Object Relation, Attachment Theories, And Dissertation

S., experts estimate the genuine number of incidents of abuse and neglect ranges three times higher than reported. (National Child Abuse Statistics, 2006) in light of these critical contemporary concerns for youth, this researcher chose to document the application of Object Relation, Attachment Theories, and Self-Psychology to clinical practice, specifically focusing on a patient who experienced abuse when a child. Consequently, this researcher contends this clinical case study dissertation proves to be vital venture, which will contribute to enhancing research in the field of psychology.



For this clinical case study dissertation exploring Object Relation, Attachment Theories, and Self-Psychology, along with researching information for the application of these theories to clinical practice, this researcher answered the following research questions.



Research Questions



What is Winnicott's Relational Model Theory?



What is Bowlby's Attachment Theory?



What is Kohut's Self-Psychology?



How may components of these three theories be applied to the clinical case chosen for this clinical case study dissertation's focus?



Enhancing Understanding



During the course of this study, as this researcher implements the previously identified, purported principles in an effort to treat, as an adjunct to anti-depressive medication, a 43-year-old woman, referred to this researcher by her psychiatrist for individual psychotherapy, the introductory thought by Bowlby (1985, p. 20; cited by MacDonald, 2001, ¶ 3) serves as poignant pointed prompt. While conducting this study, holding the view that a patient's internal world reflects their external world and that "there is a constant interaction," this researcher regularly recounts the fact that understanding one of the patient's world mandates that this researcher understands the other. During the next chapter of this clinical case study dissertation, the Literature Review section, this researcher relates accessed information that contributes a sampling of previous research to begin to enhance the understanding needed to help a patient "grow" not only in therapy, but also in life.



CHAPTER II



LITERATURE REVIEW



The theories and techniques used in psychoanalysis are very diverse; Freudian analysis is only one approach."



Thomas and McGinnis, 1991, ¶ 1)



Diverse Contentions



One recent University of New Hampshire study indicated that 63% of more than 3,000 surveyed American parents surveyed reported experiences of one or more instances of verbal aggression toward children in their homes. A Child Protective Services study, albeit reported that only 6% of child abuse cases involved "emotional maltreatment," form of abuse in which verbal abuse constitutes the most common form of maltreatment. The apparent low number of "official" verbal abuse cases likely relates to the fact verbal abuse signs prove more difficult to recognize and prove than the more obvious signs of physical abuse. (Vardiganm, 2008)



During this clinical case study dissertation's Literature Review chapter, this researcher presents information, as well as diverse contentions accessed from a barrage, more than 25, of credible sources, including books, journals and websites. Themes explored during this study's segment include emotional abuse/maltreatment, along with theories and techniques other than Freudian, specifically those relating to Object Relation, Attachment Theories, and Self-Psychology.



2.2 Emotional Abuse/Maltreatment



According to Vardiganm (2008) in his web post article, reviewed by Bruce Linton, PhD, a psychoanalyst specializing in marriage and family counseling in Berkeley, California, the following denote signs that a child is or has been verbally abuse.



Negative self-image: This sign denotes "the most common and pervasive effect of verbal abuse." child may verbalize statements such as "I'm stupid," or, "Nobody likes me."



He/she may appear withdrawn, sullen, or depressed, other signs a person possesses a poor self-image. The National Committee for the Prevention of Child Abuse defines emotional abuse by explaining that "attacks a child's... sense of self-worth." (Vardiganm, 2008)



Self-destructive acts: "Cutting," using razor blades or knives to cut oneself, and numerous other forms of self-injury, as well as a number of reckless activities that put a child in danger indicate a problem exists.



Antisocial behavior. According to the New Hampshire study, verbally abused children exhibited more physical aggression, delinquency, and interpersonal problems than children who were not verbally abused. Verbally abused children may hit their siblings and friends. They may quarrel regularly with their classmates, and/or abuse/torture animals.



Delayed development.



A verbally abused child may display delayed development signs in his/her physical, academic, social, and/or emotional development. he/she may experience problems making/keeping friends. he/she may also fall behind in his/her schoolwork, and/or engage in regressive acts as bed-wetting, rocking, and thumb-sucking. (Vardiganm, 2008)

Discipline vs. Abuse

May (2008) points out a number of differences between discipline of a child and abuse, as the following figure (1) portrays. He also stresses, albeit, that both discipline and abuse are taught by example.



Figure 1: Differences Between Discipline and Abuse (adapted from May, 2008)



The following table (1) depicts numerous physical and behavioral indicators of abuse.



Table 1: Physical and Behavioral Indicators of Abuse (May, 2008)



Type of Abuse



Physical Indicators



Behavioral Indicators



Physical Abuse



Unexplained bruises (in various stages of healing)



Unexplained burns, especially cigarette burns or immersion burns



Unexplained fractures, lacerations or abrasions



Swollen areas



Evidence of delayed or inappropriate treatment for injuries



Self-destructive



Withdrawn and/or aggressive - behavioral extremes



Arrives at school early or stays late as if afraid to be at home



Chronic runaway (adolescents)



Complains of soreness or moves uncomfortably



Wears clothing inappropriate to weather, to cover body



Bizarre explanation of injuries



Wary of adult contact



Physical Neglect



Abandonment



Unattended medical needs



Consistent lack of supervision



Consistent hunger, inappropriate dress, poor hygiene



Lice, distended stomach, emaciated



Inadequate nutrition



Regularly displays fatigue or listlessness, falls asleep in class



Steals food, begs from classmates



Reports that no caretaker is at home



Frequently absent or tardy



Self-destructive



School dropout (adolescents)



Extreme loneliness and need for affection



Sexual Abuse



Sexual abuse may be non-touching: obscene language, pornography, exposure - or touching: fondling, molesting, oral sex, intercourse



Torn, stained or bloody underclothing



Pain, swelling or itching in genital area



Difficulty walking or sitting



Bruises or bleeding in genital area



Venereal disease



Frequent urinary or yeast infections



Excessive seductiveness



Role reversal, overly concerned for siblings



Massive weight change



Suicide attempts (especially adolescents)



Inappropriate sex play or premature understanding of sex



Threatened by physical contact, closeness



Emotional Abuse



Emotional abuse may be name-calling, insults, put-downs, etc., or it may be terrorization, isolation, humiliation, rejection, corruption, ignoring



Speech disorders



Delayed physical development



Substance abuse



Ulcers, asthma, severe allergies



Habit disorder (sucking, rocking, biting)



Antisocial, destructive



Neurotic traits (sleep disorders, inhibition of play)



Passive and aggressive - behavioral extremes



Delinquent behavior (especially adolescents)



Developmentally delayed



Crises Considerations



In regard to crises situations, such as suicide attempts, when perceived as "situational mediators that place an individual's typical defenses and resistances in question," a crisis state can help facilitate dynamic change. Winnicott's contributions to psychoanalytic theory provide positive groundwork in this area. His idea of a time-limited therapeutic consultation proves particularly useful for the brief nature of crisis work. When individuals experience suicidal ideations involving the use of a gun, according to Kohut (1971; cited by Romano, 2004), this type scenario portrays an idealizing self-object transference. The use of a gun permits the person to feel in control and exert dominance over other individuals in his/her life. (Feldman & Johnson; cited by Romano, 2004) Often within suicide attempts or other crises' contexts, the present crisis depicts only one of numerous unconscious expectations and reactions to external events perpetuating the situation. Change at a dynamic level can negate the necessity of repeating crisis-precipitating behaviors in the future. (Jerry, 1998)



May (2008) notes the following acronym proves helpful…