Margaret Mahler was a psychoanalyst commonly renowned for her separation-individuation theory of child development. In this theory, Mahler makes the speculation that after the first few weeks of infancy, when the infant spends most of its time either sleeping or almost unconscious, the infant progresses from one phase to another. The very first phase is the normal symbiotic phase. Under this particular phase, the infant perceives itself as a single entity with its mother within the larger environment (Akhtar & Parens, 2013). However, with time, the infant progresses into a more extended phase known as the Separation-Individuation phase. More specifically, this phase consists of several stages and sub-phases through which the infant gradually begins to distinguish itself from its mother and later begins to discover its own will, identity, and individuality.
Therefore, based on the case in this particular disability letter, it is evident that the patients parents failed to provide minimal nurturing, care and safety, with the worst case scenario, happening at the age of six months; when the patients father came home from work and found her almost dead from dehydration in her crib. Based on Mahlers theory, at the age of six months, the patient was in her early sub-phases of the separation-individuation phase. It is during this phase that the infant breaks out of its autistic shell and begins to connect with its environment and the people around it. Similarly, according to Mahlers theory, it is evident that the patient was able to understand the emotional adversities in her life right at the hatching sub-phase of the Separation-Individuation Phase, which is between 5 to 9 months. It is at this phase that the infant begins to understand the difference between itself and its mother. Therefore, based on the fact that this sub-phase is characterized by an increase in both interest and awareness of the surrounding, it is evident that the patient in this particular case picked a lot of her current emotional distress at this age. Besides, because her mother offered her nothing in the way of mothering or nurturing and also had a father who was away from home for extended periods, the patient, right from the age of infancy did not borrow any emotional attachment or compassion from either of her parents. This, in essence, can be said to have continually prevented the normal emotional development of the patient based on the fact that her current dysfunctional pattern evolved from infancy and was later reinforced in her childhood and adolescence.
According to Mahler, rapprochement is the final sub-phase of the separation-Individuation phase and is said to occur when the child is the age of 15 months and beyond. Besides, this phase is characterized by the child being close again to the mother, and from this close relation, the child understands the emotional attention and compassion that they receive from the mother. This is, however, does not happen to the patient in this particular case. Instead, she explains that being a firstborn of three children, the mother was partial to her brothers and consequently offered her nothing in the way of mothering or nurturing. Drawn from this premise, it is evident that the patient was deprived of the emotional attachment with her mother during the rapprochement phase and hence her pervasive pattern of instability of interpersonal relationships and self-image. This conclusion is also substantiated by Mahlers believe that any possible disruptions in the fundamental process of the separation-individuation phase have grave impacts later in life of an individual. These negative results are reflected in a disturbance in the ability to maintain a reliable sense of individual identity, as perceived in this patients case.
The attachment theory is a common concept in developmental psychology which relates to the importance of attachment regarding personal development. According to John Bowlby, the theorist, the attachment is considered as a deep enduring emotional bond that primarily connects one person to another across time and space. Besides, in the explanation of this theory, Bowlby observed that infants who were separated from their parents would go to extraordinary lengths such as clinging, crying or even frantically searching, as a means to prevent this separation from their primary attachment figure, somebody who provides care, love, and support or to establish the proximity to a missing parent. Besides, from a general perspective, Bowlbys attachment theory claims that an individual attains a sense of stability and security that is necessary to take risks as well as develop a personality if they can form an emotional and physical attachment to another person (Holmes, 2006).
Thus, a conceptualization of this theory to this particular case gives evidence that the patient was deprived of any form of attachment with her parents, family and loved ones. This being the case, the patient and right from a tender age did not get the sense of security and stability necessary for her personal growth. This, therefore, explains why the patient developed a desperate need for connection, or rather an attachment which in most cases, is chronically interrupted by an inability to trust and expectation betrayal. This, in turn, explains her failure to maintain positive relationships with other people in her adulthood.
Similarly, Bowlby contends that the role of the parent as a caregiver grows over time to meet the specific needs of their attached child. This, is nonetheless, not the case in both the infancy and early childhood stages of the patient. Drawn from the disability letter, the patient has no form of attachment with a primary caregiver. Instead, she is deprived of any form of attachment not only with her parents but also with other family members. This is evidenced in the letter after the patient revealed her six-month-old ordeal to her caseworker, and received a retribution for telling her familys secrets. Besides, she was virtually ostracized from family activities and for the remainder of her time at home, she was treated as though she was not part of the family. This, in turn, fostered an estrangement from other family members persisting into adulthood.
In a nutshell, the attachment theory states that a secure emotional or physical attachment to at least one primary caregiver is overly crucial for an individuals personal development. This being said, it is evident that the primary reason behind the patients severe emotional distress is based on her early childhood influences which were characterized by her parents failure to accord her with the required nurturing and safety. This, in essence, acted as a barrier to the patients normal personal and emotional development, and hence her chronic feelings of emptiness, into her adulthood.
Winnicott's Treatment Approach
Winnicotts treatment approach centers on how an infants early environmental experience influences the development of anti-social tendencies in adolescence. The approach is considered as considered essential to Donald Woods Winnicott and, specifically, his concepts of delinquency and its aetiological roots being embedded in the experiences of infancy. Despite the fact that Winnicott, a renowned 20th Century psychoanalyst, and pediatrician developed various theories and concepts of psychoanalysis, his treatment approach is considered one of his greatest contribution to psychology. In his approach, Winnicott made the use of the term holding to refer to a fundamentally supportive environment created by a therapist to his or her client. Besides, Winnicott claimed that the holding concept relates to the caring and nurturing behavior accorded by a mother to her child and hence resulting in the sense of safety and trust. Therefore, concerning the case presented in this disability letter, it is evident that the therapist earns the trust of his distressed patient and can draw much information about her personal life and upbringing based on the fact that the therapist creates this kind of supportive environment.
According to Winnicott, this holding environment is an essential factor of the therapeutic environment and is mainly created through the direct engagement of the therapist with the client. Besides, based on Winnicotts treatment approach it is possible to establish the existing relationship between the antisocial behavior exhibited by the patient in this case, and her childhood environment. Concerning this context, Winnicott contends that an individuals antisocial behaviors have a significant probability of being developed from a persons having been deprived of a holding environment in their childhood. Thus, as a result, the individual grows up with feelings of insecurity and distrust (Anderson, 2014).
Also, based on the fact that Winnicott argued that the foundations of health, both physical and mental health are structured by the primary mother and child relations, it is possible to draw an understanding of this patients poor mental and emotional health. According to the letter, the patient was not only deprived of her mothers compassion as an infant but was also deprived of the holding environment throughout her upbringing. The patients former therapist writes, in the disability letter, that the patient grew up without any family support system, except for, rare and brief interactions with her brothers. For this reason, the client was forced to become self-reliant since her early teens. Similarly, connected to the concept of holding is the antisocial tendency. For instance, in this case, the fact that the patient suffers from an incapacity to relate to other people is a key sign of the anti-social behavior which according to Winnicotts approach, is a patients cry for help that is evidently fuelled by a sense of loss of integrity (Messer, 1984). More specifically, this sense of loss of integrity is, similar to this patients case, as a result of an inadequate or a raptured holding environment.
In a nutshell, Winnicott approach centers on an innovative approach to treatment which particularly emphasizes on a holding environment. Therefore, with regard to the contention, it is with no doubt that this patients interactions with other people became as chaotic as her relationships with her parents because she did not get a proper holding environment. This is after, having been brought up by parents and especially a mother who did not nature a mother-child relationship right from the patients infancy.
Akhtar, S., & Parens, H. (2013). Beyond the Symbiotic Orbit: Advances in Separation-Individuation Theory: Essays in Honor of Selma Kramer, MD. Hoboken: Taylor and Francis.
Anderson, J. W. (2014). How D. W. Winnicott conducted psychoanalysis. Psychoanalytic Psychology, 31(3), 375-395. doi:10.1037/a0035374
Holmes, J. (2006). John Bowlby and Attachment Theory (1st ed.). Routledge.
Messer, S. B. (1984). The Integration of Psychoanalytic Therapy and Behavior Therapy. Psychoanalytic Therapy and Behavior Therapy, 359-369. doi:10.1007/978-1-4613-2733-2_29
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