The possible impact of animals on Job’s body image: A psychoanalytical perspective

The body plays an important role in the book of Job – as do animals. According to psychoanalytical specifically object-relations theory, a subjective body image was partly constructed through the internalisation of external stimuli from significant others who mirrored the subject through their feedback or through their own bodies, which served as an ideal or critique to the subject. Amongst the external stimuli, animals constitute such significant others. Animals could therefore have impacted Job’s subjective body image, particularly as their bodies were described in detail by God as a response to Job’s complaints and searching.Contribution: Two theoretical and interrelated problems were acknowledged although they cannot be satisfactorily solved: the cultural aspect of the body image and the relationship to animals.

Reformulated Object Relations Theory: A Bridge Between Clinical Psychoanalysis, Psychotherapy Integration, and the Understanding and Treatment of Suicidal Depression

In contrast to the fruitful relationship between psychoanalysis/psychoanalysts and the humanities, institutionalized psychoanalysis has been largely resistant to the integration of psychoanalysis with other empirical branches of knowledge (infant observation, psychotherapy research, psychological and neurobiological sciences), as well as clinical ones [primarily cognitive-behavioral therapy (CBT)]. Drawing from two decades of theoretical and empirical work on psychopathology, psychotherapy, and psychoanalysis, the author aims to show how a reformulation of object relations theory (RORT) using (neuro-)psychological science may enhance a clinical-psychoanalytic understanding and treatment of suicidal depression, which constitutes one of the most formidable health challenges of our time. Specifically, he rewrote the notion of Melanie Klein positions—primarily the depressive position—using extant knowledge of structure of emotions, the centrality of mental representations of the future (“prospection”) and the toxic nature of criticism-based emotions. This reformulation enables a dialog between clinical psychoanalysis and other therapeutic schools of thought and sheds light on the understanding and treatment of suicidal depression.

Attachment Theory and Research

Attachment theory was founded by John Bowlby (1907–1990), a British child psychiatrist and psychoanalyst. The theory builds on an integration of evolutionary theory and ethology, cybernetics and cognitive science, as well as psychoanalytic object relations theory. The theory postulates that an attachment behavioral system evolved via natural selection processes. Bowlby conceived of the attachment system as a behavioral control system that continuously monitors the offspring’s proximity to caregivers, which has in turn been associated with protection from dangers and thus increased chances of survival and reproduction in humans’ and many other mammals’ ancestral environments. Attachment is a species-wide phenomenon denoting the strong bonds that children form to their caregiver(s), seeking to maintain proximity and communication, protesting separations, and using the caregiver(s) as a safe haven to return to for comfort and protection and as a secure base to explore the environment from. Attachments take time, maturation, and repeated sequences of interaction to form and are typically observed from the second half of children’s first year of life onward. According to the theory, attachment-related experiences with the caregiver(s) become internalized in the form of cognitive-affective representations of self and others (internal working models [IWMs]) that organize the child’s behavior and displays of affect in relation to the caregiver(s). Although malleable, such IWMs display a certain measure of continuity across time and situations and may generalize to affect the individual’s expectancies and behavioral inclinations in other and later interpersonal relationships. As pioneered by Mary Ainsworth and colleagues, attachments vary in quality, largely depending on the caregiver’s behaviors (e.g., responsivity and sensitivity to the child’s signals), whereas evidence for a direct influence of genetic heritability is limited. Variations in attachment are typically described using two dimensions (secure–insecure, organized–disorganized) subsuming four categories (secure, insecure–avoidant, insecure-resistant–ambivalent, disorganized–disoriented). Much of the empirical research regarding attachment has focused on these variations and their measurement. Ainsworth and colleagues’ Strange Situation Procedure (SSP), applicable for children aged 10–18 months, is often heralded as the “gold standard” attachment measurement tool. The concerted body of research indicates that secure attachment (or associated factors), marked by confidence in the caregiver’s availability, is generally a protective factor in socioemotional development. In contrast, insecure (avoidant and resistant) attachment, characterized by lack of confidence in the caregiver’s availability, is generally a vulnerability factor in development. Disorganized attachment, reflecting confused, conflicted, or apprehensive child behaviors in the presence of the caregiver (in the SSP), is a risk factor in development, most notably for externalizing behavior problems. Notably, the effect sizes observed have typically been small to moderate, and much is unknown about linking mechanisms and moderating influences. Although most readily observed in early childhood, humans form attachments throughout the lifespan. Accordingly, much research has also focused on adult (e.g., spousal) attachment and the intergenerational transmission of attachment from caregivers to their children.

The Construct Validity of the ICD-11 Severity of Personality Dysfunction Under Scrutiny of Object-Relations Theory

The current classification of personality disorder in ICD-11 includes a description of personality functioning, derived from a number of theoretical paradigms, but most notably consistent with the psychodynamic approach. Concurrently, an object-relations model of personality functioning in a dimensional assessment of severity is provided in the Structured Interview of Personality Organization-Revised (STIPO-R). To date, there are no published measures of International Classification of Diseases-11 (ICD-11) personality severity, though the construct is very comparable to the concepts assessed in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) levels of personality functioning concept, which is measured by the Level of Personality Functioning Scale-Self-Report (LPFS-SR). This study examined the validity of ICD-11 personality functioning, as measured by the LPFS-SR, by evaluating its associations with the STIPO-R in Kurdistan region. The samples included 231 University students and 419 inpatient participants across four hospitals (267 with a diagnosed personality disorder). All the components of LPFS-SR and STIPO-R were positively and significantly intercorrelated. The components of each measure discriminated PD and non-PD patients from a University, non-clinical group adequately. Despite slightly better performance of the STIPO-R in this discrimination, the measures had a high congruence in predicting personality dysfunction. Overall, the findings of the present study support the validity of ICD-11 construct for evaluating personality functioning.

Transference-Focused Psychotherapy for Pathological Narcissism and Narcissistic Personality Disorder (TFP-N)

In this article, we provide an overview of transference-focused psychotherapy for patients with pathological narcissism and narcissistic personality disorder (TFP-N). In TFP-N we have modified and refined the tactics and techniques of TFP, an evidence-based treatment for borderline personality disorder, to meet the specific challenges of working with patients with narcissistic personality pathology whose retreat from reality into an illusory grandiosity makes them particularly difficult to engage in treatment. We first describe a model of narcissistic pathology based on considerations of psychological structure stemming from object relations theory. This model provides a unifying understanding of the core structure of narcissistic pathology, the pathological grandiose self, that underlies the impairments in self and interpersonal functioning of those with narcissistic pathology across the levels of personality organization (from high functioning to borderline to malignant). We then delineate the clinical process of working with patients with pathological narcissism and narcissistic personality disorder. Starting with the assessment process, using a detailed clinical example, we guide the reader through the progression of TFP-N as it helps the patient move from the distorted, unintegrated sense of self underlying the narcissistic presentation to the more integrated, realistic sense of self that characterizes healthier personality functioning. In TFP-N the focus on the disturbed interpersonal patterns of relating in the here and now of the therapeutic interaction is the vehicle to diminish grandiosity and improve relatedness, thereby effecting enduring changes in mental representation and real-world functioning.

Applied Transference-Focused Psychotherapy: An Overview and Update

Transference-focused psychotherapy (TFP), developed and studied as an extended individual psychotherapy for patients with borderline personality disorder (BPD), rests on a rich theoretical foundation informed by psychoanalytic object relations theory. “Applied TFP” is a developing initiative using TFP principles in multiple clinical situations other than the standard extended individual psychotherapy, which has been empirically validated and is detailed in the TFP treatment manual. The growing application of TFP principles in innovative, overlapping ways has been focused primarily in three spheres: (1) the integration of TFP principles in pluralistic theoretical approaches to treatment of patients with personality disorder pathology; (2) the use of TFP elements in multiple teaching situations as part of curricula for trainees and practicing clinicians, and (3) the employment of TFP theory and interventions in settings across a continuum of patient acuity, tailored for patients with varying diagnoses. The use of TFP principles in the situations described directly addresses needs emerging in particular contexts that reflect specific requirements of clinician practice and training and of broader public health missions.

Transference-Focused Psychotherapy for Adolescents With Personality Disorders

This article presents a conceptualization of personality disorders in adolescence and the adaptation of transference-focused psychotherapy (TFP) for personality disordered adolescents (TFP-A). The model of assessment and treatment presented is based on contemporary psychoanalytic object relations theory developed by Otto F. Kernberg and supported by findings from current evidence-based outcome research. We present a method of assessing personality disorders in adolescents that addresses the variability of personality disorder symptoms and traits among adolescents and their instability over time. We then present the goal of TFP-A and its major phases of implementation. A major focus is therapist interventions.