Transcending the Self: An Object Relations Model of Psychoanalytic Therapy (Book Review)

Author:  Summers, Frank
Publisher:  Hillsdale, NJ: The Analytic Press, 1999
Reviewed By:  Zanevel Liff, Summer 2000, pp. 13-14

As psychoanalysis continually evolves, there is an ongoing cross-fertilization of diverse ideas. Converging trends are now bridging classical with relational approaches, and many classical analysts are even embracing intersubjective thinking. Frank Summers makes an important contribution to this forward movement with his own integrative object relations model as he describes the details of his treatment with borderline, narcissistic and neurotic patients.

Following the line of thought of Winnicott (Maturational Processes and the Facilitating Environment, 1954) and Kohut (The Restoration of the Self, 1977), Summers has written a stimulating and absorbing new book. He, too, posits an inborn developmental drive he calls "self-realization." He views psychopathology as arrested development regardless of whether it stems from deficit and/or conflict. He sees it as defensive behavior, the consequence of unresponsive or abusive early objects. Thus, the blockage of growth potential is in the service of maintaining object ties, no matter how painful. After this developmental derailment, Summers' vision is to get the patient back on track within a customized transitional space.

Despite Summers' claim that all realization goals are unique, I remain puzzled about what a realized self might be? Is it similar to Freud's analytic goal of post-narcissistic loving and productive work? Does it have the same meaning as separation-individuation? I missed a more lucid elaboration of the definitions of realization and potential. Both terms appear somewhat nebulous.

Despite these ambiguities, Summers writes with courage, creativity and a sophisticated enlightenment. This is a highly positive book that counters Freudian pessimism. It is upbeat and offers new opportunities for "being and relatedness." It is also a rare treat and a welcome literature addition to read the accounts of effective treatment with the extensive clinical case material. For this reviewer, Summers is most thought-provoking in his comprehensive chapters on the different patient groups. These chapters are entitled "fragile self-fused object," "defective self-protective object," and "unworthy self-bad object." Each of these chapter titles is far more dynamic and interactional than the more traditional labels of borderline, narcissistic and neurotic.

It is interesting to note, as a historical aside, that Freud can be viewed as the original object relations theorist before he changed his mind about the role of trauma and developed his theory of fantasy determinants. Melanie Klein, in her subsequent work with children, returned to this earlier notion of trauma-based pathology and essentially became the mother of the object relations approach.

Another precursor of object relations took place in the later evolution of ego psychology. This included its multiple functions, including very prominently, the sense of self and others as well as object relations. Among the other functions often included are: reality testing, defensive, integrative, regulatory, thought, adaptive regression in the service of the ego, stimulus barrier, autonomy, judgment and mastery. Unfortunately, Summers, in criticizing ego psychology as exclusively drive-based, intrapsychic and solely interpretive is really referring to the earliest ego thinking with its primary function the defense against anxiety from intolerable drives.

Among the most intriguing parts of the book are the clinical revelations of his successful work with the various borderline patients. These are patients who have had their basic fusion needs thwarted leaving them with fragile, vulnerable, raging and depressed inner selves. Their attachment fusion needs remain hidden under a variety of defensive postures. Summers assumes the challenge of analytic work with the belief that only with the actual provision of a deeply sustained fusion experience in the context of an analytic framework, can growth with the capacity for intimacy occur. It is this second chance new object relationship that is seen as most mutative. I would rather think, more specifically, it is the disconfirming shock and surprise that extinguishes the irrational negative expectations and the maladaptive defenses. Summers utilizes analytic interpretations to understand the urgency of the defensive anger to protect the meager structure of the self, and to promote the unfolding of the fusion longings. He also displays an unusual confidence in offering a continual emotional availability to his patients, which he describes as "affective bonding." In addition, Summers astutely focuses on his treatment as a usable opportunity and attempts to interpret patients inability or unwillingness to profit from the experience, including the interpretations.

In reading the various descriptions of the fusion experience, I missed more precise verbatim reports of the specific interventions that cultivated and sustained these interactions. I was also curious how rage reactions from the inevitable empathic ruptures were treated. And furthermore, I wanted to know how object constancy translated itself into self-coherence so that that the self loss threats are only temporary recoverable disturbances.

It is also somewhat unclear how the fusion experience is differentiated from the selfobject experience in the treatment of narcissistic pathology, and how the fragile self is different from the defective self. Both are deficit disorders of the self and developmentally less structured than the guilt-ridden and conflicted neurotic. Summers' chapter on the neurotic unworthy self and the bad object is more clearly defined than the differential theory and treatment about the borderline and the narcissistic.

One virtue of a profound book is the number of ideas and questions raised in the mind of the reader. In this regard, Summers succeeds profusely. Among these questions is one about the all-inclusive applicability of the model. I believe pre-neurotic patients, those who are developmentally and structurally differentiated from neurotics, do not have the ego capacity to translate insights into new actions and thus need more of the restitutional fusion experience. In contrast, neurotic patients have much more internal self-continuity and coherence and can often respond to guilt-alleviating interpretations without a new object experience. The acceptance and understanding implicit in the interpretations become the basis for the new object experience.

I was also disappointed by the choice of the books title even though the subtitle delineates the object relation model of treatment. The usage of the word �transcending� sounds like the book is offering a pathway into the spiritual realm, or any realm beyond selfhood. The word also implies that the self is already substantive, fully formed and ready to go beyond itself into higher levels. It would have been a more appropriate and relevant title, if the word "transcending" were required, to qualify it with self related adjectives like "childhood," "impaired," "deficient" or even "delimited." As it is, the title remains misleading, suggestive even of the philosophy of transcendentalism in the Emersonian sense.

Nevertheless, Summers has written a fresh, challenging book. He uses the exciting metaphor of the search for buried treasure, the hidden autonomy and authenticity arrested in the patient, either arrested in an undeveloped or in a self-punitive sense. Regardless of the patient's level of differentiation, Summers conveys a strong personal "attitude" about new possibilities for being and relatedness which can emerge in the provided transitional space. According to Summers, it is in this therapeutic transitional arena where patients relinquish old defensive patterns and try out new ways of relating, the space where they redesign or reinvent themselves. It is evident that the current debate, even preoccupation with what is truly mutative, has extended beyond interpretation and the professional therapeutic relationship to the very subjective idiosyncratic emotionally available presence of the therapist. Back in 1976, Merton Gill already stressed the powerful influence of the real person of the therapist. At present there is a growing recognition that the role of the unique therapist-person, especially the affect dimension, is inseparable from his or her theory and technique. Despite the prominence of postmodern pluralism, there is also a trend toward integration, or at least acknowledging the shifting figure-ground relationship, between the analytic interpretative and the therapeutic empathic holding stances, between the professional framework and personal beliefs about the change processes.

Finally, I am reminded about two seemingly contradictory statements. Kohut stated that we all have ongoing lifetime needs for selfobjects, while Margaret Mahler claimed that we have ongoing lifetime needs for separation-individuation. To solve the paradox, it may be that the therapeutically affective fusion experiences become the necessary prerequisite for self-realization and the uncovering of buried potential, especially for those patients who suffer and struggle with disorders of selfhood. In this light, Summers book contributes significantly to the understanding of the deeper dynamics of therapeutic-analytic action and is thus very worthwhile and rewarding reading for all clinicians.

Zane Liff is a past president of Division 39 and is currently serving as co-chair of its Policy, Planning and Organization Committee. He is also a Board member of the Academy of Psychoanalysis of ABPP.

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