Inner Community and Therapeutic Mutuality

Object Relations Theory

Anna Freud 1895- 1982

Melanie Klein 1882 - 1960

Exploring the relationship between real, external people

and

Internal images and residues of relations with them

Object Relations Theory Klein focused on inner life, re-establishing unconscious.

She taken into account aggressive world of id more seriously.

She focused on first year of life.

Melanie Klein 1882 - 1960

Unconscious Phantasy Klein put great emphasis on person’s subjective experience over the impact of real events.

From birth all bodily impulses and emotional experiences have a mental representation in the form of phantasies.

They constitute our internal world and affect or experiences with external world.

Unconscious Phantasy Being poisoned: I am ill; it can be due to cold or flu.

Because the manager does not monitor water supply or husband prepared a food which was past its sell by date.

Internal experience of others as neglectful.

Hunger: A bad object inside is attacking.

Internal World Internal world is built up with projection and introjection.

Introjection is taking into something, projection is getting rid of.

Child is in the hospital and waiting for the operation, playing with the doll. She pretends to be the doctor and says the doll there is nothing to worry.

In another play, doctor operates the doll that is made to die.

Both are projecting their anxieties but in two different forms.

Internal World Our internal world also consists of versions of ones we hate and love.

Good objects — want best for us and support us.

Bad objects — make us suspicious, criticised and unsupported.

Internal World Internal world is representation of internalised relationship between mother and the child.

The paranoid-schizoid position The first six months; frustration baby’s needs is not a pain but perceived as an attack from external world/breast.

Fed or neglected by the breast — good breast/bad breast

Bad objects are totally bad; good objects are totally good

(SPLIT)

Internal World The depressive position Next first six month; if the child learns that love is constant.

The hated one and the loved one are the same.

This recognition leads to feelings of sadness, guilt, regret.

Guilt feelings leads to repairing the damaged object.

Self Psychology - Self Object • Heinz Kohut evolved self psychology concepts. • Sense of self dependent on quality or relationships with parental figures. • Self-object: person who is experienced intrapsychically.

Self Object • Mirroring self-object: recognises a child’s capabilities and talents. • Idealizing self-object: links a child with admired caregivers.

Internalization of Self-objects • Self-objects perform adaptive functions of soothing and tension regulation • Transmuting internalization: Child is gradually able to perform soothing and tension regulation functions in absence of original self-object. • Without positive self-object experiences internalization of a “healthy self” cannot occur – Shame, humiliation, helplessness the result of selfobject failure

Empathy • Kohut (1913 - 1981) – Experiencing attunement allows self to evolve from early, narcissistic needs to capacity for empathic attunement to others.

• Empathy as “vicarious introspection”: ability of the therapist to investigate inner world of client. • Experience of therapist by client NOT solely based on past “representations” • Through “transmuting internalization” of the therapist as calming (mirroring) and competent (idealizing) client can learn to selfsoothe, self-comfort and self-empathize. • Therapist becomes a new “self-object”

Internal Working Models

Schema Therapy and Mode Work •

Jeffrey Young ve ark. (2003)

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Schema mode is a a set of schemas that are currently active for an individual.

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All dialogs with two different modes are forms of mode work.

Common Schema Modes Child Modes Maladaptive Coping Modes Dysfunctional Parent Modes Healthy Adult Mode

Common Schema Modes Child Modes

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The states that resembles the children’s perceptions of the world.

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They are all innate, represent emotional range of human.

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Early child environment either suppress of enhance child modes.

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Ağlamak, kapıyı çarpıp çıkmak, küsmek…

Child Modes •

Vulnerable child

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Angry child

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Impulsive/Undisciplined child

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Happy child

Child Modes Vulnerable Child Feelings of abandonment/isolation/mistrust/shame/ emotional deprivation

Ayşe’nin okul hayatı boyunca ailesi sık sık taşınmıştır. Her gittiği yerde “yeni g e l e n ç o c u k ” o l m u ş t u r. Ş i m d i üniversitedir ve arkadaşları açıkça kendisini bir buluşmaya davet etmediği sürece kendisini dışlanmış ve onlardan biri değilmiş gibi hissetmektedir.

Child Modes Angry and Impulsive Child Not able to feel like an adult, when they feel neglected they feel anger.

The problem is expressing needs inappropriately and impulsively.

A/I Child modes are triggered at the same time or sequentially.

Child Modes Angry and Impulsive Child Feelings of anger, aggressiveness, resistance, impulsivity, spoiling,

Begüm’ün oldukça yoğun, yorucu bir iş hayatı vardır. Eve gelip çocuklarının eşyalarının etrafa saçtıklarını görünce öfkeden köpürmekte, küfür etmeye başlamaktadır. Kendisini kontrol etmekte zorlanmaktadır. Çocukken sıklıkla yalnız kaldığını, annesinin çok yoğun çalıştığını, babasının sıklıkla eve ağır alkollü geldiğini ve öfke patlamalarına tanık olduğunu ifade etmektedir. Hayatla kendi başına başa çıkabilmeyi öğrenmiştir ancak hayatının zorlaştıran şeylere yoğun öfke göstermektedir.

Child Modes Happy Child They engage in enjoyable activities, they play in their lives.

They fell intimate with others, fell not to be alone.

Dysfunctional Parent Modes •

Internalization of parent figures in the patient’s early life.

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Patients become their own parents and treat themselves as the parent treated them when they were children.

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Punitive/Critical Parent Mode

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Demanding Parent Mode

Dysfunctional Parent Modes Punitive/Critical Parent Mode Restrict, criticises or punishes the self and others.

Person feels pressure, thinks that his/her emotions are ridiculous and criticise him/herself. Anna, rahibeler okulunda ağır ve sadistçe cezalara maruz kalmıştır. Birine karşı geldiğinde yemek yemesine izin verilmemektedir. Anna yetişkinliğinde, haksızlığa uğrasa dahi başkalarına karşı gelememektedir. Karşı çıkmaya çalıştığında bundan utanç duymakta, kendisinden nefret etmektedir. Lezzetli bir yemek yese dahi keyfini çıkaramamakta, keyifli bir yemeği hak etmediğini düşünmektedir.

Dysfunctional Parent Modes Demanding Parent Mode (Emotion/Success Focused) Set high expectations and high levels of responsibility toward others; pressures the self or others to achieve them.

Parents expect a lot but may not blame or punish.

Right way is to be perfect; worn way is to be spontaneous.

Dysfunctional Parent Modes Demanding Parent Mode Magnus gençliğinde yüzme ile ciddi anlamda uğraşmış, çok iyi bir yüzücü olmuştur. Çok sert antrenmanlar yapmış, ancak yarışlarda ikinci olmuştur. Kendisini hep kaybedenmiş gibi hissetmeyi öğrenmiştir. Anıları elde ettiği bölgesel başarılar ile ilgili değildir, düşük performansı ile ilgili hayal kırıklığı yaşayan eğitmeni ile ilgilidir. Üniversitede sınav sonuçları kendisine benzer duyguları yeniden yaşatmaktadır.

Maladaptive Coping Modes Compliant Surrender Patients think that they don’t have any other alternative other than surrendering their modes. They are obedient, allow others to abuse, neglect, control and devalue them to preserve connection. Andrea, güçlü bir Başarı Odaklı Talepkar Ebeveyn moduna sahiptir. Herşeyi mükemmel şekilde yapmak zorunda olduğunu, düşünmekte, gece gündüz çalışmaktadır. Mola verdiğinde kendisini suçlu ve başarısız hissetmektedir. Kendi moduna tamamen teslim olmaktadır.

Maladaptive Coping Modes Compliant Surrender

Anita çocukluğunda babası ve büyükbabası tarafından çok ağır cinsel istismara maruz kalmıştır, sürekli kendisine küfür ederek daha iyisini hak etmediğini söylemişlerdir. Şimdi Anita kendisi ile cinsel ilişkiye girmek isteyen erkeklere karşı kendisini savunmamakta, daha iyisini hak etmediğini düşünmektedir. Cezalandırıcı ebeveyn moduna teslim olmaktadır.

Maladaptive Coping Modes Detached Protector Coping style is psychological withdrawal. They detach from other people and shut off their emotions in order to protect themselves from pain of being vulnerable. Patients feel numb or empty. Addictive self soothing, fantasizing, stimulation seeking. Bernard, okul hayatı boyunca zorlukla karşılaşmamış, talepkar ebeveyn modunun gereklerini yerine getirmiştir. Üniversiteye gelince akranları ile yarışamamış, başarısız olmuş, üniversiteye uğramayarak tüm gününü World of Warcraft oynayarak ve internette oyalanarak geçirmeye başlamıştır.

Maladaptive Coping Modes Over-compensation Acting as the opposite of the schema is true.

Feeling dominated, dominate others.

Feeling bullied, bully others.

Feeling used, use others.

Markus, psikoterapi bölümü şefidir. Sıklıkla çalışanlarını aşağılamaktadır. Kendi muhteşem bilgi ve yeteneklerinden emindir. Hiç tanımadığı hastaların tedavileri ile ilgili abartılı j e s t l e r l e t a l i m a t l a r v e r i r, v e rd i ğ i talimatların hastalarla alakası yoktur. K e n d i s i i ç i n a r k a s ı n d a n “ Ta n r ı ” denilmektedir.

Health Adult Mode •

Nurtures, affirms, protects Vulnerable Child.

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Set limits for the angry/impulsive/undisciplined child in accordance with the principles of reciprocity and self discipline.

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Battles and moderate maladaptive coping and dysfunctional parent modes.

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Performs adult functions; nurture, work, take responsibility, show commitment etc.

Mutuality of the Therapeutic Relationship •

Good enough therapist

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Being with our patients

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Right brain to right brain resonance

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Implicit to implicit resonance

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Embrace the whole person

Mutuality of the Therapeutic Relationship Foundations of mutuality:

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We must commit deeply to going into patient’s world, regardless of how painful it is.

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We need to be comfortable providing comfort.

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We must be able to track our patients’ internal movements.

Embracing the Whole Person Spiritual aspects: We need to be sensitive to spiritual issues.

Punitive God, terror of emptiness, despair

We need to let our mirror neutrons do the work without the cognitive content.

If we struggle spirituality, we may find our mental models resonating our patients.

They need neuroception of safety.

Embracing the Whole Person Somatic aspects: Sensitivy to the states of our patients’ body

Our bodies carry the impact of bot positive and negative impacts

Our muscles, nervous system, breathing rate…

Allowing calmness through out our body

We should not be criticising parent; we need to understand the language of the body together.

Embracing the Whole Person Rapture and Repair: Mothers misattuned to their infants 66% of the time.

Reestablishing warn contact is important.

Repair brings resilience together.

Meta-communication is critical for repairing.

Siegel’s Triangle of Wellness