PAPER 2

Treatment Plan According to Object Relations Theory

Brooke Weber

Counseling Theories

Dr. Jordan

February 23, 2019

Basic Concepts of Personality Development

According to Object Relations Theory (ORT), relationship of self and objects, or human beings, is strongly influential (Jordan, 2019). Sharf (2016) discusses various concepts among ORT, and include attachment, separation- individualization, splitting, integration-object constancy, and power aspects. Each concept holds additional keys to development, relationships, and the outcomes of each. Experiences that occur mostly in childhood and influence one’s development later in life (Jordan, 2019).

Basic Concepts of Development of Personality Disorder

Relationships with objects hold a strong influence on one’s personality development and the development of personality disorders (Sharf, 2016). In addition to relationships, attachment to others is crucial to development (Jordan, 2019). According to the PowerPoint by Jordan (2019), development is skewed when early relationships are affected, and is a key concept of personality disorders.

Approach to Assessment

A common theme in ORT are the effects of early relationships (Sharf, 2016). If an individual experiences a disconnect with relationships, a decline occurs as a result (Jordan, 2019). Based on ORT, assessment of the individual will need to include gathering symptomology and information regarding the client and the client’s relationships (Jordan, 2019).

The matrix of problem(s), important elements, and target behaviors, according to ORT, are discussed below (Jordan, 2019). According to the case study, Mark is the individual whose behavior is of concern. Mark is showing behaviors of self-harming which may include suicidal ideation, decline in hygiene, and decrease in the motivation for continuing and developing relationships with others. The symptomology started two weeks ago and are present currently. In addition to Mark’s symptoms, isolation from others and a decline in other established relationships has occurred. Mark’s symptoms seemed to develop from a traumatic experience, a car accident that resulted in the death of Mark’s wife and unborn child. For example, Mark has lost marital, parental, and friend relationships. Additionally, Mark was the driver during the accident and may feel responsible for the events that occurred (Jordan, 2019).

An assessment technique that would be used, according to ORT, include allowing the client to talk to build rapport, identify patterns within client’s relationships, and gather information regarding client’s symptomology and previous relationships (Jordan, 2019). By allowing the client to talk, a strong, therapeutic relationship can be build, which is the foundation of ORT (Sharf, 2016). Other assessment techniques utilized within ORT include gathering symptomology, using transference, assessing for patterns regarding relationships and client roles in relationships, personality testing, gaining input from others in the client’s life, and listening to and understanding the client’s life story (Jordan, 2019). Therefore, gathering further input from adjunct sources, such as Mark’s friends and mother, could be beneficial for ORT therapy. Not only are the adjunct individuals helpful for gathering information regarding Mark’s situation, but may also provide insight to Mark’s early childhood and past relationships (Jordan 2019).

Lastly, goals of therapy and how to determine goals are essential to assess. Sharf (2016) states that client should focus on improving relationships with self and others, and be able to determine patterns of relationships and roles in relationships. By exploring issues from early childhood, Mark will experience improved relationships (Sharf, 2016). The therapeutic relationship is a part of relationship building and is one of the main focuses of therapy (Jordan, 2019). Goals are set by assessing the client and the client’s past relationships (Sharf, 2016).

Interventions

Interventions utilized would need to focus on the four-step process within ORT (Jordan, 2019). The four-steps include engagement, projective identification, confrontation, and termination. Specific interventions and goals of each, and evidence-based strategies will be discussed in the following section (Jordan, 2019).

The interventions follow the four- steps of ORT (Jordan, 2019). The first steps include engagement and relationship building, which is the foundation of the ORT process. Building a relationship is essential and limitations that arise may be due to the lack of attachment the client experienced in early childhood. The goal of engagement is to establish a “real, authentic relationship”. The four-steps allow a strong rapport to be built, and the client to understand and experience a positive relationship (Jordan, 2019).

The second step is projective identification, and is when the client focuses on splitting to the negative self and tries to reinforce the behavior (Jordan, 2019). Being self-aware for both client and counselor are important in the second step, to limit reinforcing the unwanted behaviors. The counselor experiences countertransference, and attempts to guide the client to correct the disturbances of past attachment patterns (Jordan, 2019).

The third step is confrontation (Jordan, 2019). The therapist refuses to indulge in the client’s fantasy, and by doing so confirmation of the therapeutic relationship is built. The client is also encouraged to talk openly about the pattern of roles in past relationships. By doing so, the client may conceptualize the fantasy and normal relationship between client and therapist. The client can then internalize the normal relationship, complete developmental stages that have been affected by past relationships, and obtain a completed self. Confrontation allows the client to overcome the disturbance that resulted from the past and leads to decreased disordered relationships in the future (Jordan, 2019).

The fourth and final stage is the termination phase (Jordan, 2019). The client is able to create relationships without fear, externalize the relationship to the “real world”, and utilize feedback provided by the counselor. Utilization of feedback allows the client to be confident in creating new relationships to become a more complete self. The four stages allow the client to become independent, confident in relationships, and develop a complete self, which limits further disturbances (Jordan, 2019).

Evidence based techniques for interventions found include the use of empathy and transference (Conway, 2014). According to Conway (2014), empathy towards the client allows reflection and effective verbal responses. Empathy also assists in developing a strong client-counselor relationship, which is the basis of ORT. In addition to empathy, Conway (2014) discusses the importance of transference within the therapeutic process. Transference assists in establishing roles of client and counselor, and allows client to see oneself through the counselor’s perspective. Empathy and transference are utilized to build strong relationships in the therapeutic process, allow client to respond appropriately, and allows client to become a more complete self (Conway, 2014).

Role of the Therapist

The therapist utilizing ORT should have the following personal characteristics: flexibility, stability, empathetic, genuine, committed, and focused (Jordan, 2019). By facilitating therapy through the use of the previous personal characteristics, a strong therapeutic relationships may be established. Additionally, a strong relationship is the basis of an ORT approach (Jordan, 2019).

Therapeutic skills required and that are essential to benefit the client and the relationships include the use of transference, using micro-skills (e.g. empathy, mirroring), showing a strong, positive regard, and being authentic (Sharf, 2016). Transference allows the client to gain techniques and understanding from the counselor (Sharf, 2016). Micro-skills that are beneficial are listening, attending, and paraphrasing, and would positively impact the client-counselor relationship (Ivey, Ivey, & Zalaquett, 2016). Empathy allows the client to feel understood (Sharf, 2016). Additionally, mirroring positive regard allows the client to see and mimic a positive behavior which should then be transferred to the ‘real world’ (Jordan, 2019). Lastly, authenticity creates a real and beneficial relationship for object relations therapy to occur (Jordan, 2019).

The relationship between client and counselor should be trusting, supportive, and the basis of therapy (Jordan, 2019). According to ORT, the use of the personality characteristics and therapeutic skills listed above, will for a strong and trusting relationship. Therefore, the appropriate relationship will be formed and the main focus of ORT achieved. Additionally, the relationship is essential for improved outcomes of the client (Jordan, 2019).

Role of the Client

Mark is the client in the case study, according to ORT (Jordan, 2019). Mark presents with the symptomology necessary for diagnosis, and is experiencing disturbances. Based on the information given, Mark needs to be assessed for past relationships influenced the disturbances. Relationships to assess include mother-son and husband-wife. The mother-son relationship should be considered and determine if the aspects of the ‘good-enough mother’ affected the instabilities being experienced (Jordan, 2019).

The client is expected to participate and actively utilize the relationship techniques observed and performed in sessions (Jordan, 2019). The client will collaborate with the counselor to determine beneficial ways for the client to better relationships, resulting in a truer self. The client is able to be an active part of the relationship and should, by termination, apply social skills to real life situations. Additionally, the client should be more confident in future relationships and encouraged to seek relationships (Jordan, 2019).

Therapeutic Outcomes

Successful therapy is defined as the client’s ability to gain confidence and attribute that towards relationships, according to ORT (Sharf, 2016). Additionally, if ORT is successful, the client should gain strong relationships outside of the counseling sessions (Jordan, 2019). The client should be able to utilize and gain experience from the client-counselor relationship and transfer social and communication skills, to ‘real world’ experiences (Jordan, 2019).

Measureable outcomes for Mark would include decreased self-doubt and suicidal ideation, and better, continued relationships with mother, friends, and others Mark was once close to (Sharf, 2016). Successful therapy, based on ORT, can be measured by Mark’s relationships. Therefore, the success of the therapy is subjective and considers relationship types, utilization of social and communication skills, and Mark’s confidence regarding relationship and each relationship’s success (Sharf, 2016).

Personal Reaction/Evaluation to The Theory

The most essential part of the ORT is the focus of the client-counselor relationship for the client to incorporate skills and confidence into other relationships. By having the client mirror techniques, the client is able to practice skills which can be perfected for ‘real world’ use. Additionally, reviewing past behaviors may assist in determining how to become a truer self for the future. Reflecting back on past and present relationships seems to be beneficial, however, too high of a reliance on past relationships seems to limit growth, focus, and client’s positive regard. Therefore, determining past patterns then improving within various relationship areas would need to be incorporated into the sessions.

Much of ORT seems to be beneficial and focuses on several important factors for individuals. Relationships and the aspects and contributed strengths are important for individuals to understand and utilize. The basis of ORT seems to be strong and beneficial for the client and positive outcomes to occur. Ultimately, based on the theory’s strength, concepts, and focus I could see myself basing my practice on ORT.

References