Working with Personality Disorders in Psychoanalytic Supervision: The Object Relations View

Object Relations theory has been particularly necessary to understand those who have early developmental arrest within their first three years of life, when the basic core self structure is forming.

At this Fall 2015 Open House, Dr. Susan Kavaler-Adler will address the phenomena of Borderline, Narcissistic, and Schizoid conditions in developmental object relations terms.  She will speak about the different psychic structure character formations, and how they require different psychotherapeutic approaches.  She will also speak about self-integration, psychic structure internalization, and separation-individuation – in relation to the psychoanalytic psychotherapist’s capacities to process dissociated trauma, since this dissociated trauma impacts the therapist as “objective countertransference” (Donald Winnicott) and as “projective-identification” (Melanie Klein, Heinz Racker, Wilfred Bion, and Paula Heimann).  She will speak about how every psychotherapist can be helped with the difficult task of processing projective identification and “objective” or induced countertransference through an object relations mode of supervision. This supervision involves “in vivo” clinical experience in the form of “role-plays” as well as in the form of “meditative visualization.” 

As primal trauma and its sadomasochistic enactments are understood, rather than reacted to in a retaliatory manner, each therapist in this supervision learns about the clinical technique spoken about by D. W. Winnicott as “object survival.”  Through survival of primitive aggressive reenactments, patients can begin to tolerate containing their own experience (Wilfred Bion on the “container” and the “contained”).  Then the therapist can begin to interpret the compulsive primitive enactments that were formerly too traumatically overwhelming to discuss. 

Once the patient/client/analysand comes to contain their inner compulsive reenactments, rather than to act them out in a dissociated way, they move from more primitive psychic state of being (Melanie Klein’s “paranoid-schizoid position”) to a more advanced one (Klein’s “depressive position”).   Then, symbolization naturally develops along with all the organically evolving ego functions, and internal psychic space and transitional space (Winnicott) allow the person to become an “interpreting subject” (Thomas Ogden), as well as to receive new “internalizations.”  The patient begins to receive interpretations, rather than experience them as an invasive persecutory assault.  At the same time, the therapist interprets how persecutory they are perceived when making interpretations. 

Can they then interpret being a Kleinian “toilet breast” as well as a persecutory “bad object” (as the Kleinians do)?  Through all this, the therapist learns how to be there with a patient, who by developmental necessity must mourn the loss of an early symbiotic object (prior to the developmental trauma).  Developmental mourning (Susan Kavaler-Adler) precedes, from the core self and object loss to later losses.  This understanding of mourning overlaps with James Masterson’s “abandonment depression.”  Without the working through of the “abandonment depression,” the patient seeks addictive highs that regressively return them to the “reunion fantasy” (James Masterson and Margaret Mahler) of being one again with the symbiotic mother (fused together with the mother in a split off “grandiose self” structure in the narcissistic character pathology).

The role-play will be used to demonstrate how the therapist responds, moment to moment, to the patient’s developmental trauma enactment, and intervenes with empathic attunement, within the “in vivo” clinical process.  One of the Open House participants will have the opportunity to volunteer and play the role of his/ her patient, to get inside of their patient’s internal experience, with Dr. Kavaler-Adler who will role-play the object relations psychoanalyst.