Example responses –
This case vignette of Michaela demonstrates several behaviors related to her presenting issue and childhood experience that can be understood through the lenses of ego psychology and object relations theory. In this paper I will use these theories to develop an understanding of what might be happening for Michaela psychologically and some practical suggestions for working with her.
One of the first things that stood out to me in reading this vignette was Michaela’s thoughts that the clinician “needs [her]” because the clinician “seems quite lonely.” I identified this as a likely example of the ego defense of projection (Schamess & Shilkret, 2021). Michaela could be projecting her feelings of needing connection and loneliness onto the clinician because they feel too difficult to bear on her own. These feelings could be a result of her early relationship with her father where she “sought his approval despite his unavailability and what seems to be frequent rejection of her.” A pattern like this with her parent could have likely led to a negative-affect laden object relation. Goldstein (2001) describes Edith Jacobson writings about how infants can internalize an object-representation of a parent in a bad or dismissive mood with a corresponding negative self-representation related to the infant’s neediness. This would lead Michaela to feel that her need for connection was something unacceptable or bad, and thus explain why she might project it onto the clinician. This could potentially be related to her underlying sense that it was her fate to remain “alone.”
Another thought that comes to mind in relation to this projection onto the clinician of needing connection and feeling lonely, is passive-into-active testing as described by Schamess & Shilkret (2021). This involves the client acting towards the clinician in a way the parent acted towards the child. Michaela may be reenacting the dismissive attitude her father gave in response to her own needs, to see how the clinician will respond when put in a similar situation. This is an opportunity to begin repairing some of the initial wounding that is leading to Michaela’s current struggles. Schamess & Shilkret (2021) discuss how when a clinician is able to respond to the testing from the client in a more mature, less traumatized way than the client did when they were a child, the clinician can help the client disconfirm the maladaptive belief formed in the original relationship with their parent. In this specific instance with Michaela, the belief might be something like “it is bad to have needs.” The clinician, in disconfirming this belief, can open the door for further healing.
If it is the case that Michaela has this belief and it can be disconfirmed through experiencing the therapist responding to the same challenge adaptively, Michaela may be open to improving her object relations. Her experience with a needy, depressed mother and a distant, rejecting father would likely not have provided her with an adequate holding environment or atunement as described by Winnicott in Flanagan (2021), which could result in her developing a predominantly false self. The characteristic of the false self of molding oneself to the needs of others (Flanagan, 2021) can be seen in Michaela’s difficulty in ending her relationship with her partner because of her sense that Laura “needed her.” Providing a corrective, attuned holding environment in the clinical setting could help Michaela attune to her own sense of needs more clearly and thus help her move towards the more adaptive true self (Goldstein, 2001).
A final observation from reading this vignette is Michaela’s alternation between praising and criticizing the clinician. This suggests that she may be employing the object relations defense of splitting (Flanagan, 2021). Given Michaela’s unhappy experience of childhood and inadequate holding environment, it is likely that she learned to make use of splitting to order her early chaotic life experiences. Once again, providing Michaela with a secure, attuned holding environment in the clinical setting could allow her to safely experience the chaotic feelings of anxiety leading to the splitting and help her see the clinician, and others in her life, as more whole objects (Goldstein, 2001).
Example 2 –
When working with Michaela, one can consider using ego psychology and object relations theory in order to make more sense of the impact of her past on her current behavior and feelings. Within the ego defenses, self-esteem regulation is relevant because she appears to have low self-esteem by believing she will end up “alone” despite her life experiences proving otherwise (she has been in romantic relationships before, even healthy ones) (Schamess & Shilkret, 2021). She had a strained relationship with her dad who was “dynamic and successful” — she felt rejected by him and sought his love. Displacement, another ego defense, can perhaps explain sexual and aggressive feelings toward her father which she has now placed on another emotionally unavailable yet culturally acceptable person in her life, her partner Laura (Schamess & Shilkret, 2021). Michaela shows to be splitting with the therapist, an ego and object relations defense, by being appreciative of her therapist one day and using verbal put-downs the next. Perhaps the therapist offers complex perspectives for Michaela but because she is not ready to see herself or her life with complexity, she feels anxious and threatened by the therapist and thereby splits them into “good” and “bad” parts (Schamess & Shilkret, 2021 ; Flannigan, 2021).
Michaela’s mother was experiencing mental health challenges and drank often in her childhood, which may mean that Michaela experienced some neglect. She did not experience “primary maternal occupation,” or a stable attachment, with either caregiver, nor a safe “holding environment” where she could feel safe emotionally and physically at home (Goldstein, 2001). Fairbairn offers that through the “central ego,” Michaela is accustomed to internalizing objects (or people) who reject her, and continues choosing people who will not love her because of these internalized objects (Flannigan, 2021). Guntrip, another object relations theorist, may also pose that finally having love will destroy or undo Michaela, which can also be described as the fear of engulfment, in conflict with the fear of abandonment (Flannigan, 2021). Michaela appears to introject, or take in, the pain from her past and blame it on herself, in order to protect the goodness in the world and her hope of being in a satisfying relationship, however small that hope (Flannigan, 2021).
Michaela describes pushing away healthy partners and described them as “boring,” which could be an example of devaluation, an object relations defense that can explain why she may push people away before they can ultimately hurt her (Flannigan, 2021). Object relations can also help explain why Michaela told her therapist that they “seem quite lonely,” which is an example of projective identification. This defense is commonly used by abusers of domestic violence in order to de-center the person who provides stability in their life. In the case of Michaela, she is attempting to hurt the therapist so that she may feel better about herself or more in control of her life (Flannigan, 2021).
As Michaela’s therapist, I would first build rapport and trust with her by creating a welcoming “holding environment” so that she can feel safe in therapy (Goldstein, 2001) and feel more comfortable being vulnerable. I may explore her projective identification with her by asking “Tell me more about me as a therapist and how I seem lonely. Would you feel more similar to me if I were also lonely? What would that mean for you?” This may get her to open up about wanting to feel similar to someone else or wanting to feel as though she’s not alone in her loneliness. As discussed in class, sometimes the therapist needs to be disliked or put down by the client for certain exploration to happen.
I may address her object relations by challenging her beliefs that she will always be alone or rejected by others even though this pattern may be deeply entrenched for her. I would ask “Tell me about your past relationships that were ‘boring.’ What was boring about them? What does excitement look like in your relationships?” This would allow me to get a better understanding of her sense of excitement in relationships, which could very well mean instability to an extent, because she appears to be recreating the relationship she had with her father. Michaela also mentions being in a caretaking role with her mother in childhood, which she appears to be doing in her relationship with Laura. I would work with Michaela to explore ways that she can take care of herself if she continues to see Laura, while also providing psychoeducation about the cycle of abuse so that she can make a more informed decision about what may be right for her moving forward.
References
Flannigan, L.M. (2021). Chapter 5: Object relations theory. In J. Berzoff, L.M. Flannigan, & P. Hertz. Inside out and outside in (5th Ed.). UK: Rowman & Littlefield.
Goldstein, E. (2001). Chapter 2, The evolution of Object Relations Theory and Self Psychology page 22-40: Object Relations Theory and Self Psychology in Social Work Practice. New York: The Free Press.
Schamess, G., Shilkret, R. (2021). Chapter 3: Ego Psychology. In J. Berzoff, L.M. Flannigan, & P. Hertz. Inside out and outside in (5th Ed.) (p.249-268). UK: Rowman & Littlefield.
Example 3 –
When considering the case of Michaela, a 40-year-old single woman who sought treatment because of a deteriorating relationship with her former partner, the first thing that jumped out at me was the parallels between her romantic relationships, and the relationships with her parents. Although Michaela’s father was cruelly unavailable to her, and rejected her frequently during her upbringing, Michaela displaced all her feelings of disgust and anger at him onto her mother, who was depressed and drank excessively (Schamess & Shilkret, 2021). Despite Michaela voicing her disgust at her mother’s actions, she chose Laura as a romantic partner, who was also depressed and drank excessively. One explanation for her choice in romantic partner could be seen through the lens of control-mastery theory. Michaela felt shame and guilt for the way in which she venerated her father and put down her mother, to help mitigate the guilt and shame, she chooses woman who resemble her mother in presenting problems. In doing this, she is unconsciously and retroactively, helping to “fix” her mother’s issues (Schamess & Shilkret, 2021).
Because of Michaela’s upbringing, and disturbances in her object relations, Michaela withdraws from healthy relationships and instead focuses energy on unhealthy ones (Schamess & Shilkret, 2021). This is illustrated in previous relationships when she found women well-functioning women “boring,” and pushed away one woman in particular who wanted to marry her. When she pushes away stable women who want to marry her, Michaela feels tremendous shame and regret, and she falters in her self-esteem regulation (Schamess & Shilkret, 2021). Michaela also shows a lapse in her ego functioning as it pertains to her self-esteem regulation in her relationship with Laura (Schamess & Shilkret, 2021). This is illustrated when Michaela attributes the failure of her relationship with Laura to her own inability to choose the right person, rather than Laura’s dysfunction.
The theoretical lens of object relations can also be applied to the relationship between Michaela and her therapist. Michaela uses the splitting defense in her interactions with the therapist, on some days calling them a “fantastic find” and on others accusing them of being “weak, incompetent, and insensitive” (Flanagan, 2021). It can be assumed that Michaela splits her perception of the therapist to preserve the relationship and help to organize feelings of anxiety that may arise during a therapeutic session (Flanagan, 2021). When the therapist challenges Michaela’s perception of self, they are “bad” or “weak, incompetent, and insensitive,” and when the therapist validates Michaela’s sense of self, they are a “fantastic find.”
Another object relations defense that is utilized by Michaela in the therapeutic relationship with her therapist is projective identification. Michaela projects her feelings of loneliness onto the therapist, while also fantasizing that the therapist “needs her” to help ease that loneliness (Flanagan, 2021). Doing this distances Michaela from her feelings of loneliness, while simultaneously communicating those feelings to her therapist to unconsciously facilitate understanding and empathy (Flanagan, 2021).
To help address Michaela’s needs as well as improve a working relationship, I would work with Michaela to explore how dysfunctions in her early significant relationships infiltrate current ones (Goldstein, 2001). By asking questions about how her mother and father were attuned to her, practiced mirroring, and presented as idealized figures, I could help Michaela identify some of her lapses in self-esteem (Goldstein, 2001). Additionally, I would explore with her the parallels and patterns of her early relationships and her current relationships, and how shame and guilt may play a role in repeating patterns. (Goldstein, 2001). Finally, I would explore the transference and countertransference in the therapeutic relationship, and Michaela’s projection identification of loneliness, to help establish a safe holding environment for her to explore her anxieties (Flanagan, 2021).
References
Goldstein, E. G. (2001). Object relations theory and self psychology in social work practice. The Free Press.
Flanagan, L.M. (2021). Object relations theory. In J. Berzoff, L. M. Flanagan, & P. Hertz, (Eds.), Inside out and outside in: psychodynamic clinical theory and psychopathology in contemporary multicultural contexts (5th ed, pp. 92-124). Rowman & Littlefield Publishing Group.
Schamess, G., & Shilkret, R. (2021). Ego psychology. In J. Berzoff, L. M. Flanagan, & P. Hertz, (Eds.), Inside out and outside in: psychodynamic clinical theory and psychopathology in contemporary multicultural contexts (5th ed, pp. 47-73). Rowman & Littlefield Publishing Group.