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Chapter 3.Clinical Psychodynamics Within the Framework of Object Relations Theory: Conflict, Anxiety, Defense, and Internal Object Relations

Conflict, Anxiety, Defense, and Internal Object Relations
https://doi.org/10.1176/appi.books.9781615373529.ec03

Sections

Psychological Conflict Within the Framework of Object Relations Theory | Psychological Conflicts, Anxieties, and Level of Personality Organization | Internal Object Relations, Defense, and Level of Personality Organization | Defense Within a Single Object Relation: Neurotic Projection, Projective Identification, and Role Reversals | Anxieties and Conflicts Central to the Treatment of Personality Disorders: Paranoid and Depressive Anxieties and Oedipal Conflicts | Ambivalence, Integration, and Structural Change | References

Excerpt

up to this point in the book, we have focused diagnostic and structural perspectives on personality disorders within the framework of object relations theory. We turn now to dynamic perspectives, focusing on the nature of the psychological conflicts that characterize personality disorders at different levels of severity and on the relationship among internal object relations, defense, and conflict. In the transference-focused psychotherapy—extended (TFP-E) model of treatment, the therapist links the progressive integration of internal object relations and structural change to the working through of psychodynamic conflicts motivating pathogenic defensive operations, focusing on the role of anxieties that interfere with integrative processes. As anxieties are contained and worked through, the patient relinquishes maladaptive defenses, takes responsibility for conflictual motivations, and comes to tolerate ambivalence. These dynamic shifts correspond with identity consolidation, the attainment of higher levels of personality organization, and decreased personality rigidity.

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