Perspectives:

Self Psychology

by

William A. Kelly, MD

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Self psychology is a relatively new theory within the field of psychoanalysis. The name was chosen because of gradual recognition that the difficulties some people experience have to do with self-esteem regulation and maintenance of a solid sense of self in time and space, often referred to as self cohesion. Previously, these were considered to be narcissistic problems and usually not amenable to psychoanalysis.

Like all psychoanalytic theories, self psychology attempts to explain human motivation. Over a thirty-year period, Heinz Kohut and other self psychologists evolved a new perception, a new understanding, of what patients were trying to tell us. Dr. Kohut acknowledges in his writing a woman patient called Miss F. who contributed to these discoveries. Earlier theories did not explain her suffering, and interpretations based on those theories worsened her condition. Heinz became convinced that human motivation could not be fully understood solely on the basis of sexual and aggressive drives.

A significant observation struck Kohut when he was President of the American Psychoanalytic Association in 1965: namely, the difficulties so plainly evident in many of the leaders in my profession — brilliant, well-analyzed men who fought over who spoke first or where they sat on a podium. Kohut did not believe analysis and resolution of Oedipal conflict alone affected such behavior, and our classical theories could not fully explain it.

From his own work, listening, and trying to understand, Kohut outlined three major areas of human motivation that had not been described before:

1)   The need to be admired and to bask in the appreciation of the other, i.e., “the gleam in mother’s eye,” often called a Mirroring Need.

2)    The need to idealize and feel close to and supported by the powerful, beautiful, all-knowing Other — Idealizing Need

3)   The need to be with like-minded souls — Alter Egos, buddies, sidekicks.

He and other self psychologists see these needs as ubiquitous and present throughout life from the earliest development of the self. These are often given the name of selfobject needs.

Initially, these needs are met by the empathic functioning of healthy parents. One can imagine a child fortunate to have the “gleam in mother’s eye,” a gleam that matches their skills and talents in an optimal way. Place this side by side with an acceptance of Idealization, with optimal disappointments over time, and the freedom to associate with friends over time. Such a person has taken in qualities that solidify the self and enable that person to meet the problems of life and feel connected to parents, the past, and the friends who help us transcend time.

Failures in that process manifest themselves in a variety of adult problems. I am reminded of Wilder’s play Our Town where the young woman looks at her mother and asks, “Mother, look at me once like you really saw me.” Or a parent who cannot accept or see a child’s admiration or allow them to share in their strength. Or parents who are threatened and cannot allow normal play with friends. Clearly, personal pathology, disease, depression, loss, separation, divorce, all play a part in these failures.

Kohut listed what he felt were frequent accompaniments of these problems in self cohesion or solidity and self-esteem regulation. These accompaniments were:

1)   In the sexual sphere, perverse fantasies and lack of interest in sex.

2)   In the social sphere, work inhibitions, inability to form and maintain significant relationships, delinquent activities.

3)   In manifest personality features, lack of humor, lack of empathy for other people’s needs and feelings, lack of a sense of proportion, tendency toward uncontrolled rage, pathological lying.

4) In the psychosomatic sphere, hypochondriacal preoccupations with physical and mental health and disturbances in various organ systems.

The earlier and more egregious the failures, the more obvious the problems. Others are more subtle, as in the following two textbook stories which exemplify self disorders.

Mr. A.:

Mr. A. was a very successful businessman in his late 40s, sociable and well dressed, with graying hair and a trim athletic build. He was highly regarded by his colleagues and was often sought for advice, counsel, and support. He was married; had three children, of whom he was proud; and lived in comfortable surroundings. Though his income was high, he was not given to lavish display or excess. Mr. A. appeared to have everything anyone might desire.

Why would this man consult a psychoanalyst? Basically he was unhappy. He was perplexed. Though he had achieved far more than most, he found little joy in life and had spent years seeking circumstances in which he might finally feel the pleasure and satisfaction that eluded him. As he poignantly told me, he could buy anything he wished, could do anything health or wealth would permit, but he was neither happy nor satisfied.

Superimposed on Mr. A.’s chronic vague unhappiness were acute episodes of painful discomfort. For example, Mr. A. invariably did poorly at the annual tennis competition his corporation hosted for his employees. No matter how he tried, how many lessons he took, and how diligently he practiced, he was a bad tennis player. No matter that he was the chief executive officer, that his income had been in seven figures for years, or that he had founded and built the company entirely by his own efforts and skill. No matter that he was personally well liked. He was mortified and painfully ashamed, and he dreaded the annual outing.

Mr. B.:

Mr. B., a student in his late 20s, was referred by one of his instructors because his attitude and demeanor were not fitting for his intended vocation. When I first saw this man, I was struck by his disheveled appearance, which stood in sharp contrast to his arrogant, demeaning behavior. Upon entering my office and moving the chair I indicated, he remained standing, almost imperceptibly nodded, and imperiously said, “Please be seated.” (I later learned that his acquaintances referred to him as “Prince.”)

This patient complained of having difficulty with his graduate program. Instructors and fellow students did not think well of Mr. B. professionally and shunned him personally. Mr. B. had few friends; people avoided him. He was mystified as to the cause of his isolation and angry at what he perceived as mistreatment by those around him. He was lonely, subject to vague states of tension and a myriad of physical complaints, and driven to search for anonymous, unsatisfying homosexual contacts.

When offended, which was often, Mr. B. was subject to episodes of poorly controlled rage and had, on occasion, demonstrated his displeasure by upsetting food-laden dishes — once, a full plate of soup — at formal dinner parties. (Subtle and more obvious form of self-pathology.)

Kohut and later self psychologists saw how these needs — Mirroring, Idealizing, and Alter Ego — emerge in analysis and become focused on the analyst. They can be more deeply understood not only in the present, but in terms of the past, so that a person can find sustenance in the analyst’s presence, and in the many experiences of being understood, especially following misunderstandings. These experiences in analysis help the person place his or her story of life in perspective and relive it with the analyst to mourn what was and what was not. This can become the core of a new way of relating to oneself, to family, to friends, to the world. One might say that by learning to consolidate yourself, you are capable of giving to others.

This new capacity is seen as the essence of cure in psychoanalysis. Clearly, it implies a self reliance, a capacity for independence, but always in connection to vital others in the past and present. Much as we connect with each other, friends and colleagues are sharing ideals and working side by side, mutually appreciative.

Kohut’s work has evoked considerable passion and interest in the Psychoanalytic community. This is nothing more than a necessary revitalization of our theories and practice.   Kohut’s works are now translated into over 16 languages, and his ideas continue to generate interest nationally and internationally. One question that is often asked is, why the increased incidence of self psychological disturbances? Kohut felt this phenomenon was due to a cultural shift in family and child rearing practices during the past 100 years.

William A. Kelly, MD, is a current Faculty member and past Director of the St. Louis Psychoanalytic Institute and a Clinical Professor at St. Louis University School of Medicine. He also maintains a private practice. Dr. Kelly began his psychoanalytic training at the Chicago Institute for Psychoanalysis and finished at the St. Louis Psychoanalytic Institute, becoming our first graduate. He is previous Director of The David P. Wohl Memorial Institute at St. Louis University School of Medicine.

Dr. Kelly has served as Secretary/Treasurer, and President of the Eastern Missouri Psychiatric Society, President of the Missouri State Psychiatric Association and is a past President of The St. Louis Psychoanalytic Society.

Additional Reading:

◈Heinz Kohut, The Chicago Institute Lectures, Analytic Press, edited by Paul and Marian Tolpin

◈ Textbook of Psychoanalysis, Nerissian et al. Chapter on Self Psychology by Robert J. Leider, MD

A more complete bibliography can be obtained from the Betty Golde Smith Library of the St. Louis Psychoanalytic Institute. Contact David Bachman, Librarian, at (314) 361-7075, ext. 324, or library@sltpi.org.