Heinz KohutHeinz Kohut

1913 - 19811913 - 1981

Attachment theory & Psychoanalysis

Heinz Kohut: Empathic immersion

Kohut dealt with narcissistic PDs and discoveredin the transference things which led him to a newview of the development of narcissism.Kohut saw himself as challenging theory from anempirical perspective rather than from a competing theoretical one.He thought theory was getting in the way ofPractice.He took a stance of empathic immersion orvicarious introspection in the psychic world of hispatients

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To Kohut, it is the construction of the self and its role in human affairs that dictates what is normal and abnormal – psychopathology is viewed as a disturbance of the self, with very severedisorders rooted in very early disturbances of the mother-infant relationship.

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The child is born into a social milieu, and The child is born into a social milieu, and relatedness with others forms a basic relatedness with others forms a basic prerequisite for psychological survival. The child prerequisite for psychological survival. The child needs adults not only to fulfill physical needs adults not only to fulfill physical requirements, but also to fulfill psychological requirements, but also to fulfill psychological needs. Perhaps the most important of these is needs. Perhaps the most important of these is support for a vague and undifferentiated sense support for a vague and undifferentiated sense of self. In the beginning, that sense of self of self. In the beginning, that sense of self amounts to little more than a set of reflexes and amounts to little more than a set of reflexes and an innate potential, but through parental an innate potential, but through parental expectations and encouragement, it quickly expectations and encouragement, it quickly becomes transformed into a central organizing becomes transformed into a central organizing force in the psyche.force in the psyche.

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The significance of selfobjects lies in the The significance of selfobjects lies in the psychological functions they contribute to psychological functions they contribute to the child’s developing self. Selfobject the child’s developing self. Selfobject responses such as praise or the induction responses such as praise or the induction of shame are “taken in” by the child and of shame are “taken in” by the child and experienced as pride or guilt. the concrete, experienced as pride or guilt. the concrete, observable communications that make up observable communications that make up the mother-child interaction form the the mother-child interaction form the building blocks of what ultimately comes to building blocks of what ultimately comes to be known as the self.be known as the self.

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There are two basic narcissistic needs that the There are two basic narcissistic needs that the child seeks to satisfy through early selfobject child seeks to satisfy through early selfobject relations: one is the need to show off developing relations: one is the need to show off developing capabilities and to be admired for them: “if capabilities and to be admired for them: “if others see me as good, then I must be good.” others see me as good, then I must be good.” The other is to form an idealized image of one of The other is to form an idealized image of one of the parents, usually the mother, so as to the parents, usually the mother, so as to experience a sense of merger. Both needs are experience a sense of merger. Both needs are normal; the first, a healthy omnipotence, and the normal; the first, a healthy omnipotence, and the second, a healthy desire for connectedness.second, a healthy desire for connectedness.

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The significance of these tendencies is that they The significance of these tendencies is that they become incorporated in one’s representational become incorporated in one’s representational world. By means of “transmuting internalization” world. By means of “transmuting internalization” the two types of external object relations are the two types of external object relations are transformed into two inner relational transformed into two inner relational configurations. The first, comprised of configurations. The first, comprised of grandiose, exhibitionistic self-images, is the grandiose, exhibitionistic self-images, is the result of interchanges with “mirroring result of interchanges with “mirroring selfobjects” “I am perfect and you must admire selfobjects” “I am perfect and you must admire me.” The second, consisting of self-images me.” The second, consisting of self-images involving fusion, evolves out of interchanges involving fusion, evolves out of interchanges with “idealized selfobjects.” “You are perfect and with “idealized selfobjects.” “You are perfect and I am part of you.”I am part of you.”

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Psychopathology represents an inability to Psychopathology represents an inability to transcend the narcissistic internalizations transcend the narcissistic internalizations of infancy. In the course of treatment, the of infancy. In the course of treatment, the patient develops either a mirroring or patient develops either a mirroring or idealized transference - or both. Mirroring - idealized transference - or both. Mirroring - the patient casts the analyst into the role the patient casts the analyst into the role of admiring audience. Idealizing - the of admiring audience. Idealizing - the patients view of the therapist is patients view of the therapist is extraordinarily inflated. extraordinarily inflated.

Attachment theory & Psychoanalysis

Freudian theory would insist upon interpretation ofthese various transferences, seeing them asresistances to ego growth

Kohut found patients needed to experience thesetransferences as a way of recouping missingdevelopmental inputs

Change takes place by transmuting internalizationin which gentle and repetitive narcissistic failureson the part of the selfobject build up the patient’scapacity for narcissistic self-regulation.

KohutKohutThe beginning of therapy is marked by the analyst’s The beginning of therapy is marked by the analyst’s willingness to allow the patient to dwell in the infantile willingness to allow the patient to dwell in the infantile aspects of the relationship. As the therapy progresses, aspects of the relationship. As the therapy progresses, the patient outgrows the narcissistic, infantile aspects of the patient outgrows the narcissistic, infantile aspects of the transference and moves on to more mature ways of the transference and moves on to more mature ways of relating. Resolution of the transference (relating to the relating. Resolution of the transference (relating to the analyst as a positive and healthy selfobject) provides for analyst as a positive and healthy selfobject) provides for a positive transmuting internalization. Psychoanalysis is a positive transmuting internalization. Psychoanalysis is seen as providing the patient with an opportunity for a seen as providing the patient with an opportunity for a developmental second chance. Selfobject failures early developmental second chance. Selfobject failures early in life lead to deficiencies in the self.in life lead to deficiencies in the self.

Narcissistic Personality DisordersNarcissistic Personality Disorders

Understimulated Self – feel bored, empty. Understimulated Self – feel bored, empty. Parents failed to respond empathically to Parents failed to respond empathically to mirroring/idealizing needs. Typically mirroring/idealizing needs. Typically engage in various stimulating, but engage in various stimulating, but dangerous behaviors.dangerous behaviors.

Fragmenting Self – Feels uncoordinated, Fragmenting Self – Feels uncoordinated, slow, awkwardslow, awkward

Narcissistic Personality DisordersNarcissistic Personality Disorders

Overstimulated Self – Excessive Overstimulated Self – Excessive responsiveness. No optimal frustrations. responsiveness. No optimal frustrations. Discrepancy between primitive grandiose self Discrepancy between primitive grandiose self and weak nuclear self – leads to avoidance of and weak nuclear self – leads to avoidance of becoming the center of attentionbecoming the center of attention

Overburdened Self – views the world as hostile Overburdened Self – views the world as hostile and dangerous – results from inability to merge and dangerous – results from inability to merge with the calmness of omnipotent selfobjectswith the calmness of omnipotent selfobjects

Narcissistic Behavior DisordersNarcissistic Behavior Disorders

Mirror-Hungry PersonalitiesMirror-Hungry Personalities – look for people to – look for people to admire themadmire themIdeal-Hungry PersonalitiesIdeal-Hungry Personalities – look for people to – look for people to admire. Eventually become disillusioned and admire. Eventually become disillusioned and move on the the next one.move on the the next one.Alter-ego PersonalitiesAlter-ego Personalities – need someone like – need someone like themselves – opinions, values, etc.themselves – opinions, values, etc.Merger-Hungry PersonalitiesMerger-Hungry Personalities – lose themselves – lose themselves in othersin othersContact-shunning PersonalitiesContact-shunning Personalities – Same needs – Same needs as merger-hungry, but keep their distance to as merger-hungry, but keep their distance to prevent losing themselvesprevent losing themselves

Object Relations TheoryObject Relations Theory

Emphasized the role of interpersonal, pre-Emphasized the role of interpersonal, pre-Oedipal experiences in the development of Oedipal experiences in the development of personality and psychopathologypersonality and psychopathology

Freud (1923): “the character of the ego is a Freud (1923): “the character of the ego is a precipitate of abandoned object cathexes precipitate of abandoned object cathexes and it contains the history of those object and it contains the history of those object choices.”choices.”

Melanie Klein, W.R.D. FairbairnMelanie Klein, W.R.D. Fairbairn

Margaret MahlerMargaret Mahler

Utilized systematic observation to identify the Utilized systematic observation to identify the stages of the separation-individuation processstages of the separation-individuation process

Autism (birth – 2 months)Autism (birth – 2 months)Symbiosis (2 – 6 months)Symbiosis (2 – 6 months)Separation-IndividuationSeparation-Individuation

Hatching (6 – 10 months)Hatching (6 – 10 months)Practicing (10 – 16 months)Practicing (10 – 16 months)Rapproachment (16 – 24 months)Rapproachment (16 – 24 months)

Object ConstancyObject Constancy

Separation-Individuation Theory of Separation-Individuation Theory of child developmentchild development

Normal Autistic PhaseNormal Autistic Phase - First few weeks - First few weeks of life. The infant is detached and self of life. The infant is detached and self absorbed. Spends most of his/her time absorbed. Spends most of his/her time sleeping. Mahler later abandoned this sleeping. Mahler later abandoned this phase, based on new findings from her phase, based on new findings from her infant research. infant research.

Separation-Individuation Separation-Individuation Theory of child developmentTheory of child development

Normal Symbiotic PhaseNormal Symbiotic Phase - Lasts until - Lasts until about 5 months of age. The child is now about 5 months of age. The child is now aware of his/her mother but there is not a aware of his/her mother but there is not a sense of individuality. The infant and the sense of individuality. The infant and the mother are one, and there is a barrier mother are one, and there is a barrier between them and the rest of the world. between them and the rest of the world.

Separation-Individuation Separation-Individuation Theory of child developmentTheory of child developmentSeparation-Individuation PhaseSeparation-Individuation Phase - The arrival of - The arrival of this phase marks the end of the this phase marks the end of the Normal Symbiotic Phase. Separation refers to the . Separation refers to the development of limits, the differentiation between development of limits, the differentiation between the infant and the mother, whereas individuation the infant and the mother, whereas individuation refers to the development of the infant's ego , refers to the development of the infant's ego , sense of identity, and cognitive abilities. This sense of identity, and cognitive abilities. This process, labeled process, labeled separation-individuation, is , is divided into subphases, each with its own onset, divided into subphases, each with its own onset, outcomes and risks.outcomes and risks.

Separation-Individuation Separation-Individuation Theory of child developmentTheory of child development

– Hatching – first months. The infant ceases to be Hatching – first months. The infant ceases to be ignorant of the differentiation between him/her and the ignorant of the differentiation between him/her and the mother. "Rupture of the shell". Increased alertness mother. "Rupture of the shell". Increased alertness and interest for the outside world. Using the mother and interest for the outside world. Using the mother as a point of orientation. as a point of orientation.

– Practicing – 9-about 16 months. Brought about by the Practicing – 9-about 16 months. Brought about by the infant's ability to crawl and then walk freely, the infant infant's ability to crawl and then walk freely, the infant begins to explore actively and becomes more distant begins to explore actively and becomes more distant from the mother. The child experiences himself still as from the mother. The child experiences himself still as one with his mother. one with his mother.

Separation-Individuation Separation-Individuation Theory of child developmentTheory of child development

– Rapprochement –15-24 months. In this subphase, the Rapprochement –15-24 months. In this subphase, the infant once again becomes close to the mother. The infant once again becomes close to the mother. The child realizes that his physical mobility demonstrates child realizes that his physical mobility demonstrates psychic separateness from his mother. The toddler psychic separateness from his mother. The toddler may become tentative, wanting his mother to be in may become tentative, wanting his mother to be in sight so that, through eye contact and action, he can sight so that, through eye contact and action, he can explore his world. The risk is that the mother will explore his world. The risk is that the mother will misread this need and respond with impatience or misread this need and respond with impatience or unavailability. This can lead to an anxious fear of unavailability. This can lead to an anxious fear of abandonment in the toddler. A basic ‘mood abandonment in the toddler. A basic ‘mood predisposition’ may be established at this point. predisposition’ may be established at this point. Rapprochement is divided into a few sub phases: is divided into a few sub phases:

Separation-Individuation Separation-Individuation Theory of child developmentTheory of child development

Beginning - Motivated by a desire to share Beginning - Motivated by a desire to share discoveries with the mother. discoveries with the mother.

Crisis - Between staying with the mother, being Crisis - Between staying with the mother, being emotionally close and being more independent and emotionally close and being more independent and exploring. exploring.

Solution - Individual solutions are enabled by the Solution - Individual solutions are enabled by the development of language and the superego. development of language and the superego.

Disruptions in the fundamental process of separation-Disruptions in the fundamental process of separation-individuation can result in a disturbance in the ability to individuation can result in a disturbance in the ability to maintain a reliable sense of individual identity in maintain a reliable sense of individual identity in adulthood. adulthood.

Separation-Individuation Separation-Individuation Theory of child developmentTheory of child development

Object Constancy - Object Constancy - The phase when the child The phase when the child understands that the mother has a separate identity and understands that the mother has a separate identity and is truly a separate individual. This leads to the formation is truly a separate individual. This leads to the formation of of InternalizationInternalization, which the internal representation that , which the internal representation that the child has formed of the mother. This Internalization is the child has formed of the mother. This Internalization is what provides the child with an image that helps supply what provides the child with an image that helps supply them with an unconscious level of guiding support and them with an unconscious level of guiding support and comfort from their mothers. Deficiencies in positive comfort from their mothers. Deficiencies in positive Internalization could possibly lead to a sense of Internalization could possibly lead to a sense of insecurity and low self esteem issues in adulthood.insecurity and low self esteem issues in adulthood.