Considering Object Relations Therapy

A friend considering resuming her Masters in Counseling asked me the main theory taught at RTS Orlando under Gary Rupp.  Gary didn’t push any particular theory on us; he wanted us to weigh them from Scripture.  But that doesn’t mean he didn’t have a favorite theory.  He preferred Object Relations Theory, and most of us read Sheldon Cashdan’s Object Relations Therapy: Using the Relationship.  This is also the theory that lies behind much of the work of John Townsend and Henry Cloud (Boundaries, The Mom Factor and others).

I will confess ORT intrigued me, and I find aspects of it helpful (when I remember) in counseling.

Object Relations Theory has its origins in the work of Melanie Klein who was a contemporary of Freud.  The basic tenet is ” that the core of selfhood is inextricably tied to the infant’s first and most fundamental object relationship.”  This idea was developed studying attachment among ducks and other animals.  So, from my perspective the “science” would be flawed since people are uniquely made in the image of God and therefore qualitatively different from the animal kingdom.  It is based on a materialistic view of the world.

But where the theory (inadvertently?) gets it right is that many people’s psychological problems have their root in relationships.  The damage is done there, and must be repaired there.  “The core fear centers about the loss of contact, and the individual does all he or she can to avoid the pain of abandonment.”  This is what we as sinners do- we live in the fear of abandonment (among others) and find ways to remain in relationship with others even if it is an incredibly unhealthy or sinful way.

What separates object relations therapy from traditional psychoanalysis is that countertransference is seen as a good thing.  Traditionally countertransference was viewed as bringing your own baggage into the counseling room. 

“Countertransference is “the therapist’s experiential response to the patient’s pathology and is a valuable part of the treatment procedure.  Not only does it perform a diagnostic function but it also guides many of the therapist’s interventions.” 

This means 2 things.  First, the pull you experience from the client (and your response) are an indication of what is wrong with the client.  Second, you should use that as part of the intervention by expressing the pull and how you want to respond.  “I experience you as a very needy person, as if you cling to me so I will take care of you.  But this makes me want to turn and run.”

Pathology in Object Relations Theory is partly about how an individual has learned to cope with the good and bad parts of themselves.  Are they in denial about their “badness” or so fixated on it that they can’t affirm anything good about themselves?  This matters greatly in how they view relationships (I need you to balance my ‘badness’ or make me complete, for instance).  The person then develops, through experience, a default pattern of relating to people to keep them in relationship.

“(P)rojective identifications are patterns of interpersonal behavior in which a person induces others to behave or respond in a circumscribed fashion. … More often than not, the target of the projective identification feels used and manipulated.  … Projective indentifications represent serious efforts to undo a pathological conflict in the self.  The problem is that they do so at the expense of ongoing relationships.  In the end, projective indentifications only prolong and intensify the patient’s pathology.”

Pretty heady stuff in some ways.  They view this as the patient trying to resolve their personal issues in the relationship by getting you to respond in certain ways.  This usually backfires and the relationship is often destroyed.  But rather than changing their behavior, they intensify it becoming more extreme.

Sheldon sums up his 4 main projective identifications this way:

Projective Identification	Relational Stance	Metacommunication	Induction
Dependency	Helplessness	“I can’t survive.”	Caretaking
Power	Control	“You can’t survive.”	Incompetence
Sex	Eroticism	“I’ll make you sexually whole.”	Arousal
Ingratiation	Self-sacrifice	“You owe me.”	Appreciation

The relational stance is their goal, the metacommunication is what they are trying to communicate and the induction is the attitude they want you to adopt to remain in relationship with them.  They are looking for the perfect complement for their own problems, thinking all will be balanced out.

I see these in the form of idols.  Some worship caretakers and have learned to act helpless to find one.  Some worship control and seek out people they can dominate.  If you don’t play along, you may be destroyed.  Some worship sex, or the sense of power sex can give them.  They can build an identity on sexual prowess.  But some with damaged sexuality think they are useful only as sex objects.  Lastly, some worship the glory of admiration.  They are kind to others, the problem is that strings are attached.  They are like the Godfather rather than genuine, loving persons. 

In terms of how you do therapy, ORT does not rely on interpretations of actions or behavior.  The therapist learns “to rely on their own responses to the patient’s projective indentifications.”  You elicit the projective indentification so you can confront it and build a relationship not founded on that projective indentification.  Some literature calls this “reparenting” since they believe this pathology is often (not always) rooted in the relationship with mom.

I agree that the relational aspect is key.  But what they need is to be “parented” by God.  I understand this to be part of the sanctification process.  A biblical counselor would confront the illegitimate means of building relationship, and repentance is learning to live in relationship as God intended by seeing how He loves and interacts with us.

ORT is messy precisely because you will find yourself responding to the patient.  Unlike other therapeutic approaches (say Rogers’ unconditional regard) the response is more authentic and tied to the way in which the person relates to you.  The counselor will want to pay close attention to what is going on inside themselves (how does this person make me feel?), for this is probably how they make others feel.  If you want to help them, for instance, they are probably a depedent personality.  If you feel like you have to fight for your survival, they are seeking to gain control. 

I had one patient I wished I could “dispatch” because each session was a 50-minute power struggle.  I can understand why his wife left, I wanted to leave him.  One time I lived in denial during a group.  One woman usually wore clothes that had bare midriffs or a bit more skin than I was comfortable.  After about 4 group meetings she asked a question that indicated she had been abused and viewed her body as common property.  This was why she dressed that way.  But I had not paid attention to my responses to her enough to ask any questions about her clothing that may have brought the truth to the surface sooner.  I should have brought my discomfort to the table rather than pretending it didn’t exist.

“But squashing the projective identification before it really gets underway prevents a therapist frm fully experiencing what it means to be a recipient of the patient’s projective fantasy and to accurately indentify its precise character.”

The counselor must then challenge the patient.  You want to do this in a way that affirms the relationship.  However, by changing the rules you will often incur some wrath.  By not playing along, you invite lots of relational discomfort.  This requires a person who is sure of who they are (preferably in Christ), to invite the person into a safer, healthier, more godly relationship amidst the kicking and screaming (or running away) that can occur.  What happens is that they often intensify their projective identification, and may verbally abuse you for not providing your side of the equation.  When this is confronted, they may try a secondary projective indentification.  Sin runs deep, folks.

The dangerous side of this is:

“all of us have dependency, sexuality, ingratiating and power components within us.  Interactions with patients along these dimensions may allow the therapist to get in touch with and explore parts of himself that otherwise might remain hidden.”

What he means is that some of your own problems may be brought to light in the process.  You may have to repent, too.  You may find that you want to take care of the dependent client, for instance.

“Doing object relations therapy stretches one as a therapist and as a human being.  It forces you to explore parts of yourself that might not otherwise be explored.”

So while Object Relations Theory poses some major problems for me, Object Relations Therapy is a pretty good picture of what biblical counseling should look like.  Sin is inherently relational.  As made in God’s image, we are relational (the members of the Godhead have loved and related to one another for all eternity).  So relationships are part of the process for applying the gospel to sinful patterns of relating to others.  You can recognize some of those patterns by the internal response they produce in you.  But you then lovingly refuse to give in to the pattern in the hopes of developing a more appropriate process for relating to one another.

All quotations are from Object Relations Therapy: Using the Relationship by Sheldon Cashdan, NY, W.W. Norton & Company, 1988.