Klein, Mahler, Kohut, and Bowlby were all psychoanalysts trained in orthodox Freudian psychoanalytic practices. However, each modified psychoanalytic treatment to different theoretical orientation. Because these theorists varied among themselves on therapeutic procedures, Object relations psychotherapy approach used by Melanie Klein will be predominantly discussed here.
What to expect?
According to Klein people are born with two strong drives—the life instinct and the death instinct. Infants form a passionate caring for the good breast and an intense hatred for the bad breast, leaving a person to struggle a lifetime to reconcile these unconscious psychic images of good and bad, pleasure and pain. The most important stage of life is the first few months, a time when relationships with mother and other significant objects form a model for later interpersonal relations. A person’s adulthood ability to love or to hate originates with these early object relations.
How does it work?
Klein’s initial use of psychoanalysis with children was not well accepted by other analysts during the 1920s and 1930s. Anna Freud was especially resistive to the notion of childhood psychoanalysis, arguing that young children who were still attached to their parents could not develop a transference with the therapist because they have no unconscious fantasies or images. Thus claiming, young children could not profit from psychoanalytic therapy. In contrast, Klein felt that both disturbed and healthy children should be psychoanalyzed; disturbed children would receive the benefit of therapeutic treatment, whereas healthy children would profit from a prophylactic analysis. Consistent with this belief, she insisted that her own children be analyzed. She also insisted that negative transference was an essential step toward successful treatment, a viewpoint not shared by Anna Freud and many other psychoanalysts.
To encourage negative transference and aggressive fantasies, Klein provided each child with a variety of small toys, pencil and paper, paint, crayons, and so forth. She substituted play therapy for Freudian dream analysis and free association while dealing children, believing that young children express their conscious and unconscious wishes through play therapy. In addition to expressing negative transference feelings by means of play, Klein’s young patients often attacked her verbally, which gave her an opportunity to interpret the unconscious motives behind these attacks (Klein, 1943).
When is it used?
Having an unresponsive or inconsistent caregiver might leads to children’s inability to reduce anxiety and frustration. As applied for eating disorders, when these individuals feel anxious, they look for comfort in external sources; and food is a primary means of soothing and regulating their anxiety. Prior research has supported these assumptions, primarily in women. For instance, Smolak and Levine (1993) found that bulimia was associated with over separation (detachment) from parents, whereas anorexia was associated with high levels of guilt and conflict over separation from parents, lending support to the theory of Klein and to her psychotherapy.
Role of therapist:
The fundamental aim of Kleinian therapy is to mitigate depressive anxieties and persecutory fears and to decrease the harshness of internalized objects. To accomplish this aim,therapist encourages the patients to re-experience early emotions and fantasies but this time with the therapist pointing out the differences between reality and fantasy, between conscious and unconscious. The therapist also allows the patients to express both positive and negative transference, a situation that is essential for patients’ understanding of how unconscious fantasies connect with present everyday situations. Once the connection finds proper establishment, patients feel less persecuted by internalized objects, experience reduction in depressive anxiety, and are able to project previously frightening internal objects onto the outer world.