ORT is a theory of infant development and interpersonal relationships rooted in psychoanalytical theory. However its theorists, Melanie Klein, Margaret Mahler, WRD Fairbairn, DW Winnicott, and others, depart from Freud in their emphasis on relationship rather than sexuality and aggression, as a fundamental human drive. The term “objects” refers to influential humans such as caregivers, but also to significant things in a person’s life; perhaps a teddy bear, a blanket, a cat, or later a tub of ice cream or a crack pipe. Objects such as teddy bears are known as transitional objects, that lessen the pain of separation from a caregiver. Objects can be external – the real person or blanket, or internal – the symbols, meanings and fantasies attached to that object. Development is postulated to occur in stages. According to Mahler, they are as follows: - Autistic phase – first 1-2 months. The infant is essentially oblivious to others. - Symbiotic phase – next 4-5 months. Others are recognized as extensions of the self, not as autonomous beings. - Separation/Individuation Phase – to 2-3 years of age. This period is crucial for a child’s later mental health This is the period when a child begins to establish a sense of self distinct from others. The child is presented with the conflicts of autonomy vs. closeness and abandonment vs. engulfment. During this phase the primary caregiver’s role is to “hold” the child as s/he moves away and then returns for assurance. It is this stage at which a child develops object constancy, the knowledge that mother exists even when not present and the knowledge that mother can be angry and still love the child.
Trauma can cause an individual to become stuck in one phase of development. For example those with borderline personality are prone to splitting, an indication that they have not developed the ability to hold a person’s good qualities along with the bad. They are also unable to tolerate being alone. Dysfunctional behavior is seen as an unskillful and “immature attempt to resolve earlier trauma.”
One writer I encountered, Thomas Klee, PhD, provided a helpful metaphor. Through a combination of genetic predisposition and experience in the first couple of years of life, a child develops a script for a drama. S/he then spends the rest of her life looking for people to play the roles in that drama. “The more traumatic our early experience, the more rigid the script.” Problems arise of course because of the discrepancy between the internal object and the real person being expected to play a role, someone who may or may not be bringing their own distorted view into play.
Psychotherapy involves a therapist who is able to “hold” the patient without reacting when he or she plays out the drama. Change occurs as a result of the therapist being accepting and non-reactive, while at the same time gently pointing toward the patterns that emerge. In ORT, as in other psychodynamic models, the relationship between patient and therapist is a major focus of therapy and a tool for healing.
Winnicot was a pediatrician who observed the interaction of mothers and their infants. He developed the concept of the “good enough mother” to suggest that parents need not be perfectly attuned in order to raise emotionally healthy children. In fact, he suggested that the child’s struggle for attention at times could be healthy and lead to greater resiliency. He also coined the term holding, both as it relates to the mother’s role and to that of the psychotherapist.
ORT provides an elegant and direct link to early childhood as a means to understand behavior in adults. From my brief look, it appears to among the most straightforward and commonsense psychodynamic theories, free from the almost universal pathology that Freud ascribed to early human experience.
Great Post Will! Team, I know that Object Relations Theory may not be as exciting as a topic as some of our former topics but it should be. It should be because its your opportunity to start conditioning your skill set and build upon tangilbe skills to help the interdisciplinary teams that you particpate with. When we look at the "impossible pt" or difficult behaviors from patients, these developmental theories play a huge role in a clinicians ability to understand that behavior and educate other team members around that behavior. Your education to the team will also show understanding and compassion and will allow you to solicit their support with less barriers because of it.
Team, I would like you to bring some of your most impossible clients to life in this discussion and integrate this developmental theory
Team, I also think the impossible patient is a patient that members of the team don't necessarily understand. Sometimes the behavior of the pt is so outlandish that it is truly hard to find a healthy understanding. And heres where i think using these developmental modalities can really serve to demystify this behavior. Understanding is an excellent foundation for compassion.
Understanding and Compassion ='s more permission and support to the clinician to practice in a healthy atmosphere.
When in doubt fall back on the theory's to drive your practice.
I am at a loss here! This is the first time I have heard of this theory and may need to research it more. Will's post is interesting, I just don't think I have enough of an understanding of the theory.
Will, thank you for such great info! ORT is new to me, and I will be thinking about it now, and how to apply it. For now, this comes to mind: Several months ago I had a client who would have benefited from ORT, had I known about it. She was dx'd w/Bipolar disorder, and took multiple painkillers, including diluadid. Her PCP had no hospital privileges, and would pretty much write a Rx for whatever she asked. This was worrisome to me as her case mgr, b/c I felt her meds and needs could use closer mgt. This client would call me nearly everyday, and talk for usually 30 minutes about whatever the drama/crisis/problem of the day was, all the while soliciting my help. I had to limit her to one TC/day for time mgt (and personal sanity) reasons. I noticed that periodically she seemed to create large dramas in her life, and they would grow to epic proportions (no exageration). She loved being the center of attention. So, perhaps some histrionic traits here, which would indicate she was stuck in the symbiotic phase. ORT would seem to be a possible solution. She also had a very large network of "helpers." This would support the symbiotic phase idea. I'd like to learn more about ORT. It sounds very interesting. Looking forward to discussing it w/everyone on Wed.
Excellent example Karyn, keep them coming team, its this frame of reference that is going to change, support and condition your practice. "The power of the generalized other isn't only theraputic to the patient but to the clinician as well
Object Relations Theory (ORT)
ReplyDeleteORT is a theory of infant development and interpersonal relationships rooted in psychoanalytical theory. However its theorists, Melanie Klein, Margaret Mahler, WRD Fairbairn, DW Winnicott, and others, depart from Freud in their emphasis on relationship rather than sexuality and aggression, as a fundamental human drive.
The term “objects” refers to influential humans such as caregivers, but also to significant things in a person’s life; perhaps a teddy bear, a blanket, a cat, or later a tub of ice cream or a crack pipe. Objects such as teddy bears are known as transitional objects, that lessen the pain of separation from a caregiver. Objects can be external – the real person or blanket, or internal – the symbols, meanings and fantasies attached to that object.
Development is postulated to occur in stages. According to Mahler, they are as follows:
- Autistic phase – first 1-2 months. The infant is essentially oblivious to others.
- Symbiotic phase – next 4-5 months. Others are recognized as extensions of the self, not as autonomous beings.
- Separation/Individuation Phase – to 2-3 years of age. This period is crucial for a child’s later mental health This is the period when a child begins to establish a sense of self distinct from others. The child is presented with the conflicts of autonomy vs. closeness and abandonment vs. engulfment. During this phase the primary caregiver’s role is to “hold” the child as s/he moves away and then returns for assurance. It is this stage at which a child develops object constancy, the knowledge that mother exists even when not present and the knowledge that mother can be angry and still love the child.
Trauma can cause an individual to become stuck in one phase of development. For example those with borderline personality are prone to splitting, an indication that they have not developed the ability to hold a person’s good qualities along with the bad. They are also unable to tolerate being alone. Dysfunctional behavior is seen as an unskillful and “immature attempt to resolve earlier trauma.”
One writer I encountered, Thomas Klee, PhD, provided a helpful metaphor. Through a combination of genetic predisposition and experience in the first couple of years of life, a child develops a script for a drama. S/he then spends the rest of her life looking for people to play the roles in that drama. “The more traumatic our early experience, the more rigid the script.” Problems arise of course because of the discrepancy between the internal object and the real person being expected to play a role, someone who may or may not be bringing their own distorted view into play.
Psychotherapy involves a therapist who is able to “hold” the patient without reacting when he or she plays out the drama. Change occurs as a result of the therapist being accepting and non-reactive, while at the same time gently pointing toward the patterns that emerge. In ORT, as in other psychodynamic models, the relationship between patient and therapist is a major focus of therapy and a tool for healing.
Winnicot was a pediatrician who observed the interaction of mothers and their infants. He developed the concept of the “good enough mother” to suggest that parents need not be perfectly attuned in order to raise emotionally healthy children. In fact, he suggested that the child’s struggle for attention at times could be healthy and lead to greater resiliency. He also coined the term holding, both as it relates to the mother’s role and to that of the psychotherapist.
ORT provides an elegant and direct link to early childhood as a means to understand behavior in adults. From my brief look, it appears to among the most straightforward and commonsense psychodynamic theories, free from the almost universal pathology that Freud ascribed to early human experience.
Great Post Will! Team, I know that Object Relations Theory may not be as exciting as a topic as some of our former topics but it should be. It should be because its your opportunity to start conditioning your skill set and build upon tangilbe skills to help the interdisciplinary teams that you particpate with. When we look at the "impossible pt" or difficult behaviors from patients, these developmental theories play a huge role in a clinicians ability to understand that behavior and educate other team members around that behavior. Your education to the team will also show understanding and compassion and will allow you to solicit their support with less barriers because of it.
ReplyDeleteTeam, I would like you to bring some of your most impossible clients to life in this discussion and integrate this developmental theory
Team, I also think the impossible patient is a patient that members of the team don't necessarily understand. Sometimes the behavior of the pt is so outlandish that it is truly hard to find a healthy understanding. And heres where i think using these developmental modalities can really serve to demystify this behavior. Understanding is an excellent foundation for compassion.
ReplyDeleteUnderstanding and Compassion ='s more permission and support to the clinician to practice in a healthy atmosphere.
When in doubt fall back on the theory's to drive your practice.
I am at a loss here! This is the first time I have heard of this theory and may need to research it more. Will's post is interesting, I just don't think I have enough of an understanding of the theory.
ReplyDeleteWill, thank you for such great info! ORT is new to me, and I will be thinking about it now, and how to apply it. For now, this comes to mind: Several months ago I had a client who would have benefited from ORT, had I known about it. She was dx'd w/Bipolar disorder, and took multiple painkillers, including diluadid. Her PCP had no hospital privileges, and would pretty much write a Rx for whatever she asked. This was worrisome to me as her case mgr, b/c I felt her meds and needs could use closer mgt. This client would call me nearly everyday, and talk for usually 30 minutes about whatever the drama/crisis/problem of the day was, all the while soliciting my help. I had to limit her to one TC/day for time mgt (and personal sanity) reasons. I noticed that periodically she seemed to create large dramas in her life, and they would grow to epic proportions (no exageration). She loved being the center of attention. So, perhaps some histrionic traits here, which would indicate she was stuck in the symbiotic phase. ORT would seem to be a possible solution. She also had a very large network of "helpers." This would support the symbiotic phase idea. I'd like to learn more about ORT. It sounds very interesting. Looking forward to discussing it w/everyone on Wed.
ReplyDeleteExcellent example Karyn, keep them coming team, its this frame of reference that is going to change, support and condition your practice. "The power of the generalized other isn't only theraputic to the patient but to the clinician as well
ReplyDelete