Manifestation of the Psychic Retreats - Essay Example

John Steiners Model of Psychic Retreats due: Table of Contents Table of Contents 2 Introduction 3 Manifestation of the psychic retreats 4 Working of the psychic retreat 5 Projective identification 5 Envy 7 Internal objects 8 Kleinian technique 9 Oedipus complex 10 Unconscious phantasy 10 Moving ahead after psychoanalysis 11 Various ways of moving ahead 12 Conclusion 12 References 14 Introduction How a person reacts to a situation may tend to beat our understanding. This gets even complicated when the person in question is a patient and comes into contact with an analyst who is trying to establish the main cause of the patient’s withdrawal. This retreat, called the psychic retreat, according to an experienced psychoanalyst, John Steiner, makes it very difficult to make any contact with such a patient. The psychic retreats are manifestations of the underlying pathological organizations of the personality, according to John Steiner, an experienced psychoanalyst. Steiner observes that the psychic retreat tends to provide the patient with relative peace (Steiner, 2003). By making use of the novel developments in the psychoanalytic theory of Melanie Klein, Steiner helps us get a better understanding of the psychic retreats. By examining the organization of object relationships and defences into complex structures leading to a personality and an analysis which is rigid and stuck, Steiner observes that it leads to little opportunity for any development or change. The pathological organization of the personality is determined by these systems of defence, being referred as psychic retreats and they are the ones responsible for the withdrawal by the patient for avoidance of contact with the analyst and with the reality. Klein’s distinction between paranoid-schizoid and depressive positions provides a strong foundation for reviewing of pathological organizations of the personality. The psychic retreats provide a respite both from the paranoid-schizoid and the depressive anxieties. Based on the paranoid-schizoid and depressive positions enabled Klein to show how the two mental states can impact on the adult. The pathological organization operate as defence against the unbearable guilt and provides a mechanism for reversal of the fragmentation of the personality so as to regain the lost parts of the self and reintegrate it into the personality (Boyle, 2013). Intolerable feelings of shame, humiliation and embarrassment are dangers exposed to patients coming out of psychic retreat. Out of shame, the patients wish to get revenge on the shaming object as well as the persecutory fears that the shaming object might retaliate. Emergence from the psychic retreat evokes fears of being seen as well as the fear of seeing (Josephs, 2011). Manifestation of the psychic retreats A psychic retreat will manifest itself as freedom from anxiety, but in the real sense, it will result to isolation and alienation from the crowd. As a result, the patient gets the feeling of imprisonment and slow death, from the alienation which contributes to the feeling of rejection. In this particular state, the patience experiences no development. When such a patient is approached by an analyst, he/she will try to avoid contact with the analyst since they fear facing the reality. In a clinical setting, therefore, the analyst needs to take precaution when dealing with the patient and pay maximum attention to the reactions of the patient (Sweet 2011). Steiner notes that his view of common features shared by pathological organizations is different from Kenberg, whose view is critical, for instance in contrasting borderline and narcissistic personalities. Steiner’s claim for the universality of pathological personality structure is challenged on the grounds that it does not contain enough evidence. As it is, it is simply asserted. Even though Steiner is challenged to include more evidence on his theory, his work provides clinical riches that are useful for working with a variety of types of patients suffering from narcissistic disorders. An explanation on the working of psychic retreats focuses on the perverse gratification that shows pathological organization of personality. Psychic retreats are pathological because they are often congruent with sadomasochism. Contributing to Kleinian theory, Steiner adds a new position and a new phase within both the paranoid/schizoid and depressive positions. Introducing borderline position, Steiner further modifies the Kleinian model. In this, he observes that the experience of some patients fails to fit either in the paranoid/schizoid or the depressive position. The self is thus stuck in the borderline position, unable to engage basic life issues. The borderline position includes borderline pathology and is seen to represent a mental structure in which one feels neither inside nor outside one’s objects. In line with this, Steiner observes that the characterization of the borderline strongly resembles psychic retreats. Steiner observes that a borderline patient has the feeling of prematurely and cruelly pushed out of a maternal state and attempt to regain his right to reside there (Jurist, 1997). Working of the psychic retreat For proper understanding of the working of psychic retreat, there is a need to understand the terms projective identification, reversibility and mourning. Projective identification Is a defence mechanism used by everyone in one stage of their lives. In the mental functioning, it works in a reversible manner such that the persons tend to take back their projections. In some situations, lack of reversibility is evident, resulting to a loss of the ego of a person, making the person unable to come to accept the reality. According to Steiner, reversibility is directly linked to mourning. Projective identification will however lead to regaining of the self-lost, by involving coming into terms with what belongs to one, and to the object. Projective identification can be reversed if the patient can see the damage that his hatred has produced. The process of mourning initiates the reversal of projective identification. The process helps in regaining of the parts of the self which had been lost. One of the features of projective identification as observed by Stein is forgiveness. It is at this period that the analyst can be able to help the patient. This is because forgiveness requires the patient to recognize the coexistence of good and bad in another person. The analyst is required to provide consolation to the patient by creating an environment where the patient can have reflection, to prompt reversal of projective identification allowing mourning to take place. As Klenian explains in her theory, healing involves coming to terms and accepting the loss. This is expressed through mourning, after which the victim will feel relieved. For a person suffering from the retreat, however, the case is different since the power of retreat will tend to offer an alternative to mourning. That is why factors such as groups or cults may have an influence on the patient of psychic retreat. For instance, in the presence of a large group, the patient may have difficulty in reversing projective identification to mourn the loss of a loved one. On the same note, a cult or a religious organization may as well strengthen its members who have a psychic retreat to face certain aspects of reality such as death and avoid mourning. It is on the basis of these factors that discussion will be made to give a proper understanding of emotional experiences like the psychic pain which at this stage can be understood as the acute emotional and mental distress often felt by trauma victims. The pain is felt when a deep psychological wound is experienced by the human spirit (Panksepp, 2011). John Steiner’s model of psychic retreats will further aid in understanding of the psychic retreats, and the discussion will be done based on the Kleinian theory. According to Klein, paranoid-schizoid position does not tolerate ambivalence and it only splits predominate, either positive or negative. The anxieties of this position are experienced as coming towards the subject (Caligor, Kernberg & Clarkin 2007). The paranoid-schizoid position is categorized depending on the type of splitting involved, and this could be normal splitting or pathological splitting. In normal splitting, of whether the object is good or bad, involves organizing one’s experience. If good experiences predominate, integration will proceed. Splitting therefore deals with the anxiety brought by threats to the self (Carvalho, 2002). Pathological fragmentation, on the other hand, occurs when the persecutory anxiety is very severe, and the individual feels threatened. As a result, he may consider taking a defensive manoeuvre which may involve splitting of the self into fragments and ending in violent projections of these fragments. Depressive position is a mental constellation which is central to a child’s development and is experienced towards the middle of the initial year of the child. It gets refined throughout the life of the child all through to adulthood. It is the position following the paranoid-schizoid position in the infant’s development. The central anxieties of this position have to do with guilt over one’s own potential to be destructive or hurtful (Gimpel & Holland, 2003). Envy As Klein puts it, envy is a feeling of anger that towards something possessed by somebody else and is often accompanied by a desire to destroy it or take it away. Klein sees envy as a manifestation of primary destructiveness and is normally worsened by adversity. Difficulties with depressive position integration will result from the confusion between good and bad. Envy aggravates guilt and persecution. John Stein in his model contributes to this by observing that the good qualities of the object stimulate love and gratitude, arousing envy. Anxiety and guilt are aroused as the patient wishes to repair the damaged object, from the attacks he made on the good object. However, Klein failed to explain the anxieties that arise from being watched by an observing object as a person becomes more vulnerable. In his take on this, Steiner states that this anxiety is more advanced in the case of narcissism when there is exposure of one’s self-admiration. Collapsing of the narcissistic pride leads to feelings of embarrassment, humiliation and shame which follow naturally (Steiner 2006). Internal objects According to Klein, this is a term which refers to the inner mental and emotional image of an external figure. The internal objects come in the form of the things derived from parents to the infants, like the breast from which the child suckles. The infant develops a loving instinct for the breast. On the other hand, the child will grow to have a feeling of hate towards the eventuality of death. Kleinian theory states the importance of the internal objects. Enormous anxiety may result from damaged internal objects leading to personality disintegration. On the other hand, internal objects felt to be in a good place will result to a feeling of well-being and self- confidence. Shunning more light on this aspect, Steiner notes that the internalization of human figures more so the parents, is very crucial in the development of the superego of a person right from childhood. On the issue of death where the child has a lot of hate, Steiner puts it better by noting that all good things must come to an end and therefore the reality of death should make us recognize the need to live life creatively and enjoy it. According to Piven (2003) Money-Kyrle (1955) in his paper, suggests that failing to confront our own mortality will result to the distortion of our human values. Observing the object brings out the importance of association of anxieties and the primary object. Shame and humiliation are the first experiences confronting the patient while facing a new reality. Steiner notes that these experiences have to be endured if progress is to be achieved, especially in relation to the anxieties of the depressive position (Steiner 2011). Kleinian technique In this technique, Klein expounds on Freud’s concept of transference, in which the analyst may have both positive and negative feelings based on both conscious and unconscious expression of present and past experiences. This technique focuses on the analyst -patient relationship and uses countertransference as a source of information about the patient. Klein agrees with the general idea of Freud of life and death instincts. She however fails to conceptualise on the abstract of the specific content of the instinctual drives. She interacts observations with ideas to engender new observations and further theories. Even though she tries to link her technique with clinical content, she fails to describe her technique in abstract terms without accompanying the clinical content (Carignan & Iseman 2004). John Steiner borrows from this technique and improves on it by linking it with Freud’s insight that perversions are characterised by the disavowal, a mechanism allowing contradictory versions of reality to coexist simultaneously. Steiner argues that it is the artful reconciliation of irreconcilable facts that constitute the perverse relationship to reality. According to Steiner, death is another fact of life subject to misrepresentation by the persistence of contradictory views. He observes that a perverse relationship will arise when the patient begins to heal. The patient will be on the road to health if he is willing to accept the facts of life by accepting pain and anxiety. On the other hand, the patient will be on the road to psychoses if he refuses to accept these facts. A separate option to the psychotic solution is a perverse relationship to reality. Oedipus complex It gives an explanation of the struggle for dominance in the Oedipus situation. It helps in describing the conflicts over power and dominance that can result from the Oedipal situation (Steiner 2011). The Oedipus complex involves the wish-fulfilling fantasies of death of the same-sex parent and usurpation of their place in a couple. This complex is based on the play by Oedipus who killed his father as revenge for the plans by the father to kill Oedipus when he was still a child. Klein considers this complex as central but goes ahead to modify it. According to Klein, there is a close link between the Oedipus complex and the depressive situation. Steiner explains that Oedipus had turned a blind eye to the knowledge that was emerging, leaving him in a retreat and with a perverse relationship to reality. Even after Oedipus changed his character of arrogance, Steiner notes that it is difficult to convince anyone that Oedipus has actually changed. It is not justifiable for anyone to kill his own father, as Stein notes. Steiner explains that it would be very painful and arouse guilt in trying to confront the reality, that is the facts of life, and that would be too much to bear forcing one to prefer fleeing from truth and retreating into omnipotence. Steiner concludes the Oedipus’ plays by illustrating two types of retreat as either Oedipus rex, which is ignoring the truth or Oedipus colonus which results to omnipotence and self-righteousness. Unconscious phantasy Phantasy can be explained as a mental expression of both libidinal as well as aggressive impulses and also of defensive mechanisms against those mechanisms. Klein broadened the idea of unconscious fantasy because her work with the children gave her a vast experience of the wide-ranging content of children’s fantasies. Steiner observes that a patient will feel it is dangerous to express his desire for retribution openly. As a result, the patient becomes entangled in an impossible internal struggle which makes him feel wronged and unable to demand compensation. As a result, the patient will retreat into a phantasy. The feeling makes the patient relate to ruthless, destructive internal objects which react in a mafia-like manner. The unconscious phantasy feelings will make the patient start phantasy-attacks on the hated object which could lead to devastating consequences that are too horrific to bear (Weegmann, 2002). Moving ahead after psychoanalysis Research on psychoanalysis has a potential beyond the documenting effect. For instance, there is conceptual research, like the one conducted on a patient, taking its starting point case material from interviews with patients, and during follow-up research, interview is conducted on former patients. This is done is done as a special case since a clinician will rarely have the opportunity to follow on the patient (Steiner, 2011). It is essential to consider the patients’ experience of change in most of the psychotherapy research. The change is normally indicated with mental health scales. Use of the mental health scales is however faced with its own limitations and can, therefore, not be used as the principal source of subjective reports of change in the psychotherapy research. The limitations include possible sources of error variance in rating scales; which include temporal variance, referring to the tendency of behaviour ratings to be only moderately consistent over time. Setting variance refers to the situational specify of behaviour. The other variance is the instrument variance which refers to the slight variations among rating scales purportedly measuring similar constructs. In the experiential domain, psychoanalysis may develop its own concepts of change, enabling psychoanalysts to conduct studies on the outcomes of the psychoanalysis without depending on the concepts and instruments borrowed from other clinical traditions. Various ways of moving ahead After psychoanalysis, there are patients who will not undergo structural change. Such patients will appear to be reluctant in reflecting about transference in interviews. Structural change is characterized by higher levels of ego function manifested in the way a person thinks about himself or herself (MacDonald, 2011). Other patients will show cognitive dissonance. The theory of cognitive dissonance states that an individual will change his or her attitude towards an activity if the investment is large. This leads to the prediction that since psychoanalysis is both time-consuming and expensive, patients will experience dissonance if they are unable to dedicate to it a substantial meaning in their lives. The theory further suggests that a patient will try to rationalize his or her lack of change. Thus, a patient will be loyal and positive toward psychoanalysis because of the effort it required and in spite of a lack of outcome (Stänicke, 2011). Conclusion John Steiner emphasizes on the need for analysts to have a proper understanding of their patients to avoid conflict which may arise. Psychotherapists are faced with technical problems which reveal themselves in uncomfortable counter-transference feelings. It is at this point that Steiner notes that even though the patient may not express interest of understanding the situation, he would like to be understood. The analysts refer to the feeling of getting understood as containment. The main idea brought out in the discussion is that emerging from a psychic retreat results in a feeling of being observed. According to (Steiner 2011,) this causes shame and humiliation, especially when narcissistic defences have created an illusion or delusion of superiority. In most cases, shame and humiliation are the initial experiences confronting the patient as he encounters a new reality (p.18). By all means, making client-cantered interpretations should be avoided as it weakens containment. This is because when an analyst expresses his thoughts to the patient, the patient may take it as an attack and feel offended. Instead, Steiner proposes that analysts should phrase their interpretations in such a way that emphasis is on the analyst or the analyst’s mind. Such interpretations called the analyst-cantered should be applied when dealing with cases of psychic retreats as they give the patient a feeling of being understood (Caper, 2014). Steiner has, therefore, improved his model by explaining the anxieties something which Kleiner had failed to do exhaustively. He notes that if the patient feels humiliated by the difference of power between him and the analyst, then there will be a risk of the patient withdrawing into a retreat or leaving the analysis altogether. John Kleiner’s clinical insights have, therefore, improved on the Kleinian theory and technique. This has been done by thorough examination of the emotional experiences that Klein had failed to achieve. References Boyle, J. (2013), A Syncretic Approach to the Role of Pathological Organizations in Violence. British Journal of Psychotherapy, 29: 329–345. doi: 10.1111/bjp.12032 Caligor, E., Kernberg, O. F., & Clarkin, J. F. (2007). Handbook of dynamic psychotherapy for higher level personality pathology. Washington, DC: American Psychiatric Pub Caper, R. (2014). Seeing and Being Seen: Emerging from a Psychic Retreat. Contemporary Psychoanalysis, 50(1-2), 270-274. Carignan, L. and Iseman, D. 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