Transcending the Self, Frank Summers (1999)
There are three main psychoanalytic traditions: ego psychology, relational analysis, and object relations.
Psychoanalysis originally held that our actions are determined by our drives or biological urges. To be more precise, every action is ultimately (1) an attempt to reduce the tension caused by a drive or (2) a defense meant to repress a drive. (Our unconscious might try to repress drives to prevent us from experiencing guilt or anxiety.)
However, this claim has been contradicted by both research and clinical evidence. (1) Harlow’s experiments revealed that young monkeys prefer “a cloth mother-model" that does not provide food to a wire monkey model that does; put differently, they prefer the mother-model that does not provide tension reduction to the mother-model that does. (2) John Bowlby found that children form attachments to figures who do not meet their biological needs. (3) Ronald Fairbairn wrote that children often form strong attachments to abusive figures. (4) Infant researchers have found that “the neonate is preadapted to interaction with the mother within the first few days of life. (5) If “tension-reduction is the goal of the psyche,” then it should follow that people who prioritize pleasure should be the happiest, but clinicians have found this to be untrue.
Relational Model
The relational model sees client problems in terms of relational patterns. One of his clients, Dexter, has two dominant relational patterns, one causing him to avoid emotional closeness lest he be engulfed and imposed with burdensome expectations and another causing him to fail lest he threaten others. The relational analyst would focus on the patient-analyst relationship in order to expand the client’s relational patterns. According to this model, the analyst must understand her own contribution to the analysis and would ask what she is doing to make Dexter feel engulfed, what she is doing to make him feel exploitative, etc.The goal is for the patient and analysis to look at what’s happening in their relationship, how they’re each contributing to these relational dynamics, and to then find ways to relate to one another differently.
Summers provides a number of arguments against the relational model. One argument comes from the writings of Blatt and Blass, who argued that humans have two primary motives, relatedness and self-definition. If this is true, then it follows that the relational model “is an imbalanced theory that overemphasizes the need for relatedness at the expense of autonomy, a differentiated, defined sense of self.”
Object Relations Model
Two Needs
We have two inborn needs: a need for relatedness and a need for self-realization (that is, a need to develop and actualize our innate affective tendencies). Summers makes two main points about self-realization: we all naturally strive for self-realization, and we need an optimal parental response to attain self-realization.
(1) We Strive for Self-Realization. Winnicott writes that the infant “has an inborn disposition to grow in a particular direction,” as evidenced by his “spontaneous gesture,” “the reaching, grasping, and natural curiosity that is not reducible to tension reduction or any other motive and that requires no external stimulation.” Demos concurs, writing that the infant is not only inherently active but also born with an impressive array of competencies, including a fully formed set of emotions. Moreover, the infant is curious, and wants to explore and develop mastery in various ways.
(2) We Need an Optimal Parental Response. Winnicott believed that if the child receives a facilitating environment, he will learn “that he can rely on his affects and states of excitement to guide his path through life.” If this process is impinged upon, his self will become split between a false self and a true self “of inborn potential the lies buried beneath the protective shell.” Research has reached similar conclusions. Attachment research, for example, has shown that a secure attachment with the mother is essential for the infant’s later psychological health, the key to secure attachment being “parental emotional availability with a push toward autonomy.”
When the child receives an optimal parental response, her feelings are acknowledged, and her sense of agency develops. Demos writes that an optimal parental response has three components: the response comes at just the right time (not too soon and not too late), and the response is congruent to the situation. For example, imagine that a child becomes distressed: if the parent intervenes too soon, the child will not realize that she was distressed; if the parent does not intervene soon enough, the child will become overwhelmed; and if the parent’s response is incongruent to the situation (e.g., if the parent responds to a scared child as though she’s hungry) the child will become confused and never learn to understand his emotions.
When the parent responds optimally over time, three positive consequences will follow. First, the child will gain emotional intelligence, developing the ability to listen to her emotions and the confidence to use them as guides for her behavior. Second, she will gain the skills needed to solve problems as well as confidence in her ability to use these skills to solve problems. Third, she will feel like an object of interest and value to her parent and consequently develop a healthy self-esteem.
When the parent fails to respond or fails to respond adequately, the child looks for another way to connect to the parent. In so doing, she is forced to bury aspects of her authentic self, thus arresting her self-realization. Put differently, she sacrifices her “authentic self development” for “relatedness.” Consequently, the child will not experience the above positive consequences. Additionally, she will develop symptoms.
“Authentic desires and interests, assuming disguised form, become realized through symptom formation. An index of what cannot be communicated directly, symptoms are the fate of the buried self.” For example, one bulimic patient felt the need to constantly be pleasing to others — for example, by complying with their requests and by keeping her weight down. Summers interpreted the binge-eating component of her bulimia as a protest “against an identity [she] hated but to which she felt bound” — namely, the need to always please others and be “the pretty one.”
Categories of Pathology
There are three main ways in which we can sacrifice our authentic self development in order to maintain a form of relatedness. Put differently, there are three main categories of self-arrest, “each of which correlates with a type of object relationship.”
(1) Fragile Self, Fused Object. Both borderline and schizoid defenses fall under this category because they both “suffer from a shaky, undeveloped self.” The schizoid’s “sense of self is so fragile that all relatedness threatens her boundaries,” and she responds by withdrawing from others. The borderline’s sense of self is also fragile, and she responds by attempting to compensate for this fragility by fusing with select objects, although she will often withdraw from these relationships.
(2) Defective Self, Protective Object. When parents are not abusive or neglectful but fail “to provide consistent recognition,” the child concludes that she is not interesting and not valuable to her parents. She grows to feel that she is not fragile but defective. Such an individual might become a narcissist and use grandiosity as a defense to prevent from feeling defective. She grows to use object relations to “maintain as much emotional connection with others as possible while shielding the feeling of defectiveness.” She will use idealization to maintain her grandiose feelings, “idealization by the connection with an object that has exaggerated value, and devaluation by enhancing the feeling of self-worth in comparison with the devalued object.” If unable to maintain this grandiose feeling, she will seek gratification another way and might develop an addiction.
(3) Unworthy Self, Bad Object. When the parent recognizes the child but “conveys consistently that the child fails to meet expectations,” the child may conclude that “she is a disappointment to the parent and may believe the relationship is threatened.” In an effort to “preserve the relationship, the disappointed parent becomes internalized as a harsh, disapproving voice so that the child may experience the actual parent as benign.” The child “preserves the actual relationship at the cost of self-attack.” The child believes that “if she could just be good enough, the caregiver relationship would be secured.”
The Analytic Relationship as Transitional Space
Introduction. “All relationships are defined by boundaries that determine permissible and forbidden modes of interaction.” The analytic relationship only differs from other relationships in its aim, which is “the development of [of the patient’s] hidden self potential.” To make this possible, the therapist provides “the maximum possible space for the patient’s self-expression within the limits of the therapist’s capabilities.”
Winnicott. Summer’s conception of the analytic relationship is informed by Winnicott’s notion of transitional space. Winnicott initially defined transitional space as a child’s experience of illusion, defined as his experience of something that is “neither fantasy nor reality” but “a blend of both spheres” (“Transitional objections and transitional phenomena,” 1951). Winnicott later applied this concept to psychoanalysis, defining transitional space as the patient’s experience of knowing “in some sense” that the analyst is “a person with real qualities” but nonetheless treating him “as though he were an object of the patient’s creation.” Once the patient enters this transitional space, it is the job of the analyst to “provide sufficient space in the relationship for the patient to create the analytic relationship in the way he needs” (Playing and Reality, 1971).
Not Just Interpretation. The analyst’s job, in other words, involves not just interpretation but being adaptive to the patient and doing “whatever is needed to promote the development of arrested development. To the extent that the elucidation of meaning aids in the accomplishment of this goal, interpretations are a necessary part of this process, but they subserve the therapist’s facilitation of the unfolding of previously dormant capacities. The analytic arena is conceptualized as a space for realization of new aspects of the self rather than as a dyad organized around interpretation” (“Transcending the self: An object relations model of psychoanalytic therapy,” 1997).
In Winnicottian terms, the analyst must provide a type of “formlessness,” meaning the analyst must “be flexible enough to adapt to the experience the patient needs to create.” Providing “too much ‘form’ or structure restricts the space the patient can make use of in order to realize the yet unborn self.” And so the analyst strives to be attuned to the patient so he can “adjust himself insofar as possible to provide an experience the patient can use to articulate new ways of being and relating.”
Of course, the analyst does not perfectly know the patient’s needs, and so he will offer interpretations that are “intended to be ‘played with’ by the patient. If the patient is able to use the interpretation in a way that fits his authentic experience, the therapeutic offering facilitates self development.” Additionally, the analyst must “have a vision of the patient that fits who the patient is but that goes beyond the reality of who the person has been in order to envision the possibilities of who the patient can be.”
Transference. Transference fits in with Winnicott’s notion of transitional space, as transference is “an illusion, a blend of reality imbued with personal meaning.” Transference has an as-if quality; “the patient knows that some of his affective responses contrast with the person he perceives the analyst to be, but the patient treats the analyst according to his feelings anyway.” Transference does not simply involve the patient transferring “an object relational pattern from the past” but also involves the patient enacting the old relational pattern “in some new ways with the therapist, thus creating a new version of the old relationship.”
Theory of Therapeutic Action
(1) Interpretation. An interpretation is analogous to the parental responses which a child receives. Just as the “child uses the parental response to create meaning from the experience,” the purpose of our interpretations is for the patient to create meaning out of it. Thus, an interpretation’s value “is the meaning the patient creates from it rather than the analyst’s intended meaning.” “A ‘good’ interpretation is an analytic offering that the patient can imbue with meaning that adds to or enriches his authentic experience; a ‘bad’ interpretation is an analytic submission from which the patient cannot create a useful meaning.”
Although interpretations are not sufficient for bringing about change, they are nonetheless necessary. Interpretations can “make defenses conscious, thus loosening the protective covering of the patient’s adaptation” and pointing “to unrealized ways of being that lie dormant beneath them.” Moreover, interpretations communicate to patients that we understand the purpose of their defenses, that we understand that their pathological behavior is an “effort to communicate blocked potential.” Being understood in this way is “the first step toward realizing previously dormant potential.”
When we interpret a patient’s symptoms “as indirect communications of potentially authentic forms of self-expression,” we are “making visible previously unseen object relationships.” One of the best indicators of a patient’s object relationships is our countertransference. “The patient will attempt to draw the therapist into his characteristic self and object role patterns.” For example, when one patient constantly compared himself to Summers and tried to best him, “he stirred competitive feelings” in Summers, “a clue to the reenactment of his competition with his father.”
(2) Recalcitrance of Pathological Patterns. Patients are often slow to change. According to the classical model, this phenomenon is understood as resistance to new insight. Summers instead claims that there is an “abundance of research findings showing that there are human (and even subhuman primate) needs for both novelty and familiarity.”Additionally, we can be resistant to change because change often requires us to relinquish object relations.
(3) Threat to Self. “If a patient is to change his ways of being and relating, his sense of who he is must be altered. By bringing to light the defensive nature of the patient’s way of relating to the world, the analytic process threatens not only the patient’s mode of engagement with the world but also his self-definition. For example, when Dexter understood his pattern of constructing relationships as competitive or exploitive, he tried to construct a different form of relationship with me but lost the connection. Having no concept of how to relate to me without competing or feeling exploited, he felt lost, embittered, confused, simply stating, ‘I do not know who I am.’”
What is often called resistance is “the patient’s defense against losing” a “sense of self” or a “threat to the patient’s experience of himself.” The threat to self is the deepest form of anxiety, what Klein called “annihilation anxiety” and what Bromberg referred to as the need for self-continuity (“Resistance, object-usage, and human relatedness,” 1995). “The patient who stubbornly refuses to yield pathological patterns is like the rock climber desperately clinging to the rope as he begins to lose his footing.” Thus, we should understand transference regression as “an effort to return to earlier modes of adaptation in response to the analytically induced threat to the self.” Similarly, what is called “acting-out” can be understood as “the patient’s desperate effort to obliterate the experience of nonbeing.” When the patient engages in such behavior, we must “point out the connection between such regressive behavior and the threat of nonbeing.”
The goal of psychoanalysis is “to overcome the threat to the self while changing the object relational patterns that define the very sense of self.” There are two therapeutic interventions that allay this annihilation anxiety.
(a) The holding function helps the patient “bear the edge of nonbeing.” The patient “requires an other to feel and contain the sense of threat while he explores new ways of being and relating.” If the patient trusts the therapist, “the therapeutic presence provides a sense of safety in the reliability of an other when the patient has little self of sense on which to rely.”
(b) The “double-sided nature of the therapeutic vision helps to diminish the threat to the self. The therapist sees not only the anxiety avoided but also the possibilities that may potentially emerge from the empty space of nonexistence.” The success of this “hinges on the analyst’s ability to see as yet unrealized possibilities in the patient and on the analyst’s openness to new and unforeseen ways of relating to him.” The patient’s free associations abet his “arrival at the ‘spontaneous gesture.’” The therapist’s job is to “find the spontaneous gesture when it appears, to attend to it, and to facilitate new models of self-expression as they appear.” For example, Summers asked Dexter, “If you were not competitive with me, then what?” Dexter said that he wanted to be loved. “This admission was a spontaneous gesture, an emerging revelation that surprised him even as it appeared. This expression of longing led to a new arena of therapeutic material.”
(4) Creating the Analytic Third. As Winnicott wrote, the analytic relationship is formless, thus enabling the patient to use the analyst so that she can “create a new object relationship, the analytic object.” She creates the analytic object “out of the givens of who the analyst is, his adaptations, his interpretations, and the analytic setting.” This is what differentiates the analytic relationship from all other relationships: the analyst “makes himself as usable as possible by the creation for new ways of being and relating.”
Case Study: Zelda. Zelda learned at a young age “to charm her father in order to avoid outbursts of his volatile temper,” a pattern that “became her primary modeling of relating.” She grew to believe that pleasing others was her only talent. Regarded by her family as “the pretty one,” she did not consider herself intelligent and did not take school seriously. Summers made interpretations revealing that her “flirtatious, charming social exterior was a protective veneer that served to keep hidden her threatening but more genuine feelings of ambition, aggression, intelligence, capability, and resourcefulness.” Zelda started to realize that she was angry with her parents for only seeing her as the pretty one and thus stifling her potential. However, she now feared that “if she openly opposed others she or was even unpleasant, she would lose her only way of relating to others, thus risking those relationships she did have.
Case study: George. George grew up with an abusive father, and in analysis he came to realize that “his chronic self-flagellation was the internalization of his father’s voice.” George strived to please the analyst-father while worrying that the analyst take credit for any progress he made. When asked what it would be like to give up this view of the analyst as exploiter, George said it would feel like his father inside him would die. This refusal to give up his representational father both illustrates Fairbairn’s thesis that abuse strengthens our attachment to objects; it also illustrates the idea developed by Ogden and Reubens that “the attachment to the bad object preserves the sense of self” (Fairbairn and the Origins of Object Relations Theory, 1994).
It was in the transference that George came to understand his object relationships. Moreover, it was in the transference that George came to experience new ways of being. He had always felt his father’s judgments when he felt indecisive, and in one session he had the experience of feeling indecisive without also feeling his father’s judgments. He had also always felt his father’s judgments whenever he needed someone’s help. He began to experience in analysis that although he needed the analyst’s help, he was entitled to this help and could receive help without feeling shame.
Fragile Self, Fused Object
The Borderline Personality Organization
Both the borderline and schizoid individual have a fragile sense of self, but unlike the borderline, the schizoid has lost hope that this fusion can be achieved. The schizoid, Summers writes, “cannot bear the pain and futility of pursuing the longed-for object and tends to withdraw from emotional connections.” The borderline desires fusion with others and thus tries to blur the boundaries between self and others. However, if they find success and causes these self-other boundaries to blur, her “minimal sense of self is threatened, resulting in annihilation anxiety,” and she will then withdraw from the relationship.
Summers uses the traditional definition of the borderline syndrome, writing that these individuals live in the “borderline” between psychosis and reality adaptation. Their attempt to fuse with others can “lead to delusional or nearly delusional interpersonal states.” However, they’re able to remain grounded in reality in other aspects of their life; although their interpersonal lives are chaotic, they might, for instance, function well professionally.
Most borderline individuals had difficult childhoods and were never able to bond with their mothers. Their desire to blur self-other boundaries “is not the arrest of a developmentally normal desire but a result of the failure of the early relationships to facilitate self development.” This failure left the borderline feeling “helpless to influence [her] destiny.” A fused relationship “provides the illusion of complete control over the object,” thus providing the sense that she can “manage the dangers and frustrations of life.”
Transference and Countertransference
The borderline patient makes constant demands of the therapist, and in time the therapist feels that he has no good options: comply and you’re unhappy, don’t comply and she will do something drastic. The patient desires fusion and thus seeks a relationship that blurs the therapist-patient boundary. When she is unable to fuse, her sense of self is threatened and she experiences annihilation anxiety.
This is a different type of transference than what Freud described. In Freud’s version, the patient “transfers an already formed image from the past” on the therapist. In borderline transference, what is transferred “is not a template but unmet needs from the past for which the patient seeks gratification in the therapeutic relationship.” Summers nicely summarizes this transference-countertransference: “The therapist is caught between the patient’s dual feelings of threat and despair in response to limit setting and fear of engulfment in response to compliance. The resolution of this dilemma is the central task of the therapeutic process.”
Borderline patients often respond negatively to interpretations and any type of boundary-setting because these “signify a gap between patient and therapist,” and this reminder of their separateness can be triggering. Empathy also does not work with these patients, as it does not meet their need for fusion. Borderline patients tend to have three main expectations that show up in the transference: (1) the expectation that the therapist “is to be there for the patient whenever the wish or need arises,” (2) the expectation that the therapist “should understand without having to be told,” and (3) the expectation that the therapist “is to help or even take responsibility for all manner of tasks and needs in the patient’s life.”
Therapeutic Action
It is essential to manage one’s countertransference with these patients. “The patient’s oscillation between contact and withdrawal is wearing on the therapist’s patience and strains her emotional tolerance as the hopes generated by contact continually give way to despair in response to withdrawal.” It is essential that the therapist experiences this “painful sense of hopelessness” in order to understand the patient’s pain. At the same time, the therapist must see that this cycle is not never-ending but that it can include “a trajectory in the direction of connection.” The patient will come to experience the therapist’s hope and come to rely on them. Successful therapy “hinges on the therapist’s believing enough in the patient’s potential to contain hopelessness and to sustain belief in the process in the face of apparently insoluble therapeutic dilemmas.”
What works with others does not work with borderline patients: she will not accept an interpretation of her defenses; she will not be affected if we recognize her needs; she might find temporary relief if we recognize her need for fusion, “the verbal response leaves an intolerable emptiness, an unfulfilled longing for the actual experience.” In order for the patient “to feel an emotional connection, the needed relationship must be created.” Although the patient will “quickly retreat from this [newly formed] connection,” the fact that she “survives such moments with an intact sense of self provides the basis for a relationship. Having control of these moments of merging and withdrawing from them as needed allow the patient to titrate the anxiety of emotional connection. If the therapist tries to push in either direction,” the patient’s anxiety will be exacerbated. If she is allowed “to test the waters of emotional relating without traumatic disruption,” she will find herself able to “gradually move toward the long-sought bond of fusion.”
The key is for the therapist to allow a relationship that allows for “some degree of fusion without concretizing the relationship in a way that eliminates the therapeutic space,” e.g., by physically holding the patient. Different patients will be able to find fusion in different ways. Summers provides a few helpful examples.
Case Study
Mary came to understand that she was relying on substances instead of relying on Summers “because of her inability to tolerate disruptions in the therapeutic bonder.” Summers told her that “the therapy could not work if she sought the relationship she needed from me in substances.” Although she found the idea of giving up substances terrifying, she found that “telephone contact calmed her by restoring the therapeutic connection.
In time, however, the phone calls no longer reassured her, and she once told him, “I don’t think you’re there! I need to know you’re there!” To calm her, he started to repeat in a soothing voice, “It’s meeeee! ””This almost chanting, repetitive chorus became the way she felt connected” to Summers both over the phone and in sessions. “Successful episodes of this type almost magically transformed her immediate state from catastrophic anxiety to a beatific calm.” During these times, she felt that the separation between her and Summers had disappeared and that she and he were one.
“Although temporary, these instances became the transformative experiences of therapy. By stringing together these powerful moments, she began to feel a sense of calm between sessions and eventually gave up telephone calls.” As Mary “strung together” these experiences, she felt that she was taking Summers “inside” her. “When she became disturbed outside of sessions, she talked to the ‘Dr. Summers in my head,’ and the sense of [his] presence provided her with the calm she sought.” She would tell herself what she thought he would say to her, “and this capacity to relieve her anxiety provided a sense of freedom to pursue interests for the first time in her life.”
Defective Self, Protective Object
The narcissist believes that his self is defective. He consequently feels afraid that he will be exposed, which would result in a feeling of shame. This anxiety of being exposed is known as narcissistic tension.
The narcissist acts in a contradictory way, working hard to hold onto his belief in his defectiveness while at the same time working just as hard make sure that others do not see his defectiveness.
In order to develop a positive view of self, it’s necessary that we accept and listen to our emotions. And in order to develop this trust in our emotions, we need our parents to provide the right response when we have both negative and positive emotions.
We need our parents to allow us to experience negative emotions and to at times help us cope with them. If they do this, we will learn how to regulate our negative emotions and gain the confidence that we can handle difficult situations. If they don’t do this, we will become easily overwhelmed by negative emotions and in turn these emotions as well as difficult situations.
We need our parents to facilitate and encourage our positive emotions, namely the emotions of interest and enjoyment. If they do this, we learn to trust our positive emotions. Specifically, we will learn that we can use these emotions as guides for our beliefs and actions and that acting on these emotions can sustain our relationships, even if our emotions and interests “are different from or in opposition to those of others.” If our parents ignore or discourage our interests and enjoyment, we will conclude that these emotions are unacceptable to others and that we ourselves are defective. We will in turn look for other “guides” for our beliefs and actions.
When we have this confidence, “positive affects can be enjoyed and experienced fully, and negative affects are met with the belief they can be overcome, both of which issue in a positive feeling toward one’s core subjectivity. This belief in the appeal of one’s affects constitutes trust in the self, or confidence, healthy self-esteem.”
He elaborates: “The child who possesses this confidence trusts that this genuinely experienced affects, the core of his subjectivity, are attractive to others and therefore have value. The child who does not believe his affective experience is acceptable to the early caretakers tends to feel defective to the very core of his being.”
Case Study
Growing up, Zeda’s affects were not “responded to in a way that facilitated the development of positive and regulated negative affects.” She consequently grew to have “no faith in her subjective states and frequently did not even know what they were. Unable to use her spontaneous affects, Zelda learned to mold her behavior to what pleased others.” For example, she chose her husband, not because she loved him, but because her parents had chosen him for her. She picked her college major based on what others recommended and never gave it much thought herself.
Zelda did not believe she “possessed capacities on which she could rely” and became “easily overwhelmed by adversarial events.” She learned to use “flirtation and social grace” to “navigate her way through the world.” He continues: “Having constructed this false self, she was especially threatened by the possibility that negative states could disturb her only way of relating to others. By receiving positive responses from others, she protected her feeling of defectiveness, but the approval of others never felt real.” She relied on binge-eating for narcissistic tension relief.”
Summers summarizes Zelda with the following statements. (1) She “could not trust her feelings as guides to action.” (2) She could not regulate negative emotions and as a result either “disavowed negative experience or became so overwhelmed by it the she binged to obliterate unpleasant affects.” (3) Not trusting that her emotions could guide her, she “felt that her very core was inadequate” and “had little confidence in her ability to control events in her life.” (4) “Having buried her genuine affects, she remained emotionally disconnected from other people; she loathed her false veneer but knew no other way to make genuine interpersonal contact.”
Defensive Strategies
To prevent from feeling the shame of being defective, narcissists cope in two ways — first, by trying to find gratification “to substitute for their missing esteem,” and second, by trying to hide their feeling of defectiveness.
Attempts to Find Gratification. Attempts to find gratification to substitute for one’s missing esteem can take three forms. (1) Addictions. Addictions “create an illusion of well being in which ‘all is right,’ so that the anxiety about one’s sense of value temporarily abates.” (2) Perversions. Sadomasochism is a perversion commonly used by narcissists. Submitting masochistically “provides the illusion of being recognized as a subject of desire,” and acting sadistically can temporarily obliterate one’s self-doubts and feelings of defectiveness. (3) Delinquency. Engaging in antisocial behavior gives one a temporary feeling of elation, as the individual “feels the defect erased and a sense of triumph over the world.”
Attempts to Conceal One’s Defectiveness. (1) Compliance. Such patients had parents who demanded success. (2) Grandiosity. “When self-esteem sinks to the point of desperation, and little environmental approbation is forthcoming, grandiosity is sometimes an effective defense against the sense of defectiveness.” In order to “believe in the reality of the grandiose image, the patient must have it confirmed and bolstered by others, resulting in a personality organized around the desperate need to sustain the feeling of self-inflation.” (3) Devaluation. (4) Idealization. Identifying with “exceptional figures boosts one’s sense of value and thereby temporarily mitigates anxiety over the feeling of inadequacy.” (5) Clinging Attachment. The attachment here relieves the narcissistic tension, and the attached figure is valued for what she does, not for any of her inherent qualities.
Summers writes that, although there are several defensive strategies that the narcissist can use, Kohut and Kernberg only focus on the strategies of grandiosity and idealization.
Maintenance of the Narcissistic Defect
Not only does the narcissist feel defective, but he works to maintain this feeling for defectiveness. We know this because he both holds onto negative experiences that confirm his defectiveness and discounts positive experiences that disconfirm his defectiveness. The narcissist does this for three main reasons.
First, persisting in his feeling of defectiveness provides “him with a sense of self-continuity,” and if he allowed positive experiences to register, his sense of self would be threatened, “causing him to feel lost, disorganized, and, most important, subject to annihilation anxiety.”
Second, the narcissist clings to the feeling of defectiveness because this feeling motivates him to action in a meaningful way. One patient, Dick, believed himself to be defective and spent his life trying “to prove his value to himself and his father.” He felt “no sense of purpose apart from the goal of demonstrating his value to his father.” Another patient, Zelda, believed herself to be undesirable, and feared that if she lost this feeling she would stop being healthy and trying to look attractive.
Third, the narcissist clings to the feeling of defectiveness because this prevents him from becoming aware of other emotions. “Each time a negative experience is added to the store of inadequate feelings, the patient has successfully avoided confrontation with his affects.” As has been already seen, “a lack of trust in one’s affects lies at the root of the narcissistic patient’s feeling of defect, and the maintenance of this feeling is crucial to the sense of self, modes of engagement with the world, and motivation.”
The Therapeutic Process
Threat of the Therapeutic Process. When we question a narcissist’s reasons for doing something, he feels threatened because he does the things he does in response to the feeling of defectiveness. For example, Zelda married a man she didn’t love because he took care of her, preventing her from interacting with the world and thus becoming aware of her feelings of defectiveness. When the therapist asked why Zelda had married her husband, she became defensive.
The narcissist’s transference will be defense; he will attempt to use the therapeutic relationship to prevent himself from becoming aware of his feeling of defectiveness. Zelda was at first a perfectly compliant patient, and in so doing she tried to keep her therapist from seeing her pain and thus defectiveness. “When I suggested to Zelda that her agreeableness was a way to render me ineffective and unable to see her more deeply, she agreed and felt relieved at being seen,” although “her humiliation led to intense anger and even a feeling of persecution by the therapeutic process.”
This humiliation, common in narcissists, is why Kohut recommended that the therapist empathize with the patient for a long time before making interpretations. Summers believes that sometimes this approach has merit but that sometimes interpretations can relieve anxiety. This is a conundrum: When, following Kohut, “therapist is sensitive to the patient’s vulnerability to injury and careful not to expose sore areas, the patient tends to feel that the process is not going anywhere.” On the other hand, when following Kernberg, “therapist illuminates the patient’s vulnerability and sense of defectiveness, the patient tends to feel injured and regards the therapist as insensitive, perhaps even sadistic, and the process is too painful.”
Interpretation of the Buried Self. So this is the dilemma: interpret, and the patient will feel the shame of exposure; don’t interpret, and the patient will feel bored. The way out of this dilemma, Summers writes, is to remember that “the purpose of interpretation is to uncover the buried potential beneath the patient’s defensive constellation.” While the patient sees exposure as “a revelation of defect,” the therapist “sees possibilities of self-realization that the patient cannot consciously perceive.”
For example, Summers made this interpretation to Zelda: she had always defensively hidden behind an “agreeable persona” because deep down she believed “that she had no merit other than her comely appearance.” Summers then pointed out that this belief had resulted from the way her parents had treated her as a child, and he further pointed out that because she complied with this belief, “she had developed very little of her intellectual and emotional potential.” By making his interpretation in terms of arrested development, he was implying that she had “greater potential” for ways of being and relating to others.
Summers later interpreted her binge-eating as “a protest against being imprisoned in an identity she found devaluing and false. Unable to contain tears at being recognized, Zelda felt that her plea had finally been heard.” Her tears “provided the emotional outlet for the feeling that another person saw potential within her.”
Summers’ interpretations expressed that he saw “intellectual capacity in her,” and she concluded that if he believed this, she might be able to believe this too. “In this way, the interpretation of her socially agreeable veneer as a defense provided holding — a positive, hopeful environment within which she was able to sustain new awareness of her vulnerability and motivations.” She felt held because he had seen who she was “beneath her limiting self-definition” and because his “vision of her embraced unrealized potential.” When Summers saw “beyond her defenses,” he “did not find a defect, as Zelda expected, but new possibilities, and this vision allowed her to achieve a new level of self-understanding that was relieving rather than traumatizing.”
Oscillation: Development and Regression. Interpretation provides a holding place but does not “eliminate the tendency to regressive avoidance.” Patients oscillate between wanting to change and not wanting to face “the shame and vulnerability of exposure” that comes with change. Zelda started to be direct with people and “relinquish her coquettish exterior” while still considering “returning to her ex-husband and her former life of hiding.”
Transitional Space and the Development of Authenticity. When interpretation starts to loosen “the defense transference, transitional space emerges, and possibilities open up for more authentic modes of engagement.” The therapist problem “to access underlying affects.” When his comments “stimulate new affective responses in the patient in a way that fits the mystery of the patient’s symptoms, the true self begins to emerge.” The patient is not simply “getting in touch with his feelings” but is gaining access to his potential. Because the narcissist believes that “the articulation of his genuine affects will cost him relationships,” the therapist must “provide room for the elaboration of the patient’s authentic affective expressions.” A new object relationship begins to form in which the patient starts to believe that “affects can be used to engage the world without loss of connection with others.”
Zelda used therapy to “gain access to her aggression.” Upon learning that her charming persona was a defense “against feelings of inadequacy and emptiness,” she “came into session one day and unexpectedly exploded with rage,” angry with an interpretation Summers had made even though at the time she had said she agreed with it. “Zelda was convinced that this aggressive outburst would disrupt [their] bond” and was surprised when the aggression did not damage their relationship. Summers told her that her expression of anger “created a new dimension” in their relationship: “use of aggression to assert some control and influence in how [he] treated her.”
Zelda began to more regularly express her anger. She then started to express more anger with people in her life. “No longer buried beneath an agreeable veneer, her anger was in synchrony with her way of engaging [him]. This congruence between affect and relating facilitated the trust that her affective states could direct her relationships — that is, helped her develop self-confidence.”
Zelda began to relate to Summers more authentically, and this included her acknowledgement that he valued her intellect. She began to have sexual dreams about him, a development that “signaled a closeness with [him] she had never before experienced. Feeling understood and valued for who she was, she could manage the emotional intensity of her attachment to [him] only by eroticizing the relationship. All past relationships having been sexual, Zelda had the new experience of being in a relationship that was close but not physical.”
He continues: “We understood her erotic dreams of me as her way of experience being valued and the feeling of gratitude. When she verbalized these feelings, Zelda felt a powerful emotional connection to me, the first nonsexual intimacy she had ever experienced, and the resulting bond became her first genuinely close relationship. She wept frequently as she told me of the importance to her of feeling valued for who she was, but she continued to be angry with me whenever she felt I was not understanding her.”
Zelda’s gratitude “signified a new level of interpersonal sensitivity,” the ability to see that Summers “had a subjectivity on which she had an influence.” When he survived her aggression, her view of him shifted “from a source of gratification or frustration to a person with a separate mind.”
Unworthy Self, Bad Object
Classical psychoanalysis holds that neurotics suffer from internal conflict between wish and guilt. However, if this were a sufficient explanation, it is not clear why neurotic patients often come to understand their internal conflict but still find it difficult to change their behavior. Guilt, Summers writes, serves the additional purpose of “maintaining an object tie.”
Summers returns to Dexter, who feared that success would cause him to lose his relationship with his father. Consequently, Dexter continually failed in life, and in so doing, he maintained his relationship with his father. When he obtained success, he would experience guilt, the purpose of the guilt being to maintain his connection with his father. Additionally, because he felt that his mother would exploit his successes for her own purposes, when had some success, he felt fraudulent, experiencing existential guilt, the “feeling of having violated his integrity by denying the needs of his self.”
Case Study: Nora
Guilt. Nora, grew up with a harshly critical mother. As an adult, she moved far away from her mother and proceeded to choose a series of denigrating romantic partners and jobs. “In the course of psychotherapy, as she associated these problems to her mother’s attacks, she realized that her mother was, in this sense, always present, ready to tell her that she was undeserving of the goods of the world and to pounce on any movement of freedom with harsh judgments about Nora’s unworthiness.” This “harsh, negative maternal influence was preferable to abandonment.”
Nora also felt guilt for submitting to these denigrating partners and jobs, this existential guilt representing “the voice of genuine integrity refusing to accept total submission.” These relationships and jobs “left her feeling suffocated to the point of intolerableness” and represented “the dilemma of her life: she strove for happiness but felt unworthy of it, and she put up with misery until her sense of dignity screamed, ‘No more!’”
Interpretation. We must first interpret “the origins and function of the unworthy self in order to open a therapeutic space within which the sense of a deserving self may be created.” In the below example, Nora gained insight through interpretations, but these insights alone did not lead to significant change.
Subservience, Connection to Mother. Early in therapy, Summers pointed out that Nora had always taken a subservient role in her romantic relationships. When he asked for “associations to her undeserving feeling,” she talked about her mother’s critical voice. Nora could not imagine having a relationship in which she wasn’t subservient, and they connected this with “her need to maintain a sense of connection with her mother.”
Subservience, Underlying Belief, Connection to Mother. He noted that she was subservient in the therapy relationship and asked if she believed “she had any rights or claims” in their relationship, and she “acknowledged that her honest answer was no.” He then pointed out that she had an underlying belief “that she was undeserving of equal treatment” and that her subservience in her adult relationships was “rooted in her sense of undeservingness.” Nora then associated to her mother’s verbal denigration of her, “a devaluing attitude that Nora had always assumed to be an accurate reflection of her flaws.”
Anger, Guilt. Nora “connected her mother’s scorn to the close bond between her sister and mother, and she realized that she had always hated her sister as a representative of the truth of her mother’s accusations.” She then realized that “she had hateful feelings toward both her sister and mother, and her guilt was related to those unacceptable feelings.”
Inner Voice, Function. Nora became increasingly aware that she regularly heard her mother’s “voice,” e.g., after a trip to the grocery store “hearing” her mother tell her “not to buy certain products because they were in some ways too good for her.” Summers asked what she would do if she no longer heard this voice, and Nora replied that she would feel free but also that she would not know how to act. According to object relations theory, guilt can be understood “as a structure of the self, as a way of being in the world that defines one’s existence.”
Guilt, Function. Upon learning that “guilt served as a guide, it became clear that Nora had the unconscious conviction that her only protection against selfishness and greed was her sense of unworthiness. This inability to believe in the realization of potential without selfishness is typical of guilt-burdened patients.”
Opening the Therapeutic Space. Nora unexpectedly announced one session that she was thinking about sailing around the world with a man she had just met. When asked what was drawing her to go on the trip, she said she just felt an urge “to get away.” Summers asks more questions, and it became clear that she was only parroting the man’s answers, not giving her own feelings.
Nora finally admitted that the man’s money “and the power that went with it were influential in her attraction to the trip.” Summers then made a connection between this man and her first husband: “She was once again influenced by a powerful man with money and was tempted to put her life under his control.” She became shocked that she had considered “putting herself under such total influence of a man she barely knew.” Summers suggested that going on the trip would not be an escape but a repetition, a “reenactment of her lifelong pattern of assuming a second-class status of dependence on the ‘more deserving’ party.” Once Nora realized this, she no longer wanted to go on the boat trip.
.This led to a discussion about the attraction that wealthy and powerful men had held for her. “She was attracted to these powerful men not so much because she was impressed with their money but because, by their power and control over her, they became the personification of the bad maternal object, complementing and satisfying her need to be unworthy.”
Nora considered this to be the turning point of the therapy. What had been helpful had not just been Summers’ insights but also that his “attitude conveyed a sense of her worth.” By communicating his “conviction that she was repeating a pattern of unworthiness,” he had “treated her as worthy of experiencing herself in a different way.” He continues: “No amount of praise or reassurance had ever affected her feelings about herself because she did not believe such comments reflected an appreciation of why she felt so undeserving. By contrast, my attitude emanated from a recognition of who she was, an appreciate of her need to believe and sustain a feeling of being unsuited for positive life experience.” His “vision of her as deserving of equal treatment opened up the possibility of a new way of treating herself.”
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