Reparenting

This is a difficult decision and can open up a can of worms.  Reparenting if not done correctly can come off as a reintroduction to the SMP abyss.  The formation of a malignant regression can be dangerous when it shifts into a realm of impossibility.  However, a benign regression can be most helpful and therapeutic. 

The benign regressions are carried out as goals focused through excises to progress through developmental fixation.  For example, a patient is regressed when old unresolved hurts (transferences / distortions) resurface and are directed toward the treater.    For the more fragmented individual, integration takes place through the taking in of (introjection) positive interactions with the treater. Lets say old wounds are resurrected, amplified (unresolved rage) and projected onto the treater, (the treater is the target of transferences), it is the treater�s function to empathetically acknowledged the rage (projected object in the transference), and handle resurrected dynamics of the rage by taking it in, detoxifying the rage, and offer it back in a less threatening form. In other words, the patients close core structures are modified when the treater acknowledges the rage first, and then helps defuse the situation as a new role model (identification). For example the regressed patient may say, �I HATE you!  You are just like my mother!  You always twist things around!�  The treater responds, �I can see you are angry, really mad.  I would be mad too if my mother twisted everything around.  I bet being misunderstood would be crazy making.  So if things appear as twisted around, lets figure out what happened because I wouldn�t be doing my part to let you go on thinking that.�  Here we see the treater has accepted the rage, contained it, and is now aligning a positive and corrective stance with the patient, (the patient has split off the bad object in the transference, projected into the treater, and the treater as contained, detoxified the bad object, now modified, and offered it back in a more harmless form to the patient).  What the treater has done in effect, has reparented the patient and built a stronger trust, with means, strengthen the therapeutic alliance.  Once this alliance has become stronger, and the bad objects in the patient has been modified through repeated interactions with the treater, which after a time, will bring us to the next step.

Be forewarned, this usually works only for the more integrated individual.  Through clarification, confrontation and interpretation, the regression in transference promotes growth through insight and self-awareness and especially through the cathartic release, (great pain released in tears).

The malignant and dangerous regressions into reparenting would be the sinking of self, fused with the powerful SMP.  Rule of thumb, regressions are benign and helpful when they promote growth to a period of moving on.  Regressions are malignant when they become the object of fusion and static with the symbiotic magnetic pull, and there is no relief, but more of a demand for unreasonable entitlement.  The task of reparenting should take place in the framework of structured holding environment because it can act as the safety net from the abyss of the SMP. 

Borderline Personality Manifestation

The hallmark traits of borderline personality disorder (BPD) are a lack of identity, pervasive emptiness, excessive anger and the inability to regulate emotion.  The sources of these symptoms were caused by the dynamic, ambivalent and powerful struggle between the SMP vs. individualization during the rapprochement subphase.  �The rapprochement subphase is where the fixation becomes apparent, with the point of origin in the symbiotic phase [11].  Here we see dependence vs. independence. 

Emptiness � lack of a maternal constant object

Since the subphase of object constancy has not developed within the borderline individual, he resides predominately within the rapprochement subphase.  There is a constant reverberation of the push-pull behavior. A sort of �I hate you, don�t leave me� or �I run away, come rescue me� dynamic.  We see this because a borderline individual has not internalized the �all-good nurturing maternal object� (emptiness) and when his fleeting maternal supplies diminish, there is a run-away behavior to prompt the chase.  We can sum it up in this way, �If you catch me, you love me, if you don�t catch me, you hate me.�  When �captured� the borderline individual�s maternal supplies are replenished for a time.  We can see this clearly when the borderline patient tries to woo and extract maternal attention from the treater.  If the treater fails, like the toddler, the borderline patient will up-the-stakes, sort of speak.  Note this observation in the toddler. �It is quite impressive to observe the extent to which the normal infant-toddler is intent upon extracting, and in usually able to extract, contact supplies and participation from the mother, sometimes against considerable odds; how he tries to incorporate every bit of these supplies into libidinal channels for progressive personality organization [9].  Here we see that the borderline individual is behaving as the normal toddler through rapprochement with his treater.  The problem a treater faces is that active approaching (rapprochement) and the �catch� appears as chronic, and therefore draining on the reserves of the therapeutic relationship.  Sooner or later the therapeutic relationship with the borderline individual will take the normal course into a rapprochement crisis that is age appropriate with the toddler.  What may appear to a treater as �regression� is actually a resuming course of development that was fixated in childhood.

Rage

The hallmark of the borderline individual is rage.  Rage from the separation of the maternal symbiotic orbit without the compensation of the internalized maternal constant object because the resolution of the rapprochement subphase has failed.  Rage derived from the repeated failure of environment�s attunement with the infant�s inborn ego endowment. In other words, the child has failed to get what he needs because of problems from attunement with the primary love object or from abuse.  The oscillation of rage is directly in sync with the borderline�s fluctuation of maternal supplies from his environment.  Since a constant object does not exist within the borderline individual, then the constant modulation to defuse rage does not exist either.  The containment of rage is much like the containment of maternal effect.  Neither are subject to containment without external attention.  To say it another way, the borderline individual is able to contain his rage as well as he is able to contain the constant object, which is to say, not very well. Note this observation. �Rage tends to wipe out positive experience in relationships and maintain a predominance of angry over loving feelings.  Good experience fails to �stick to the ribs� of psychic structure� [1].  This is why in borderline individuals we see the rollercoaster affect.  Their moods are fluid and can begin or end abruptly in direct relation to the success of the rapprochement catch.

Treatment

The goal of the treater is to experiment and develop an attunement with the borderline individual.  Through validation and positive mirroring a strong therapeutic alliance can be constructed.  One of the signs of a strong alliance is the resumption of the rapprochement subphase that will move forward into the rapprochement crisis.  Here we see the flare up of rage, which seems puzzling because things were going so well as the alliance developed.  We use the analogy in which rage is like nuclear fusion and if not contained can be a bomb. However, nuclear fusion can be contained in specially built nuclear power plants (holding environment) and the energy (rage) can be modified.  It is important to note that without fusion (rage-heat) there is nothing to modify (structural change).  The negative affects that were repressed due to failed attunement or abuse are resurrected in the holding environment.  If the treater is successful, rage from the negative affects is modified into the formation of the internalized constant object.

Treaters face problems when they �are afraid to upset the patient� and employ all sorts of tactics to maintain a positive affect in the patient.  The holding environment that was constructed for fusion is not utilized.  Sessions are uneventful, boring and dead.  Some treaters take the low road to pass the time in chitchat.  This would be much like a blacksmith attempting to shape a cold chuck of metal without heat.  However, with the application of heat, and the skillful use of development tools, the blacksmith is able to modify the metal. 

Working with the borderline individual is an art and similar to the navigation of a vehicle because there must be balance of acceleration and breaking to get someplace.  Breaking (speed regulation in dangerous areas) is akin to the establishment and promotion of positive affects (positive transferences) to maintain the holding environment that is needed for treatment compliance.  In other words, the strength of the alliance and the ability to get something done is based on the positive emotion toward the treater.  Acceleration (working through � going somewhere) is the application of negative affects (negative transferences) that generate anger and rage.  The treater�s employment of developmental skills can reshape the psychic structures while contained within the holding environment.  However, the treater must be prudent not to pervasively overwhelm the patient with negative affect since to do so would equate to a car going over a cliff (the therapeutic alliance has severally deteriorated and cannot be repaired).  During these times breaking (use of positive affects), and backing off on acceleration (shelving negative affects) can preserve the alliance.  This will give the client a chance to fall back and regroup. This attunement carries the rapprochement crisis forward through regressions � progressions, unavailability � availability, and rage � soothing.  It is the successful reverberation of comings and goings with the treater that produces useful derivatives in the formation of the constant object.  

The Holding Environment

This term, coined by Winnicott suggested the treater create a holding space, which can provide a safe place for experimentation and change with the patient. Winnicott emphasized that the critical element of the holding environment was its framework, or operating boundaries.  To help prevent unnecessary treatment failures Winnicott suggested explaining to the patient at the onset of treatment an agreement between the therapist and patient.  For example, lateness is handled this way, or missed sessions in this way, or dangerous behaviors in this way.  Be consistent!  How can the patient internalize a constant object if the treater does not model one?!  Action should take place as matter-of-factly without irritation (countertransference reaction). This is especially important with personalities that are prone to feel slighted without perfect mirroring.  In other words, a treater that changes the rules as he goes can have a deadly effect.  It may come off as the �rejecting mirror� and validate beliefs, and destroy months carefully constructed introjects that modified the patients poor objects relations. The treater that changes the rules as he goes may come off as a cheater, weak, passive, aggressive or a whole range of affects.  And, the patient with a ridged and unforgiving personality (rightly so in many cases) will walk or act out dangerously and then, treatment has failed.   It is important to discuss with the patient the difference between �acting out� (physical aggression, missed or late appointments, dangerous behaviors) and �working through.�  Working though is the verbalization of feelings, emotions and affect.  Acting out on the other hand must confronted using a preset framework of consequences.  For example, consequences (other then the execution boundary) can strengthen the therapeutic alliance.  In some cases consequences will validate the rapprochement-patient that he as been �caught� in the unconscious compulsion to �shadow and dart away.�   Much in the same way as the rapprochement-toddler, object constancy will progress for the patient through testing, the comings and goings of the treater. 

Transitional Space

Once the holding environment is constructed it can provide a safe place for transition.  Winnicott viewed the transitional space (the transitional phenomena) as an intermediate space to invite experimentation and exploration.  It was modeled from the mother-infant transitional space during the separation-individualization phase.  It is sort of a playground, a place to assign roles that are resurrected from the past (transferences) and played out.  As these roles take shape, a distorted reverberation based in the past (transferences � countertransferences) will take place between the treater and the patient.  For example a treater may kindle an exaggerated rage in the patient from slight rejections.  In other words the joint assigned roles between the treater and the patient has stirred emotions of the over critical and rejecting parent.  Once the roles are in motion in a safe place (activated transferences of the bad object in the transitional space) the treater guides the treatment course with skillful tools.  The skillful treater may apply more �heat� to ambiguous transitions to bring clarity, to help the situation become more obvious.  Usually, during a return to baseline there is a cathartic release within the patient from repressed emotions.  Guidance from the treater in the form of clarification, confrontation and interpretation can crystallize the flooding of emotions into a meaningful experience.  This is similar to our analogy of the blacksmith that quenches the carefully shaped metal in the water.  The modified metal is crystallized as the steam escapes, much as the patient is modified as the repressed emotions escape the cold labyrinths of confusion�. all while in Winnicott�s transitional space within the framework of the holding environment. 

Narcissist Personality Manifestation

Unlike the borderline individual fixated in the rapprochement subphase, the narcissist individual is fixated in the earlier practicing subphase. Narcissistic manifestation originates from the infant�s inability to separate from the grandiose delusional derivatives of the symbiotic orbit. This poses as a curiosity (Masterson) because the infant �develops� through the rapprochement crisis consisting of successes and failures. I say curious because in order for the infant to separate from mother, the infant would have to had actually experienced the successful resolution of environmental difficulties based in reality, and of course since the resolutions are reality based, one would expect the infant to have realized through such experiences that he is NOT as powerful or grandiose as he perceived he was at the height of the practicing phase. In other words, the dilemma can be postulated in this analogy "How does an individual acquire financial credit, if the individual does not have the required credit history?" For instance a banker may say, "I�m sorry, you do not have a credit history. We cannot give you the money." The response is, "How can I get a credit history if I cannot get a loan to began with?!" Of course to circumvent the banker�s requirement, the individual can provide phony credit documents. Basically, that is to lie. So, we now see the infant was manipulated to lie (use defense mechanisms [denial et al] to 'bypass' the rapprochement crisis.)

Back to our narcissistic model, the infant distorts (lies) on an unconscious level though the primitive defenses of denial, projection and splitting to maintain the illusion that he is STILL powerful and grandiose. But why would the infant feel pressured into distorting though denial?

Lets say mother is projecting her needs and insecurities into the infant.  The infant feels obligated to engage and to expend his energy to satisfy mother else he may risk losing her love. In the infant�s engagement to satisfy mother, his development is arrested as he constructs psychological structures to please her needs. The infant�s psychological structures shaped from the projection of mother�s needs are called the false self. One of the major components of this model of the false self is the grandiose and omnipotence distortions. In other words the infant is busy clinging onto his delusion of power, because without it he would not be able to meet mothers needs, and lets face it, how many of us would lie, cheat and steal to save the life of a loved one? The infant is busy clinging onto his distortions (lying) because without them he would be small, helpless, and powerless to save mother and himself. Hence we see the infant�s chronic adaptation of denial (one of many) as a defense to survive and maintain mother�s love.

In this model the infant was not able to relinquish the narcissistic component so he could save mother, and therefore he could not fully benefit from the rapprochement crisis. Most of the infant�s successes and failures during the rapprochement crisis were grounded in distortions (lies) and now, the result is the end product of the false self. In service of the mother, the infant gave up himself. In the military, when an individual gives up himself for his country, he is considered a hero and decorated with honors and metals. However, in contrast to the military hero, the narcissistic infant is unfairly despised for his sacrifice of self later in life.

The narcissist adult is in a very sad place. One prominent narcissistic individual (Vaknin) said, "I HATE it when a women tells me that she loves me!" On the surface this would appear confusing since love is to be desired. However, with the narcissist, love equates to obligation (mother-infant dyad), which equates to psychological death. On the unconscious level, the narcissist must HATE love in order to survive, in order to have the HOPE of finding the true self. Love to the narcissist is a force that discarded the true self into a coffin and buried it alive. Love is not to breath, but to suffocate. To reverberate with love means to throw oneself away. Of instance, the woman says, "I�m falling in love with you" translates to the narcissist on an unconscious level to "I�m beginning to obsess with the idea of murdering you."

Supplies
Stay Tuned

Treatment
Treating the narcissist patient is challenging. Because the narcissist patient�s development was subphase arrested, the treater must construct an environment in which to promote and encourage developmental growth.  Growth for the patient occurs in the resumption of empathy based mirroring and/or safely idealizing the treater (mirror and/or idealizing transferences).  Lets look at each of these transferences:

Mirroring
To get past the argument of defense mechanisms, conflicts and etc, Kohut looked at the �self� as the essence, the core personality. Working with the concept of the �total-self� enabled the role of the treater to provide mirroring and empathy that was transcendent of resistant barriers in the patient. We could say that since the narcissist personality is subphase fixated, it is therefore fragmented. 

Attention is focused toward perfect mirroring, a system of reverie (mother validating the infant�s true-self) that failed in the original developmental practicing subphase.  What we are talking about is this: the patient will act-out old wounds from the past, (I will prove to you I am worthy � invalidated infant), amplify those wounds toward the treater, (I will impress you with my worthiness � invalidated infant is now the amplified invalidated adult).  The treaters role is to take the, �empathic-introspective stand, which allows him or her to be responsive to the patient�s total-self� [11].  We see though the technique of perfect mirroring; a gradual consistently is taking place. 

However, what is perfect mirroring? The narcissist will be the first to argue there is no such thing as perfection when it comes to mirroring.  They should know.  As infants they have unconsciously strived over and over again to win mother over though the development of the false-self as an attempt to perfectly mirror mother!  And, nothing work!  Interesting, for the narcissist adult to acknowledge the perfect mirror would equate to acknowledging the destruction of the self.  In other words, to face perfection would be to face destruction.  Because quite frankly, the narcissist has already PROVED that as infants, the perfect mirror destroyed them. It was a double loss.  (1) The true self was lost at the formation of the false-self in service of the mother, and (2) Mother was also lost in the process. 

What the treater can hope to achieve is dialectal mirroring.  In other words, through the process of working through, the treater is able to dialectally reverie with the patient toward a common ground.  In other words, the not-good-enough mirroring becomes good-enough built on sincerity, empathy, and constancy toward a vector of perfection.  Dialectal because the patient is in need of perfect mirroring, and the treater mirrors imperfectly.  The process repeats (dialectally) again, except this time a synthesis has occurred and the treater is positioned closer to the patient�s unconscious appeal for perfect mirroring.  So as you can see, the narcissist patient is unconsciously fragmented (splitting) into perfect mirroring vs. failed mirroring.  However, through the dialectal empathic mirror, integration may be able to take place.             

VI. Conclusion

We have learned that objectifying the psych into object relations can provide powerful tools to deconstruct (reverse engineer) the end product of pathology that originated in childhood.  In other words, the end product of present day behaviors (i.e. neurotic, ridged, obsessive, object attachment or failure to attach) that originated in childhood can be reexamined and identified to provide insight into that which was unknown (unconscious).  We have learned that fixation or arrest in a critical phase(s) during the first three years of life can have lasting implications.  In some cases we have learned that �knowing� and �insight� is at times not enough.  Treatment is necessary when a disturbed individual�s quality of life is severely undermined by their pathology.  �The process of structural change involves the undoing of pathology and the resumption of development.� [1] Sometimes relief can only come from working-through with a skilled professional that has a solid foundation in developmental knowledge.  There are times the professional can assist with validation (a supportive stance of benign behaviors that provide relief), or a system of working through.  Working through tackles developmental obstacles with a balance of treatment stances.  Some stances are educational, supportive, confronting, or a delicate mixture of complex stances that lead (they own it) the patient to self-discovery.  A treater must know when to guide, when to carry, when to support and when to intermittently let go. 

We have learned about defense mechanisms.  The closer their orbit to the symbiotic magnetic pull, the more primitive they are.

We have learned that change is intrinsic of the life cycle, either through re-validation (i.e. strengthen self-esteem or strengthen �I am bad�) or modification (a corrective, harmful, or educative experience).  We have seen how disturbances in the rapprochement subphase manifests into borderline personality organization or fixation in the practicing subphase can manifest into narcissist personality organization.  Depending on the period of arrestment, developmental manifestations are amplified at the point of fixation.  In other words, the infant will to proceed at the drop-off-point, much like a seed that fell out of the planter�s pouch.  Rather then grow at the planter�s destination in rich soil; the seed took root where it fell.  Perhaps the soil was bare (abandonment), or perhaps it was saturated (engulfment).  The end result may be a stunted or distorted tree.  However, the knowledgeable nurturing caretaker (treater) can prune the limbs to encourage redirection and enrich the ground with the necessary ingredients to correct and promote growth.

Test Yourself:

1. What are the two fore runners of the Separation � Individuation phase?
2. What is the dual unit of the mother � infant termed?
3. What would a security blanket for an adult or child be called?
4. What does Rapprochement mean?
5. What does Reaction Formation mean?
6. What protects the ego from anxiety (self)?
7. What term did Winnicott coin to describe the framework for treatment?
8. Which subphase may determine mood baseline for life?
9. What is the SMP?
10. What do we mean by �object?� as in object relations?
11. What is the main difference between object relations and drive theory?
12. What is �Object Constancy?�
13. What are we talking about when we say, �Nature vs. Nurture?�

REFERENCES:

1. MAHLER AND KOHUT � Perspective on Development, Psychopathology, and Technique � Selma Kramer M.D., and Salman Akhtar M.D.  p. � 10, 13, 20-21, 31, 28, 204-205, 50, 72
2. Rapprochement � The Critical Subphase of Separation � Individuation � Mahler et al.   p. � 83
3. The Internal Mother � Conceptual and Technical Aspects of Object Constancy.  Mahler, Akhtar, Kramer, Parens.
4. The Psychological Birth of the Human Infant � Symbiosis and Individuation.  Mahler, Pine and Bergman p. � 24, 42, 44, 87
5. Infantile Psychosis and Early Contributions. Mahler
6. Building the Bonds of Attachment.  Daniel A. Hughes
7. Malignant Self Love � Narcissism Revisited, Sam Vaknin, Ph.D.
8. The Narcissistic and Borderline Disorders � An Integrated Developmental Approach � James F. Masterson, M.D.  p. � 12
9. The Work and Play of Winnicott � Simon Grolnick, M.D. p. � 75, 84, 104
10. Separation Individuation � Margaret Mahler M.D. p. � 57, 124
11. Theories of Psychotherapy & Counseling � Concepts and Cases � Richard S. Sharf
12. The Treatment of the Borderline Personality � Patricia M. Chatham. P. � 265, 277, 281, 387

Courtesy of Kathi Stringer
Kathi's Mental Health Review