Appendix A Stages or Phases of Development

Transcription

1 Appendix A Stages or Phases of Development A nettlesome issue we encountered that requires special attention is the confusion surrounding the concept of stages and phases to describe periods of development. Freud used these terms loosely and at times interchangeably, although he was inclined to use the term phase more consistently to refer to the different libidinal periods. Abraham clearly refers to stages of development. Most ego psychologists, with the exception of Spitz, refer to phases of development without defining the distinction between a phase and a stage. Most object relations theorists tend to follow that convention, except that Klein uses the concept of positions, whereas Kernberg divides development into stages. Erikson in his description of the Eight Ages of Man, actually refers to the eight periods as stages. Sullivan avoids the use of the terms, preferring to refer to epochs instead. Stern clearly defines the concept of domains as his preferred term. Kohut avoids both terms and is inclined to use the term periods. Greenspan reverts to the use of the concept of stages. Attachment theorists present a mixed picture. Bowlby specifically avoids the terms stages or phases in his description of the developmental process and patterns of attachment. However, he speaks of the phases of the process that children go through following a loss. Ainsworth refers to phases of development during the process of attachment. Schore and Fonagy do not refer to phases or stages of development. In this work, we have followed the convention of using the terms that each author has used to characterize developmental periods (see Table A.1 ). To clarify the distinction between the terms stages and phases, we cite the following discussion found in the Appendix to Spitz s (1965) book, The first year of life: A psychoanalytic study of normal and deviant development of object relations. In this appendix, Cobliner reviews some of the criteria that Piaget used to determine what constitutes a stage of development. He gives the following: a) A stage is marked by dominant characteristics which are interdependent and form a totality, a structural whole. b) Stages are set off by breaks in the unfolding psyche. There is a sudden acquisition at its beginning; this gain is consolidated, integrated with previous acquisitions. 369

2 370 Appendix A Table A.1 Authors use of the concepts stages, phases, or alternative terms Author Uses concept of developmental stages Uses concept of developmental phases Does not use either concept of stage or phase Sigmund Freud X Karl Abraham X Heinz Hartmann X Anna Freud X Rene Spitz X Peter Blos X Melanie Klein X Positions Donald Winnicott X Margaret Mahler X Use a different concept Otto Kernberg X Levels H. H. Sullivan X Epochs Erik Erikson X Modes Daniel Stern X Domains Heinz Kohut X Periods Stanley Greenspan John Bowlby Mary Ainsworth Allan Schore Peter Fonagy X X X X X Later on a new acquisition is being prepared. Psychic growth is both continuous and discontinuous. c) The date of an acquisition of psychic faculties, skills, or mechanisms characteristic for the particular stage varies considerably from population to population and within that population, from individual to individual. d) [T]he serial order of the acquisition remains constant ; it is the same for all populations, it is universal. Piaget stresses that the elements of a given stage are invariably integrated into the next higher ones ; this is indeed the hub of his concept of stages (italics in original, pp ). Cobliner goes on to state Piaget s concept of stages, his sharp division of psychic unfolding into distinct episodes, finds no corresponding parallel in classical psychoanalytic theory. (p. 315). However, he maintains that Spitz, whose scheme utilizes the concept of stages, accounts for a wider spectrum of phenomena than Piaget s (p. 316). Part of the problem of making the distinction between stages and phases may reside in the fact that Piaget s theory narrowly addresses cognitive development, whereas psychoanalytic theories deal with the emotional dimensions of relationships. Psychometric tools are available to test for levels of cognitive development, whereas no such tools exist for libidinal investment in others, which complicates the issue of either determining the onset of a stage/phase or determining the component elements that constitute a stage/phase. Furthermore, in contrast to Piaget s clear-cut criteria for what constitutes a developmental stage, psychoanalytic

3 Appendix A 371 developmental theorists do not provide a consensus definition either for the concept of stage or for the concept of phase. One feature of psychoanalytic theories that further complicates the issues of definition is the use of the organismic metaphor, in particular the analogy drawn between psychological development and ontogeny or epigenesis. As we have seen, Freud popularized a version of the principle that ontogeny recapitulates phylogeny that was erroneous. Those developmental theorists who continued to use the term ontogeny did not revise its definition to place it in line with modern evolutionary biology. Others, who chose to use the epigenetic model, drew the analogy with embryology as a more accurate metaphor for psychological development. However, the embryological model alone could not provide parallels to stages or phases. Other principles had to be imposed on the model in order to make it psychologically meaningful. For example, Mahler s epigenetic model ascribed a value to separation and individuation, rather than to interdependence, which would be equality consistent with the model. In any case, the distinction between stages and phases was lost in the process. We may infer the following tentative definition for the concept of phase from the usage that ego psychologists and object relations theorists have made of the term. A developmental phase is a period that emerges ontogenetically or epigenetically, during which a new set of psychological phenomena emerge irrespective of whether a consolidation of the elements of the prior phase has occurred. The new phenomena achieve dominance and become focal issues for the individual. Phases are discontinuous in the sense that they have an approximate chronological beginning and end, although elements of each phase may be carried over to subsequent phases if an adaptive resolution has taken place, such as when sublimation occurs. They are also hierarchical in that the chronologically earlier phases represent less mature forms of differentiation than later phases. Fixations can occur at specific phases, in which case these would impede the progression to the next phases; furthermore, individuals can regress from a higher phase of development to a lower one when confronted by trauma or other obstacles. Given these considerations, we can conclude that, whereas a theory that makes use of the epigenetic metaphor to describe the developmental sequence is on more solid ground that one that makes use of the model of ontogeny, the rationale for a differentiation between stages or phases of development remains difficult. We are left with historical convention for the use of the term phase with no firm theoretical ground for it. It is not surprising that some chose to avoid the terms and substituted their own concepts instead. References Spitz, R. A. (1965). The first year of life: A psychoanalytic study of normal and deviant development of object relations (pp ). New York, NY: International Universities Press (Appendix by W. G. Cobliner, titled The Geneva School of Genetic Psychology and Psychoanalytic: Parallels and Counterparts ).

4 Appendix B 373

5 374 Appendix B Comparative chart of psychoanalytic developmental theories Theorist/school/ publishing era Major works Concepts/terms Main contributions/ideas Sigmund Freud School Classical Psychoanalysis Drive Theory Publishing era The neuro-psychoses of defence Studies on hysteria (case of Anna O) 1895/ Project for a scientific psychology The interpretation of dreams The psychopathology of everyday life Three essays on the theory of sexuality Fragment of an ana-lysis of a case of hysteria (case of Dora) Notes upon a case of obsessional neurosis (case of The Rat Man) Five lectures on psychoanalysis Dynamics of trans-ference Totem and taboo On the history of the psychoanalytic movement On narcissism Instincts and their vicissitudes Papers on meta psychology Mourning and melan-cholia Anal phase Castration anxiety Cathexis Conscious Constancy principle Defense mechanisms (Isolation; Identification; Introjection; Projection; Reaction formation; Repression; Reversal; Turning against the self; Undoing) Drive/drive theory Narcissism Phallic/urethral/narcissistic phase Pleasure-unpleasure principle Polymorphous perverse sexuality Preconscious Primary and secondary process Psychic determinism Psychosexual stages Reality principle Regression Resistance Structural hypothesis Superego Topographic hypothesis Transference Tripartite model Unconscious Father of psychoanalysis Discovered the existence of a dynamic unconscious The unconscious is the source of our motivations Fundamental human motivation is drive discharge Outlined the psychical apparatus of mental processes in his topographical hypothesis (pcs,cs,unc); later proposed the tripartite structural hypothesis (id, ego, superego) Cs: what one is aware of at a given moment; Pcs: available memory; Ucs: all things that are not available to awareness, including things that have their origins there (such as drives or instincts) and things we put there because we cannot bear them (such as memories and emotions associated with trauma) Id: instincts or drives (movement from need to wish is primary process ); Ego: relates to reality to get needs met ( reality principle ) and searches for objects to fulfill drives ( secondary process ); Superego: conscience and ego ideal Outlined psychosexual stages of development. Oral (0-18 months): focus of pleasure is the mouth - task is weaning; Anal (18 months-3 years): focus of pleasure is the anus - task is potty training; Phallic (3-7 years): focus of pleasure is the genitals - task is Oedipal crisis; Oedipal crisis (3-5 years): major point at which psychopathology is centered.; Latency (7 years to puberty): sexual impulse suppressed in the service of learning; Genital (pubertyadult): resurgence of sex drive in adolescence

6 Appendix B 375 Heinz Hartmann School Ego Psychology Publishing era On transformation of instinct as exemplified in anal erotism From the history of an infan tile neurosis (case of The Wolf Man) A child is being beaten Beyond the pleasure principle Group psychology and the analysis of the ego The ego and the id The infantile genital organization of the libido The dissolution of the Oedipus complex The question of lay analysis The future of an illusion Inhibitions, symptoms and anxiety Civilization and its discontents Moses and monotheism The fundamentals of psychoanalysis Ego psychology and the problem of adaptation Psychoanalysis and the concept of mental health Comments on the psychoanalytic theory of instinctual drives The genetic approach in psychoanalysis Adaptive point of view Alloplastic change Autoplastic change Average expectable environment Change in function Conflict-free ego Ego-dystonic Discovered phenomenon of transference. Analysis of transference is most important part of treatment because original conflicts will be reenacted in relationship with therapist. Neurotic symptoms are attempts to defend against unconscious wishes that are unacceptable. They are developmental obstacles Resistance is used to defend against awareness of unacceptable wishes Treatment includes free association, analysis of resistance and transference, and dream analysis Emphasized greater appreciation of environmental influences on intrapsychic world Shifted emphasis from chaotic id motivating all thoughts and actions, to emphasis on a resilient ego capable of coping with drives, superego, and the environment Emphasized the primacy of the ego in development Introduced the idea of ego as independent of id and having autonomy and intentionality Adaptive point of view: infants are born with the equipment they need to adapt to their environment (continued)

7 376 Appendix B Comparative chart of psychoanalytic developmental theories (continued) Theorist/school/ publishing era Major works Concepts/terms Main contributions/ideas Comments on the formation of psychic structure Notes on the theory of aggression Psychoanalysis and developmental psychology Comments on the psychoanalytic theory of the ego The mutual influences in the development of the ego and the id Notes on the theory of sublimation Notes on the reality principle The development of the ego concept in Freud s work Comments on the scientific aspects of psychoanalysis Psychoanalysis and moral values Notes on the superego Concept formation in psychoanalysis Essays on ego psychology Papers on psychoanalytic psychology Psychoanalysis: A general psychology Ego-syntonic Neutralization Primary autonomous ego functions Secondary autonomous ego functions Structural theory Sublimation Synthetic function of the ego A child will flourish if provided an environment that is reasonably responsive to his or her needs (average expectable environment) The ego s cognitive functions are important for learning about reality for the purposes of adaptation. Synthetic function of the ego is important because it involves the ability to synthesize experiences and thus adapt to reality Modifications of ego occur through two processes (1) alloplastic change - people attempting to change their environment to cope with challenges, (2) autoplastic change - people attempting to change themselves to accommodate their environment

8 Appendix B 377 Anna Freud School Ego Psychology Publishing era Rene Spitz School The writings of Anna Freud are published in 8 volumes Vol. 1: Introduction to psychoanalysis: Lectures for child analysts and teachers ( ) Vol. 2: The ego and the mechanisms of defense (1936) Vol. 3: Infants without families: Reports on the Hampstead nurseries ( ) Vol. 4: Indications for child analysis and other papers (1945) Vol. 5: Research at the Hampstead Child Therapy Clinic and other papers ( ) Vol. 6: Normality and pathology in childhood: Assessment of development (1965) Vol. 7: Problems of psychoanalytic training, diagnosis, and the technique of therapy ( ) Vol. 8: Psychoanalytic psychology of normal development Assessment of childhood disturbances The concept of developmental lines Diacritic and Coenesthetic Organization Adolescent phase One of the first to practice child psychoanalysis Enlarged the structural point of view Anaclitic phase Avoidance Defense mechanisms (Altruism; Asceticism; Avoidance; Denial; Displacement; Identification with the Aggressor; Intellectualization; Sublimation) Developmental lines Egocentricity Instinctual anxiety Latency phase Object constancy Objective anxiety Phallic-oedipal phase Superego anxiety Her work, along with Hartmann s, defines the ego psychology perspective Added eight more defense mechanisms to her father s original list of nine defenses Looking at a patient s defenses will reveal their history of ego development Development moves back and forth along multiple lines of development; a child can develop in one area, but not in another The level a child reaches on a developmental line is the result of the interaction of drives, ego development, and its relation to the nurturing environment Made a distinction between normal and pathological development Anaclitic depression Autoerotism Body ego Did not believe that drives determine the direction of a child s development; documented the effects of environmental deprivation on a child s development (continued)

9 378 Appendix B Comparative chart of psychoanalytic developmental theories (continued) Theorist/school/ publishing era Major works Concepts/terms Main contributions/ideas Ego Psycholog Publishing era Hospitalism: An inquiry into the genesis of psychiatric conditions in early childhood Anaclitic depression The smiling response: A contribution to the ontogenesis of social relations The psychogenetic diseases in infancy The primal cavity: A contribution to the genesis of perception and its role for psychoanalytic theory No and yes: On the genesis of human communication On the genesis of superego components A genetic field theory of ego formation: Its implication for pathology Early prototypes of ego defenses The first year of life: A psychoanalytic study of normal and deviant development of object relations Autoerotism re-examined The derailment of dialogue Coenesthetic mode of functioning Critical periods Diacritic mode of functioning Eight-month anxiety Ego organizers Failure to thrive syndrome Fixation points Hospitalism Marasmus Maturation Negation Preobjectal Primary narcissism Semantic no Smiling response His ideas came from direct observation of infants An infant deprived of adequate mothering is prone to developmental deficits, which can lead to failure to thrive syndrome Proposed that development occurs unevenly with periods of stability followed by periods of transformation, and that certain times represent critical periods of development Hospitalism describes maternal deficits due to longterm institutionalization; anaclitic depression refers to children who became depressed after separation form their mothers An infant s early psychological development occurs within three stages; each stage includes specific affective behaviors, or ego organizers : First ego organizer is the smiling response - signals the beginning of object relations; Second ego organizer is eight-month anxiety - infant can now distinguish between familiar and unfamiliar persons, which can lead to stranger anxiety; Third ego organizer is capacity for negation - acquisition of semantic no and shift from passive to active

10 Appendix B 379 Peter Blos School Ego Psychology Publishing era Prolonged male adolescence: The formulation of a syndrome and its therapeutic implications Preadolescent Drive Organization On adolescence: A psychoanalytic interpretation The initial stage of male adolescence The second individuation process of adolescence Character formation in adolescence The young adolescent: Clinical studies The function of the ego ideal in adolescence Twelve to sixteen: Early adolescence When and how does adolescence end? The adolescent passage: Developmental issues Modifications in the traditional psychoanalytic theory of female adolescent development Psychoanalytic perspectives on the more disturbed adolescent Son and father: Before and beyond the Oedipus complex Adolescence proper Asceticism Drive organization Homosexual defense Incomplete adolescence Miscarried adolescence Pregenitality Preoedipal mother Second separation individuation process Uniformism Focused his developmental theory entirely on adolescence Phases of development Latency (7-11): sets foundation for passage into adolescence Preadolescence (11-13): increase in libidinal and aggressive drives Early adolescence (13-15): adolescent is heavily influenced by peer pressure and faces the challenges of separation from early object ties Adolescence proper (15-18): appropriate sexual drives and higher levels of thought emerge Late adolescence (18-20): psychic structure solidifies and stability finds expression in work, love, and ideology Postadolescence: the harmonizing of the component parts of the personality; transition from adolescence to adulthood Conceptualized the entire phase of adolescence as the second separation-individuation process, emphasizing the developmental necessity of shedding family dependencies (continued)

11 380 Appendix B Comparative chart of psychoanalytic developmental theories (continued) Theorist/school/ publishing era Major works Concepts/terms Main contributions/ideas Stanley Greenspan School Theories of the Self Publishing era 1972 to the present Melanie Klein School Object Relations Publishing era Intelligence and adaptation: An integration of psychoanalytic and Piagetian developmental psychology Psychopathology and adaptation in infancy and early childhood The development of the ego: Implications for personality theory, psychopathology, and the psychotherapeutic process The growth of mind and the endangered origins of intelligence The clinical interview with the child (third edition) The first idea: How symbols, language, and intelligence evolved from our primate ancestors to modern humans The development of the child The role of school in the libidinal development of the child Infant analysis Infant analysis Symposium on child-analysis The psychological principles of infant analysis Engaging Neuronal connections Preverbal self Regulation Sensation Shared attention Symbolic self Synchronic interchanges Thinking self Willful self Bad breast Death instincts Denial Depressive position Depressive anxiety Envy Charted critical stages in the development of mind Proposed that emotions, not cognitive stimulation, serve as the mind s primary architect Six stages of functional/emotional development are : 1. From birth on - no differentiation between self and environment; task is to make sense of sensation and develop capacity for regulation months on - Engaging and relating to others; synchronic interchanges occur between infant and caregiver 4-8 months on - intentionality; infant uses feelings to express intentions; boundary between me and you develops months on - preverbal self emerges within caregivers context; child can deal with ambivalent feelings; emerging capacity to communicate verbally widens possibilities months on - symbolic self ; feelings are put into words; child creates internal world using images, ideas, and symbols months on - thinking self ; emotional thinking, logic, and a sense of reality develop One of the first to practice child psychoanalysis Disagreed with Anna Freud in two ways (1) Believed children could be analyzed using essentially the same techniques as those used with adults and (2) Believed that children are capable of establishing transferences Challenged the timing of the Oedipus complex, proposing that it takes place at the end of the first year, rather than the fourth or fifth year

12 Appendix B Early stages of the Oedipus conflict Infantile anxiety situations reflected in art, creative impulse Personification in the play of children The importance of symbol formation in the development of the ego A contribution to the theory of intellectual inhibition The psycho-analysis of children A contribution to the psychogenesis of manic depressive states Mourning and its relation t o manic-depressive states The Oedipus Complex in the light of early anxieties Notes on some schizoid mechanisms A contribution to the theory of anxiety and guilt Some theoretical conclusions regarding the emotional life of the infant The mutual influences in the development of ego and id The origins of transference On identification On the development of mental functioning A note on depression in the schizophrenic Narrative of a child analysis Fantasies Femininity complex Femininity phase Good breast Idealization Internal representations Introjection Life instincts Manic defense Object relations Omnipotence Paranoid-schizoid position Part object Phantasies Positions Projection Projective identification Schizoid Splitting Symbol formation Whole object Speaks of positions rather than phases of development, to emphasize speaking of a whole way of organizing one s internal world Paranoid-schizoid position: infants phantasize danger coming from the outside; Depressive position: Child recognizes his mother as a whole object, a real and separate person (crucial step in development) Early object relations is first a part-object relationship, specifically to the mother s breast Introduced concept of good breast (gratifying) and bad breast (ungratifying), with good breast serving as prototype for all gratifying objects and bad breast serving as prototype for all persecutory objects Development is organized around phantasies infants have of relationships to the object Ego/superego develop from internalization of object relations Introduced idea of projective identification: fantasy of projecting oneself into another object, taking possession of it, and attributing to it one s own characteristics 1930 paper opened the area of symbol formation and of the relation between inner processes and cognitive development Attempted to relieve guilt in children by having them direct toward the therapist aggressive and Oedipal feelings they could not express to their parents (continued)

13 382 Appendix B Comparative chart of psychoanalytic developmental theories (continued) Theorist/school/ publishing era Major works Concepts/terms Main contributions/ideas Donald Winnicott School Object Relations Publishing era Clinical notes on the disorders of childhood The observation of infants in a set situation Primitive emotional development Hate in the counter-transference Aggression in relation to emotional development Transitional objects and transitional phenomena Primary maternal preoccupation On transference Mother and child: A primer of first relationships Psycho-analysis and the sense of guilt Collected papers: Through paediatrics to psycho-analysis The theory of the parentinfant relationship Ego distortion in terms of true and false self Maturational processes and the facilitating environment: Studies in the theory of emotional development Absolute dependence Come into being Continuity of being Facilitating environment False self Going on being Good enough mother Holding environment Impingement Integration Maternal care Maturational process No such thing as an infant Personalization Potential space Realization Relative dependence Self-object distinction Toward independence Transitional object Transitional phenomena True self Believed the environment played a critical role in development Saw development in terms of three phases of dependence between the mother and child (1) Phase of Absolute dependence : earliest; mother and child are a unit; infant has no experience of an external object; (2) Phase of relative dependence : begins when the child becomes aware of dependence on an outside object; (3) Toward independence : synonymous with the oedipal phase of development Proposed three developmental tasks (1) Integration - personality starts out in an unintegrated state; (2) Personalization - infants are able to claim experiences as my experiences ; (3) Realization - infant develops a sense of reality A child develops in relation to an object, an essential other (usually the mother). A child comes into being based on whether environmental conditions are favorable or unfavorable. Too much doing, or not enough responding results in impingement, to which the child must react The mother must supply a holding environment for the child, which allows for the child s transition to being more autonomous. Good enough holding by the good enough mother promotes a child s development

14 Appendix B 383 Margaret Mahler School Object Relations Publishing era Playing: Its theoretical status in the clinical situation The use of an object Playing and reality Through paediatrics to psycho-analysis The piggle: An account of the psychoanalytic treatment of a little girl Deprivation and delinquency Babies and their mothers Human nature The family and individual development Talking to parents Thinking about children On two crucial phases of integration of the sense of identity: Separation-Individuation and bisexual identity Observations on research regarding the Symbiotic Syndrome of infantile psychosis Thoughts about development and individuation On early infantile psychosis: The symbiotic and autistic syndromes On the significance of the normal separation-individuation phase: With reference to research in symbiotic child psychosis Autistic phase Body ego Coenesthetic receptivity Diacritic organization Differentiation subphase Hallucinatory omnipotence Hatching Low keyedness Normal autism Object constancy Practicing subphase Rapprochment subphase Representations Sensoriperceptive Separation-individuation phase When adequate holding takes place, the child acquires an authentic true self ; if adequate holding does not take place, an inauthentic false self will develop, the primary function of which is to act as a mask that hides the true self Transitional objects are objects that a child endows with qualities that are associated with their mother; these objects help the child bridge the gap between internal and external Proposed a theory of psychological birth and development of a child from ages 0-3 An infant s psychological birth and the processes of separation and individuation are analogous to the division of a fertilized egg Failure to proceed successfully through the developmental phases will result in psychopathology Phases of development Autistic phase (0-1 month): undifferentiated Symbiotic phase (1-5 months): child sees self and object as the same Differentiation subphase of separation-individuation (5-10 months): beginning differentiation of self and object (continued)

15 384 Appendix B Comparative chart of psychoanalytic developmental theories (continued) Theorist/school/ publishing era Major works Concepts/terms Main contributions/ideas Otto Kernberg School Object Relations Publishing era 1963 to the present The mother s reaction to her toddler s drive for individuation Symbiosis and individuation: The psychological birth of the human infant The psychological birth of the human infant The selected papers of Margaret S. Mahler Object constancy, individuality, and internalization The separation-individuation process and identity formation Structural derivatives of object relations Borderline personality organization The treatment of patients with borderline personality organization A psychoanalytic classification of character pathology Prognostic considerations regarding borderline personality organization Early ego integration and object relations Basic psychoanalytic concepts on the theory of instincts Splitting Practicing subphase of S-I (10-16 months): child can Symbiotic phase leave the object through crawling, but is pulled by object and outside world Rapprochement Subphase of S-I (16-24 months): child needs object s presence, wants to share everything with the object Object constancy (24-36 months): child can maintain a stable mental representation of the object whether it is there or not Borderline psychopathology Consolidation of superego and ego integration Differentiation of self from object Higher level of organization of character pathology Integration of self-representations and object-representations Intermediate level of organization of character pathology Introjection Lower level of organization of character pathology Neurotic psychopathology Normal autism Integrated major aspects of drive theory with the structural model of ego psychology and its developmental perspective Three tasks of development (1) clarify what is self and what is other; (2) overcome splitting ; and (3) integrate good and bad self- and object-images Five stages of normal development are : 1. Normal autism or Primary undifferentiated (0-1 month) - the infant s normal primary undifferentiated self-object representations are gradually constructed through interactions with the primary caregiver 2. Normal symbiosis or primary undifferentiated self-object representations (1-6/8 months) - self and object become differentiated

16 Appendix B Normal and pathological narcissism: Structural and clinical aspects Borderline conditions and pathological narcissism Technical considerations in the treatment of borderline personality organization Some implications of object relations theory for psychoanalytic technique Self, ego, affects, and drives Severe Personality Disorders Identification and its vicissitudes as observed in psychosis An ego psychology-object relations theory approach to the transference Projection and projective identification: Developmental and clinical aspects Object relations theory in clinical practice Psychic structure and structural change: An ego psychologyobject relations theory viewpoint Transference regression and psychoanalytic technique with infantile personalities Psychopathic, paranoid and depressive transferences Object relations, affects, and drives: Toward a new synthesis Normal symbiosis Primary undifferentiated self-object representations Primary undifferentiated stage Psychotic states Splitting 3. Differentiation of self- from object-representations (6/8-18/36 months) - integration of both good and bad self-images and good and bad object-images; object constancy 4. Integration of self-representations and object-representations and development of higher level intrapsychic object relations-derived structures - libidinal and aggressive self-images solidify into a definite self-system (occurs through Oedipal period) 5. Consolidation of superego and ego integration (end of Oedipus and beyond) - integration of superego fosters ego identity Three levels of character pathology are : 1. Higher level of organization - ego and superego are relatively well integrated; ego identity is harmonious; selfconcept is stable 2. Intermediate level of organization - superego is punitive, less integrated, and unanchored to the rest of the person s ego, thus interrupting ego regulation; fewer character defenses; more unstable and impulsive behavior 3. Lower level of organization - superego integration is minimal; severe ego weakness; inner world includes chaotic and exaggerated self- and object-representations; inability to contain anxiety or control impulses (continued)

17 386 Appendix B Comparative chart of psychoanalytic developmental theories (continued) Theorist/school/ publishing era Major works Concepts/terms Main contributions/ideas Erik Erikson School Life Cycle Theory Psychosocial Publishing era The management of affect storms in the psychoanalytic psychotherapy of borderline patients Psychotherapy for borderline personality: Focusing on object relations Configuration in play - Clinical notes On submarine psychology Hitler s imagery and German youth Childhood and tradition in two American Indian tribes Ego development and historical change - Clinical notes Growth and crises of the Healthy Personality Sex differences in the play configurations of preadolescents Wholeness and totality Ego identity and the psychosocial moratorium The nature of clinical evidence Affiliation Antipathetic Authenticity Authoritarianism Basic ego, strength, and virtues Competencies Dogmatism Ego-dystonic Ego-syntonic Elitism Formalism Ideology Idolism Impersonation Legalism Principle of social order Radius of significant relations Ritualism Ritualization Technological ethos Totalism Transmission of values and ideals Views development as occurring not only in interaction with the maternal responses to the child, but also within the broader social context in which the child is situated Believed development continues throughout the life cycle Ego is developed through a series of psychosocial crises. At each stage the ego has a task to master, a crisis to overcome, that includes not only aspects of instinctual drives, but also social and personal skills Eight stages of development (1) Trust vs. mistrust (0-18 months); (2) Autonomy vs. shame and doubt (18 months to 3 years); (3) Initiative vs. guilt (3-5 years); (4) Industry vs. inferiority (5-13 years); (5) Identity vs. role confusion (13-21 years); (6) Intimacy vs. isolation (21-40 years); (7) Generativity vs. stagnation (40-60 years); (8) Integrity vs. despair (60 years to death) Progress through each stage is determined by the degree of success at the preceding stages

18 Appendix B 387 Harry Stack Sullivan School Interpersonal Publishing era Daniel Stern School Schizophrenia: Its conservative and malignant features Affective experience in early schizophrenia The training of the psychiatrist, IV: Training of the general medical student in psychiatry A note on the implications of psychiatry: The study of interpersonal relations for investigation in the social sciences Anti-Semitism The illusion of personal individuality Conceptions of modern psychiatry The interpersonal theory of psychiatry The psychiatric interview Anxiety gradient As if performances Bad me Developmental epochs Dynamism Fear dynamism Good me Lust dynamism Malevolence Not me Parataxic mode of experience Personifications Prototaxic mode of experience Rationalizations Selective attention Sublimation Syntaxic mode of experience Tensions of need Tensions of anxiety Clinical studies in psychiatry Theorem of escape Theorem of reciprocal emotion Warps The fusion of psychiatry and social science Personal psychopathology The interpersonal world of the infant Diary of a baby Affect attunement Affiliation Antipathetic Extended Freud s theory to the treatment of severe mental disorders; in contrast to Freud, he believed that social and cultural factors played a role in these disorders It is only possible to understand people by observing their interpersonal interactions, and personality develops through these interpersonal interactions The primary source of anxiety is interpersonal interactions All experience occurs in three modes (1) prototaxic - undifferentiated; no awareness of self as a separate entity, (2) parataxic - momentary, unconnected ways of being, and (3) syntaxic - language, meaning, symbol activity Divides his developmental theory into six epochs (1) infancy; (2) childhood; (3) juvenile era; (4) preadolescence; (5) early adolescence; and (6) late adolescence Replaced Freud s idea of mechanisms of the mind with the idea of dynamism - personality is made up of interacting interpersonal dynamisms, which occur as patterns that shape one s identity Defenses are against other people, not against one s own unconscious Through interpersonal situations, people develop personifications of themselves, images of themselves that are important parts of the structure of their personality (1) Good me - come from experiences which are rewarding in character, (2) Bad me - come from experiences that arouse anxiety, and (3) Not me - keeps a person from noticing things they do not want to see about themselves Responsible for revolution in infant research. Challenged Mahler s idea that infants are born into undifferentiated state; showed that human social relatedness is present from birth (continued)

19 388 Appendix B Comparative chart of psychoanalytic developmental theories (continued) Theorist/school/ publishing era Major works Concepts/terms Main contributions/ideas Theories of the Self Infant Research Publishing era 1963-present Heinz Kohut School Theories of the Self Self Psychology Publishing era The motherhood constellation: A unified view of parent-infant psychotherapy The birth of the mother: How the motherhood experience changes you forever The first relationship: Infant and mother The present moment in psychotherapy and everyday life Introspection, empathy and psychoanalysis 1966/ Forms and transformations of narcissism 1968/ The psychoanalytic treatment of narcissistic personality disorders Amodal perception Affect attunement is the way to indicate a sharing of internal states Used the term domains to describe his developmental Coherence of form, intensity structures, and temporal structures Coming into being Core sense of self Emergent sense of self Evoked companion Interaffectivity Islands of consistency Joint attention Narrative sense of self Physiognomic perception RIGS Self-affectivity Self-agency Self-coherence Self-history Subjective sense of self Verbal sense of self Vitality affects Bipolar self Cohesive self Compensatory structures Deidealization Disintegration products Empathy Entry into adulthood eras Five domains of the sense of self are : 1. Emergent self (0-2 months) - infant is actively forming emergent sense of self, testing hypotheses about the world 2. Core self (2-7 months) - self experiences necessary for a self to come together include self-agency, self-coherence, self-affectivity, self-history; introduced concept of RIGs (Representation of Interactions that have been Generalized) - these come from lived experiences; several lived episodes lead to a sense of a generalized episode; the basic unit for representation of the core self 3. Subjective self (7-12 months) - quantum leap in development; infant discovers he/she has a mind and so do other people; enters the domain of intersubjective relatedness 4. Verbal self (15-30 months) - language; symbolic play 5. Narrative self - (30-48 months) - human activity is understood in terms of psychological story plots Breaks from drive theory. Places development of self as the central organizing principle instead of drives. Sex and aggression are secondary phenomena, expressions of the needs of a fragmenting self. Founder of Self Psychology Empathy defines the psychological field. It is the method used to gather data about a person s inner world

20 Appendix B 389 John Bowlby School Traditional Attachment Theory The analysis of the self 1972/ Thoughts on narcissism and narcissistic rage The restoration of the self Discussion of On the adolescent process as a transformation of the self Remarks about the formation of the self - Letter to a student regarding some principles of psychoanalytic research 1978/ Introductory remarks to the Panel on Self Psychology and the Sciences of Man Four basic concepts in selfpsychology Introspection, empathy, and the semi-circle of mental health How does analysis cure? Self Psychology and the humanities: Reflections on a new psychoanalytic approach Maternal Care and Mental health: A report on behalf of the World Health Organization as a contribution to the United Nations program for the welfare of homeless children Exhibitionism Introduced concept of selfobject : experienced as part Experience near of the self; fulfills functions the self cannot perform for Fragmentation Grandiose self Horizontal split Idealized parental imago Mirroring Nuclear self Omnipotence Optimal frustration Self Selfobject Self-regulation Subordinate view of the self Superordinate view of the self Transmuting internalization Twinship or alter-ego Vertical split Virtual self Attachment behaviors Caretaking behaviors Despair Ethology Grief and mourning itself A self needs three things from a selfobject (1) mirroring - need for admiration and approval; (2) idealizing - need for acceptance and support from an idealized other; and (3) twinship - need for the presence of a like other Crucial factor in development of pathology is the selfselfobject relationship. Failures in selfobject responses result in fear of loss of self (since selfobject is part of the self) Grandiose self - Infant will try to regain the lost state of narcissism by creating inside a state of perfection. Parent needs to mirror the developing grandiose self at this time Idealized parental imago - A child spends energies in the idealization of the parent. The parent needs to supply self needs at this time, such as safety, regulation of excitement, soothing, teaching rules of behavior, and conveying values If parents are unable to mirror their child s grandiosity, the narcissistic needs will become frustrated and will either be repressed ( horizontal split ) or disavowed ( vertical split ) Transmuting internalization is the process which results in new psychological structure Founded attachment theory, and based it on ethological premises, which led to exclusion from psychoanalytic circles Development does not occur in phases. Patterns of attachment are formed that may be modified by experience or may persist throughout the lifespan (continued)

21 390 Appendix B Comparative chart of psychoanalytic developmental theories (continued) Theorist/school/ publishing era Major works Concepts/terms Main contributions/ideas Publishing era Mary Ainsworth School Traditional Attachment Theory Publishing era The nature of the child s tie to his mother Grief and mourning in infancy and early childhood Separation anxiety Symposium on Psycho- Analysis and Ethology : Ethology and the development of object relations Processes of mourning Note on Dr. Max Schur s comments on grief and mourning in infancy and early childhood Pathological mourning and childhood mourning Attachment and loss: Vol. I: Attachment Attachment and loss: Volume II: Separation, anxiety and danger Attachment and loss: Volume III: Loss: Sadness and depression Patterns of attachment: A psychological study of the strange situation Exploratory behavioral system Early attachment behaviors and experiences with caregivers determine the patterns of Internal working models attachment Primary anxiety Protest, despair, and detachment Proximity to the mother Secondary drive theory Secure base Sensitive caregiver Separation anxiety Species-specific behavior patterns Anxious-avoidant attachment Anxious-resistant attachment Attachment-in-the-making phase Clear-cut attachment phase Psychopathology is due to disturbances in attachment behaviors, not fixations or regressions Infants are innately driven to seek proximity to their mothers, who provide a secure base that protects from predators Attachment behaviors (sucking, clinging, following, crying, and smiling) are species-specific behaviors activated by separations and designed to restore proximity to the mother If infants are not reunited with their mothers, infants will go through a period of protest, followed by a period of despair, followed by a period of detachment If children are not exposed to traumatic separations, they are able to develop internal working models of themselves and caregivers (similar to the psychoanalytic concept of representations ) Developed the strange situation lab procedure to assess infant attachment styles. It consisted of eight episodes, including two episodes of separation and reunion. The infant s behavior after the parents return forms the basis for classifying the infant in one of the three attachment categories (1) secure attachment, (2) anxious-avoidant attachment, or (3) anxious-resistant attachment

22 Appendix B 391 Mary Main Birth date unknown School Traditional Attachment Theory Publishing era 1974 to the present Exploration, play, and cognitive functioning as related to child-mother attachment Discovery of an insecuredisorganized/disoriented attachment pattern: Procedures, finding, and implications for the clarification of behavior Interview-based adult attachment classifications: Related to infant-mother and infant-father attachment. (Unpublished manuscript) Disorganization and disorientation in infant strange situation behavior: Phenotypic resemblance to dissociative states The organized categories of infant, child, and adult attachment: Flexible vs. inflexible attention under attachment-related stress Predictability of attachment behavior and representational processes at 1, 6, and 19 years of age: the Berkeley Longitudinal Study Maternal sensitivity Object constancy Object permanence Patterns of attachment Preattachment phase Secure attachment Strange situation procedure Adult attachment interview Adult secure-autonomous attachment Dismissing attachment Disorganized/disoriented attachment Intergenerational transmission of attachment Preoccupied attachment Unresolved/disorganized Identified a fourth pattern of attachment Disorganized/disoriented attachment - some children exhibited behaviors that appeared disorganized as they alternated between crying loudly for the parent to moving away from the parent when picked up; behaviors indicated being disoriented to their environment, or being trance-like Hypothesized that instead of being a haven of safety, the mothers of these infants were actually frightening to them, suggesting that the children had either been maltreated or neglected Devised the adult attachment interview - elicited caregiver s histories of their own attachment experiences; found a correlation between attachment pattern revealed by the adult s Internal Working Model and the type of attachment that adult s child developed, thus establishing the existence of an intergenerational transmission of attachment patterns (continued)