Effective NY Psychoanalytic Psychotherapy Using Kohut's Self Psychology

Kohut’s self psychology and it's modern successor, intersubjective self psychology (ISP), provide a clear treatment approach compared with the strict interpretive methods of classical analysis. In addition the concept of the self to be valuable, holistic, and flexible enough to accommodate a wide range of personal styles in analysts. Kohut posited that empathic attunement to the child by the parents is critical to the child’s development. He identified three major selfobject needs of the child — mirroring, idealization, and twinship — are provided by the parents and contribute to the building of a child’s cohesive, strong, and harmonious self. These selfobject needs continue throughout the individual’s lifetime, although they will mature over time and take different forms. For example, the idealizing selfobject needs for a child for a calm, reassuring, strong parent may morph into an adult idealization of an altruistic cause. The concept of attunement is important in the analytic setting because intersubjective self psychology places a focus on validating the patient’s affective experience. Intersubjective self psychology builds on Kohut’s theories by incorporating Robert Stolorow’s principles of intersubjectivity and acknowledging the rich complexity of continuous reciprocal and mutual creations of experience between the patient and the analyst. In both self psychology and intersubjective self psychology the analyst does not necessarily know which selfobject needs the patient seeks, rather the analyst uses their empathic immersion in the patient’s subjective experience and discovers the patient’s yearnings. In this way the selfobject dimension of the treatment operates silently in effective treatments. The development-enhancing modes of relatedness called selfobject transferences constitute the “leading edge” of treatment. The repetitive modes of relatedness that derive from the patient’s traumatic experiences are known as the “trailing edge.” These two types of transference can be viewed as a duality in the intersubjective field called “hope vs. dread” (Hagman, Paul, Zimmerman, 2019). Patients bring both their hopes and dreads into treatment and the intersubjective analyst works with both via interpretation and selfobject experiences.

Classical approaches maintain that pathology originate from the patient's experience of his impulses, wishes, and drives, particularly archaic sexual desire and hostility. This Freudian approach. Self psychology off also differs from The Kleinian view that a successful treatment will involve the reexperiencing and overcoming of archaic layers of depression, suspicion, enrage. In self psychology all forms of psychopathology are based on defects in the structure of the self which can also be viewed as weaknesses of the self. These weaknesses — the lack of a strong, harmonious, cohesive self — are a result of faulty self-self-object relationships in childhood. Unlike classical psychoanalysis self-psychology does not view the Oedipus complex as a primary cause of psychopathology but rather as a result of faulty progression in the child’s development in relation to one or both parents. Kohut did not believe in the inevitability of oedipal conflict and resulting pathology as did Freud. Rather, Kohut believed that an oedipal conflict would only ensue if in the child’s developmental and sexual maturation was met with hostility or seduction by either parent, which would result in a disturbance of the self, primarily because the parent would be reacting to this part of the child’s self rather than the child’s complete self and thus inducing enfeeblement. Freud wrote about the fear of loss of the object’s love, but Kohut added that disintegration anxiety is the deepest fear a person can experience, greater than that even than the fear of death. Because death is a physical extinction but disintegration anxiety is a loss of humanness and psychological death. In my opinion, many cases of severe anxiety in patients may have an underpinning of disintegration anxiety, or as Wilfred Bion similarly described, “falling to bits.” Freudian psychology considers the reach of adulthood to involve the transformation from narcissism into object love, where is self psychology posits that the relationships between the self and others, self-objects, will remain throughout the individual's life and are important to the development and sustenance of a healthy self, much like the way any living organism needs oxygen to survive. An example of a rebuttal to Freud's claim that unambivalent object love was the ultimate developmental goal is that of Emily Dickinson, who although she was alienated from others and lived a isolated life, she did lead a satisfying and significant one.

Kohut was skeptical of the ability of psychoanalysis to treat psychotic and borderline disorders because he believed those conditions involved a central hollowness of the self that, in combined with the chaos and defensive structures involved, and great anxieties, would not allow the patient to establish a self-objected transference with the analyst. However in such cases the patient can still be helped by strengthening existing defensive structures and building new supportive structures. So this adds a vagueness to Kohut's claim about analyzability to such patients because it can be difficult to draw a line between “improvement” and “analyzability.” In narcissistic personalities a nuclear self has been established in early development and therefore Kohut considers the patient analyzable. In contrast to self psychology, the classical approach is not a developmental approach - the classical analyst does not lend himself in the form of a selfobject to the patient to reinstate the developmental process. Classical analysis focuses on insight and restructuring the way the patient thinks about things using the process of interpretation of the transference. Intersubjective self psychology views interpretation of the trailing edge, to be a necessary but not sufficient condition for analytic cure, and the analyst must also provide a needed selfobject experience for the patient. The “leading edge” of intersubjective self psychology is the dimension of the transference that promotes growth and transformation of the patient’s self. To put it in Kohut’s terms, to help transform archaic selfobject needs into more mature ones. Intersubjective self psychology asks more from the analyst than classical approaches. In addition to interpreting the trailing edge the analyst provides a selfobject experience (leading edge) for the patient. However, the analyst does not need to be perfect in providing this selfobject function. The analyst need only be honest about who and what they are what we they are not. This was important for me to realize: we don’t have to be Superman (for example, in the idealizing transference), all we have to do is to admit that we are not Superman when we are not, and empathically understand how disappointing it must be for the patient, who may yearn for us to be that. This analytic honesty helps to make the disappointment non-traumatically disappointing rather than traumatically disappointing. The disappointment can then be talked about, processed, and worked through. Kohut, in his “pouring new wine into old bottles,” referred to small disappointments as “optimal frustrations” for the patient, while intersubjective self psychology has rethought the term and provided us with the phrase “optimal responsiveness” instead. In intersubjective self psychology the analyst is not only responsive but also takes an active role in the therapeutic context so that the patient’s “generative transference can flourish and psychic development can resume via a reliable experience of merger with an idealizable figure, a sustained experience of mirroring, or a sustained experience of twinship.” (Hagman, et al., 2019). In these transference situations, or what I sometimes think of as “developmental recreations,” the patient is helped to develop and consolidate their self experience. The analytic session is a co-creation, sometimes referred to as an intersubjective field, between the analyst and patient. Empathy is a foundational principle of intersubjective self psychology. The analyst “shows up” for how the patient feels failed and is able to be an empathic receiver for the patient’s experience. Intersubjective self psychology facilitates a rich curative experience that involves not only the transformation of existing psychic structures but also the development of new ones.

References:

Hagman G., Paul, H., Zimmerman, P., 2019. Intersubjective Self Psychology: A Primer.

Kohut, H. 1984. How Does Analysis Cure?

Zimmerman, P. 2019. On Leading and Trailing Edge: Toward a New Conceptualization of What Is Curative in Psychoanalysis.