Children of Alcoholism: The Struggle for Self and Intimacy in Adult Life

CHAPTER 5. The Restoration of Psychic Structure in Psychotherapy

5 THE RESTORATION OF PSYCHIC STRUCTURE IN PSYCHOTHERAPY THE BRITISH object relations theorists, and Heinz Kohut , proposed models of psychotherapy that aim to uncover, clarify, and strengthen key aspects of psychic structure that have been distorted or badly damaged in struggles with parents. These theorists have all suggested that certain critical aspects of the true self have been driven into hiding (repressed or split off) as a means to preserve them. They thus believed that psychotherapy should aim at the liberation of the hidden self, and its integration into the central sector of the psyche. Their approaches to the unification of the psyche, or as Kohut would have it the restoration of the self, are remarkably similar in many respects and diverge dramatically from the classical approach to resolution of transference neuroses. Perhaps the structural approach is most easily understood by comparing it to psychoanalytic perspectives on several important aspects oftreatment, including therapeutic goals, the nature of transference, the problem of defense and resistance, and the process and technique ofpsychotherapy. The Goals of Treatment The classical approach to analysis and analytically informed psychotherapy emphasizes the analysis of repressed sexual and 72 Children ofAlcoholism aggressive impulses and their integration into conscious life. Liberating libidinal energy by lifting extensive repression allows the patient to seek and obtain gratification in work and love. Freud believed that self-regard was gained mainly through gratification of object libido (having love returned and possessing the loved object) and the sufficiently successful pursuit of the ego-ideal, which he conceived as a model ego, based on identifications with parents or with collective ideals (LaPlanche and Pontalis 1973,44). When analysis is successful, the patient gives up the possibility of actual gratification of instinctual urges that are at odds with the demands of civilized adult life. He also accepts gratifications which can be realized in relationships with nonincestuous love objects as well as through sublimation of instinctual urges in the pursuit of culturally approved ideals. Object relations theory-as it was conceived by the British school-and Kohut's Self Psychology, aim at much different goals. They are concerned with the analysis of early environmental failure, its devastating impact on the evolution ofpsychic structure, and bringing to consciousness those structural elements that have been repressed or split off from consciousness as a result of environmental trauma. Like psychoanalysis, these two theories aim at a loosening of ties to infantile objects, but they are not centrally concerned with the maturation and sublimation of sexual instinct. They seek instead the release from the unconscious of the massively destructive objects that the patient has internalized in the course oflibad" relationships with parents, and the subsequent renewal of the patient's self, and self-regard, in relationships with supportive and loving objects. Winnicott believed that a child's true self is driven into hiding by the parents' failure to adapt to compelling psychic and physical needs that the child experiences in early life. He found that the splitting off of the true self leads to psychic instability as well as great subjective distress. Winnicott proposed that the analytic situation provides an opportunity for an analyst to facilitate the emergence of the true self. He felt that under con- The Restoration of Psychic Structure in Psychotherapy 73 ditions of considerable psychological safety the false self can be surrendered, and the true self can penetrate to consciousness. The psychic split finally healed, the patient recovers her individuality and vitality and discovers a "new sense of self" ([1954a] 1975,290). Fairbairn was also concerned with the reunion ofa pervasively split psyche. Like Winnicott, he felt that psychic splits are the result of parental failure, especially extremes of neglect and abuse. Where Winnicott saw a true-self-false-self split, however Fairbairn saw a "multiplicity of repressed egos" ([1944] 1981, 94), each associated with "bad" (neglectful or abusive) aspects of the parent(s). He thought that the goal of psychotherapy should be to alter the "basic endopsychic situation" (p. 109), which consists of pitched and painful warfare between these psychic structures as they vie for control of the individual's pursuit of objects. In Fairbairn's scheme, it will be remembered, the central ego attacks both the antilibidinal and libidinal egos, as well as their objects, and the antilibidinal ego attacks the libidinal ego and its object. While Fairbairn said that one of the most important aims of psychoanalytic therapy is a reduction in...