Psychoanalysis & development new

Psychoanalysis &Psychoanalysis &
DevelopmentDevelopment
Development, attachment,Development, attachment,
affectregulation and pathologyaffectregulation and pathology
Dr. M. de Wolf, Psychoanalysis & Development. Tallinn 2012

Psychoanalysis
General Remarks

PsychoanalysisPsychoanalysis
It is all about:
• Love and Hate
• Relatedness and Autonomy
• Relation and Interpretation
The Freud Ferenczi Debate

Dr. M. de Wolf: Psychoanalysis & Development. Tallinn 2012Dr. M. de Wolf: Psychoanalysis & Development. Tallinn 2012 44
• The relational focus was there from the beginningThe relational focus was there from the beginning
• In between Biology and Psychology: genetic vulnerabilities in interactionIn between Biology and Psychology: genetic vulnerabilities in interaction
with the primary caregiverswith the primary caregivers
• How do somatic sensations develop into human feelingsHow do somatic sensations develop into human feelings
• How do emotions develop into feelingsHow do emotions develop into feelings
• How develop somatic sensations into intentional behavior with a symbolicHow develop somatic sensations into intentional behavior with a symbolic
meaningmeaning
• How do biological factors, genetic vulnerabilities and environmental factorsHow do biological factors, genetic vulnerabilities and environmental factors
interact with each otherinteract with each other

Dr. M. de Wolf: Psychoanalysis &Dr. M. de Wolf: Psychoanalysis &
Development. Tallinn 2012Development. Tallinn 2012 55
• How does a reflexively acting human being developHow does a reflexively acting human being develop
– into a human being with specific intentions,into a human being with specific intentions,
– with the possibility to empathize intuitively/unconscious with others,with the possibility to empathize intuitively/unconscious with others,
– with the possibility to read the mind of other peoplewith the possibility to read the mind of other people
– with the possibility to understand social relationswith the possibility to understand social relations
– with the possibility to develop relations at a reciprocal levelwith the possibility to develop relations at a reciprocal level
• How can we understand the interactive relation between “mind” and “brain”.How can we understand the interactive relation between “mind” and “brain”.
These kind of questions occupied psychoanalysis and the mind
of analysts from the beginning

Psychoanalysis on the edge ofPsychoanalysis on the edge of
biology and psychologybiology and psychology
Intersubjectivity; Attachment;Intersubjectivity; Attachment;
Relatedness/Intimacy and AutonomyRelatedness/Intimacy and Autonomy

UnconsciousnessUnconsciousness
1.1. Which is not accessible for the consciousness and yet not repressedWhich is not accessible for the consciousness and yet not repressed →→
procedural unconscious .. (habits and skills)→ implicit memory system,(habits and skills)→ implicit memory system,
or theor the non consciousconscious
2.2. Which had to be repressed because it was unacceptable on a consciousWhich had to be repressed because it was unacceptable on a conscious
level (conflicts and impulses) → explicit memory system →level (conflicts and impulses) → explicit memory system → dynamic
unconscious
3.3. Pre-conscious which is not remembered spontaneously but can becomePre-conscious which is not remembered spontaneously but can become
conscious when attention is focused upon itconscious when attention is focused upon it

88
Explicit versus ImplicitExplicit versus Implicit
DynamicDynamic
• Mental representations verbalMental representations verbal
mediatedmediated
• MemoriesMemories
• Psychological meaningPsychological meaning
• Psychological SelfPsychological Self
• Manifest themselves in theManifest themselves in the
analysis to be interpreted withinanalysis to be interpreted within
the context of adequate holdingthe context of adequate holding
(transference)(transference)
• Mentalizing ability;Mentalizing ability;
representational disordersrepresentational disorders
ProceduralProcedural
• No verbal mediation, first orderNo verbal mediation, first order
representationsrepresentations
• BehaviourBehaviour
• Not IntentionalNot Intentional
• Soma is the SelfSoma is the Self
• Enactments instead ofEnactments instead of
transferencetransference
• Adding psychological meaning toAdding psychological meaning to
the behaviourthe behaviour
• Facilitating mentalization; processFacilitating mentalization; process
disordersdisorders

Psychoanalysis
1. Nowadays contemporary theorists in psychoanalysis agree with
Freud’s/Darwin’s premise that emotions are innate biological
pheneomena that play a vital role in the existence and survival
of living organisms (Emde 1988; Krystal 1988)
2. In the human organisme the highly evolved neocortex adds a
psychological dimension to emotions as this allows them to be
processed cognitively and experienced subjectively as feelings.
The symbolic function of language is involved in that proces
(Thompson 1988).

Psychoanalysis
3. Cognitive procesing of emotions and mental representation of
affective experiences of the interaction between Self and Others
foster the creation of memories, fantasies and dreams which help
in containing and modulating states of emotional arousal; as
these cognitive capacities mature, the child becomes less
dependent on external objects for reducing psychic tension and
regulating his behavior (Stern 1985)

Intersubjectivity
4. Hidden within the interactions between the infant and the mother are a
number of sensorimotor processes whereby the mother can regulate
aspects of the infant’s biology untill the infants self regulating mechanisms
mature………the mother serves as an external regulator of the infants
behavior, its autonomic physiology and even the neurochemistry of its
maturing brain (Emde and Robinson 1979;Hoffer 1983; Porter 1988)
5. Infant and mother are connected at the level of biological symbiosis, as well
as by an emotional bond → intersubjectivity from the start

IntersubjectivityIntersubjectivity
SternStern::
• Intersubjectivity from the beginningIntersubjectivity from the beginning
FonagyFonagy::
• Intersubjectivity related to mentalisationIntersubjectivity related to mentalisation
• Mentalisation is going together with affect regulationMentalisation is going together with affect regulation
• Mentalisation supposes the development of language with the symbolicMentalisation supposes the development of language with the symbolic
functionfunction

Biology versus PsychologyBiology versus Psychology
• Circulair instead of lineair causalityCirculair instead of lineair causality
• GeneticGenetic vulnerabilities in the child/personvulnerabilities in the child/person
• Interactions with primary caregiversInteractions with primary caregivers →→ the importance of early attachmentsthe importance of early attachments
figuresfigures
• What will be expressed in the Behaviour depends on the way earlyWhat will be expressed in the Behaviour depends on the way early
attachment relations are internalizedattachment relations are internalized

Behaviour:Behaviour:
 Is the result of the mutual relation between “nature” andIs the result of the mutual relation between “nature” and
“nurture”.The result of a complicated interaction between “genes”“nurture”.The result of a complicated interaction between “genes”
and “environment”→ integration Mind and Brain.and “environment”→ integration Mind and Brain.
 Focusing on the concept of developmentFocusing on the concept of development

1515
Consequences for PathologyConsequences for Pathology
1.1. No causal relation between risc factors and the development ofNo causal relation between risc factors and the development of
pathology; the amount of risc factors is in a way predictable.pathology; the amount of risc factors is in a way predictable.
2.2. The quality of the early attachment relationships is important forThe quality of the early attachment relationships is important for
the possible development of pathologythe possible development of pathology
3.3. The process of internalising early experiences and the creation ofThe process of internalising early experiences and the creation of
an internal psychological model of the interpersonal world →an internal psychological model of the interpersonal world →
mentalization/ creation of a mind or mental representations.mentalization/ creation of a mind or mental representations.
4.4. Internal representations of the earlier experiences with theInternal representations of the earlier experiences with the
primairy care givers will influence later relationships and theprimairy care givers will influence later relationships and the
development of psychopathology later ondevelopment of psychopathology later on

1616
Internal Working Models
• From the beginning experiences are translated into unconsciousFrom the beginning experiences are translated into unconscious
internal working modelsinternal working models
• Interpretation schema’s used in meeting the environmentInterpretation schema’s used in meeting the environment
• To anticipate and understand new experiencesTo anticipate and understand new experiences → giving meaning→ giving meaning
and constancyand constancy
• Sometimes creative, productive leading to creativitySometimes creative, productive leading to creativity
• Sometimes fruitless, destructive and leading to rigiditySometimes fruitless, destructive and leading to rigidity
• The character of the internal working models is related to theThe character of the internal working models is related to the
developmental level of the persondevelopmental level of the person
Psychoanalysis should be a revision laboratoryPsychoanalysis should be a revision laboratory
→→ a place where non-constructive aspects ofa place where non-constructive aspects of
unconscious inner working models are provokedunconscious inner working models are provoked
detected and reviseddetected and revised

Pathology
• Psychopathology is linked to the loss or the serious failing ofPsychopathology is linked to the loss or the serious failing of
attachment figures and the response to this of the individualattachment figures and the response to this of the individual
• It is about pathological responses to traumatic separationsIt is about pathological responses to traumatic separations
• Underlying is the basic need to form emotionalUnderlying is the basic need to form emotional attachmentsattachments toto
othersothers
• AttachmentAttachment::
– distancy versus intimacy
– autonomy versus relatedness

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Relatedness/Intimacy - AutonomyRelatedness/Intimacy - Autonomy
• Freud (1914;1926;1930):(1914;1926;1930):
– Libido - AgressionLibido - Agression
– Object libido - Ego LibidoObject libido - Ego Libido
– Altruism - EgoismAltruism - Egoism
– Attachment – AutonomyAttachment – Autonomy
• Ferenczi (1909; 1933)
– Introjection – Transference
• Balint (1959):(1959):
– Clinging - AutonomyClinging - Autonomy
• Bowlby (1969;1973):(1969;1973):
– Libido – AgressionLibido – Agression
– Attachment – Separation/LossAttachment – Separation/Loss
• Hartmann (1939;1949)
– Libido – Agression
– Neutralization
• Winnicott (1958;1965)
– Being alone in the presence of an
object
• Kohut (1966; 1971)(1966; 1971)
– Object libido – Ego libido revisitedObject libido – Ego libido revisited
– Idealized parental figures - GrandioseIdealized parental figures - Grandiose
SelfSelf
• Blatt (1995;1998;2004)(1995;1998;2004)
– Relatedness/intimacy – autonomyRelatedness/intimacy – autonomy
• Fonagy (2003)
– Balance between relatedness and
autonomy: secure attachment and
good containment

Some historySome history
Forerunners in developmentalForerunners in developmental
psychopathologypsychopathology

Classic versus RomanticClassic versus Romantic
S. Akhtar: 1992, Broken StructuresS. Akhtar: 1992, Broken Structures
• A classic and Romantic vision about human natureA classic and Romantic vision about human nature
• Both sides of the Freud – Ferenzci debateBoth sides of the Freud – Ferenzci debate
• Classic vision: from pleasure to reality principleClassic vision: from pleasure to reality principle
• Romantic vision: development to a cohesive selfRomantic vision: development to a cohesive self

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Classic versus RomanticClassic versus Romantic
S. FreudS. Freud
• Man is limited but can be trained, fromMan is limited but can be trained, from
pleasure to reality principle, innatepleasure to reality principle, innate
vulnerabilitiesvulnerabilities
• ConflictConflict
• Neutral and abstinent,Neutral and abstinent,
• Transferential objectTransferential object
• Acting out: undesirableActing out: undesirable
• Curative: Insight by interpretationCurative: Insight by interpretation
• Strengtening autonomyStrengtening autonomy
• A.Freud; M.Mahler; M. Klein; EgoA.Freud; M.Mahler; M. Klein; Ego
-psychology.; Kernberg-psychology.; Kernberg
S. FerencziS. Ferenczi
• Man is intrinsically good, capable, onlyMan is intrinsically good, capable, only
restricted and injured by failing of therestricted and injured by failing of the
environmentenvironment
• DeficitDeficit
• Compassionate, credulous, trustCompassionate, credulous, trust
• New primary objectNew primary object
• Acting out: the only possible way toActing out: the only possible way to
communicate for the momentcommunicate for the moment
• Curative: the psychotherapeuticCurative: the psychotherapeutic
relation, C.E.E.relation, C.E.E.
• Cohesive Self, developmental flowCohesive Self, developmental flow
• The Independent group, KohutThe Independent group, Kohut

FreudFreud
From affect trauma, to the first topography and the structuralFrom affect trauma, to the first topography and the structural
modelmodel
• From external reality (trauma) toFrom external reality (trauma) to inner psychic realityinner psychic reality (wish)(wish)
• Drive (Trieb) as motivational force looking for gratification: That’s wereDrive (Trieb) as motivational force looking for gratification: That’s were
thethe Object comes into the picture.comes into the picture.
• The way gratification is reached differs during development:The way gratification is reached differs during development:
psychosexual developmental stages
• Drive is aDrive is a mental representation
• It is about conflict pathology: “conflicting mental representations”

Freud, the structural modelFreud, the structural model
• Id, Ego and SuperegoId, Ego and Superego
• Resistance and TransferenceResistance and Transference
• Mental representations: conflictMental representations: conflict
• The unconscious = the dynamic unconsciousThe unconscious = the dynamic unconscious
• Psychoneurosis instead of anxiety neurosisPsychoneurosis instead of anxiety neurosis
• It is about gratification of the drivesIt is about gratification of the drives
ButBut
• Identification also came inIdentification also came in
• Anxiety, guilt and pain more and more related to loss and separationAnxiety, guilt and pain more and more related to loss and separation

Freud: summary
Personality Structure:
1. Drive derivates: Id
2. Internalized Object relations: Superego.
3. A third structure focused upon the adaptation of inner and outer
world → within the frame of egopsychology the ego is no longer a
drive derivate but it has an autonomous development within a
space free of conflicting representations

EgopsychologieEgopsychologie
• Hartmann (1939) Ego not seen as a drive derivate but as autonomous(1939) Ego not seen as a drive derivate but as autonomous
• Erikson:: (1950) Emotional relatedness is more important than the gratification of the
drives
• R.Spitz: (1945) When there is no adequate emotional relationship the potentials of
the child will disappear and he will be get depressed even when his fysical needs are
adequately gratified
→ from structural drive model to structural relational model
• Jacobson: (1964) Self and Object are representations, she introduces the proces of
Self and Object differentiation, introjection, internalisation and identification are
helpfull to overcome the primitive fusion between the representations of the self and
the other

Ego Psychology: A.FreudEgo Psychology: A.Freud
• The first who explicitly related psychopathology to the developmental historyThe first who explicitly related psychopathology to the developmental history
• Instead of the psychosexual developmental stages she introduces theInstead of the psychosexual developmental stages she introduces the
concept of developmental lines to detect the risc factors for pathologyconcept of developmental lines to detect the risc factors for pathology
• Developmental lines:Developmental lines: It is an ongoing process from normal toIt is an ongoing process from normal to
pathologicalpathological
• The results of the reciprocal interaction betweenThe results of the reciprocal interaction between
– Innate factors,DrivesInnate factors,Drives
– Internalized ObjectsInternalized Objects
– External environmentExternal environment

Ego Psychology: A.FreudEgo Psychology: A.Freud
Hampstead War Nurseries, to observe developmentHampstead War Nurseries, to observe development
– She was convinced about the impact of separation and loss on theShe was convinced about the impact of separation and loss on the
development.development.
– For her the most inportant issue was the way the concrete separationFor her the most inportant issue was the way the concrete separation
was represented in the inner world or in the Mind of the child:was represented in the inner world or in the Mind of the child: innerinner
worldworld
– It was about the process of internalisation
– For Bowlby the concrete situation of loss in which the child was involvedFor Bowlby the concrete situation of loss in which the child was involved
was inportant:was inportant: externalexternal worldworld
– Next to the drives, inner object relations were for A.Freud crucial in
development
– the external object was very important too as well as the way they were
internalized
– The primary object is needed, to contain what the child cannot yet
contain because it is to overwhelming

2828
Developmental linesDevelopmental lines
From dependency to emotional self reliance and adult objectFrom dependency to emotional self reliance and adult object
relationshiprelationship
 The baby does not yet realize that the mother is not a part of himself andThe baby does not yet realize that the mother is not a part of himself and
not under his controlnot under his control
 The need fulfilling anaclitic relationship between the child and his objectThe need fulfilling anaclitic relationship between the child and his object
 A consistent representation of the mother, which can be maintainedA consistent representation of the mother, which can be maintained
irrespective of the satisfaction of drives: object constancyirrespective of the satisfaction of drives: object constancy
 The toddler´s positive and negative feelings are focused on the sameThe toddler´s positive and negative feelings are focused on the same
person and become visible: ambivalencyperson and become visible: ambivalency
 Object - centered characterized by the possessiveness of the parent of theObject - centered characterized by the possessiveness of the parent of the
opposite sex and jealousy, rivalry with the same sex parentopposite sex and jealousy, rivalry with the same sex parent
 Transfer of libido from parents to peers and others: latencyTransfer of libido from parents to peers and others: latency
 The pre adolescent revolt: pubertyThe pre adolescent revolt: puberty
 The adolescence: to master the upsurge of sexuality and agressionThe adolescence: to master the upsurge of sexuality and agression

Developmental linesDevelopmental lines
Two forms of pathology/treatmentTwo forms of pathology/treatment
• Conflict or neurotic pathology
1.1. Hysterics and the Obsessive compulsive neurosisHysterics and the Obsessive compulsive neurosis
2.2. Conflicting mental representationsConflicting mental representations
• Developmental pathologyDevelopmental pathology
1.1. Psychosomatics and BorderlinePsychosomatics and Borderline
2.2. Process disorders: inhibition of the developmental processProcess disorders: inhibition of the developmental process
• TreatmentTreatment
1.1. Insightgiving therapyInsightgiving therapy
2.2. DevelopmentalDevelopmental therapytherapy

Ego- Psychology: M.Mahler
Separation individuation process
• There is the need in the child to function apart from the mother but
supported by her presence and emotional availability
• Processes of internalisation, identification and splitting
• The inner life which was empty becomes more and more
differentiated and filled with internalized (part) objects
• Growing object constancy: mental representation of the object
• Separation – Individuation: rapprochement is crucial

M.Klein
• From te beginning the Ego is organized in such a way that it is able
to experience anxiety, to make use of defense mechanisms and to
create primitive object relation in phantasy as in reality.
• The paranoid schizoid position (unmentalized) versus the
depressive position (mentalized)
• Projective Identification
• Interactive from the beginning

W.R.Bion (1962,1963)
• Container and the contained (holding environment)
• Containing and digesting
• Introjecting the containing and digesting mother
• Rêverie: the attitude the caring object is taking in, to be an
adequate container (Stern: attunement; Winnicott: holding
environment; Fonagy: mind reading)
• The transformation from beta to alpha elements, which supposes
the availability of the alpha function.

Independents: M.Balint (1937;1959)
• People are not looking for gratification of the sexual and agressive
drives
• They are looking for primary object love
• From te start there is the need for primary object love related to the
quality of the primary relation between mother and child, if that is
failing: The basic Fault
• Basic Fault is a risc factor for the occurence of an object relational
pattern of the type of “Autonomy” (philobatic) or “Relatedness”
(Ocnophilic)
• It is about a new experience, the therapist offers himself as a new
primary object.
• It is about relation and not about interpretation
• Fundamental critics on Freud’s ideas about narcissism (1914)
• All the attention is focused upon the primary relation, genetics are
lost

Independents: D.W.Winnicott (1958,1965)
• Primary maternal preoccupation, adequate sensitivity and
responsiveness to the needs of the child: adequate affective
attunement
• It is about the quality of the primary relation, it is about holding
from the mother which gives the child the feeling of cohesion
• Not perfect but good enough mothering
• Intermediate space: transitional space/phenomena
• All the attention is focused upon the quality of the primary relation,
genetics are lost
• The quality of the psychotherapeutic relationship is in itself curative.
• Pathology is related to failures in the empathic primary relationship

D.W. Winnicott
• Capacity to be alone in the presence of an object
• Being with someone else without loosing your self
• Being with yourself without loosing the other
• Balance between autonomy and intimacy

Kohut (1971,1977,1984)
• From the beginning
– object related libido and
– self related libido
• Selfobjects: idealized parental self objects and mirroring self objects
• Rejects Freud’s drive theory
• Taking the patient at face value
• Pathology: related to empathic failures of the primary objects, that is
why the need for idealized and/or mirroring objects is still there to be
fullfilled
• Difference between the guilty and the tragic man
• Cure by offering yourself as a new primary caring object which is
more empathic than the earlier primary objects: (re)parenting
• Transmuting internalisation

AttachmentAttachment
Safe haven, secure base; affectSafe haven, secure base; affect
representationrepresentation

J.Bowlby: AttachmentJ.Bowlby: Attachment
• There is a genetic based need for relatedness, safety or intimacyThere is a genetic based need for relatedness, safety or intimacy
• It is about the balance between autonomy and intimacyIt is about the balance between autonomy and intimacy
• Related to the primary aspect of the relation.Related to the primary aspect of the relation.
• Activated in case of dangerActivated in case of danger
• Related to separation and lossRelated to separation and loss
• Attachment is a way of regulating anxiety/stressAttachment is a way of regulating anxiety/stress
• Related to the concept of Internal Working ModelRelated to the concept of Internal Working Model

Attachment

The primary relation
• Mother as environment, containing, background as a horizonMother as environment, containing, background as a horizon
• Mother as an object: frustrating or gratifyingMother as an object: frustrating or gratifying
• Primary attachment relationPrimary attachment relation
• It is more about attachment and less about the objectIt is more about attachment and less about the object
4040

AttachmentAttachment
• Related to development / pathologyRelated to development / pathology
• It is about the way primary care givers are emotional availableIt is about the way primary care givers are emotional available
• Basic trust /safetyBasic trust /safety
• Anxieties always related to separationAnxieties always related to separation
• It is a way of regulating anxietyIt is a way of regulating anxiety
• Internal Working ModelInternal Working Model
4141

m.de wolfm.de wolf 4242
Attachment stylesAttachment styles
SafeSafe
• Secure AutonomousSecure Autonomous
Organized unsafeOrganized unsafe
• Avoidant DismissingAvoidant Dismissing
• Resistant/Ambiv. Preoccupied/EntangledResistant/Ambiv. Preoccupied/Entangled
Disorganized UnsafeDisorganized Unsafe
• Disorganized Disorganized/DesoriDisorganized Disorganized/Desoriëëntednted
4242

Attachment
Developmental psychopathologyDevelopmental psychopathology
• Tries to trace those developmental paths that leads toTries to trace those developmental paths that leads to
psychopathologypsychopathology
• In that biology, psychology and the social context come together.In that biology, psychology and the social context come together.
EquifinalityEquifinality
• There are different developmental paths leading to specificThere are different developmental paths leading to specific
forms of pathology in a specific developmental period.forms of pathology in a specific developmental period.
MultifinalityMultifinality
• There is not one specific factor causing one specificThere is not one specific factor causing one specific
developmental path.developmental path.

Development
• “For normal development the child has to experience a mind
that has its mind in mind and is able to reflect his feelings
and intentions accurately, yet in a way which does not
overwhelm him”. (Bateman & Fonagy 2004)
• Mentalising Other
• Affect Regulation
• Accurate Mirroring: adequate sensitivity and responsivity
• All within a safe attachmentAll within a safe attachment

DevelopmentDevelopment
A safe attachment relationship supposes:A safe attachment relationship supposes:
• Adequate sensitivityAdequate sensitivity :: The knowing that something isThe knowing that something is
going on in the othergoing on in the other
• Failing SensitivityFailing Sensitivity :: Introjective pathologyIntrojective pathology → Blatt→ Blatt
Externalising pathologyExternalising pathology → Dozier→ Dozier
• Adequate responsivityAdequate responsivity :: Reacting in such a way, that it isReacting in such a way, that it is
clear what is from whomclear what is from whom
• Failing Responsivity :Failing Responsivity : Anaclytical pathologyAnaclytical pathology → Blatt→ Blatt
Internalising pathologyInternalising pathology → Dozier→ Dozier

Pathology and Relatedness/AutonomyPathology and Relatedness/Autonomy
Externalising pathologyExternalising pathology
• TheyThey minimalizeminimalize their need for relatedness as a strategy against the pain oftheir need for relatedness as a strategy against the pain of
separation and the experience not to be seen.separation and the experience not to be seen.
• Predisposition to Externalising pathology because the attention of the self is gonePredisposition to Externalising pathology because the attention of the self is gone
without the solution of the negative representationswithout the solution of the negative representations→→ failing sensitivityfailing sensitivity
• Divert the attention from the SelfDivert the attention from the Self
Internalising pathologyInternalising pathology
• TheyThey maximizemaximize their need for relatedness and they are always occupied with thetheir need for relatedness and they are always occupied with the
emotional pain and the not being available of the attachment figures.emotional pain and the not being available of the attachment figures.
• Predisposition to Internalising pathology: the attention is fixated to the availabilityPredisposition to Internalising pathology: the attention is fixated to the availability
of the caring other and the negative representations are staying vivid in a veryof the caring other and the negative representations are staying vivid in a very
painful waypainful way →→ failing responsivityfailing responsivity
• Focusing the attention on the SelfFocusing the attention on the Self
(Dozier 1999)(Dozier 1999)

4747
Relatedness and AutonomyRelatedness and Autonomy
Two basic needs:Two basic needs:
1.1. RelatednessRelatedness
2.2. AutonomyAutonomy
(Blatt 1998)(Blatt 1998)
• Anaclytical pathologyAnaclytical pathology
• Preoccupied /AmbivalentPreoccupied /Ambivalent
• Failing responsivity /notFailing responsivity /not
marked mirroringmarked mirroring
• I can not be on my ownI can not be on my own
• Introjective pathologyIntrojective pathology
• AvoidantAvoidant
• Failing sensitivityFailing sensitivity
• I do it my selfI do it my self

Pathology: AutonomyPathology: Autonomy
Externalising pathologyExternalising pathology
 Schizoid/Schizotypical p.d..Schizoid/Schizotypical p.d..
 Narcissistic p.d.Narcissistic p.d.
 Antisocial p.d.Antisocial p.d.
 Avoidant p.d.Avoidant p.d.
 Obsessive Compulsivep.d.Obsessive Compulsivep.d.
 Somatisation ,Somatoform disorder. DID, PTSDSomatisation ,Somatoform disorder. DID, PTSD
(Blatt 1998; Dozier 1999; Slade 2000; Bakermans-Kranenburg 2009)(Blatt 1998; Dozier 1999; Slade 2000; Bakermans-Kranenburg 2009)

Pathology: RelatednessPathology: Relatedness
Internalising PathologieInternalising Pathologie
 Borderline p.d.Borderline p.d.
 Histrionic p.d.Histrionic p.d.
 Dependent p.d.Dependent p.d.
(Blatt 1998; Dozier 1999; Slade 2000; Bakermans-Kranenburg 2009)(Blatt 1998; Dozier 1999; Slade 2000; Bakermans-Kranenburg 2009)

Affect-regulationAffect-regulation
Avoiding/dismissingAvoiding/dismissing
• Affective signals in a consistent way
neglected
• Meaning and signal function of the
affects is missing
• Put confidence in cognitions
Ambiv./PreoccupiedAmbiv./Preoccupied
• Inconsistent reaction to affectiveInconsistent reaction to affective
signalssignals
• Are not able to make use of cognitionsAre not able to make use of cognitions
in affectregulationin affectregulation
• Over-regulating of the affectsOver-regulating of the affects
• Minimalising the need of relatednessMinimalising the need of relatedness
• Maximising the need for autonomieMaximising the need for autonomie
• Externalising pathologyExternalising pathology
• Introjective pathologyIntrojective pathology
• Under-regulation of the affectsUnder-regulation of the affects
• Maximising the need for attachmentMaximising the need for attachment
• Minimalising the need for autonomieMinimalising the need for autonomie
• Internalising pathologyInternalising pathology
• Anaclytical pathologyAnaclytical pathology

Autonomous/secureAutonomous/secure
• Adequate and consistent reaction toAdequate and consistent reaction to
affective signalsaffective signals
DisorganizedDisorganized
• Attachment figures at the same timeAttachment figures at the same time
source of safety and dangersource of safety and danger
• The capacity to calm down themselvesThe capacity to calm down themselves
and to modulate their affectsand to modulate their affects
• Balance between automie andBalance between automie and
relatednessrelatedness
• Can be with someone else withoutCan be with someone else without
loosing himself and be with himselfloosing himself and be with himself
without loosing the otherwithout loosing the other
• Missing the capacity to calm downMissing the capacity to calm down
themselves and to modulate theirthemselves and to modulate their
affectsaffects
• Can not be on their own nor withCan not be on their own nor with
othersothers

Balance between autonomy and intimacyBalance between autonomy and intimacy
““Secure attachment is the outcome of successful containment, whileSecure attachment is the outcome of successful containment, while
insecure attachment is a defensive compromise in which eitherinsecure attachment is a defensive compromise in which either
intimacyintimacy (avoidant/ dismissing) or(avoidant/ dismissing) or autonomyautonomy (resistant/ preoccupied)(resistant/ preoccupied)
appears to be sacrificed for the sake of retaining physical proximityappears to be sacrificed for the sake of retaining physical proximity
to the caregiver incapable of containing the infant’s affect”.to the caregiver incapable of containing the infant’s affect”. (Fonagy et
al 1995: 243)

AffectsAffects
From Emotions to FeelingsFrom Emotions to Feelings
• Emotions:Emotions: biology and the “genen” are involved it isbiology and the “genen” are involved it is
about somatic sensations.about somatic sensations.
• Feelings /Affects:Feelings /Affects: It is about mental representations,,
psychology is involvedpsychology is involved
• Mentalising:Mentalising: connecting them bothconnecting them both
- The capacity to digest
- The capacity to symbolize is involved- The capacity to symbolize is involved
- It is about memories, fantasies and dreams- It is about memories, fantasies and dreams

The capacity to create affective/self representations:The capacity to create affective/self representations:
1.1. Will be acquired within primary attachment relationsWill be acquired within primary attachment relations
2.2. Is related to the quality of the relation with the primary care giversIs related to the quality of the relation with the primary care givers
3.3. Will be influenced by the quality of the mirroringWill be influenced by the quality of the mirroring
4.4. Is related to biological /genetical vulnerabilitiesIs related to biological /genetical vulnerabilities
At the end is what was outside inside, “soma” will beAt the end is what was outside inside, “soma” will be
transformed into “psychtransformed into “psych è”è”

At the startAt the start
• The Soma is the SelfThe Soma is the Self
• It is aboutIt is about doingdoing instead of reflectingreflecting
• Behavior is communication and not resistanceBehavior is communication and not resistance
• No psychological intentions, no inner psychic conflicts, no mentalNo psychological intentions, no inner psychic conflicts, no mental
representationsrepresentations
• Only momentanous and concrete behavior, no containmentOnly momentanous and concrete behavior, no containment
• Behavior as the only channel of communicationBehavior as the only channel of communication
• No interpretation of underlying conflicts but connecting behavior withNo interpretation of underlying conflicts but connecting behavior with
intentionsintentions

At the EndAt the End
1.1. Someone is able to reflect upon himself and others in psychologicalSomeone is able to reflect upon himself and others in psychological
termsterms
2.2. He has developed an Inner Working Model, by which he canHe has developed an Inner Working Model, by which he can
organize himself and his environment and can anticipate, select andorganize himself and his environment and can anticipate, select and
give meaning to that what is cominggive meaning to that what is coming
3.3. He has become intentional, behavior has got a meaning.He has become intentional, behavior has got a meaning.
4.4. He is able to function on an autonomous way, no longer dependentHe is able to function on an autonomous way, no longer dependent
on the being there of the otheron the being there of the other

Psychoanalytic TreatmentPsychoanalytic Treatment
• No longer a place for reconstruction of the past where all the troubleNo longer a place for reconstruction of the past where all the trouble
startedstarted
• No longer the removal of the infantile amnesiaNo longer the removal of the infantile amnesia
• It is a laboratory for revising unconscious internal working modelsIt is a laboratory for revising unconscious internal working models
• It should be facilitating developmentIt should be facilitating development
• It is about the future not about the pastIt is about the future not about the past

Dr. M. de Wolf, Psychoanalysis & Development. Tallinn 2012Dr. M. de Wolf, Psychoanalysis & Development. Tallinn 2012 5858
Therapeutic RelationTherapeutic Relation
• Patiënt and therapist are both from their own inner workingPatiënt and therapist are both from their own inner working
model looking for the optimal balance between distance andmodel looking for the optimal balance between distance and
intimacy, between autonomy and relatednessintimacy, between autonomy and relatedness
• Their inner working models are determining the character of theTheir inner working models are determining the character of the
therapeutic relationship.therapeutic relationship.
• Within the psychotherapeutic relationship the patiënt shouldWithin the psychotherapeutic relationship the patiënt should
have the possibility in the relation with his therapist tehave the possibility in the relation with his therapist te
experience an alternative inner working model and to test theexperience an alternative inner working model and to test the
safety and reliability of this new modelsafety and reliability of this new model → to acquire a new→ to acquire a new
corrective emotional experiencecorrective emotional experience

• Psychotherapeutic action are creating new neurological pathwaysPsychotherapeutic action are creating new neurological pathways
• The old ones are not disappearingThe old ones are not disappearing
• There is an alternative path created next to the old pathwaysThere is an alternative path created next to the old pathways
• The new pathways are strenghtened by rehearsalThe new pathways are strenghtened by rehearsal
• The old ones are weakened by preventionThe old ones are weakened by prevention

6060
Therapeutic Att.
Reluctant Emotional
PREOCCUPIED
x
AVOIDANT
x
A good matchA good match
DISORGANIZED Alternating
Patiënt

Effective Therapeutic RelationEffective Therapeutic Relation
• A good attunement between the pathology of the patiënt andA good attunement between the pathology of the patiënt and
the inner working model of the therapist increases thethe inner working model of the therapist increases the
possibility of an effective psychotherapeutic relation.possibility of an effective psychotherapeutic relation.
• It is about attachment, match, mismatch and repair.It is about attachment, match, mismatch and repair.
• It is about the intersubjective relation between the patiëntIt is about the intersubjective relation between the patiënt
and his therapist , the internalization of that relationship andand his therapist , the internalization of that relationship and
by that mirror neurons are playing an important role.by that mirror neurons are playing an important role.

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