Heinz Kohut was born in Vienna in 1913. When the war broke out in 1914, his father, a concert pianist, was drafted into the army, and Kohut was alone with his mother for much of his first five years of life. He was an only child, and his parents hired tutors to teach him, so he never had the experience of mixing with children his own age in a school context. He obtained a medical degree from the University of Vienna in 1938 at the age of 25, and emigrated to the United States in 1940. He graduated as a psychoanalyst from the Chicago Psychoanalytic Institute in 1950. From 1948, until his death in 1981, he was married to Elizabeth Meyer. They had one son, Thomas.

In the early years of Kohut's psychoanalytic career, he was an ego psychologist in the classical tradition, with close professional and friendship ties with mainstream psychoanalysis in the United States. He served as president of the American Psychoanalytic Association in 1964, and as vice president of the International Psychoanalytic Association. He had a reputation as a brilliant teacher and training analyst in the Chicago Institute for Psychoanalysis with a deep knowledge of classical analytic theory.

Until he began to formulate his new theories about the place of narcissism in development, Kohut was a central figure internationally, a friend and respected colleague of Anna Freud, Heinz Hartmann, Kurt Eissler, and other influential figures on the psychoanalytic scene. He was widely expected to become the president of the Association. This changed as his writings made clear the extent to which he was reformulating classical psychoanalytic theory. By the time of the publication of the Analysis of the Self in 1971, he had been shunned by the psychoanalytic community, lost his position on the International Psychoanalytic Association, and was gathering around himself a new group of colleagues and close collaborators, who were to form the nucleus of the self tradition.

Kohut's three major works, The Analysis of the Self (1971), The Restoration of the Self (1977) and How Does Analysis Cure? (1984) mark the progressive development of a theory of self increasingly differentiated from the classical tradition in which he had trained. Self psychology, founded on Kohut's reformulation of the Freudian approach to narcissism, and his innovations in the area of psychoanalytic technique, now forms an influential and vigorous branch of psychoanalysis in the United States.

The point of early differentiation between classical Freudian theory and Kohut's theory centred on the concept of narcissism. In Freudian theory, primary narcissism is a stage between auto-eroticism and object-love, in which the developing infant experiences herself as omnipotent and relatively undifferentiated from the object world (Freud, 1914). Secondary narcissism is a pathological state in which there is withdrawal of libido from the outside world. Such states are characterised by an incapacity to form and maintain mature relationships with others, because they are driven by preoccupation with self (Pulver, 1986). Patients with narcissistic disorders which, in terms of Freudian theory, included psychosis and severe depression, as well as borderline and narcissistic personality disorders, were thought to be unanalyzable, primarily because of their self-involvement and inability to benefit from analysis of the transference.

Kohut's contribution to psychoanalytic theory began with a new look at narcissism, not as a primitive or pathological state, but rather as an indispensable and life-long aspect of experience, with its own course of development (1966). In this early paper, “Forms and transformations of narcissism”, he laid the ground for the theory of self development that was to follow. He saw love of self and a capacity for pleasure in one's own achievements as a fundamental pre-requisite for mature relationships, and described narcissistic needs of the personality “as a healthy enjoyment of our own activities and successes and as an adaptively useful sense of disappointment tinged with anger and shame over our failures and shortcomings” (1966, p. 255). Narcissistic needs for affirmation and for soothing remain with us throughout life, although the means of fulfilling those needs change many times in the course of development. He also described idealization as an aspect of narcissism, and the idealized parent as the carrier of the projected perfection and bliss of primary narcissistic states (1966, p. 250). Idealised relationships become internalised by the developing self as “a healthy sense of direction and beacon for our activities and pursuits” (1966, p. 255). Having redefined narcissism in this way, Kohut then set about the task of identifying and describing the trajectory of healthy narcissism in normal development, and mapping its relationship to specific needs and self-states. The term 'narcissism' with its complex connections with mainstream psychoanalytic theory was gradually replaced with a rich and experience-near vocabulary of self, and self development.

The implications for treatment of Kohut's new approach to narcissistic phenomena is explored in perhaps the most famous of his clinical papers, “The two analyses of Mr Z” (1979). In the paper, he describes two analyses with the same patient, each lasting approximately four years. The first was a classical analysis in which Kohut systematically confronted his patient, through interpretation, with the links between his “narcissistic demands” on his analyst and his “fixation on the preoedipal mother” (1979, p.5). Mr Z's father had been absent from the childhood home for a year and a half, until Mr Z was five years old, and during this time had enjoyed an exclusive bond with his mother. In the first analysis, Kohut understood his patient's unrealistic grandiosity and demands for attention from his analyst as a defence against oedipal competitiveness and castration anxiety. His patient responded to his interpretations with rage, saying that he felt misunderstood. After a year and a half he became calmer, and Kohut at the time believed this was the result of effective interpretation. His patient believed otherwise, claiming that he had finally felt understood by Kohut's comment that “Of course, it hurts when one is not given what one assumes to be one's due” (1979, p.5). When Mr Z returned for a second analysis, Kohut took a fundamentally different stance towards the narcissistic demands that quickly emerged. Instead of regarding these as defences bulwarks against oedipal anxieties, he saw them as a valuable reconstruction of early experience, presenting itself to be accepted and understood. The iatrogenic rages precipitated by the interpretations of the first analysis were replaced by an unfettered exploration of early experience, previously unavailable to analysis.

Mr Z is a complex case, and has been the subject of a great deal of critical debate (Schoenewolf, 1990). It's importance lies in its dramatic presentation of the effects on the same patient of a reorientation to narcissistic phenomena such as an unrealistic sense of entitlement, demands for attention, grandiosity, previously regarded as an impediment to successful analysis. The acceptance of such phenomena as a window onto early childhood development formed the nucleus of self theory.

The developmental context

Definition of self

The self, central to Kohut's theory, cannot be objectively observed or described. It describes an experience of oneself as continuous in time, with a history and a future (Wolf 1988). It includes our ambitions for ourselves, our ideals, our sense of having particular talents and skills, our exploratory and creative energy, and the affects that colour them all. Thus, Kohut describes the self “as a unit, cohesive in space and enduring in time, which is a centre of initiative and a recipient of impressions” (Kohut 1977, p.99). An embryonic or virtual self is the term Kohut gives to the loosely organised experience of newly-born infants. This develops into the nuclear self, as the infant's experiences become organised through repeated interactions with caregivers. Patterns of interaction will create a set of expectations about the world and the self in that world. Experiences of selfhood are never separate from relationships with others. In fact, it is through relational experience that self is both known and sustained.

One of the most compelling concepts in self theory is the use of the cohesion-fragmentation continuum as a description of self experience. A cohesive self is vigorous, responsive, flexible and energetic, optimistic and available to experience pleasure, regardless of whether it is attuned to the outer or the inner world. It implies a capacity for self- soothing and self-regulation in the face of unsettling experience. When fragmentation occurs (as it does in all people from time to time) it is generally brief, and does not affect basic self-regulatory structures. By contrast a self, fragile as the result of problems in early relationships with caregivers will be prone to fragmentation. A fragmented self will have compromised vitality, exploratory energy and flexibility. Attachments may be anxious or clingy, or withdrawn and wary. The fragmented state is one in which there may be a combination of the following: depression, emptiness, anxiety, or rage, ambivalence, confusion, poor bodily co-ordination, misperception of the body in time and space, disorganization, withdrawal, memory loss, mood swings, and diminished capacity for creative problem solving. The individual may describe a sense of 'falling apart', of being disconnected, panicky, overwhelmed, unable to concentrate, and unable to be soothed.

To be fragmentation-prone is one form of self disorder. However, there are a number of other self experiences that are indicative of difficulties in the development of self structure. For example, some people experience themselves as empty and lacking in energy, or as struggling to find meaning in their lives. Others experience themselves as disproportionately powerful and special, and struggle with any encounter in which they are not centre-stage. There are also individuals who persistently engage in self-sacrificing activity and are unable to value themselves except through their provision for the well-being of those around them. Then there are a range of problems that occur as the result of an individual's attempts to prevent fragmentation, or to overcome experiences of loneliness, emptiness or overwhelming need. These are often maladaptive self-soothing behaviours and may include addictions, sexual perversions, avoidant behaviour and the pursuit of dangerous activity.

Selfobject experiences

An infant's earliest experiences of selfhood are always mediated by interactions with primary caregivers. For example, early experiences of well-being might arise from being rocked or stroked when distressed. These first encounters of relatedness are undifferentiated and are part of a seamless merger with the caregiver. Merger states give way to an increasingly differentiated sense of self-as-agent as physical and cognitive capacity expands. Admiring responsiveness from caregivers over first smiles, learning to grasp an object, or taking first steps are the mirror in which the self as a centre of goal-directed successful behaviour is seen. In other words, without an admiring and containing audience, the infant has no sustained and cohesive way of experiencing selfhood. The essential link between self and other is captured in the term 'selfobject'. According to Bacal and Newman, an object is a selfobject “when it is experienced intrapsychically as providing functions in a relationship that evoke, maintain, or positively affect the sense of self” (Bacal and Newman 1990, p.229). To put it another way, Wolf describes any experience that “functions to evoke the structured self (which manifests as an experience of selfhood) or to maintain the continuity of such selfhood” as a selfobject experience (Wolf 1988, p.52). Selfobject experiences do not always involve a relationship with another person. For example, cuddly toys, dummies and soft blankets may soothe and sustain a sense of well-being in an infant. However, these objects, transitionally soothing, are secondary to a network of responsive relationships within which the self gains strength and structure. Selfobject experiences continue to serve the role of maintaining and affirming the self throughout life, in developmentally appropriate ways. The form taken by selfobject needs in adulthood, and the urgency with which they are felt, depend on the pattern of strengths and deficits in the early care giving matrix. Selfobject experiences always have a relationship to a sense of relative well-being in the self, whether directly through adequate fulfillment of selfobject needs, or indirectly through the hope or expectation that such needs might be fulfilled.

Infant research within the general framework of psychoanalytic theory has given empirical weight to Kohut's insistence on the relational aspect of self development (Beebe and Lachmann, 1994; Lachmann and Beebe, 1996; Tronik, 1998). The finely nuanced dance between infant and caregiver forms a complex pattern of self- and mutual regulation, which includes moments of intense connectedness and also periods of appropriate disengagement. Sometimes this dance is well-attuned and substantially enhances the infant's sense of attachment, containment and curious joyful well-being. At other times, mis-attunement will disrupt the interaction and cause distress. For example, a caregiver might intrusively insist on face-to-face interaction, at a time when the infant needs a period of quiet disengagement, or may fail to respond to the infant's appeal for social interaction (talking, smiling, and eye contact). Prolonged mis-attunement between infant and caregiver may lead to a wide range of interactive difficulty, including for example anxious and clingy attempts to extort needed responses, or at the other extreme, a helpless inertia or withdrawal.

Types of selfobject need, and the bipolar self

Kohut identifies a primary set of selfobject needs in relation to the development of a cohesive self. The infant is protected from inevitable disturbances to her sense of well-being in two different ways. Primitive grandiosity, a sense of limitless power, attractiveness, of being in some way the centre of the universe, is the first of these. The second is an unelaborated but equally powerful sense of merging with something or someone perfectly knowing and soothing. Each of these self states has an important role to play in the acquisition of self structure and is associated with specific selfobject needs.

Primitive grandiosity can be seen in young children's sense of entitlement to instant attention and to gratification. It is also apparent in children's games when, for example, they joyously celebrate being king of the castle or proudly display their first attempts at drawing. With appropriate affirmation from selfobjects, these grandiose displays of self are built into self structure as mature self esteem. Kohut (1971) referred to the need to be affirmed, recognised, accepted and appreciated, particularly in relation to displays of the self, as mirroring needs. While it is important to give confirmation to the growing child's unique specialness as she/he masters a growing set of physical, cognitive and emotional skills, there will be times when the child experiences the limits of her capacities. So long as these disappointments are not traumatic or overwhelming, they contribute positively to the modification of primitive grandiosity. Children whose caregivers protect them from disappointment and in this way over-stimulate their primitive grandiosity may develop difficulties in relation to the inevitable failures and mishaps they later encounter in the outside world. Some might protect themselves from the painful feelings this evokes by holding onto aspects of their primitive grandiosity, expecting constant attention and admiration and by blaming the world for failing to accommodate to their unique needs; others may be overwhelmed by a sense of humiliation in response to minor criticisms or problems and present as having low self esteem.

Mirroring needs, and the grandiose sector of the self, are associated with what Kohut termed the 'pole of ambitions' (Kohut 1977). Failure to meet mirroring needs in infancy is related to later failure in striving to achieve, and may take the form of either lack of ambition or over-ambitiousness.

The need to experience oneself as being part of an admired and respected selfobject; needing the opportunity to be accepted by and merge into a stable, calm, non-anxious, powerful, wise, protective, selfobject form what Kohut terms idealising needs (Kohut 1977). These needs may be fulfilled initially by a parent, or caregiver, and later by teachers, mentors, and still later by an abstract structure such as an ideology. When idealising needs are met, the self develops the capacity for self-soothing, having absorbed the qualities of the idealised selfobject. When idealising needs are not met, the self may become overburdened and lack self-soothing structures. In The Analysis of the Self (1971), Kohut describes addiction as one possible result of the traumatic failure of an idealized selfobject during early development. He suggests that when the caregiver fails to provide needed stimuli and also to form “a stimulus barrier” to mediate between infant and environment, the resulting damage to the self will include an incapacity to maintain equilibrium without recourse to a variety of drugs, or else to addictive activity (1971, p.46).

Ambitions and ideals are in tension with one another, and form the basis of what Kohut referred to as the bipolar self (Kohut, 1977). In healthy development, personal ambition and the need to achieve success in competition with others will be balanced by the capacity to work co-operatively towards a shared vision for the greater good of all concerned. Self-sacrificing individuals may, for example, persistently put aside personal success in order to serve a political or religious organisation. A very ambitious individual might sacrifice the needs of the organisation of which she is a member in order to achieve fame, material success or personal power.

Mirroring and idealising selfobject needs are central in the development of the self and are not always easily separable from each other. There is a dynamic interplay between them throughout development and into adulthood. Moreover, later theorists have suggested that many different selfobject needs are encountered in each unique interactive dyad (Ornstein and Ornstein 1995). Adversarial selfobjects affirm the self through the acceptance of opposition, argument, and self-assertion without punitive retaliation. Adversarial relationships often mark stages of separation from the caregiving matrix. They imply the provision of a space within which demands, assertiveness, oppositional behaviour and independence can be negotiated without threat of the loss of the selfobject tie.Twinship experiences are those in which the individual is given an essential sense of kinship with like-minded others, of fitting in with the group, sharing values, activities and interests. Alterego selfobjects, which the original theory does not differentiate from twinships, has been recast in the work of Doris Brothers (1998), and refer to a pairing of apparent opposites, as in for example, an outgoing and socially confident person sharing a friendship with a quiet and reflective one. In these alterego relationships there is a recognition of difference and complementarity, rather than sameness.

The place of rage, guilt and shame in Kohut's model of personhood

In Self theory, aggression is not considered to be a basic drive-driven state, nor is it seen as fundamental to disorders of the self. According to Kohut, “destructive rage, in particular, is always motivated by an injury to the self” (Kohut 1977, p.116). This clearly distinguishes Self theory from the work of Klein, for example, or Kernberg, both of whom consider aggression and rage to be primary affective states, and treat them as such in the therapeutic situation. Self psychologists focus their attention not on the rage or destructiveness, but on the injury to self that is presumed to lie behind it. In Kohut's view, a focus either on the content of rage, or on the conflict aroused in the patient about her destructiveness, fundamentally obscures the narcissistic injury that threatens the cohesion of the self.

It is important to distinguish between a variety of angry, aggressive or enraged states in coming to an understanding of their origin and function for the self. On the one end of the continuum, assertiveness may at times be coloured with aggression, and is an appropriate exploratory or aversive response to a demanding or unfamiliar environment. Aggression as a line of defence may be adaptive and successful as a means of protecting a self under threat. An extreme of this, a brief state of rage, may prevent fragmentation, and allow for clarity and focus in dealing with a threat. However, rage may also be disorganizing and contribute to the state of fragmentation. There are also states of chronic rage, in which a self experienced as continually under threat, is bolstered by an inflexibly suspicious and antagonistic orientation to any experience, no matter how benign.

Kohut was careful to differentiate disorders of the self from the structural conflicts that form the content of a classical analysis (Kohut, 1966; 1971; 1977). He suggests that the central psychopathology in the transference neurosis of a classical analysis “concerns conflicts over (incestuous) libidinal and aggressive strivings which emanate from a well-delimited, cohesive self and are directed toward childhood objects which have in essence become fully differentiated from the self” (1971, p.19). Such conflicts are characterized by castration anxiety and guilt (Kohut, 1977). By contrast, the central psychopathology in disorders of the self lies in the “psyche's inability to regulate self-esteem and to maintain it at normal levels” (Kohut 1971, p.20). He identified a propensity to the experience of shame as central to problems with self-esteem (Kohut, 1966).

Morrison suggests that shame is often experienced in relation to a perceived defect or deficit in the self; it is not the result of doing, but of being (Morrison, 1989). When the reflection of the self from the other is misattuned, nonattuned, abusive or punishing, shame inevitably follows. Shame may be a reaction either to a failure to be given a needed affirmation from a responsive selfobject, or to the failure to achieve an ideal goal. Both, Kohut argues, may lead to an affective experience of “nameless mortification” , dejection, depletion of energy, and hopelessness (1977, p.224).

Therapeutic implications: theory and technique

The goal of therapy in self psychology is to strengthen the self. This implies decreasing the tendency to fragmentation, while increasing resilience to threat. It will involve building the person's capacity for self-soothing in ways which are flexible and creative. It will also involve enhancing the person's ability to seek out affirming selfobject experiences, and to actualise his/her potential.

Vicarious introspection and empathic attunement

The central component in strengthening the self is the experience of being understood, through the empathic attunement of the therapist. Empathy is frequently misunderstood as being synonymous with sympathy, or with a warmly responsive and caring attitude towards the patient. For Kohut (1982) empathy was first and foremost a means of collecting information about the inner world of others. It is an act of imagination, an entry into the essentially private experience of another through immersion in it. Empathy provides the therapist with an affective grasp, a picture beyond words, of the patient's experience.

Kohut (1982) defined empathy as 'vicarious introspection' and the terms are often used synonymously. However, Teicholz points out that empathic responsiveness, through vicarious introspection, involves the therapist in the activity of being in touch with her own internal world as well as that of the patient. She suggests that it is the therapist's “contact with her own subjectivity” that forms the basis for empathy with the patient's inner world (1999, p.27 ). For the therapist to imagine what an experience might be like involves not only an attuned responsiveness to that patient's unique history and needs, but also to a much broader field of experiences encountered in many situations. Empathic attunement involves the therapist in a process of using both the patient's verbal and nonverbal communications and her own field of experience, to adjust and re-adjust her grasp of a many-layered and constantly shifting message. Schwaber calls this oscillation between the subjectivities of therapist and patient “our resonance of alikeness” (1990, p.239). She goes on to caution that “we must not confuse patient with us; we must know that his world is not our world, her psychic reality not ours. It is our mutuality which allows us to discover our individuality; the more we find our echoes of alikeness, the more we enhance the possibility of locating our differences” (1990, p.239).

The resonant understanding arrived at through vicarious introspection may then be communicated to the patient, and if it is sufficiently accurate, it will fulfil a selfobject need. This however, is only the first step. While the experience of being understood is in itself helpful to the patient, this must be followed by interpretation of current circumstances and past experience. As Kohut makes clear, “Analysis cures by giving explanations - intervention on the level of interpretation; not by understanding, not by repeating and confirming what the patient feels and says, that's only the first step” (Kohut 1981, p. 532). The timing and content of interpretations will depend upon the therapist's understanding of the patient's capacity to experience them as helpful, and to absorb their implications as part of a joint effort at strengthening the self. For a very fragile patient early in a therapy, the experience of having his/her inner world heard and understood may be all that is possible. Interpretation of the origin and problems of that inner world will follow later. Other patients may need to approach their inner world through an intellectual appreciation of its contours: the full affective experience may come later.

Optimal frustration and optimal responsiveness

Just as caregivers necessarily fail in their provision of an empathically attuned environment for the infant, so therapists will, from time to time, fail in their attempts to be empathically attuned to their patients. Frustration of need is essential to growth: the infant whose every need is anticipated and met by the caregiver will struggle to develop self-reliance. Kohut (1984) suggested that there are two steps to the development of the healthy self. “First, a basic intuneness must exist between the self and its selfobjects. Second, selfobject failures (e.g., responses based on faulty empathy) of a non-traumatic degree must occur” (Kohut 1984, p.70). Optimal frustrations in the course of ordinary development allow the child to disengage gradually from total reliance on the selfobject, and to internalise the self-regulatory functions of the selfobject as part of the self structure. This process Kohut termed “transmuting internalisation” (1971, pp. 49-50). The therapy relationship follows a parallel path through two stages. The first is the development of a basic intuneness between therapist and patient, and this mobilizes archaic selfobject needs, experienced as idealizing or mirroring transferences. The therapist's empathic failures will momentarily fracture the gratifying sense of being understood, and it is this that causes “a gradual shift from the self relying for its nutriment on archaic modes of contact in the narcissistic sphere… to its ability to be sustained most of the time by the empathic resonance that emanates from the selfobjects of adult life” (Kohut 1984, p.70).

Kohut saw the disruptions to attunement and the process of understanding the failure, and restoration of the transference as intrinsic to cure. Healing involves not only the experience of being understood, but also a sense of authencity and efficacy in relation to the therapist. Restoration of the empathic bond between the therapist and patient frequently requires the therapist to take responsibility for the role she played in creating the empathic failure. It is this mutuality of exploration that strengthens the patient's sense of self. The disruption-restoration cycle leads to the patient's increasing ability to withstand the urgency of selfobject needs and to internalise some of the functions of the selfobject as self structure.

Although the experience of being understood often fulfils a selfobject need, Kohut is clear that gratification of such needs is not the goal of self analysis. Instead, the therapist identifies the selfobject need, and interprets its relationship both to the transference and to its origins in the selfobject relationships of early childhood.

There is general agreement that although disruptions inevitably occur, therapeutic progress depends on the re-establishment of the tie with the selfobject. However, the function of frustration in the analytic process has been the subject of debate (Bacal 1985; Tolpin 1988). The debate is a clear challenge to the notion of analytic abstinence. Bacal argues that it is the therapist's optimal responsiveness that effects change, and that this includes “a wide spectrum of verbal (interpretive and noninterpretive) and nonverbal responses that may variously by experienced as optimal by the patient” (1995, p.357). The shift in emphasis away from the curative effect of frustration, to the centrality of the restoration process, is described in using the term 'optimal responsiveness' in preference to the term 'optimal frustrations'.

Identifying selfobject transferences

The therapeutic situation, with its consistency of frame, focus on the inner world of the patient, and communication of empathic understanding from the therapist, mobilises unmet selfobject needs and establishes the regressive experience of selfobject transferences. Identifying the nature and intensity of the transference at any given moment, and its relation to patterns of selfobject relating in the past will determine the appropriate therapeutic response. Selfobject needs are made apparent through demands on the therapist, or through defences against those needs. Thus, a patient may take care to make no demands whatever on the therapist, as a defence against a frightening experience of overwhelming dependency need.

A mirror transference, associated with the damaged pole of ambitions, can take a number of forms, but in essence consists of demands to be recognised, admired or praised by the therapist. The patient needs to understand his/her search for affirmation, and its origins in a pattern of selfobject failure in childhood (Kohut, 1971). This involves a double focus: on the one hand, the patient needs to be shown “how the intrusion of unmodified childhood demands” of a grandiose and exhibitionist kind, may “cause him realistic embarrassment” (Kohut 1971, p.231). On the other hand, interpretations of primitive grandiosity carry with them the immediate danger of being experienced as deeply shaming. Kohut therefore suggests that the therapist approach the material carried by the mirror transference with “sympathetic acceptance of the legitimate position of these (grandiose) strivings as seen in an empathically reconstructed genetic context” (Kohut 1971, p.231). “Mirroring” is frequently misunderstood as a form of active and sympathetic provision of affirmation (Wolf 1988). Although any experience of being deeply understood necessarily entails provision of wanted affirmation, it is interpretation that will provide the impetus for change.

An idealising transference, associated with the damaged pole of ideals, mobilises an archaic need for merger with a calm, strong and wise selfobject. Kohut (1971) stressed the importance of allowing the idealising transference to unfold naturally without subjecting it to vigorous or premature interpretation. He suggests that vigorous and early interpretation of an idealizing transference is frequently defensively motivated: “The analytically unwarranted rejection of the patient's idealizing attitudes is usually motivated by a defensive fending off of painful narcissistic tensions (experienced as embarrassment, self-consciousness, and shame, and leading even to hypochondriachal preoccupations) which are generated in the analyst when the repressed fantasies of his grandiose self become stimulated by the patient's idealization (Kohut 1971, p.262). Idealisation often forms an early part of the therapeutic picture, and is the bedrock of a working alliance. This orientation to the idealising transference is another clear point of difference between self psychology and other object relations approaches, which might interpret idealisation as a defence for example against unconsciously experienced hostile or aggressive fantasies about the therapist.

A twinship transference , associated with the intermediate area between ambitions and ideals of talents and skills, “seeks a selfobject that will make itself available for the reassuring experience of essential likeness” (Kohut 1984, p.192). In adversarial transferences, the patient might take up an oppositional or argumentative stance in relation to the therapist. Optimal responsiveness to this form of transference involves supportive and non-relatiatory recognition of the patient's need to maintain autonomy.

In addition to these forms of transference, Kohut also identified merger states in which the patient does not experience herself as separate from the therapist, and is easily overwhelmed by experiences of the therapist's separateness. At times, these merger states may be maintained by the patient's defensive inability to retain, in consciousness, any sense of the therapist's separate life.

It is misleading to think of selfobject transferences as mutually exclusive. One kind of transference may predominate in a particular phase of therapy, but there will always be a complex interplay between different selfobject needs within and between sessions.

The case of Zareena will illustrate features of these transferences and the interplay between them in the course of a year-long twice-weekly therapy. Zareena was a 32 year-old woman recently appointed to lectureship in a prestigious university. She had a brilliant student record, and the research on which her doctoral dissertation was based had received considerable media attention. She was delighted to be appointed to her job, and had looked forward to the challenges of academic teaching and research. She was warmly received by her colleagues, and settled quickly into her duties. However, soon after this she became depressed, anxious and filled with self-doubt. She sought therapy partly because of the depression, and partly because she was struggling to settle to the task of meeting a series of publishing deadlines.

An idealizing transference was quickly established in the early weeks of the therapy. Zareena frequently commented on her therapist's wisdom, calm demeanour and ability to see “right to the depth of my soul”. She also made many admiring comments about the therapist's room, and the beauty of her garden. She said she was sure her therapist never had any difficulty with writing, because she seemed so calm and so sure of her knowledge. By contrast, she experienced herself as panicky and ignorant, not trusting that her research was either what it claimed to be, or a real contribution to her field. In fact she was beginning to feel that when her work was closely scrutinized by colleagues they would see that she had made many mistakes and erroneous assumptions, and that she would be discovered to be a fraud. At this stage in the therapy, a twinship transference was also fleetingly apparent in assumptions she made about sharing her therapist's taste in clothes, books and movies, and reactions to political events. This twinship served to consolidate her sense of being accepted and her capacity to trust the therapy.

The therapy shifted dramatically after Zareena had a dream in which she was giving a public lecture in front of many thousands of people. She described her dream-self as articulate and powerful, commanding the attention of the entire audience, until the microphone abruptly stopped working, and she could no longer be heard. People began to leave the hall, angry and disappointed in her, and she woke up crying. This dream marked the activation of her grandiose self in the therapy context, and opened the way for the exploration of her intense need for, and fear of admiration for her achievements. She began to recognise the extent to which hr colleagues' high expectations of her and their frequently-stated respect for her work had simultaneously gratified and scared her. This material coincided with the establishment of a mirror transference in which Zareena tentatively explored her fantasy that she was somehow special to her therapist. She felt sure that her therapist had changed her schedule particularly to accommodate Zareena's need to be seen early in the morning. She also remarked that she was sure her therapist had never seen anyone as difficult or as complicated as she was. Soon after this, the therapist experienced made a comment in a session that Zareena found distressingly unattuned, and she reacted angrily, accusing her therapist of not paying attention sufficiently to what she was saying. A pattern of demands to be understood and closely attended to, quickly followed by a sense that she was boring and not worth listening to followed. The therapist and Zareena explored this pattern as an effect of a childhood in which her mother had abruptly withdrawn from her when she was two years old, as a result of the onset of a chronic illness. During the next few years, she was constantly told to occupy herself, to be quiet, and not to make demands. Her mother was preoccupied and frequently did not listen to Zareena's excited stories. She received some soothing and comfort from the calm presence of her capable, clever but somewhat unemotional father, and it was this selfobject relationship that had been recreated early in the therapeutic relationship.

The therapist's acceptance and understanding, first of Zareena's idealizing needs, and later her need for mirroring in the form of close attention, followed by explanation of those needs in terms of the difficulties she had experienced in her early relationship with her mother, began the process of integrating her frightening exhibitionist and grandiose self, and allowed her to begin to write regularly, and to consolidate her academic standing. In other words, she was able to experience both her ambitions and her creativity, and affirmation of them, without disappointing fear of failure.

In addition to the selfobject dimension of the transference, which represents in the therapeutic dyad a relational expression of a developmental need, there is also a repetitive dimension, one that reproduces the patterns of expectation and fear of failure derivative of early experience (Lachmann and Beebe 1992; Stern 1985 ). As Stern puts it, “patients actively seek to enlist the therapist both in old pathogenic interactional scenarios and in new therapeutically needed relational configurations” (1994, p.317). Attention to both components of the transference, and the complex relationships between the two, are necessary to therapeutic change. Lachmann and Beebe suggest that selfobject experiences, that directly address the tie between self and other, provide a context within which repetitive aspects of the transference may be given expression. Conversely, exploration of patterns of expectation and behaviour will precipitate particular selfobject needs (Lachmann and Beebe 1992).

Defensive and compensatory self structures

Kohut (1977) distinguished between defensive and compensatory structures in the psychopathology of patients with disorders of the self. Both are related to a primary defect in the structure of the self. A structure is defensive “when its sole or predominant function is the covering over of the primary defect in the self” (Kohut 1977, p.3). He illustrates this by describing the exhibitionistic, dramatic or grandiose presentation familiar to those working with narcissistic patients, and points out that this empty energy shelters a depleted, depressed self with poor self-esteem. The pseudo-vitality of these patients is seldom “alloyed with mature productivity” (1977, p.6). By contrast, he suggests that a structure is compensatory when “rather than merely covering a defect in the self, it compensates for this defect” (1977, p.3). The idea of a compensatory structure has its roots in Kohut's view of developmental deficits, and the dynamic nature of the bipolar self. If the self is damaged in the area of ambitions, through faulty mirroring of primitive grandiosity in early childhood, then there are likely to have been automatic attempts in the course of development to address this weakness, through the idealized selfobject tie. This would then lead to a relative strengthening of the pole of ideals, and self-esteem in adulthood is rooted in the pursuit of idealized goals, rather than personal ambitions. For example, patients with well-elaborated compensatory structures that have resulted in the strengthening of the pole of ideals might lead a life in which they selflessly work on behalf of an organisation, and neglect their own need for recognition, in terms of status, salary, holidays, or time for recreation.

Varieties of self disorder

Kohut and his collaborator Ernest Wolf outlined a number of specific types of disorder, all of which fall broadly into the range of disturbances in self cohesion (Kohut and Wolf 1978).

• The fragmenting self is apparent in the most severe forms of narcissistic pathology, and particularly in borderline states. These patients are prone to chronic states in which they lose a sense of continuity in time and connectedness in space. Fragmentation affects their ability to manage time, and also states of hunger and tiredness, and simple routines of self-care. They react to even minor disappointments or criticism with protective rage, dissociation or overwhelming panic. They often have complex and rigid defences against fragmentation, and these are not easily susceptible to analysis. These patients have been exposed to massive mirroring failure in infancy, and lack the capacity either to reflect on their difficulties without destructive or self-destructive acting act, or to soothe themselves in non-addictive ways. For example, Susan was a patient who presented with recurrent, severe states of fragmentation. She had suffered prolonged physical and sexual abuse from her step-father as a child, and instead of protecting her, her mother had blamed her for creating unhappiness in the household. She left home at the age of seventeen, and boarded with the family of a friend. She worked in various temporary jobs for the next five years, and presented herself for therapy at the suggestion of a sympathetic employer, who was concerned about Susan's unhappiness, her use of drugs and alcohol, and her inability to manage practical aspects of her life. The routine of work provided the only consistent structure in her life, and helped her to get from day to day. However, she had trouble with punctuality, and with time management. She would arrive at work late, spend a long time on one task, and underestimate the amount of time she needed to complete others. She would get angry or tearful when offered feedback or assistance. She would spend her salary impulsively, often buying gifts for acquaintances. There would often be weeks during which she had almost no money for food. She had lived in a number of rented rooms, and problems with paying the rent constantly caused tension with house-mates. She was sexually promiscuous, and had sought terminations for three unwanted pregnancies, at the insistence of the current partner. She described “black days”, often following an argument with someone, in which she was unable to get out of bed. During these times she would feel anxious, frightened, and easily overwhelmed by noise or movement.

• In the overstimulated self, there has been inappropriate early gratification of grandiose fantasies, and these remain disavowed and unmodified. As a result, these patients suffer from low self-esteem. Primitive grandiosity is experienced as overwhelming, and these patients will find admiration both disconcerting and disorganising. For example, Joe was the only child of parents who were both in their forties when he was born. His mother resigned from her job to look after him, and devoted her life to giving him a “perfect childhood”. Both parents thought of him as gifted, and from an early age they enrolled him in many extra-mural activities, including art, music lessons, karate, and swimming. By the time he was ten years old, he had developed a pattern of engaging in an activity, boasting that he was excellent at it, and then soon becoming bored and refusing to continue to apply himself. His parents indulged this, and did not insist that he sustain effort in any direction. Their constant and unrealistic admiration thus became divorced both from his own initiative, and from visible achievement. At the same time, his rather brash style made him unpopular at school. He became overweight and shy, and recalled his adolescence as being a time of loneliness and depression. He responded to his parents' attempts to encourage him in any way as unsettling intrusions. He sought therapy during his first year at university, at a time when he was struggling to decide on a course of study, and was feeling lonely and depressed. The legacy of his parents' unmediated admiration and over-investment in him became apparent during a brief interaction with his therapist. During a session he told his therapist that he had just achieved a very high mark for an examination, but was unable to feel pleased about it. In fact, he had noticed himself becoming very anxious about the mark, feeling he would never be able to reproduce the mark, and that somehow a mistake had been made. His therapist greeted the news of exam result with a warm smile, and then spent the session exploring Joe's anxiety about his achievement. The following session, Joe came in looking defeated and withdrawn. It eventually became clear that he had responded strongly to his therapist's smile about his exam achievement. On the one hand, this had led to the fantasy that he was going to have a brilliant academic career that would make his therapist proud of him. On the other, he became aware of a sense of resentment, both that he had to achieve in order to be valued, and that his therapist had not taken his anxiety and apprehension seriously.

• In another form of overstimulation, the self has been exposed to a selfobject matrix in which an idealised other has persistently demanded admiration. This presents a threat for the developing need to experience the self as a centre of initiative, and in later life may cause excessive wariness in relation to the pursuit of ideals. Nomsa for example, was raised by politically active parents, both of whom were influential in local and central government. Looking back on her childhood, she recalled the ways in which her parents took pride in having busy careers, and a successful and harmonious family-life. They were always available to participate in school events, and both at different times served on a variety of school committees. Although Nomsa felt proud of her parents, she also felt increasingly worried about being a disappointment to them. As a young adult she had no interest in politics, and did not want to pursue a professional career. She wanted to travel and have fun, an ambition she was sure they would not like. It was this conflict that brought her into therapy. Nomsa's response to her therapist's interpretations illustrates the nature of her conflict in relation to selfobject experience. She was profoundly sceptical of her therapist's interpretations, commenting that she felt alienated rather than understood by the connections she made between past events and her current dilemma. Repeated exploration of her affective response to the therapist's attempts to remain empathically attuned to her experience revealed that she felt as if she was being asked to accommodate and comply to knowledge that she did not share. She felt obliged to be helped and to feel grateful for the therapist's time. She also experienced her therapist as needing to be right, and to be seen as wise and omniscient. She slowly recognised that her difficulty in talking readily about herself had contributed to misunderstandings in the therapy. As she began to trust that her own needs would be properly attended to by the therapist, she gradually was able to accept interpretations without feeling invaded by them.

• The overburdened self occurs when there has been a lack of responsiveness from a calm and soothing selfobject. The self is easily experienced as being flooded with disturbing emotional states. As they lack the capacity for self-soothing, these patients will often experience any form of stimulation through relationship as intrusive and potentially damaging. Pieter was one of two siblings, whose mother became chronically ill soon after he was born, and died when he was two years old. The children were cared for by a series of housekeepers. His father was an anxious man, who tended to get flustered and angry quickly when the children were distressed. As a result of this, Pieter and his sister soon learnt not to confide in him, or to burden him with their difficulties. He seldom made close friends at school, finding intimacy of any kind alarming. He sought therapy as a young adult, at the suggestion of his first girlfriend, who was concerned about how little he could tolerate sharing feelings with her. Although attentive and warm, he withdrew if she showed any sign of anxiety, anger or distress. He also found it difficult to tell her anything about his own feelings. In therapy, Pieter struggled to voice feelings, and responded to interpretations as an overwhelming intrusion and a burden. At the same time, the calm responsiveness of his therapist stirred selfobject needs unmet in childhood, and a silent, submerged idealising transference sustained the relationship through its early difficulties. He gradually learned to talk about his feelings, and later to experience his therapist as affectively responsive, without withdrawing.

• By contrast, the understimulated self experiences pervasive states of both deadness and boredom, and may seek highly stimulating, even dangerous activities to ward off frightening emptiness. Drugs that are stimulants serve to create an illusion of liveliness for short periods. Fights, both physical and verbal, may serve a similar purpose. For example, Esther and her husband Thabo came for marital counselling at a time when they were contemplating divorce. They described long periods of relative peace between them, followed by bitter fights, usually precipitated by a trivial event. The fights were dramatic and noisy, and usually ended with Esther storming out of the house, and returning some hours later. Although both Esther and Thabo were both playing a role in the marital difficulties, it became clear that the fights served a particular function for Esther. In the third session of therapy, while describing a fight that had taken place the day before, she realised that her dominant feeling during the fight had been excitement. “When we fight, I feel we are really together, and committed to each other,” she said. “It's the only time I feel sure that Thabo is completely part of my life.” This clarified an important aspect of the dynamic between them. Esther had grown up in a large family, and both her parents had worked all day. The children were largely expected to care for themselves, and had only received attention when they committed some misdemeanour. As a result of this, Esther came to experience fights in her relationship with Thabo as an important sign of attachment and recognition. By contrast, she misinterpreted peaceful coexistence as lack of interest.

A Self approach to defence and resistance

In Self theory, sexual and aggressive conflicts are not primary components of the developing psyche. They arise as phenomena secondary to problems in the cohesive development of the self (Ornstein and Ornstein 1995). This is the theoretical context in which defence and resistance are understood.

Self psychological theory offers an orientation to the understanding and analysis of defence which places two primary motivations at the centre of all defensive activity. One is the protection of vulnerability in self-structure; and the other is the preservation of a needed selfobject tie (Brandschaft 1985). Kohut insisted that defence was to be understood in terms of “activities undertaken in the service of psychological survival, that is, as the patient's attempt to save at least that sector of his nuclear self, however small and precariously established it may be, that he has been able to construct and maintain despite serious insufficiencies in the development-enhancing matrix of the selobjects of childhood” (1984, p.115). The more endangered the self and the more threatened the needed selfobject ties, “the more secondary and tertiary defensive systems develop, the more narcissistic rage and erotization begin to take over, and the more chronic self-preservative but pathological characterological attitudes develop and become fixed” (Tolpin, 1985, p.87).

The orientation to the fragile self beneath defensive covering has meant that within this theory interpretation of defence “is neither necessary nor optimal” (Lichtenberg, Lachmann and Fosshage 1992, p.154). Instead, identification of defence is understood as an invaluable tool, allowing the therapist access to disavowed states. It is these inner states that are optimally the focus of the analytic work. Interpretation of defence in the absence of an empathic appreciation of the need or state being defended against may lead to shame, further resistance or compliant acceptance of the therapist's view-point as a defence against anxiety-arousing awareness of a failure of attunement or trust (Shane 1985; Tolpin 1985; Brandschaft 1985).

Shane points out that, “the traditional analyst, if any good, also waits for something better to come along before working interpretively on a resistance or a defence” (1985, p. 81). It is standard analytic technique not to interpret the defence prematurely without linking it to the underlying anxiety, and the hidden impulse or need (Malan 1979). Thus, the insistence of self psychologists on a basic orientation to the self state, and the selfobject need against which the defence is mobilized is not in itself a radical departure from traditional technique. However, the empathic stance precludes the therapist from taking up a perspective which in any way implies knowing more about the patient's inner reality than the patient herself understands. Moreover, according to self theorists, traditional defence interpretation does not necessarily facilitate increasing awareness of previously unavailable memories, needs or beliefs; it simply teaches the patient to recognise the processes through which these are kept from awareness. It is through trust in the therapist's availability to explore what is unknown in a non-judgmental manner that allows for the emergence of hidden layers of the self-state (Lichtenberg, Lachmann and Fosshage 1992). Moreover, Kohut (1971) regarded the self-in-treatment as fundamentally disposed to seek and use needed selfobject experiences. These needed selfobject experiences may be for admiration and affirmation, or for the soothing effect of merger with an idealised selfobject; in either case their initial appearance is likely to coloured by an expectation that they will not be empathically understood. For example, a patient seeking affirmation, but fearing that she will be met with criticism, may become defensively boastful, or self-denigrating, or she may disguise her pride in an achievement within a narrative filled with digression. For Kohut, the primary aim of therapy was to maintain a focus on the primary selfobject need, and not to be distracted by the defences mobilized to protect the injured self. Thus, “the therapist's major effort must be concentrated on the task of keeping the old needs mobilized. If he succeeds in this, then they will gradually – and spontaneously – be transformed into normal self-assertiveness and normal devotion to ideals” (Kohut and Wolf 1978, p.423).

In self theory resistance is understood intersubjectively, as a reaction to an experience of the therapist as misattuned, or to a fearful retreat from exposing aspects of the self in the therapeutic situation. While defence is primarily seen as intrapsychic, resistance always implicates a particular analytic context.

Developments in Self theory

To the end of his life, Kohut was constantly in the process of revising his work. He reported to Paul Ornstein, a close colleague, that although in pain, new theoretical ideas continued to come to him (Ornstein, 1990). He always encouraged debate and exploration of his paradigm, and was reputed to be a charismatic and encouraging teacher. For all these reasons, self psychology, although fathered by Kohut, quickly grew well beyond the limits of his own writings. Self psychology has become a well-established school of psychoanalysis, with associated institutes and training programmes. Within the school debate continues to flourish, and a number of separate strands of self theory, research and clinical practice are now discernible within the loose boundaries of the self paradigm. Although the divisions between theoretical strands are fluid, broadly they fall into three groups. There are those whose work has largely confined itself to the elaboration of Kohut's original contributions, particularly in the areas of self structure, selfobject experience, and optimal provision. This strand of self theory is closely identified with the work of Ernest Wolf (1988), Paul and Anna Ornstein (1995), Morton and Estelle Shane (1988), Arnold Goldberg (1988, 1990), Paul Tolpin (1988), and Marion Tolpin (1993). Two other strands in the development of self theory are marked by more radical transformations of Kohut's work, and these shall be explored briefly below.

Contributions from infant research: The motivational systems and self and mutual regulation

Kohut's original mapping of the selfobject milieu has in the last decade been expanded and enriched by work undertaken in the field of infant observation and research. A comprehensive account of the child's developmental needs, based on systematic empirical research, can be found in Lichtenberg, Lachmann and Fosshage (1992). They describe five motivational systems within which innate potential is organised. Fulfilment of innate potential is dependent upon a responsive caregiving.

• Physiological regulation concerns the basic management of bodily systems, such as eating and attention to hunger, sleep, elimination, and perception of the body in space and time.
• The attachment motivational system concerns the need for secure attachment to significant persons in the environment.
• The exploratory motivational system includes the infant's need to explore his/her environment with energy and curiosity, the will to open new areas of experience and to acquire new skills and competence.
• The aversive motivational system is the area traditionally referred to under the rubric of defence, and includes ways in which potential threat is dealt with. There are two basic lines of reaction to aversive experience: withdrawal (flight) or aggression (fight). Some forms of aversive reaction are helpful in building a cohesive sense of self, whereas others may become inhibitory of change, rigid, and self-defeating.
• The sensual/sexual motivational system is concerned with seeking sensual pleasure in a variety of bodily experiences, and the eventual engagement in fulfilling sexual relationships.

All the motivational systems are attached to innate developmental imperatives, and although they have widely differing goals, they are dynamically related. For example, failure to provide an infant with food when she is hungry will impact upon attachment to the caregiver, upon the ability to explore the environment with a sense of joyful efficacy and upon the sense of sensual enjoyment of the body. Failure to provide mirroring for the infant's exploratory impulses by reacting with anxiety or by restricting movement will impact on the aversive motivational system by mislabeling benign situations as dangerous. It will also limit opportunities for sensual pleasure.

This view of development stresses the need for mirroring of achievements within each motivational system. The balance between being mirrored by a selfobject and idealizing a selfobject shifts with both motivational system and developmental growth. For example in the regulation of physiological needs, the soothing, holding selfobject reads the infant's body as tired or hungry or colicky and provides the required regulatory experience. In later years, this regulation may be mediated by an idealizing relationship with the selfobject, which provides the growing child with models of when to eat and sleep.

Patterns of mutual regulation in early infancy between infant and caregiver set up interaction structures (Beebe and Lachmann 1988). These are patterns of engagement that shape expectations of the experience of the self with others. Identifying patterns of mutual regulation, laid down in infancy and shifting in relation to moment-to-moment changes in motivation, offers psychotherapists a way of understanding and interpreting subtle changes in affect, patterns of compliant accommodation or persistent misattunement, and a wide range of pre-symbolic nonverbal communications (Kiersky and Beebe, 1994).

Intersubjectivity and the analytic third

Self theory as a whole has always paid close attention to the early caregiving matrix as being the network of relationships within which the self is able to develop. Its primary focus is not therefore with the unfolding of intrapsychic structures that are implicitly or explicitly regarded as biological givens. This is apparent in the place given to selfobject transferences and their management in the therapeutic process. The intersubjectivists, who form an influential subgroup of self theorists, take this approach one step further, in shifting attention to, “the mutual interplay between the subjective worlds of patient and analyst, “ (Stolorow and Atwood 1992, p.1). The intersubjective field is a system of mutual reciprocal influence(Beebe and Lachmann, 1988). This has important implications for therapeutic technique, because it opens to way to a full exploration of the subjectivities of both therapist and patient as they co-create the self-in-treatment. There is no assumption of a fixed and unchanging self, nor of an innate unfolding developmental programme. The self as experienced in the therapy is always a fluid construction, brought into awareness through dialogue. Repeated patterns of behaviour are understood as the manifestation of unconscious organizing principles that express expectations of self experience, but always in relational contexts. The organization of relational contexts, and the insertion of the therapist into that organization in the flow of attunement and disruption is the object of analysis.

Although Stolorow, Atwood, and a growing number of psychoanalytic theorists (see for example Aron 1996) identify intersubjectivity as clearly separable from mainstream self psychology, they also acknowledge that Kohut's insistence on the empathic stance in therapy, and centrality of selfobject experience in development, as implicitly intersubjective.

The position of the intersubjectivists has much in common with Ogden's concept of the analytic third Ogden 1994). He used this term to refer to the merging subjectivity that results from the complex inter-relationship of the subjectivities of analyst and patient. Recent literature has expanded the concept to include the part played by the psychoanalytic community as a silent but powerful participant in the work of each analytic dyad. Lewis Aron extends this yet further to include broader cultural influences on each relational matrix (Aron, 1996). Clearly, our theory shapes every aspect of our work, and enters the intersubjective field through our reading, supervision, professional meetings, and sense of kinship with colleagues. This third is an active partner in shaping clinical choices, in containing our anxiety as we work, and in helping to prevent boundary crossing and ethical slips. At times it is fluid and ambiguous, at other times rather rigid and dictatorial.

Implications for psychoanalytic practice in South Africa

We also participate in a wider third, one that enters the dyad through our class, our ethnicity, and our gender. Class, gender and racial dynamics in psychotherapy are issues that confront many of us in our daily practice. Our capacity to be helpful to patients depends upon the extent to which we are able to be attuned to their experience. Class, gender and racial divides, deepened by our apartheid history, makes this a challenging task.

The difficulties lie in two directions. Firstly, our own racialised, gendered and class-conscious experience shapes what we are able to hear and limits our capacity to immerse ourselves in the experiential world of someone we perceive to be very different from ourselves. As Stephen Cooper points out, “The analyst is always listening within particular constraints, always looking, consciously or unconsciously for support of beliefs and convictions. The analyst is never without memory or desire” (1996, p.257). Our capacity for empathy is determined by the extent to which we acknowledge the effects of our own beliefs and convictions on the intersubjective field.

Secondly, an orientation to the inner world of the patient, and our construction of that inner world through the lens of an analytic theory, runs the risk of our inadvertently colouring the patient's communications with fundamental assumptions embedded in that theory. For example, unquestioned assumptions about normal development, attachment patterns in early infancy, and heterosexual middle-class family structures are seldom interrogated in much of psychoanalytic theory.

Self theory offers a way forward through the complexities of working analytically with difference. Empathic immersion involves, “respecting the patient's communication as providing the essential information needed to explore his inner life at that moment without transposing time, place, or person in a manner guided by theory” (Lachmann and Lichtenberg, 1992, p.164). To guard against a theoretical knowingness, there must be an explicit acknowledgement that the “patient's theory about himself or herself will usually be the final arbiter of what is valid for him or her” (Bacal, 1995, p.354).

Critique of Kohut's work

There is general agreement among self theorists that Kohut's greatest contributions to psychoanalytic theory lie in two directions. Firstly there is his delineation of a method of psychoanalytic inquiry, which entails sustained empathic attunement to the patient's experience. Secondly, Kohut's bold insistence on a developmental line for the self, in relation to a web of selfobject experiences gives the theory its unique character (Bacal 1995; Ornstein and Ornstein, 1995).

At the centre of the Kohutian explanation for pathologies of the self are the closely-connected areas of trauma on the one hand, and arrested development on the other. Kohut's vision is essentially an optimistic one, in which trauma, located in problematic relationships between self and selfobjects, leads to arrested development. In his view, what is curative in analysis is the experience of being understood and accepted in the context of a new and sustaining selfobject relationship with the analyst. It is this that will allow for development of the self to begin again. Moreover, he argues that there is a natural impetus towards seeking self-sustaining experience. The emphasis on environmental trauma and the primacy of relationships in understanding pathology throughout Kohut's writing has led to a concomitant under-emphasis on the role played by unconscious conflict in the development of problems of living. Much of the criticism levelled at self psychology turns on this central point. For Kohut, rage, envy, greed and primal destructiveness follow trauma; they do not precede it, nor do they distort its expression. Self theorists have made regular attempts to answer the persistent suggestion from Kohut's critics that the theory results in a blindness to, and reluctance to work with innate destructiveness, a critique that often takes the form of suggesting that self psychology provides a corrective emotional experience, rather than an intrepid analysis of unconscious conflict. The most important of these answers came from Kohut himself (1981, 1984). He stated categorically that analysis cannot cure “through love, through empathy, through kindness, through compassion” (1981, p.527). Empathy is the means through which the analyst arrives at an understanding of the patient's inner world; empathically-driven interpretations of the early environment will automatically foreground conflictual emotions and their source in traumatic experience.

Another area of criticism concerns the relationship of Kohut's theory to mainstream psychoanalytic theory. Kohut was careful to outline the implications of his theory of self development for a classical conceptualisation of the Oedipus conflict, describing the Oedipal drama in terms of faulty relational responses to emerging sexuality. He commented that “the oedipal selfobjects are imperfect, just as they were before the oedipal period” (1984, p.27). So for example, he would understand castration anxiety as resulting from the failure of parents to respond appropriately to healthy age-appropriate sexual development, rather than as a derivative of an unconscious drive and the conflicts that this produces. However, Kohut was less explicit about the relationship of his theory to newer derivatives of classical psychoanalysis. There is no doubt that in moving away from a model that gives primacy to instinctual drives, and in placing emphasis on the relational origin of psychopathology, and its centrality to cure, he had much in common with object relations theory, and particularly with Winnicott. These commonalities were never addressed, and therefore a potentially enriching dialogue between a variety of object relations approaches and self psychology has yet to be developed (Bacal and Newman 1990).

Case study

John is a 26 year-old single man, living in a rented flat near the city centre. He is currently employed as a programmer in a large computer business. He was referred for therapy by his doctor, after an incident in which he cut his hand badly by smashing it through a window. While he was being stitched, he told his doctor that he felt out of control and panicky nearly all the time. He had smashed a window in his flat after hearing that an arrangement with friends to go out for the evening had fallen through. He described being swept into a wave of rage, during which he not only broke the window, but also broke the legs off a small table. Afterwards, he felt shaken and confused.

John says that as long as he has continuous social engagements to fill his evenings, he feels relatively calm. He is aware, however, of a constant tension in his mind, as he lines up events for each evening and weekend. He has managed to avoid being alone by having a large group of acquaintances, many of whom he met in bars and nightclubs. On a typical weekend, he will go out each evening, often until 2.00 or 3.00 a.m. He will drink a large quantity of alcohol and also use a variety of drugs, including ecstasy and cocaine. He will then spend most of the morning asleep. He will surf the Internet for a couple of hours in the afternoon, often spending time in chat rooms. He will then go to the gym, shower, and get ready for another evening out. This lifestyle is an expensive one and financial difficulties are adding to his anxiety.

Although John is familiar with many nightclubs and bars, he strongly dislikes the idea of going into them alone. He feels that unless he arrives at a place in a group of friends, he will seem to everyone like “a loser, someone who can't make it”. This is why he spends so much energy on making his arrangements. He wishes he had one or two close friends who he could rely on to go out with him every evening and weekend, but he says he has never had friendships like that. He also wishes he had a girlfriend, but as soon as an intimacy develops between himself and a woman, he feels himself withdrawing and becoming critical of her. He occasionally sleeps with women, but seldom more than once.

John comes from a small family, living in the Eastern Cape. His father is a builder, and his mother has never worked outside the home, except for occasional employment in her church community, with which she is very involved. He has one sister, two years younger than himself, who is married, with two small children. John has been the only member of the family to have tertiary education. He completed a B.A., and has since done courses in computer technology.

He describes his family as close-knit and private. He says his father is a tense and rather depressed man, who worries constantly about money and drinks heavily on weekends. He was never approachable or very involved with the upbringing of the children, but would occasionally punish them severely for small misdemeanours. His mother, a very religious woman, would often be out of the house in the evenings, at bible or church meetings. The family seldom entertained or saw friends, and the children were discouraged from bringing friends home. The parents' marriage is stable, but unaffectionate.

His mother was hospitalised for three months immediately after the birth of his sister, for a severe depressive episode. During this time, John was looked after by his mother's sister. He has few memories of this time, but remembers sitting at his aunt's front door, crying, and saying, “I want mommy back”.

John's schooling was uneventful. He did well in his studies and played a lot of sport. He identifies his problems as beginning in his second year at university, when he began to drink and smoke dagga regularly. Since leaving university, things have gradually felt more and more out of control. He feels that his life has lost purpose and that he has no real goals. He occasionally has suicidal thoughts, but says he never gets as far as making concrete plans to kill himself.

At his first interview with a female therapist, John seems anxious and distracted. He says he feels depressed about his life, and wants things to change. He has resolved to take control of his drinking and drug use, and discusses his plans to apply for a job in a small computer firm in which he will be expected to work long hours. He feels that the challenge of the new job will help him to change.

The therapist understands John's attack of rage and subsequent fragmentation as responsive to an injury to self, caused by the failure of his friends to meet his needs. His inability to go out alone and his need to be seen as having friends is an indication of the fragility of his self-esteem. She also notes the addictive quality of his social activity, drinking and drug-use, all attempts to self-soothe, in the absence of well-established patterns of mature self-regulation. She is aware that addictive forms of self-soothing, and the sense of emptiness they defend against, are often linked to early mirroring failures and she wonders whether John's mother was preoccupied and even depressed when John was an infant. Certainly, depression and remoteness characterised his mother's behaviour later in his life. The trauma of separation from her during her hospitalisation for depression, coinciding with the birth of a sibling, may have compounded an already anxious attachment pattern. It also seems that his father was unavailable to meet either his mirroring or his idealising needs. It seems unlikely that either parent was able to affirm his achievements.

There is evidence of an effective compensatory self -structure, seen in John's school, university and sporting achievements. It is possible that affirmation in these settings met some of John's mirroring and idealising needs, and also that twinship selfobject ties with his peers compensated for the failing archaic selfobject matrix. The therapist feels that the compensatory self structure will provide a foundation for the work that needs to take place in therapy. She anticipates that the therapy will need to address early misattunements in self- and mutual regulation, that John will be very sensitive to perceived criticism, rejection and abandonment, and that he will react to these with either rage or withdrawal or both.

In the first phase of therapy, which lasts for approximately four months, John establishes himself in his new job, and as he anticipated, this substantially changes his after-hours behaviour. He has very little free time. The close relationships with new colleagues in a demanding and creative work situation has made him feel confident and full of energy. Although he still occasionally goes to nightclubs, he is drinking far less and seldom uses drugs. He expresses his gratitude to his therapist, telling her that therapy has changed his life.

In the next phase of the therapy, John begins to withdraw. He often cancels sessions at short notice, saying that there has been an emergency at work. His therapist is aware of some annoyance in herself about this and the rather high-handed way in which he brushes aside her attempts to explore his absences. She is also aware that he is beginning to make critical remarks about her therapy room, the building in which she works, and sometimes therapy itself. She anticipates that he will soon suggest that he terminate. With this in mind, after another cancellation, she interprets the link between his withdrawal from the therapy, and his difficulty in maintaining intimate relationships with women, and suggests that both of these might be his way of protecting himself from the possibility of being hurt. She goes on to say that he might anticipate being hurt because when he was a young child his mother was not often emotionally available to him, as a result of her church work, her depression, and later, her involvement with his young sister.

John reacts to this interpretation with hurt and anger. He says he feels that the therapist does not understand the urgency of his work demands, and under-estimates the difficulty he has in getting away. The therapy is important to him, and he looks forward to coming. He says he cannot understand why she is taking his absences so personally.

At this stage, the therapist realises that although her interpretation might have been accurate in some ways, it also constituted an empathic failure for two reasons. Firstly, it was not attuned to the element of primitive grandiosity mobilised by John's new work, and his need to have his work achievements, including a sense of being indispensable, admired. Secondly, although her interpretation had linked his defensive withdrawal to the underlying injury to self, she realised that he had felt criticised. She thought this might well be linked to her own feelings of irritation, which probably gave the tone of her interpretation a critical edge. She also thought that he might not yet be ready to consciously face the dependency needs activated by the therapy. She noted that her interpretation had not taken into account the extent to which she was still an idealised selfobject for John. With these thoughts in mind, she commented that perhaps it was important to John that she understand how much he is needed at work when there is an urgent project going on. He accepted this with relief and in the interaction that followed he talked eagerly about how great it feels to him to know that his colleagues need him to perform certain tasks at work. The therapist then asks how it feels when he has to miss a therapy session. He says he sometimes feels relieved, because he doesn't want to be dependent on it, and knows he will have to stop at some point. This remark allows them to move into an exploration of his pattern of defensive withdrawal at his own pace.

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