Panel I
Evolving Perspectives on the Selfobject Transference

Judith Rustin, LCSW

This panel explored the usefulness and relevance of the selfobject transference as originally defined by Kohut in the 1970's for clinical work today. The question of relevance was embedded in a rich and detailed case presentation by Dr. Amy Eldridge. The patient, a married mother of three had a childhood history of chronic, ongoing abuse; at the time of the presentation the patient had been in treatment for 10 years.

Dr. Eldridge's formulation of the patient included two fundamental senses of self: One organized around a fundamental sense of being defective and the second crystallized around a sense of being powerful and destructive when she behaved in a provocative, angry manner. Embedded deep within these two alternating senses of self was a longed for a fantasied ideal mother who intuitively understood and met her needs and with whom she could merge.

The patient presented herself in treatment as hyper vigilant, frightened and simultaneously desperate; she wanted to improve for the sake of her children. The patient devised her own frame for the treatment. Initially, she barely came into the room and insisted the door be kept open. Once some trust was established and she was able to enter the room she sat at Dr. Eldridge's feet with her back to the therapist. Throughout the treatment the patient continuously challenged the frame by demanding personal information and wanting or expecting gifts and special attention from the therapist.

Dr. Eldridge's sensitive handling of the patient's fears and demands quickly set the stage for the patient to develop an idealizing selfobject transference. Dr. Eldridge became the sequestered, fantasized good mother of the patient's childhood's dreams. This development was balanced by the patient's fear of and shame in overtly exposing this idealized transference wish. And, although this selfobject transference was in place, other transference issues were also prominent, namely, the provocative, angry child/woman and the self attacking fundamentally flawed child/woman. Little discussion with the patient of the latter two transferences seemed to have an impact upon any of these essential senses of self. Dr. Eldridge highlighted the therapeutic challenge for her by describing the lack of "as if" in the patients' experience. For this patient "the reworking was in the action, not the discussion". Given the complexities of the transferences and the patient's need to enact rather than talk as a way of working through, the therapist was faced with an unenviably difficult therapeutic challenge.

At the time of this presentation, 10 years into the treatment, the patient was somewhat improved, deeply attached to Dr. Eldridge, able to acknowledge her attachment, but still prone to enacting considerable provocation with others, intractably viewing herself as defective and easily injured. The patient continued to have little self reflective capacity. Why, after 10 years of treatment, numerous sensitively handled ruptures and repairs was the patient not further along in her psychic development? This question embedded in the case presentation provided the raw material to define the evolving perspectives on the selfobject transferences.

Both discussants, Dr. James Fisch and Dr. Peter Buirski, acknowledged the clinical value of working with the selfobject transferences as originally defined by Kohut, but both also felt additional theoretical concepts are required in working with a traumatized patient such as the one presented by Dr. Eldridge. Dr. Fisch pointed out that in today's psychoanalytic practice, patients like the one presented are far more common and present unique and difficult challenges for even the most patient, sensitive and experienced therapists. In contrast to the perspective of today's panelists, Kohut's conceptualization of the selfobject transferences and his use of them clinically derived from working with narcissistic patients who were far more organized in their functioning and psychic structures. Thus, the linear trajectory of the maturation from archaic to mature forms of self object transference as defined by Kohut for those patients was a reasonable expectation. That trajectory may not be as relevant in today's psychoanalytic practices.

After noting the patient population difference, Dr. Fisch concludes that traumatized, psychically damaged patients like the one presented require much longer periods of sustained merger with the therapist. This requirement precludes mutual engagement and makes "humanly impossible demands on the therapist". He supports the use of the selfobject transference in clinical work with such traumatized patients; in fact "he wouldn't leave home without it". But, he notes that in addition to selfobject transferences, there are also relational transferences that are present that need analysis before development can proceed.

Dr. Fisch suggests the non-linear developmental systems model as one that might be better suited to clinical work today. He notes that rather than thinking of archaic to mature senses of self, interim views of self that organically emerge within the specific patient-analyst dyad such as "old self with old other, old self with new other and new self with new other" expands the clinical domain by offering additional ways to understand and work through the various transferences. This kind of formulation would not require mutual engagement on the part of the patient and might provide interim benchmarks through which the therapist might monitor the patient's progress thereby reducing therapist frustrations and the sense of stalemate.

Dr. Buirski's discussion of the case had a similar overarching theme. He felt the selfobject transference provided a useful framework in this treatment, but did not "feel good" to the patient and therefore was not enough. Dr. Buirski suggests the emphasis on the more traditional selfobject transference obscured attending to other transferences that may have been more in the foreground. Dr. Buirski tentatively offers a different formulation of the patient's angry, provocative outbursts and intractable connection to herself as victim. He postulates that these aspects of the patient's behavior represent the patient's striving for psychological health. In his view the patient developed these modes of being as a way of enlivening herself, giving herself a sense of agency and warding off usurpation by her psychiatrically ill mother. Dr. Buirski viewed these repetitive, conflictual aspects of the transference as being foreground issues that were not acknowledged, affirmed and mirrored by the therapist. Thus, the curative aspects of the selfobject transference were never fully realized. Dr. Buirski believes that attending to the repetitive conflictual dimensions need to be worked with as they emerge in the transference in order to unleash the full power of the mutative aspects of the selfobject transferences.

In summary, Dr. Eldridge's comprehensive and detailed clinical presentation of a traumatized patient provided an excellent platform from which the two discussants made convincing arguments that using Kohut's vision of the working through of selfobject transferences was not sufficient to effect change with many patients who today appear in our consulting rooms.

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