The Integrative Psychotherapeutic Framework - Assignment Example

Petruska Clarkson’s and Heinz Kohut’s Contributions to Psychotherapy Petruska Clarkson’s Personal History Petruska Clarksonoriginated from Pretoria, South Africa, in 1947. Her ancestors had fled to South Africa from Counterreformation Europe. She was Smuts’ daughter. Smuts founded the ideology of holism. Clarkson was amongst the founders of Metanoia in 1980s. She established Physis training institute in 1993. Petruska Clarkson stands out as one of the notable personalities who popularized Gestalt therapy in England (Clarkson 45). She authored fifteen books and many articles. Clarkson lectured nationally in England and internationally. She worked in Counseling and Psychotherapeutic committees. She committed suicide by taking an overdose of drugs. Heinz Kohut’s Personal History Heinz Kohut made an indelible mark in self psychology in the twentieth century. 1913 was Kohut's year of birth in Vienna, Austria. In his formative years, he did not go to school, and he later joined public school when he was eleven years old. Kohut was a fluent speaker of Greek and French. He studied biology and European literature. His secondary education was in the University of Vienna where he studied medicine. It is here that he formed a liking for psychoanalysis. He studied in Paris and graduated in 1938. Kohut’s father was Jewish, and in 1939, Kohut fled the Nazis who were in Austria. He went to England and would later end up working in the University of Chicago hospitals in the, United States. He changed to psychoanalysis and taught psychiatry in the university (Gabbard et al 83). In 1964, he rose to the presidency of the American Psychological Association. In 1965, the International Psychoanalytic Association appointed Kohut to the post of its vice president. He defended psychoanalysis strongly but would later differ with Sigmund Freud’s structural theory and develop his own self theory. He made notable contributions to the field of Psychology. His theory of self had four fundamental components. These components include nuclear self, biological component and the one born in infants. The image of a baby which parents retain is the virtual self. Virtual self and the nuclear self are constituent components of the cohesive self. Development of a cohesive self slows because of problems such as abuse and trauma (Gabbard 54). A grandiose self is a self-centered form of self that emanates from the feelings that one is at the very core of the world. To Kohut, almost every psychological problem arises from parents’ failure to offer emphatic responses to their children. Kohut sought an understanding of a client’s experience in the process of therapy. Developing an all-encompassing theory of self was not one of his interests. Rather, he emphasized on capturing the client’s experience and presenting it in a robust way. Kohut believed that maladaptive coping mechanisms and many psychological issues originate from developmental needs remain unmet. His theory gained fame in the 1970s, when it became of the most preferable methods of psychotherapy. Heinz Kohut died in 1981. Petruska Clarkson’s early life shares something similar with that of Heinz Kohut. Both of them faced the danger of losing their lives. Clarkson’s ancestors fled the Counterreformation Europe and Kohut fled from the Nazis during their Anti-Semitic campaign. Interestingly, both of them lived their lives in places away from their places of birth and excelled in their endeavors. Both Clarkson and Kohut developed ideas that have revolutionized psychotherapy. Clarkson's fame derives from her Five Relational model, and Kohut formulated his theory of self. The following section of this paper discusses the contributions of these two renowned personalities. Petruska Clarkson’s Five Relational Model and its Contribution to Psychotherapy Petruska Clarkson formulated the integrative psychotherapeutic framework in which she identified five modalities in client-psychotherapist relationships effective in psychotherapy. Every one of these modalities pre-dominates psychotherapy at a time. It is also possible for two of these modalities to operate concurrently. The structure of a psychotherapeutic activity determines which of the modalities will be the focus or the figure. Working alliance is Clarkson’s first modality. To Clarkson, it is a working alliance that makes therapeutic help possible. Clarkson used the term working alliance to refer to the cooperation between psychotherapist and client. Help cannot be achieved in the absence of this cooperation. A working alliance calls for a psychotherapist to involve patients in setting goals and setting therapeutic tasks so as to bond with them. This happens through signing a psychotherapeutic contract and the two parties agreeing that they will not always be in each other’s company (Clarkson 46). This underscores the significance of the initial stage of a therapeutic process. This stage lays a foundation for therapy and provides a point of reference in which people can resort to in case of a future problem in the therapeutic process. Important considerations in an effective working alliance include, the personality of a psychotherapist, their understanding of clients’ problems, how the psychotherapists encourages and helps clients to understand their situations. Working alliance depends on a psychotherapist’s level of experience in psychotherapy. Recent research has shown that there is a high level of premature drop out of clients from psychotherapy for psychotherapists who are inexperienced. This research has revealed that many patients report successful behavior change when working with highly experienced psychotherapist (Gabbard et. al. 84). Several attributes in psychotherapist affect their quality and ability to foster effective working alliance with patients. These attributes include rapport building skills and skills in the use of different therapeutic interventions and techniques. A psychotherapist ability to come up with an own theory of psychotherapy builds his or her ability to influence working alliance positively. The second modality is the transferential and counter-transferential relationship. Transference refers to the repetition of conflicts experienced in the past directed onto a client’s significant others. In transference, a client directs his or her attitudes, behaviors and feelings onto a psychotherapist. It defines a client’s misinterpretation and misperception of a psychotherapist that is either positive or negative. To Clarkson, counter-transference refers to a psychotherapist’s feeling towards a patient. Counter-transference is an instrumental tool in therapy that helps psychotherapists understand a client’s experience and responses. A psychotherapist awareness of personal counter-transference is as important as his understanding of a client’s transference. This understanding helps psychotherapist control their emotions (Gabbard 55). Initially, psychoanalysis did not acknowledge psychotherapists’ feeling. Counter-transference explains a psychoanalyst’s unresolved issues. Modern day psychoanalysts have embraced the significance of transference and counter-transference. A psychotherapist may feel sexually attracted to a client. If the psychotherapist understood that this is a counter-transference, he or she will observe how the client elicits that the reaction within him or her. The psychotherapist then implores the client to reveal her feelings toward him or her. The psychotherapist will then relate these feelings with their significance in the client’s unconscious fears, desires and motivation. The reason clients seek therapy is important in anticipating possible transferences (Strozier 44). In the same regard, psychotherapists can anticipate their likely counter-transferences drawing their past experiences. Developmentally-needed or reparative psychotherapeutic relationship refers to when a psychotherapist provides a client with a corrective relationship if the client’s parents were over-protective, abusive or deficient. Clarkson reckoned that even if psychotherapists do not acknowledge this relationship, clients remembers it as one of the most important stage in their psychotherapeutic relationship. Clarkson identified a number of injuries and deficits for which psychotherapist can provide reparative relationship (Clarkson 47). These injuries include traumas that clients go through for instance abuse. Repeated less severe traumas include injuries that happen to clients due to deprivation and neglect. Another injury to that plagues clients is extra-familial short-comings and catastrophes such as genetic conditions. In this reparative relationship, elements that psychotherapist provide to clients with include, care, witness and containment. Client has suffered neglect would need responsiveness and careful attention. Those who have lived through smothering experiences need warmth and respect. Clients such as those with learning disabilities can benefit a lot from this reparative relationship. The reparative role that psychotherapist take in psychotherapy is deliberate and purposive. Clients articulate their needed experiences with ease (Gabbard et al 85). This makes it easy for a psychotherapist to address directly reparative roles implied by clients. Psychotherapist need to know that they may need to allow their clients a set level of dependence. As psychotherapy progresses, psychotherapist need to give clients space to try out their newly-acquired emotional strength and independence. It is crucial for a psychotherapist to ensure that clients do not remain stuck and dependent on their reparative role. Person-to-person relationship is the real relationship. In this relationship, both the psychotherapist’s and client’s interpretations and perceptions about each other’s actions are realistic and appropriate. There is genuineness and congruence in their behaviors and feelings. The psychotherapist should be caring, responsive and complete to the client. Psychotherapists would accomplish this with the realization that patients mature and develop from psychotherapists’ skills, and humanity. Person-to-person psychotherapeutic relationship emerges and deepens throughout the duration of therapy and reduces transference. Proponents of these ideas suggest that person-to-person relationship requires psychotherapist’s self disclosure. Psychotherapist’s self-disclosure requires proper timing and degree and should be for the good of the client. Person-to-person relationship is important to clients suffering from learning disabilities (Gabbard 56). Person-to-person relationship draws from a here-and-now existential experience between psychotherapist and client. The two participate mutually in the psychotherapeutic process, and recognize that they change one another. Person-to-person relationship uses the approach of subject-relations and not object-relations. Being real does not imply a psychotherapist’s freedom to turn the therapeutic relationship into a social one or get extraneous benefits from the client. Instead, it upholds the elements of mutual human equality and respect for clients. Clarkson’s supporters added that when the psychotherapist and client find the persons behind each other’s issues they achieve successful psychotherapy (Clarkson 48). Successful psychotherapy marks a moment of real meeting between the psychotherapist and client. Overstaying in the person-to-person relationship can make it abusive. Clarkson’s fifth psychotherapeutic modality is the transpersonal relationship. Clarkson described it as a timeless element in the psychotherapeutic process that is hard to describe. Transpersonal relationship is the spiritual element of psychotherapeutic relationship. Jungian and existential traditions acknowledged the qualities of psychotherapy that goes beyond the understanding that comes from the physical senses. Carl Jung perceived of this relationship as the one between psychotherapists’ and client’s unconscious without conscious mediation. Transpersonal therapeutic relationship has not been as widely documented as other psychotherapeutic relationships. This is because it is rare and hardly accessible to the form of description used to discuss other psychotherapeutic modalities (Gabbard et al 86). An emptying of ego and some form of intimacy is what characterizes transpersonal relationship. It is as if the ego of a psychotherapist’s personal unconscious escapes from the psychotherapeutic context. This gives room for a mystical experience in the psychotherapeutic relationship. A supporter of Clarkson’s idea of transpersonal relationship argued that it is as if a third self enters the therapeutic space. This happens when the inner core energy of the psychotherapist merges with that of the client. Sharing the third-self comes with self-awareness, together-awareness and other-awareness (Gabbard 57). This idea resonate Jung’s prototype of self in which he implied an individual’s innate and intuitive disposition to experience life’s experience and centeredness. This experience is the equivalence of God within individuals. Heinz Kohut’s Self Psychology and its Contribution to Psychotherapy Kohut believed that subjectivity is the focus of the psychoanalysis. Kohut’s self theory comprised several key components. To Kohut, there is a distinct self that results from immersing one’s self in an individual’s inner life. The self denotes the centre of a person’s psychological universe. Dissatisfied with Freudian ideas of counter-transference and transference, Kohut coined his concept of selfobject (Strozier 45). The psychotherapist appears to the client as a quintessence of an impersonal psychological utility. An individual’s inner depiction of an external item is what Kohut called the selfobject. Selfobject can be expanded to mean any object or individual experienced as an element of the self or utilized to accomplish a function. Selfobjects are susceptible to the control similar to the one that a person would exert over his mind and body. There are two types of selfobjects that are significant in a therapeutic process. There are selfobjects that respond to perfection and vigor of a child. There are also selfobjects whom children can depend on and merge as images of power and tranquility. The responsiveness and availability of a child’s significant others determines the development of a healthy unified self. Developmental needs of idealization and mirroring, derive from empathic receptiveness. These needs are central to the regulation and development of a unified sense of self through space and time (Gabbard et al 87). Healthy narcissism develops and maintain through the action of empathic responses that develop from infancy throughout an individual’s lifespan. When parents confirm and respond to children’s inherent sense of perfection, greatness and vigor, the first function of self objects ends. This response is what Kohut referred to as mirroring. At another level, the child looks at the parents dependable and merges them as images of power, infallibility and peace. This fulfils the second function of selfobject. These two functions are fundamental conditions for the internalization and development of a sound interdependence (Gabbard 58). Disorders of the self result from the failure of caregivers to fulfill these functions. Kohut’s idea suggests that addiction draws from a breakdown in the process of fulfilling these functions. There are three axes along which a sound self develops. Grandiosity refers to an individual’s ability to achieve an unwavering sense of purpose, self-esteem and ambitions. This axis requires selfobjects to affirm an individual’s accomplishments and qualities. Caregivers who admire and praise children are the most efficient selfobjects in this axis. Early narcissistic needs and a sound sense of grandiosity result from fulfillment of this function. Idealization axis denotes the ability of an individual to develop an unwavering system of ideals of goal setting. A relationship with individuals important to a person enhances the development of stable goal-setting system (Strozier 46). These significant others are individuals whom children can merge. Children should be admired by their parents, and they should identify with their parents. They need to do this until they feel that they relate with these admirable qualities. Alter-ego-connectedness axis denotes a person’s ability to be original in expressing feelings to those people who matter to individuals and develop intimate relationships with them. Children need to grow up in a place where they feel similar to and as a part of a group. This has the effect to make individuals feel accepted and understood. These three axes shape psychic development through normative guidance. Qualities that individuals perceive as external goes in when an individual’s relationships develop enough to make axes fulfilled. The necessity of selfobjects diminishes gradually as the unified self becomes the key focus of self-regulation. Individuals achieve grandiosity, connectedness and idealization when their narcissistic developmental needs actualize. When this happens continually, it enables individuals to master their ambition and self-esteem without the help of selfobjects (Gabbard et al 88). This helps individuals to form sound relationships with other individuals without demanding them to meet selfobjects’ functions. To Kohut, what parents are is more important to the growth of children than what they do. Transmuting internalization and optimal frustration are also important in development of a sound self. Transmuting internalization refers to the ability of a person to relate healthily with himself or herself, others and reality. Transmuting-internalization occurs due to the continual responses by selfobjects’ action of merging, idealization-fulfillment and mirroring. Children’s demands on selfobjects materialize with minimal traumatic failures. Parents will at times not meet the demands of a child, and at other times they will overindulge in them. The frustration that results between deprivation and overindulgence is optimal frustration. Non-traumatic failures on the part of parents include the excuse of business or tired to play, or being told no to certain demands and requests (Gabbard 59). Such responses are non-traumatic for as long they do not call for a child’s ego strength. Optimal frustration in children derives from constant non-traumatic failures by their caretakers. When children encounter difficulty getting their parents to meet their demands, they resort to finding innate sources for comfort and soothe them. Repeated occurrence of non-traumatic frustration causes children to stop associating mystical attributes to their parents and instead starts to form an own inner structure. Internalization of previously attributed qualities changes variously due to non-traumatic failures (Strozier 47). Transmuting refers to marks the shift of the child from being dependent on the selfobject to relying on internalized functions. Selfobjects’ failures in empathic responses cause children to replace selfobjects with a distinct functional self. To Kohut, psychopathology is a function of the failure of the aforementioned processes. Narcissism and addiction are results of failures of these processes. Flawed interaction between a child and his or her selfobjects results in disorders, in the self. Development of a self and a sound structure depends on the quality of the relationship between the self and selfobjects. Self disorder is also the result of inability to attain harmony, cohesion ad vigor. Therapy works towards creation an enabling environment for the child to achieve these elements (Gabbard et al 89). A strong self enables individuals to endure changes in their emotional states that result from failures and successes. A caregiver’s inability or unwillingness to mirror a child hampers development of transmuting internalization. Parent figures who have a weak sense of self insist an archaic merger because of their insecurity. Archaic merger manifests in individuals who did not do maneuver pre-oedipal stages successfully. This means that insecure adults can seek to meet the parenting needs that they did not enjoy children. Kohut believed that poor child upbringing emanates from an unfavorable home environment. Examples of adults’ failure to perform the aforementioned functions include a mother turning a child story into her own story (Gabbard 60). A father declining sharing with a child his heroics when the child intended to idealize him will have the same effect. Failure of selfobjects to mirror children’s demands leads to increased needs to be mirrored. To Kohut, this is what causes narcissism. Kohut’s differed with Freud’s view of narcissism by purporting that selfobjects are the objects of narcissistic demands. Freudian traditional reaction to narcissism was to find ways of suppressing its symptoms through education and persuasion. On the other hand, Kohut held that the task of the clinician it to address the core disturbance that causes narcissism demands. Instead of clinician trying to find out a client’s repressed, Kohut prescribes that the clinician should consider the narcissistic injury. Parapraxes point a clinician to a narcissistic injury. Clinicians should pay attention to the emotions elicited in the client by feelings of helplessness as a result of failure (Strozier 48). Narcissistic transference comes up because a clinician frustrates a client’s narcissistic demands. This helps the client to experience transmuting internalization of desired selfobject attributes missed in an early life stage. Cognitive reconstruction would help gain insight into a client’s sensitivity towards certain types of feedback. Kohut’s ideas help conceptualize addictive behaviors. Addiction arises from problems that a client encountered during his or her transition from symbiosis to individuation. Kohut suggests that addictive behavior stems from poor formation of relationships with significant selfobjects. This happens due to a breakdown in object relations that consequently breaks down transmuting internalization (Gabbard et al 90). Addiction to a drug is a function of failure to transmute internalization of attributes to soothe the self and master his affects. Addicts experience a reversed direction of the movement of proper functioning. Treatment of addicts should seek to establish and generate these same affects but now seeking to establish a healthy context. Supporters of Kohut’s ideas added that addicts try to reenact primitive feelings and affects hailing from the milieu of archaic selfobject relationships. They suggest that the parents of addicts were not available to enhance their learning of functions of the selfobject indispensable in later life. This failure is what drives these individuals to indulge in external objects such as drugs, alcohol or drugs so as to master their affects. This gives these individual a semblance of a validated, encouraged and confirmed self-development. Addicts seek to recreate healthy selfobject milieu that they experienced before their traumatic failure in self-selfobject relationship so as to enhance psychic development (Gabbard 61). In other words, the addiction is an attempt to experience distinctly helpful selfobject response. Kohut’s ideas contributed greatly to endeavor to treat addiction. Addicts have difficulty developing a unified self structure. The individual needs to be provided a way to internalize attributes he missed when he was growing up. Treatment then moves into the stage of helping the addict restore his sense of self. In the process of treatment, the addict may regress into a stage of archaic self. Here, he may experience infantile grandiosity, isolation, unrealistic goal-setting, and fragmentation (Strozier 49). The addict may also experience depression, emptiness, deficit self-control, entitlement, poor differentiation of self and others, and need of power control. At this stage mirroring and idealization are important. Narcissistic-transference should be avoided because the therapist needs to respond to a client’s unresolved parenting needs. The therapist has the duty to mold proper interdependence between the addict and others. Treatment of addiction should seek to empower the addict to reduce his reliance on external objects and form healthy intimacy. Heinz Kohut’s ideas remain influential to date for use in addition treatment and in all other form of psychotherapy. The impact of Clarkson’s and Kohut’s theories on my work with clients My practice of counseling has benefitted variously from the knowledge of these theories. Petruska’s therapeutic modalities have enriched my approach with clients. With insight from her ideas of working alliance, I have understood that it is important to focus more on bonding with the client, than on my theoretical orientation. As much as therapy would not be possible without theory, it would be extremely difficult to use the theory on a client with whom I have not connected. Petruska’s concepts of transference and counter-transference helped me to understand how to unravel client’s unresolved issues and my own reactions to them. Reparative therapeutic modality helped me understand the tension that results when I find myself inclined to express care and concern for my clients (Gabbard 62). Person-to-person therapeutic modality encouraged me to keep up my emphasis on how real I relate with my clients. Clarkson’s idea of transpersonal relationship served to demystify the feeling that I get when certain incorrigible things happen in the process of therapy. Heinz Kohut’s theory of self has given me insight into the dynamics of handling various issues of my diverse clientele. It underscored the indispensable role of understanding individual clients from their subjective frame of reference. This is especially so with the understanding of the varying perception of psychotherapists as selfobject by different clients. Kohut’s ideas served to expound the role of caregivers to the behavior and consequent psychological issues of individuals. His emphasis on provision of makeup developmental needs to clients by psychotherapists revolutionized my way of addressing specific issues of clients (Strozier 50). I benefitted tremendously from the insight he offered on how and when to wean clients off these makeup developmental needs cautious not to derail therapeutic progress. His ideas have certainly been useful in enriching my understanding of narcissistic manifestation in clients. Clarkson’s and Kohut’s theories are concepts worthy of every psychotherapist’s time and attention. Works Cited Clarkson, Petru?ska. The Therapeutic Relationship. London: Whurr, 2003. Print. Gabbard, Glen O, Judith S. Beck, and Jeremy Holmes. Oxford Textbook of Psychotherapy. Oxford: Oxford University Press, 2007. Print. Gabbard, Glen O. Textbook of Psychotherapeutic Treatments. Washington, DC: American Psychiatric Pub, 2009. Print. Strozier, Charles B. Heinz Kohut: The Making of a Psychoanalyst. New York: Other press, 2004. Print. Read More