EXAM 3 Winnicott Object Relations annihilation anxiety as developmental purpose of symptoms self to other development 3 stages of personality development good enough mothering ordinary devoted mother cuddling as communication going on being 5 levels of the False Mask PS 251 Review annihilation anxiety threat to psychic survival experienced as a present menace or anticipation of an imminent catastrophe Winnicott saw this as developmental child realizes they re not grandiose result of lack of good enough mothering child feels lack of control and creates false self lets ppl know you re in distress so they can help infant no concern begins in pitiless relationship to external objects to satisfy its own needs growth ability to have concern for others maturity indicated by the capacity to pity 1 Personality Integration no person to embody personality born w biological needs they don t even know they have predictable behavior pattern results from care received 2 Personalization take ownership of own body me vs not me caring for others bc we ve been cared for 3 Realization reality kicks in world of magic disappears lose omnipotence realize they depend on someone less self centered develop pity mother is well enough attuned and responsive to protect baby with a sense of omnipotence allows baby to feel confident calm curious holding environment all an ordinary baby needs to develop into a healthy separate being capable of mature object relations is an ordinary mother who can respond to her baby s needs communicates security love to infant lays foundation for object relations experience of being alive what doesn t kill you makes you stronger life goes on 1 Extremely Maladaptive Mask TS completely covered by FS TS isn t even acknowledged FS takes over everything but cannot be sustained psychopathic 2 Moderately Maladaptive Caretaker TS dimly acknowledged allowed to have secret life FS protects TS compartmentalization sociopathic 3 Minimally Adaptive Defender FS protects TS from exploitation pain waiting for right situation for TS to emerge greatest risk for suicide ex someone who hides that they re gay 4 Moderately Adaptive Imitator much more prosocial as if personality don t know who they are FS imitates good qualities in others leave impression of not being real aspects of true self problems w true self transitional objects Stephen Prior 8 problems in the literature Judith Hermann 3 stage theory of treatment role of annihilation anxiety 4 pivotal factors result of trauma 4 traumogenic factors Finkelhor Browne 5 Adaptive Facilitator FS organized through social behavior have to behave a certain way in public otherwise you re unvarnished sense of feeling alive in one s body working towards something feeling complete increasing complexity over time life s difficulties taken in stride FS is sublimation of TS rather than its defender gap btwn TS FS too big TS cannot communicate accurately greatest danger FS is too successful hides TS then the TS potentials are buried person is not whole causes annihilation anxiety purpose comfort represent a positive period of time to help ppl learn who they are connect us to our past represent something inside of us child assumes rights over object affectionately cuddled loved mutilated have reality of their own gradually decathected loses meaning 1 Borderline children are not borderline adults 2 Limitations of etiological theories Mahler too phase specific 3 BPD supplanted by PTSD but not clear about implications 4 Childhood trauma childhood psychopathology 5 Resistance to looking at experience of traumatized child 6 Misdiagnosing PTSD as ADHD PTSD triggered by everything ADHD they are the trigger 7 Why does sexual trauma cause a particular pattern of sexual behavior 8 Treatment difficulties beta blockers treat physiological symptoms but ass w memory probs need diff approach for kids 1 Safety Stability 2 Recovery 3 Reconnection may be missing preliminary triage stage sorting based on need for likely benefit from treatment takes time but workable Dan Brown said this process is bidirectional annihilation anxiety is caused by trauma child trauma survivor runs from runs back into annihilation anxiety through repetition of relational patterns 1 repetition of abusive relational patterns 2 identification w aggressor 3 self blame 4 seeking object contact through sexual violent means 1 Traumatic Sexualization not act of sexuality but of violence physical damage society tends to blame victim they blame themselves 2 Betrayal often comes from someone who has access to child 3 Powerlessness kid can t do anything about it 4 Stigmatization kid can t explain it but knows something happened feels soiled self victim or sadistic avenger other sadistic abuser or victim both involve violent abuse but the abuser feels glee guilt while the victim feels terror pain victim abuses out of fear trauma is a RELATIONAL disorder form of resistance in the seriously disturbed they attack emotional links the therapist attempts to create therapist in turn needs to pull back and re approach later on danger of forcing interpretation replicating abuse whatever children are given is what they label as love devil known is better than the devil unknown bc child has undeveloped personality reacts w anxiety ridden identification w aggressor rather than w defenses child s psyche fragments to maintain order where love abuse innocent are guilty those who you trust hurt you etiology of DID victim grows up looks for same types of relationships becoming habitual victims and perpetrators to defend against internal feelings of fear weakness if you can t beat em become them recognize they ve chosen to become bad deserve anger judgment felt toward aggressor takes it out on themselves thinking they re the cause of the abuse MOST IMPORTANT TREATMENT ISSUE perversion sexualization of the avoidance of intimacy desire to love be loved causes violence traumatized kids look for contact on their own terms violent abuse explains fetishes phelias child comes to believe that who they are as a person is enough to evoke rejection aggression from adults child tries to provoke the inevitable abandonment rather than helplessly waiting for it to happen think they have a bad self that must be destroyed suicidal dilemma victim fears being abused again but also fears becoming an abuser both are equally intolerable relational dilemma how can someone who says they love me hurt me hard to be angry at perpetrator bc of fear of loss