{"id":37685,"date":"2024-04-15T13:23:56","date_gmt":"2024-04-15T13:23:56","guid":{"rendered":"https:\/\/academicwritersbay.com\/writings\/ft-dq10-nursing-school-essays\/"},"modified":"2024-04-15T13:23:56","modified_gmt":"2024-04-15T13:23:56","slug":"ft-dq10-nursing-school-essays","status":"publish","type":"post","link":"https:\/\/academicwritersbay.com\/writings\/ft-dq10-nursing-school-essays\/","title":{"rendered":"FT DQ10 | Nursing School Essays"},"content":{"rendered":"
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This presentation will explore several concepts and techniques within the Object Relations theory\u00a0 of family therapy which, \u00a0if understood, provides a framework for looking at couples and families. Before talking about this approach to family therapy, I would like to explain what object relations theory is all about.
Object Relations Theory was originated in England by a group of British psychoanalysts, including Klein, Balint, Fairburn, Winnicott, and Guntrip.\u00a0 Object relations theory was a break from Freud\u2019s drive model, and differs from it as follows:
Freud\u2019s\u00a0 model\u00a0 held\u00a0 that\u00a0 a\u00a0 newborn\u00a0 infant\u00a0 is\u00a0 driven\u00a0 by\u00a0 animal instincts, such as hunger, thirst, and pleasure, but cannot relate to others. Relationships with others only develop later in the course of satisfying\u00a0 those\u00a0 needs. In this sense, Freud\u2019s model considers relationships to be secondary.
In\u00a0 contrast, object relations theory maintains that the infant\u00a0 can relate to others at a very early age and\u00a0 that\u00a0 relationships\u00a0 with others\u00a0 are,\u00a0 therefore,\u00a0 primary.\u00a0 The drive to attach oneself to\u00a0 an object is considered to be the major motivating force.
Since we are talking about object relations theory, this is a good time to ask what an object is.\u00a0 In object relations theory, the word object is used with a very specific meaning. It\u2019s not\u00a0 literally\u00a0 a physical\u00a0 person, but an internal mental structure that is formed throughout early development.\u00a0\u00a0 This mental structure is built through a series of experiences with significant others\u00a0 through a psychic process called introjection.\u00a0 Because an infant\u2019s earliest experiences are usually with its mother,\u00a0 she is usually the first internal object formed\u00a0 by the infant.\u00a0\u00a0 Eventually,\u00a0 the father and other significant people also become internalized objects.
Introjection, the process of creating internal mental objects, leads to another process called splitting.\u00a0\u00a0 Splitting occurs because\u00a0 the infant\u00a0 cannot\u00a0 tolerate certain feelings such as\u00a0 rage\u00a0 and\u00a0 longing, which occur in all normal development.\u00a0 As a result, the infant has to split\u00a0 off\u00a0 parts of itself and repress them.\u00a0 What happens\u00a0 to\u00a0 those repressed\u00a0 split-off\u00a0 parts?\u00a0 They\u00a0 are\u00a0 dealt\u00a0 with\u00a0 through\u00a0 another important process, called projective identification.\u00a0\u00a0\u00a0
Projective\u00a0 identification\u00a0 itself \u00a0is a very specific part of object relations theory.\u00a0 It is a defense mechanism which was conceptualized by Melanie Klein in 1946,\u00a0 having evolved from her extensive study and work\u00a0 with children.\u00a0\u00a0 According to Klein,\u00a0 projective\u00a0 identification consists\u00a0 of\u00a0 splitting off parts of the self,\u00a0 projecting\u00a0 them\u00a0 into another person, and then identifying with them in the other person.
For example,\u00a0 the earliest relationship the infant \u00a0has with its mother is\u00a0 feeding and touching, but the mother is not always able to\u00a0 respond quickly enough to the infant\u2019s need.\u00a0 Since the natural rage and longing the infant feels at such times are intolerable,\u00a0 to survive these feelings the\u00a0 infant\u00a0\u00a0 \u201csplits\u00a0\u00a0 them\u00a0 off\u201d and\u00a0 represses\u00a0 them\u00a0\u00a0 from\u00a0\u00a0 its consciousness.\u00a0 The\u00a0 \u201csplit off\u201dfeelings can be thought of as\u00a0 other parts of the self (ego).When\u00a0 such splitting takes place,\u00a0 the infant is free of the rage but has placed that part of itself inside the mother. To make itself whole again\u00a0 it\u00a0 must identify with the mother.\u00a0 The mother may or\u00a0 may\u00a0 not allow herself to become the container for the infant\u2019s negative feelings.\u00a0 Even if she doesn\u2019t, the projective identification still occurs.
The above process begins in the first half year of life,\u00a0 known as the paranoid-schizoid\u00a0 position.\u00a0 It\u00a0 is characterized by\u00a0 an\u00a0 ability\u00a0 to distinguish\u00a0 good feelings from bad,\u00a0 but an inability to\u00a0 distinguish the mother from the self. Depending on how consistent the mothering is, the infant may or\u00a0 may not\u00a0 progress to a higher level of development known as the depressive position.\u00a0 In\u00a0 the depressive position,\u00a0 which starts at\u00a0 about\u00a0 eight months of age,\u00a0 the child takes back its bad feelings from the mother and separates from her.\u00a0 The mother is now seen as a separate\u00a0 object, with both good and bad feelings of her own. The infant is aware of its own good and bad feelings.
For a child to reach this level of development,\u00a0 the earlier mothering must be consistent. The mother must have accepted most of the child\u2019s projected feelings.\u00a0 A child who reaches the depressive position will, in adulthood,\u00a0 be capable of experiencing,\u00a0 at best, such feelings as empathy, or will at least become neurotic.
In contrast,\u00a0 if the mothering is not consistent, the child can\u2019t take back\u00a0 its\u00a0 projected feelings and splitting continues both inside\u00a0 and outside the child. It remains in the paranoid-schizoid position or, at best, a precarious\u00a0 form of the depressive position.\u00a0 This type of development is associated with borderline personalities.
In the above infant-mother example, the repressed parts of the self, if unresolved, will remain repressed into adulthood.\u00a0 Those parts will govern the choice of marital partner and the nature of marital relationships, and by extension the nature of relationships with children. By\u00a0 the\u00a0 time\u00a0 the couple or family come to\u00a0 therapy\u00a0 the\u00a0 projective identification\u00a0 process\u00a0 has likely progressed to the point\u00a0 of\u00a0 being obvious to the therapist, and will be seen in the members\u2019\u00a0 behavior toward each other.\u00a0\u00a0 This is usually not so in individual therapy because it often takes time to build the\u00a0 transference relationship with the therapist.\u00a0
So what does this mean for the therapist?\u00a0\u00a0 What does a therapist have to\u00a0 know\u00a0\u00a0 in order to work with a family, using the object\u00a0 relations\u00a0 approach?\u00a0\u00a0 The therapist needs to be trained in individual\u00a0 developmental theory from infancy to aging \u00a0and\u00a0 to understand that the internal object world is built\u00a0 up\u00a0 in\u00a0 a child,\u00a0 modified in an adult and\u00a0 re-enacted\u00a0 in\u00a0 the family.\u00a0 The family has a developmental life cycle of its own,\u00a0 and as it\u00a0 goes\u00a0 through its series of tasks from early nurturing of its\u00a0 new members,\u00a0 to\u00a0 emancipation of its adolescents,\u00a0 to taking care of\u00a0 its aging members,\u00a0 the family\u2019s adaptation is challenged at every\u00a0 stage by unresolved issues in the adult members\u2019 early life cycle. Conflicts\u00a0 within any of its individual family members may threaten to disrupt the adaption previously achieved.\u00a0 If any member is unable\u00a0 to adapt to new development,\u00a0 pathology,\u00a0 like projective identification, becomes a stumbling block to future healthy development.
The clinical approach is to develop, with the family, an understanding of the nature and origins of their current interactional difficulties, starting\u00a0 from their experience in the here-and-now of the therapeutic sessions, and exploring the unconscious intrapsychic and interpersonal conflicts\u00a0\u00a0 that\u00a0\u00a0 are\u00a0\u00a0 preventing\u00a0\u00a0 further\u00a0\u00a0 healthy\u00a0\u00a0 development.\u00a0 Interpretation\u00a0 and insight are thus the agents of family\u00a0 change.\u00a0 By uncovering the projective identifications that take place among family members, and\u00a0 having\u00a0 individuals take back\u00a0 their\u00a0 split-off\u00a0 parts, members\u00a0 can\u00a0 be\u00a0 freed to continue healthy\u00a0 development.\u00a0 If\u00a0 further therapy\u00a0 is indicated,\u00a0 individual therapy would be a\u00a0 recommendation.\u00a0 Symptom reduction in individuals is not necessarily a goal here. In\u00a0 fact,\u00a0 individual\u00a0 family members may become\u00a0 more symptomatic\u00a0 as projective\u00a0 identifications are taken back and the members become more anxious.
To do this, the therapist needs the following four capabilities:
1.\u00a0The ability to provide a \u201cholding environment\u201dfor the family \u2013 a place\u00a0 which\u00a0 is consistent \u2013 so that eventually the family comes\u00a0 to feel\u00a0 comfortable\u00a0 enough\u00a0 to be themselves in\u00a0 the\u00a0 presence\u00a0 of\u00a0 the therapist.2.\u00a0\u00a0An\u00a0 ability to understand the \u201ctheme\u201dof each session,\u00a0 so that\u00a0 a broad theme can be identified over the course of treatment.3.\u00a0\u00a0An\u00a0 ability to interpret the latent content of patients\u2019\u00a0 manifest statements.4.\u00a0\u00a0\u00a0An\u00a0 understanding of unconscious processes like transference and countertransference.
Given those tools, \u00a0it is the therapist\u2019s job to uncover the projective identifications in the family that prevent the children from having\u00a0 a healthy\u00a0 development.\u00a0 Once these projections are uncovered,\u00a0 and\u00a0 the split-off\u00a0 parts\u00a0 given\u00a0 back to the family members\u00a0 they\u00a0 belong\u00a0 to, children are freer to continue healthy development. Having introduced projective identification, I\u2019d like to show how this process\u00a0 operates\u00a0 later\u00a0 in life-in couples and families-and\u00a0 is\u00a0 a framework\u00a0 for doing couple and family therapy.\u00a0 I\u2019m going to\u00a0 present two cases-one of a couple and one of a family-to show how projective identification works.
A male patient of mine with little ambition fell in love with a\u00a0 woman who subsequently pushed him to be ambitious. As it turned out, the woman had been repressing her own ambition under pressure\u00a0 from\u00a0 a father who didn\u2019t believe women should\u00a0 work.\u00a0\u00a0 This woman\u00a0 was quite intelligent and obtained a professional\u00a0 degree,\u00a0 yet she chose to stifle her ambition in order to please her\u00a0 father.\u00a0\u00a0 She remained dependent on her father, both emotionally and financially.
The\u00a0 husband,\u00a0 my patient,\u00a0 was a professional but quite\u00a0 unambitious.\u00a0 His\u00a0 family\u2019s\u00a0 philosophy was that one is lucky to have a job and\u00a0 pay the\u00a0 bills.\u00a0\u00a0 His father had held the same low paying job\u00a0 for\u00a0 twenty years although he, too, had a professional degree. So why did these two people get married?\u00a0\u00a0 Since it was\u00a0 unacceptable for\u00a0 her\u00a0 to be ambitious,\u00a0 the wife needed someone to\u00a0 contain\u00a0 those feelings for her.\u00a0\u00a0 My patient was the ideal object because,\u00a0 although he\u00a0 had\u00a0 an\u00a0 inner\u00a0 ambition,\u00a0 he had no parental\u00a0 support\u00a0 for\u00a0 these strivings.\u00a0 Therefore, he was predisposed to accept and collude in his wife\u2019s projection.\u00a0
What\u00a0 is\u00a0 the\u00a0 effect of projective identification when a\u00a0 couple\u00a0 has children?\u00a0\u00a0 The following example shows how parents use their children as objects.
Fern\u00a0 was a woman in her second marriage with two adolescent children.\u00a0 When Fern was a child,\u00a0 her mother favored her brother.\u00a0\u00a0 The\u00a0 message she received from her mother was that men were important and had to be taken care of, while women were stupid and born to serve men.\u00a0 Both of Fern\u2019s\u00a0 husbands\u00a0 agreed with her mother\u2019s philosophy,\u00a0 so Fern spent most of her married life serving them.When\u00a0 the family came to see me,\u00a0 both children were having\u00a0 emotional problems.\u00a0\u00a0 The\u00a0 son was a heavy user of pot and cocaine.\u00a0\u00a0 His sister had emotional and learning problems in school.\u00a0
Fern had projected into her son that males were special and needed\u00a0 to be taken care of. It\u2019s not hard to see why the son colluded with his mother.\u00a0 The rewards of accepting her projected feelings were too hard to\u00a0 resist,\u00a0 so when he reached adolescence he satisfied his excessive dependency needs with drugs. The\u00a0 message Fern\u2019s daughter received was that she was unimportant and stupid.\u00a0\u00a0 Why did Fern project these feelings onto her daughter?\u00a0 Fern grew\u00a0 up\u00a0 unable to develop her own career goals\u00a0 because\u00a0 her\u00a0 other ignored\u00a0 her wishes to go to college.\u00a0\u00a0 For Fern to feel\u00a0 sufficiently competent\u00a0 and\u00a0 achieve\u00a0 some career success,\u00a0 she had to get\u00a0 rid\u00a0 of feelings that she was stupid and unimportant.\u00a0\u00a0 So she projected those feelings\u00a0 on\u00a0 to\u00a0 her\u00a0 daughter and was then able\u00a0 to\u00a0 start\u00a0 a\u00a0 small business.\u00a0 To avoid being totally rejected by her mother, the daughter colluded by remaining stupid and unimportant to herself.
Fern\u2019s reenactment with her daughter of her mother\u2019s relationship with her is a form of projective identification called \u201cidentification with the aggressor,\u201dbecause Fern is acting as if she is her own mother and her daughter is her (when she was a child). Fern\u2019s relationship to her son\u00a0 is also similar to the relationship Fern\u2019s mother had\u00a0 to\u00a0 Fern\u2019s brother.\u00a0 Because\u00a0 Fern is treating her children so differently,\u00a0 when they grow up they will have very different views of this family.\u00a0 This explains why,\u00a0 in therapy,\u00a0 siblings often talk about the same\u00a0 family very differently.
Notice\u00a0 how unresolved feelings from childhood,\u00a0 which Fern split\u00a0 off and repressed,greatly affected her relationship with both\u00a0 children.\u00a0 What do you think is going on in her second marriage?
Now\u00a0 I\u00a0 will\u00a0 present\u00a0 an actual transcript of part\u00a0 of\u00a0 a\u00a0 session\u00a0 I recently\u00a0 had with this family.\u00a0\u00a0 As you will see,\u00a0 it illustrates the process\u00a0 of\u00a0 projective identification and will serve as a\u00a0 basis\u00a0 for further discussion.
T:\u00a0 Fern, I wonder, when Donald was talking about being like Roberta and John asked him a question how did you feel?
F:\u00a0 What do you mean how did I feel?
T:\u00a0 When John asked Donald when he figured out that he was like Roberta and Donald said just now.
J:\u00a0 How do you feel about him saying just now.
T:\u00a0 And you changed the subject and I wondered what you were feeling.
F:\u00a0 I don\u2019t know.\u00a0 I
T:\u00a0 Donald owned up to some feelings that he was like his father and that part of what he saw in Roberta was like himself.
F:\u00a0 Donald is definitely part of
D:\u00a0 No but what she\u2019s saying is that you changed the subject.\u00a0 That is why she\u2019s wondering if you have some feelings about that.
T:\u00a0 Exactly.\u00a0 You seemed to have moved away from what was going on here.\u00a0 John was talking to Donald
R:\u00a0 She doesn\u2019t want us to be like our father.
T:\u00a0 Maybe that was upsetting to you?
R:\u00a0 He wasn\u2019t good to her.
D:\u00a0 Subconsciously maybe.\u00a0 It\u2019s deep but it\u2019s there.
F:\u00a0 Well, I don\u2019t like Martin, naturally.\u00a0 It\u2019s true.\u00a0 I don\u2019t like him \u2013 I don\u2019t think he\u2019s a nice person.
R:\u00a0 You don\u2019t like him at all?
D:\u00a0 She loves him but doesn\u2019t like him
F:\u00a0 I loved him but I never liked him as a person. I never thought he was a good person;\u00a0 that he really cared about me, that he took care of me, that he was ever concerned with me.\u00a0 I remember a couple of things that \u2013 I remember having a bloody nose one night when I was pregnant and he went out to play racketball and left me alone.\u00a0 Things like that \u2013 He was mean to me \u2013 he had no compassion for me.
D:\u00a0 That\u2019s one thing, I\u2019m not like my father.
F:\u00a0 I\u2019m not saying \u2013 I\u2019m trying to say I see certain characteristics of their father in them.
T:\u00a0 How does that make you feel?
F:\u00a0 How does that make me feel?\u00a0 I don\u2019t know.\u00a0 I guess part of it, not too good because I would rather them be above that, that is, above that anger, why can\u2019t they rise above that anger.\u00a0 I don\u2019t want them to be like that because it didn\u2019t get Martin anyplace in life.
J:\u00a0 I have a very deep question.
F:\u00a0 I don\u2019t know if I want to answer it.
J:\u00a0 You may not but how can you find that with Roberta and Donald being so much alike in personality, like Martin, how do you separate Donald\u2019s being like Martin and accepting it from Roberta and saying Roberta is just like her father and not accepting it?
F:\u00a0 Because Donald never directed his anger at me as a person, as a human being.\u00a0 In other words he never \u2013 he might have been angry but he never said to me \u2013 he never was mean to me, whereas Roberta has been mean to me, attacked me as a person, Donald never attacked me as a person.
T:\u00a0 Donald attacked himself as a person.
D:\u00a0 Hmm.
T:\u00a0 By taking drugs.
F:\u00a0 But he never attacked me as a person.
D:\u00a0 Never, I\u2019m not a mean person.\u00a0 I don\u2019t have that mean streak in me.
T:\u00a0 You sure?
F:\u00a0\u00a0 You may have it in you
D:\u00a0 I don\u2019t have a mean streak.
F:\u00a0 Sure, everyone
T:\u00a0 Who did you direct that meanness to? Roberta directs it out to her mother and who did you direct it to?
D:\u00a0 I direct it to her.
T:\u00a0 No
R:\u00a0 No you directed it at yourself.
D:\u00a0 Myself, yeah \u2013 I\u2019m mean to myself.
F:\u00a0 You were destructive to yourself.
T:\u00a0 So what
D:\u00a0 But that\u2019s different from being destructive to other human beings.
F:\u00a0 No, maybe you would have been better off being mean to me or somebody else.\u00a0 Or to your father.
R:\u00a0 Let\u2019s get back to Uncle John\u2019s question.
J:\u00a0 No this is part of the answer.
D:\u00a0 Yeah \u2013 I\u2019m mean to myself.\u00a0 I still am.\u00a0 But I don\u2019t destroy myself with anything \u2013 with any kind of substances, but I still am.
R:\u00a0 What do you mean, you still are?
D:\u00a0 I\u2019m hard on myself, critical of myself.
R:\u00a0 See, you would never think that of Donald because he walks around like he\u2019s above the world.\u00a0 He does.
T:\u00a0 But why would somebody walk \u2013
D:\u00a0 But I\u2019ve been working on that very heavily now
T:\u00a0 But why would someone
D:\u00a0 That\u2019s the way I am; it\u2019s the way I am.
T: \u00a0Why would someone walk around like that.
D:\u00a0 It\u2019s very basic \u2013 when I was on drugs and everything like that and I\u2019m fully aware of it, aware that I\u2019m conceited and like I have that air about me \u2013 I\u2019m fully aware of it.\u00a0 When I was on drugs I had that part to me but it wasn\u2019t as strong as it is now.
T:\u00a0 You weren\u2019t aware of it then?
D:\u00a0 I wasn\u2019t really in control of the fact that I control my conceitedness now \u2013 I choose to put that on because I have nothing, I have nothing else now.
T:\u00a0 Right
D:\u00a0 It seems it\u2019s like my only defense, to be arrogant and to be conceited because I don\u2019t have anything else to back me up so I figure that wall.
R:\u00a0 Why do you need \u2013 I don\u2019t need anything.
D:\u00a0 Roberta \u2013 because when I was on the drugs and everything like that, it was a great wall\u00a0 for me to keep everybody out.\u00a0 Now I want everybody to think big things.
Respond to that lecture\u2026.
Now\u00a0 let\u2019s\u00a0 look at the latent content of this\u00a0 session and identify the projective identifications.<\/p>\n

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