Ronald Fairbairn and the Object Relations Tradition”

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Presentations, Thoughts, and Reflections on the International Conference “Ronald Fairbairn and the Object Relations Tradition”

Xing Xiaochun

Abstract

To celebrate the publication of Ronald Fairbairn and the Object Relations Tradition, cross-continental contributors gathered at the international conference held at the Anna Freud Centre, London. The presentations of such contributors as Norka Malberg, Viviane Green, David and Jill Scharff, Anne Alvarez, Valerie Sinason, and Rubén M. Basili are extracted and introduced to a Chinese audi- ence in order to better understand the legacy of Fairbairn and the current debates on the development of object relations theory, as well as how his conceptions can shed light on contemporary clinical work. Furthermore, the author’s own reflections on Fairbairn’s ideas and their acceptance in China are followed by a clinical vignette interpreted through the insight derived from the conference. Key words: Fairbairn, object relations, conference, reflections.

OVERVIEW OF THE CONFERENCE

Ronald Fairbairn was the father of object relations theory, who first proposed that the infant’s need to seek objects was central to development. The newly published book, Ronald Fairbairn and the Object Relations Tradition (Clarke & Scharff, 2014), one of the series of “Lines of Development: Evolution of Theory and Practice over the Decades”, published by Karnac, formed the focus of the international conference “Ronald Fairbairn and the Object Relations Tradition”. The conference was held in the Anna Freud Centre in London, 7–9 March 2014. The conference was co-sponsored by the Freud Museum, London, the International Psychotherapy Institute, and Essex University. During this fruitful weekend, dozens of contributors—psychoanalysts and other clinicians from the UK, Europe, Latin and North America, Australia and other parts of the world—gathered together to review the legacy of Fairbairn and to share its extension, further development, and practical application in clinical work in particular and in society in general.

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The presentations and discussions covered such areas as theory, history, clinical practice, and the broader application of Fairbairn’s ideas in the fields of religion, philosophy, art, politics, and social issues.

PRESENTATIONS, WITH SHARING OF CLINICAL EXPERIENCE

From Friday night to Sunday afternoon, nearly two dozen contributors shared their ideas on the legacy of Fairbairn and the evolution of object relations theory along with interesting clinical cases, discussions, and debates. Here, I summarise several of the presentations which I attended. Some of the contributors are also involved in psychotherapy training in China, such as Viviane Green, and David and Jill Scharff.

Norka Malberg: On being recognized Dr Norka Malberg trained at the Anna Freud Centre and is Associate Clinical Professor at the Yale Child Study Center and President of Section II of Division 39, American Psychological Association. She is also co-editor of the book The Anna Freud Tradition (Malberg & Rafael-Leff, 2012), in the same series of “Lines of Development: Evolution of Theory and Practice over the Decades”. Dr Malberg illustrated how Fairbairn’s theories inform clinical work through her presentation of the case of Jeremy, a twelve-year-old boy adopted by lesbian parents. Jeremy had a history of early trauma prior to his adoption, in the form of abuse and neglect. He attended a special school for children with emotional disturbances. At eight years old, he would still leave faeces on his leg after going to the bathroom. He began four times a week psychoanalytic treatment with Dr Malberg when he was ten. Jeremy’s behaviour in the consulting room, such as hiding under the table or in the cupboard and crawling like a baby, was understood as a desperate attempt to repair his early experience of neglect. Such regression can allow a sort of psychological rebirth. He projected familiar exciting and rejecting objects on to the therapist. The therapist used her internal experience to further understand the libidinal and anti-libidinal objects that Jeremy remained attached to. By exploring Jeremy’s fantasies and her own countertransference, Dr Malberg was able to recognise Jeremy’s rela- tional needs, resulting in psychological progress and some integration. Jeremy was better able to recognise his therapist as a real person, beyond being only the container of his projections.

Viviane Green: Internal objects: fantasy, experience, and history intersecting? Dr Viviane Green is an adult and child and adolescent psychoanalytic psychotherapist in London, and a lecturer. She conducts training programmes 15-Event-Review_OPUS_7_1.qxp copy.qxp 01/06/2015 10:11 Page 182

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in Beijing, China on mentalization in children and adolescents. Her paper integrated perspectives from attachment theory, mentalization, intersub- jectivity, and neuroscience as a developmental perspective for the analytic exploration of internal objects and their relationships to fantasy, history, and experience. By describing a seven-year-old child’s fantasy of dolphin babies living inside a prince’s head, expressing both an oedipal scenario and the experience of the child’s brain dysfunction, which was a kind of trauma, Dr Green illustrated a developmental view on different ways of internalising objects. Biology and fantasy contributed to the child’s development and related unconscious meanings.

David Scharff: Internal objects and external experience Chair of the Board of the International Psychotherapy Institute based at Washington, DC, Dr David Scharff also co-edited several books on Fairbairn, including: From Instinct to Self: Selected Writings of W. R.D. Fairbairn (Scharff & Birtles, 1995) and co-edited the book which formed the basis of this conference (Clarke & Scharff, 2014). He and his wife, Dr Jill Scharff, have been extensively involved in psychotherapy training in China. Dr Scharff elaborated the central idea of Fairbairn’s model of the self. During development, the child’s experience of the outside world organises his or her internal world. Dr Scharff discussed the context within which Fairbairn developed his ideas—how Fairbairn expanded Freud’s discovery of internalisation of objects. It is not the drives per se but the drives within relationships that organise development. Dr Scharff illustrated through diagrams Fairbairn’s theory of the breakdown of the self, explicating the resultant parts of the self. Dr Scharff developed his own addition to Fairbairn’s original diagram, which stimulated much interest and debate. He explained, by using this diagram, how, for some patients, love is impos- sible. For these persons, the possibility of love and being loved is under attack internally due to the dynamic of the anti-libidinal object (internal saboteur) attacking the exciting object. In general, Fairbairn’s concept of self is a dynamic, open system, formed through the relationship between the self and its objects, influenced by the external world and influencing recipro- cally the nature of external relationships. Attachment theory, neuroscience, and Bion’s concept of containment also contribute to understanding the reciprocal shaping between the internal objects and external experience.

Jill Scharff: Fairbairn’s clinical theory Dr Jill Scharff is the Co-founder of International Psychotherapy Institute and Clinical Professor of Psychiatry, Georgetown University, as well as the co-editor (with David Scharff) of the book The Legacy of Fairbairn and 15-Event-Review_OPUS_7_1.qxp copy.qxp 01/06/2015 10:11 Page 183

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Sutherland: Therapeutic Application (Scharff & Scharff, 2005). She and Dr David Scharff conduct training programmes on couple therapy based on object relations theory in Beijing, China. Dr Jill Scharff described the influence of Fairbairn’s theory and the influence of the person of Fairbairn on her learning and current practice of individual, couple, and group psychotherapy. Speaking, as it were, to different parts of the self, psychotherapy can help people with the capacity to interact with the outer world and learn from experience. Dr Jill Scharff used clinical examples to elaborate Fairbairn’s notion of the “internal saboteur”, which persecutes the libidinal ego. The internal saboteur is a kind of representation of self-destructive actions, attacking the need for pleasure, satisfaction, self-confidence, and the capacity for love. The internal saboteur may also attack external objects. This was illustrated in a clinical case from a couple’s therapy. Mora, a forty-two-year-old woman, suffered from depression and fragility. She imagined her husband’s penis as a knife and she dissociated and blacked out during sexual intercourse. Her father had been violent and abusive and her mother acted as an exciting and rejecting object. Eric, her husband, had a mother who had been raped as a teenager. She gave Eric, who was the result of that rape, up for adoption. As a result, he found a traumatised woman, Mora, to attend to and love. The couple came to therapy with the images and expectations that Eric was to care for a mother and Mora needed a man unlike her father. After several months of couple therapy, they were able to better enjoy their sexual life. However, when approaching termination, they abruptly stopped their sexual therapy. From this transference, it can be seen that the internal saboteur attacked pleasure. The saboteur in the marriage came from Mora’s violent father and Eric’s rejecting biological mother. Projections of these internalised objects from the couple on to the therapist were heightened during termination.

Anne Alvarez: Paranoid-schizoid position, or paranoid and schizoid position? Anne Alvarez is a consultant child and adolescent psychotherapist, and author of Live Company: Psychoanalytic Psychotherapy with Autistic, Borderline, Deprived and Abused Children (Alvarez, 1992). Dr Alvarez shared her experience of treating neglected, autistic, and deprived children. She presented the notion that an interesting or engaging object, rather than a bad object or a love object, is sometimes crucial for these patients. She elaborated a brilliant clinical moment for an autistic young adult, Robby, when she and Robby encountered each other at the front door. Robby, his eyes lighting up, said he wanted to be the shiny door- knob. The therapist adapted her technique to this encounter and felt con- nected to Robby through his eyes lighting up at the moment of their greeting. 15-Event-Review_OPUS_7_1.qxp copy.qxp 01/06/2015 10:11 Page 184

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Valerie Sinason: Abuse, trauma, and multiplicity Working as a consultant psychotherapist at the Tavistock Clinic for twenty years, specialising in abuse and intellectual disability, Dr Valerie Sinason is the Director of the Clinic for Dissociative Studies. She edited the book Attachment, Trauma and Multiplicity: Working with Dissociative Identity Disorder (Sinason, 2011). Dr Sinason used three clinical examples to illustrate Fairbairn’s theories on trauma, dissociation, and the moral defence. The first example illustrated the moral defence. Mary, a ten-year-old with an intellectual disability, was referred for masturbating in the classroom. In the therapy sessions she would masturbate, offering her body to the therapist with a big smile, and calling herself, “Dirty Mary”. Dr Sinason used a doll she called “Lucy” to further explore this with Mary. In the play with Lucy, the analytic pair took turns exchanging the roles of self and other. Mary treated Lucy, who was assigned to have, as Mary did, Down’s syndrome, as her own girl. She said “No” to abusive behaviour towards Lucy and shocked Dr Sinason with the power of her response. Mary then stated, “I’m going to wash ‘Dirty Lucy’”, and she took the doll to the sink and gently washed her. It seems that Mary washed herself psychologically to embrace a “Clean, Happy Mary”. Dr Sinason explained that children with intellectual disabilities have feelings and fantasies of their situation and origins. She argued that they have the emotional capacity for deep understanding. Fairbairn would say that Mary saw herself as bad in order to feel some control over having Down’s syndrome. This was a vivid example of Fairbairn’s idea and of clinical interaction.

Rubén M. Basili: Emptiness pathology Dr Rubén Mario Basili is a training and supervising analyst of the Argentine Psychoanalytic Association (APA) and Founding Member and Coordinator of Espacio Fairbairn of APA. Dr Basili presented his work on emptiness pathology as a pre-oedipal pathology in patients with borderline personality organisation. He pointed out that this form of psychopathology can be recognised and diagnosed in the transference and countertransference. Emptiness is used as a defence against separation–abandonment anxieties by keeping object loss unconscious. In the transference, the analyst is experienced as the part-object with a quality of emptiness—an empty breast/mother. He also quoted some words from his patients that described their feelings in intimate relations that felt empty. These patients feel empty to avoid feeling abandoned or becoming psychotic. When the fear or experience of abandonment becomes conscious, emptiness disappears. Emptiness is not only a defence, but also a claim, a transference that seeks help from the analyst to 15-Event-Review_OPUS_7_1.qxp copy.qxp 01/06/2015 10:11 Page 185

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fill the patient. Dr Basili used his patient’s words to illustrate the clinical importance of fantasies related to emptiness.

PERSONAL REFLECTIONS ON, AND CLINICAL APPLICATIONS OF, FAIRBAIRN’S THEORIES

Upon registering for the conference, I wanted to prepare myself to better understand the topics under discussion, especially relating to Fairbairn. I could find few resources in China—several articles by using key words that included Fairbairn, and half of a book dedicated to Fairbairn (Xu & Wang, 2010). On reflecting on what was the fruit I derived from this conference, and in reviewing my training experience, including Chinese–German Training Course in Psychoanalytic Psychotherapy, I realised that the legacy of Fairbairn is underestimated in China. Fairbairn’s contribution has been less emphasised. This conference enlarged my view through presentations, discussions, debates, and talking with overseas colleagues so that my current clinical practice still draws on what I learnt about Fairbairn’s ideas. I will present a brief vignette from China in which I applied Fairbairn’s concept of internal saboteur and which also corresponds to Dr Basili’s formulations on emptiness in order to show how what I learnt from the conference can match the clinical situation while working with a Chinese patient.

Case vignette Miss Y was in her early thirties with borderline personality organisation, and also suffered from depression. Whenever a boyfriend proposed marriage, she would postpone the decision and suspend the relationship. Boyfriends would stop contacting her after many efforts to continue the relationship and often found someone else to marry. Miss Y would then feel abandoned. In a recent relationship, she went through the conven- tional ceremony of a feast, but not a formal, registered marriage. She then became pregnant and had an abortion. Miss Y’s sister, who is five years younger, was given up for adoption after birth, and came back to the family when she was a teenager. When the patient had a younger brother at the age of six, her father suffered severe illness. Her mother had to go away to earn a living, and Miss Y would see her only during Spring Festival each year. Miss Y was left to her grand- parents and her sick father. Her father became violent and abusive towards her. In treatment, Miss Y would often mention her sense of emptiness. She said, “My whole inner part is filled with my mother, without anything from myself. I am empty.” Whenever she felt threatened with abandonment by a boyfriend, she would suffer severe headaches and would fear becoming 15-Event-Review_OPUS_7_1.qxp copy.qxp 01/06/2015 10:11 Page 186

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psychotic. She had a pervasive sense of emptiness during periods when she had no romantic partner. I understand her sense of emptiness to be a defence against the more painful feelings of separation–abandonment, as described by Dr Rubén Basili. The internal saboteur for Miss Y was born of her violent, abusive father and her rejecting mother. She identified with her experience of a rejecting mother, and she would project this rejecting image on her boyfriends, and she enacted this by pushing them to leave her. In the third year of treatment, she was able to have some awareness of her wish to destroy our work when she complained of not making the progress she had expected. In the transference and countertransference, one can see the internal saboteur attacking the treatment. Last, but not least, I was much impressed by the way Fairbairn’s reach was expanded by this multi-disciplinary gathering of contributors, which also raised my awareness of how psychoanalysis can be influential in the wider society and in furthering our understanding of human nature. I hope that this kind of debate on contemporary and historical topics in psychoanalysis can be extended to China, where psychoanalytically orientated approaches are being increasingly accepted and embraced as helpful in meeting the urgent needs for mental health approaches in the context of pervasive rapid development and social change.

REFERENCES

Alvarez, A. (1992). Live Company: Psychoanalytic Psychotherapy with Autistic, Borderline, Deprived and Abused Children. London: Routledge. Clarke, G., & Scharff, D. E. (Eds.) (2014). Fairbairn and the Object Relations Tradition: Lines of Development—Evolution of Theory and Practice over the Decades. London: Karnac. Malberg, N. T., & Rafael-Leff, J. (2012). The Anna Freud Tradition: Lines of Development—Evolution of Theory and Practice over the Decades. London: Karnac. Scharff, D. E., & Birtles, E. F. (1994). From Instinct to Self: Selected Papers of W. R. D. Fairbairn. Northvale, NJ: Jason Aronson. Scharff, J. S., & Scharff, D. E. (2005). The Legacy of Fairbairn and Sutherland: Psychotherapeutic Applications. London: Routledge. Sinason, V. (Ed.) (2011). Attachment, Trauma, and Multiplicity: Working with Dissociative Identity Disorder. New York: Routledge. Xu, P. P., & Wang, Y. P. (2010). The Object Relations Theory of Independent Group: Researches on Fairbairn and Balint. Fuzhou: Fujian Education Press.