Structural Derivatives of Object Relationships, Kernberg (1966)
Introduction
Kernberg observed early in his career that borderline patients exhibited selective impulse control. He further observed that these individuals alternated between different ego states and had little emotional connection between these different states. One woman, for instance, alternated between being extremely afraid of sex and being extremely promiscuous, both conditions “being temporarily ego syntonic during their respective appearance.” She was able to control her impulses in other areas of her life, just not when she was in the promiscuous ego state. Another patient would alternately regard Kernberg as all-good and all-bad. When this man saw Kernberg as all-good he had no awareness of having any negative feelings for him even though he could easily remember those times he regarded him as all-bad. When Kernberg would remind the patient of the times he had seen him as all-bad, the man would experience intense anxiety. Kernberg consequently concluded that splitting the ego was not a defect of the ego but a defense mechanism.
Kernberg came to realize that such patients exhibited specific transference patterns, each ego state corresponding to an image of a primitive object as well as a self-image of how they felt when relating to that object. For instance, when the above-mentioned male patient regarded Kernberg as all-bad, he had a “depreciative, harsh, and haughty” image of him that corresponded to an image of his mother, and connected to this image was an image of himself as a “rejected, depreciated, attacked little boy.” When in this state, the patient felt extreme rage. When the patient regarded Kernberg as all-good, he had an “all-forgiving, all-loving and understanding” image of him that corresponded to an image of “a fused, ideal mother and weak but protective father,” and connected to this image was an image of himself as a “longing, guilt-ridden child.” When in this state, the patient felt overwhelming guilt.
Internalization
To make better sense of this, Kernberg clarifies our internal object relationships. He writes that there are three different ways in which we can internalize object relationships, each progressively more complex: (a) introjection, (b) identification, and (c) ego identity. He further writes that each type of internalization contains three basic components: (a) object-images (object-representations), (b) self-images (self-representations), and (c) the accompanying affect.
Introjection involves (a) an image of an object, (b) an image of the self in interaction with the object, and (c) the affect that accompanies the interaction. Identification is more complex and can only occur once the child is able to recognize that an object fulfills certain roles; for example, a child might realize that by helping him to get dressed, his mother is fulfilling a socially accepted role. Identification involves (a) an image of an object fulfilling a role in relation to oneself, (b) an image of oneself, and (c) the affect that accompanies the interaction.
Ego identity is still more complex and involves the one’s ego organizing their introjections and identifications. One who has achieved ego identity has a continuous sense of herself and others. Whereas introjections and identifications are “structures of the psychic apparatus in general,” ego identity is a “structure characteristic of the ego.”
As one develops, their internal object relations become more and more complex. Some internal objects become depersonalized and, for instance, can contribute to the development of the superego.
Stages of Ego Development
The infant initially keeps separate good objects (introjects) and bad objects (introjects) because she experiences them at different times and lacks the ability to integrate them. Unable to differentiate herself from others, she fuses these good objects with her self image; she also fuses these bad objects with her self image but rejects or projects these self-object fusions.
Around the third month of life, the infant develops the ability to differentiate. She continues to keep separate good and bad objects but does so now in order to defend against anxiety, marking the beginning of splitting as a defense mechanism. Kernberg doesn’t spell this out, but I think that splitting reduces anxiety because it would be terrifying for the infant to recognize that a bad object is the same as a good object; for if this were the case, then she would realize that the good object could hurt her. When the infant splits, she (a) organizes her ego around good introjected objects, (b) experiences good external objects as different from herself, and (c) experiences threatening external objects as well as her own projected early introjects as bad external objects.
Toward the end of her first year, the infant integrates her object-representations (seeing her good objects and bad objects as belonging to the same object), and she also integrates her self-images (seeing herself as containing both good self-images and bad self-images). This development leads to guilt, for she realizes that her aggression has not just been directed at a bad object but at a whole object containing both good and bad. Whereas the infant previously relied primarily on splitting, she now relies primarily on repression. Repression involves moving an impulse or idea from consciousness
Another important development occurs: the infant develops “image of an ideal self representing the striving for reparation of guilt and for the re-establishment of an ideal, positive relationship between self and object” as well as “the image of an ideal object which represents the unharmed, all-loving, all-forgiving object.”
Clinical Applications
Kernberg now resumes his discussion of borderline individuals. Psychoanalysis has historically focused on making the unconscious conscious. Borderline patients do not need help making the unconscious conscious because when they move from one ego state to another, they remain conscious of the preceding state. Consequently, he writes that with such patients, we must make bridges between these ego states in such a way that elicits severe anxiety and mobilizes the patient to develop new (repression-based) defense mechanisms.
Returning to the patient who alternated between sexual timidity and sexual recklessness, Kernberg realized that she would not benefit by learning greater impulse control, for in most areas of her life she had excellent impulse control, nor by having the “deeper meaning” of her acting out behavior interpreted. Rather, he consistently interpreted “the rigid dissociation between the episodes of sexual promiscuity and her usual self.” In such cases he generally found that “a consistent interpretation of the patient's efforts to keep two areas of [her] experience completely separated from each other may bring about, for the first time, more deeply felt anxiety and guilt, and may also mobilize the conflict more specifically in the transference.”
Borderline individuals, he continues, possess an unusually high number of bad introjects. This causes significant anxiety, and they respond through intense splitting, which helps them to protect their good objects. They project their high number of bad introjects, which creates the impression that they lived in “a dangerous world of persecuting objects.” They further try to mitigate their anxiety by idealizing “good” external objects, needing them to be all good in order to make sure that they cannot be contaminated, spoiled, or destroyed by the projected ‘bad external objects.’”
Kernberg observed early in his career that borderline patients exhibited selective impulse control. He further observed that these individuals alternated between different ego states and had little emotional connection between these different states. One woman, for instance, alternated between being extremely afraid of sex and being extremely promiscuous, both conditions “being temporarily ego syntonic during their respective appearance.” She was able to control her impulses in other areas of her life, just not when she was in the promiscuous ego state. Another patient would alternately regard Kernberg as all-good and all-bad. When this man saw Kernberg as all-good he had no awareness of having any negative feelings for him even though he could easily remember those times he regarded him as all-bad. When Kernberg would remind the patient of the times he had seen him as all-bad, the man would experience intense anxiety. Kernberg consequently concluded that splitting the ego was not a defect of the ego but a defense mechanism.
Kernberg came to realize that such patients exhibited specific transference patterns, each ego state corresponding to an image of a primitive object as well as a self-image of how they felt when relating to that object. For instance, when the above-mentioned male patient regarded Kernberg as all-bad, he had a “depreciative, harsh, and haughty” image of him that corresponded to an image of his mother, and connected to this image was an image of himself as a “rejected, depreciated, attacked little boy.” When in this state, the patient felt extreme rage. When the patient regarded Kernberg as all-good, he had an “all-forgiving, all-loving and understanding” image of him that corresponded to an image of “a fused, ideal mother and weak but protective father,” and connected to this image was an image of himself as a “longing, guilt-ridden child.” When in this state, the patient felt overwhelming guilt.
Internalization
To make better sense of this, Kernberg clarifies our internal object relationships. He writes that there are three different ways in which we can internalize object relationships, each progressively more complex: (a) introjection, (b) identification, and (c) ego identity. He further writes that each type of internalization contains three basic components: (a) object-images (object-representations), (b) self-images (self-representations), and (c) the accompanying affect.
Introjection involves (a) an image of an object, (b) an image of the self in interaction with the object, and (c) the affect that accompanies the interaction. Identification is more complex and can only occur once the child is able to recognize that an object fulfills certain roles; for example, a child might realize that by helping him to get dressed, his mother is fulfilling a socially accepted role. Identification involves (a) an image of an object fulfilling a role in relation to oneself, (b) an image of oneself, and (c) the affect that accompanies the interaction.
Ego identity is still more complex and involves the one’s ego organizing their introjections and identifications. One who has achieved ego identity has a continuous sense of herself and others. Whereas introjections and identifications are “structures of the psychic apparatus in general,” ego identity is a “structure characteristic of the ego.”
As one develops, their internal object relations become more and more complex. Some internal objects become depersonalized and, for instance, can contribute to the development of the superego.
Stages of Ego Development
The infant initially keeps separate good objects (introjects) and bad objects (introjects) because she experiences them at different times and lacks the ability to integrate them. Unable to differentiate herself from others, she fuses these good objects with her self image; she also fuses these bad objects with her self image but rejects or projects these self-object fusions.
Around the third month of life, the infant develops the ability to differentiate. She continues to keep separate good and bad objects but does so now in order to defend against anxiety, marking the beginning of splitting as a defense mechanism. Kernberg doesn’t spell this out, but I think that splitting reduces anxiety because it would be terrifying for the infant to recognize that a bad object is the same as a good object; for if this were the case, then she would realize that the good object could hurt her. When the infant splits, she (a) organizes her ego around good introjected objects, (b) experiences good external objects as different from herself, and (c) experiences threatening external objects as well as her own projected early introjects as bad external objects.
Toward the end of her first year, the infant integrates her object-representations (seeing her good objects and bad objects as belonging to the same object), and she also integrates her self-images (seeing herself as containing both good self-images and bad self-images). This development leads to guilt, for she realizes that her aggression has not just been directed at a bad object but at a whole object containing both good and bad. Whereas the infant previously relied primarily on splitting, she now relies primarily on repression. Repression involves moving an impulse or idea from consciousness
Another important development occurs: the infant develops “image of an ideal self representing the striving for reparation of guilt and for the re-establishment of an ideal, positive relationship between self and object” as well as “the image of an ideal object which represents the unharmed, all-loving, all-forgiving object.”
Clinical Applications
Kernberg now resumes his discussion of borderline individuals. Psychoanalysis has historically focused on making the unconscious conscious. Borderline patients do not need help making the unconscious conscious because when they move from one ego state to another, they remain conscious of the preceding state. Consequently, he writes that with such patients, we must make bridges between these ego states in such a way that elicits severe anxiety and mobilizes the patient to develop new (repression-based) defense mechanisms.
Returning to the patient who alternated between sexual timidity and sexual recklessness, Kernberg realized that she would not benefit by learning greater impulse control, for in most areas of her life she had excellent impulse control, nor by having the “deeper meaning” of her acting out behavior interpreted. Rather, he consistently interpreted “the rigid dissociation between the episodes of sexual promiscuity and her usual self.” In such cases he generally found that “a consistent interpretation of the patient's efforts to keep two areas of [her] experience completely separated from each other may bring about, for the first time, more deeply felt anxiety and guilt, and may also mobilize the conflict more specifically in the transference.”
Borderline individuals, he continues, possess an unusually high number of bad introjects. This causes significant anxiety, and they respond through intense splitting, which helps them to protect their good objects. They project their high number of bad introjects, which creates the impression that they lived in “a dangerous world of persecuting objects.” They further try to mitigate their anxiety by idealizing “good” external objects, needing them to be all good in order to make sure that they cannot be contaminated, spoiled, or destroyed by the projected ‘bad external objects.’”
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