THE STRATEGIES OF TFP
STRATEGY 3: OBSERVING AND INTERPRETING LINKAGES BETWEEN OBJECT RELATIONS DYADS
THAT DEFEND AGAINST EACH OTHER
After having begun to delineate the patient’s set of internal object relations dyads, the therapist seeks to carry his or her understanding of the patient’s internal world a step further. The self-object dyads do not merely exist as fragmented, split-off elements of the patient’s psyche totally independent of one another.
The organization of an individual’s internal world includes a level of complexity beyond that described thus far, involving the individual’s set of object relations dyads. We have emphasized the discrete and discontinuous nature of the internal representations of self and other—representations that are split off internally from each other. This system is not static; there are patterns of interrelation between the part–self- and part-object repre-sentations. A first pattern within this system was described in Strategy 2:
any dyad can oscillate so that the characteristics attributed to the self abruptly shift to the object, and those attributed to the object shift to the self. This abrupt oscillation explains some of the confusion in the subjective experience, affect dysregulation, and interpersonal relations of the border-line individual, especially because the individual is often not consciously aware of the change. An example of this is a patient who is experiencing himself or herself as a helpless victim and who continues to experience this even if his or her behavior takes on the angry and threatening characteris-tics the patient sees in the person he or she perceives as the persecutor.
A second pattern is that the internal representational system includes dy-ads that are opposites of each other (Figure 2–2), although one of the oppo-sites may be closer to consciousness than the other. This is the crux of splitting.
Splitting is not only the stark contrast between a good self-representation and a bad object representation within the same dyad, but it is even more funda-mentally the unbridgeable gap between a dyad totally imbued with negative,
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hateful affect and one imbued with positive, loving affect. These dyads coexist but are totally dissociated from one another. This dissociation serves the de-fensive purpose of protecting each dyad from contamination or destruction by the other. The split protects the dyad imbued with love and caring from de-struction by the hatred carried in the opposite dyad. In a symmetrical way, the split protects the hate-filled dyad from contamination by any positive affect.
It may at first be less clear why the hateful dyad should be protected, but in borderline pathology a clear and unadulterated sense of hatred can provide a temporary respite from the confusion of identity diffusion and can protect against guilt feelings that could stem from the patient’s own aggression toward what is at other times the good object.
In therapy with borderline patients, the hate-laden dyad is usually closer to the surface in the beginning stages of therapy. The internal experience of being loved and cared for is more hidden and fragile and is evident only in glimpses of longing, which the therapist must be very attentive to. When the therapist can help the patient gain some awareness of this internal pos-sibility of love in the place of hatred, it helps the patient understand the in-tensity of the hatred as a desperate attempt to keep the fragile longing for love hidden and protected from the risk that it might be destroyed if it were to see the light of day.
FI G U RE 2 – 2 . Object relationship interactions: defense.
Victim
Cared - for child
Persecutor
Perfect provider
Opposites
Fear, suspicion, hate
Longing, love
The preceding paragraph describes the most classic example of an ob-ject relations dyad defending against the opposite dyad in a borderline pa-tient. However, the system of internal object relations is such that any specific dyad can defend against another dyad, each one representing a pole of an intrapsychic conflict. The internal dyads, each with its specific affect, may represent libidinal or aggressive drives in conflict either with internal prohibitions or with each other. Both drives and prohibitions are repre-sented in the individual’s internal world by object relations dyads. For ex-ample, a libidinally laden dyad involving a representation of the sexually aroused self and a representation of a maternal other may be in conflict with an anxiety-laden dyad involving a representation of the fearful self and a representation of a menacing paternal other.
In another example, a libidinally invested dyad involving a passive, sub-missive self-representation linked by longing with a powerful, distant pater-nal object representation may be in conflict with an aggressively invested dyad involving a cutthroat, competitive representation of self linked by rage with a threatening, tyrannical paternal object representation (see Figure 2–2). Ac-cording to the makeup of the individual, either one of these dyads could be the more conscious, predominant one defending against the generally sup-pressed other one. A borderline individual has no simultaneous conscious awareness of the more predominant dyad and of the suppressed, split-off one, even though the latter may surface in acting-out behaviors and even in moments of awareness of it. Conflicts that are kept out of consciousness are experienced either 1) behaviorally, through acting out, or 2) as physical symptoms in somatization. An occasional intermediate state between aware-ness and unawareaware-ness of conflicts is that of pseudohallucinations.
Splitting involves a dyad being unconsciously paired off with another dyad against which it defends, each one representing one pole of an internal conflict. This pairing is because internal drives and the prohibitions di-rected against them are represented in the psyche by corresponding affec-tively charged pairs of self- and object representations.
An example would be a patient who often experienced herself as a fright-ened, paralyzed victim and who angrily denounced the therapist as being a sadistic prison guard to whose arbitrary and self-serving rules she was forced to submit. At other times the patient experienced the therapist as a perfect, all-giving mother while experiencing herself as a satisfied, happy, loved baby who is the exclusive object of the mother’s attention. In the first dyad, the prison guard represents a bad, frustrating, teasing, and rejecting caretaker/
mother, and the victim represents an enraged baby who wants to take re-venge but is afraid of being destroyed because of the projection of her own rage onto the mother. This terrible mother–suffering infant relationship is
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kept completely separate from the idealized one out of fear of contaminating the idealized one with the persecutory one and of destroying all hope that—
despite the rageful, revengeful attacks on the bad mother—the perfect rela-tionship with the ideal mother might be recovered. In terms of drives, this latter dyad is invested libidinally whereas the dyad of the victim child–
sadistic mother is invested with aggression. Each dyad, when conscious, de-fends against concurrent awareness of the other dyad.
Understanding the function of dyads in representing drives and the de-fenses against them adds a new level of complexity to the task of the thera-pist. Drives stem from primary affect states. From a practical point of view, drives can be defined as the superordinate common motivational force of all similar affect states; the most basic drives are the libidinal and the ag-gressive. In patients with BPO who lack internal integration, the drives generally remain split and defend against each other. This is illustrated in the preceding example, in which a dyad invested with an overriding aggres-sive affect defends against a dyad invested with the opposite, libidinal affect.
The system is unstable, with abrupt shifts between the dyad/affect/drive that is conscious and the dyad/affect/drive being defended against.
In summary, to fully understand the fragmentation and conflicts that ex-ist within the patient’s internal world, the therapex-ist working with borderline patients must not only delineate the different caricatures constituting the dyads and the oscillation between self-representation and other represen-tation within the dyad, but must also note the function that one dyad may play in relation to another. To achieve this level of understanding, the ther-apist must first be constantly attentive to the different roles the patient ex-periences or enacts and also to the roles evoked in the countertransference.
The therapist must then consider how these role pairs, or dyads, can carry the different drives as well as the prohibitions against them and must orga-nize them in a way that provides a primitive attempt at stability based on an internally fragmented state whose elements cannot be brought together and integrated.