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Kohut and counselling Applications of self psychology

Michael J. Patton a ;Naomi M. Meara b a Department of Educational and Counseling Psychology, University of Missouri-Columbia, Columbia, Missouri, USA b Department of Psychology, University of Notre Dame, USA

To cite this Article Patton, Michael J. andMeara, Naomi M.(1996) 'Kohut and counselling Applications of self psychology', Psychodynamic Practice, 2: 3, 328 — 355 To link to this Article: DOI: 10.1080/14753639608411284 URL: http://dx.doi.org/10.1080/14753639608411284

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PSYCHODYNAMIC COUNSELLING 2.3 AUGUST 1996

Kohut and counselling

Applications of self psychology

MICHAEL J. PATTON AND NAOMI M. MEARA

ABSTRACT We summarize Kohut’s (1971) bi-polar self which enables counsellors to understand and treat narcissistic behaviours and narcissistic personality disorders in a psychoanalytic framework. After Patton and Meara (1992), we describe Kohut’s formulations regarding self-development and disorders of self and how such formulations inform critical components of psychoanalytic counselling with partic- ular emphasis on the explicit and implicit strategies and characteristics the counsellor brings to the process. Finally, we suggest that a promising arena for hture theorizing and applications of Kohut’s ideas is consultation with parents, teachers and other community leaders to help prevent or remedy psychological self-injuries with systemic inter- ventions outside short-term counselling or long-term therapy.

KEYWORDS

Kohut, self psychology, empathy, narcissism, devel-

opment of the self, virtue ethics

SOME CRITICAL ELEMENTS OF PSYCHOANALYTIC COUNSELLING: APPLICATIONS OF KOHUT’S SELF PSYCHOLOGY

During the late 1950s and into the 1960s, while practising as a clas- sical psychoanalyst, Kohut (1971) began to see an increasing number of patients who did not develop a neurotic transference in their work

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with him. Many of these patients eventually terminated unsuccess- hlly and without a resolution of what had been assumed to be their neurotic, conflict-based problems. Kohut came to realize that many of these patients seemed to be especially sensitive to lapses in his understanding of them and separations from him at weekends and during vacations. He began to construe the transference that these patients did develop as a primitive, narcissistic form of relatedness to him. In other words, these patients acted as though Kohut were there either simply to appreciate and applaud their grandiosity or to be available instantly as a powerful figure to idealize. In The Analysis of the Self, Kohut (1971) attempted to construct

a theory of the self that was consistent with Freudian psychoanalytic

metapsychology. Accordingly, he attributed the formation of the self to the development of narcissistic libido. This made the self a content of the ego. As Patton and Sullivan (1980) pointed out, however, this approach was logically incompatible with classical Freudian

theory, and Kohut (1982 personal communication) agreed. In 1977, Kohut revised his theory and jettisoned the drive and structure

models of classical psychoanalysis. These concepts were replaced with

a single psychological structure called the self which stands at the

centre of the personality. As a theory of the person, self psychology provides an extensive model on which to build a therapeutically useful understanding of many of the client’s problems in living; and, we might add, an equally useful means of understanding the char- acter of both client and counsellor. In terms of treatment, Kohut adheres primarily to the classical tradition in the actual conduct of the analysis. He departs from classical technique by giving a central role to the analyst’s use of empathy, and, as will be seen later, this ability, and other characteristics of a counsellor’s personal qualities and techniques, make his ideas useful for psychodynamic counselling and for training others to participate in a variety of helping rela- tionships. In Kohut’s terms, the self develops from interpersonal experiences. Key relationships with others provide the child with important narcis- sistic functions. Unlike classical psychoanalysis, Kohut did not attribute the client’s suffering to conflicts concerning drives and defences (Brenner 1982). Rather, he saw psychological problems as arising from deficiencies in the self. Those deficiencies are primarily attributable to faulty relationships with the parents, and occur during critical periods of development. In contrast to Freud and the instinc- tual drive theory, Kohut assumes that the hndamental properties of

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the mind are representations of self and others. Thus, he places emphasis on the structure and development of the self, its central role in personality and its intrapsychic relations with mental repre- sentations of other persons. Many other contemporary psychoanalytic viewpoints share the same assumption that the mind is primarily a matrix of relational structures. These other theories include the British school of object relations (Klein 1932; Fairbairn 1958; Winnicott 1958, 1965; Guntrip 1961)’ attachment theory (Bowlby 1980) and interpersonal psychoanalysis (Sullivan 19.59). Stephen Mitchell (1988) argues that all the major, contemporary psychoan-

alytic theories have in common the assumption that mind exists as a matrix of relational configurations. It is this assumption that sepa-

rates all of these theories from

There are many features of Kohut’s (1977) theory that make it attractive for use in psychodynamic counselling. First, his theory is less complex than Freud’s (1916) and provides helpful, experience- near concepts to account for client behaviour. It addresses, as well, problems that many modern-day clients bring to counselling. These problems often manifest in such complaints as difficulty sustaining the ambition needed to accomplish work, lack of direction or purpose, pain in the form of disappointment, disillusionment or lowered self-esteem, a painful sense of fragmentation and problems of self-regulation such as managing tension or, more seriously, addic- tion to drugs or alcohol. Additionally, the concept of empathy occupied a very important place in both Kohut’s theory of person- ality (i.e. development of the self) and theory of treatment (ix. appropriate counsellor behaviours and characteristics in facilitating the work). Kohut makes empathy an essential attribute of the child’s early relational matrix. Reliable parental empathy for the child’s needs is necessary for healthy development of the self. Second, the coun- sellor’s empathic understanding is critical to the well-being of the client. These and other features ofKOhut’s theory make it also appro- priate to shorter-term counselling. For example, the theory can be used to select a focal problem that is experienced by the client. Finally, self psychology seems to address important questions which feminists and others have raised with respect to the appro- priateness of using any psychoanalytic approaches when counselling women. For example, Gardiner (1987) sees a number of areas of compatibility between self psychology and feminist approaches to women’s development. She believes that Kohut’s (1974, 1977) char- acteristics of psychological maturity are not related to cultural

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expectations of masculinity: for example, autonomy is not seen as the major goal of psychological development. ‘Self-psychologists see all people embedded for life in a network of human relations, and they posit mature interdependence and altruism as among adult development goals for both sexes’ (Gardiner 1987: 772). Patton and Meara (1992) conclude that Kohut’s self psychology can be produc- tively applied to processes and techniques of counselling both men and women. Below we summarize Kohut’s self psychology and suggest it is a good vehicle for understanding what brings a client to counselling:

namely, disorders of the self or self-injury. We also review several strategies and ‘ways of being’ a counsellor must bring to and offer in the counselling encounter if the work is to succeed. We define success as the client being able to reduce complaints, achieve insight and hnction with more satisfaction. We turn finally to implicit qual- ities, characteristics or virtues we believe a counsellor or any facilitator must have, continue to develop and bring to an encounter if coun- selling or other helping relationships are to be effective.

KOHUT’S VIEW OF THE DEVELOPMENT OF THE SELF

The infantile self and its selfobjects

At about 18 months to 2 years of age, previously fragmented, dis- crete and unreliable mental images that the child has used to repre- sent experience combine into a cohesive, yet fragile structure called

the infantile self and its two selfobjects. Kohut describes selfobjects

as objects ‘which are either used in the service of the

are themselves experienced as part of the self‘ (Kohut 1979: 455); ‘the expected control over them [selfobjects] is therefore closer to the concept of the control which a grown-up expects to have over his own body and mind than to the concept of the control he experiences over others’ (Kohut 1979: 457). At this stage, the self and its selfobjects now serve as the organizing centre of the infant’s personality and will continue to do so unless events occur that weaken it. There are two kinds of selfobjects: (a) the grandiose self (ix., the mirroring selfobject) and (b) the idealized parental image. As such, they represent the two lines of normal narcissistic development of the personality: grandiosity and idealization. The selfobjects are mental

representations of the child and the parents that function to main-

or which

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tain the infant’s self-esteem and the cohesion of the self. In this way, the child is seen to have self-selfobject relations. The grandiose selfobject is the child as the powerful centre of the universe. We understand this aspect of the child when we recognize his or her noisy and prideful attempts to elicit our undivided atten- tion, approval and pleasure in exhibitionist displays. The parents serve to maintain and strengthen the cohesiveness of the child’s normal grandiose displays. The grandiose self-selfobject relationship is one in which the parents are perceived as part of the child and func- tion as a mirror to reinforce its sense of greatness. It includes the child’s sense of having complete control of the mirroring selfobject. Consolidation of the child’s self is maintained by a parental matrix of reliable, age-appropriate, empathic responsiveness to the demands of the grandiose self. Infantile grandiosity and exhibitionism are, then, normal, phase-appropriate expressions of narcissism. The other selfobject, the idealized parental image, is the child as part of the powerfully perceived parent figures. The child constructs this selfobject to idealize the parental figures and to merge with them in times of stress. Like the grandiose selfobject, the idealized selfobject functions to help the child maintain self-esteem and cohe- sion. The child is, thus, able to perceive itself as part of the parent’s calm, power and infallibility. Parental empathy for this aspect of the child’s inner life permits them to be used by the child as reliable targets for idealization and merger. In the area of the grandiose self, the child’s formula is, according to Kohut (1971), ‘I am perfect’. On the idealizing side, the formula is, ‘You are perfect; but then, I’m part of you.’ In both cases, the child and the parents are one unit, psychologically. This is the essence of narcissism. The other person, in this case the parent, is there not as a separate person with his or her own needs but as something that helps the child maintain self-esteem and a cohesive, harmonious and vigorous self.

Further development of the self

Normal parents will inevitably fail to mirror the child’s grandiosity or to be available as targets for idealization. They will not always show appreciation and delight at the child’s noisy demands for atten- tion and praise. They will not always grasp or be patient enough to understand the child’s desire to cling or to be soothed. The child is not yet able to have empathy for the inner life of a separate person

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and so does not yet understand that the parents have needs of their own. Still, these normal parental failures in empathy to mirror the child’s grandiosity or to be available for its idealizing needs wound the child’s self-esteem. It hurts not to be paid attention to or to be confirmed in one’s greatness. It also hurts to realize that one’s parents are not perfect, and that one cannot maintain self-esteem through union with the parents. Such lapses in parental empathy and the child’s hurt and often rageful reactions cause the selfobjects to lose their firmness and cohesion. They are unable to promote the cohesion of the self. Phase-appropriate and small lapses in parental empathy promote a manageable break-up of the infantile self and its selfobjects. Reality begins to intrude on the nursery, as it were. The child is unable to sustain the archaic, infantile sense of itself through the parents. Instead, the child is forced to reconstruct its selfobjects along increasingly more realistic lines. Development in the grandiose lines continues from infantile exhi- bitionism to assertiveness. This phase in the development of the grandiose line replaces the energetic, but diffuse, attention-getting and controlling behaviour of the toddler with the more concentrated assertiveness of the 4-,5- or 6-year-old. Now, the child’s demands for attention are more reality-focused. The child’s healthy assertive- ness pis-h-vis the mirroring selfobject is a bid for approval and recognition of its ability to make and follow through with tasks and plans it has initiated. The child’s assertive initiative in this regard will later be converted into the basic pattern of ambition or striving of the self. The last phase of development of the grandiose self is that of ambition. This is the healthy adult’s desire and energy for accomplishment and the mature expression of self-interest. The teen years are the critical period when the basic pattern of the initiative becomes consolidated. Throughout the life span, the individual has need for grandiose self-selfobject relations with others. However, the nature of those relationships changes with age. What a teenager might require in the way of attention and approval from others for her or his initiatives is quite different from the selfobject relation- ships required by a middle-aged person. Development in the idealizing line continues from the child’s merger with the omnipotent caretaker and its idealization of him or her to more healthy admiration of the selfobject’s realistic attributes. Following the earliest phase and the experience of normal lapses in the selfobject’s availability as a target for idealization, the child begins to de-idealize the parental figure around 4 to 6 years of age.

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In reconstructing this selfobject, the child’s admiration consists of happy, wide-eyed acceptance of the idealized figures and praise for them. The child incorporates realistic elements of this person into the self as an emerging pattern of goal-setting ideals. These struc- tures help organize the personality by giving it a sense of direction. The last phase of development in this line consists of the formation of increasingly realistic goals or ideals during the teenage years. Goals help organize the strivings of the infantile grandiose self to mature into the organizers of ambitions. The maturing child learns through phase-appropriate lapses in parental empathy how to become its own centre of initiative. On the grandiose site, the adult, bi-polar self consists, then, of patterns of ambition or striving that have their origins in the infantile grandiose self, and that serve to provide the person with initiative or determination. On the idealizing side, the adult self and its self- objects consist of patterns of mature ideals that arise from the idealized parental image. These patterns of goals or ideals function to organize the ambitions of the grandiose side and provide a sense of direction in life. The character of the parents is pivotal in determining how the child’s self develops. Kohut and Wolf (1978: 368) argue ‘it is not so much what the parents do that will influence the character of the child’s self, but what the parents me’. As we describe below, we believe the same to be true for the counsellor. The character (e.g., the cohesiveness, vitality and harmony of the self) the counsellor brings to counselling is as important as what the counsellor does in counselling such as establishing the working alliance, displaying appropriate empathy and engaging in other techniques which facil- itate the therapeutic work. What the counsellor isdetermines in some measure how well the counsellor is able to perform the relational and technical aspects of therapy needed to repair client self-injury.

Disorders of the self

Defects or weaknesses in the self come about because of chronic frustrations of the child’s narcissistic needs. In such cases, there is frustration of either (a) the need for the approval and affirmation of the mirroring selfobject, or (b) the wish for merger with and acceptance by the idealized selfobject. Disturbances in the cohesion of the self injure self-esteem and threaten it with painfbl frag- mentation. Severe, chronic lapses in parental empathy can cause

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development to be fixated in the injured sector of the self. They can also prompt the self to defend or compensate to avoid a painful sense of discohesion or fragmentation. To avoid a painful sense of emptiness or a permanent break-up of the self, either or both of the selfobjects may become defensively isolated through fixation. In this case, they do not develop. If this occurs, in the grandiose line, the adult person continually seeks a mirror for his or her infantile sense of grandiosity to feel whole. In the idealizing line, the person may seek strength through merger with powerhlly perceived others, or with political, religious or social movements. A disturbance in the self can include other manifestations such as constant lying, shame-proneness, restlessness, work or study inhibi- tions and hypochondriasis. In more severe cases, one can also observe alcoholism, drug abuse, delinquency, psychogenic obesity and sexual perversion. Each of these examples represents a defensive manoeuvre. When there is an injury in either line of development, the person may defend against it by using ideas, affects or behaviours to protect or cover over the defect. If the injury is on the grandiose side, the person may develop fantasies or actively engage in behaviours that, temporarily, restore a sense of power or greatness by controlling the mirroring selfobject. In this case the person denies his or her weak- ness or sense of shame by trying to find an approving mirror for her or his exhibitionist displays. When the injury is on the idealizing side, defensive manoeuvres are intended to restore cohesion through merger with or approval of the omnipotent selfobject. Here, the person tries to acquire the missing confidence, acceptance and secu- rity by a merger with perfection. The more severe the disorder, the more the person will likely use something in the environment, rather than his or her mind, to solve the problem. Besides using defensive manoeuvres to avoid or deny an injury to the self, the person may also build compensatory structures. These structures are an attempt to strengthen the healthy parts of the self in that sector that has been less injured. Compensatory structures usually consist of work, study or leisure activities. They are related to the infantile selfobject in the healthier line primarily because it was to this selfobject that the child turned when severely disappointed by the selfobject in the injured line. From compensatory activities, the counsellor can usually find evidence of residue from this earlier self-selfobject relationship. Whether the defensive or compensatory manoeuvres are effective depends on the severity of the defect in the self. More severe defects are usually accompanied by the person’s use

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of the environment to solve the problem. Alcoholism, drug abuse, sexual perversion and the rest are urgent, yet inefficient, attempts at self-cure (Patton 1980). They are temporary measures at best and are grossly inefficient. With less severe narcissistic injury, the person is more likely to use his or her mind to create fantasies (for example, of power and greatness, or of merger with powerfully perceived others) and/or to adopt personality characteristics like ingratiation, vanity or hero worship. As with the more severe measures, these manoeuvres provide a transitory sense of wholeness and strength and raise self-esteem. Here again, however, these measures, while being less socially and personally destructive, are, none the less, wasteful of the person’s time, energy and talents. Compensatory actions are more likely to be stable solutions if the injury in the other line has not been too severe. For Kohut (1977), every individual has two chances of developing a healthy, adult self. The narcissistically injured person may yet develop a cohesive adult self with compensatory structures that are organized on the more cohesive line. From a self-psychology perspective the goal of therapy is repair of self-injuries. From this framework Patton and Meara argue that the goals of psychoanalytic interviews are ‘client insight and concomitant reductions of com- plaints and symptoms’ (1992: 70). They see these goals as interactive events which can be achieved through the ‘client and counsellor’s concerted management of their conversation’ (1992: 70; see also Patton 1984). It is selected critical elements of these conversations to which we now turn our attention.

PSYCHOANALYTIC COUNSELLING FROM A SELF- PSYCHOLOGY PERSPECTIVE

An in-depth consideration of psychoanalytic counselling from a self- psychology perspective is not possible in the space allotted here, but we would like to mention several key elements of such counselling interactions: (a) theoretical perspectives on the process, (b) the working alliance and (c) the character of the counsellor. We realize that this list is incomplete and leaves out many technical consider- ations; and, in addition, with the space allotted we cannot cover thoroughly any of the areas we do discuss.

Selective aspects of the psychoanalytic counselling process

Elsewhere, we (Patton and Meara 1992) have suggested that the counsellor’s use of theory serves three important functions in coun-

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selling: ( 1) theory helps the counsellor organize the things the client says and the counsellor’s other observations of client behaviour into a systematic understanding of the client’s problems; (2) theory operates as a guide in helping the counsellor make appropriate inter- ventions with the client; and (3) theory provides a resource for developing hunches about the client and then testing them against the client’s responses to our interventions. To illustrate how theory can serve these functions we present a theoretically derived model. The model is adapted from Menninger’s (1958) ‘flow of insight model’ and illustrates important events in counselling, and their desired outcomes. For illustration purposes (after Patton and Meara 1992), these events are presented sequentially with the implication that they are orderly occurrences within or across interviews. In fact, the events are repetitive, and interactive; and their sequence is often disrupted. Cycles of these events, however, do occur within and across interviews and constitute the process and outcomes of psycho- analytic counselling. As Patton and Meara note:

Client insight and the concomitant reduction of complaints and symp- toms are the goals of the psychoanalytic interview. In our model of interview events, insight is defined as client and counsellor produc- tion and understanding of factors within the client that contribute to his or her emotional difficulty. Insight and reduction of complaints are interactive events. They are, therefore, the joint achievements of

the participants.

(Patton and Meara

1992: 70)

We have reproduced the model in Figure 1. Although we consider accomplishing the work of counselling as a conjoint endeavour, our focus here in describing the events contained in the model is on the counsellor’s contribution to the interaction. For a more complete explanation of the model, including the client’s contribution and an illustrative case example see Patton and Meara (1992: 69-90). The model is best understood if the reader begins at the apex of the triangle (with ‘clients complaints’) and moves clockwise. The conjoint management of these events may be seen as the theme or narrative of counselling. The unique features of a particular narra- tive depend on the client’s presenting story (‘client complaints’) and the client’s abilities (via his or her story telling and with the help of the counsellor’s presence and skills) to understand the personal, emotional difficulties and self-injuries that occasioned seeking coun- selling in the first place. The uniqueness of the narrative depends as well on the counsellor’s character (beginning with the maturity of

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past in the present (insight)

Counsellor interpretation-

-Counsellor

empathy and

countertransference

Client transference-

-

- Counsellor restraint

Counsellor

Client

Client depth

confrontation

resistance

of material

Source:

Patton and Meara

(1992), used with permission

Fbuw 1

Path of client understanding in psychoanalytic counselling with

emphasis on the explicit contributions of the counsellor

his or her bi-polar self), motivation, empathic capacity, skill and resourcehlness in building and maintaining the working alliance and competence in accomplishing the technical tasks of the work.

Empathy and countertransference

In order to ‘keep the conversation going’, that is, respond appro- priately to client comments regarding current events, a counsellor must be capable of experiencing affect and understand his or her own affective reactions to the client’s presentations. To participate in the work of psychoanalytic counselling, the counsellor must be able to handle empathy and countertransference. The counsellor uses empathy to understand the client’s emotional and intellectual perspective, to communicate that understanding and to set the stage for a ‘deeper’ intervention (Robinson 1950) such as confrontation or interpretation. Empathy also facilitates client readiness to deal with painful material in greater depth. Countertransference enables the counsellor to increase empathic understanding of the client. Patton and Meara (1992) argue that countertransference is not exclusively pathological or an occasion for unresolved conflict, although the counsellor must guard against enacting a role in the counselling relationship which reinforces the client’s self-injuries, vulnerabilities or faulty relationship patterns.

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Our view is that the non-pathological, interpersonal element of coun- tertransference is of great importance to the counsellor. It helps the counsellor understand more about the client’s inner life. Countertransference in this sense is a form of empathy in which the

counselor experiences reactions that are evoked

scious] transference wishes and

By attending to the internal

by the client’s [ uncon-

reactions, the counselor can derive clues to the underlying problem for which the client needs assistance. (Patton and Meara 1992: 77)

Counsellor cognitive appeal

The purpose of the psychoanalytic counselling intervention known as cognitive appeal is to enable the client to engage in the serious work of counselling: talking and thinking (i.e., using his or her mind), to achieve insight with respect to the complaints that brought the client to the counsellor. Without counsellor recourse to cogni- tive appeal, the client may not know how to move beyond voicing the complaints to working to reduce them. The goal is not to blunt affect but rather to encourage the client to interrupt his or her stream of experience (ix. the complaining mode) to observe, reflect and comment upon the complaint. The counsellor does this by asking for specifics, examples or elaboration of the material. The interven- tion can help a client learn the kind of work and collaboration expected in the client role, accept (or in some cases restore) the working alliance (discussed below) and set the stage for deeper client understanding of the material.

Counsellor restraint

Restraint is often a difficult trait for counsellors to develop. If cogni- tive appeal is successful, however, the client is now reflecting upon his or her complaints and linking the emotions and thoughts they generate in order to gain a deeper understanding about the self. Now that the client is far enough along to begin the work in earnest, the counsellor collaborates by being restrained (both verbally and non-verbally) so as not to distract the client from relating or strug- gling with painful material. ‘Counsellor restraint is called for when the client is able to use his or her own mind. Restraint or silence is not appropriate when the client needs to hear from the counsellor because he or she is becoming overwhelmed by affect’ (Patton and Meara 1992: 80).

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Appropriate counsellor restraint allows the client to approximate free association and encourages the client to take greater responsi- bility for the work. The frustration that a client may experience from counsellor restraint can be productive in pressing the client to rely on his or her own resources and experiences in the search for under- standing. Counsellor restraint requires judgement about the progress of the work and the client’s capacity for coping. Cognitive restraint is a deliberate, carehlly timed strategy which is often difficult for empathic persons to learn. When inappropriately exercised, this strategy can be a deterrent to the working alliance. Even when appro- priately used, beginning counsellors are often hesitant to exercise this strategy because of the frustration (however productive) that counsellor cognitive restraint evokes in the client. Being able to exhibit this skill however is an important component of developing client insight.

Counsellor confrontation

This intervention helps the client become aware that he or she is resisting some experience. It is used to enable the client not only to understand what is being resisted, but why the material is being resisted and how the client’s mind works to maintain the resistance and avoid painful material. When a client is being resistant, the ‘flow’ of client understanding can become derailed, and thus counsellor confrontation may be needed. The counsellor must first recognize that resistance is occurring, understand its mode or the form it is taking and then carefully calibrate the content, strength and time- liness of the confrontation. In short, tact, timing and dosage are all important. To be effective the confrontation must not be prema- ture, and must have significance for the client. The client must be secure in the working alliance with the counsellor and his or her ego must be of sufficient strength both to experience the resistance (once confronted with it by the counsellor) and to observe that experience. For example, if the client’s mode of resistance (to discussing a painful subject) is topic switching, the counsellor might suggest that the client has switched topics several times in the last five minutes; and probe the client’s awareness of this fact. If the client can acknowledge the behaviour, but is unable to understand it, the counsellor could offer an opinion such as ‘talking about this relationship seems to make you anxious’. If the client can resonate with that feeling, then the counsellor can once again put the respon-

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sibility on the client and ask him or her to elaborate on or ‘account for’ the anxiety.

Counsellor interpretation

Patton and Meara note:

Counselor interpretation is an event in the flow of client insight that promotes the client’s understanding of the central emotional prob- lems in his or her life as they become manifest in the [client’s] transference. It is the counselor’s formulation of the gist of some aspect of the client’s material in the conversation thus far. (Patton and Meara 1992: 87)

Interpretation links the client’s history or past with present events in the counselling and in the client-counsellor relationship. The counsellor attempts to help the client (via interpretation) understand how the client’s personal past is being re-enacted in the present. Interpretation is to be used sparingly and is the most important intervention for helping the client obtain insight. It requires partic- ipation from the client to confirm or disconfirm its substance, i.e. what is framed in the interpretation’s content. Thus, as Patton and Meara point out:

A period of time and a strong working alliance between the partici- pants are, therefore, necessary to prepare the client for interpretation and to provide the counselor with enough knowledge of the client to enable him or her to understand the meaning of the client’s memories.

(Patton and Meara 1992: 87)

Again, the interaction we describe (and the particular emphasis on counsellor behaviour we emphasize here) are not to be understood as a linear chain of events. The events leading to client insight are better characterized as interactive, repetitive and often disrupted. Over the course of a series of interviews, however, these client- counsellor events constitute a sequence, however configured, that represents the work of psychoanalytic counselling and can lead to the achievement of client insight and the reduction of initial complaints or symptoms.

The working alliance

We consider the working alliance the sine qua non of psychoanalytic counselling. Much has been written about the working alliance and

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its centrality in the effectiveness in any helping relationship (cf. e.g., Bordin 1979; Gelso and Carter 1985; Greenson 1967; Robbins 1992). For an historical account of this literature and a thorough explanation of the working alliance, various perspectives on it, appli- cations and measurement of it the reader is referred to Robbins (1992). We focus here on a brief description of the concept and the counsellor’s contribution to it.

The working alliance consists of that sector of the overall experience of the counseling participants characterized by their collaboration, mutuality and cooperation with regard to the work of counseling. (Meara and Patton 1994: 163)

Each alliance is unique, is created by the participants and enables

the work of counselling.

consisting of three components: (a) an emotional bond between

participants, (b) agreed-upon goals for the work and (c) agreement with respect to the mutual tasks involved in accomplishing the goals.

As Robbins (1992) and

must be motivated and able to form a rational relationship with the counsellor, have the ability to experience as well as both observe and

reflect on personal experience (sometimes referred to as ‘splitting the ego’), be aware of the need for assistance and finally be curious enough about his or her self to work hard. How ready the client is to accept the working alliance depends in part on how well the counsellor has set the stage, communicated the invitation and timed empathy, cognitive appeal and other basic interventions. Robbins ( 1992) explains that a counsellor contributes to the working alliance in two major ways: (a) counsellor technical

procedures and (b) counsellor personal qualities. Again, we see it is

not only what the counsellor does, but who the counsellor is. Meara and Patton summarize Robbins’s major points in this regard.

Bordin (1979) characterizes the alliance as

others (e.g., Greenson 1967) note, the client

The counselor’s personal qualities are essential in maintaining an effec- tive alliance with the client. Genuineness and warmth, along with natural and occasional humor, help the client feel accepted and supported. The counselor’s ability to admit not understanding the client or to accept feedback from the client is as important in this regard as the avoidance of demeaning the client by a rigid adherence to ‘rules’. Finally, the counselor’s innate capacity to show interest in and concern for the client’s well being comrnunicatcs humanness and helpful intentions. (Meara and Patton 1994: 165)

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From this description we can see that the counsellor’s truthfulness, accurate sense of self and personal competence are critical to effec- tive participation in a productive alliance. Enumerating the responsibilities and activities of counsellors (e.g., understanding the client, establishing and maintaining the working alliance, being appropriately empathic) opens the door to an explicit examination of the implicit characteristics needed by counsellors to enhance the substantive and technical aspects of the work of coun- selling.

IMPLICIT CHARACTERISTICS OF THE COUNSELLOR’S SELF

Implicit in the counsellor’s abilities to be empathic, use counter- transference, cognitive appeal, confrontation and interpretation as well as to establish and maintain the working alliance (towards the goal of deepening mutual understanding of client emotional diffi- culties) is the assumption that the counsellor is free from significant self-injury. It seems particularly important that a counsellor does not have a narcissistic personality disorder or habitually exhibit narcis- sistic behaviours. In addition, we argue, and we elaborate this argument below, that the intrinsic nature of the counselling rela- tionship and the intimate work of counselling calls for (or at a minimum is enhanced by) other counsellor character traits such as prudence, integrity, respecthlness and benevolence. Professionals, be they counsellors, professors or physicians (and the professions they represent), depend ultimately on their character and their competence for their livelihood, accomplishments and the welfare of those they serve. Their character is at the root of their reputation and influences their competence (and how they present it), the ways their expertise can benefit clients and the promise their field has for contributing to the common good. In order to func- tion, professionals need to be trusted by their clients and they need to be worthy of that trust. In no field is this more the case than counselling which depends on a kind of verbal and affective inti- macy between participants and where issues of transference and countertransference are salient. Transactions among intimates depend on trust; those among strangers rely on justice. While issues of char- acter have always been implicit in the selection, training and sanctioning of professionals, they have become more explicit in recent years. As the professional culture and those they serve have become

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more diverse, the ‘taken for granted’ behaviours of professional and client have become (if not called into question) a target for exami- nation. One form of this examination has been renewed interest in

virtue ethics and its application to professional life. For example, a number of commentators have discussed the essence of a profession and the virtues inherent in that essence (e.g., Jordan and Meara 1990; Meara, Schmidt and Day 1996; Patton and Meara 1992; Pellegrino 1995; Punzo in press; Punzo and Meara 1993). Pellegrino (1995) makes a cogent argument that it would be difficult to restore virtue as a normative force in general ethics becausc there is not, to use MacIntyre’s (1984)terms, a community of shared values to sustain it. Pellegrino believes, however, that a restoration of virtue ethics is possible in the health professions where there is general agreement about the purpose of these professions (to heal) and the essence of the healing relationship. He hrther asserts that such restoration needs to be conceptually anchored in a coherent moral philosophy of the health professions. To that end he articulates three necessary ingredients of such a philosophy, using medicine, specifi- cally the physician-patient or nurse-patient relationship, as his exemplar. These ingredients are (a) theory of medicine, (b) definition of virtue commensurate with that theory and (c) a set of virtues which capture or characterize the ‘good’ health-care professional. Pellegrino (1995) goes on to offer a theory of medicine that includes (a) the fact of illness, (b) the act of profession (meaning when one offers services there is an implicit promise that one has the skills to help and will use those skills in the best interest of the patient) and (c) the act of healing. From this theory follow, or so Pellegrino believes, several virtues (he lists seven) inherent to the healing professions. He includes in this list (a) fidelity to trust and promise, (b) benevolence, (c) compassion and caring, (d) intel- lectual honesty and (e) prudence. Drane (1994) focuses on much of the same material in developing a list of virtues for physicians which he bases on the premise that healing is practised in every culture and the central feature of that healing is the doctor/patient relationship. He states ‘the characteristics and virtues of a good

doctor derive from the needs of patients

beliefs about what it means to be ill’ (1994: 297). Included in this list are caring, prudence, humility and hope. Beauchamp and Childress (1994) have a somewhat different but compatible list of physician virtues: compassion, integrity, truthfulness and discern- ment.

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Meara and her colleagues (Meara, Schmidt and Day 1996) take much the same approach as Pellegrino (1995) in proposing that attention to virtue ethics and specific virtues could enhance the work of psychologists and counsellors and the character of those professions. Their ideas build on the work of Jordan and Meara (1990) and Patton and Meara (1992: 288-304), who explicitly linked virtue ethics to counselling and psychoanalytic counselling respectively. Meara et al. (1996) suggest, and we elaborate on these below, four virtues: the self-regarding virtues of prudence and integrity and the other-regarding virtues of respectfdness and benev- olence. They base the selection of thesc four virtues on the argument that the goals of psychologists are to be competent and to serve the common good; and we would extend that argument to note that for counsellors the welfare of their individual clients is paramount. Some, if not all, of the virtues Meara et al. suggest (and perhaps others) may be particularly salient in psychoanalytic counselling from a self-psychology perspective. We purpose that counsellor virtues and character traits should be set forth for critical analyses, subjected to empirical test (in the context of their usefulness in advancing the work of counselling) to ensure that whatever virtues or traits may survive such scrutiny are conceptually and theoretically rooted in a coherent moral philosophy of psychoanalytic counselling. In partic- ular, we believe that an integration of a Kohutian view of self and these contemporary views on virtue ethics can inform our views of the ‘ideal’ psychoanalytic counsellor and provide insights for training, supervision and the work of counselling itself. Because of the intimate nature of counselling interactions and the vulnerability of the client (due to a fragility, if not serious fragmen- tation, of self), the counsellor needs to have achieved a mature bi-polar self with an appropriate balance among ambitions, ideals and well-developed talents and skills. We would argue that the devel- opment of these characteristics (ix., traits of character) are the minimum necessary for a counsellor to engage in appropriate empathic mirroring of client grandiosity and to be an appropriate target for client idealization. The counsellor, then, like the parent, needs to do and be. We propose a description of counselling based on self psychology and analogous to Pellegrino’s ( 1995) theory of medicine. First, there is the fact of self-injury; second, the profession of faith is the offering of the working alliance; and, third, there is the actual healing, the conjoint collaborative process of the counselling itself. In the context

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of this theory we suggest virtues that capture the essence of the good psychoanalytic counsellor. Above we have elaborated upon self- development and disorders of the self that result from childhood experiences of not having either appropriate mirroring of grandiosity or targets for idealization or both. We see the fact of such self-injury as analogous to the fact of illness. As Pellegrino notes:

Persons become patients when they acknowledge that they are suffi- ciently concerned over a physical or psychological symptom to believe they need help. In this state to varying degrees, they are anxious, dependent, in pain, disabled, and extremely vulnerable and exploitable. (Pellegrino 1995: 267)

Individuals become clients in counselling when they are sufficiently anxious, depressed or otherwise psychologically distressed as a result of narcissistic injury. The offer of help, in Pellegrino’s (1995) terms the act of pro- fession, begins when the counsellor first agrees to see the client. It deepens during the initial phase of counselling while the counsellor is offering empathy and dealing with the countertransference as well as engaging in other strategies such as cognitive appeal and cogni- tive restraint. The commitment is secure, however, when the counsellor invites and establishes the working alliance. Implied in all this activity is a promise: a promise to help with the further impli- cation that the counsellor can be trusted to keep that promise. Finally, there is the counselling itself (i.e. the process of healing), the mutual collaboration between the participant with goals of symptom reduction and the attainment of insight.

Characterizing and selecting virtues

Meara et af. (1996) review definitions of virtue and understandings of the construct in different cultures and historical periods. They note that definitions may vary slightly and the virtues that are proposed might vary greatly; however, both the definitions and examples of virtue become meaningful only within a context. For example, Pojman notes that Aristotle believed that ‘virtues are char- acteristics that enable individuals to live well in communities’ ( 1990:

121). For Homer a virtue is a quality needed to fulfil a well-defined social role. As noted above, the context Meara et af. suggest (for the virtues they propose for psychologists and counsellors) includes the responsibilities of being competent and providing for

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the common good. A virtue then describes a quality of a person that has merit or worth in the context related to matters of right or ideal conduct. Pellegrino (1995) combines the ideas of Aristotle and MacIntyre (1981, 1984) in defining and enumerating the virtues inherent in the healing relationship. Virtues, from this perspective, are traits, dispositions or habits that dispose agents to excellence of intent and performance with respect to some practice. All professions have activ- ities which are intrinsic to their essence and if conducted well earn the agent who accomplishes them the reputation of being a good or virtuous professional.

Healing is the activity specific to nursing and medicine. Those dispo-

sitions that impart the capacity to heal well arc the virtues of medicine,

nursing, dentistry and the like. They arc the virtues ‘internal’ - in MacIntyre’s ( 1981, p. 187) sense - to the practice. Possession of these

internal virtues defines the good nurse or physician.

(Pellegrino 1995: 268)

Distinctive features of virtue ethics then are that it focuses on ideals inherent to a practice (or for our purposes here the professional activity of psychoanalytic counselling) and on the character of the agent (or psychoanalytic counsellor) rather than the practice (or action of counselling) itself Punzo and Meara (1993) and others distinguish between self-regarding and other-regarding virtues. Self-regarding virtues primarily benefit the agent who possesses them. Possession of self- regarding virtues could be viewed as a basis for enabling one to develop other-regarding virtues. The other-regarding virtues are oriented towards producing moral good for others. Meara et al. ( 1996) argue that these virtues (self-regarding and other-regarding) interact to depict the character of the person. Within the context of the responsibilities of psychologists to be competent and provide for the common good they propose the two self-regarding virtues of prudence and integrity and the two other-regarding virtues of respectfulness and benevolence as essential characteristics of psychol- ogists and counsellors which enable them to perform the tasks of these practices (or professions) well. Articulating a list ofvirtues intrinsic to an activity or practice such as medicine or counselling presents difficulties. There is no defini- tive list and, even if there were, virtues do not operate in isolation. They interact with one another so the distinctions among them are often not as great as precise rhetoric might imply. While we would

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agree that virtues are linked and not particularly meaninghl in isola- tion, the ones proposed for the helping professions which we have reviewed above (Beauchamp and Childress 1994; Drane 1994; Meara et al. 1996; Pellegrino 1995) may have enough merit to warrant further debate and empirical test. For counsellors to think about the meaning of these virtues or characteristics, how they could be implemented in establishing and maintaining the working alliance, in providing appropriate empathy and being a suitable or fitting target for a client’s idealization could enhance the counsellor’s under- standing of the client’s self-injuries. Counsellor success and abilities in these and other aspects of collaborative counselling encounters depend not only on technical competence, but also on an enhanced mature self. As with the constructs in the ‘flow of insight model’ presented above, we describe these virtues and their relationships to psychoanalytic counselling sequentially but we do not wish to imply that they occur in a linear fashion or that particular ones relate only to the specific counselling events where we suggest the most obvious connections exist. These virtues are part of the counsellor’s character and interact with the collaborative events throughout counselling. The virtues proposed for psychology and counselling (prudence, integrity, respectfulness, benevolence) have been clearly defined, but as yet not linked sufficiently to particular activities intrinsic to the practice of counselling. Valid empirical tests cannot be designed until such links are clearly conceptualized. To that end we suggest some connections. In particular, however, it seems to us as if integrity and respecthlness can be viewed as enhancements of the mature self described by Kohut and thus intrinsic to our conceptualization of psychoanalytic counselling. A coherent self and a lack of narcissistic disorder seem essential to personal integrity and the capacity to be respectful of others. Meara et al. (1996) adopt the Beauchamp and Childress defini- tion of integrity: ‘Moral integrity, then, is the character trait of a coherent integration of reasonably stable, justifiable moral values, together with active fidelity to those values in judgement and in action’ (1994: 473). In relation to psychoanalytic counselling integrity relates closely to Pellegrino’s (1995) notion of the pro- fessional’s fidelity to the trust the patient has in the professional and in the promise of the profession to heal. Integrity of the counsellor, and the client’s trust in that integrity, seem essential in establishing and maintaining the working alliance.

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Respectfulness means more than simply respect for the autonomy of others. It includes respecting individuals in terms that they define (Meara et af. 1996). With reference to psychoanalytic counselling we respect a client as a partner in a collaborative effort. A client is not to be treated as a depersonalised commodity or someone to be used to the advancement of our own careers, financial security or personal agenda. Respecthlness seems particularly critical in the counsellor’s ability to be empathic and handle countertransference in the counselling encounter, and be a full participant in an effec- tive working alliance. Benevolence is integral to articulating the differences between professional and personal relationships. In a counselling relationship the counsellor’s first responsibility is always the welfare or good of the client. Psychoanalytic counselling is not the occasion for the counsellor to collaborate with the intent of directly meeting the counsellor’s needs, resolve the counsellor’s problem or provide for the counsellor’s welfare. Benevolence is about intent to engage in the collaborative effort of counselling to help the client reduce symp- toms or achieve insight. A professional who has not achieved a mature bi-polar self would have difficulty exercising the virtue of benevolence. Counsellor benevolence is so intrinsic to the healing or curative aspects of counselling relationship (in particular empathic responding and participation in an effective working alliance) that the term ‘non-benevolent or malevolent counsellor’ could be consid- ered an oxymoron. Meara et af. (1996) argue that prudence is the cornerstone virtue for psychologists and counsellors. We would like to elaborate on that analysis with respect to counselling. Prudence we would argue is important and directly related to the more technical aspects of coun- selling outlined in the ‘flow of insight’ model described above (see also Patton and Meara 1992). In particular, prudence would seem essential in counsellor restraint and cognitive appeal. We think too that prudence interacts with integrity and respectfulness in accom- plishing appropriate confrontations and effective interpretations. Many of the counsellor’s responsibilities in the more technical arena can be captured in the terms ‘tact, timing, and dosage’, all attributes of a prudent person. Prudence implies that one is planful, self-regulating and restrained as opposed to impulsive (Haslam and Baron 1994). A prudent person visualizes and pursues long-term goals; thinks through the consequences of choices and exercises good judgement in the face of uncertainty. Thus a disposition towards

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Client recognition of the past in the present (insight)

ARTI<: LBS

-

Counsellor interpretation-

(Respectfulness)

- Counsellor empathy and countertransference (Integrity & Respectfulness)

-Counsellor

cognitive appeal

Client transference -

-

Sotrrce:

Fkure 2

confrontation

resistance

of material

(Prudence)

(Integrity)

(Respectfulness)

Developed from Patton and Meara (1992), used with permission

Path of client understanding in psychoanalytic counselling with

emphasis on desired implicit characteristics of the counsellor

prudence would seem an advantageous trait in accomplishing the technical aspects of counselling; as Meara points out, ‘prudence refers to practical wisdom and those who are prudent have goals and reasoned places for accomplishing them’ (in press: 316). Accom- plishing the technical aspects of counselling paves the way for an

effective working alliance. Prudence then may be seen as a neces- sary prerequisite of the working alliance, but may be somewhat less central to its intrinsic nature per se than integrity, respectfulness and benevolence. But all four virtues are continually interacting with the events of counselling to maintain a strong working alliance. These links between the virtues and the counsellor’s contribution to the ‘flow of insight’ model are depicted in Figure 2. More conversations are needed about which virtues are implicit in psychoanalytic counselling from a self-psychology perspective and

mature bi-polar

how they enhance Kohut’s (1977) conception of the

self. Just as there is some disagreement (cf. Beauchamp and Childress 1994; Drane 1994; Pellegrino 1995) among scholars with respect to virtues intrinsic to healing relationships in medicine, so too there can be disagreement about the virtues intrinsic to the psychoanalytic counselling relationship. Some might argue that the basic virtue of professionals is trustworthiness and all others relevant to being a

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good or virtuous professional are derived from that (cf. e.g., Bok 1989). We suggest that psychoanalytic counselling consists of a series of complex activities, and to reduce counsellor character to one over- arching trait loses some of the subtleties of the therapeutic effectiveness of the personhood of the counsellor. We have tried therefore to extend the conversation of self psychology and virtue ethics by attending to the complexities of their specific linkages with each other and their applications in psychoanalytic counselling.

Beyond counselling: enhancing prevention

There are other helping relationships in addition to counselling where we think linking virtue ethics and self psychology could be useful: for example, parent-child and teacher-student relationships. Counsellors and psychologists are often called upon to consult when there proves to be ‘trouble’ in such relationships. Frequently parents or teachers seem to feel out of control in encouraging their chil- dren or their students to engage in behaviours or activities these elders deem appropriate for them. Often they ask a consultant to ‘account for’ a parent’s or a teacher’s lack of influence. Explaining self-development from the perspective of self psychology, in partic- ular how self-injury can occur, can be useful here. Such consultations may broaden professional influence in helping to prevent or remedy psychological self-injuries with systemic interventions (actually accomplished by parents, teachers or other community leaders) apart from short-term counselling or long-term therapy. Many strive to be good parents or teachers but from a psycho- logical perspective are not knowledgeable or skilled with respect to what that might mean. Many are not sympathetic (or may even be hostile) to psychological approaches to child rearing or applying therapeutic techniques in the classroom (Kirkpatrick 1992). They fear that too much reliance on psychology could result in children with moral defects. A blending of ideas from self psychology and virtue ethics could be helpful here. Parents and teachers could be informed about their role in the healthy development of the bi-polar self. They could learn as well about how the self has surfaced in the area of ethics or personal morality in the newly emerging (really re-emerging) scholarship and commentary on narrative and virtue ethics. For example, Baron (1989) states that personality is not complete without a study of the moral self. From some perspectives psychological approaches in the home or school are too ‘permissive’

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and morality approaches are too ‘restrictive’. Blending these topics could balance these perspectives. Parents and teachers could learn how to be appropriate targets for idealization and how to engage in appropriate mirroring of a child’s grandiosity. They could learn about how the implicit virtues that many of them probably already have can assist not only in providing models for children but in enabling them to be empathic, restrained and, when necessary, confrontational in establishing good relationships and productive working alliances (Bordin 1979) in their roles as parents and teachers. They may be able to gain insight as well about how their own self- injuries may influence the ways in which they enact these important roles.

SUMMARY AND LOOKING AHEAD

We have suggested that Kohut’s self psychology is a good vehicle for understanding what brings a client to counselling: namely, disor- ders of the self or self-injury. We review strategies and ‘ways of being’ a counsellor must bring to and offer in the counselling encounter if the work is to succeed. We also examine implicit qualities (beyond the achievement of a mature bi-polar self) we believe a counsellor or any facilitator must have if counselling or other helping rela- tionships are to be effective. We purpose hrther conversations and empirical analyses which specifically and conceptually link critical components of psychoanalytic counselling to self psychology and to essential counsellor traits or virtues that seem intrinsic to good coun- selling practice.

Michael J. Patton Professor and Chair, Department of Educational and Counseling Psycholofiy, University of Missouri-Columbia, 16 Hill Hall, Columbia, Missouri 65211, USA

Naomi M. Meara, Professor and Former Chair, Department of Psychology, University of Notre Dame, USA

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