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    Object Relations

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    Arthur Robbins Object Relations and Art Therapy (1 An Encounter with a Patient's Inner World A pavint comes ito my office 1 2 sanmeaiately aware of er eves, 8) WE sad Tiquid emptiness. Her face Gs presiontess an occasional Sm breaking through. At Fa vena ad very tired. AS = occfalds, {learn that she does nol nes 47 one ore has asa come FO Ne tat estate THsshould low Nero toot she busily, even frantically, move paren ask to ane. She feck he cass ingby her, becoming increasingly move peta the span of one ifetime 70% endless re aly she feels Younse® than Ne" rns den a series of hort and [Ong SX affairs for this woman. Some disso elena they beginsothersare filled with Pat ove jae Aveo tasin a YAU PO veeye am interested aed Htrigueds Wy strangely ed, There's an ethereal ‘Jalty about tis patent that dee metigity or definition. The that comes quay atone and strongisthe depth ntiness and sense of bein Jmpulse to be war th as she eludes me, He sands) PPY Aen Anu, the sty Of 8 YOU vy Fore, eroticism ole) sore defined which she meres dain the session” S01 8k ES would De enh nome, She realy Brees j all at hae ing ne 8 of 1y,alllooking quickly #80 jn nmonochromaticblve. There pata lack of im ina arealany pleased with one Pa Ato Pot heel the art tat Tae co sensu a any aout tn dana She does BS Fawr is chapor appear Tie Ar eo jan by Arti Bi Packs of ed by permusian ofthe pulses Object Relations and An Therapy 55 = en! Figure 4.1. pictures, however: The hands reaching out (Fig. 4.1B) represent the part of herself that heeds tobe a part of something bigger. In the fourth (Fig. 41D), representing the Jewish Community she loves, she expands further: “All those people around a big ark in a Semicitcle meet and ate part of something bigger.” Again, Iam aware of eyes, as those in the picture stare out and search to be taken in, Her drawings are like soft, sensual fragments, reaching out to say “Hold me.” “The patient's representations of her body (Fig 41) sem segmented rather than for inga flowing whole, leading me to wonder whether the holding she had received had been givenby someone who was disengaged and unseated, Pulting these impressions Me mana es i Jnodynamic Approaches Figure 41. (Continued) feness and supertic tory mechanism Foret snd child's early resonance giving her feeling of liv see the religious fo acting asa compe ‘long, with her esotcis, W connections, that of the mother nections apoken of her mother J sense Be Fg A Dre, eaiyovereliming 9 Ret NE The il PE fr contact while atte sae Og gether, sionand, ‘the most bas ‘Although this pat room, She isa brisk, hurries jai dwells within this P Figure 4.1, (Continued) 58 Psychodynamic Approaches frightened of being overwhelmed and controlled, 26 he was by her mother. These dual pullseause ber to ragment and io become fast when intimate contact is offered a pase Pe tee a images of the meter permeate (M6 ‘atmosphere, 2 sense of Rer atnesteowrds into the room with us in spite of his having BO ‘unmentioned by the patient. Isuspecthe isthe aoa rpc piysicalcontactand warmthin anonverbal Play offering her some semblance of definition. Discussion In this brie description, plex interaction of objective Ie ectie vealtis that create a psychologial space beTwes” ‘people, from the api of therapy Within thsspace, pastand resem merge tocreate aunique mood eed atmosphere experience the patients spar representations ofher pastexpressed in Aepreent sence, ar sex teats, moody on attitudes originally connected the Pres eaonhips as they ave represented in images and PERS ‘hat literally fl sy office. vote. tentations speak ofthe me and ou inside ACh O° that create our ine tiouinl perceptions ofthe worl, and atte same dine 8 and shape the soc divi oe to each of us. The representations witha 21) 21 patient make srl rape aatonships [carry inside me. My inter) OWT father, and child come of the ptient at points of simile experience, PTE ‘and feeling, reasgettoknovs one another becomes cea thal 0h single encounter between to Trp, nee are multiple levels of consclousnehs eNO fo the engagement, a8 the eer ahaps from each person's past make contac, and Becasionaly lose sight of ne another. the ga dimension this engagement Sometimes the Nt mIETE deepens whet ss already going om in the relationship. b the artform may offer some thing diametrically opposed tothe verbal fed dimension gives a new Derapective on our internal elationships, 6 8074 of conscious. spect nteralze relatinshs, with ther ffect on me ccarrent realty, ves ese a object relations theory es] uestinmy praise 1A 7 refering dance lied theory which canbe foundin asingle book ‘espoused bya particu toa Sy use ofthis term reflets my own cstilaton fom ® ‘body of theory in psychoanalysis. qi poatyack ois roots in payhoanalytictheary the oble object relations theory sehen Ene who ane what in which a person’ slibidina! ene) invested. By “ibidinal ree Taenn that constitution reservoir of ener Nn that is part sexual, pat artdeve, but snore than either tis the fel sk oN each of us 40 reach out fy ar and contac withthe world Wahi hie fame or ‘human behaviot ane uatzed within a tripartite system of ego, on¢ NAPE ‘which, i coreeP id creates te conic manifesting themselves m(heTANBE of defenses Symptoms characteristic ofthe neuroses s gh elec primitive fantasies, ese, and 05° constant ee res ee fl and fo find satisfaction. Deivatves of Tess forces aft 1 put if in such formas dreams an fetes, an te stuff of Pi tress thinking Wit maturation the ego and SPE ‘ounter and modify the Prereesr the ego, with is rational, logical, secondaty POSS thinking, ifeeprate the demands of outer realty with the ine world the superego: integra iy conistng of such notions asthe del, ood, ba and evi, if Object Relations and Art Therapy 59 ithe ego's reactions tothe id, An imbalance among these forces is thought to arise when the oedipal crisis is not successfully resolved. Paychoanalytic treatment of the neuroses is directed at analyzing defenses, resis- tances, and the transference, as well as dealing with such issues as shame, guilt, and Uixie intheneurotcindividual, there isa clearsonse ofanestablished internal meand you. Much emphasis is placed on making the unconscious conscious, and on bringing, primary process material within secondary process organization. The ideal outcome of frerapy s modifying the defenses of the ego and prohibitions ofthe superego, tallow the patent's life space to expand and to tolerate @ richer symbolic and imaginative existence. ‘The patient described in the opening paragraph does no fall within the neurotic eate- gory. Like many, she falls into the wide continuum of primitive mentalstatesincluding— the psychotic, borderline, narcissistic personality, mood disorder, psychopath, and schizoid—all of whom suffer from deficits and problems in the early mother-child relationship. Therapy for these patients cannotbe in making the unconscious conscious. ‘That isnot possible, asthe disparate systems of mental structure lack integration and cohesiveness. The task. therefore, becomes one of building rather than uncovering, and cofcompleting lost dialogues ofthe early maternal matrix. Resonance is important inthis kind o therapeutic encounter. The therapist “mieror,” or offers emotional responsiveness, which facilitates the process of empathy, crucial in this treatment process. For instance, in the description of the patient in the opening pages, central theme of treatment would be object loss: the absence ofa central igure to give cohesion to the patient's lif. The cognitive awareness of this issue by itself ‘would be of little help to her. She would need a relationship in treatment that would both repair the damages of loss, and give her the courage t live through her feelings of pain and abandonment. As in ll treatment where the problems involve inadequate early object relations, there is a paradox. The therapist cannot actualy be that which the patient lost, yet the therapist's presence and actual living with the patient's problems serve to repair the original damage and problem. In this tteatment, we experience pation's'early losses and problems, contain and organize their experiences, and hope togive thernaclimate where trauma, disappointment, and confusion can be reorganized on a higher, more satisfying level. Other issues in dealing with more primitive mental states are oss of boundaries and regression to fusion states, both of which will be tested out and experienced within the treatment relationship. The Role of Art Ach inthis context canbe a container or oganizer that misrors intemal object ations, 2s well as associated defenses and developmental problem The celationstp offers 8 safe framework within which to iavestigate and experience the object world. The expressed artform will exhibit the various levels of definition the relationship creates. Thus, in the opening clinical example, the sbstract, but sel-contained quality ofthe at rierred the quality of the initial therapeatic relationship ‘Art therapy offers the possibility for psychological space—that whichis created through the interactions two individuals—tobe reorganized by mirroringor complementarity (offering opposites). This space has much i common with what Winnicot call transi tinal space (1971), tis an intermediate area thats neither inside nor ouside, but which bridges subjective and objective reality. By extension, dead ox phological! space can also ‘oceus ether in the art form or inthe relationship, when expression is weighed down by rangement EO SST 60 Psychodyriamie Approaches pressive defenses, Relationships are on oP Anood interactions. Pathological space #6 ot particular Space, ond can be experienced on atleast Wt cifferent levels ace, Save at the various representations of Ye patient's world are shaped andl ene ough atic frm, Thik also happens Wi the interpersonal therapeutic cele py canelther complement of ICT! WHS S going onin the artexpression. Fratnerapits kil isbrought to bearin main sn nEe psitve, supportive relationship Tae ers Proud, or structure, inorder forthe att UEY ‘process to proceed. When pathological space takes over the inferachn requires ingenuity and creativity to Pano he Nien object relations and fo find the “pproprate art form to regenerate psychological space Tmplicit in these oti sitional and pathological space isthe idea hat fe energy systems, which shape and form the space aro iierent levels of openness or closure, completeness oF s the art therapist offers @ GE tistic form to a personal image, snore awe moredirectly hooked to-eelity ‘Changing poeticmetaphorinto art expression sword a ranstion toe word of word, aed bape ie snake sense ofthe truism that although verbal tn alisctrong)y connected treaty, nota reality isencompas by words. Prom this perspective, difers™ evels of reality can be experienced Oy eoreood within the context of nonverbal expres ion “The act form, then, organizes yet eelatons and miszors them back to Fhe patient. (1 Developmental Object Relations nhezent in the cinical use of object relations theor} & © deep-seated underst ical sof ntl lines, and how they marist heme Mind his heirs postulated a develope somal cle ati ey believed at OF ed overwhe ‘hatit overrodeall that wrentbetore Margate Mahler incorporated Freud's drive arg snw immportance in he fist thee years of Tifeand the vicissitudes of the Daal a hn shaping the personality (MARNE: Pie, DEAN *975). tisha e randaions ofan side me and you ate nN AOA ; athe foan(iy7) evelopmenl levels begin with sO of normal a eenann py fl oneness with moter At about Ise Tmonths the ‘Object Relations and Art Therapy 61 rent begins, with what she calls symbiosis, Slowly, out of a nondifferentiated “tite, he me andl you inside the child become defined, As we trace the stages of sym- ‘Bass where mother and child struggle with separateness and sameness, individuation ‘ee dferentiation aze born, and the child proceeds through the subphases of ching, cng, and rapprockersent. The child's grovth—from symbiosis to seperation an pejvidutlion —culminates in achieving an identity and objec! constancy “atthispoint, atabout twoand abalf, thechid hasa firm senseotselfand differentiated er and con relate to people as wholes, rather than as need-satisfiers, A child can now (Glerate ambivalence, having mended the splits of “good” and “bad,” and can maintain narcissistic equilibrium by a form of self-feeding and self-affirmation that is unique tohimorherself Pathology of Object Relations Horner (1979) gives afine outline of some of the problems associated with each develop mental period, connecting pathology with issues stemming from faulty early abject re- Istions Problems in the autistic phase form the basis of primary infantile autism, which ischeracterized by @ lack of attachment and organization. Psychopathic personalities are viewed as having had problems in making primitive attachments, although having had a satisfactory initial period of normal autism, Around the fourth and fith months, ‘when normal symbiosis starts, failures in differentiation create difficulty in discrimi- rating inner and outer reality, seen in psychotic states. Schizoid character formation is seen as stemming from denial of the atiachment, which begins in the differentiating phase of symbiosis, Finely, in the rapprochement tage, occurring somewhere between 12 and 18 months, there ae failures in integration and self-cohesion. Problems here result inthe border line and narcissistic personalities. Both types retreat from autonomy, the task of the rapprochement crisis, but they chaeacterstcally do so in different ways. The borderline personality tends toward fusion states anda pervasive use of splitting good and bad in the search forthe ideal; whereas the narcissistic personality takes efuge in a grandiose self. Although differing in form, there isin both an attempt to return to the perfection ofanearly sate ofoneness with mother. The affective disorders are also associated with failures in the rapprochement stage. These patients have rot resolved the dilemma of good and bad existing side by side in one space. All that is “good” and nurturing remains on the outside, while their “bad” hunger and greed stay on the inside. Art Therapy, Creativity, and Play As just described, each developmental problem generates a particular clinical picture, with its own pain and anxiety, which is recreated in the therapeutic relationship. The att therapist is faced with the challenge of differentiating sometimes similar pictures ‘and reacting appropriately. Put another way, each requires a complex art frame, to help transform pathologi ‘al into therapeutic space. Where pathological space lies stagnant, therapeutic space promotes new solutions and new potentialities, with the accompanying sense of a self being reborn. There is room for new relationships and expanded levels of aware- “The challenge for the art therapist is to provide an art experience that makes this transition possible, and keeps therapeutic space alive. Canned recipes related to each 62 Psychodynamic Approaches developmental level cannot nope fo aggre sesues of such complexity: What is called Sipon isthe at therapis's arity) nang a conscious ayinboie awareness of the Jareork ail te reatonshiP-10 6690 the therapeutic process moving. tients es 1973) conceptvalization of ee ity ond play help te together, oe shreads of developmental theory he Foe, and therapeutic vchnique, WAC approaches these relationships For jduatshandle inner approater pace. He begins at te tat of 1 the mother’s anticipation of her ays needs allows the infant to matsit Me. oton that moli's breasts at of the infant om bie, therfore the human ng i concerned wi tbe problem oT relationship ram bat objectively perelved and WP “jective conceived of ad 3h ofan of tis robles ean eho has not been stare rll enough by the mote wre art bere pinay crt a cen ey esting, TH theif enemenarepecent nee SBE Soe ofillasion, without which there wansiona Porte human being in eS Ilonchip with an object 3 perceived foun as extera to hatbedng orsic 397,10) Ceeativit, then, sen win He One “of human development. The origins of ‘ugten provide the foundation fr the cree of the transitional space of NET at Meret. in this space the hill 8 At st ne the fsion thatthe world is utes eh can maintain ihe isl state in ee Only gradually = this losin of arose seorganized, to take inthe dere 4 “Phe goal of development, howeve in, but of developing, the skills and techniques to make OvF thin the contest fof human relationships, Permit jal ko become congruent Olah the outside, so that each person "The ability to actually e the seat of one’s social world is contingent om Tving successfully met the ‘developmental Challenges of one’s Past artes because of the deticiencis ant problems of one's past artiste may bea means torediscover reat an Epovation although thiscreatvit) Ma Tany overinto social elaionships Wat know of artist for whom this {500 ‘Artalone, carry over suppentve therapeutic relations grat not separ developmental 2eFichs thot cae recover ear creativity a8 the transitional bridge inner and outer says Winnicott (1 the patient to become a must be ready to play. Pay faving fun, although capacity torel Prexperiencing and working With er apace, mages and symbols Move vromgciousness with their own organization ogarding time and Pee "Through symbolic Pla reine peyehological space, Both WN the art form an Sead content becomecne, rough synthesisof primar Form allows the merging of bound $n ‘unbound energy, and BF ‘Rajon and separateness, and organizahich and loss of control. Therapeut Recomes the means by which to creates Shalding environment” of related becom within which defiitsin early objet Metations canbe repaired andthe Po daorreatve living can be regenerated Object Relations and Ant Therapy 63 proaches for Patients at Different Developmental Levels ould be noted that problems from each developmental period requize a different tavof “balding,” For instance, in patients who have suffered extreme deficiencies in rormal autistic phase resulting in autistic psychosis, the holding environment in {heart form and relationship involves structure, sensory contact, and a capturing of the pth in dschythic patients ‘patients who have been traumatized in the early stages of symbiosis, when self and Guher have not been clearly defined, require structure and boundaries, as well as clarity ghd definition. Becasse their worlds are so chaotic and disorganized, the holding needs tape gente, bat firm, with words to clarify and to connect the workds of image and cnster reality. nMFor the psychopathic individual, whose capacity for attachment las been severely Impaired, the world of power and games is the language that connects him to people. Tobeetectve, thea therapist must enter this world, and play within ts rues. Demon- strating a degree of savvy and alertness to the psychopathic game pian is important. Conversely, “feeding” this kind of patient with materials or love, with the hope of pro- viding and promoting atchment, is a misuse and abuse ofthe therapeutic relationship. Here asin all instances, avoiding experiences that are out of synchrony with a patient's objet life isthe prime diagnostic and therapeutic isu, requiring skill and artistry as wellas thought. ‘Much has been written about the borderline patient, and I refer you to Masters (1976) and Kernberg (1975) as important resources in this area. Here the patient is stuck in the rapprochement phase of separation-individuation—the “terrible twas” — ‘when a parent often feels he can do nothing tight. The child, aware of separateness yet frightened of aloneness, wants to go in two different directions at the same time. ‘The dilemina is to separate while maintaining connection. As he screams, yells, and says “Nol” the child's cries for autonomy are enmeshed with the silent need to be held, a ned often rejected when the parent tres to come near. In a two-year-old this is understandable. In an adult patient, the picture can be confusing and infuriating. Maintaining a cognitive understanding of these issues is of immeastirable help tothe at therapist ‘This patient titeally consumes both art materials and patience, The task ofthe art therapist is to keep a very strong and clear perception of what the patient is regressing, to, when he or she becomes frightened and “disappears” beneath a cloud of hunger for succor and support. Also the art therapist must not be taken in by swings between dovaluation and overevaluation, and must be sensitive to the ever-present splits of {good and bad. This patient is wonderfully adept at splitting a therapeutic team into warring camps. Also part ofthe picture are such defenses a8 projective identification {identifying with what we projet outward), withdrawal, introjection and dental. Man- ifesiations of these must be attended to and confronted in the art therapeutic play Neediess to say, passive approach isnot the best holding environment for the border- line patient. By contrast, the idealization a narcissistic patient offers an art therapist isn’t usu- ally defensive in nature. Unlike a neurotic, who idealizes to defend against hostility, idealization is an important developmental sep in hs treatment process. This patient has not been adequately mirzozed or affirmed by a consistent maternal object, s0 the art therapy interaction can provide a crucial reparative opportunity, offering the long- soughtafter mirroring and definition missed in the ealy family matrix. The interplay fart and the relationship can vary. At times the patient may take in the mirroring of the G4 Psychodynamic Approaches astin a way that parallels the therapeutic relationship. Arothers, the patient's i183 rat oeth he och wanted/ feared mirroring SS te uous that itean only be tolerated nonverbally. Depressive ually from thatused by the fevel, patients with affective inside themselves and have bi s while expelling all that fe good. Art exercises ate directed = ents find strength and self-worth, heugh the discovery oftheir own ests BS Rion. The nourishment found in perience of mastery promotes the discovery ‘pn good self dhat had been Tost, fused ‘path an internal bad object ith an i herapit’sasessment of developments Jevel and his or her ability 40 exp sence, organize, and reflect back the inner Se ss the person provide the envirorument Fe cena to rclima lost experience, a4 1° ind new levels of self-definition and integration. “Bran. I cannot emphasize 100 ONE TA growth oceus from the process of £98 mot emp anmet stage of development aes 1h, from the therapists ‘otient's hunger. I sepeat the paradox ‘of treatment: Tam with you bat pation’ your need, but Cannot take away YOu" FET, ‘To rab a patient sepreecrges pain, and despait, no mater how trail intentioned, is to do a disservice See ar erapats con offer isa holding envionment ‘which ean make pain bearable, Wa allow progres and growth 0 proceed, raped in this approach ithe notion of “oat in ou internal psyche structne, 2 duality that necessiates experiencing af on loag ahe same time softness and hardness antec and lack of it, distance and closenc™, warmth and cold. The resonance art

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