good enough” to raise a well-adjusted child.

The Experience of Emptiness Winnicott’s ideas about object relations enabled him to better understand certain clinical phe- nomena that were reported by his patients (Winnicott et al., 1989). Among these phenomena was the fact that some patients reported experiencing what they described as deep emptiness. Winnicott conceptualized this, along with most phenomena, as a relationship event. He assumed that the emptiness likely occurred before the person developed language, when there was no response from the primary attachment object/figure. In relation to Freudian development, this would be termed pre-Oedipal. Winnicott believed that it was easier for a patient to remember a traumatic event than to recall a lack of responsiveness from a primary attachment figure. With- out the benefit of language to form a narrative of what was experienced, the patient is left with deep emptiness.

What was important in the development of object-relations theory was that it offered a new way of looking at pre-Oedipal insufficiency, or what might now be termed “emotional neglect.” In some ways, it provided a better explanation for clinical phenomena. Michael Balint (1968) also drew attention to the problem of faulty or insufficient parenting—that is, emotional neglect. He believed this led to a chronic sense that there is something wrong or defective about oneself— hence sensations of emptiness. The basic fault, explained Winnicott and other object-relations theorists, has to do with disrupted or unformed infant–caregiver attachment, a fact that under- lines the importance of early attachment on the development of the self.

The theoretical formulations and research in this area are tremendously important as they affect an increasing number of individuals. In 2011, the U.S., Department of Health and Human Services found that approximately three-quarters of a million children were reportedly abused or neglected in the United States. Victimization rates are approximately 9 for every thousand chil- dren, with the youngest children (less than 3 years of age) having the highest victimization rates. For example, children under 1 year of age had victimization rates of over 21 out of every thousand children. In addition to the incredible toll on the children and their families, the total lifetime eco- nomic burden for those cases reported in a one-year period (2008) would be between $124 billion and $585 billion, depending on the type of analysis (Fang, Brown, Florence, & Mercy, 2012). Thus, a better understanding of this problem and the development of intervention strategies is critical.

A logical extension of object-relations theory is that if we can improve the mental and physical health of parents, we may minimize problematic attachment, have more mothers who are “good enough” to meet their children’s needs, and in the long run, avoid the experience of emptiness by those children when they are adults.

Winnicott provides a theoretical connection between the maternal levels of adjustment and level of adjustment of their children. Research on this topic suggests that emotional neglect by moth- ers in childhood increases the incidence of psychopathology for the children later in life (e.g., Jaite, Schneider, Hilbert, Pfeiffer, Lehmkuhl, & Salbach-Andrae, 2012; Young, Lennie, & Minni, 2011). The literature also suggests that emotional neglect may predict individual differences in

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CHAPTER 3 3.2 Early Development of Contemporary Psychodynamic Approaches: Self Psychology

physiological responding, such as amygdala reactivity (White et al., 2012) and cerebral infarcts in old age (Wilson et al., 2012). One logical extension of this body of research and the underlying theory is to examine the implications of maternal interventions, especially with high-risk mothers.

A study by Mayers, Hager-Budny, and Buckner (2008) involved an intervention study targeting low-income, teen mothers and their infants enrolled at inner city public high schools. The findings indicate that mothers who had received treatment had improved interactions with their infants in the areas of responsiveness, affective availability, and directiveness. Infants in the treatment group were also found to increase their interest in the mother, respond more positively to physical contact, and show improved emotional tone relative to the control infants. The findings are also consistent with object-relations theory.

Psychoneurosis and Normal Development Winnicott views normal and abnormal personality development in terms of how defenses are uti- lized (recall that defenses are means of protecting the individual from conflict related to anxiety). Winnicott suggests that healthy individuals are those who can marshal their defenses to combat internal conflicts that arise. Like Freud, he believed that healthy individuals employ a wide range of defenses and can shift defenses in a flexible manner. In contrast, unhealthy individuals tend to have a more rigid set of defenses (Winnicott et al., 1989). Also, the unhealthy person may resort to massive repression or denial. In contrast, healthy individuals can tolerate the conflicts inherent in life and maintain contact with the self; they are less prone to see others in terms of “good” or “bad” objects, as they are referred to by object-relations theorists.

The work of the object-relations theorists provides important insight into child development and suggests new ways of understanding adult psychopathology and severe personality disorders. Another important contribution relates to the emotions we develop toward our selves, especially our sometimes-extreme self-love, or, as we discussed in the opening to the chapter, narcissism.

3.2 Early Development of Contemporary Psychodynamic Approaches: Self Psychology

One of the central figures in the self-psychology movement was Heinz Kohut, who believed that all children have a need for someone to affirm and admire their achievements, a role most commonly filled by the parental (and more typically, maternal) figure. We here pres- ent what Kohut believed to be some of the essential components in the development of the self and include a discussion of Erik Erikson’s theory, which emphasizes the development of the self over the lifespan.

Mirroring The concept of mirroring refers to the act of providing an accurate response to the thoughts, moods, and feelings of another. Although this clearly involves empathy, mirroring implies more than just understanding another person’s emotions. An essential aspect in the development of a healthy self-system includes a relationship with a mirroring figure. Mirroring is the process by which the primary attachment figure provides feedback in the form of reflection and affirmation of the positive qualities that a child demonstrates (for a review, see Ornstein, 1991).

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CHAPTER 3 3.2 Early Development of Contemporary Psychodynamic Approaches: Self Psychology

Mirroring is expressed in somewhat different ways, depending on the developmental stage of the individual. In infancy, it is evident in a kind of synchrony of responses between caregiver and infant, calibrated to the infant’s needs, such that when the infant is crying the caregiver might naturally mimic the sad face, or when they are smiling and laughing, the caregiver would likewise smile broadly. Later in life, when language has developed, mirroring might entail reflecting feel- ings and thoughts that are discerned through active listening—a process that, in a sense, allows one person to locate the essence of the other. For example, when you are talking to a close and trusted friend about your concerns regarding the difficulty of several upcoming exams, they might reflect back to you that you appear to be expressing a more general fear of failure. Assuming this is an accurate read, this could function as a form of mirroring.

Kohut believed that the experience of mirroring is key to development (Kohut & Wolf, 1986). The thesis is that the newborn does not have a self, but has certain prewired adaptations important for biological survival (breathing, sucking, and coughing reflexes, for example), as well as response tendencies and needs critical for psychological survival. Psychological survival, Kohut explains, requires the presence of responsive and empathetic caregivers. In this contemporary psychoana- lytic view, relationships with caregivers become internalized, give rise to self-objects, and lead to the development of a mature, normal sense of self. But this does not occur in the absence of an early stage during which mirroring provides an adequate response to the child’s needs. It requires, as well, the gradual replacement of self-objects with a more mature, consistent, self-structure.

In his treatment of patients suffering from narcissistic disorders, Kohut emphasized the impor- tance of empathy on the part of the psychotherapist. He believed that this was a key component of the healing process, but that it was not sufficient in and of itself. In other words, having some- one respond to us with empathy will not necessarily change our maladaptive behavior patterns.

Kohut emphasizes the central importance of emotional attunement in healthy personality development. In fact, this type of emotional responsiveness on the part of the parent may be necessary for the development of healthy brain functions. There is mounting evidence to suggest that humiliation may actually damage the brain, negatively influencing brain structure and func- tion (Cozolino, 2006; Siegel, 1999). The explanation is that the experience of humiliation can result in a state of acute stress, leading to the release of the stress hor- mone cortisol. Excessive production of cortisol over an extended period of time can have negative effects on the body (Dickerson & Kemeny (2004). As a result, early shame experiences can impact brain develop- ment (Schore, 1998).

Kohut also introduced the concept of transmut- ing internalization, which refers to the growth-pro- ducing process by which self-object relationships become internalized, leading to a normal notion of self in which the self-concept includes other objects, yet remains distinct from those objects. In Kohut’s

Stockbyte/Thinkstock

Is this child suffering neurological damage?

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CHAPTER 33.2 Early Development of Contemporary Psychodynamic Approaches: Self Psychology

language, this results in normal, stable psychic structures. Psychic structures refer to our inter- nal object relations (simply put, our internalized notions about what relationships with others are or should be). The current terms schema and template are used interchangeably with psy- chic structure.

The process of transmuting internalization involves three steps:

1. The psychic structure is receptive to absorb introjects (literally, internalizations of others’ ideas, or the turning of feelings for others toward oneself).

2. These internalizations are, to some extent, frustrating: They don’t satisfy all the infant’s needs, and this leads to a sense of loss in the infant. This frustration and mourning is considered essential for the development of normal personality structure as it leads the infant to replace some of the functions of the lost object. Thus, according to Kohut, minor parental absences, failures, and disappointments all play a fundamental role in the infant’s development of self.

3. Finally, minor losses and parental absences prevent total identification with the object (the parent), allowing for the development of a differentiated self.

What Kohut is saying, basically, is that a child will gradually take in the features of a parent. At first, the entire parental matrix will be taken in either as “good” or “bad,” and then slowly, over time, the good and bad parts will be integrated into a coherent picture of the parent. Through this process, Kohut believes children develop their internal structure. For some, especially those with delayed emotional development or those with some personality disorders (discussed in Chapter 10), this process is delayed well into adulthood or may never occur.

Identity Development Kohut believed that the mirroring process is, then, the first step in the long journey of identity for- mation. Once the infant begins to develop an internal structure, that structure will be challenged and revised continually according to what the child, and then the adult, experiences across the lifespan. This global perspective on self psychology brings us to the work of Erik Erikson.

Erik Erikson as an educator, intellectual, and clinician who had a vast influence on both theo- retical and practical developments in contemporary psychoanalysis (E. H. Erikson, 1970). Erikson was analyzed and mentored by Anna Freud, who influenced his decision to become a lay analyst. Although he never received a doctoral degree in medicine or psychology, he held teaching posi- tions at prestigious universities, including Harvard, and made a major contribution to psycho- analysis in 1950 with the publication of his book, Childhood and Society.

Erikson’s theory of psychosocial development rests on the assumption that cultural forces are a vital aspect of an individual’s growth and development. He postulated the epigenetic principle— the idea that how the biological origins of behavior manifest in a particular individual is influenced by the available environmental factors. Erikson states that individuals develop through a series of eight stages, each of which is defined by key developmental tasks that need to be mastered before proceeding to the next stage. For example, Erikson believed that if the infant was unable to suc- cessfully negotiate the early stage focusing on the discernment of when to trust others and when to be more cautious (i.e., trust vs. mistrust), then he or she would likely struggle with properly negotiating later stages, such as finding a lifelong romantic partner (i.e., intimacy vs. isolation). Importantly, he viewed personality development as occurring over the entire lifespan, and each stage as offering a different set of challenges. The stages of life, as Erikson (1959) outlined them, along with the corresponding Freudian psychosexual stages, are shown in Table 3.1.

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CHAPTER 33.2 Early Development of Contemporary Psychodynamic Approaches: Self Psychology

Table 3.1: Erikson’s eight stages of personality development and the corresponding Freudian psychosexual stages

Erikson Freud

Infancy Trust versus mistrust Autonomy versus shame/doubt

Oral stage Anal stage

Childhood Initiative versus guilt Industry versus inferiority

Phallic stage Latency stage

Adolescence Identity versus confusion Early genital

Adulthood Intimacy versus isolation Generativity versus stagnation Ego integrity versus despair

Later genital

According to Erikson, success at one stage of development and the manner in which the life crises are resolved will necessarily affect the following stages, as the number of positive versus nega- tive outcomes at each stage will determine the long-term impact of experiences. In each stage are embedded developmental challenges, such as separating from parents, establishing a career path, leaving home, and selecting a mate. Progression to the next stage requires overcoming the challenges of the preceding stage, and there is some support for the contention that successfully negotiating earlier stages leaves one better able to manage stressful adjustments in the future (e.g., Marcia, 1966). It should be noted that there have been some attempts to both realign and even expand Erikson’s basic stages, especially the stages of later life (e.g., Erikson & Erikson, 1997). However, the original eight-stage theory remains as the most commonly referenced and widely used model.

The Significance of Identity and Identity Crisis Identity is a central concept in Erikson’s (1968) theory. It relates to individuals’ sense of self, of who they are and who they can be. Erikson believed that identity is characterized by a sense of continuity and integrity, a notion that one’s meaning as an individual is real, identifiable, and rec- ognizable by significant others. Erikson is also the one who coined the term “identity crisis.”

Erikson believed that the timing of the adolescent identity crisis is driven by a number of dramatic changes occurring at this stage in life, including sexual and physical maturation, and becoming more aware of how others view us. As a result, our sense of who we are is challenged. Erikson believed that the ease with which one navigates this identity crisis is driven in large part by the negotiation of the earlier stages. Thus, if one successfully masters the discernment of when and whom to trust and develops a sufficient degree of autonomy and mastery, then they should have a more coherent sense of self.

It appears that Erikson’s stages are strongly influenced by the social-developmental opportunities and expectations in our culture. For example, the age at which one deals with intimacy versus isola- tion has less to do with some invariant developmental milestone, and more to do with social and cultural norms of when people in a given culture or society typically begin to date or get married. For example, consider the average age at which people first marry, which tends to be at a later age in societies where a larger number of individuals attend college (as with most first-world countries). In contrast, in societies where higher education is a rare occurrence, then the bulk of the population

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CHAPTER 3 3.2 Early Development of Contemporary Psychodynamic Approaches: Self Psychology

is likely to deal with intimacy and isolation (at least when defined by marriage) at a much earlier age (United Nations, Department of Economic and Social Affairs, Population Division, 2000).

Perhaps the most noteworthy of Erikson’s contributions was the suggestion that identity develop- ment extends well into adulthood (notice that three of Erikson’s stages are hypothesized to occur post-adolescence, whereas Freud had only one stage during this same period). For example, Erikson noted that a central task of midlife is that of generativity versus stagnation, where individuals are focused on assessing their contributions to, and guidance of, future generations. Erikson argued that engaging in socially valued work is a direct expression of generativity. He argued that generativity could also be achieved through one’s family; however, having children in and of itself does not neces- sarily result in generativity. Thus, individuals who believe they have productively contributed to the next generation will emerge favorably from this stage, whereas a person who has led a more self- centered life will be unsatisfied with their lack of contributions and experience stagnation.

The final stage of integrity versus despair also involves a life review with a focus on one’s life achievements. If the life review results in identifying many disappointments and unachieved goals, then the consequence is depression. Interestingly, a large epidemiological study (Mirowsky & Ross, 1992) indicates that depression reaches its peak levels in older adults (aged 80 and up), and the National Institute of Mental Health reports that suicide rates among those aged 80–84 is twice that of the general population (National Institute of Mental Health, n.d.). Although the higher rates of depression and suicide are likely influenced by factors such as declining health, losses (e.g., death of spouse), and economic declines, Erikson might argue that this finding reflects a negative outcome in the integrity versus despair stage.

Regrets may be an inevitable part of life, but how we manage our regrets can determine the extent to which they influence us negatively (Wrosch, Bauer, & Scheier, 2005). Erikson associated the last stage of his theory with a life review, in which the individual might compare unachieved goals with achieved goals to assess integrity versus despair. One approach to conceptualizing this late life review is to consider regrets. Research suggests that how we think about our regrets can influence how available they are to us (i.e., how easily they are remembered) and the emotional pain associated with regrets (Gilovich & Medvec, 1995; Gilovich, Medvec, & Kahneman, 1998; Gilovich, Wang, Regan, & Nishina, 2003).

A study examining 155 older community college students (older community college students were explicitly targeted because they were reporting significant life changes, such as divorce, job change, or return to school) used regret and goal ratings to predict psychological well-being (Lecci, Okun, & Karoly, 1994). The most common regret reported was educational/academic in nature (nominated by approximately a third of the sample), and this was likely influenced by the fact that the data were collected in an academic environment. The other two most common categories were occupational regrets and leisure (i.e., hobby-related) regrets. The relative frequencies of these content categories were the same regardless of the age of the respondents. The number of listed regrets did relate positively to depression scores for all participants, but they only related to life satisfaction for the oldest subjects. That is, for older individuals, the more regrets they had, the lower their life satisfaction. Part of this can be explained by the fact that as we age, we have fewer opportunities to make amends for any regrets (i.e., they are more permanent), and thus they come with a higher cost.

These findings suggest that regrets in later life can be predictive of psychological well-being (as per Erikson’s theory). However, it is not how many regrets we have, but rather how we think about them and how they relate to our future goals that is more influential to our level of adjust- ment (see Wrosch et al., 2005). Importantly, this better reflects the individual difference approach

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CHAPTER 3 3.2 Early Development of Contemporary Psychodynamic Approaches: Self Psychology

adopted in personality, as it highlights the importance of how we interpret these events rather than their mere occurrence (see also Chapter 6 for a discussion of the cognitive approach and idiosyncratic interpretations of events).

In the previous sections, we have discussed core aspects of human development, such as mirroring and identity formation. However, some individuals experience less adaptive outcomes, whether that be due to the absence of effective mirroring, difficulties negotiating some of Erikson’s theo- retical stages, or some other traumas in early identity formation. The next section discusses one area that has received considerable theoretical and research attention.

Development of Narcissism Kohut developed a model similar to Winnicott’s, in some respects, especially in its emphasis on the importance of early relationships in the development of self and personality. Kohut’s primary focus was on the development of the self from the fragile and fragmented state of the infant to the stable and cohesive adult self-structure. He did not agree with the classical psychoanalytic view that considered intrapsychic conflicts as the central cause of psychopathology. Instead, Kohut believed that most psychopathology resulted from deficiencies in the structure of the self (Millon & Davis, 1996b, p. 52). Kohut also rejected Freud’s conceptualization of psychosexual develop- ment as being the formative factor in personality development. Instead, he believed that the drive toward maturation was fueled by an innate potential that he called narcissism.

Like Winnicott, he also believed that attachment to the primary caretaker is crucial for this aspect of development. Kohut’s formulation, following Freud’s early conceptualization, described narcis- sism as the investment of libidinal energy into the self. In pathological states, too much libidinal energy is invested, result- ing in an extreme form of self-love, which limits the possibility of establishing other loving relationships. He explains that the child’s early experience is part of the mother–infant dyad, undifferentiated from it. It serves as a precursor to the “I-you” differentiation that occurs in nor- mal development, but does not occur in pathological forms of narcissism (Kohut, 1986). When there is an appropriately responsive caregiver, the self develops optimally, but when there is a lack of empathic attunement, which is the responsiveness of an attentive and loving caregiver, the emerging self falters.

Kohut believed that exhibitionism, which is the act or practice of deliberately behaving so as to attract attention, was the narcissistic manifestation of all drives. That’s because, in the narcissistic individual, the drives for intimacy and sexual gratification are directed toward the self instead of toward others. The primary goal that drives exhibitionism is that of re-creating the wished-for parental response. Children’s normal exhibitionism is motivated by their need to obtain paren- tal approval. As development proceeds, this normal need is increasingly frustrated, eventually leading to more mature and socially acceptable behaviors. Yet, the older child still looks for the

Glen Wilson/©Warner Bros./Courtesy Everett Collection

Is this man a narcissist? Kohut argues that for narcissists, sexual gratification and intimacy comes from focusing attention on oneself versus someone else.

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CHAPTER 3 3.2 Early Development of Contemporary Psychodynamic Approaches: Self Psychology

mother’s smile, her approval, to maintain the drive toward mastery and more mature functioning. Kohut (1971) believed that a healthy individual is autonomous and possesses high self-esteem and self-confidence. In contrast, individuals suffering from narcissism have fluctuations in self- esteem, often triggered by perceived slights or disapproval. Thus, to maintain consistently high evaluations of self, they need constant external validation (e.g., praise from others).

Among the hallmark signs of narcissism is that the individual has a self-centered viewpoint, which can undermine their ability to understand and appreciate the views of others. Indeed, past research suggests that narcissists often see themselves quite positively (Clifton, Turkheimer, & Oltmanns, 2004). This can be described as a narcissistic ignorance view (i.e., they do not know the views of others). Alternatively, it is possible that narcissistic individuals are aware that those that know them well hold negative views, and as a result, they would see new acquaintances as having a (relatively) more favorable view of them compared to people who know them well. This can be described as a narcissistic awareness view.

A study by Carlson, Vazire, and Oltmanns (2011) was designed to compare the narcissistic aware- ness and ignorance views by comparing how narcissists are seen by others (referred to as others’ perception), to how they view themselves (self-perceptions), to how they believe they are viewed by others (meta-perceptions)—both those who know them well and new acquaintances. Unac- quainted participants came to the lab in pairs and completed a self-perception measure and a standardized narcissism measure: the 16-item Narcissistic Personality Inventory (Ames, Rose, & Anderson, 2006), which measures traits such as exhibiting a grandiose sense of self, feelings of entitlement, lack of empathy for others, and an exploitative interpersonal style. Next, participants were introduced and instructed to get to know each other by talking for five minutes. Participants were then taken back to their separate rooms where they provided perceptions of their part- ner’s personality (i.e., other-perceptions) and perceptions about how they thought their partner perceived their personality (i.e., meta-perceptions). Individuals also identified three people who knew them well and they were contacted via email for personality ratings (there was a 67.7% response rate from these nominated individuals, who were mostly friends and parents).

Self-perceptions, meta-perceptions, and others’ perceptions were all assessed with the same questionnaire with only a minor change in instructions, and all items were rated on a 7-point Likert-type scale (1 5 strongly disagree to 7 5 strongly agree). Some key findings indicate that nar- cissism was associated with holding positive self-perceptions and with being seen more positively by new acquaintances than by well-acquainted others. Moreover, narcissists’ meta-perceptions for positive traits appeared to be less positive than their self-perceptions of those traits. A second study by Carlson and colleagues (Carlson et al., 2011) that was longitudinal in nature also indi- cated that the ratings changed, such that narcissists had some awareness that their reputation was deteriorating over time.

Understanding whether narcissists have some self-awareness is important from a practical stand- point, as poor self-insight makes it less likely that these individuals would be motivated to seek treatment or would try to effect any change, simply because they would be unaware of the need for any change. The current research suggests that they do possess some insight, though they are biased toward assuming that others’ view them somewhat favorably.

Core Effects of Narcissism: Shame and Rage Kohut’s formulation of narcissism emphasized the emotions of shame and rage. These emotions, he explains, result from disequilibrium of the intrapsychic system. Shame arises when the paren- tal figures—self-objects—do not provide the needed mirroring, admiration, and approval of the

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CHAPTER 3 3.3 Early Development of Contemporary Psychodynamic Approaches: Ego Psychology

emergent self of the child. Mirroring, as we saw, is the ability to respond to the affective state of another person. Through mirroring, children learn that they are distinct from the parental fig- ure. This allows them to form healthy relationships. Rage, the other core emotion in narcissism, is a reaction to a range of possible frustrations of the infant’s narcissistic tendencies. It arises from an unresolved psychic injury related to the infant’s early narcissism. For example, if mothers are continually unresponsive to their children’s need for admiration, the result may be rage and developmental fixation. This fixation can last into adulthood, where what had been an age- and phase-appropriate response—frustration and anger in response to perceived injury—is no longer appropriate. Kohut refers to this as narcissistic rage and likens it to the fight component of the flight-or-fight response. The importance of rage and shame within the construct of narcissism is reflected by the fact that a recently developed measure of narcissism (e.g., the Pathological Nar- cissism Inventory; Pincus et al., 2009) incorporates these as two central components.

Most of us have experienced episodes of severe anger or rage when we are injured or we are prevented from reaching our goals. These can sometimes be appropriate responses. But narcis- sistic rage and anger are different. According to Kohut, narcissistic rage results from injuries to a person’s self-concept or sense of esteem. As an illustration: When his wife did not serve dinner at precisely 5:30 pm, a narcissistic male became enraged and smashed his plate of food on the floor—and then expected his wife to clean it up. He experienced his wife’s failure to comply with his demands as a major injury and responded with uncontrolled narcissistic rage.

3.3 Early Development of Contemporary Psychodynamic Approaches: Ego Psychology

Heinz Hartmann who trained as a physician and emigrated from Austria before World War II, elaborated another important development in contemporary psychodynamic theory: ego psychology (1939/1958, 1964). As the label implies, Hartmann attributed greater signifi- cance to the ego than Freud did.

The ego, as defined by Freud, is the level of personality that mediates between the instinctual forces of the id and the value system and conscience of the superego. Hartmann was concerned with presenting a conceptualization that would describe not only pathology but also healthy per- sonality functioning. His was one of the earliest calls for a psychology of healthy functioning as opposed to a psychology preoccupied with neurotic adjustment. (This trend has continued with the current positive psychology movement.) The traditional view had long been that the main cri- terion of mental health is freedom from the symptoms of abnormality. Hartmann (1964) objected to this view.

Modes of Normal Functioning Normal functioning, as opposed to neuroses, Hartmann (1939/1958) explained, is a function of adaptation. And normal, healthy adaptation is largely a function of the ego. After all, the ego is concerned with self-preservation. In other words, Hartmann was suggesting that the ego is that part of our internal operating system that adapts to the demands of the world. It learns to adapt more effectively as we grow and develop. In a sense, this is an example of the gradual evolution of more mature ways of functioning and solving problems. Clearly, an adaptive solution at one phase in development might not be adaptive later, as environmental demands and social circumstances change. For example, crying may be a very effective solution for a frustrated 3-year-old whose

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CHAPTER 3 3.3 Early Development of Contemporary Psychodynamic Approaches: Ego Psychology

parent will give her the coveted toy, but it is a far less adaptive solution for the college student who covets a new sports car or higher grades (though this hasn’t stopped some from trying this method).

Ego functions are essentially what we would describe as coping mechanisms, explained in terms of what Hartmann called ego adaptive capacity. Someone with good ego functions (high ego adap- tive capacity) is able to maintain a balance between demands of the outer world and internal needs and desires. Good ego functions include the capacity to tolerate frustration, disappoint- ment, and other forms of stress. According to Hartmann (1939/1958), those with strong ego adap- tive capacity make limited use of defenses; they have a high capacity to tolerate anxiety without calling on defense mechanisms. This is in marked contrast to Freud, who viewed the utilization of a wide range of defenses as a sign of being adaptive.

Interpersonal Functioning Harry Stack Sullivan, often considered the founder of ego psychology, emphasized the role of interpersonal factors in ego development. That is, the ego’s primary role is to interpret and adapt to social demands, expectations, and roles. In fact, his theory was known as the Interpersonal Theory of Psychiatry, and he launched a movement that later became known as Sullivan’s school of interpersonal relations (Rioch, 1985).

Like Erikson, Sullivan believed that personality changed throughout our lives, but the impetus for that change was seen as changing and new relationships with others. Because the primacy of the social self in ego development is defined in terms of the presence of others, Sullivan believed that we adopted new ego identities to meet the demands of different social situations. Thus, in com- ing to college, a student will establish a new identity for that set of relationships. However, when returning home to be with family and friends, those individuals will engender the emergence of the identity they knew. In this respect, there is no single or fixed personality. (Consider the last time you ran into friends from high school. Did an old self emerge that was associated with those friends?)

Sullivan believed that interpersonal interactions drive the development of what he termed personifications of the self and others. Sullivan defined personifications as mental images (similar to the idea of object relations) that allow us to better understand ourselves and our world. Sullivan identified three personifications: (1) the bad-me (the aspects of ourselves that are negative and hidden), (2) the good-me (the aspects of our self that we like and openly share with others), and (3) the not-me (everything we consider not part of ourselves, in theory because it would induce too much anxiety to do so). Thus, focusing on the bad-me or the not-me is one way to increase anxiety.

Interestingly, Sullivan himself published very little theoretical or empirical work, but his ideas spurred the work of others.

Making Sense of the World and Using Defenses Jane Loevinger, whose work was based largely on that of Sullivan, believed that the primary func- tion of the ego is to help make sense of our world and everything we experience (Loevinger, 1976, 1987). As was the case with Sullivan, the bulk of the ego’s work is focused on object relations (i.e., it is grounded in interpersonal experiences). The ego helps makes sense of early relationships and both attachment and separation from one’s primary caregiver. The ego then attempts to make sense of interdependence and autonomy with respect to others and even society as a whole (note the overlap with many of the developmental themes outlined by Erikson and other theorists). This can also include gaining an understanding of societal rules, as these rules typically address issues

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CHAPTER 3 3.4 Malan’s Psychodynamic Model of Integration Theory

directly related to social interdependence. Thus, as we age, the ego also increases in complexity and in its ability to make sense of an increasingly complex world.

Even the ego psychologists spoke at length about defenses, and for the most part, they utilized the same terms and definitions as those forwarded by Freud. Indeed, Loevinger (1976) suggested that a primary function of the ego in any interpersonal interaction is to control impulses, and the ego mechanisms of defense were one of the primary ways of achieving this. Loevinger and more recent interpretations by Cramer (1987) suggest that as part of normal ego development, there is a sequencing in the emergence of defenses. Denial is seen as an immature defense that emerges early in the developmental sequence (i.e., childhood), and projection, which is also an imma- ture defense, is seen to be prevalent in adolescence. In an interesting study by Cramer (1999), the author sought to examine a group of subjects in their early 20s to determine if their use of defenses, such as denial and projection (both reflecting defenses that would indicate devel- opmental immaturity), could be predicted. Cramer hypothesized that these lower-level defenses would be associated with lower intellectual functioning (IQ) and with weak impulse control.

The participants in the study were taken from a longitudinal project that began tracking the par- ticipants at age 3. The current study examined 89 individuals (43 males and 46 females), who were aged 23 at the time of data collection.

Ego development was assessed using two methods, including the TAT, which is discussed in Chap- ter 2 and in this chapter. Defense mechanism use was assessed by trained coders using six of the TAT picture cards. As a brief illustration, denial was coded if the respondent omitted major char- acters or objects or denied reality. Projection was coded if respondents included magical thinking in their stories, or if they attributed hostility to other characters. Intelligence was assessed with a standardized measure during one of the previous waves of evaluation in the longitudinal study.

Results indicated that although IQ and defense mechanism use was unrelated, both variables predicted ego development. Importantly, the relation between the use of defenses and ego level varied as a function of IQ. When IQ was lower, use of denial and projection was associated with higher ego development. However, when IQ was lower, use of denial was associated with lower ego development.

Cramer (1999) concludes that ego development is influenced by both intelligence and defense mechanism use but in different ways. Intelligence resulted in a simple linear association, such that the higher intelligence the higher the ego development. However, the use of defenses appears to be more complex, with ego development characterized by lower impulse control resulting in greater use of defenses. This highlights the issue of developmentally appropriate defense use. In other words, while a young child who uses denial may be developing normally, it is considerably more problematic if denial is used extensively by an adult.

3.4 Malan’s Psychodynamic Model of Integrative Theory

Contemporary psychodynamic models of personality tend to be increasingly integrative in that they have assimilated many constructs from earlier theories. Psychoanalytic theorists were the first to develop a theory of personality, and contemporary formulations remain strongly rooted in psychodynamic concepts. Psychodynamic conceptualizations of personality have emerged primarily from the study and treatment of psychopathological adaptations and per- sonality disorders. Therefore, the main body of literature emphasizes personality disorders and

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CHAPTER 3 3.4 Malan’s Psychodynamic Model of Integration Theory

treatment approaches (Clarkin & Lezenweger, 2004). However, there are important constructs that can be used to organize and depict how normal personality functions. This section describes some of those, along with the theoreticians who developed them. David Malan (1979), a pioneer- ing psychiatrist, theorist, and researcher, has contributed important constructs for understanding personality and the contemporary psychodynamic treatment model. He developed two triangular formulations to explain the psychodynamic process. He calls them the triangle of conflict and the triangle of persons.

Malan’s Triangle of Conflict Malan’s triangle of conflict was borrowed from Ezriel (1952). It is used to show the processes that occur in the mind and body. This triangle depicts the interplay among underlying emotions such as anxiety (affective domain system) and the defensive operations that serve to control emotions and lessen anxiety. Malan (1979) combined these two representations and applied them to a form of clinical treatment called short-term dynamic psychotherapy (STDP). The triangles are useful for depicting the structure and process of many of the component systems that make up personal- ity. They describe the interrelationship between our intrapsychic and interpersonal functions. In other words, they show how our internal schema are expressed in our relationships with others, and the manner in which internal schema are expressed forms the basis of our personality (Mag- navita, 1997; McCullough Vaillant, 1997).

The triangle of conflict represents the intrapsychic functions (or mental processes) related mainly to affect-regulation (Westen & Blagov, 2007). The three corners of the triangle are feelings in the lower corner, anxiety in the upper-right corner, and defense in the upper-left corner. These three mental processes are hypothesized to be in constant motion within all of us (see Figure 3.1). The triangle of conflict is essentially a self-regulating feedback system (a cybernetic model). For example, an individual who has experienced a traumatic episode resulting in painful feelings and anxiety will tend to re-experience this affective complex in similar situations. Thus, experiences of physical or sexual abuse, typically associated with a range of emotions such as anger, fear, shame, and sadness, might result in the same emotions when the individual is confronted with stimuli that are reminiscent of the abuse. For example, when an adult male who was physically abused as a child sees another adult acting in a domineering manner with a child, it may trigger the same emotions he experienced as a child. (Note: These conceptualizations will later be labeled generalization in the behavioral perspective; see Chapter 5). As this complex of feelings threatens to surface into conscious awareness in a painful and possibly disorganizing manner, anxiety is trig- gered; the anxiety signals the intrapsychic system to call forth defenses. The theory assumes that defenses keep thoughts, images, and intolerable impulses out of consciousness awareness.

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CHAPTER 3 3.4 Malan’s Psychodynamic Model of Integration Theory

Figure 3.1: Malan’s triangle of conflict

The figure depicts the interplay among the underlying emotion of anxiety (affective domain system), and the defensive operations that serve to control emotions and in turn lessen anxiety.

Triangle of Conflict, from Jeffrey Magnavita, Theories of Personality: Contemporary Approaches to the Science of Personality, John Wiley & Sons, 2002, Fig. 6.3, p. 216. © Jeffrey Magnavita.

In this representation, we can place all the defense mechanisms discussed in Chapter 2 in the upper left corner of the triangle. In this way, we can begin to illustrate both the individuality we see in personality and some of the personality types that various theoreticians and researchers have documented. The array of defenses allows for infinite variation, accounting for individual dif- ferences. It is hypothesized that certain types of personality use certain constellations or clusters of defenses (Magnavita, 1997). For example, individuals described as having obsessive personality traits or, if extreme, an obsessive-compulsive personality disorder will generally use defenses such as intellectualization, isolation of affect, rumination, repression, and compulsiveness. Of course, there will be great variation in the specific combination of defenses that individuals will employ, and this can account for differences at a micro level of analysis. At the same time, at the macro level, the similarities will make overall obsessive-compulsive traits recognizable.

Defense Categorization

Phoebe Cramer (1998) offers a more contemporary working definition of a defense mechanism:

The term “defense mechanism” refers to a mental operation that occurs outside of awareness. The function of the defense mechanism is to protect the individual from experiencing excessive anxiety. According to the older, classical psychoana- lytic theory, such anxiety would occur if the individual became aware of unaccept- able thoughts, impulses, or wishes. In contemporary thinking about defenses, an additional function is seen to be the protection of the self—or self-esteem and, in more extreme cases, protection of the self. (p. 885)

This definition combines elements of both classical and contemporary psychodynamic thinking. Anxiety is seen as emerging from threats of perceived danger from the external world. It can also result from internal threats—conflicts deriving from our fear of expressing our impulses. In addi- tion, anxiety can be generated by a challenge to our internal schema or object relations. This defi- nition is in keeping with recent research characterized as Terror Management Theory (TMT), which

Impulse/Feeling

AnxietyDefense As anxiety is mobilized, defenses are called into operation to contain the anxiety.

When too much feeling threatens to become conscious, anxiety is elicited.

When the anxiety reaches a certain threshold, the defenses contain or repress the feeling.

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CHAPTER 3 3.4 Malan’s Psychodynamic Model of Integration Theory

suggests that anxiety and other negative reactions emerge as a means of preserving one’s own worldview and meaning of reality (e.g., Greenberg, Pyszczynski, & Solomon, 1986; Pyszczynski, Sol- omon, & Greenberg, 2002; Solomon, Greenberg, & Pyszczynski, 1991a). (Recall how the ego was defined as playing a significant role in understanding the world.) Interestingly, TMT research has also identified self-esteem as a way to reduce anxiety (Greenberg, Simon, Pyszczynski, Solomon, & Chatel, 1992), and this too would be consistent with the discussed theories on ego development.

Various authors have placed the defense mechanisms into categories (Meissner, 1981; Perry, 1992; Vaillant, 1992). Doing so gives us another way to understand and measure variability in personality. Most authors place defenses along a continuum, from psychotic, to immature, to neu- rotic, to mature (see Figure 3.2). These categories of defenses are not precisely defined, and there is some overlap among them. However, the general schema does have some empirical validation (Vaillant, 1992) and can be useful for organizational purposes. Figure 3.2 represents a compilation of defenses from various sources (Magnavita, 1997).

Figure 3.2: Categories of defenses

A compilation of a number of defenses and their general organization.

Adapted from Magnavita, J. J. (1997). Restructuring personality disorders: A short-term dynamic approach. New York: Guilford Press.

Psychotic defenses

Immature Neurotic Mature

• Delusional projection • Severe denial • Distortion (cognitive/perceptual)

• Projection • Schizoid fantasy • Hypochondriasis • Passive-aggression • Acting-out • Dissociation • Blocking • Introjection • Regression • Externalization • Splitting • Projective Identification • Devaluation • Idealization • Omnipotence • Withdrawal • Explosiveness of affect • Weepiness • Depression

• Repression • Displacement • Reaction formation • Intellectualization • Somatization • Controlling • Isolation of affect • Rationalization • Sexualization • Undoing • Detachment • Avoidance • Compartmentalization • Complaining

• Altruism • Humor • Suppression • Anticipation • Sublimation

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CHAPTER 3 3.4 Malan’s Psychodynamic Model of Integration Theory

Anxiety: A Common Aspect of Human Existence

Defenses are one corner of the triangle; anxiety is another. In psychoanalytic theory, anxiety arises from unacceptable id impulses that would present a serious threat to the superego if they were to break through to consciousness. In contemporary psychodynamic theory, anxiety can result from conflict and associated emotions that are not experienced fully at the conscious level. The individual may fear experiencing certain emotions that could cause anxiety (McCullough, 2003). Each of us has a different level of emotional tolerance, depending on our ego adaptive capacity.

Anxiety is a universal emotion that is essential for our adaptation. When you walk through a dan- gerous neighborhood at night, you may experience fear because of potential danger. Simply think- ing about walking in that neighborhood may arouse the related emotion, anxiety. You may also experience anxiety when public speaking, even though there is no threat of harm. Rather, there is a psychological threat to the self, which could result in a narcissistic injury—“I am not good enough” might be the associated internal negative belief. Most theorists assume that there is a clear connection between the original manifestations of fear, which are more directly linked to situations where there is mortal danger, to the psychological sense of fear that develops later in life, which is focused on an injury to the psychological self, broadly defined.

Anxiety includes both a subjective sense of distress and physiological activation, reflected in changes such as increased heart rate, palpitations, sweating, need to urinate, sweaty palms, dry mouth, muscle tension, nausea, tightness in the chest, and restlessness (autonomic arousal). Most of us can recognize when we are in a state of increased anxiety; we are familiar with our own constellation of physiological reactions. For many people, imagining being asked to stand up in front of a class to give an extemporaneous talk is sufficient to bring about autonomic arousal associated with anxiety.

Various types of anxiety have been described in psychodynamic literature. They include (1) sepa- ration anxiety—fear relating to loss of a significant other; (2) castration anxiety—fear of damage to the body, especially to the genitals; (3) moral anxiety—fear of violating one’s values; (4) annihi- lation anxiety—fear of being destroyed or overwhelmed; (5) fragmentation anxiety—fear of disin- tegration of the self; and (6) persecutory anxiety—irrational fear of harm to loved ones (PDM Task Force, 2006). Anxiety includes an emotional and physiological experience as well as a cognitive component. Over the course of development, anxiety tends to shift from being mostly a somatic (bodily) experience (e.g., physical symptoms, such as sweating, tingling, heart palpitations, etc.) to a psychic or mental phenomenon (e.g., thoughts of worry, low sense of control over events, etc.).

Feelings/Affect/Emotions: Our Interpersonal Survival System

Anxiety and defenses are two of the corners of the triangle of conflict; the third relates to feelings (affect or emotion). Researchers in affective science have identified six probable basic emotions (anger, fear, sadness, disgust, happiness/joy, and surprise) and three secondary or social emotions (guilt, shame, and pride) (Davidson et al., 2003; Maine & Bonanno, 2001). In keeping with the contemporary psychoanalytic models, neuroscientific findings support the belief that both feel- ings and cognitions can exist at the unconscious level (Anderson, Reznik, & Glassman, 2005; Lane & Nadel, 2000).

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The purpose of emotions is to facilitate and guide our responses to environmental circumstances, and psychopathology reflects a deficit in emotional processing (Newman & Lorenz, 2003). Feelings orient us to what needs to be attended to in our life and give meaning and importance to various activities necessary for survival and growth. In this sense, they are our personal navigational sys- tem. When individuals are out of contact with their feelings, we see them as emotionally flat or wooden. Like Sheldon, the character from the television series The Big Bang Theory, who seems to only process his experiences at an intellectual level, these people miss much of the meaning of social interactions. Instead, emotions should be experienced as bodily reactions and interpreted through internal cognitive appraisal. They are communicated to others through facial expression (Ekman & Rosenberg, 2005), gestures, and vocal expression (Davidson, et al. 2003).

The affective system and how it is managed by defenses is an important component system of per- sonality. All of us can be placed on an emotional continuum with regard to how well our emotional system functions. We might describe certain people as being emotionally reactive, suggesting that they have trouble regulating their emotional system. In fact, extreme emotional dysregulation is a central feature of some forms of severe personality disorders. Other people appear emotionless and in fact are emotionally inexpressive. And most display emotional reactions that we consider normal for their social and cultural circumstances.

Malan’s Triangle of Persons: The Interpersonal Matrix Basing his work on what Karl Menninger (1958) had earlier presented as the triangle of insight, Malan renamed it the triangle of persons to better describe the hypothesized interpersonal or dyadic nature of these processes. The model shows how early attachment relationships are encoded (represented by means of internal schema), and how past relationships (early attach- ment or object relationships), current relationships (relationships in our current life), and the ther- apeutic relationship (transference that occurs in the therapeutic process) parallel one another in terms of core relational themes.

The triangle of persons represents interpersonal relationships. At the lower corner of the triangle are past relationships, as seen from the adult’s vantage point. This represents core relational experiences, starting with early attachments that shape the individual’s ideas about trust, inti- macy, and attachment to others. If an individual has positive, growth-promoting attachments, the emotional network will develop without the need for excessive or restrictive defensive func- tioning. Malan’s theory suggests that if the early relational system is disturbed, defenses will be developed in an attempt to protect the self in the most adaptive way possible.

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CHAPTER 3 3.4 Malan’s Psychodynamic Model of Integration Theory

Figure 3.3: Personality as expressed in the triangle of persons

Malan proposed that personality is created, maintained, and expressed in the context of our mental representations of interpersonal experiences.

From Jeffrey Magnavita, Theories of Personality: Contemporary Approaches to the Science of Personality, John Wiley & Sons, 2002, Fig. 6.3, p. 216. © Jeffrey Magnavita.

The theory suggests that as individuals mature, the early components of the relational matrix in which they were immersed will be retained, internalized, and re-created in relationships with oth- ers (see Figure 3.3). These then become characteristic traits and relational patterns that mark part of our personality. Psychodynamic therapists also note that these patterns of interpersonal rela- tionships are brought to the therapeutic relationship and become part of the therapist–patient dynamic (Luborsky & Crits-Christoph, 1997).

Using the Triangles to Explain Personality Development and Organization Personality is shaped by our positive and negative experiences in the interpersonal domain (depicted by the triangle of persons). These interpersonal experiences, interacting with tempera- ment dispositions, lead to the building of an intrapsychic matrix (depicted by the triangle of con- flict). Thus, our personality is expressed in our interpersonal patterns as well as in how our intra- psychic matrix is organized and structured. For example, a father who tends to be authoritarian and controlling may create angry and hostile feelings in his son. To protect himself, the son may learn ways of expressing this hostility that are not open to direct attack. For example, the son might adopt a passive defense system, such as stubbornness, forgetting, and withholding love. Although he may appear to be compliant and pleasing on the surface, he is expressing hostility by resisting his father’s control in passive-aggressive ways. He may forget to do something his father has asked him to do or deliberately underperform in a sport his father values. If this type of personality pattern is consolidated over time, the son might become an individual who uses passive-aggressive traits to deal with conflict. This would leave him ill-equipped to deal more openly or constructively with his feelings of anger. (See Chapter 10 for a complete description of the personality disorders.)

Past Relationships

Current Relationships

Transference Relationship

Past relationship patterns are re-created in current relationships, expressing aspects of personality.

Past relationship patterns are re-created in the relationship with the therapist.

Personality is expressed in all interpersonal contexts.

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CHAPTER 3 3.5 Assessment Strategies and Tools for Contemporary Psychodynamic Models

3.5 Assessment Strategies and Tools for Contemporary Psychodynamic Models

Contemporary models of psychodynamic personality theory utilize a wide array of assessment strategies and tools, though many are similar to the projective tests reviewed in Chapter 2, with the key difference being that some of the assessment tools have since been revised. Thus, in this chapter, we will emphasize some of the revisions to the Rorschach and TAT, as well as the literature that evaluates the current status of psychodynamic assessments. We will also review the clinical interview and attempts to objectify that approach.

The Clinical Interview Psychodiagnostic interviewing methods and techniques are a mainstay of psychodynamic approaches. Psychodynamic theory emerged and was later expanded almost exclusively within the context of clinical settings while working with patients. Therefore, it is not surprising that one of the most central assessment tools for the contemporary psychodynamic theorists is the clinical interview to facilitate diagnostic decisions and treatment directions.

The structural interview, which was pioneered by Kernberg (1984) and Davanloo (1980), is used to assess the integrity and structure of the personality by presenting anxiety-provoking questions that serve to activate the defense system. This allows for moment-to-moment observation of how emotions are regulated, how defenses are mobilized when anxiety increases, and how effective the individual is with respect to interpersonal or object relatedness. Although this approach effec- tively maps on to contemporary object-relations theory as espoused by Kernberg, it lacks suffi- cient detail and standardization, thereby undermining some of the basic psychometric properties necessary to qualify as a formal test. Indeed, it might be argued that it is better characterized as a technique (see Dahlstrom’s 1993 criteria for what constitutes a psychological test).

More recently, a semi-structured inter- view was developed to capture Kernberg’s theoretical formulations, the Structured Interview of Personality Organization (Stern et al., 2010), and the data suggest that it has reasonable psychometric prop- erties when assessed in a clinical sample.

Although not specifically designed to capture the constructs forwarded by object-relations theory, other struc- tured diagnostic interviews have been developed, most notably the Structured Clinical Interview (SCID), described in Chapter 1, which assesses personality disorders outlined in the Diagnostic and Statistical Manual (DSM) of Psychiatric Disorders. There have been hundreds of published studies using the SCID, and it

iStockphoto/Thinkstock

Clinical interviews are used to gather background information on the client and guide the interpretation of standardized tests.

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CHAPTER 3 3.5 Assessment Strategies and Tools for Contemporary Psychodynamic Models

has been translated into many different languages, indicating its broad acceptance in the field and diagnostic success. The SCID was designed for use by trained mental health professionals and represents one of the more successful attempts at converting the DSM’s nosological structure into a usable diagnostic tool.

However, other attempts to standardize diagnostic interviews have been decidedly less effec- tive (e.g., Linden & Muschalla, 2012) with low to moderate inter-rater reliability (Rettew, Lynch, Achenbach, Dumenci, & Ivanova, 2009). One of the primary factors undermining the adaptation of clinical interviews into more standardized forms and tests is that they are less regimented; they rely heavily on the clinical skill of the diagnostician, as was noted in Chapter 1. However, research shows that a systematized assessment is superior to any test that relies primarily on the skills of a clinician (e.g., Dawes, Faust, & Meehl, 1989).

Projective Tests Another important assessment approach developed by psychodynamic innovators is a range of projective techniques. These include projective drawings such as the Draw-a-Person (DAP), House- Tree-Person, and Kinetic Family Drawing, as well as sentence completion forms such as the Rot- ter Incomplete Sentences Blank (RISB) and the Washington Sentence Completion Test (Weiner & Greene, 2008). These methods are based on the assumption that we tend to project our thoughts and feelings onto ambiguous stimuli—such as when we look at clouds and see fantastic worlds in them. Survey research suggests that despite their problems, projective tests remain somewhat popular (Lubin, Larsen, & Matarazzo, 1984; Watkins, Campbell, Nieberding, & Hallmark, 1995).

The Rorschach Test

Probably the most famous of the projective tests is the Rorschach Inkblot Method, which, despite considerable criticism, still holds an important position in both psychodynamic assessment and research. Indeed, this instrument continues to be used extensively in the personality assessment of both children and adults (Goode, 2001) and is the most frequently used among the projective tests (Lubin et al., 1984).

Developed in the 1920s by Swiss psychiatrist Hermann Rorschach (1921/1942), the test was based on a popular European parlor game that involved making inkblots and then telling a story about them. Rorschach devised the test by spilling ink on paper and folding it in half, creating symmetri- cal inkblots, 10 of which were selected for the test.

There are a variety of ways to score responses to Rorschach ink blots. In Chapter 2 we referred to the earlier scoring methods, but here we will describe one of the more thorough attempts to standardize the Rorschach. In 1986, John Exner devised a comprehensive scoring system, includ- ing a full standardization of the administration and scoring criteria, and this is now a widely used approach. Exner promoted four primary criteria for scoring:

1. The location of the response (i.e., the specific part of the card that is being referred to by the subject);

2. the rationale for why the subject had that particular interpretation (i.e., did the shape, color, etc. play a central role in the interpretation of the stimulus), referred to as the determinant;

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CHAPTER 3 3.5 Assessment Strategies and Tools for Contemporary Psychodynamic Models

3. the extent to which the response reflects popular (i.e., commonly cited) responses; and 4. the content of the response (e.g., does it refer to human, human-like, animal, human or

animal parts, blood, nature, etc.).

Exner also collected extensive norms and developed formulas to facilitate standardized scoring. As a consequence of these changes, Exner has taken what was a psychometrically inferior test, and developed an instrument with much improved reliability and validity (Hiller, Rosenthal, Bornstein, Berry, & Brunell-Neuleib, 1999).

Despite these apparent advances in the scoring, a debate continues as to the best way to utilize the Rorschach, with many practitioners still adhering to the older methods that rely more on clini- cal intuition (Moreland, Reznikoff, & Aronow, 1995; Ritzler, 1995).

The Thematic Apperception Test (TAT)

Another well-known and widely used projective test is the Thematic Apperception Test (TAT) devel- oped by Christine Morgan (who drew most of the pictures) and Henry Murray (Weiner & Greene, 2008). As discussed in earlier chapters, the TAT uses a series of ambiguous images and subjects are asked to provide a “dramatic” story that includes the events leading up to the image, the events occurring in the image, and the outcome (i.e., what will happen next). Most of those using the TAT select approxi- mately 10 cards and they rely on their own judgment in decid- ing which cards to use (Cramer, 2000). The rationale is that the ambiguity of the images will facil- itate a less defensive response set because the respondent feels less personally threatened about the material (i.e., it is perceived as a story about the picture, not about oneself).

The original scoring system is somewhat laborious and sub- jective (Vane, 1981), and other more recent clinical scoring sys- tems have been developed (see Holt, 2008). Like the Rorschach, the TAT has also received con- siderable criticism, most notable for its subjective scoring and questionable validity (Lilienfeld, Wood, & Garb, 2000).

Beyond The Text: Classic Writings

“What if you were asked to describe images you saw in an inkblot or to invent a story for an ambiguous illustration— say, of a middle-aged man looking away from a woman who was grabbing his arm? To comply, you would draw on your own emotions, experiences, memories and imagination. You would, in short, project yourself into the images. Once you did that, many practicing psychologists would assert, trained evaluators could mine your musings to reach con- clusions about your personality traits, unconscious needs and overall mental health. But how correct would they be?” (Lilienfeld, Wood, & Garb, 2001, p. 82).

In this thought-provoking paper, Lilienfeld and colleagues (2001) take a close look at the uses and misuses of projec- tive tests. Read it at http://www.psychologicalscience.org /newsresearch/publications/journals/sa1_2.pdf.

Hibbard’s 2003 paper provides an opposing view.

References: Lilienfeld, S. O., Wood, J. M., & Garb, H. N. (2001). What’s wrong with this picture? Scientific American, 284, 80–97. http://www.psychologicalscience.org/news research/publications/journals/sa1_2.pdf

Hibbard, S. (2003). A critique of Lilienfeld et al.’s (2000) “The scientific status of projective techniques.” Journal of Personality Assessment, 80(3), 260–271.

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CHAPTER 3 Summary

The Sentence Completion Test

Sentence completion tests provide respondents with sentence stems and ask them to complete each sentence with whatever comes to mind. The assumption is that the responses will reflect internal experiences, including attitudes and affect, and that that these responses can be scored and analyzed to reveal psychological aspects of the respondent (Loevinger, 1979, 1985). Relative to other projective tests, the sentence completion tests tend to have greater face validity. Like the other projective approaches, both subjective, clinician-driven scoring and more objective, quanti- tative scoring methods have been developed.

Summary

This chapter presents a synopsis of contemporary psychodynamic theory along with some of the important developments that later psychodynamic theorists advanced in an effort to expand on Freud’s psychoanalytic theory. Object relations emerged as what is arguably the strongest contemporary branch, and the primacy of attachment was emphasized by a number of researchers and theoreticians, most notably Winnicott. Object relations describe the process by which significant attachment figures are internalized and their representation (objects) are carried around inside each of us. This theoretical model converges with one of the basic assumptions of cognitive theory, as both emphasize internalized representations of the outside world (see Chap- ter 6). Winnicott developed the concept of the good-enough mother to explain how most mother- ing does not need to be perfect to produce satisfactory adjustment—it simply needs to be good enough. However, if it is not good enough, it may result in psychopathology.

Self psychology was pioneered by Kohut, who suggested that normal identity development requires the mirroring of emotional experiences from others. Other theorists, such as Erikson, proposed that normal personality development extends into adulthood. He describes various stages that need to be mastered before progression to the next stage, and suggested that iden- tity crises may occur at various developmental transition points. Narcissism is used to explain how development is derailed when the caretaker’s insufficient mirroring and lack of responsive- ness causes narcissism. Kohut believed that this narcissism then leads to the core emotions of shame and rage. In contrast, when narcissistic needs are satisfied, development of a healthy self is more likely.

Ego psychology focuses on the role of the ego in adapting to the world and the defenses used to protect the personality. Two foundation constructs, the triangle of conflict and the triangle of per- sons, can be used to depict the dynamic processes that occur among feelings, anxiety, and defense mechanisms, as well as patterns of interpersonal relationships.

Additionally, this chapter reviewed some of the primary assessment tools employed by contem- porary psychodynamic theorists and researchers, including the clinical interview and several pro- jective tests, whose scoring has been revised to more closely align with object-relations theory.

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CHAPTER 3 Key Terms

Key Terms

ego functions The mechanisms that allow an individual to maintain a balance between the demands of the outer world and internal needs and desires, as well as tolerate various forms of stress.

epigenetic principle The idea that how biologi- cal aspects of behavior are expressed in a par- ticular individual is influenced by the available environmental factors.

exhibitionism The act or practice of deliber- ately behaving so as to attract attention; the narcissistic manifestation of all drives.

good-enough mother The idea that the mother must be available at a critical level of parental functioning in order to fulfill the basic needs of uncomplicated developmental pro- gression and healthy development.

individuation The process by which the infant becomes increasingly separate from his/her primary caretaker in terms of identity and self-sufficiency.

mirroring The act of providing an accurate response to the thoughts, mood, and feel- ings of another, including both reflection and affirmation.

narcissism A personality disorder character- ized by extreme, pathological self-love.

object-relations theory The notion that each of us carries around in our minds certain well-established ideas (referred to as objects), often based on our early relationships with our mothers or fathers, that influence our later relationships.

personifications Mental images (similar to the idea of object relations) that allow us to better understand ourselves and our world.

psychic structures Our internal object rela- tions; our internalized ideas about what rela- tionships with others are like or should be like. Also known as a schema or template.

rage A core emotion in narcissism, that begins as a reaction to frustrations of the infant’s nar- cissistic tendencies.

shame A core emotion in narcissism, it rises when the parental figures—self-objects—do not provide the needed mirroring, admiration, and approval of the emergent self of the child.

structural interview Tool used to assess the integrity and structure of one’s personality by asking anxiety-provoking questions that serve to activate the defense system.

symbiosis The mother–infant unit, of which the child is initially an undifferentiated part.

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