Reformulated Object Relations Theory: A Bridge Between Clinical Psychoanalysis, Psychotherapy Integration, and the Understanding and Treatment of Suicidal Depression

Abstract

In contrast to the fruitful relationship between psychoanalysis/psychoanalysts and the humanities, institutionalized psychoanalysis has been largely resistant to the integration of psychoanalysis with other empirical branches of knowledge (infant observation, psychotherapy research, psychological and neurobiological sciences), as well as clinical ones [primarily cognitive-behavioral therapy (CBT)]. Drawing from two decades of theoretical and empirical work on psychopathology, psychotherapy, and psychoanalysis, the author aims to show how a reformulation of object relations theory (RORT) using (neuro-)psychological science may enhance a clinical-psychoanalytic understanding and treatment of suicidal depression, which constitutes one of the most formidable health challenges of our time. Specifically, he rewrote the notion of Melanie Klein positions—primarily the depressive position—using extant knowledge of structure of emotions, the centrality of mental representations of the future (“prospection”) and the toxic nature of criticism-based emotions. This reformulation enables a dialog between clinical psychoanalysis and other therapeutic schools of thought and sheds light on the understanding and treatment of suicidal depression.

Yalom, Strenger, and the psychodynamics of inner freedom: A contribution to existential psychoanalysis.

“…However, my acquaintance with Carlo and the close relationship we developed have made a huge impact on these "same things" that I have been doing, and perhaps they even continue Carlo's legacy in one or more ways. I am referring here to my relatively recent reformulation of Klein's (1928) notion of the positions, and particularly the depressive position (Shahar, 2018(Shahar, , 2021. Specifically, Klein viewed the positions as a synergistic amalgamation of key anxieties (a paranoid-schizoid anxiety centered around a fear of overwhelming aggression versus a depressive anxiety evolving about the fear of harming the "good"), defense mechanisms (in Klein's theory: primitive defenses aimed at polarizing good and bad, which are mobilized against the paranoid-schizoid anxiety versus more neurotic anxieties causing unawareness of one's inner flaws, thus addressing the depressive anxiety), and part-versus-whole mental representations of self and object (in Klein's theory: experiencing self and others as solely good or bad, or, alternatively, in a holistic and nuanced way).…”

Study Protocol for an Ecological Momentary Assessment Study: TempRes “Temporal Variability of Risk and Resilience Factors for Suicidal Ideation”

“…Lastly, there are seminal psychodynamic contributions to the understanding of both “normal” development and psychopathology, including suicidal crises [e.g., ( 28 – 30 )]. In spite of attempts at building bridges between disciplines [e.g., ( 31 , 32 )], so far psychodynamic approaches have not been brought together with the major developments in the empirical study of suicidal ideation and behavior described above. However, recent advances in the operationalization of central psychodynamic concepts facilitate the integration of these perspectives.…”