A psychodynamic approach: what can be gained from loss - Essay Example

? A Psychodynamic Approach: What can be Gained from Loss? In his groundbreaking essay “Mourning and Melancholia”, Freud (1917, pp. 245) asked a profound question: why accepting the loss and withdrawing the attachments is so extraordinarily painful? He did not answer the question; however, concluded that ego is freed after completing the painful process of mourning. He also noted that rejecting the command of reality and refusing to mourn may lead to the psychosis. Freud delineated the stages of mourning and its difference from melancholia. Although Freud's theory was primarily drive-oriented, his article influenced both object-relations theory and attachment theory. Indeed, early attachment is central to both theories of object relations and attachment. In his pioneering triology, Attachment and Loss, John Bowlby scrutinized the processes of attachment, separation and loss in children and adults. The aim of this brief is to explore what understanding of loss we can gain from psychodynamic theory. In “Mourning and Melancholia”, Freud (1917, pp. 243) noted that both mourning and melancholia develop as a response to the loss of a loved person, while he described melancholia as a pathological condition. However, whereas a person suffers from the loss of the object in the normal grieving process, a melancholic suffers from “a loss in regard to his ego” (pp. 243). Nevertheless, Freud's account is a bit problematic, since he also made a paradoxical claim that the melancholic does not feel any shame in front of other people in contrast to the mourning person who feels big shame. Although what he said can be empirically valid, theoretically it is problematic, since the feelings of shame are always related to the ego and it is not clear why the person who mourned for the lost object felt shame, while the melancholic who mourned for the loss of ego did not feel any shame. According to Freud, in normal mourning process, the person finally overcomes the loss of the object, withdraws his attachments and becomes ready to make new libidinal investments; but, the melancholic cannot since he is identified with the lost object; thus, cannot detach his libido from the lost object without risking the loss of his ego. Although Freud's article was groundbreaking, his instinct theory focused on the oedipal level and did not give an account of the separation/individuation process of the child. Later on, Melanie Klein and John Bowlby elaborated the concepts of mourning and loss. In his trilogy, John Bowlby, made extensive studies on separation, loss and early parent/child relationship and pioneered the attachment theory. Bowlby stressed the importance of earlier attachment behavior on later relationships in life. In fact, empirical researches of Fonagy showed that earlier insecure or disorganized attachment patterns may even lead to the personality disorders like borderline, schizoid and narcissistic personality disorders (Bowlby, 1979, pp. Xviii). According to Bowlby, the child develops the attachment response in line with an evolutionary heritage. Attachment system denotes a set of psychological dynamics that motivate a person to attain or maintain his/her “proximity to some other clearly identified individual who is concerned and better able to cope with the world” (Bowlby, 1982, pp. 668). The child feels safe if he or she knows the attachment figure is in a close proximity and responsive. Availability of the attachment figure creates a secure base for the child, and the child can explore the world freely in his/her presence. Meanwhile, unavailability of the attachment figure triggers several reactions. However, Bowlby's and others' clinical observations revealed that the reactions to separation are universal: protest (anger), depression (sadness and mourning), and eventual detachment (defensive avoidance). Attachment theory gave a great importance to the issue of separation since several observers noted the morbid consequences of the maternal loss. As Lieberman (1987, pp. 114) stated: “the data made clear that babies separated from their mothers from the second half of the first year onward experienced severe grief. When this grief was not assuaged either by mother's return or by adequate surrogate care from a reliable caregiver, the grief became depression: the babies withdrew from human contact, failed to progress in their development, and within a few months to a year seemed irreversible damage by the morbid conditions compounding the original maternal loss”. Bowlby agreed with Freud in major terms. Similar to Freud, Bowlby considered anxiety as a basic reaction against the fantasized object loss, while he saw grief as a normal response to the actual object loss. Bowlby, concluded that the child who experienced an acute separation anxiety may develop maladaptive psychological dynamics later in life. Bowlby also stressed the importance of secure base in therapy. In “A Secure Base - Clinical Applications of Attachment Theory” (1995), he drew parallels between secure parenting and good psychotherapy. He explains his central concept of good parenting as follows: “both parents of a secure base from which a child or adolescent can make sorties into the outside world and to which he can return knowing for sure that he will be welcomed when he gets there, nourished physically and emotionally, comforted if distressed, reassured if frightened. In essence this role is one of being available, ready to respond when called upon to encourage and perhaps assist, but intervene only when clearly necessary” (1995, pp. 12). In short, parents provide a secure base for their children by nourishing, comforting and reassuring them. Therapists can also help their patients to build a secure base by encouraging and assisting them. Hazen and Shaver proved that people, who securely attached to the primary caregivers, also formed secure and healthy adult relationships. But what if the parents are unavailable, unresponsive, neglectful or downright abusive and unable to provide a secure base? Then, the child develops an attachment disorder, at best. Indeed, in The Making and Breaking of Affectional Bonds (1979, pp. 18), Bowlby gave an example of a delinquent boy, whose mother died when he was 15 months old and who had several substitute mothers. Bowlby (1997, pp. 18), quoted the poem of the boy that described his despair upon his loss: “Oh, my little darling, I love you; Oh, my little darling, I don't believe you do, If you really loved me, as you say you do, You would not go to America and leave me at the Zoo.” Bowlby noted that the boy's intense despair coupled with intense hatred and led to violent behavior. He also quoted the work of his colleague Heinicke and compared two groups of little children; the first group in the residential nursery, the second in day care. While both groups concerned about their caregivers; while the first group was prone to crying, the second group showed a violent hostility (pp. 19). Bowlby (1979) concluded that “one of the major effects of mother-child separation is a great intensification of the conflict of ambivalence”. Bowlby (1973, pp. 26) stated that whenever a child was separated unwillingly from her mother he showed distress. “At first he protests vigorously and tries by all the means available to him to recover his mother. Later he seems to despair of recovering her, but none the less remains preoccupied with her and vigilant for her return. Later still he seems to lose his interest in his mother and to become emotionally detached from her”. However, the child cannot remain detached forever, as soon as the child reunited with his mother, his attachment is reinstated. Here, Bowlby, repeated Freud for whom missing the loved object is the source of anxiety. According to Bowlby, availability of the attachment figure is the major variable of his attachment style and confidence (or lack of it). The availability of the caregiver makes the child less susceptible to fear and anxiety; thus, helps him to develop secure affectionate bonds. Nevertheless, unavailability paves the ways for insecure and anxious attachment styles. Bowlby (1973) delineated “over-dependency or anxious attachment” as an attachment disorder. He gave the example of Jim in order to illustrate this attachment style. Jim seemed to show “strong attachments” to the nurses looked after him, he was clinging and possessive. According to Bowlby, clinging behavior characterized this type of attachment. Bowlby (1973, pp. 211) used the adjectives of “jealous”, “possessive”, “greedy”, “immature”, “overdependent”, “strong” or “intense” to describe this attachment style. He also noted that “when we come to know a person of this sort it soon becomes evident that he has no confidence that his attachment figures will be accessible and responsive to him when he wants them to be and that he has adopted a strategy of remaining in close proximity to them in order so far as possible to ensure that they will be available” (pp. 213). Bowlby's depiction of anxious attachment reminds the borderline personality disorder, characterized by the fear of abandonment, and borderline patients display similar tendencies of clinging and possessiveness. However, it must be noted that in most cases, the fears of children, who show over-dependent tendencies, are not fictional. Newson noted that most of these fears were reality based, since a kind of separation has already taken place. Thus, the children without permanent mother figure, or those in daily care or who faced the threats of abandonment are prone to develop anxious attachment style. Hence it is possible to conclude that the fears of loss paved the ways for insecure attachment style. Although the fears of insecure children are reality-based; nevertheless, these fears shape their psyche and, even if there is no actual threat of loss, their fears are easily triggered or they may tend to attach unavailable figures like their caregivers. For psychodynamic theory, it is important to understand the earlier attachment style, since it sets the very dynamics of the human psyche. Children who experienced intense fears of abandonment, likely to repeat that anxious attachment style in their adult life and it becomes their dynamic later in life. Over-dependent and anxious child becomes a clinging borderline adult in future. Furthermore, insecure adults treat their children in the same way they were treated in childhood. Thus, anxious mothers raise insecure children like themselves. Bowlby gave Mrs. Q and her son Stephen as an illustrative case of the anxious attachment. Stephen was 18 months old and seriously underweight since he refused to eat (p. 230). Mrs. Q suffered from a chronic anxiety, which began when her child was born. Mrs. Q had a father who fought in the WWI and became invalid and he treated his family badly, he and Mrs. Q's mother had terrible and violent fights. Bowlby (1973, p. 231) noted that “Mrs. Q's mother had attempted suicide, and many more when she had threatened it.” In that wild and threatening environment, Mrs. Q had become a very insecure and anxious girl, while experiencing violent anger at times. Although her anger was a response to her violent mother, Mrs. Q refused that she felt any hostility and hatred towards her mother. However, she remembered that she treated her dolls violently after her mother's violent outbursts. Mrs. Q's problems with his son were crystallized in this context. As soon as he was born, Mrs. Q wanted to throw her baby out and felt intensely anxious that he would die, so she tried to make him eat frantically. Bowlby concluded that Mrs. Q's hostility towards her mother was redirected to her son. Mrs. Q admitted that she still experienced violent outbursts. When Stephen turned seven, he started to display anxiety and a kind of social phobia as he was afraid to go to school and feared that her mother would die. Mrs. Q determined that since she suffered from similar problems in her childhood, she would make her son's life secure and happy. Yet, she seemed to forget that decision whenever she had a violent outburst. She confessed that on those occasions “she said the most dreadful things, the very same things, in fact, that her mother had said to her when she was a girl. Stephen's fear that his mother might die was a direct reflection of his mother's threat of suicide, made during comparatively rare outbursts with an intensity that might alarm anyone” (p. 232). Bowlby arranged a meeting between the mother and son, in this session, Mrs. Q regretted for her threats and his son expressed his fears of losing her, and she assured him that she will never do that again. The clear communication between the mother and the child released the tensions and eased the situation. Nevertheless, Bowlby noted that in many cases, the real issues would remain in the closet, since a great number of parents would be reluctant to confess what they have done and their children would often be voluntary conspirators in silence. Bowlby's case did not just illustrate the anxious attachment style, but also revealed how it became a dynamic pattern repeated in generations if it was not treated. However, as the case also showed most of the times they remained hidden in the family histories. Bowlby (1973, p. 244) stated that “threats by a parent either to withdraw love or to abandon the child, are apt to be kept very secret.” Thus he refuted Freud and argued that anxiety over loss of love was not caused by an excess parental affection but the opposite (pp. 244). He also reported the cases in which parent-child roles were inverted. Anxious attachment also leads to several phobias like school phobia, animal phobias and agoraphobia. As it can be seen, even a threat of loss caused several psychic disturbances. Thomas Ogden, in The Matrix of Mind (1986) gives another example of depressive anxiety stemmed from the fear of the loss of an object from a different perspective. The British object-relations school and especially Melanie Klein underpinned Ogden's theoretical approach. Mr. L, Ogden's patient, utilized manic defense against his depressive anxiety. Manic defense deals with the separation anxiety and possible loss by denying the dependence on the object. As Ogden (1986, pp. 85) stated “this denial is reinforced by unconscious phantasy of omnipotent control over the object, which phantasy protects the individual against the anxiety of being abandoned by the object: One need not fear the loss of an object over which one feels one has absolute control. Moreover, contempt for the object serves to insulate the individual from loss, since one need not be concerned by the loss of the despised, worthless object”. Mr. L was hospitalized and still he spoke with Thomas Ogden as if nothing happened and tried to chat with him as two educated men. He asked how many languages Ogden knew. Ogden tried to bring him back to the real subject. However, Mr. L thought Ogden was trying to control the conversation and refused to talk with him any further. Ogden (1986, pp. 87) concluded that Mr. L relied primarily on manic defenses: denial (of the nature of their relationship), a grandiose twinship phantasy (two superior educated men), contempt and phantasied omnipotent control over the conversation. According to Ogden, he was trying to protect himself against a loss of self esteem and loss of connectedness. Mr. L would not risk a severed attachment, while he yearned for a meaningful contact and a person whom he can depend on. The condescending attitude and grandiose fantasies of Mr. L can be considered as the symptoms of narcissistic personality disorder. While Bowlby's case Mrs. Q, exemplified anxious attachment style of a borderline person, Ogden's case illustrated avoidant- attachment style of a narcissistic person. Mr. L's insistence on independence can also be considered within Bowlby's concept of compulsive self-reliance. However, while Klein and her followers like Ogden focused on phantasies, Bowlby concentrated on the trauma of the actual loss. As Jeremey Holmes (1993, p. 4) stated “Bowlby was stuck by the extent to which his clients had suffered from privation and loss, and horrified by the apparent disregard of real trauma as compared with an emphasis on the importance of autonomous phantasy in the Kleinian approach”. Nevertheless, Klein’s and Bowlby's views with regard to the impact of the death on inner life were compatible. According to Bowlby one needed to rebuild a secure base in the grief process and secure attachment required a secure holding environment. He also agreed with Klein that depression is a response to a loss. Bowlby has contributed to our understanding of the child’s attachments and showed the effects of loss and separation on the child’s development, as well as the prominence of attachment style in adult life. His studies on bereavement in the childhood convinced him that adult disturbances can be traced back to the earlier traumas. Studies of Van de Kolk and Gabbard proved his views and reported that early separation affected the brain receptors and raised the anxiety levels permanently (Holmes, 1993, pp. 95). Thus, building a secure base is crucial in therapeutically grief work, so that the patient can recover from his old traumas. Holmes used the clinical illustration of a widower at the age of 26. Jock's wife died because of hemorrhage and left him with 6 children. He tried to go on with his life for a while, but could not manage. He left his children to his sister and brother-in-law and went to London. He became a tramp, lived on the streets, drank heavily and fought a lot. He ended up at the emergency. He was full of despair and anger. He was angry with his wife thinking that she abandoned him, he was angry with God; he was also feeling guilty. He continued to drink and live on the streets, but regularly visited the clinic. Then he disappeared suddenly, few weeks later he was back in Glasgow, stopped drinking and looked after his children. Jeremy Holmes (1993, pp. 95) interpreted this case as follows: “perhaps Jock felt sufficiently 'held' (in Winnicottian sense) by his weekly contact with the therapist at the hospital to be able to rebuild his inner world so that he could become once more a secure base for his children-leaving his therapist as abruptly as his wife had 'left' him.” For Bowlby, expressing emotions and emotional release are indispensable for healthy mourning. However, it was also argued whether children are capable of comprehending death and if they could grieve for loss. Nevertheless, as Lerner noted (1987, p. 380) “there is a consensus that early parent loss has a traumatic impact and that the younger the child, the more devastating the effects”. Meiss and Wolftein asserted that children and adolescents were inclined to identify with the lost parent, which was different from the normal mourning process (p. 380). Indeed, the identification of the child with the lost object reminds Freud's melancholic position. Identification with the lost object further heightened the feelings of loss and made it difficult to “let it go” as adolescents fantasized that dead parent would return. The denial and fantasy helped the child to keep the integrity of the ego, which was still in the midst of developmental processes. Indeed, a plethora of research indicated the crucial role of denial for children. However, their denial strengthened the adults' belief that they were not upset by the loss. Psychoanalysts also paid attention to the effects of object loss on child's narcisissism and emerging sense of self. Many of them reported a “flight into narcissism” (pp. 382). Wolfenstein noted that the child conceived the parent as a part of himself and the loss of an object may leave the child in a “developmental vacuum” (pp. 382). According to Atwood, a loss of the object can lead to overemphasis on the body and self-image manifested in “narcisstic imbalance” and fantasies of grandiosity (pp. 382). According to Atwood “the traumatically intensified need for comfort and security is satisfied indirectly and vicariously through constant attention to the real or imagined needs of the others” (pp. 382). In treatment, the therapist assumed the significant functions of the lost parent so that the child could complete the mourning process through transference. Lerner gave the case of a 27 year old, married, childless woman as a clinical example. She suffered from depression due the death of his father from cancer. She had lost weight, “was experiencing sleep disturbances including frequent nightmares of either being chased or her father's having to choose between herself and another woman and his inevitably choosing the other woman, recurring self-reproaches about her being a disappointment to both her parents, nagging feelings of guilt, painful feelings of being orphaned, and intrusive obsessive thoughts of harm befalling her younger brother.” (pp. 383-384). Her mother had also died from cancer when she was 14. The death of his father evoked her earlier feelings of loss and sadness. She filled the hours with her father's death and her worries about her brother. However, it was soon obvious that she was suffering from low self-esteem. She had a self-diminishing, self devaluing style and she was defending herself against the non-existent critical remarks of the analyst. Her defense gradually diminished as her hypersensitivity became the focus, and the attention shifted from his lost father to her previously lost mother. As her mother come to the fore, she recognized her ambivalent feelings towards her and began to mourn for her loss. “In this respect, then, the hypersensitivity and continuous vigilance had served to ward off, in the person of the analyst, the loving, devoted, and competent but intrusive and impinging mother of childhood who had inordinate difficulty permitting the patient genuine independence and autonomy.” (p. 385). While grief-work continued, transference has begun to change gradually. She started to complain the analyst's overly cautious and delicate attitude toward her, she complained about his non-reactivity. She saw his non-reactivity as a confirmation of her dullness and unattractiveness. However, she failed to recognized that it was her hypersensitivity that blocked her analyst's capacity to attune to her in a more engaged way. Nevertheless, her reactions veiled her intense rage toward her father due to his non-responsiveness. “She felt that he not only had never 'grabbed hold of her' but also had never taken pride and delight in her as a woman, never given her a sense of 'specialness', never permitted her to feel that she could have significant impact on him” (p. 386). While she released her rage and disappointment to her unavailable father, who aroused her feelings of inadequacy by choosing other women over herself; she began to mourn for his loss in a more genuine manner. The second clinical case Lerner presented was more traumatic and severe. The patient is a 32 years old interior designer. She was divorced and she came to the treatment due to her successive failed relationships. Before seeking treatment, she had already recognized her pattern of romantic involvements with married or unavailable men. She concluded that she was destined to be alone and it was coincided with “being told by a palm reader that she had been fated by her father's death--that is, she would forever have difficulty in relationships with men, and there was nothing she could do about it” (p. 386). She had lost his father when she was 6, her mother had a stroke when she was 9, resulting in paralysis to one side of her boy and loss of speech. Her uncle came and divided her family; he sent her older sisters to a boarding school and took her mother and herself with him to his farm. In successive years, her maternal grandmother died, they moved from one relative to other. When she turned 16, her mother died of another stroke. At the midst of her adolescence, she had lost parents and her grandmother and she practically had reared herself. At the beginning of the analysis, she displayed an affectless and controlled manner as she carefully listed her several losses, her two marriages and divorces, her cervical cancer operated after the birth of her daughter, her successive failed relationships. The analyst realized her excessive need to be in control, insistence on self-sufficiency combined with yearning for the ideal man, and desire to feel genuine. “Throughout this period, her analyst, paradoxically, felt himself an ignored (dead) bystander watching her, in her characteristic self-reliant manner, conduct her own analysis, as well as a captive (controlled masochism) audience that was being constantly monitored to ensure that he, or his attention, not wander off. She felt a controlled gratitude for his infrequent remarks but also saw them as mildly intrusive (as her uncle). In the 11th month of treatment, after three weeks of extended break, the patient's efforts to be self-sufficient failed as intense feelings of emptiness and loneliness erupted. With her spontaneous feelings came a non-defensive grief for the death of her father for the first time in her life. After the release of grief, her early memories flooded. She tried to recapture the image her lost father in her desperate attempt to remember forgotten experiences. While she searched more information about him frantically, she saw a dream: “I went to the hospital to visit my father. Two people were in the room and my father was furthest away. It was the first time in a very long time I had seen him. I walked in the room and he recognized me. He had only one eye. Where his right eye once was, skin had grown over it. I felt that he felt self-conscious, I hugged and held him for a long time with my hand behind his head and kissed the right side of his face, the side with the missing eye. I sensed that he knew I was not repulsed by him. Later, I moved to the other side of the bed, and from that perspective he looked the same as always. I then began having a conversation with the man in the other bed. I had vague sexual feelings toward him which I can't explain” (p. 388). Her dream evoked a highly painful memory; she recalled that when he was sent to a hospital for a brain surgery, he looked like the deformed shadow of the father she had once known. She felt repulsed and horrified by his weak appearance. He was in a wheelchair, had lost weight and lost his color, a bandage was covering one side of his head, his genitals exposed. She felt it was humiliating for both of them. For the first time after his death, she conjured up “a full, total, undisguised inner image of him” (pp. 389). Lerner (1987, pp. 391-92) noted that while the patient had a developed self and she had already begun mourning in the 1st case, the second case displayed a false self which indicated a lower developmental level and a little sense of self-identity. The illusion of self-sufficiency was hiding the fears of loss and abandonment. Her tendency to choose unavailable men was not the result of an unresolved oedipal struggle. “Rather, they signified an oedipal conflict compounded and influenced by an earlier-based defect in psychic structure— namely, a failure in the internalization and representation of her father” (pp. 391). She could begin to mourn for his loss only by rediscovering him. As Lerner's cases showed loss is a very painful experience, and it becomes even more complex if it is experienced early in life. The treatment gave the patients a second chance to continue their developmental growth, which was arrested due to the early loss. Therapeutic relationship substituted the nuclear family and provided a secure base to the patients to explore themselves and integrate alienated parts of their psyche. As they truly mourned for their losses, they began ready to form new and healthier attachments. Since the major task of the development is individualized and integrated sense of self, the separation-individuation process is extremely important. Indeed, struggles with psychological separation could cause severe psychopathology. In “Transitional Phenomena and Psychological Separateness in Schizophrenic, Borderline and Bulimic Patients” Alan Sugarman and Lee S. Jaffe (1987) explored four types of severe psychopathology with respect to the separation- individuation process. It has been already noted that non-paranoid types of schizophrenia were related to the basic problems in separating from the symbiotic relationship with the mother (Sugarman and Jaffe, 1987, p. 425). Their overdependence on the caregiver made them extremely vulnerable to the real object loss (p. 425). Their object relationship is so primitive that their self-representation is undifferentiated from the object representations and their self/other boundary is so delicate (pp. 425). However, the paranoid psychoses have been least intertwined with problems in separation/individuation process. Sugarman and Jaffe also noted that bulimia represented an attempt to maintain self/other boundary. They asserted that maternal over-involvement leads to the suppression of tendencies for growth and independence and concluded that “the caretaker's inability to tolerate or promote her child's separateness from developing a firm boundary between self -and object representations” (pp. 437). For bulimic person, absent mother means lost mother, since she cannot evoke her representation in her absence, thus she fantasizes a fusion. With binge/purge cycle, she tries to be dependent/independent in order to maintain self/other boundary. Several psychoanalysts identified the main reason of the borderline personality as an early arrest in separation/individuation process, especially during rapprochement. “The child feels in dilemma, wherein regressive clinging is supported, and efforts toward separation and growth are met by a withdrawal of the maternal supplies needed to promote ego development and further separation-individuation” (p. 443). Although, they are successful in relating to the world, their personal relationships suffered due their fragmented self / other representations. Since they did not develop object-constancy, they are extremely vulnerable to the separation anxiety. Sugarman and Jaffe showed that seemingly very different disturbances are actually linked with the separation-individuation process. They suggested that schizophrenia, paranoia, bulimia and borderline personality stemmed from early developmental struggles with regard to the separation. To sum up, understanding the dynamics of separation and loss is indispensible for the psychodynamic approach, since a plethora of psychic disturbances developed as a response to the actual or imagined loss. While the threat of loss caused several attachment disorders, anxiety and several phobias; the actual loss led to pathological mourning, depression and if it happened early in life may result in even more severe pathologies. The difficulty of establishing affectionate bond with the caregiver did not just lay the foundations of personality disorders; however, as Sugarman and Jaffe showed, it was also linked with severe psychopathology like schizophrenia and paranoia. In any case, the therapist must provide a holding environment and build a secure base for the patient so that he/she can integrate his/her sense of self and mourn for his/her loss. REFERENCES: Bowlby, J. (1995) A Secure Base - Clinical Applications of Attachment Theory, London: Routledge. Bowlby, J. (1982). “Attachment and Loss: Retrospect and Prospect.” American Journal of Orthopsychiatry, 52 (4), pp. 664-678. Bowlby, J. (1973). Attachment and Loss. New York: Basic Books. Bowlby, J. (1979) The Making and Breaking of Affectional Bonds, London: Routledge. Freud, Sigmund (1917). “Mourning and Melancholia”. The Standard Edition. London: The Hogarth Press. Holmes, J. (1993) John Bowlby and Attachment Theory, London: Routledge. Lerner, Howard D. and Paul M. Lerner (1987) “Separation, Depression, and Object Loss: Implications for Narcissism and Object Relations” The Psychology of Separation and Loss. San Francisco and London: Jossey-Bass Publishers. pp. 375-396. Lieberman, Alicia F. “Separations in Infancy and Early Childhood: Contributions of Attachment Theory and Psychoanalysis”.The Psychology of Separation and Loss. San Francisco and London: Jossey-Bass Publishers.pp. 109-1136. Ogden, T. (1986) The Matrix of the Mind, New York: Jason Aronson. Sugarman, Alan and Lee S. Jaffe. (1987) “Transitional Phenomena and Psychological Separateness in Schizophrenic, Borderline and Bulimic Patients”.The Psychology of Separation and Loss. San Francisco and London: Jossey-Bass Publishers. pp. 416-459. Read More