Bila et SN 2, HE oseansiosnoy Bor ibietwam THE O.R.T. (THE OBJECT RELATIONS TECHNIQUE): A Reintroduction Danielle S. Knafo, PhD Long Island University ‘The purpose of my writing this essay is to familiarize readers with an interesting projective device called the ORT. (the Object Relations Technique), witich has been described by James Grotstein as “an innovative and unique descendent of the heritage of projective testing on one hand and of projective aspects of psychoanalytic clinical technique on the other (1993, pp. 1).” Its an objectfied (operationalized) method for the assessment of an individual's actual, underlying models for relationship that has been employed primarily as a clinical therapeutic tool. Its history is as interesting as the technique itself Origins ‘The English psychologist Herbert Phillipson (1911-1992) originated the O.R.T. during bis tenure at the Tavistock Institute, where he later served as chief psychologist until his retirement in 1974, He had been part of the famous British War Office Selection Board (WOSB) for officers, specializing in mental assessment and working closely with, among other major contributors in the fleld, Henry Murray. Phillipson developed the ORT doving the postwar years, His ideas for the technique evolved primarily from his obser- vational study of group therapy sessions at Tavistock, with attention in particular to interpersonal projection. Phillipson recognized that the Rorschach (1921) possessed a perceptual openness offering a certain optimal “space” for projection but, because the stimuli were abstract, it did not sufficiently access perceptions of persons and projections onto them, The T.A.T. (Morgan & Murray, 1938; Murray, 1943), on the other band, introduced lhuman figure stimuli as well as narrative as the irreducible erux of human experience. Phillipson saw that in human figure stimuli one bad the most natural opportunity for expression of a subject’s actual relational models and that responses should be fully narrative. But he also considered thatthe familiar T.A.T. images unnecessarily constrained the perceptual space available for full subject projection. It was stictly a narrative method, rather than one based upon the actual (phenomenal) immediacies of experience itself ‘Danielle S. Knafo, PRD, Clinical Psychology Doctoral rogram, Long lslaad University. ‘Comespondence conceming this article should be addressed to Danielle S. Knafo, PLD, 20 Gilchrest Road, Grest Nesk, NY 11021. E-mail: dinafo linda 182THE OBIECT RELATIONS TECHNIQUE 185, Phillipson endeavored to incorporate the best of both the Rorschach and T.A.T. innovations by using human figure stimuli asin the T-A-T., but with a perceptual plasticity broadly analogous to that of Rorschach inkblots. Consistent with his owa deeply ingrained Tavistock sensibilities, Phillipson conceived his Plates as Winnicottian “mirrors” for the world of internal object relations, the so-called Inner World. He meant them as “transi- tional objects” (Winnicott, 1953), in that a subject's perception of each of the special images will be something the subject part-diseovers and part-creates, Tavistock published the ORT. Plates along with a manual by Phillpson in 1955 (Phillipson, 1955), Phillipson employed a method similar to that employed with the TAT, that is, the subject is asked to create stories to the Plates, However, in the ease of the O.R.T. subjects rite their stories (vs. dictate them to the psychologist), inviting them to be alone with the Plates and with their thoughts. The idea of a fixed matrix of human and interpersonal relations (see Figure 1) derived from psychoanalytic developmental theory, introduced a structure that did not exist in either the Rorschach or T.A.T. stimulus series. This perceptual technique was made specifically for the purpose of tapping into subjects’ ‘unconscious fantasies and their intemal object representations and relations. Tn the years shortly following the publication of the O.R.T.. Herbert Phillipson became rather consumed by an involvement as second author to R.D. Laing on a book eventually published under the ttle Jnterpersonal Perception (Laing, Phillipson, & Lee, 1966), which hhas been widely read in Latin America but, like the O.R-T. itself, is today hardly known elsewhere, By about 1970, Tavistock had withdrawn all support from the O.R.T. and the technique became all but forgotten. Enter Martin Shaw, a developmental psychologist and psychoanalyst with an expertise in visual perception. While studying in Madison Wisconsin, Shaw became a Piaget scholar with a special concentration in cognitive schemes and perception as a form of action, He wrote his Ph.D. dissertation on nonconscious visual perception. Shaw devel- oped a keen interest in the O.R.T. once he became aware of it, He discovered it was long Infancy Latency Maturity A-level Bevel C-level = (| (| ( -~- [| (=| (a om [| (| [ oo [| [Mi |[m Figure I. The ORT. Matix of levels (A, B,C) and settings (1. 2 3, G). Reprinted with permission from O.RT. Institute, Copyrigit © 1900-2006. All rights reserved.tet KNAFO out of print and made it his personal mission to revive its reputation and applicability Before doing this, he had to engage in some detective work to track down this obseure and litle known psychoanalytic tool. [a 1980 he located Herbert Phillpson and he traveled to England a number of times over the next 6 years ‘Shaw leamed all there was to lear about the O.R.T. One unfortunate discovery was thas the all-important Plates were not only out of print but were declared, upon exami- nation by experts at the Museum of Modem Art to in fact be “irretrievable.” Undeterred Shaw consulted with Zeiss Opties, Inc.. and was able, by special technical means, to reconstruct the long-lost original master Plates, making a new edition possible. He also \wrote a new manual for the ORT, which was published in 2002. In 1984, he gave an invited address at Tavistock Institute on the role of nonconscious visual perception in the ORT. (Shaw, 1984), ‘The Plates Herbert Phillipson had approached two women artists, Elizabeth Carlisle and Olga Szekely-Kovaes to help create the series of 12, extremely subtle photolithosraphs that would be required for the O.R.T. Szekely-Kovaes was a known artist in analytic circles, and in fact published a book (1954) of her caricatures of famous psychoanalysts drawn from life at the Eighth (1924) Intemational Psychoanalytic Congress in Salzburg. Carlisle and Szekely-Kovacs created the 12 Plates for the O.R-T, These Plates were created on a matrix (see Figure 1) of four interpersonal “settings”: I-person or solitude, 2-person or the basic dyad, 3-person or potential rivalry, and last the Group setting, Each of them is represented in addition on one of three distinct “levels” of perception: (A) Infancy or birth to ¢, five years; (B) Latency or midalle childhood, e. 6-12 years; and (C) Maturity, adolescence through adulthood, ‘The various fine-tuned stimulus attributes of the Plates were created according to understandings drawn from the research literature in visual perception and how it accu- rately develops through the formative years. The A-level images, for example, establish the rudimentary world of infancy by using softly diffuse and textured graphics, reflecting earliest needs for contact comfort over and above visual (distal) objects per se, The B-level images curtail textures and contact-based stimuli and are superseded by sharp boundaries, distinctions and categories of experience (compare Piaget's “concrete operations”). The C-level images seffect a mature environment with indeterminate figures enclosed in domestic situations alone, with a partuer, in familial diseussion, or outside in confrontation ‘with an overpowering society or crowd. Phillipson believed that all three levels of perception remain active within us at all ages, which is why all 12 cards are administered to subjects in a fixed random order. ‘Human figures on the ORT. have been made purposely indeterminate as to age, gender, attire, movement, and affective or motivational disposition, so that the prepoa- derance of all such particulars must be supplied by the examinee out of his or her personal models, At the A level, the indeterminacy of the images results in a “misty/smoky/cuddly ‘kind of appearance, devoid of reality content other than a presence of human figures or an ambiance. The Bs present sharp boundaries and contrasts in a generally unyielding and texrureless object surround, refiecting the greater reality aud field-dependency character- istic of the latency years. In the C-level images texture reappears but is now articulate and bold, helping visualize the matuze needs and opportunities for contact which take shape in adolescence, including those peculiarly preoceupying ones attendant on genital awak-THE OBIECT RELATIONS TECHNIQUE 185 ening. Some idea of the stimulus properties of the O.R-T. is given in Figure 2, reprodueing small areas of two of the Plates. Scoring and Analysis ‘Narratives evoked by the Plates are objectified in this method by a system of action analysis that is fully operationalized, There are five steps involved, beginning with a crucial reduction of each story to single-sentence form, and culminating in schematic representations of the central action or relational “deep structure” of each theme. Through these steps the narrative material is abridged to simple schematic representation, The schemes extracted from each of the 12 stories are, lastly, assembled in an ORT. spreadsheet form corresponding to the Matrix (3 levels by 4 settings), Like the genogram (McGoldrick, Gerson & Shellenberger, 1999), this spreadsheet offers a certain visual overview of a subject's relational terrain, ‘Besides its amenability to quantification and hence scientific study, the O.R.T. Spread sheet also lends itself to a wide range of pattern analyses along more qualitative, clinical-exploratory lines of the petson’s unique relational development and personality formation. For example, what dynamics are shared by the various A-level, or Infancy. themes as against those in the Latency or B-level and Matwity, C-level themes? Do problems found among the As ‘contaminate’ later levels (epigenetic determinism) or have they managed to be genuinely assimilated and superseded there? In either case, precisely ‘how so? Whst parallels may exist across levels among settings of solitude, the dyad, the ttiad, and groups? Where do we see nestings of disturbance and, also, of special strengths across columns and rows? ORT. Manual Herbert Phillipson’s own approach to O.R-T. story data was qualitative and impression- istic. Seoring and analysis proper were later developed by Martin Shaw, who spent 10 years writing the new O.R-T. Manual (Shaw, 2002). This new manual for work with the ORT. Plates is a 232-page text intended primarily as a teaching and research tool, Strongly seience-minded and interdiseiplinary, it draws on sources in perception and developmental psychology as well as psychoanalysis and Object Relations Theory. Figure 2. Selected detsils of ORT. Plates, illustating their graphic subleties. Reprinted ‘with permission from O.R.T. Insitute. Copyright © 1999-2006, All rights reserved6 KNAFO Peychologist James W. Bagby (1912-1987) had made his own, highly innovative use of the ORT. over 30 years of independent practice and as a consulting psychologist to Roosevelt Hospital in New York. Bagby was one of Shaw's early teachers and had provided several key elements incorporated by Shaw into his final seoring system. ‘The new manual includes a central section on defense mechanisms along with a seale for their abjectified assessment, whieh is additionally cross-referenced with the DSM-IV section on “Defenses and coping styles” (DSMLIV, 1994). Shaw describes the scoring system with the help of flowcharts, case fragments, and an S0-page case of one “Ms. Dove.” Ms. Dove was an artiste 20-year-old woman who had an emotional breakdown at college. Shaw advocates analyzing the O.R T. story data together with the patient. As such the OR.T. became part of the treatment, a collaborative vehicle to help structure and move analysis forward, Miss Dove's O.R.T. analysis revealed that underlying a manifest set of anxiety symptoms and problems with heterosexual intimacy, lay a more basic relational fault that was centered on the earliest A-level mother-infant interaction. ‘A specimen story analysis from the new manual has been reproduced in Figure 3 to help illustrate the method, presenting both the single-sentence reduction and the final schemes derived for the CG (C-level, Group) story of an adult male. Shaw states in bis ‘manual that the initial reduction of each ORT. story to a single sentence is crucial because the sentence is “our quintessential unit for representation in words, profound at once for its expressive capacities, economy, and structural constraints” (p. 14), Here reduction has resulted in this, bare essence of the story in question: Despite being acquitted from some unspecified charge, a solitary figure (male) has the ‘worriments ofa hateflly glaring mob (mostly male) blocking his way “a man for whom I eel great compassion.” Consistent with procedure, some verbatim bits of this string have additionally been marked as conspicuous: the first to appear “(male)” next appearing “(mostly male)” and CG Model Despite being aguted fom some wspeciid cage, 2 solar gue (sal) has the worimoms of ely sling mb Gos male) Hosking his wey — ana forshom [fel aes comsaason LM ORALg $0050 f DEMONS (AMT ORAL Cazaane (Rey Riacenwone ft Soma fan) Rounction (ps FREE ono ff} 2 GRPM? DESTsyy — M Lens (Aen) REGRESSION [Der15] FERALARL = (Aird) -FROECTION Det 2] Figure 3. Semple nsrative analysis from the new OT. ManTHE OBIECT RELATIONS TECHNIQUE 187 thea ast, the mere afterthought of outright “man.” Prom these compressed story data, two raumbered sehemes have been derived to complete final searing. Now a proper account of this or any like specimen would plainly exceed the limits of a brief introduetion such as the present one, but nearly all basie components ofthe seoring system are represented and a certain, clear soapshot is thus already there. As with the Rorschach, to lear this technique is to learn and master the derivations of final scores. Which in themselves are easily acquired. Conceraing just the wo litle schemes in Figure 3, then, the following points are quite easy to see J Scheme 1, the man’s not-guilty plea has been diagrammed as an oral-symmbolie action (speaking = ORAL y,) taken by a male (M) upon an object symbole of superego Gudgefjury = SEGOsyy.) I the second and final scheme, where the man's acquittal is effectively overtumed, # DESTsyy, scoring records his symbolic destruction (despised outcast) by the mob (group = GRP, etc). For each ofthese schemes making up the final CG Model, a number of affects [AfFX] and defenses [Def X] have also been scored, The DENIAL [Def 3] scoring, for example, derives in pat from the story's strange treatment of its protagonist's sex, parentheses and other devices seeming rather at pains to half-hide the fact. The closely associated defense scoring of RITUALUNDOING [Def 10] ad- dresses, among other narrative elements, the deeply ritualized nature of trial by jury. In emotional terms, trials are of course all about one’s sense of DOUBT [Aff 17] and BLAME [Aff 20]. The swerve from trial by jury (Scheme 1) to mob rule (Scheme 2 is) Js on its face classic REGRESS [Def 1S], and s0 on. In the end this man's CG narrative would resolve into @ picture of a cartain bewil- dering (= unconscious) auilt complex that, for some reason, got built up around the sheer fact ofhis being male. An examination ofthe complete O.R.T. Spreadsheet would address how that evidently developed and why. ‘The spreadsheet provides a virtual map of a subject's psychie terrain, specifying areas of developmental arrest. These arrest-points can serve as guideposts for the analyst's attention to expectable defenses and resistances to treatment as well asthe establishment of treatment goals. The O.R.T.’s practical value, therefore, may appeal to those who wish psychoanalysis to be more focal, structured and efficient. The Previous O.R.T. Literature With its own manual, Herbert Phillipson’s invention has for the first time a data analysis system that is at once comprehensive and objective. Through the previous ORT. literature, beginning in 1955, data analysis was necessarily confined to variously delim- ited, ad hoe measures. As might be expected from the history already recounted here, the same literature has been sparse—about 1.5 items on average per Year over the approximate half century, and many of them in journals of relatively Limited international distribu- tion— and yet one finds even there @ noteworthy range of interesting O.R.T. applications in both research and treatment. ‘In one Finnish hospital-based research (Koski, Holmberg & Torvinen, 1987), for example, the O.R.T. was used to compare diabetic (7 = 24) and nondiabetic (n = 21) adolescents for presence of alexithymia, The results not only supported the suspected link between alexithymia and the juvenile onset metabolic disease, but helped significantly to elucidate the subsurface dynamics of this interesting comorbid association. 1n their Springer-Verlag volume on Need-specific treatment of schizophrenic psycho- sis, another Scandinavian group, Alanen etal. (1986), employed the T.A.T. as well as thess KNAFO ORT. to make various assessments. Ad hoe scorings of both instruments were reliably predictive of success in psychotherapy through 2-year follow up). The O.RT., however, surpassed its famous predecessor at illuminating the respective parts played by such subsurface factors as “self-object differentiation,’ “tolerance for depression,” and “tenden- cies 10 paranoiaciomnipotent control of object representations,” an effect the authors aseribe altogether to the enhanced visual plasticity of the O-R T. Plates. On a related note in Malan’s (1967) classie study of short-term psychotherapy. the Rorschach and ORT. \were together used to presereen patient candidates for the research, Several other published studies from over the years have found the OR T. to be especially effective for treatment sereening and planning, and the new manual has a complete listing of the ORT. literature 1955-2002. Here it must suffice to note such other, diverse areas of application as: (a) assessment of waking fantasies following interrupted and completed REM petiods (Fiss, Ellman & Klein, 1969; (b) the study of interpersonal perception in adolescence (Coleman, 1974); (€) the ORT. as a training tool in psychotherapy (King, 1988): (@) agoraphobia (Gleed, 1974): () personnel selection (Sandal! & Sandahl, 1990); and (f) studies of adaptation to trauma (Koenig, 1992; Young, 1992). Conelusion ‘The ORT. isa tool with many research possiblities because it can be employed as a measure of object cepresentations and relations. Ts most common research and assessment uses to date have been with forensic and delinquent populations, vocational and educational guidance, and ‘work: in human resources. Most ofall, the O-R-T. isa method which invites the expression and elaboration of unconscious fantasies and, as such, offers a uniquely structured assessment of what a person perceives, experiences, and feels, and the ways a person's relationships come into being in the frst place (Knafo & Feiner, 2006). References Alamen, Y., Rakkldinen, V.Laakso, J, Rasimus, Ry & Kaljonen, A (1986), Towards need specific tmeannent of achizapivenic prchasis. New York: Springer-Verlag. Coleman, 1. (1974) Relationships in adolescence. London: Routledge and Kegan Paul DSM-IV (1994), Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC. American Psychiatrie Association, . H. Bllman, S., & Klein, G. (1968), Waking fantasies following intermpted and completed REM periads. drchiver of General Paychiatry, 21, 230-239. Gleed, E, (1974), Some psychological mechaniatas in agoraphobia. British Journal of Projective Psychology, 20, 27-33, Grotetein, J. (1993). The O. TL: Value in reatient: Retiieved from hip: wens omtinstinate org rotten bl ‘King, D. (1988). Pillipson’s Object Relations Tecligue as an aid tothe teaching of psychotherapy. Brush Journal of Projeenve Paychology, 33, 106-113, Knafo, D., & Feiner, K. (2006). Unconscious fantasies and the relavional world. Hillsdale, N3 ‘Analytic Press Koenig, W. (1992). The presence of survivor gult in the sequalae of elective abortions. Unpublished Aoctoral dissertation, Professional Schoo! of Psychology, San Francisco. (University Microfilms No, LD-02, 523) otk. M., Holmberg, R., & Towvinen, V. (1987) Alexithymia in javenile diabetes. Peylhiamsa Fennioa,THE OBIECT RELATIONS TECHNIQUE 189 Laing, R. D., Phillipson, H, & Lee, A. R (1966). Jnterperzonal perception: theory and a method of research, London: Tavistock, Malan, D. (1967). study of brief psychotherapy. London: Tavistock MeGoldick, M., Gerson, R. & Shellenberger, S. (1999). Genograms: 4ssessment and wnervention. ‘New York: Norton ‘Morgan, C.& Murray. H. (1938). Thematic Appereeption Test In. A. Musray (Ed.) Explorations in personality: New York: Oxford University Musay. H. (1943). Themasie apperception rest? Manual. Cambridge, MA: Harvard Univers Press. Puillipson, H. (1958). The olyect relations technique (Plates sad Maul). London: Tavistock. Rorschach, . (1921), Paychodiagnosties: A test based on pereeption (P. Lemkau & B. Kronenberg, Trans), Bem: Hans Huber Sandal, C & Sandahl, P. (uly, 1990). Expesiences of the O. RT. in industial selection. Paper prevented a te XIIth Intemational Congress of Rorschach aad Other Projestive Tecluiques, Pari Shaw, M. (1984). The objet relations eclmigue (O. RT): Perceprual considerations. Unpublished lectar, Tavistock Institute of Human Relations, London, 1984, Shave, M. (June. 2002). The object relations technique: Assessing the individual (Plates and ‘Mauual). Manhasset, Newr York: O. RT, lnttute (www extinstitate.or). Seekely-Kovacs, O.,& Bereny, R. (1984). Cartcanures of eight-eight pioneers m psvohoanalysts, ‘New York: Basic Books. Winaicott.D. (1983). Transitional objects and transitional phenomena. Imemational Jounal of Peychoanalyss, 34, $9-97, ‘Young. D. (1992). Adaptation o trauma. Unpublished doctoral dissertation, Professional School of Paychology, San Francisco. (University Microfilms No. LD-02, 396).