Self psychology

Self psychology, a modern psychoanalytic theory and its clinical applications, was conceived by Heinz Kohut in Chicago in the 1960s, 70s, and 80s, and is still developing as a contemporary form of psychoanalytic treatment. In self psychology, the effort is made to understand individuals from within their subjective experience via vicarious introspection, basing interpretations on the understanding of the self as the central agency of the human psyche. Essential to understanding self psychology are the concepts of empathy, selfobject, mirroring, idealising, alter ego/twinship and the tripolar self. Though self psychology also recognizes certain drives, conflicts, and complexes present in Freudian psychodynamic theory, these are understood within a different framework. Self psychology was seen as a major break from traditional psychoanalysis and is considered the beginnings of the relational approach to psychoanalysis.

Origins
Kohut came to psychoanalysis by way of neurology and psychiatry in the 1940s, but then 'embraced analysis with the fervor of a convert ... [and as] "Mr Psychoanalysis" ' took on an idealizing image of Freud and his theories. Subsequently, "in a burst of creativity that began in the mid-1960s ... Kohut found his voice and explored narcissism in new ways that led to what he ended up calling a 'psychology of the self'".

Self
Kohut explained, in 1977, that in all he wrote on the psychology of the self, he purposely did not define the self. He explained his reasoning this way: "The self...is, like all reality...not knowable in its essence...We can describe the various cohesive  forms in which the self appears, can demonstrate the several constituents that make up the self ... and explain their genesis and functions. We can do all that but we will still not know the essence of the self as differentiated from its manifestations.

Empathy
Kohut maintained that parents' failures to empathize with their children and the responses of their children to these failures were 'at the root of almost all psychopathology'. For Kohut, the loss of the other and the other's self-object ("selfobject") function (see below) leaves the individual apathetic, lethargic, empty of the feeling of life, and without vitality – in short, depressed.

The infant moving from grandiose to cohesive self and beyond must go through the slow process of disillusionment with phantasies of omnipotence, mediated by the parents: 'This process of gradual and titrated disenchantment requires that the infant's caretakers be empathetically attuned to the infant's needs'.

Correspondingly, to help a patient deal in therapy with earlier failures in the disenchantment process, Kohut the therapist 'highlights empathy as the tool par excellence, which allows the creation of a relationship between patient and analyst that can offer some hope of mitigating early self pathology'.

In comparison to earlier psychoanalytic approaches, the use of empathy, which Kohut called "vicarious introspection", allows the therapist to reach conclusions sooner (with less dialogue and interpretation), and to create a stronger bond with the patient, making the patient feel more fundamentally understood. For Kohut, the implicit bond of empathy itself has a curative effect, but he also warned that 'the psychoanalyst ... must also be able to relinquish the empathic attitude' to maintain intellectual integrity, and that 'empathy, especially when it is surrounded by an attitude of wanting to cure directly ... may rest on the therapist's unresolved omnipotence fantasies'. )

The conceptual introduction of empathy was not intended to be a "discovery." Empathic moments in psychology existed long before Kohut. Instead, Kohut posited that empathy in psychology should be acknowledged as a powerful therapeutic tool, extending beyond "hunches" and vague "assumptions," and enabling empathy to be described, taught, and used more actively.

Selfobjects
Self Objects are external objects when young. Over time the child learns to regulate her internal world through internalized self objects - think Bowen's differentiation, the person no longer needs the external object to regulate their inner world. We mature to Winnicott's object use. To be dependent on an external object in adulthood is explored in the world of codependency and the formation of fascism. The internal self objects and the healthy use of external objects function as part of the "self machinery". They are persons, objects or activities that "complete" the self, and which are necessary for normal functioning. 'Kohut describes early interactions between the infant and his caretakers as involving the infant's "self" and the infant's "selfobjects"'.

Observing the patient's selfobject connections is a fundamental part of self psychology. For instance, a person's particular habits, choice of education and work, taste in life partners, may fulfill a selfobject-function for that particular individual.

Selfobjects are addressed throughout Kohut's theory, and include everything from the transference phenomenon in therapy, relatives, and items (for instance Linus van Pelt's security blanket): they 'thus cover the phenomena which were described by Winnicott as transitional objects. Among 'the great variety of selfobject relations that support the cohesion, vigor, and harmony of the adult self ... [are] cultural selfobjects (the writers, artists, and political leaders of the group – the nation, for example – to which a person feels he belongs)'.

If psychopathology is explained as an "incomplete" or "defect" self, then the self-objects might be described as a self-prescribed "cure".

As described by Kohut, the selfobject-function (i.e. what the selfobject does for the self) is taken for granted and seems to take place in a "blindzone". The function thus usually does not become "visible" until the relation with the selfobject is somehow broken.

When a relationship is established with a new selfobject, the relationship connection can "lock in place" quite powerfully, and the pull of the connection may affect both self and selfobject. Powerful transference, for instance, is an example of this phenomenon.

Optimal frustration
When a selfobject is needed, but not accessible, this will create a potential problem for the self, referred to as a "frustration" – as with 'the traumatic frustration of the phase appropriate wish or need for parental acceptance ... intense narcissistic frustration'.

The contrast is what Kohut called "optimal frustration"; and he considered that, 'as holds true for the analogous later milieu of the child, the most important aspect of the earliest mother-infant relationship is the principle of optimal frustration. Tolerable disappointments ... lead to the establishment of internal structures which provide the basis for self-soothing.'

In a parallel way, Kohut considered that the 'skilful analyst will ... conduct the analysis according to the principle of optimal frustration'.

Suboptimal frustrations, and maladaptations following them, may be compared to Freud's trauma concept, or to problem solution in the oedipal phase. However, the scope of optimal (or other) frustration describes shaping every "nook and cranny" of the self, rather than a few dramatic conflicts.

Idealizing
Kohut saw idealizing as a central aspect of early narcissism. 'The therapeutic activation of the omnipotent object (the idealized parent image) ... referred to as the idealizing transference, is the revival during psychoanalysis' of the very early need to establish a mutual selfobject connection with an object of idealization.

In terms of 'the Kleinian school ... the idealizing transference may cover some of the territory of so-called projective identification'.

For the young child, ' idealized selfobjects "provide the experience of merger with the calm, power, wisdom, and goodness of idealized persons"'.

Alter ego/twinship needs
Alter ego/twinship needs refer to the desire in early development to feel alikeness to other human beings. Freud had early noted that 'The idea of the "double" ... sprung from the soil of unbounded self-love, from the primary narcissism which holds sway in the mind of the child.' Lacan highlighted 'the mirror stage ... of a normal transitivism. The child who strikes another says that he has been struck; the child who sees another fall, cries.' In 1960, 'Arlow observed, "The existence of another individual who is a reflection of the self brings the experience of twinship in line with the psychology of the double, of the mirror image and of the double".'

Kohut pointed out that 'fantasies, referring to a relationship with such an alter ego or twin (or conscious wishes for such a relationship) are frequently encountered in the analysis of narcissistic personalities', and termed their transference activation 'the alter-ego transference or the twinship'.

As development continues, so a greater degree of difference from others can be accepted.

The tripolar self
The tripolar self is not associated with bipolar disorder, but is the sum of the three "poles" of the body:
 * "grandiose-exhibitionistic needs"
 * "the need for an omnipotent idealized figure"
 * "alter-ego needs"

Kohut argued that 'reactivation of the grandiose self in analysis occurs in three forms: these relate to specific stages of development ... (1) The archaic merger through the extension of the grandiose self; (2) a less archaic form which will be called alter-ego transference or twinship; and (3) a still less archaic form ... mirror transference'.

Alternately, self psychologists 'divide the selfobject transference into three groups: (1) those in which the damaged pole of ambitions attempts to elicit the confirming-approving response of the selfobject (mirror transference); (2) those in which the damaged pole of ideals searches for a selfobject that will accept its idealisation (idealising transference); and those in which the damaged intermediate area of talents and skills seeks ... alter ego transference.'

The tripolar self forms as a result of the needs of an individual binding with the interactions of other significant persons within the life of that individual.

Cultural implications
An interesting application of self psychology has been in the interpretation of the friendship of Freud and Jung, its breakdown, and its aftermath. It has been suggested that at the height of the relationship 'Freud was in narcissistic transference, that he saw in Jung an idealised version of himself', and that conversely in Jung there was a double mix of 'idealization of Freud and grandiosity in the self'.

During Jung's midlife crisis, after his break with Freud, arguably 'the focus of the critical years had to be a struggle with narcissism: the loss of an idealized other, grandiosity in the sphere of the self, and resulting periods of narcissistic rage'. Only as he worked through to 'a new sense of himself as a person separate from Freud' could Jung emerge as an independent theorist in his own right.

On the assumption that 'the western self is embedded in a culture of narcissism ... implicated in the shift towards postmodernity', opportunities for making such applications will probably not decrease in the foreseeable future.

Criticism
Kohut, who was 'the center of a fervid cult in Chicago', aroused at times almost equally fervent criticism and opposition, emanating from at least three other directions: drive theory, Lacanian psychoanalysis, and object relations theory.

From the perspective of drive theory, Kohut appears 'as an important contributor to analytic technique and as a misguided theoretician ... introduces assumptions that simply clutter up basic theory. The more postulates you make, the less their explanatory power becomes.' Offering no technical advances on standard analytic methods in 'his breathtakingly unreadable The Analysis of the Self', Kohut simply seems to blame parental deficit for all childhood difficulties, disregarding the inherent conflicts of the drives: 'Where the orthodox Freudian sees sex everywhere, the Kohutian sees unempathic mothers everywhere – even in sex.'

To the Lacanian, Kohut's exclusive 'concern with the imaginary', to the exclusion of the Symbolic meant that 'not only the patient's narcissism is in question here, but also the analyst's narcissism.' The danger in 'the concept of the sympathetic or empathic analyst who is led astray towards an ideal of devotion and samaritan helping ... [ignoring] its sadistic underpinnings' seemed only too clear.

From an object relations perspective, Kohut 'allows no place for internal determinants. The predicate is that a person's psychopathology is due to unattuned selfobjects, so all the bad is out there and we have a theory with a paranoid basis.' At the same time, 'any attempt at "being the better parent" has the effect of deflecting, even seducing, a patient from using the analyst or therapist in a negative transference ... the empathic analyst, or "better" parent'.

With the passage of time, and the eclipse of grand narrative, it may now be possible to see the several strands of psychoanalytic theory less as fierce rivals and more 'as complementary partners. Drive psychology, ego psychology, object relations psychology and self psychology each have important insights to offer twenty-first-century clinicians.'