[Book note 5/5] Object Relations Therapy: Using the Relationship – The Therapist

(This is the final part of the five-part book note of Object Relations Therapy: Using the Relationship by Sheldon Cashdan published in 1988)

The Personal Side of Object Relations Therapy

The therapist has to believe in the premises, often times philosophical, upon which the therapy is based.
- An object relations therapist need to believe in the motivational significance of early object relationships and their influence on later relationships, as well as the commitment to the formation of therapist-patient relationship as the basis for therapeutic change.
The demand on the object relations therapist:
- The therapist as target
  - “The therapist’s unconscious participation in the patient’s interpersonal construction must precede its recognition”
  - The therapist needs to acknowledge the fact that he or she is subjected to powerful unpleasant feelings i.e. guilt, anxiety, anger and the sense of being sexually manipulated
  - The feelings might be carried over across sessions and to off-session times.
  - “The therapist walks a thin emotional line.”
- Countertransference
  - A good definition: “Countertransference is an inevitable product of the interaction between the patient and the analyst rather than a simple interference stemming from the analyst’s infantile drive-related conflicts.”
  - The difficulty arises from how the therapist knows whether feelings are countertransferential or not.
  - The therapist needs to regularly scrutinize feelings that are considered countertransferential.
  - “An ongoing dialogue with a supervisor, consultant, or colleague is often an indispensable adjunct to work with very disturbed patients because of the difficulty entailed in recognizing one’s unconscious participation in a patient’s projective identification.”
- Confrontation
  - The two places in object relations therapy where great pressure are put on the therapist:
    - at the end of stage two where the therapist elicits a frank expression from the patient of the metacommunication
    - in stage three where confrontation is involved – attacking the premises upon which the patient builds relationship
  - Confrontation is hard because the exercise of it conjures up “images of rejection, of denial, of doing something that is contrary to the empathic sensitivity the therapist feels he or she possess as a therapist and a human being.”
  - Concerns can derive from the therapist’s own inner splits and the need to preserve an inner sense of goodness.
  - The fear for loss – “most therapists have a heightened sensitivity about loss either because of personal experiences having to do with abandonment or because they share experiences of this sort with so many of their patients.”
  - Therefore therapists often find ways to sidestep and avoid confrontation – making interpretations, or bringing the discussion outside the therapy room by talking about other relationships the patient have.
  - It is crucial to acknowledge the pitfalls and take precautions.
Rewarding experiences:
- “The therapy is rarely boring – there is a creative tension in the air.”
- “The therapeutic change, when it occurs, is palpable.”
- “Doing object relations therapy stretches one as a therapist and as a human being. It forces the therapist to explore himself/herself and deal with the goodness-badness division within.”

Beyond the Therapy Room

Splitting in fairy tales for children
- Snow White
  - Badness is encapsulated within a single figure (the queen).
- Cinderella
  - Badness is encapsulated within the stepmother and her daughters.
  - “The Grimm bothers version (Aschenputtel) stays faithful to the Cinderella story’s origininal intent and presents the splitting dynamic in full force.”
- Vasilisa the Beautiful (Russian)
  - The goodness and badness might coexist.
Splitting in fairy tales for adult
- Doppelgänger
  - A German myth, a folkloric belief which presupposes that every human being possesses a replica self – a double. The double encapsulates the badness, and attempts at killing the double to eliminate badness are futile and only lead to self destruction.
- Dr. Jekyll and Mr. Hyde
  - “Dr. Jekyll at the last moment takes poison. By killing himself he puts an end to the despicable Hyde, but at the same time he destroys himself.”
- William Wilson
  - “Wilson forces his opponent against a wall and with brute ferocity plunges his sword into his chest. … Wilson peers into the mirror and is terror stricken to see himself, all bloodied, approaching with a sword in his chest.”
- Lesson: Human beings must learn to integrated the good and the bad that is their interpersonal legacy in order to nurture and sustain mature interpersonal relationships.
Splitting in cinema
- The Student of Prague
  - The movie is a film version of a traditional doppelgänger tale.
- The Purple Rose of Cairo
  - “The movie puts goodness against badness by playing Tom Baxter off against Gil Shephard and questioning whether pure goodness is at best a celluloid fantasy.”
- The Wizard of Oz
  - “In journey to the Emerald City to help the Scarecrow, the Tin Man, and the Lion come to terms with their deficiencies, Dorothy is really trying to come to terms with her own.”
  - “Her journey has led to the realization that she must search within herself if she hopes to overcome her own personal shortcomings. The source of badness lies not without but within, and one needs to come to terms with this if life is to proceed.”
Bringing materials from fairy tales and cinema provides the patient and the therapist with metaphors that can leapfrog the constraints of verbal interpretation and reaches the beyond-word emotional experiences from early object relations and early splitting.

(Featured image: someBooks Icons by c55inator / CC BY-NC-ND 3.0)

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