An Emotionally and Psychologically Corrective Experience in Patients by Heinz Kohut and Albert Bandura - Research Paper Example

INTRODUCTION Heinz Kohut and Albert Bandura are renowned, prominent and highly influential theorists of contemporary psychology. Heinz Kohut, known for his development of self psychology, focused on the subjective experience of the individual. Kohut’s self psychology gives theoretical basis for many therapeutic benefits of modern psychoanalytic psychology and it was the first psychoanalytic movement in the United States that saw empathy as the key role that influenced on human development. Albert Bandura main achievements are embedded in social learning theory and theory of self efficacy. Bandura made numerous contributions to the development of contemporary psychology, which includes understanding children’s cognitive development, observational learning, self-regulation, and self-efficacy. This particular paper aims to discuss main theoretical aspects of Kohut’s and Bandura’s psychological systems and explain and analyze their practical application in psychology and therapy. HEINZ KOHUT’S SELF PSYCHOLOGY Heinz Kohut’s self psychology evolved from his study of narcissistically disturbed individuals who were dissatisfied with interpersonal relationships (Kohut, 1971). His theoretical writings (Kohut, 1971) suggested that he considered the individual to be in need of certain responses from other persons in order to maintain his or her sense of well-being. In theory, interpersonal relationships help maintain self-esteem and self-cohesion. The self emerges in the interplay between a child’s inborn tendency to organize its experience of the world, and the presence of caretakers who provide certain interpersonal experiences. The emergence and maintenance of the self depend on the continuous presence of a responsive social environment. Originally the theory he proposed was an extension of Freud’s libido theory. This changed with the publication of The Analysis of the Self (1971) in which Kohut abandoned this link to Freud and recognized self psychology as a new theory in its own right. Silverstein (1999), on the other hand, does not recognize a break with drive and ego psychology until the publication of The Restoration of the Self in 1977, which is at least a more thorough presentation of Kohut’s self psychology. However, Kohut (1977) did not regard self psychology as a replacement of Freud’s work but rather as another tool for analysts to use, or rather as a “natural extension of drive theory” (Silverstein, 1999, p. 4). In fact, Kohut believed narcissistic individuals have such poorly formed selfs they never reach the oedipal level of development which explains their inability to profit from drive level interpretations. He goes on to note that these analysands often have an oedipal experience towards the end of therapy as a healthy self is formed (Kohut, 1977). Furthermore, Kohut believes issues related to drives can occur in situations where the self has become unstable, in addition to the instances where the self is not yet formed. Self psychology explains the self from a subjective point of view. This contrasts with attachment theory which examines the development of the self from an objective point of view. Specifically, attachment theory examines relationships, particularly those between mother and child. From the personal standpoint, when reading about self psychology it is easy to lose this subjective perspective and begin to think about the theory as relationship based. This is particularly true as one reads about Kohut’s ideas for conducting treatment, because it is in the context of these discussions where the therapeutic relationship is used as a means of bringing about change in the analysand. Ultimately, the theory of self psychology is about the subjective experience of the self and not a relationship between two people as an observer might describe it. An analogy can be made to the famous picture, Rubin’s Vase, associated with discussions of figure-ground relationships, which can be viewed as either two faces or a vase. However, with Rubin's Vase the observer is at liberty to choose which form takes primary attention or to freely switch from one to the other. In contrast, the reader of self psychology must keep in mind the focus is on the subjective point of view. Kohut’s theory distinguishes between healthily narcissistic (i.e., cohesive self) and defensively narcissistic forms of self. A healthily narcissistic self results from optimum developmental conditions and is characterized, as Slyter (1989) put it, by “joyful creative activity, self-confidence, self enjoyment, productivity, empathy, a sense of humor, an acceptance of one’s limitations, and an internal system of idealized goals, values, ideals, and standards which organize ambitions.” Characterizations, such as the one by Slyter quoted above, are typical of the literature surrounding Kohut’s work. According to Kohut (1971), the development of the nuclear (that is, infantile) self proceeds along two developmental lines: the child’s need to be confirmed and validated in response to its exhibitionism and grandiosity, and the child’s needs to look up to, admire and feel attached to an idealized parent. The development of childhood grandiosity and exhibitionism into adult ambitions leads to the “Grandiose Self,” and development of the child’s needs to look up to, admire and feel attached to an idealized parent leads to the “Idealized Parent Image.” These are the two major parts of the self that grow out of the relationship the child has with its caretakers. Depending on the quality of interactions between the child and its caregivers, the self either becomes a firm, cohesive structure, or one which is easily fragmented and lacking in functional harmony, i.e., a defensive structure. Under optimum developmental conditions the foundation for a cohesive self is laid. The term “optimal developmental conditions” refers to the original empathic relationship of the caregiver with the child, in which the caregiver is responsive to the child’s needs most of the time. The Grandiose Self develops as a result of the caregiver’s responsiveness to the child’s grandiose needs. Similarly, the Idealized Parent Image develops as a result of the caregiver’s responsiveness to the child's needs to be soothed and merged with the powerfully perceived caregiver. During these processes, the child gradually develops internal means to satisfy its own needs. The development and maturation of the grandiose-exhibitionistic self in the original, empathic (usually maternal) caregiver-child relationship, for example, promote healthy self-assertiveness and ambition. The development and maturation of the idealized parent image in the original, empathic (usually paternal) caregiver-child relationship, for example, promote health-sustaining capacities to regulate inner tension, along with internalized values and ideals. In summary, the nuclear self has two potentials, ambitions being one, and values and ideals being the other. The ambition component of the mature and healthily narcissistic self entails the capacity for regulating self-esteem, for being goal-directed and ambitious, and for being able to enjoy physical and mental activities. The values and ideals component serves to regulate certain tension states. It functions as a self-soothing, self-calming, and drive-channeling structure, maintaining and restoring internal balance (Tasman et al, 1990). It provides the capacity to live up to values and ideals and to maintain mature enthusiasm in keeping with them. In Kohut’s (1977) terms, a cohesive, functioning self is one in which “ambitions, skills and ideals form an unbroken continuum that permits joyful creative activity” (p.63). Within a normal caregiver-child relationship, shortcomings or transient absence of caregiver responsiveness take place. It is the optimal failures (those that the child can manage) that push the child toward maturation. The child develops and invents internal means to maintain self-esteem, tolerate unavoidable failure and pursue appropriate ambition with vigor (Baker and Baker, 1987). When shortcomings of the caregiver functions exceeds the optimal level (when the failure occurs too early or too violently) this results in the inability of the child to develop internal structures to reliably regulate self-esteem and calm the self, leaving the person overly dependent on those in the surround to provide those functions (Baker and Baker, 1987). If either of the developmental processes which combine to result in a cohesive self are absent, or if the relative balance between them is disturbed, or if they are deficient, the self develops into a defensive structure. The defensive self is incapable of regulating self-esteem, has difficulty pursuing goals, has demands for attention, approval, and responsiveness from important others to ensure a sense of greatness. Furthermore, the defensive self is reliant on others for a missing inner sense of direction, strength or confidence, and is also vulnerable to separation from others. The nuclear self also has an additional potential, i.e., innate skills and talents, the unfolding of which takes place through the transformation of the grandiose self into adult ambitions and the transformation of the idealized parent image into internalized values and ideals. The higher mental functions, i.e., empathy, creativeness, humor, wisdom, and acceptance of one's transience emerge in the process of these transformations. However, when the developmental processes which combine to result in a cohesive self are absent, or deficient, the person develops a lack of or deficiency in, empathic capacity, creativity, humor, wisdom and acceptance of one’s transience. ALBERT BANDURA AND HIS THEORETICAL CONCEPTS Albert Bandura is considered one of the most prominent, celebrated and influential psychologists. His main contributions to contemporary psychology were formulations of social learning theory and theory of self efficacy. According to Bandura’s social learning theory, “human behavior is regulated in a reciprocally determined way as the person's behavior affects the environment, the environment in turn affects the person's behavior, and the person's awareness of these interdependencies affects behavior, environment, and changed expectations” (Monte, 1991, p.782). To learn through observation, Bandura (1986) posits that an individual must be able to: (1) attend to the model; (2) remember what is seen and heard; (3) reproduce the memory during imitation, and (4) anticipate reinforcement for an accurate performance. An important component of learning by observing is that it may either increase or decrease the intensity of a previously learned inhibition. Response facilitation, perhaps the best known principle of imitation, involves the presence of a model engaging in a behavior which encourages observers to imitate the behavior. Bandura (1986) outlines three subprocesses that are involved in the self-regulation of behavior by internal standards and self-incentives. These self-regulatory processes determine how people develop and then act upon their values and expectations. They are: self-observation, judgmental process, and self-reaction. Performance dimensions such as quantity, quality, originality and morality comprise the self-observation regulatory process; these performance dimensions are applied as evaluative standards to create incentives which in turn will determine how a person behaves in a particular situation (Bandura, 1986). The second set of self-regulatory processes is the judgments of excellence or goodness of one’s own performance (behavior) as compared to his/her previous performances and to the performances of others. A critical aspect of these judgments pertains to the individual’s style of attributing responsibility for an action and its outcome to internal or external causes. For example, a recovering drug addict who attributes his/her abstinence to a commitment to working a rigorous program of recovery (e.g. regular attendance and participation in meetings, working the steps and maintaining regular communication with a sponsor) versus serendipity will experience very different psychological effects (e.g. increased self-esteem, self-worth) than if the attribution were otherwise. His/her abstinence has more meaning and is valued more because it was necessary to work hard to achieve it. The third set of self-regulatory processes in the self-system are referred to by Bandura (1986) as self-reaction processes. According to Monte (1991), self-reaction processes would be more accurately defined by calling them self-reward or punishment processes. Following a temporal sequence in which self-observations and then judgments are made, the individual either rewards or punishes his/her behavior with feelings of self-worth or self-devaluation. The three subprocesses involved in the self-regulation of behavior all pertain to competence, mastery or self-efficacy (Bandura, 1986). These evaluative processes are so important because the way an individual feels about him/ herself will have a tremendous influence on subsequent behavior. Bandura (1986) proposed that feelings of self-efficacy or competence have four sources: enactive attainments, vicarious experience, verbal persuasion and physiological state. Enactive attainments are the most powerful regulators of self-efficacy. A person’s own efforts either succeed or fail, and the outcome is instructive in planning future efforts. Learned helplessness, as is often the case with chronic relapsers, is a behavioral phenomenon which is directly related to an individual’s future efforts based on multiple, consecutive failures during past performances. Vicarious experience is derived from observing another person’s efforts and whether or not they succeed or fail. These observations provide people with information and a basis of comparison by which they can estimate self-efficacy in similar situations. Perceived self-efficacy is based on beliefs concerning one's own capabilities to complete the courses of action required to produce results (Bandura, 1997). It is developed by the individual through cognitive, motivational, affective, and selective processes. The cognitive component refers to thought patterns which may enhance or undermine performance. According to Bandura (1997), cognitive constructions serve as guides for action in developing proficiencies. Inferential thinking is proposed to play an important role when people attempt to predict likely outcomes, and choose to create the means to accomplish those results. These cognitive representations of future outcomes may then be transformed into motivation. Motivation plays a role in the way affective processes contribute to self-efficacy. Bandura (1997) proposed that individuals are generally motivated to minimize aversive emotional states. Perceived self-efficacy regarding control over potentially threatening events has a significant inverse relationship with levels of depression and anxiety. This encourages individuals to adopt cognitive patterns which facilitate increased perceived self-efficacy. Bandura (1997) observed that individuals tend to avoid environments and activities which they believe exceed their capabilities, and choose situations in which they feel competent. Therefore, individuals with higher perceived self-efficacy are thought to choose more challenging environments (Bandura, 1997). Bandura suggested that self-efficacy develops from four primary sources of information: Enactive mastery experiences, vicarious experiences, social influences, and states of personal judgment. Of these four sources of information, enactive mastery experiences are thought to yield the most important sources of efficacy information because they allow individuals to test if they have what it takes to succeed in a given task. An enactive mastery experience occurs when an individual attempts and completes tasks to gain knowledge of one’s capabilities, receiving valuable information regarding the probability of outcome. An example would be a keyboarding student taking a typing test to learn how many words per minute he or she can type. Ideally, difficult tasks which encourage learning and growth are balanced with successes so that individuals learn to persevere in the face of adversity. Thus, tasks which are either so easy that success is meaningless, or so difficult that mastery is impossible, do not nurture the development of self-efficacy. Self-efficacy can also develop through vicarious experiences in which individuals either compare their own skills and achievements with those of others, or become more competent as the result of observing others. This may involve seeing oneself as a good student after learning of a high class rank, or having a better sense of vocal strengths and weaknesses as the result of watching choir auditions. Vicarious experiences are likely to carry the most weight in contributing to efficacy beliefs when there is uncertainty about capabilities in that area. Bandura (1997) suggests that efficacy beliefs alone are not sufficient for effective functioning unless they are paired with skills. However, efficacy seems to assist individuals in reaching the upper limits of their functioning potential. For example, some researchers found that children who regarded themselves as more efficacious academically were more successful in solving math problems than were children who doubted their abilities. Rounds-Bryant, Flynn, and Craighead (1997) found that increased self-efficacy regarding skills in resisting drug use was associated with lower rates of drug use in individuals being treated for cocaine usage. Several researchers have observed that levels of self-efficacy in individuals in smoking cessation programs are predictive of positive treatment outcome. In summary, Bandura’s social learning theory addresses the issue of how personal expectations and meanings regulate learning and behavior. Bandura (1986) distinguishes between efficacy expectations and outcome expectations. An efficacy expectation is a personal belief that a given outcome can be accomplished because one possesses the requisite skills. An outcome expectation is the person’s estimate that a particular outcome will occur if the right combination of situational and personal processes converges. As Monte explains, “the difference between an efficacy and outcome expectation might be stated succinctly by saying that a person may believe a certain course of action will result in a specific outcome, but that he or she is not the person to do it successfully” (Monte, 1991, p. 785). Bandura (1986) views self-control as a process that an individual can either activate or deactivate. He describes this flexibility of self-control as selective activation and disengagement of internal control. Due to the variability of circumstances, such as mitigating factors in a legal context, behaviors are not uniformly rewarded or punished. Bandura posits eight, self-explanatory cognitive strategies that people employ in order to rationalize reprehensible behavior and protect themselves from self-condemnation. They are: moral justification, euphemistic labeling, advantageous comparison, displacement of responsibility, diffusion of responsibility, disregard or distortion of consequences, dehumanization and attribution of blame (Bandura, 1986). PRACTICAL APPLICATIONS OF THEORIES Whether an individual will succeed or fail in a given situation is greatly affected by the ability to adapt, often a major focus of psychotherapy. Psychoanalysis and psychotherapy assist individuals to actively change their environments and/or to become better equipped to deal with them psychologically. Bandura’s theory of self-efficacy plays a crucial role in implementation of therapeutic procedures. Support, learning and action within effective therapy appear to work together to develop aspects of self-efficacy in the client, because they reflect characteristics of self-efficacy-building experiences and encompass all four sources of self-efficacy as described by Bandura (1997). Identified by Bandura as the most important source of self-efficacy, enactive mastery experiences play an integral role in several types of therapies as the client utilizes new skills between and during sessions. In addition, therapists generally encourage skill utilization in such a way that the likelihood of success is favorable. Therapists’ verbal persuasion can build clients’ efficacy beliefs by providing supportive feedback. Clients can build self-efficacy through vicarious experiences when the therapist models healthy functioning in both subtle and overt interactions (such as role playing). Finally, physiological and affective experiences during therapy can build efficacy beliefs through physiological self-assessment during sessions and new experiences, particularly when biofeedback is used. Overall, it appears that the common factors of psychotherapy are ideal for promoting positive self-efficacy, which leads to increased adaptiveness. Bergin and Garfield’s (1994) examination of psychotherapy supports these findings. They reiterate the self-efficacy-promoting characteristics of effective psychotherapy and list client self-efficacy as having primary importance in successful treatment. They propose that change is primarily cognitive, and one assigns meaning to behavior according to internal cognitive assessments. Behavior is self-regulated, and “one’s estimated sense of self-efficacy is one of the best predictors of behavior” (Bergin & Garfield, 1994, p.823). Barlow’s overview of various psychological disorders (1993) suggests that principles of self-efficacy play an enormous role in treatment success. Anxiety disorders, depression, and substance abuse all involve a component in which affected individuals are likely to lack confidence in their abilities to overcome obstacles. In anxiety disorders, excessive worry often prevents individuals from engaging in the confidence-building experiences necessary to overcome obstacles (Barlow, 1993). Bandura (1997) cites examples of sufferers of phobias who are too paralyzed by their thoughts to successfully face the objects of their fears, such as spiders or snakes. Barlow (1993) describes the vicious circle of agoraphobia in which individuals restrict their actions to the point that they lose confidence in their abilities to successfully navigate their way in the outside world. Thus, successful treatment of most anxiety-related disorders involves a component in which clients build their efficacy beliefs within the supportive environment of therapy, often utilizing the four components of efficacy-building experiences. For example, a client with a fear of spiders may conquer his or her fear through watching the therapist handle a spider (vicarious experiences), and may personally handle a spider for increasing periods of time (enactive mastery experiences). As a result, the client may receive supportive feedback for his or her efforts (social verbal persuasion), and observe that physical reactions such as hyperventilation and a pounding heart become less intense through this exposure (states of personal judgment). Unlike Bandura’s self-efficacy theory, Kohut’s (1971) insights on narcissism provide a dynamic etiologic understanding of addiction. In fact, Kohut (1971) theorized that a narcissistic disturbance is integral to the psychopathology of addiction. According to Kohut (1971), the primary difficulty for individuals with narcissistic personalities is that they lack an internal psychological structure that facilitates self-regulation of tension, self-soothing, and self-esteem. Within this conceptual framework, he perceived the chronic use of alcohol as a desperate attempt of the self to compensate for its psychological deficits. Therefore, practically applying Kohut’s self-psychology, Chelton and Bonney (1987) use it in examining the etiology of various addictions. According to Chelton and Bonney (1987), addiction is an affective prosthetic that shores up a fragile self-state. Addictions result when there are traumatic selfobject empathic failures; addiction is an attempt to affectively repair a “serious empathic break with an important developmental self object” (p. 43). Howard Brown (1992) studied the relationship between substance abuse and disorders of the self by administering the Millon Clinical Multiaxial Inventory to 50 alcoholics three to five days prior to their discharge from an inpatient chemical dependency unit. His results indicated that 70% of the patients were suffering from co-morbid disorders of the self. Addiction isolates people from necessary and legitimate dependence on others for, “healthy, validating, confirming, idealizing, and calming interaction...” (Chelton and Bonney, 1987, p. 41). In various anti-addiction programs like Anonymous Alcoholics, a sponsor and a sponsee are drawn together into a relationship where bonding occurs; there is a merger of two selves. Working together through rehabilitation program, the sponsor and sponsee achieve a sense of fellowship, togetherness, oneness, solidarity, and even love and caring. The relational dynamics within the sponsor-sponsee dyad are similar to those within the early mother-child dyad, so vividly articulated by Kohut, in that the sponsor’s actions (availability, encouragement, concern) convey to the sponsee a basic sense adequacy, self-worth and respect. Kohut (1971) proposed that the development of a consolidated nuclear self involved the fulfillment of two basic needs: mirroring and idealization. Mirroring refers to the primary caretaker’s (self object’s) empathic responsiveness, a communication to the child through a variety of non-verbal and verbal cues that the child is loved, admired and valued. A mirroring self object is attuned to both the physiological and psychological needs of the child. The mirroring self object manifests attunement by feeding the hungry child, soothing the frustrated child and by conveying an unconditional admiration for the child as he/she struggles to achieve the multiple milestones of early development. When a therapist is experienced by a patient or a sponsor is experienced by a sponsee as providing the critical functions that foster healthy self development, he/she is a self object. Therefore, developing an understanding of a patient’s narcissistic vulnerabilities through a process of vicarious introspection (empathy) is prerequisite to effecting an emotionally and psychologically corrective experience in patients (Gardner, 1999). REFERENCES Baker H.S. and Baker M.N. (1987). Heinz Kohut’s self psychology: an overview, American Journal of Psychiatry, 144: 1-9 Bandura,A. (1997). Self-Efficacy. New York: W.H. Freeman and Company. Bandura, A. (1986). Social foundations of thought and action. Englewood Cliffs, NJ: Prentice Hall. Barlow D.H. (Ed.), Clinical handbook of psychological disorders. New York: The Guilford Press. Bergin, A.E., & Garfield, S.L. (1994). Handbook of psychotherapy and behavior change (4th ed.). New York: John Wiley & Sons, Inc Brown, H. P. (1992). Substance abuse and the disorders of the self: Examining the relationship. Alcoholism Treatment Quarterly, 9,1-22. Chelton, L. & Bonney, W. (1987). Addiction, affects and selfobject theory. Psychotherapy, 24, 40-46. Gardner J.R. (1999). Using Self Psychology in Brief Psychotherapy. Psychoanalytic Social Work, 6(3-4), pp.43-85 Kohut,H. (1971). The analysis of the self. New York: International University Press. Kohut,H. (1977). The restoration of the self. Madison, CT.: International Universities Press, Inc. Monte, C. F. (1991). Beneath the mask: An introduction to theories of personality (4th Ed.). Orlando, FL: Holt, Rinehart and Winston. Rounds-Bryant, J.L., Flynn, P.M., & Craighead, L.W. (1997). Relationship between self-efficacy perceptions and in-treatment drug use among regular cocaine users. American Journal of Drug and Alcohol Abuse, 23, 383-395 Silverstein, M. L. (1999). Self psychology and diagnostic assessment: Identifying self object functions through psychological testing. Mahwah, NJ: Lawrence Erlbaum Associates, Publishers. Slyter, S.L (1989). Kohut's psychology of the self: Measures of healthy and defensive narcissism. Dissertation Abstracts International. 51.01-B. Tasman A., Goldfinger S., Kaufmann C. (1990). Review of Psychiatry, Vol.9, American Psychiatric Press Read More