SOME OBSERVATIONS ON i
OF ADULTS
i
HIS PAPER HAD ITS ORIGINS in clinical experiences in the psychoanalytic situation. Explanatory assistance in understanding the patient and in finding appropriate technique was obtained primarily from the conceptualizations of Margaret Mahler. Mahler is a true clinical researcher. She studies phenomena that are not produced experimentally, but occur naturally without known cause. The problem in such circumstances becomes one of asking questions and then identifying related variables, trying to establish causal connections. Mahler’s observational methods have established a model for clinical investigation: She has given us a frame of reference for comparing observations of circumscribed experiences in the life of a child, such as separations, with similar experiences in subsequent periods of the life cycle.. Comparison highlights differences as well as similarities, and grouping these variables points the way to generalizations of wide applicability, whether between individuals in the same age period or between different phases of development. In other words, the meanings of the variations and the factors they share in common lead to conceptualizations of general principles. In recent years, the theory of object relations and the role of objects in structure building has received increasing attention, to a large extent stimulated and facilitated by Mahler’s
T
This paper was read at the Mahler Symposium in Philadelphia, Pennsylvania, on May 18, 1974.
743 Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
744
JOAN FLEMING
useful formulations. One of these concepts, which reaches beyond childhood, is that of separation-individuation as a process. This process has relevance at all stages of the life cycle and offers a frame of reference for diagnostic understanding and therapeutic technique. My own work, in this field has gradually evolved in a similar direction, but from a different angle. For over fifteen years, I have been studying a group of adult patients in analysis, all of whom presented a history of early object deprivation. In an earlier paper I described the beginnings of our research project at the Chicago Institute, which was called the Parent-Loss Project because each patient had lost a parent by death in childhood (Fleming, .1963). As we became involved in this study and discussed our findings with colleagues, a surprising revelation came to light. Hearing other people say, “Now I begin to understand a case that has been very puzzling and seemed to be at a n impasse,” we realized we had all been analyzing parent-loss patients whose treatment had often ended in failure or an impasse, but we had not recognized that a core factor lay in the patient’s childhood reactions to the death of a parent and the interference with normal personality development caused by this experience’ (Fleming, 1974). Mahler’s concept of the separation-individuation phase as being part of normal development (1965), as well as her concept of symbiosis (Mahler and Furer, 1968), and the correlated ideas about object constancy elaborated so usefully by Fraiberg (1969) have direct bearing on our understanding of what happened to our parent-loss patients after they were deprived of an object assumed essential for their normal development to maturity.’ The patients we studied were all fairly healthy adults who had made adaptations to their loss in childhood which permitted fairly adequate development through childhood into adult years: They had built defenses that were adequate
* A wide range of pathology has been attributed in one way or another to the loss of a parent in childhood (see Alpert, 1959; Beres and Oben, 1950; Hilgard, 1953; Hilgard and Newman, 1959; Rank, 1949). Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
OBJECT CONSTANCY M ADULTS
745
until the normal course of events and the pressures of maturation demanded a change in their way of living. These events had a common denominator-namely, separation experiences that required independence and self-reliance. The developmental tasks we expect to be accomplished in the developmental process of separation-individuation, tasks leading to independence and self-reliance, these patients were not able to man age. I have described elsewhere the phenomena of arrested development, of denial of the reality of the death of the lost parent, and the immaturity these patients manifested in their object relations (Fleming.et al., 1958;Fleming, 1963, 1972). Today, I should like to go further in trying to explain the role of an object in building the structures that assist the ego in coping with separation experiences and permit the establishment of self- as well as object constancy, leading ultimately to a mature individuated identity that is both competent and gratifying (Mahler, 1963). My data come from the analyses of adult patients, and therefore the references to childhood are retrospective and subject to the usual distortions which remembering does to historical facts. Historical data do not, however, constitute the most significant findings. These come from the transference ,relationship and in the transactions of the analytic process. They are focused on the patients’ reactions to the task of coping with separation experiences in the course of analysis, how these experiences reproduced the childhood trauma and the childhood coping behavior, which was gradually modified by analytic interpretation and the object relation the analyst offered. According to Mahler’s timetable for the separationindividuation phase, the child at four years of age should have completed at least the third subphase, that of rapprochement, and should have entered the fourth subphase, characterized by Mahler as “the birth of the child as an individual.” In other words, separateness and boundary-making should have been accomplished, but the complex process of differentiation that leads to a sense of identity and an individuated self could be
Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
746
JOAN FLEMING
expected to be still going on, since it is doubtful whether individuation has reached more than a beginning at the age of four. But what about object constancy?In the fourth subphase, Mahler (1965) says, there is “an increasing degree of object constancy.” This is a concept marking a significant point of progress in .normal development. It indicates. that a mental representation of the need-satisfying object has been organized in the mind and can be.evoked as a memory in the absence of that object. The image of the object in the evoked memory is assumed to support the ego in its regulatory operations of delay and the management of separation anxiety (Fraiberg, 1969). The capacity to evoke such a memory is considered to be a nodal point of progress in building intrapsychic structure. The memory of the object needs to be stable and firm enough to tolerate the increased need tension and frustration caused by ‘delayedgratification, and to bridge the gap in exteroceptive perception caused by the actual absence. How does one make such a memory? Normally, there is a continuing process of modification and change in the configuration of that nodal point, and these modifications themselves shift in relation to the stresses of life (Burgner and Edgcumbe, 1972, p. 328). Mahler (1965) has emphasized the parallel development of object constancy and the separationindividuation process. She calls attention to the function of object constancy in restoring equilibrium disturbed by experiences of separation. At this point, I want to examine some implications in the terms separation and individuation and to emphasize that the separation-individuation phase is only part of a much more extended and continuing process of modification of the structures and experiences that function to bring about ultimate individuatiom The term separation usually refers to spatial distance between two objects. It also refers to a perception of boundaries that define space. Around.this perception of boundaries the representational world takes shape, organized into what is internal and what is external. The beginning awareness of this differentiating perception is an important developmental step Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
OBJECT CONSTANCY IN ADULTS
747
in cognitive functioning that must precede the registration of an image of the object who provides relief from physiological need tensions. An image of the needed object recognized as external and separated by space thus becomes internalized and available to the ego. When this cognitive perceptual development has occurred, the ego has support for modulating the level of need tension and preventing a flood of lifethreatening need. Experiences of separation and a developing awareness of separateness are thus both powerful forces for organizing structures that assist the ego in its regulatory and integrative operations. At first, however, that awareness seems to be associated in memory traces with anxiety-producing experiences. Only gradually is this anxiety mastered by the intrapsychic organization of an image of the caretaking object whose presence relieves the threatening tension. The phenomena that indicate establishment of such a structure have been described by a number of authorities on child development (Piaget, 1937; Spitz, 1959; Fraiberg, 1969). These phenomena have been placed in a hierarchy of explanatory concepts that are referable to the development of object relations, of which object constancy is one. Benedek (1938, 1956), Hartmann (1952), Jacobson (1964), and Spitz and Cobliner (1965) correlate this development with progress in more complex and effective organization of the ego. These authors make use of the term self and differentiate it from object, but the problem of differentiating self from ego has not been clarified to the extent that it needs to be. Jacobson (1964) recognizes this problem explicitly when she correlates the changes froin the more basic biological survival needs of primary narcissism with psychological needs for self-esteem. Such needs seem to become more prominent after object constancy has been established and indicate the beginnings of an organization of a mental representation of a self-image that, like the evocable image of object constancy, plays a most significant role in regulating self-feeling, self-reliance, and self-confidence. One important element in conceptualizing object relations and in studying behavioral phenomena relevant to this area of theory seems to have been taken for granted to a large Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
748
JOAN FLEMING
extent. I refer to the tendency in the past to concentrate on the “subject” and the “object” as tied to each other by need tensions but to pass over the reciprocating responses in the relationship between the subject and the object. I think this reciprocation has been neglected because efforts to conceptualize the economics of cathexes, the differentiation of ego, id, and superego, and the organizing of the representational world have been given priority. It seems to me that we have tended to take object responsiveness for granted and, in so doing, have not given the feedback system in the relationship the proper significance or studied in detail the characteristics of the feedback that are effective. In the early months of life, the relationship does seem to be largely a one-way street, although as early as three months a response from the child to the object is visible in the infant’s smile. This behavioral indicator of the organization of experiences of need-tension, perception, affect, mnemonic activity, and delay functioning signals a beginning of psychological and social potentials for dialogue without which human beings often do not survive (Spitz, 1959). Mahler has paid particular attention to the reciprocal nature of the relationship between mother and child. Her concept of optimal symbiosis as the basic relationship without which further development is distorted or derailed has been extremely helpful to me in my efforts to understand the initial resistances to a working alliance in the psychoanalytic treatment of adults who have been exposed to early object deprivation (Fleming, 1972). Specifically, it has raised the possibility that what we call a working alliance is actually a replica of a symbiotic relationship. Is it possible that the “alliance” in the therapeutic situation repeats the ego operations that we assume in the establishment of object’constancy? Is it also possible that, once the reciprocal relationship is in operation, the terms we use, such as “development of an observing ego,” actually refer to the beginnings of a new self-image, as well as an “introjection” of an image of the analyst? Mahler has described how the mother’s. patterns of response to her toddler’s efforts to “hatch out” of his symbiotic relationship can facilitate or interfere with this normal process of developDownloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
OBJECT CONSTANCY IN ADULTS
749
ment. Is it possible that the structural changes we hope for from the psychoanalytic experience can be facilitated by responses from the analyst other than‘ interpretation in the usual sense of the term? My experiences in trying to understand the clinical phenomena that commonly appear in the course of psychoanalytic therapy have led me more and more insistently in this direction. No aduit patient is really a baby, and an analyst is not his parent. Nevertheless, the object need in many adults reproduces in many ways the functional relationship between mother and child- the diatraphic feeling without which the analytic process meets with difficulty (Spitz, 1956; Gitelson, 1962; Fleming, 1972). ‘The first step for the analyst is to try to make a diagnosis of the developmental level of the patient’s ego state and an assessment of his level of object need. Once such a diagnosis is made, technical responses congruent with that need can be compared with optimal object responses that facilitate normal development outside of the therapeutic situation. When this can be achieved, developmental arrests due to early object deprivation are interrupted; the derailed developmental process can be set in motion again; and the resistances to the “separations” (changes) that all efforts at separation-individuation are heir to can be worked through in a therapeutic experience which is also developmental (Greenson, 1965). Let me single out as an important vector the reciprocation so significant for organizing differentiated images of object and self, an element in the experience that builds configurations that each of the parties involved learn to perceive as object and subject-“you” and “I.” The important element here is the feeling of being approved of, of being valued. This feeling is distinguished from the feeling of wellbeing by the additional perception not only of the source of the communication as coming from the object (a spatial localization), but of the content of the message. With this apperception, there is an increment of affective plus cognitive registration that the object, i.e., the mothering person, is pleased with the child and that she herself has a libidinal investment in how he responds. It is not difficult to enlarge on this beginning of the reciprocity of relatedness in which an Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
750
JOAN FLEMING
awareness that “I mean something to you which is also pleasurable to me” influences the shape of the mental representation, not only of the object, but of the subject in the transaction as well (Sandler and Rosenblatt, 1962). By object constancy, I refer to the process of establishing an evocative memory of a mental representation of an object significant as the satisfier of some. kind of need. The needs vary, and the objects vary continually. A child can use his already operative capacity with the help of an object other than mother to structure an evocative memory of such an object. I am sure the general principles of organizing a mental representation of an object invested with libidinal, aggressive, or narcissistic significance are in operation on many other occasions than in the first three years of life. I am sure that such a building of memories goes on all through the life cycle. What varies is the degree of stability and the use to which the memory is put when it is evoked. So much of the thinking around the concept of object constancy has come from observations made in children’s behavior that it is easy to fall into two errors. The first is that the earliest representation of mother, once it is established, does not become modified over time. The second error seems to be that mental representations of other objects encountered at various points in the life cycle do not serve the same dynamic, economic, and adaptive purposes when their images are evoked in memory. Perhaps I am overemphasizing this point and generalizing from, a personal realization whose meaning has only recently become conscious. I can only say that the clinical material about to be described and the explanatory fit contributed by a study of the theory of object constancy and separation-individuation have provided me with a sense of enlightenment that I value, however retarded it has been.
I should like to illustrate how a disruption of the normal separation-individuation process at the age of four years was reflected in the transference behavior with the analyst and how technical responses resulted’ in several changes in the direction of growth. The first series of events influenced the Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
OBJECT CONSTANCY IN ADULTS
751
establishment of an evocable mental representation of the analyst that served the function of an evocable memory of the mother in mastering separation anxiety. In rapid sequence, there appeared to be evidence of the structuring not only of an effective object constancy but a more intact and cohesive self-image whose development was directly related to the reciprocating relationship established in the working alliance, I want to describe and discuss the case of Frank, a man of 32, who presented early in his analysis an extreme reaction to weekend separations. He was an intelligent, competent, financially successful businessman who suffered from deep-seated feelings of loneliness and inadequacy in his social relationships. He had married in his early twenties and had one child. The marriage was not a happy one, and the patient formed temporarily intense attachments to both men and women, which never seemed satisfying and which he usually terminated in some kind of flight. The patient’s history revealed a very close relationship with his mother during his first four years and I assumed that there had been a constructive symbiotic relationship and an establishment of object constancy. At the age of four, however, his mother was suddenly hospitalized- with a chronic illness and he was separated from both mother and father for the next five years, during which he lived with his maternal grandparents. The little boy experienced moments of utter loneliness and despair, wondering if his mother was still alive and feeling that, if he thought about her hard enough, she would not die but would some day return to him. The analysis began with intense anxiety about his performance in the analytic hours, his fear of displeasing me, while at the same time there was strong reluctance to become involved. My diagnosis indicated conflict over regressive pulls toward primitive object needs and a poorly defined self-image with low self-esteem that needed reinforcement from an external object. Past experience in such situations (Fleming, 1972) influenced me to go slowly, but to encourage him to face his fears and to listen to the fantasies he had when he was alone and felt threatened. He described it as “‘fallingapart” or “not knowing where my head is.” At first, my support for his Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
.
752
JOAN FLEMING
effort to associate in my absence was intuitive, but, as time went on, I realized it was a response from me that facilitated his ability to evoke an image of me during periods of separation. Subsequent events seemed to validate that formu1at ion. What I shall describe does not indicate that either the symbiotic relationship with his mother or the earliest establishment of object constancy was historically abnormal. It does indicate that a normal separation-individuation phase may have begun, but that the “hatching out” process was not completed. Anamnestic data gave evidence that achievement of stability in mastering separation anxiety was interfered with and that organization of a self-image differentiated from object images andi’ndividuated with any cohesiveness was not f achieved. There was a tendency to transfer his longing for a return to the early symbiosis to various adult persons in his immediate surround. However, the early relationship with his mother had been full of pleasure and feelings of being worth something, which many later relationships did not provide. This kind of transference involvement with other objects was filled with conflict and made him afraid of reliving the pain of the early separation and the long waiting period before his mother returned, when he was nine. The actual return contributed to the complex conflict because, of course, the changes in both mother and son prevented a realistic reenactment of the preseparation situation, a fact that intensified his ambivalence and made the agony of waiting seem to be all for nothing. During the five-year separation, his grandparents had provided very adequate parenting, which not only gave the boy support during critical times but also assisted the analysis. The grandmother was a strong and warm person who reinforced the patient’s efforts to cope with the trauma of the sudden loss. A grandmother transference seemed to facilitate the working alliance. When that was established, the patient could tolerate some regression and re-experience with me the frightening anxiety on the weekends. The patient’s’ability to verbalize what he was experiencing and to make use of my responses made it possible for Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
OBJECT CONSTANCY IN ADULTS
753
both of us to work through a series of steps in the development of mental representations that played a part in building a more individuated sense of self and sense of other than he had had before analysis. This outcome is to be hoped for in any analysis that aims for structural change, but it is rare, in my experience, for the steps in the process of change to have such sequential clarity and to be so easily correlated with technical responses. The first indicator of a beginning ability to tolerate the weekend separation anxiety with more detachment was when he came in on a Monday with the report that, as he had left the previous Thursday, the thought that I would be gone on Monday suddenly flashed through his mind. At first he was more anxious than usual, and then he recalled the thought in more detail. Its content was, “She will go poof and disappear.” As the anxiety lessened, he recalled that was the feeling he had about his mother’s disappearance. He realized he had been afraid to let me be important to him because I might “go poof and disappear” just as she had. The next step was a report of a retrospective observation. He now realized that from Thursday to Monday he had felt suspended and “had just waited.” As we explored these associations, he recalled how, during the first few months at his grandmother’s, he often sat in a tree in the swamp trying to picture his mother’s face. After the first visit to the hospital, he could piccure her hospital room and see her lying in bed. Being able to do this helped. In other words, he was using his capacity to evoke an image of the needed object, but he also needed to know where she was. Fraiberg (1969) comments on the advance in organization of a mental representation when the child can call his mother, knowing she must be someplace. In the analysis the addition of spatial localization to the image of the needed object became a very important part of a mental representation of me that could be effective in coping with separation anxiety. After the “go poof’ weekends, he felt I was gone but would be back on Monday. “Only,” he said, “I don’t know where you are.” I asked if he had thought about where I might Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
754
JOAN FLEMING
be or of calling me. His reply was, “No, I couldn’t think about that,” and then realized he was feeling as helpless as he had felt a long time ago, although, of course, this was a feeling that did not apply to today. The next step came when, on Monday, he reported, “I felt you were gone, but now I know where you are. I found the building you live in and I can picture you there.” The next advance in the mastery of separation anxiety was indicated when the patient reported he did not feel so out of touch ever since he could imagine where I was and also imagine me being with someone else. Conjuring up that image produced discomfort, however, because it made him jealous. He felt angry at me because I was so important to him. This reminded him of imagining his mother with the doctors in the hospital. It seemed to him she enjoyed them, and this hurt his feelings. He said, “I need you to be with me to know how I feel about myself.” This remark startled me, and then I remembered the theory of the smiling response, of stranger anxiety, of the concept that a self-image begins as a reflection of the affect in the mother’s face (Spitz and Wolf, 1946; Benedek, 1956; Mahler and Furer, 1968). Southwood (1973) has written an interesting article in which he ascribes the origin of selfawareness to looking someone in the eye and seeing a response that “lie recognizes me.” Winnicott (1967) talks of the mother’s role as a mirror “giving back to the baby the baby’s own self.” He describes this experience as the “beginning of a significant exchange with the world, a two-way process in which self-enrichment alternates with the discovery of meaning in the world of seen things” (p. 27). In the psychoanalytic situation, messages are usually communicated by means of the voice. My 1972 paper discussed how useful wordless sounds of response from the analyst can be in establishing a working alliance with cases of early object deprivation. These responses are important for calling attention to the presence of the analyst in the service of differentiating current reality from illusions persisting from the past. Some patients seem to need visual contact as well. ~
Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
OBJECT CONSTANCY IN ADULTS
755
0.
This was b o h e out in a pattern of behavior that began accidentally with Frank. At the end of the analytic hour, he wyould sit for a minute on the edge of the couch looking me in the eye. Intuitively at first, I returned his gaze and made a comment or two. Occasionally, this exchange lasted for a couple of minutes. When the patient talked of feeling more defined and intact, I began to realize it had the significance that Southwood and Winnicott assign to looking into someone’s face. He’ said, “I feel differently about myself . . . I’m responsible for me and can make choices in terms of my own needs. I don’t have to fill someone else’s space in order not to feel alone and empty.” Later still, in the analysis, Frank reported the good feeling associated with these moments and how glad he was I did not interpret what was happening at the time. The exchange between Frank and myself at the end of an hour was understood as an intensified regressive need for symbiosis. I simply responded to the need without making an interpretation. The situation reminded me of a child who keeps calling for a drink of water after the goodnights have been said and the lights turned out. It does not seem strange when child analysts, in their work with children, think of the analytic process as being closely associated with the process of development in the growing child. Clearly, any child is already in some phase of development, and no one questions that the task of analyst and child is to work together to free the blocks to normal development. One difference between the attitude of an analyst of a child and the analyst of an adult is the ease with which the child analyst accepts the object needs of a child, recognizing that the therapeutic dialogue requires that responses from the object in the relationship must provide experiences that assist in the building of intrapsychic structure as well as a reorganization of handicapping defenses. A child who is fearful of the separation from the analyst and wants to climb on his lap toward the end of the hour is not pushed away, but is permitted to experience the physical contact and security he needs to master the separation anxiety. Interpretation accompanies the action or follows it when appropriate. Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
756
JOAN FLEMING
In the analysis of an adult, similar moments arise. They are manifestations of the patient’s lack of resources to master the anxiety and need-tension by himself and indicate the state of inner equilibrium and level of development of the patient’s intrapsychic structures, especially his capacities for coping with various threats to that equilibrium. I have been increasingly impressed with the fact that we expect our adult patients to possess a degree of maturity on their psychosocial developmental line that would almost preclude any need for analysis. Often, without that degree of maturity we do not think of them as analyzable. My experience with adults in an arrested state of development as a result of the death of a needed object in childhood points toward analysis as the treatment of choice (Fleming, 1963, 1972; Fleming and Altschul, 1963). The psychoanalytic situation through its structure and consistency provides security for both patient and analyst, and if the analyst conceives the psychoanalytic process to be comparable to the developmental process, especially in the area of retracking derailed self-object relations, psychoanalytic therapy can be most valuable. This patient and I were able to observe phenomena relevant to concepts of object constancy and the symbiosis pertinent to a working alliance, but we could also see the way in which object responses were an important component of experiences which structured a self-image with a sense of positive self-esteem. An effective object constancy was reconstituted in the analytic situation, but there was additional structure building. The development of a working alliance with an object whose internalized image participated in the structuring of a protective evocative memory served as a foundation of security from which self-differentiation and the organization of a self-image developed with a greater sense of self and feeling of self-confidence and Self-valuethan had ever been present before. The constant feeling of inadequacy and vulnerability to external involvements had kept the patient in a state of apprehension about being abandoned, both for inadequacy (sometimes real and sometimes not) and for “being bad.” The transference elements in this latter fear were
Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
OEJECT CONSTANCY IN ADULTS
757
reinforced by the patient’s angry and subsequently hostile, aggressive reactions to frustration of his self-esteem needs. A turning point in the analysis came with th’e interpretation of a “three-step” dream. Frank reported that he had dreamed about me, ‘first as getting up from my chair and moving to the desk in anger, displeased with somethinghe had done. He felt frightened. Then it seemed that I was not angry with him, but was more interested in someone else. He felt annoyed but not frightened. Then the dream changed again. This time I had moved to the desk to take care of something I was interested in. He did not feel that I had left him and was neither frightened nor angry, but felt it was all right with him since he knew r would be back and he could wait. Frank said he did not understand the dream, but just felt it was a good one. After a few minutes of concentration on the second part, I called his attention to the three kinds of images of mesomeone who left in anger as punishment, someone who found him uninteresting compared to someone else, and someone who had things of my own to do that took nothing away from him. Frank recognized the first two scenes as representing stages in his object relations all through his life. He realized the third scene portrayed a relationship that he admired and wanted, but was only beginning to think possible. The meaning of the dream was worked on in its many aspects of past, present, and future feelings about other people in relation to himself with an increasing tolerance for separations and individuated images of Other and self.
Summary In conclusion, I would like to restate the focus of this paper by calling it a study in the metabolism of experience from two angles: (1) the integrative task confronting the ego in organizing drive and object interactions to assist the ego in its regulatory functioning; and (2) a timetable of progression in accomplishing that task. Evidence was presented from the psychoanalytic treatment of an adult man who suffered object
Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
758
JOAN FLEMING
deprivation during the “hatching out” subphase of separationindividuation. In the course of therapy, an effective object constancy was reconstituted and the process of individuation of self and Other was re-established. The therapeutic work provided the patient with experiences in transactions between self and object useful for reorganizing the trauma of early object deprivation and thereby mobilized his resources for a resumption of the developmental process distorted in childhood. REFERENCES Alpert, A. (1959). Reversibility of pathological fixations associated with maternal deprivation in infancy. The Psychoanalytic Study of fhe Child, 14:169-185. New York: International Universities Press. Benedek. T. (1938), Adaptation to reality in early infancy. Psychoanal. Quurt., 7:200-215. (1956), Toward the biology of the depressive constellation. ThisJournal, 4~389-427. Beres, D. & Obers. S. (1950). The effects of extreme deprivation in infancy on
psychic structure in adolescence. The Psychoanalytic Sfudy of the Child, 5:212-235. New York: International Universities Press. Burgner. M. & Edgcumbe, R. (1972). Some problems in the conceptualization of early object relationships. Part 11: The concept of object constancy. The Psychoanalytic Sfudyo f f h e Child, 27515-333. New York Quadrangle Books. Fleming. J. (1963). The evolution of a research project in psychoanalysis. In: Counterpoint: Libidinal Objecf and Subject, ed. H. S. Gaskill. New York International Universities Press, pp. 75-105. (1972). Early object deprivation and transference phenomena: the working alliance. Psychoanal. Quart., 41:23-49. -(1974), The problem of diagnosis in parent-loss cases. Contemporary Psychoanal., 10:439-451. & Altschul, S. (1963), Activation of mourning and growth by psychoanalysis. Internat. J. Psycho-Anal., 44:419-431. ,Altschul, S., Zielinski, V.. & Forman, hi. (1958), The influence of parentloss in childhood on personality development. Unpublished. Read at Meeting of the American Psychoanalytic Association, San Francisco. Fraiberg, S. (1969). Libidinal object constancy and mental representation. The Psychoanalytic Study ofthe Child, 24:9-47. New York: International Universities Press. Gitelson, M. (1962), On the curative factors in the first phase‘ of analysis. In: Psychoanulysis: Science and Aofession. New York: International Universities Press, 1973, pp. 311-341. Greenson, R. R. (1965). The problem of working through. In: Dn’ves, Affects, and Behatior, Vol. 2, ed. Max Schur. New York: International Universities Press, pp. 277-314. Hartmann, H. (1952), The mutual influences in the development of the ego and the id. In: Essays on Ego Psychology. New York International Universities Press, 1964, pp. 153-182.
-
Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
OBJECTCONSTANCY IN ADULTS
759
Hilgard, J. R. (1953). Anniversary reactions in parents precipitated by children. Psyhiat., 16:73-80. & Newman, hl. F. (1959). Anniversaries in mental illness. Psyhiat., 22:113-121.
Jacobson, E. (1964), The Self and the Object World. New York International Universities Press. hiahler, M.(1963), Thoughts about development and individuation. The Psjchoanalytic Study of the Child, 18:307-324. New York International Universities Press. (1965). On the significance of the normal separation-individuation phase. In: Drives, Affects, and Behavior, Vol. 2, ed. Max Schur. New York International Universities Press, pp. 161-169. __ & Furer (1968), On Human Symbiosis and the Vicissitudes of Individuation, Vol. I. Infantile Psjchosis. New York: International Universities Press. Piaget, J. (1937). The Construction of Reality in the Child. New York Basic
Books, 1954. Rank, B. (1949), Adaptation of the psychoanalytic technique for the treatment of young children with atypical development. Amer. J. Orthopsychiat., 19~130-139.
Sandler, J. &'Rosenblatt. B. (1962). The concept of the representational world. The Psyhoanal$ic Study of the Child, 17:128-145. 'New York International Universities Press. Solnit, A. (1970). A study of object loss in infancy. The Psychoanalytic Study of the Child, 25257-272. New. York International Universities Press. Southwood. H. M. (1973), The origin of self-awareness and ego behaviour. Internat. J. Psycho-Anal., 54:235-240. Spitz, R. A. (1956), Countertransference. ThisJournal, 4256.265. (1959), A Genetic FieZd Theory of Ego Formation. New York: Inter* . national Universities Press. & Cobliner, W.G. (1965), TheFirst Year of Lge.-New York: International Universities Press. .& Wolf, K. (1946). The smiling response. Genetic Psychology Monograjhs,
-
34:57-125.
Winnicott, D. W. (1967). Mirror-role of mother and family in child development. In: T h e Predicament of the Famib, ed. P. Lomas. London: Hogarth Press. Submitted October 8, 1974 Department of P s y h i a t y CZ70 University of Colorado Medical Center 4200 Eust 9th Aoenue Denuer, Colorado 80220
Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
OF ADULTS
i
HIS PAPER HAD ITS ORIGINS in clinical experiences in the psychoanalytic situation. Explanatory assistance in understanding the patient and in finding appropriate technique was obtained primarily from the conceptualizations of Margaret Mahler. Mahler is a true clinical researcher. She studies phenomena that are not produced experimentally, but occur naturally without known cause. The problem in such circumstances becomes one of asking questions and then identifying related variables, trying to establish causal connections. Mahler’s observational methods have established a model for clinical investigation: She has given us a frame of reference for comparing observations of circumscribed experiences in the life of a child, such as separations, with similar experiences in subsequent periods of the life cycle.. Comparison highlights differences as well as similarities, and grouping these variables points the way to generalizations of wide applicability, whether between individuals in the same age period or between different phases of development. In other words, the meanings of the variations and the factors they share in common lead to conceptualizations of general principles. In recent years, the theory of object relations and the role of objects in structure building has received increasing attention, to a large extent stimulated and facilitated by Mahler’s
T
This paper was read at the Mahler Symposium in Philadelphia, Pennsylvania, on May 18, 1974.
743 Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
744
JOAN FLEMING
useful formulations. One of these concepts, which reaches beyond childhood, is that of separation-individuation as a process. This process has relevance at all stages of the life cycle and offers a frame of reference for diagnostic understanding and therapeutic technique. My own work, in this field has gradually evolved in a similar direction, but from a different angle. For over fifteen years, I have been studying a group of adult patients in analysis, all of whom presented a history of early object deprivation. In an earlier paper I described the beginnings of our research project at the Chicago Institute, which was called the Parent-Loss Project because each patient had lost a parent by death in childhood (Fleming, .1963). As we became involved in this study and discussed our findings with colleagues, a surprising revelation came to light. Hearing other people say, “Now I begin to understand a case that has been very puzzling and seemed to be at a n impasse,” we realized we had all been analyzing parent-loss patients whose treatment had often ended in failure or an impasse, but we had not recognized that a core factor lay in the patient’s childhood reactions to the death of a parent and the interference with normal personality development caused by this experience’ (Fleming, 1974). Mahler’s concept of the separation-individuation phase as being part of normal development (1965), as well as her concept of symbiosis (Mahler and Furer, 1968), and the correlated ideas about object constancy elaborated so usefully by Fraiberg (1969) have direct bearing on our understanding of what happened to our parent-loss patients after they were deprived of an object assumed essential for their normal development to maturity.’ The patients we studied were all fairly healthy adults who had made adaptations to their loss in childhood which permitted fairly adequate development through childhood into adult years: They had built defenses that were adequate
* A wide range of pathology has been attributed in one way or another to the loss of a parent in childhood (see Alpert, 1959; Beres and Oben, 1950; Hilgard, 1953; Hilgard and Newman, 1959; Rank, 1949). Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
OBJECT CONSTANCY M ADULTS
745
until the normal course of events and the pressures of maturation demanded a change in their way of living. These events had a common denominator-namely, separation experiences that required independence and self-reliance. The developmental tasks we expect to be accomplished in the developmental process of separation-individuation, tasks leading to independence and self-reliance, these patients were not able to man age. I have described elsewhere the phenomena of arrested development, of denial of the reality of the death of the lost parent, and the immaturity these patients manifested in their object relations (Fleming.et al., 1958;Fleming, 1963, 1972). Today, I should like to go further in trying to explain the role of an object in building the structures that assist the ego in coping with separation experiences and permit the establishment of self- as well as object constancy, leading ultimately to a mature individuated identity that is both competent and gratifying (Mahler, 1963). My data come from the analyses of adult patients, and therefore the references to childhood are retrospective and subject to the usual distortions which remembering does to historical facts. Historical data do not, however, constitute the most significant findings. These come from the transference ,relationship and in the transactions of the analytic process. They are focused on the patients’ reactions to the task of coping with separation experiences in the course of analysis, how these experiences reproduced the childhood trauma and the childhood coping behavior, which was gradually modified by analytic interpretation and the object relation the analyst offered. According to Mahler’s timetable for the separationindividuation phase, the child at four years of age should have completed at least the third subphase, that of rapprochement, and should have entered the fourth subphase, characterized by Mahler as “the birth of the child as an individual.” In other words, separateness and boundary-making should have been accomplished, but the complex process of differentiation that leads to a sense of identity and an individuated self could be
Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
746
JOAN FLEMING
expected to be still going on, since it is doubtful whether individuation has reached more than a beginning at the age of four. But what about object constancy?In the fourth subphase, Mahler (1965) says, there is “an increasing degree of object constancy.” This is a concept marking a significant point of progress in .normal development. It indicates. that a mental representation of the need-satisfying object has been organized in the mind and can be.evoked as a memory in the absence of that object. The image of the object in the evoked memory is assumed to support the ego in its regulatory operations of delay and the management of separation anxiety (Fraiberg, 1969). The capacity to evoke such a memory is considered to be a nodal point of progress in building intrapsychic structure. The memory of the object needs to be stable and firm enough to tolerate the increased need tension and frustration caused by ‘delayedgratification, and to bridge the gap in exteroceptive perception caused by the actual absence. How does one make such a memory? Normally, there is a continuing process of modification and change in the configuration of that nodal point, and these modifications themselves shift in relation to the stresses of life (Burgner and Edgcumbe, 1972, p. 328). Mahler (1965) has emphasized the parallel development of object constancy and the separationindividuation process. She calls attention to the function of object constancy in restoring equilibrium disturbed by experiences of separation. At this point, I want to examine some implications in the terms separation and individuation and to emphasize that the separation-individuation phase is only part of a much more extended and continuing process of modification of the structures and experiences that function to bring about ultimate individuatiom The term separation usually refers to spatial distance between two objects. It also refers to a perception of boundaries that define space. Around.this perception of boundaries the representational world takes shape, organized into what is internal and what is external. The beginning awareness of this differentiating perception is an important developmental step Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
OBJECT CONSTANCY IN ADULTS
747
in cognitive functioning that must precede the registration of an image of the object who provides relief from physiological need tensions. An image of the needed object recognized as external and separated by space thus becomes internalized and available to the ego. When this cognitive perceptual development has occurred, the ego has support for modulating the level of need tension and preventing a flood of lifethreatening need. Experiences of separation and a developing awareness of separateness are thus both powerful forces for organizing structures that assist the ego in its regulatory and integrative operations. At first, however, that awareness seems to be associated in memory traces with anxiety-producing experiences. Only gradually is this anxiety mastered by the intrapsychic organization of an image of the caretaking object whose presence relieves the threatening tension. The phenomena that indicate establishment of such a structure have been described by a number of authorities on child development (Piaget, 1937; Spitz, 1959; Fraiberg, 1969). These phenomena have been placed in a hierarchy of explanatory concepts that are referable to the development of object relations, of which object constancy is one. Benedek (1938, 1956), Hartmann (1952), Jacobson (1964), and Spitz and Cobliner (1965) correlate this development with progress in more complex and effective organization of the ego. These authors make use of the term self and differentiate it from object, but the problem of differentiating self from ego has not been clarified to the extent that it needs to be. Jacobson (1964) recognizes this problem explicitly when she correlates the changes froin the more basic biological survival needs of primary narcissism with psychological needs for self-esteem. Such needs seem to become more prominent after object constancy has been established and indicate the beginnings of an organization of a mental representation of a self-image that, like the evocable image of object constancy, plays a most significant role in regulating self-feeling, self-reliance, and self-confidence. One important element in conceptualizing object relations and in studying behavioral phenomena relevant to this area of theory seems to have been taken for granted to a large Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
748
JOAN FLEMING
extent. I refer to the tendency in the past to concentrate on the “subject” and the “object” as tied to each other by need tensions but to pass over the reciprocating responses in the relationship between the subject and the object. I think this reciprocation has been neglected because efforts to conceptualize the economics of cathexes, the differentiation of ego, id, and superego, and the organizing of the representational world have been given priority. It seems to me that we have tended to take object responsiveness for granted and, in so doing, have not given the feedback system in the relationship the proper significance or studied in detail the characteristics of the feedback that are effective. In the early months of life, the relationship does seem to be largely a one-way street, although as early as three months a response from the child to the object is visible in the infant’s smile. This behavioral indicator of the organization of experiences of need-tension, perception, affect, mnemonic activity, and delay functioning signals a beginning of psychological and social potentials for dialogue without which human beings often do not survive (Spitz, 1959). Mahler has paid particular attention to the reciprocal nature of the relationship between mother and child. Her concept of optimal symbiosis as the basic relationship without which further development is distorted or derailed has been extremely helpful to me in my efforts to understand the initial resistances to a working alliance in the psychoanalytic treatment of adults who have been exposed to early object deprivation (Fleming, 1972). Specifically, it has raised the possibility that what we call a working alliance is actually a replica of a symbiotic relationship. Is it possible that the “alliance” in the therapeutic situation repeats the ego operations that we assume in the establishment of object’constancy? Is it also possible that, once the reciprocal relationship is in operation, the terms we use, such as “development of an observing ego,” actually refer to the beginnings of a new self-image, as well as an “introjection” of an image of the analyst? Mahler has described how the mother’s. patterns of response to her toddler’s efforts to “hatch out” of his symbiotic relationship can facilitate or interfere with this normal process of developDownloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
OBJECT CONSTANCY IN ADULTS
749
ment. Is it possible that the structural changes we hope for from the psychoanalytic experience can be facilitated by responses from the analyst other than‘ interpretation in the usual sense of the term? My experiences in trying to understand the clinical phenomena that commonly appear in the course of psychoanalytic therapy have led me more and more insistently in this direction. No aduit patient is really a baby, and an analyst is not his parent. Nevertheless, the object need in many adults reproduces in many ways the functional relationship between mother and child- the diatraphic feeling without which the analytic process meets with difficulty (Spitz, 1956; Gitelson, 1962; Fleming, 1972). ‘The first step for the analyst is to try to make a diagnosis of the developmental level of the patient’s ego state and an assessment of his level of object need. Once such a diagnosis is made, technical responses congruent with that need can be compared with optimal object responses that facilitate normal development outside of the therapeutic situation. When this can be achieved, developmental arrests due to early object deprivation are interrupted; the derailed developmental process can be set in motion again; and the resistances to the “separations” (changes) that all efforts at separation-individuation are heir to can be worked through in a therapeutic experience which is also developmental (Greenson, 1965). Let me single out as an important vector the reciprocation so significant for organizing differentiated images of object and self, an element in the experience that builds configurations that each of the parties involved learn to perceive as object and subject-“you” and “I.” The important element here is the feeling of being approved of, of being valued. This feeling is distinguished from the feeling of wellbeing by the additional perception not only of the source of the communication as coming from the object (a spatial localization), but of the content of the message. With this apperception, there is an increment of affective plus cognitive registration that the object, i.e., the mothering person, is pleased with the child and that she herself has a libidinal investment in how he responds. It is not difficult to enlarge on this beginning of the reciprocity of relatedness in which an Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
750
JOAN FLEMING
awareness that “I mean something to you which is also pleasurable to me” influences the shape of the mental representation, not only of the object, but of the subject in the transaction as well (Sandler and Rosenblatt, 1962). By object constancy, I refer to the process of establishing an evocative memory of a mental representation of an object significant as the satisfier of some. kind of need. The needs vary, and the objects vary continually. A child can use his already operative capacity with the help of an object other than mother to structure an evocative memory of such an object. I am sure the general principles of organizing a mental representation of an object invested with libidinal, aggressive, or narcissistic significance are in operation on many other occasions than in the first three years of life. I am sure that such a building of memories goes on all through the life cycle. What varies is the degree of stability and the use to which the memory is put when it is evoked. So much of the thinking around the concept of object constancy has come from observations made in children’s behavior that it is easy to fall into two errors. The first is that the earliest representation of mother, once it is established, does not become modified over time. The second error seems to be that mental representations of other objects encountered at various points in the life cycle do not serve the same dynamic, economic, and adaptive purposes when their images are evoked in memory. Perhaps I am overemphasizing this point and generalizing from, a personal realization whose meaning has only recently become conscious. I can only say that the clinical material about to be described and the explanatory fit contributed by a study of the theory of object constancy and separation-individuation have provided me with a sense of enlightenment that I value, however retarded it has been.
I should like to illustrate how a disruption of the normal separation-individuation process at the age of four years was reflected in the transference behavior with the analyst and how technical responses resulted’ in several changes in the direction of growth. The first series of events influenced the Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
OBJECT CONSTANCY IN ADULTS
751
establishment of an evocable mental representation of the analyst that served the function of an evocable memory of the mother in mastering separation anxiety. In rapid sequence, there appeared to be evidence of the structuring not only of an effective object constancy but a more intact and cohesive self-image whose development was directly related to the reciprocating relationship established in the working alliance, I want to describe and discuss the case of Frank, a man of 32, who presented early in his analysis an extreme reaction to weekend separations. He was an intelligent, competent, financially successful businessman who suffered from deep-seated feelings of loneliness and inadequacy in his social relationships. He had married in his early twenties and had one child. The marriage was not a happy one, and the patient formed temporarily intense attachments to both men and women, which never seemed satisfying and which he usually terminated in some kind of flight. The patient’s history revealed a very close relationship with his mother during his first four years and I assumed that there had been a constructive symbiotic relationship and an establishment of object constancy. At the age of four, however, his mother was suddenly hospitalized- with a chronic illness and he was separated from both mother and father for the next five years, during which he lived with his maternal grandparents. The little boy experienced moments of utter loneliness and despair, wondering if his mother was still alive and feeling that, if he thought about her hard enough, she would not die but would some day return to him. The analysis began with intense anxiety about his performance in the analytic hours, his fear of displeasing me, while at the same time there was strong reluctance to become involved. My diagnosis indicated conflict over regressive pulls toward primitive object needs and a poorly defined self-image with low self-esteem that needed reinforcement from an external object. Past experience in such situations (Fleming, 1972) influenced me to go slowly, but to encourage him to face his fears and to listen to the fantasies he had when he was alone and felt threatened. He described it as “‘fallingapart” or “not knowing where my head is.” At first, my support for his Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
.
752
JOAN FLEMING
effort to associate in my absence was intuitive, but, as time went on, I realized it was a response from me that facilitated his ability to evoke an image of me during periods of separation. Subsequent events seemed to validate that formu1at ion. What I shall describe does not indicate that either the symbiotic relationship with his mother or the earliest establishment of object constancy was historically abnormal. It does indicate that a normal separation-individuation phase may have begun, but that the “hatching out” process was not completed. Anamnestic data gave evidence that achievement of stability in mastering separation anxiety was interfered with and that organization of a self-image differentiated from object images andi’ndividuated with any cohesiveness was not f achieved. There was a tendency to transfer his longing for a return to the early symbiosis to various adult persons in his immediate surround. However, the early relationship with his mother had been full of pleasure and feelings of being worth something, which many later relationships did not provide. This kind of transference involvement with other objects was filled with conflict and made him afraid of reliving the pain of the early separation and the long waiting period before his mother returned, when he was nine. The actual return contributed to the complex conflict because, of course, the changes in both mother and son prevented a realistic reenactment of the preseparation situation, a fact that intensified his ambivalence and made the agony of waiting seem to be all for nothing. During the five-year separation, his grandparents had provided very adequate parenting, which not only gave the boy support during critical times but also assisted the analysis. The grandmother was a strong and warm person who reinforced the patient’s efforts to cope with the trauma of the sudden loss. A grandmother transference seemed to facilitate the working alliance. When that was established, the patient could tolerate some regression and re-experience with me the frightening anxiety on the weekends. The patient’s’ability to verbalize what he was experiencing and to make use of my responses made it possible for Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
OBJECT CONSTANCY IN ADULTS
753
both of us to work through a series of steps in the development of mental representations that played a part in building a more individuated sense of self and sense of other than he had had before analysis. This outcome is to be hoped for in any analysis that aims for structural change, but it is rare, in my experience, for the steps in the process of change to have such sequential clarity and to be so easily correlated with technical responses. The first indicator of a beginning ability to tolerate the weekend separation anxiety with more detachment was when he came in on a Monday with the report that, as he had left the previous Thursday, the thought that I would be gone on Monday suddenly flashed through his mind. At first he was more anxious than usual, and then he recalled the thought in more detail. Its content was, “She will go poof and disappear.” As the anxiety lessened, he recalled that was the feeling he had about his mother’s disappearance. He realized he had been afraid to let me be important to him because I might “go poof and disappear” just as she had. The next step was a report of a retrospective observation. He now realized that from Thursday to Monday he had felt suspended and “had just waited.” As we explored these associations, he recalled how, during the first few months at his grandmother’s, he often sat in a tree in the swamp trying to picture his mother’s face. After the first visit to the hospital, he could piccure her hospital room and see her lying in bed. Being able to do this helped. In other words, he was using his capacity to evoke an image of the needed object, but he also needed to know where she was. Fraiberg (1969) comments on the advance in organization of a mental representation when the child can call his mother, knowing she must be someplace. In the analysis the addition of spatial localization to the image of the needed object became a very important part of a mental representation of me that could be effective in coping with separation anxiety. After the “go poof’ weekends, he felt I was gone but would be back on Monday. “Only,” he said, “I don’t know where you are.” I asked if he had thought about where I might Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
754
JOAN FLEMING
be or of calling me. His reply was, “No, I couldn’t think about that,” and then realized he was feeling as helpless as he had felt a long time ago, although, of course, this was a feeling that did not apply to today. The next step came when, on Monday, he reported, “I felt you were gone, but now I know where you are. I found the building you live in and I can picture you there.” The next advance in the mastery of separation anxiety was indicated when the patient reported he did not feel so out of touch ever since he could imagine where I was and also imagine me being with someone else. Conjuring up that image produced discomfort, however, because it made him jealous. He felt angry at me because I was so important to him. This reminded him of imagining his mother with the doctors in the hospital. It seemed to him she enjoyed them, and this hurt his feelings. He said, “I need you to be with me to know how I feel about myself.” This remark startled me, and then I remembered the theory of the smiling response, of stranger anxiety, of the concept that a self-image begins as a reflection of the affect in the mother’s face (Spitz and Wolf, 1946; Benedek, 1956; Mahler and Furer, 1968). Southwood (1973) has written an interesting article in which he ascribes the origin of selfawareness to looking someone in the eye and seeing a response that “lie recognizes me.” Winnicott (1967) talks of the mother’s role as a mirror “giving back to the baby the baby’s own self.” He describes this experience as the “beginning of a significant exchange with the world, a two-way process in which self-enrichment alternates with the discovery of meaning in the world of seen things” (p. 27). In the psychoanalytic situation, messages are usually communicated by means of the voice. My 1972 paper discussed how useful wordless sounds of response from the analyst can be in establishing a working alliance with cases of early object deprivation. These responses are important for calling attention to the presence of the analyst in the service of differentiating current reality from illusions persisting from the past. Some patients seem to need visual contact as well. ~
Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
OBJECT CONSTANCY IN ADULTS
755
0.
This was b o h e out in a pattern of behavior that began accidentally with Frank. At the end of the analytic hour, he wyould sit for a minute on the edge of the couch looking me in the eye. Intuitively at first, I returned his gaze and made a comment or two. Occasionally, this exchange lasted for a couple of minutes. When the patient talked of feeling more defined and intact, I began to realize it had the significance that Southwood and Winnicott assign to looking into someone’s face. He’ said, “I feel differently about myself . . . I’m responsible for me and can make choices in terms of my own needs. I don’t have to fill someone else’s space in order not to feel alone and empty.” Later still, in the analysis, Frank reported the good feeling associated with these moments and how glad he was I did not interpret what was happening at the time. The exchange between Frank and myself at the end of an hour was understood as an intensified regressive need for symbiosis. I simply responded to the need without making an interpretation. The situation reminded me of a child who keeps calling for a drink of water after the goodnights have been said and the lights turned out. It does not seem strange when child analysts, in their work with children, think of the analytic process as being closely associated with the process of development in the growing child. Clearly, any child is already in some phase of development, and no one questions that the task of analyst and child is to work together to free the blocks to normal development. One difference between the attitude of an analyst of a child and the analyst of an adult is the ease with which the child analyst accepts the object needs of a child, recognizing that the therapeutic dialogue requires that responses from the object in the relationship must provide experiences that assist in the building of intrapsychic structure as well as a reorganization of handicapping defenses. A child who is fearful of the separation from the analyst and wants to climb on his lap toward the end of the hour is not pushed away, but is permitted to experience the physical contact and security he needs to master the separation anxiety. Interpretation accompanies the action or follows it when appropriate. Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
756
JOAN FLEMING
In the analysis of an adult, similar moments arise. They are manifestations of the patient’s lack of resources to master the anxiety and need-tension by himself and indicate the state of inner equilibrium and level of development of the patient’s intrapsychic structures, especially his capacities for coping with various threats to that equilibrium. I have been increasingly impressed with the fact that we expect our adult patients to possess a degree of maturity on their psychosocial developmental line that would almost preclude any need for analysis. Often, without that degree of maturity we do not think of them as analyzable. My experience with adults in an arrested state of development as a result of the death of a needed object in childhood points toward analysis as the treatment of choice (Fleming, 1963, 1972; Fleming and Altschul, 1963). The psychoanalytic situation through its structure and consistency provides security for both patient and analyst, and if the analyst conceives the psychoanalytic process to be comparable to the developmental process, especially in the area of retracking derailed self-object relations, psychoanalytic therapy can be most valuable. This patient and I were able to observe phenomena relevant to concepts of object constancy and the symbiosis pertinent to a working alliance, but we could also see the way in which object responses were an important component of experiences which structured a self-image with a sense of positive self-esteem. An effective object constancy was reconstituted in the analytic situation, but there was additional structure building. The development of a working alliance with an object whose internalized image participated in the structuring of a protective evocative memory served as a foundation of security from which self-differentiation and the organization of a self-image developed with a greater sense of self and feeling of self-confidence and Self-valuethan had ever been present before. The constant feeling of inadequacy and vulnerability to external involvements had kept the patient in a state of apprehension about being abandoned, both for inadequacy (sometimes real and sometimes not) and for “being bad.” The transference elements in this latter fear were
Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
OEJECT CONSTANCY IN ADULTS
757
reinforced by the patient’s angry and subsequently hostile, aggressive reactions to frustration of his self-esteem needs. A turning point in the analysis came with th’e interpretation of a “three-step” dream. Frank reported that he had dreamed about me, ‘first as getting up from my chair and moving to the desk in anger, displeased with somethinghe had done. He felt frightened. Then it seemed that I was not angry with him, but was more interested in someone else. He felt annoyed but not frightened. Then the dream changed again. This time I had moved to the desk to take care of something I was interested in. He did not feel that I had left him and was neither frightened nor angry, but felt it was all right with him since he knew r would be back and he could wait. Frank said he did not understand the dream, but just felt it was a good one. After a few minutes of concentration on the second part, I called his attention to the three kinds of images of mesomeone who left in anger as punishment, someone who found him uninteresting compared to someone else, and someone who had things of my own to do that took nothing away from him. Frank recognized the first two scenes as representing stages in his object relations all through his life. He realized the third scene portrayed a relationship that he admired and wanted, but was only beginning to think possible. The meaning of the dream was worked on in its many aspects of past, present, and future feelings about other people in relation to himself with an increasing tolerance for separations and individuated images of Other and self.
Summary In conclusion, I would like to restate the focus of this paper by calling it a study in the metabolism of experience from two angles: (1) the integrative task confronting the ego in organizing drive and object interactions to assist the ego in its regulatory functioning; and (2) a timetable of progression in accomplishing that task. Evidence was presented from the psychoanalytic treatment of an adult man who suffered object
Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
758
JOAN FLEMING
deprivation during the “hatching out” subphase of separationindividuation. In the course of therapy, an effective object constancy was reconstituted and the process of individuation of self and Other was re-established. The therapeutic work provided the patient with experiences in transactions between self and object useful for reorganizing the trauma of early object deprivation and thereby mobilized his resources for a resumption of the developmental process distorted in childhood. REFERENCES Alpert, A. (1959). Reversibility of pathological fixations associated with maternal deprivation in infancy. The Psychoanalytic Study of fhe Child, 14:169-185. New York: International Universities Press. Benedek. T. (1938), Adaptation to reality in early infancy. Psychoanal. Quurt., 7:200-215. (1956), Toward the biology of the depressive constellation. ThisJournal, 4~389-427. Beres, D. & Obers. S. (1950). The effects of extreme deprivation in infancy on
psychic structure in adolescence. The Psychoanalytic Sfudy of the Child, 5:212-235. New York: International Universities Press. Burgner. M. & Edgcumbe, R. (1972). Some problems in the conceptualization of early object relationships. Part 11: The concept of object constancy. The Psychoanalytic Sfudyo f f h e Child, 27515-333. New York Quadrangle Books. Fleming. J. (1963). The evolution of a research project in psychoanalysis. In: Counterpoint: Libidinal Objecf and Subject, ed. H. S. Gaskill. New York International Universities Press, pp. 75-105. (1972). Early object deprivation and transference phenomena: the working alliance. Psychoanal. Quart., 41:23-49. -(1974), The problem of diagnosis in parent-loss cases. Contemporary Psychoanal., 10:439-451. & Altschul, S. (1963), Activation of mourning and growth by psychoanalysis. Internat. J. Psycho-Anal., 44:419-431. ,Altschul, S., Zielinski, V.. & Forman, hi. (1958), The influence of parentloss in childhood on personality development. Unpublished. Read at Meeting of the American Psychoanalytic Association, San Francisco. Fraiberg, S. (1969). Libidinal object constancy and mental representation. The Psychoanalytic Study ofthe Child, 24:9-47. New York: International Universities Press. Gitelson, M. (1962), On the curative factors in the first phase‘ of analysis. In: Psychoanulysis: Science and Aofession. New York: International Universities Press, 1973, pp. 311-341. Greenson, R. R. (1965). The problem of working through. In: Dn’ves, Affects, and Behatior, Vol. 2, ed. Max Schur. New York: International Universities Press, pp. 277-314. Hartmann, H. (1952), The mutual influences in the development of the ego and the id. In: Essays on Ego Psychology. New York International Universities Press, 1964, pp. 153-182.
-
Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
OBJECTCONSTANCY IN ADULTS
759
Hilgard, J. R. (1953). Anniversary reactions in parents precipitated by children. Psyhiat., 16:73-80. & Newman, hl. F. (1959). Anniversaries in mental illness. Psyhiat., 22:113-121.
Jacobson, E. (1964), The Self and the Object World. New York International Universities Press. hiahler, M.(1963), Thoughts about development and individuation. The Psjchoanalytic Study of the Child, 18:307-324. New York International Universities Press. (1965). On the significance of the normal separation-individuation phase. In: Drives, Affects, and Behavior, Vol. 2, ed. Max Schur. New York International Universities Press, pp. 161-169. __ & Furer (1968), On Human Symbiosis and the Vicissitudes of Individuation, Vol. I. Infantile Psjchosis. New York: International Universities Press. Piaget, J. (1937). The Construction of Reality in the Child. New York Basic
Books, 1954. Rank, B. (1949), Adaptation of the psychoanalytic technique for the treatment of young children with atypical development. Amer. J. Orthopsychiat., 19~130-139.
Sandler, J. &'Rosenblatt. B. (1962). The concept of the representational world. The Psyhoanal$ic Study of the Child, 17:128-145. 'New York International Universities Press. Solnit, A. (1970). A study of object loss in infancy. The Psychoanalytic Study of the Child, 25257-272. New. York International Universities Press. Southwood. H. M. (1973), The origin of self-awareness and ego behaviour. Internat. J. Psycho-Anal., 54:235-240. Spitz, R. A. (1956), Countertransference. ThisJournal, 4256.265. (1959), A Genetic FieZd Theory of Ego Formation. New York: Inter* . national Universities Press. & Cobliner, W.G. (1965), TheFirst Year of Lge.-New York: International Universities Press. .& Wolf, K. (1946). The smiling response. Genetic Psychology Monograjhs,
-
34:57-125.
Winnicott, D. W. (1967). Mirror-role of mother and family in child development. In: T h e Predicament of the Famib, ed. P. Lomas. London: Hogarth Press. Submitted October 8, 1974 Department of P s y h i a t y CZ70 University of Colorado Medical Center 4200 Eust 9th Aoenue Denuer, Colorado 80220
Downloaded from apa.sagepub.com at UNIV ARIZONA LIBRARY on May 31, 2015
