Child and Adolescent Psychopathology - PowerPoint Presentation

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Child and Adolescent PsychopathologyIntroduction to Object Relations Theory/The Klein-Bion Model

Geoff Goodman, Ph.D.Slide2

Melanie Klein and her FollowersI. Basic Developmental Origins of Klein’s Theory

Death instinct- aggressive impulses- produces annihilation anxiety and then persecutory anxiety

Object attacked and destroyed, but then fear of retaliation (e.g., Stuey on Family Guy)

Real external experiences reinforce these perceptionsObject also loved and idealizedSlide3

Continued…E. Splitting into good--idealized--breast to protect against bad--dangerous and persecuting--breast

F. Klein called this stage, “paranoid- schizoid position” (0-4 months)

G. Primitive relations--internal and external--created by projection and introjection

H. Growing capacity for integration and synthesis produces the second stage, “depressive position” (4-6 months) Slide4

Continued…I. Aggression had been directed all along against loved person (good breast = bad breast)

J. Anxiety and guilt of depressive position add powerful impetus toward beginning of Oedipus complex

K. Transference reveals irrationality of earliest object relations (“The patient is bound to deal with conflicts and anxieties re-experienced towards the analyst by the same method used in the past [in infancy]”

[Klein, 1952, p. 55])Slide5

II. Contributions of Klein’s Theory to the Development of Object Relations as a School of ThoughtObjects exist from the beginning of postnatal life

drives expressed through objects

drives do not exist without objects

relations to objects constitute the origins and development of the ego and superego, not frustrationsSlide6

B. Drives are psychological entities, not somatic entities

1. drives are relationships with objects linked by affects that have a particular valence (i.e., good or bad)

2. drives are expressed through bodily functions

a. urineb. fecesc. vomitd. flatusSlide7

Continued…3. drives can represent expressions of love or hatred

4. drives seek not only tension reduction but also relationship with objects

5. drives do not oppose external reality as parental authority but rather each other as manifested in good and bad objectsSlide8

C. Psychosexual stages replaced by positions

bodily sources of tension de-emphasized in favor of organizations of relating to object (i.e., part or whole)

qualities of psychosexual stages determined by the two positions (i.e., paranoid-schizoid and depressive)Slide9

Continued…3. Oedipus complex is not a struggle between wishes for opposite-sex parents and fears of castration by same-sex parent but rather a struggle between wishes for opposite-sex parent and “feelings of love and guilt to preserve his father as an internal and external figure” (Klein, 1945, p. 389)Slide10

D. Role of envy in object relations and psychopathologyenvy is contrasted to greed

a. greed is the collateral destruction of the good object because of insatiable desire

b. envy is the willful destruction of the good object because of resentment and spite over withholding of life-giving supplies (e.g., spoiling milk)Slide11

Continued…2. envy destroys the good object and so overwhelms splitting processes

a. confusion between good and bad

b. destruction of hope

3. negative therapeutic reaction--worsening in treatment a. Freud-- guilt over Oedipal victory b. Klein-- desire to triumph over good, withholding object Slide12

Continued…4. envious patients “spoil” interpretations to disable their sense of the therapist’s goodness, competence, and desire to help (mention Cornell patient who slit her throat)Slide13

III. Followers of Melanie KleinWilfred Bion

focused more on caregiver contributions to shift from paranoid-schizoid to depressive positions

container of split-off “beta elements”

caregiver applies “alpha function” --metabolizes these projective identifications and returns them in understandable form that aids in integration and affect regulationSlide14

Continued…

2. projective identification is not simply a maneuver to extend and control unbearable parts of the self but also a primitive form of communication with caregiver

3. predominance of paranoid-schizoid position

a. deficiencies in caregiver’s capacity for reverie (related to alpha function) or primary maternal preoccupation (Winnicott) b. overwhelming envy in the infantSlide15

B. Herbert Rosenfeld--narcissistic conditionskey features of narcissism

predominance of envy

predominance of dependence

omnipotent denial used as defense against separateness and integrity of the object 1) denial of object’s control over goodness 2) denial of vulnerability to separation from good objectSlide16

Continued…2. two forms of narcissism

a. thin-skinned (libidinal) narcissism (see Kohut’s idealizing transference)

idealization of self

omnipotent introjection and/or projective identification of good objectSlide17

Continued…b. thick-skinned (destructive) narcissism (see Kohut’s mirroring transference)

idealization of omnipotent destructive parts of self that tolerates no dependency

derogation of any suggestion of true affectionSlide18

C. Elizabeth Spillius--borderline conditionsdominance of bad self over the rest of the personality, including masochistic, perverse, addictive parts

structured pattern of defenses and impulses rooted somewhere between paranoid-schizoid and depressive positionsSlide19

IV. Criticisms of Melanie Klein’s Work

Objects exist in the form of constitutional, universal knowledge and images

De-emphasis on parental behavior, particularly negative behavior

The centrality of fantasies in mental life, which does not account for development of structures or patternsAdherence to the death instinct as philosophical proposition applied to clinical casesSlide20

Continued…

E. Elaborate cognitive capacities of infant from birth

F. Origin of the differentiation between the ego and superego

G. Marginalization of “real” mother robs her of agency and subjectivityH. Innate object categories such as “penis” and ”breast” and “vagina” reinforce idea of anatomy is destiny and make gender configurations less fluid and more binarySlide21

Continued…

Integration of objects not possible in Klein’s developmental timetable

consciousness of conflicting feelings towards same person?

unconscious integration of images?recognition that same person can generate conflicting feelings?difficulties recognizing mixed emotions younger than age 5 but ability to represent same person as sometimes angry and sometimes loving from first year of life