CONCEPTUALIZATION AND TREATMENT PLAN 1 11
Running head: CONCEPTUALIZATION AND TREATMENT PLAN 1 1
Case Conceptualization Using Object Relations Theory
Sharon M Ray
Liberty University
Abstract
Object relations theory is the idea of a person's belief about themselves based majorly on their
experiences with their mother or other primary caregivers. Object relations theorists believe that
the results of these experiences determine a person's ability to interact with others from early
childhood into adulthood. This paper will share Celie Johnson's adventures with her mother and
father as a young girl and how those experiences impacted her life as an adult and wife. As well,
this paper will talk about how Celie viewed herself as a woman, mother, and child of God due to
her experiences with her family. Although Celie had bouts of anxiety, depression, and
abandonment, she was able to overcome the outcomes of those relational objects. Through
counseling, using object relations therapy, Celie Johnson eventually found peace within herself
and her abilities through the same people that caused her the initial pains. Celie now has her own
home, owns a boutique where she sews and becomes reunited with her children.
Melanie Klein, R.D. Fairbairn & Donald Winnicott
Stemming from Sigmund Freud's psychoanalytic theory, theorists Melanie Klein, R.D. Fairbairn,
and Donald Winnicott, believed that humans get motivated by the need to have relationships
(Buchele & Rutan, 2017). According to these theorists, this need to have contact with others
begins with a person's mother. The experience with their mother and other family members
during infancy will influence and have an impact on the way that person relates to other
individuals, or any parts of them into adulthood (Murdock, 2017). By this time, these people and
their experiences with them have become objects.
Rejecting classic and instinctual drive theory, as Sigmund Freud suggested, theorists Melanie
Klein, R.D. Fairbairn, and Donald Winnicott created object relations theory. Melanie Klein, had
a significant impact on psychoanalysis, emphasizing the importance of psychic representations of
relationships and primitive fantasy, particularly aggressive urges (Murdock, 2017). R.D.
Fairbairn, considered the most radical of the object relations theorists, believed that drives are
directed at objects, not at the pleasure of expressing the drive (Murdock, 2017). Lastly, Donald
Winnicott, a follower of Klein, contributed the terms "good enough mother" and "transitional
object" to the object relations theory (Murdock, 2017). The good-enough mother is the example
of being the object that positively influences and makes an impact on the way their child will
relate to others into adulthood.
Human Nature and the Counseling Process
Excluding Melanie Klein, object-relational theorists believe that humans get motivated by the
need to relate to others (Murdock, 2017). Although considered an object relations theorist,
Melanie has negative views about aggressive instincts in humans (Murdock, 2017). Other object
relations theorists, such as R.D. Fairbairn and Donald Winnicott, are more neutral regarding
human nature. Offering a more positive view of humans, these object relations theorists
emphasize the ego's adaptive capacities (Murdock, 2017).
In counseling, object relations theorists rely on observing the client's behaviors and verbal
content as clues to underlying dynamic processes, as opposed to using formal assessments
(Murdock, 2017). Tending more to the environment, these therapists view the counseling
relationship as a replica of the client's early relationship with their caregiver (Murdock, 2017). As
well, they also believe that an object relations therapist should not influence or intrude upon a
client so that their true self can safely emerge over their false self (Murdock, 2017). In the case
of Celie Johnson, the counselor will have to be careful with replicating the client's early
relationship with her mother. It is possible that Celie may be reluctant to tell the counselor about
what is paining her. This reluctance may be due to feeling responsible for her mother's death, as
she was fussing about what Celie told her about her father. However, the counselor may have an
opportunity to create a nurturing atmosphere that makes Celie feel as if she is speaking to her
mother.
Efficacy of Theory
There have been several different types of research regarding object relations theory and the
effectiveness of them. R.D. Fairburn conducted one of them. In his study, he extended Melanie
Klein's concept of the internalized, bad object. Fairbairn's theory demonstrated that children who
were subjected to both violence and neglect by a primary caregiver internalized the actions and
were drawn more to the caregiver, as opposed to hating or rejecting them (McCluskey, 2010).
However, the internalizing of these bad objects caused serious developmental outcomes,
specifically the formation of adulthood neurosis and delinquency (McCluskey, 2010).
Another research conducted on object relations theory was the use of diaries to represent
everyday life. Diaries can be unstructured, personal accounts that are organized texts or
established research traditions in which people are invited to keep for data to be aggregated and
analyzed for different purposes (Rinkinen, Jalas, & Shove, 2015). Celie Johnson could not read
or write. She emulated diary writing by talking to God throughout the day. As an adult, she
continued to keep a diary in the same way, beginning with saying, "Dear God."
Diagnosis
Traumatizing events can cause a person to hide feelings of love and aggression, as well as retreat
and undermine moving towards healthy adult dependency (Steinberg, 2010). Object relations
theory is known to be effective with anxiety, depression, and other psychiatric problems in
adulthood. These adversities, when stemming from childhood, are associated with early
separation from caregivers, emotional neglect, physical and sexual abuse, parental issues, and
overall family unhappiness (Heinonen, Knekt, Härkänen, Virtala, & Lindfors, 2018).
Theory Appropriateness
Although Celie Johnson is experiencing some abuse and abandonment issues, they began when
she was a young girl. Due to object relations therapy's focus is to deal with childhood
experiences, it will be the most appropriate therapy to use with Celie. This therapy will help
Celie to realize that what happened to her as a young girl was not her fault. It will also help her
to gain insight into different behaviors and that they are not gender-specific.
Potential Ethical and Multicultural Issues
Ethically, Celie may have some possible issues. She will be forced to face some disturbing truths
about her father. As an adult now, Celie has to acknowledge what happened to her, accept that
they happened, act on them by participating in therapy and achieving them by allowing herself to
heal. Lastly, Celie must be willing to complete her treatment without fear or uncertainty.
Multiculturally, there may also be potential concerns. The African American cultural practices
are that what goes on in one's house is to remain in that house. Doing the opposite will shame the
family, and the family may shame you. Therefore, no one, especially a child, is to discuss private
matters with outside people. Also, as a woman, it can be embarrassing to talk about or tell
someone what is going on. As well, receiving counseling was frowned upon in the African
American community. In the past, it said that a person was crazy or looking for attention.
Because of this, it may be difficult for Celie to share her story. Also, she may not tell the truth or
full truth as an attempt to protect the home. Lastly, she may not come at all.
Crisis Situations
After many years of different types of abuse and feeling abandoned by the few people she
believed truly loved her, Celie Johnson's cries for help are now in a crisis state. Celie is missing
her sister Nettie Johnson and friend Shug Avery. Because she feels that her husband, Albert
Johnson, is responsible for them leaving her, she is beginning to hate him. For many years, Celie
thought that her sister Nettie was dead because she had not received a letter from her; neither had
she returned. Recently, Celie found a stack of letters from Nettie. Her husband had been hiding
them from her over the years. Celie was so angry about what she saw, later that evening, she
grabbed the knife out of their Thanksgiving turkey and placed it against Albert's neck. As she
held the knife, she stated to him how he took her sister Nettie from her, knowing that she was the
only somebody that loved her. As others were able to calm her down and take the knife, Celie got
in the car with Shug Avery and her new husband. Feeling free, Celie was convinced to seek
counseling. In a heated moment such as this, object relations therapy is useful because it will
allow Celie to express her frustrations openly, immediately, and freely. Having the ability to do
this will give Celie a chance to calm down and rationalize the events that had just taken place.
Also, she will realize that her sister Nettie did not abandon or forget about her as she was starting
to believe. Celie will realize that she is a strong woman that can stand up for herself. As a
defense, she will be able to utilize projective identification to create a sense of distance from
unwanted, often frightening aspects of herself (Buchele, Bonnie & Rutan, 2017).
Interventions
Celie Johnson began experiencing adversities with abuse, separation, neglect, and abandonment
during her early childhood. Her mother passed away when she was young, and she continued to
be abused by her father. Not long after her mother's death, her father gave her away to an older
gentleman for marriage when Celie was only fourteen years old. Sadly, she continued to be
abused by her husband into her adulthood. Celie related men to abuse, neglect, rejection, and
fear. She related the women she loved in her life to a loss. Unfortunately, she has internalized this
behavior as normal and deserving of her. Therefore, to address Celie's anxieties about men and
her depression about losing the women close to her, using interventions of object relations
therapy would be most appropriate. They are more empathic, less critical, less likely to cause
narcissistic injury, and are more likely to be accepted by Celie Johnson (Buchele, Bonnie &
Rutan, 2017). Some of the techniques that will be used, but not limited to, are Free Association,
interpretation, and gaining insight. They will allow Celie to express her feelings freely,
immediately, and without fear. As well, they will help Celie understand her experiences, how to
address them, and feel better about herself concerning them.
Free Association
Celie Johnson has been forced to suppress her emotions since she was a little girl. Free
Association will be beneficial to her by allowing her to release any bottled-up emotions she has
had. The release of these words, thoughts, and feelings will decrease her anxieties and fears
about men and what Celie feels other people think about her. Chair therapy is the choice so that
she can confront herself and others.
Interpretation
Interpretation can also help Celie Johnson to understand what happened to her in the past. As
well as, she will understand why those things happened. The great thing about it is that Celie will
learn that the things that happened to her by her father, especially, is not her fault. Once Celie has
accepted that she is not responsible for other's behaviors, she will be able to set goals and move
forward. Male and female baby dolls will be used for Celie to demonstrate what they mean to her
separately. The question is, will Celie hide or throw away the female dolls to interpret
abandonment? Also, will she act out the abuse she suffered at the hands of the men in her life?
Gaining Insight
Gaining insight into behavior patterns and reasons for them, Celie Johnson will be able to forgive
her father and husband. She will also be able to forgive herself for blaming herself. Light will be
shed upon her spiritually that will ease her battle with depression. Celie will have a moment
where she will feel as if she just started breathing. Resources are given on personality disorders
and behavior patterns. As well, a mirror activity will be used for Celie to tell herself that it is not
her fault. Therefore, she will not only gain insight into the people that have abused or abandoned
her, but also on herself.
Spiritual Applications
Spiritual Challenges
Reflecting psychologically on the work of the Holy Spirit has several advantages (Parker, 2008).
Due to Celie Johnson's existing, strong faith in God, I do not foresee any challenges with
counseling her. Although she has had nothing but hurts, pains, and disappointments in her life,
her faith never wavered. Celie consistently kept a verbal diary with God, often talking to him
through her trials and tribulations. Assuming that Celie is interested in Christian Counseling, it
will be appropriate to continue making her aware of God's purpose in her life. Christian
principles and worldview would mesh in object relations therapy because human beings are
essentially good and have the capacity for growth and the capability to change (Jones & Butman,
2011). These principles apply to an individual, both spiritually and worldly.
Compatible or Incompatible with Christian Beliefs
Object relations theory has compatible and incompatible beliefs with Christianity. The first
compatibility it has with Christianity is Free Association. Similar to a counselor allowing a client
to express themselves to them freely, it is the same when God asks that you cast all your
anxieties upon him (1 Peter 5:7, New International Version NIV). The second compatibility is
related to interpretation. Before assuming something about a group of people based on the
behaviors of a few, it is wise not to believe that every Spirit is the same (1 John 4:1, NIV) and
not to judge others unless you want to be judged (Matthew 7:1, NIV). There should not be an
assumption that all people of a specific race, gender, culture, or any other group are the same.
Lastly, gaining insight is vital from a worldview, as well as a spiritual one. A person must know
and love God to have the ability to know and love themselves. God's instructions are to open
your eyes so that they may see wonderful things in his law (Psalms 119:18, NIV). When the truth
is sought, God will guide you into all of it (John 16:13, NIV). Therefore, if any of you lacks
wisdom, ask God, who will give generously to all without reproach, and it will be given him
(James 1:5, NIV). Just as clients are dependent on their relationships with others, they will also
be dependent on it with God (Jones & Butman, 2011).
There are also three incompatible beliefs regarding Christian and worldviews. The first
incompatibility is that object relations therapy is usually longer than other types of treatment.
Therefore, if a counselor is encouraging spirituality, the client may begin to feel that God is not
answering their prayers in a timely manner, or at all. A great scripture to share at this time would
be 2 Peter 3:9, which states that the Lord is not slow in keeping his promise (NIV). Another
incompatible belief object relations therapy has with spirituality is that it is not a quick fix.
Clients may expect immediate results that are impossible for a counselor to provide. 2
Corinthians 6:2 states that in the time of God's favor he has heard you, and in the day of
salvation will help you (NIV). The final incompatibility that is discussed in this paper is the
dream analysis technique. Although dream analysis is considered therapeutic because it exposes
unconscious desires or conflicts, what a person has received is not the Spirit of the world, but the
Spirit who is from God, so they should understand what God has freely given them; and that
what they speak, not in words taught by human wisdom but in words taught by the Spirit,
explaining spiritual realities with Spirit-taught words (1 Corinthians 2 12-13, NIV). In addition
to the church, it would be recommended for Celie Johnson to attend group therapies for battered
women, book writing workshops, therapeutic painting sessions, and any other socialization
organizations. These will afford her an opportunity to tell her story in different forms, As well as,
it will give her an opportunity to build new and positive relationships with other women that
have gone through similar things that she has.
Conclusion
In conclusion, Celie Johnson must realize that she is only responsible for herself (Jones &
Butman, 2011). With understanding this, she will learn how to teach others about how to treat
her. It will be necessary for Celie to participate in her counseling sessions consistently.
Therefore, object relations therapy will be used for Celie because it will provide an example of a
stable and healthy relationship with her counselor, which Celie can use when building
relationships with others. She will learn how to state her feelings at that moment without fear of
being judged, abused, or abandoned. Through Jesus, the forgiveness of sins will be proclaimed to
Celie, and she will continue to develop spiritually (Acts 13:38, NIV). The only challenge that
Celie will face using object relations therapy is not attending her sessions for the time that is
needed.
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