adults despite adverse early experiences, has led some investigators to ascribe little if any significance to experiences in the early years (Kagan 1984).
The contemporary psychodynamic model incorporates the models of both continuous and discontinuous development. As Mitchell (1988) proposed, early experiences result in patterns of interaction that will be repeated in different forms at different times over the years. Present family interactions merely maintain patterns of behavior initiated in the past.
Emotionally Focused Therapy
The expression of affect in family and marital therapy can be loud, excessive, and defensive and can often conceal rather than reveal the significant issues. Emotionally Focused Therapy (EFT). Has proposed an intelligent framework to concentrate on affect to enhance the treatment process and reduce the disruptive impact of defensive affects. The therapist focuses early in therapy on the expression of affects that are usually defensive, self-protective, and accusatory toward other family members. The exploration of such affects in a manner similar to defense analysis can lead the therapist to the discovery of soft attachment affects that are the roots of the relational dissatisfaction. Emotionally focused therapy is based on the application of attachment theory in family therapy.
Goals
the primary goal of psychodynamic family therapy is similar to those of other family therapy approaches that attempts to create a more highly functioning family unit, free from enduring conflict and inhibitions. As such, the family can enhance the maturation of all family members, particularly children. Psychodynamic family therapist subscribe to the principle of resolution of presenting problems, enhanced self-esteem in family members, flexibility and adaptability of family roles, tolerance of difference among family members, clear boundaries and lines of authority, and balanced sharing of the power in the family. However these therapist also place a very strong emphasis on personal maturity and individuation in family members. This reduces the likelihood of projection of inner perceptions based on past experiences on other family members, or responding to distorted projections of other family members in a shared pathological way. From this point of enhancement of maturity and individuation, psychodynamic family therapist and practitioners of Bowen’s family system theory are closely tied. Both school of thought agree that family members need to take the following steps in family therapy :
1. Develop of sense of self that is both differentiated and internally integrated (Meissner 1978)
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exhibits a lack of vitality, low self esteem, cohesiveness, and vitality and to regulate tension or mood.
The disorder of the self, or narcissistic personality disorder, can be the result of an unemphatic parent who deprives the child of a needed “self object” in Mahler’s language , that is cognitively perceived as external to the self but is experienced as part of the self. A person functioning as a self object for another is perceived as performing some essential psychological function for the subject. Without available external self object support the individual is liable to feel helpless, ineffective, overhelmed, unworthy, unreal, incomplete, or empty.
Unconscious Assumption
Wilfred Bion (1962) described three “basic assumption groups” and processes: dependency, fight/flight, and pairing the basic assumption groups are regressive in nature in contrast to “working groups”. The basic assumption group can support or subvert tasks. Bion has described unconscious assumption with their characteristic “valency ”as the individual’s readiness to join a group that acts to the regressive basic assumption. The valencies are similar to the transference phenomenon described in a boarder psychoanalytic literature. The end result of this type of functioning is the phenomenon of merging or fusion (in contrast to fission) that can occur as a defense against the treat of personal identity dislocation and alienation (Scharff an Scharff 1987.
Fusion basic assumption group functioning support harmony, emphatic identification and togetherness appropriate to the early infant-mother bonding. The domination of the group by fusion is generally an attempt to deny difference, conflict, and loss : bowen and Minuchin describe this phenomenon as “undifferentiation” and “enmeshment”. Fission basic assumption group functioning promotes conflict, difference of opinions, divergent goals. Fusion-fission basic assumptions are the two poles in group dynamics.
Continuity or Discontinuity
Belief in the importance of “traumatic” experiences in the formative years of early childhood and an interest in identifying individual at risk for later psychiatric disorder have led researchers to look intensively for significant continuities in development (Zeanah et.al. 1989). The continuity or discontinuity model of psychopathology led early psychoanalytic theories to predict that psychological traumas and biological propensities led to predictable sequel and consequences. Contrary to expectation, one of the major results of the search for continuities in behavior has been recognition that discontinuities in early development are far more readily apparent than continuities (Emde and Harmon1984, Zeanah et.al 1989). This recognition, coupled with evidence of adequate coping in some resilient children and
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her instinctual needs. Instead, the caretaker deprived the infant trough her own self-involvement. As a result, a child often withdrew from spontaneity and authenticity. Intellectualization is often associated with the false self. The concept of true and false self have central relevance to family pathology and family therapy because the predominance of false self and intellectualization can significantly reduce a married couple’s ability to satisfy one another in the relationship. Since marital choice or love object choice is a matter of idealization and looking only at the best in the loved one to complement oneself, persons with a false self will hide their own unpleasant feelings but seek the needed love from the partner.
Separation – Individuation theory
The separation individuation theory of Margaret Mahler (1975) has become an increasingly dominant theory for the explanation of childhood development, particularly in the first three years of life. Mahler’s theory is based on her observation of the developmental process in infancy and early childhood. It proposed that the infant enters as a symbiotic relationship with his or her care giver after a brief phase of being primarily preoccupied with the establishment of internal homeostasis. In the first three years of life, the child goes through a succession of phases by which he or she attempts to arrive at a differentiated sense of self and the mother (object). By the end of the third year, the child is on the way to individuation,” a process which would take many evolutionary years. However, at the third year of life, the child is expected to have achieved the minimum level of individuation and separation from the caregiver and be able to function with relative autonomy, for a period of time, in the physical absence of the caregiver. This capacity is related to the achievement of “object constancy”. The establishment of an internalized and relatively stable sense of self and object that can with stand the anxiety of the separation.
A decisive period in the separation-individuation process is the “rapprochement”, phase, in which the infant is pulled between two forces : the need to stay close to the caretaker while being pushed to function autonomously. This result in the “rapprochement crisis” that that reaches its height in the second half of the second year of life. The failure to negotiate the rapprochement phase successfully can result in the inability to establish a satisfactory distance and harmonious relationship with the caregiver or other people in the future.
Self Psychology Theory And Self Pathology
The model of “self” proposed by the school of self psychology of Kohut (1977) has clear application to family therapy, because the disturbances of self can readily result in the projection of a person’s inner experience onto intimate relations in family. “Self” or “self organization” refers to three phenomena: the cohesive self, the fragmented self, and the self regulatory structure. The person with a cohesive self exhibits a high level of well-being, self esteem, vitality and productivity. The “fragmentation” of self occurs when there is a failure to establish the cohesive sel. The person with a fragmented self
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Winnicott (1958) refers to this holding environment provided by the mother “ as good enough mothering”, through which the infant experiences an omnipotence that is essential for the child’s healthy development. This holding provides sufficient security for the infant to ultimately tolerate the inevitable failures of empathy.
The concept of the holding environment can also be applied to the nonspecific and supportive continuity provided by the therapist and the therapeutic situation. The regularity of visits, the steadiness of the therapeutic environment, and the very continuity of the care by the therapist all contribute to a metaphorical holding that can help contain the disruptions that occur during meaningful treatment (Moore and Fine 1990, p. 206). The provision of therapeutic holding is particularly important for patient who have not experienced a satisfactory “holding” experience in their early childhood. An important aspect of therapeutic holding is to accept the total range of the expressions by the patient, to contain such as expressions, and to help the person to integrate his or her experiences in a growth-promoting fashion. Kohut’s (1971a) concept of idealizing and mirroring functions in self psychology are very similar to the concept of holding environment.
Bonding/ Attachment
The concept of bonding or attachment is based on Bowlby’s ethologically based observations on the child’s tie to his mother. Bowlby (1988. P. 27) defined attachment as any form of behavior that a results in a person’s attaining or maintaining proximity to some other to clearly identified individual who is conceived as better able to cope with the world. The presence of an available and responsive attachment figure gives a person a pervasive feeling of security and encourages him or her to value and continue the relationship. This definition addresses both the protective aspects of attachment as well as relational nature of this type of behavior. The need for personal relationships is the basis for bonding and attachment rather than the need for food or some other sustenance necessary for life. Proximity to the attachment figure and the security therein is a crucial aspect of the therapeutic situation. The environment for the patient must be safe and secure. Bowlby labeled this protective environment a secure base. The concept is related to the concept of holding or containment described by Winnicot (1985) and Bion (1962), respectively, and incorporated into the theory of object relations in family therapy.
True self false self
The concept of true and false self proposed by Winnicot (1958) are rooted in his view of early development. The “true self” is based on the child’s experience of nurture by “a good enough mother” who appreciates the importance of need satisfaction in the infant.
The disorder of the “false self” can indicate the absence of this experience : as an infant, this individual had a caretaker (usually a mother) who was unable to meet his or
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Projective Identification
Projective identification is an interpersonal defense mechanism shared by two or more people based on a shared fantasies object relationship. Here, the parts of the self and internal objects are split off and projected onto and external object. The object then becomes “identified” with the spilt off part as well as possessed and controlled by it. In family ahd material treatment, a therapist can easily become involved in projective identification, he or she subsequently gets pulled toward one partner’s side of the battle and begins to act out against the other partner, thereby disrupting treatment.
Projective identification occurs extensively and frequently between the spouses as well as between parents and children. The mechanism of projective identification between marital partners is facilitated by choosing a partner that shares one’s neurotic conflict and then accusing the partner for the problem. A parent’s continued use of accusations (i.e. “You’ll become just like your father”) can initiate projective identification. This is the colloquial “self-fulfilling prophecy”. In parent-child relationships, projective identification can occur readily and extentively because the child may view the parent’s projections as reality. Children often base their developing identities on these projections.
Family Image
The concept of family image described by Sonne (1981, p. 82) refers to a developing child’s recognition of the existence of a marital dyadic relationship between the parents and his internalization of such an image. The child learns to relate to the parental dyadic relationship in a fashion similar to how or she relates to the individual parental figures. This family image expands the child’s possibilities for the identification with the roles assumed by both parents. The development of triadic family image is influential in the issue of mate selection as well as transference distortions outside of the marital relationship.
Holding environment
The concept of holding environment developed by Winnicot refers to a quality and characteristic of interaction between the mother and infant. This concept has been further utilized to describe a certain aspect of the therapeutic situation. The function of “holding” refers to those facilitative aspects of the environment that the provide infant with the feeling of safety, constancy, and “containment”. The holding environment produced by the mother provides safety, constancy and protection for the infant. It also provide a precise reflection of the infant’s experience and gestures to him or her that can facilitate growth as well as allowing temporary regressions
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Sager cautioned therapist that countertransference often occurs in the triangular of the therapist and two patients, in marital treatment. Such countertransference reaction take the form of becoming competitive or resorting to “male chauvinistic”.”feminist”,or “anti-male” thinking. He cautions to “check one’s value system constantly so that it is not imposed upon the couple” (Sager 1976,p.207)
Resistance
The concept of resistance describes all oppositional forces within the therapeutic situation that hinder progress in treatment (Greenson 1965). Resistance may be conscious, preconscious, or unconscious. Any human behavior can be used as a resistance in treatment, such behaviors include emotional expressions, attitudes, ideas, impulses, thought, fantasies, or actions. Object relations psychotherapists see the motive for the resistance as reluctance on the part of the patient to allow a painful relationship into awareness. The patient therefore avoids the return of the repressed bad object relations and the attendant pain of the earlier experiences with the bad object (Guntrip 1969, scharff and Scharff 1987). In family and marital therapy, resistance exhibits itself by the collusive avoiding conflictual topics, scapegoating, becoming depressed to avoid expression of anger, refusing to consider one’s own role in dysfunctional interactions, seeking individual sessions or individual treatment , keeping secrets, threatening to leave treatment or changing therapist, and acting-out. All of these forms of resistance allow the patient to avoid pain, including the anxiety about remembering previous painful experiences.
Sonne, Speck, and Jungress (1986) described one form of resistance to family therapy called the “absent member maneuver in family therapy”. Family members representing one side of the family conflict can absent themselves from family sessions are collusive behavior to conceal and avoid family conflict. That resistance can only be successfully overcome once all family members are encouraged to attend the sessions and express their viewpoints.
Socially Shared Psychopathology
The concept of socially concept psychopathology is the end and result of a number of interpersonal psychological mechanisms such as projective identification and delineation. Through these mechanism, a person delineates part of his psychopathological tendencies and imparts it to another intimate member of his social group, particularly his family. The other person invites and receives this psychopathology and claims ownership of the projected part.
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Countertransference
Countertransference refers to the phenomenon of unconscious feelings in the therapist in reaction to the patient’s verbal and/or non verbal communications in treatment. Countertransference can become a potent impediment to the progress of treatment if it influences the interventions of the therapist. However, the therapist’s relatively early recognition of his or her feelings toward the patient can become a valuable tool for understanding the nature of the patient’s transferential projections onto the therapist in the treatment situation.
There are superficial and fleeting reactions on the part of the therapist toward the patient, based to a large degree on objective reality and under good control of the therapist. In superficialtypes of the countertransference reactions, the therapist is aware that he is concealing his own responses to the patien and that his responses may be the projection of his own fantasies rather than the reality. More serious types of countertransference reactions are relatively stable, fixed, focused, and unconscious reaction of the therapist to the patient, based on some infantile aspects of the therapist’s personality provoked by the patient’s behavior or material. The countertransference feelings in the therapist are usually the result of the therapist’s defensive behavior, based on his early life experiences or current circumstances. Countertransference arises out of the therapist’s identification of himself with the patient’s internal objects (Racker 1981). Behavior such as distancing, unempathic interpretation, taking sides and reversal, reverting to dyadic or individual therapy, simplification of the issues, preoccupation and rationalized emotional withdrawal, shaming the patient, or impulsive attempts to control on of the spouses are some of the ways countertransference is exibithed. Termination of treatment is likely to occur at this point because of the unresolved transference.
Countertansference in family therapy is often the result of several factors, some of which are listed below :
1. The presence of multiple persons in family and couples therapy is likely to give rise to oedipal transferential configurations because of alliances, coalitions, rivalries, jealousies, boundary disturbances, and triangulations (Dare 1986). Interpersonal expression of intrapsychic defenses is a common phenomenon with the more disturbed, boundary-lacking families.
2. The active and self revealing nature of family therapy promotes expressions of countertransferential reaction in the sessions. The therapist’s is to remain outsides the conflict and not take sides.
3. It may be technically more difficult to completely avoid collusion with a family therapy, particularly when the painful issues involved may be similar or mirror those encountered by the therapist in, the course of his or her own past or current intimate relationships.
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