In this article, I bring together the ideas of Fairbairn on object relations, Sutherland on self and society, and Pichon-Rivière on the link, and then illustrate them in a vignette from individual psychotherapy with a young woman. Fairbairn’s theory of object relations has been most useful for understanding individual patients and their significant attachments (Fairbairn 1952, 1963; Scharff and Birtles 1994; Grotstein and Rinsley 1994). In the late 1960s, Fairbairn’s major expositor and biographer John D. Sutherland (1963, 1989) introduced me to object relations theory and showed me that it could be applied to working therapeutically not only with individuals (1963) but also with couples—thanks to Henry Dicks’s (1967) integration of Klein and Fairbairn—and even with communities (Sutherland 1966; Savege 1975; J. Scharff 1975). Since then, I have continued to find object relations theory a flexible, powerful, full-spectrum analytic theory for working in psychoanalysis, couple, sex and family therapy, and psychoanalytic education (J. and D. Scharff 2000; J. Scharff 2005; Setton, Varela, D. and J. Scharff 2005). In the last five years, I have found a valuable extension of Fairbairn and Sutherland’s ideas in Link Theory, which stems from the social-psychological approach of Argentine psychoanalyst Enrique Pichon- Rivière (1985).

Fairbairn’s object relations theory: Splitting and repression

Fairbairn recognized the effect of dissociation, a defence that, although ubiquitous and normal, is overused out of necessity in trauma-related mental, emotional and behavioural disorders (Fairbairn 1952). It is not surprising that Fairbairn was so attuned to dissociation, and chose it as the topic of his doctorate in medicine, because he had encountered it in his clinical sessions. He worked in a clinic for children who were sexually and physically abused, in a hospital for men who returned from war with war neuroses, and in private practice with adults who suffered from hysterical neuroses and schizoid defences (Birtles and D. Scharff 1994). In these clinical populations, Fairbairn noticed the prevalence of dissociation in addition to repression as defences, but he went beyond simply delineating dissociation as a pathological defence. He realized that dissociation in those cases was simply an exaggeration of normal defensive processes and went on to build his theory on dissociation as a normal defensive mechanism for actively protecting the mind as it traversed the course of development from infantile dependence to independence.

Fairbairn believed that the infant self is whole at birth, already competent to seek its mother. The vulnerable infant uses all his instinctual competence—rooting, clinging, sucking, crying, and gazing—to appeal to the mother for food, comfort, security, and love. Most importantly, the infant looks to find meaning for his existence by mattering to the mother. As she responds to his needs and attunes to his emotional states of mind, she gives meaning to his experience. He gives meaning to her existence as a mother, and together they create a mutually gratifying relationship. Nevertheless, there will be expectable moments of misattunement that are a challenge to both mother and child, although not usually of sufficient degree to cause trauma. These moments of frustration upset the infant and he reacts by erecting defences against the pain that threatens to overwhelm his immature mechanism for self-regulation.

The infant takes in the uncomfortable experience with the mother (the external object) to control the unsatisfactory perception (the internal object) and feeling (the affect) inside his mind. He splits the internal object into two pieces: the part that felt good enough, and the part that felt uncomfortable. What is good enough remains in the conscious part of the self. What is overwhelmingly uncomfortable is split off from what is felt as good, and is repressed deep in the unconscious layers of the mind. There it is sorted into two major categories of internal object according to whether the associated feeling of discomfort is one of longing for more than is given to meet the needs (the exciting object) or angrily feeling that the needs are being pushed away (the rejecting object).

Fairbairn recognized, in a moment of creative genius, that the ego, the executive aspect of the infant self, splits itself in relation to these internal objects. It does so in order to release a part of itself to accompany the object and the affects associated with it into the unconscious and maintain its repression there, thus creating internal object relationships consisting of ego and object bonded by the specific affect that has been overwhelming. These are sorted into two main categories—the libidinal (exciting) and antilibidinal (rejecting) internal object relationships. The antilibidinal ego is connected to the rejecting object and its feelings of anger at abandonment and rejection, while the libidinal ego is connected to the exciting object and its feelings of longing and craving. This creates a mind with a conscious area consisting of a central part of the ego relating with feelings of satisfaction to the ideal object from which the uncomfortable aspects have been shorn, and an unconscious area consisting of exciting and a rejecting internal object relationships. The central ego actively keeps the split-off internal object relationships in repression, aided by the rejecting internal object relationship, which further represses the internal exciting object relationship. The overstimulation of an elusive external object that creates longing is even more painful than an absent one that abandons the infant to his needs or actively refuses to accept them, and that is why it is kept so thoroughly split off and repressed. But the split off and repressed parts of the self always seek to return in various ways, such as symptom, gesture, speech, and choice of partner.

In health, the libidinal constellation is not too rigidly repressed and it can come forward to support the central ego in feeling desire and responding to others who are expressing need. The anti-libidinal constellation comes forward to assert the will, set limits, and support the ego’s need for separateness within a committed relationship. This is normal. We find pathology only when the exciting object is excessively exciting and evoking feelings of desperate craving and when the rejecting object is excessively persecutory and evokes terror of abandonment and rage at rejection, especially when these are also turned against the libidinal constellation. A pathological endopsychic situation occurs when splitting and repression are severely maintained, and the system loses its dynamic flux. We then find an adhesive tie to the bad object (whether of the rejecting or exciting variety) that leads to self-destructive organizations, dysregulated behaviour, and disorganized attachments.

In summary, splits in the self form as a result of pulls towards and away from object relating. The central ego is the organizing, executive function of the self. It splits and represses the other parts of the self, but, learning from experience, allows the return of the repressed to remodel its structure and enrich its functioning in the light of new experience. In health, the boundary between conscious and unconscious is flexible enough to allow communication between the conscious and unconscious parts of the self, and secure enough to prevent psychotic eruptions. In neurosis, psychosis and personality disorder, the boundary is more tightly maintained. After trauma, the boundaries are even more rigid, and occur not only on the horizontal divide between conscious and unconscious but vertically as well between all parts of the self. At the extreme, this splitting encapsulates fragments of self and object and leaves empty spaces behind in the mind. Extreme splits in the self occur in survival mode to permit going-on-being in the face of great damage from betrayal, sexual overstimulation and aggression in the holding environment. Such a dissociative pattern serves the function of clearing the way for a resilient response. It provides for a part of the self that is able to carry on, but the resulting fragmentation causes vulnerability to flashbacks, poor sleep, somatic symptoms, learning disorders, and relationship difficulties.

Fairbairn: Physical and sexual trauma in childhood

The term childhood trauma refers to any early experience such as parental divorce, loss of a parent, and life-threatening illness, which leads to psychological stress and symptoms of anxiety and depression. But because this kind of trauma is not secret, there is not severe splitting. Adults can help the child put the experience into words, mourn for what might have been, and work through to an adjustment. In contrast to those types of childhood trauma, physical and sexual trauma refers to a cumulative experience, or to an egregious single shock of an aggressive or sexual nature that overwhelms the self, either because the trauma is severe or because the self is weak, and because the child is helpless to change what is happening.

Fairbairn’s theory of the endopsychic situation is particularly helpful in understanding children whose parents were victims of physical and sexual trauma. Instead of providing ordinary parental holding with good attunement and clear limits that provide safety and stimulating growth, these parents may intrude on and impose their will on the child, and stifle independence. According to Fairbairn, the child builds mental structure out of experiences primarily with the parent. When the parent breaks the physical and mental boundaries that the child uses to protect body and mind, the disturbed adult mind enters and shatters the child’s mind. The self of the child has been used as the object of the parent’s unmetabolized needs to be aggressive or inappropriately sexual.

The parent has related to the child’s self not as a unique self but only as the parent’s object. No autonomy is allowed the child, and so there is no healthy interplay. There is no gap between adult and child across which to relate. The transitional zone of relatedness is eliminated (Winnicott 1951). When that interpersonal space collapses, the transitional space inside the child’s mind is collapsed (J. and D. Scharff 1994). There is no room for dream, imagination, and creativity all of which promote growth and independent reflection.

The traumatized child splits off, buries, and seals the traumatic experience in encapsulated traumatic nuclei (Hopper 1991). In some cases, the central ego may be aware of these encapsulations and the gaps that they leave behind. In other cases when the trauma was severe or the ego weak, the ego may have totally lost contact with the encapsulations, which then operate as totally dissociated parts of the personality with separate memory banks, as seen in patients with Dissociative Identity Disorder. If the capsule weakens, traumatic material threatens to escape, and then the person may panic, desperate to avoid stress and prevent activation of trauma.

When parts of the mind are sequestered, thinking becomes restricted, preoccupied with the mundane, and language becomes somewhat literal and concrete because creativity has been stifled (J. and D. Scharff 1996). So, rather than communicate verbally, these parts of the self convert themselves to somatic symptoms, such as a cough, a tic, a pain, dysregulated food intake, obsessional behaviours, and self-harm by cutting or addiction to substances as a means of representing the traumatic experiences that cannot be recalled and cannot be expressed verbally but do, in a displaced way, express the trauma without allowing it to come to mind. These bodily symptoms convert an unbearable mental structure based on an unbearable relationship into a situation that can be recognized as being in need of help.

Trauma happens to adults too. Studies of traumatic war neurosis in World War II, post-traumatic stress disorder after the Vietnam War, and sorrow and guilt among Shoah survivors show that stress can overwhelm even the mature, well-functioning person. The new trauma resonates with any pre-existing loss or trauma, aggravates any residual pain and damage left after the person coped with it reasonably well originally, and compounds the trauma.

Sutherland: Self and society

Sutherland’s bio-social concept of the self makes a useful contribution to understanding development in various human environments, including those in which trauma has intervened. He defines the self as “a dynamic organization of purposes and commitments whose behaviour is governed by conscious and unconscious motives, and whose developments and functioning are inseparably linked to the social environment” (Harrow et al 1994, p xxv). At the centre, the person is a responsible free agent, both separate from and in connection to others. That person’s mind is an innately patterned process that drives the baby to seek others and build a self from that interaction. The self is a dynamic, affect-driven matrix, an open system, its interconnecting parts being in flux in relation to other minds. For the self to fulfil its potential and grow into the shape it can become it needs its own intention and it needs feedback from other minds. The infant self learns to recognize the states of mind of those others and to monitor its own self-states in relation to the impact on others. Above all, the self needs love if it is to hold the developmental differentiation together and enjoy a sense of wholeness and autonomy (Sutherland 1979). Within the loving context, its urge to maintain the wholeness of its shape can be realized. Sometimes, it is necessary to fight fiercely for that level of integrity to ensure continued vitality. “The organism’s life becomes the dynamic process of preserving its autonomy within the heteronomy of relatedness with its social group and the physical environment” (Sutherland 1990 in Scharff 1994, p.376).

But what happens if the loving context is not there? The child has no good mother experience to take in at the core of the self. The bad object is installed in its place ever more securely. The child withdraws internally and is forced to appear to conform to the adult’s pathology in order to maintain the necessary attachment, in this case to a bad object. In locking up his true self far from further harm, the infant cripples the object-seeking function that is so necessary for encountering other minds and experiences with potentially loving people. To make life possible under impossible conditions, “the child develops an adapted self, adapted to the mother’s excessive influence whether this be from intensive over-control or neglect, or unreliable, inconsistent responsiveness, rather than an adaptive self which good mothering fosters” (Sutherland 2005 p. 196). In a traumatizing context, the emerging potential of the self is denuded and hidden by a false self. Hatred for what has happened and identification with the hated mother locks in the adaptation and prevents new experience to avoid the possibility that the hopeful, object-seeking part of the self, if ever released, should again meet with rejection and be filled with despair.

Sutherland (1980) is highly invested in the metapsychology of the self as “the essential organizing principle” (p. 10) of each unique individual, but he is also invested in thinking of the person as part of humanity undergoing the evolutionary process. He repeatedly places the self in that context. Sutherland says that, over the centuries, the self has fostered “the flexibility, resilience and persistence of human groups by maximizing the potential resources within each individual, and did not confine communities to rigid hierarchical organizations (Sutherland 1980, p.25).

Clinical usefulness

I have found Fairbairn and Sutherland’s theory particularly helpful in clinical work with survivors of sexual and physical abuse (J. and D. Scharff 1994). Having the endospychic situation in mind, we can take up a therapeutic position of benign concern that does not impose our will on the patient. For instance, therapists who remember that literal thinking is a feature of the collapsed transitional space will not become impatient with patients’ preoccupations with the mundane and their inability to discuss sexual material and family history. They will value the resilience that is supported in this way of attaching to the ordinary as a relief from ongoing episodes of trauma. We work to establish a safe context in which therapy can proceed before attracting transference to ourselves.

Within that context, we will be experienced as a new version of those who helped or hurt the patient, and those who were bystanders to the abuse. The transference-countertransference exchange may be so painful and frightening that we need to respect the slow pace with which it becomes specific. The patient’s defensive preoccupation with going-on-being serves to protect the therapy, just as it protected the child. We must wait until we are ready to be misperceived as abusive or neglectful, or worst of all as a void, and ready to speak to it and work through it with the patient. Therapy proceeds along a rhythm of dipping into trauma and returning to going-on-being until gradually more of the trauma can be tolerated and put into words. From our experience with the patient, we put the images and themes together as a narrative of the patient’s self, from which to continue our shared reflection, exploration and eventual understanding. Then the spaces are filled in as we create new experiences in the therapeutic relationship, genera that heal the contents of the traumatic nuclei (Bollas 1992).

Transgenerational transmission of trauma

To understand how trauma is transmitted, we need to look beyond Fairbairn’s theory of dissociation. At the individual level, trauma is transmitted to children by projective identification, a mental mechanism of defence for protecting the self from its innate fear of annihilation and for protecting its good and vital functions in early life (Klein 1946). In ordinary good-enough mother-infant relationships, the infant projects rage, fear and death wishes into the mother to get rid of these unpleasant affects and stop them from disturbing the good and lively parts of his self. He misidentifies them as emanating from her feelings towards him, which causes similar pain now experienced as coming from a persecutory external source. The infant copes, as Fairbairn said, by taking in, splitting and repressing this monster aspect of the good mother. The infant also projects good feelings towards the mother and takes in a positive view of her coloured by those feelings too. In health, good and bad internal objects are in balance. After trauma, the bad object is dominant, and that is what the infant is attached to, even if it is unhealthy.

In marriage, the woman deals with her spouse as if he were the source of the part of her that she has re-found in him. Her husband has his own valency to project into her, and if the couple relationship cannot absorb and modify these mutual projective identifications, the marriage gets stuck in an unsatisfactory state, or divorce may follow. Either way, the stuckness or the divorce upset the children, who in turn may be at risk for divorce, or staying in an abusive marriage in order to avoid the trauma of divorce. When the couple cannot metabolize their mutual projective identifications, they may resort to identifying all the bad objects in a child, as if that child’s behaviour is the cause of the relationship difficulties. The child who is the object of the projective identification and who identifies with it then develops behaviours that further justify the perception of the child as bad, and so the projective identification is cemented and not amenable to modification in light of new experience.

Trauma happens to adults too, and even though they are already mature, they may resort to severe splitting and encapsulation of the trauma to help them carry on, manage their pain, and deny their fear of disaster striking again. The adult must find a way of coping with the bad internal object to the extent that it has not been balanced by the good internal object. She projects it into her own self, where it fills her with a sense of badness, devaluation, and destructiveness or she finds another object to project it into – friend, teacher, authority, spouse or her own child. She then experiences the object of her projective identification as persecutory and treats him or her accordingly. Some parents identify with their own aggressor, and do to their children what was done to them. Others are determined to spare their children but if they inhibit all excitement and rage the child has no opportunity to learn the appropriate management of sexuality and aggression. Either way, trauma affects the next generation.

At the societal level, trauma is transmitted to the next generation when social trauma such as war and natural disaster have created huge losses in segments of the population and left behind mass depression, post-traumatic disorder, and the desire for revenge. The mind of the whole society may dissociate from the pain and wall off the traumatic material. In the 1960s, we saw this in Germany when East Germany walled itself and the Eastern Bloc off from West Germany by a wall built through the middle of Berlin. East Germany wanted to keep out Fascist/Nazi elements that would interfere with its socialist vision and at the same time keep in unhappy citizens who might otherwise choose to emigrate to West Germany and Europe. The Berlin Wall was a rock hard boundary to keep out the bad Nazis from the West out and to keep in the good socialist people from the East. I’ve thought of this splitting of good and bad as a diversion from the main example of splitting good and bad in Germany before World Wars ll. The post-war generation refused to acknowledge and take responsibility for what the previous generation had done or allowed to happen to Jews onto whom they projected all that was dirty and defiling to the nationalist ideal. In 1990, when the wall came down, the trauma could begin to be acknowledged, reconciliation and repair could occur, and healing of splits could begin, not just in Germany, but in Europe at large.

Similar trauma recurred in Argentina. In the 1930s, some of the Jews who emigrated from Europe and Russia to avoid pogroms and concentration camps sailed to the Americas looking for safety. Some of them landed at Buenos Aires. In the 1970s, these Argentine immigrants lived through another period of social trauma (and some of them had to flee their country again, while others who thought they were free were secretly taken away and disappeared). The military in power in Argentina created hundreds of concentration camps to which anyone could be abducted, illegally detained without evidence, and hidden so that they were outside the protection of the law—all in the name of anti-communism. Detainees were tortured and often murdered, in which case their bodies were disposed of at sea so that they could be said to be desaparecidos, missing, not dead, and the government could deny any knowledge of their whereabouts or of what had happened to them.

Pichon-Rivière’s Link Theory

In terms of Link theory, internal and external object relations are constructed by the interaction of the twin pillars of development—individual influence and social interaction. Fairbairn described the individual infant as taking in experience with the mother to make its psychic structure, consisting of a dynamic system of internal object relationships. By contrast, Sutherland looked at the reflection of those individual object relationships in the functioning of parts of communities. Pichon-Rivière began his theory building by looking at the space between individual and society, the space into which the individual is born. Link theory looks closely at the overarching organization of internal and external world into which the infant arrives and within which he grows and develops to adulthood.

What exactly is the link? It connects the individual to previous generations and a social history of the past and to current relationships with family and social groups. The baby is born into the link. He arrives among past and present social influences. He accesses the link by expressing his need for safety, nurturance, love and knowing. He lives and grows in the network of influences and connections that constitute the link. Pichon-Rivière distinguished vertical and horizontal axes in the link. On the vertical axis, the infant connects to good, bad, and downright traumatic experiences in the previous generation, and may be dreaded as living proof of their awfulness or welcomed as a hope for the future. On the horizontal link, the infant relates to the mother and other family members, extended family, and social groups, who carry the link within them in their conscious and unconscious minds. Through the link to social experience, the individual mind is shaped in both conscious and unconscious dimensions and reciprocally shapes the groups of which the individual is a part. The quality of the link is expressed in the adult individual in dreams, individual actions, speech, symptoms, and bodily experiences. In therapy, working with manner of speech, dreams, physical and mental symptoms, behaviour revealed in attitude to work and play, and quality of relationships, we can detect the quality of the link and its impact on the individual.

Here is a clinical illustration of Fairbairn’s description of the endopsychic situation, Sutherland’s emphasis on self in society, and Pichon-Rivière’s theory of the link.

Clinical example from individual therapy

Orchidea, a beautiful, olive-complexioned, curvaceous young woman with long dark hair enters my office for her first session of psychotherapy. She sounds thoroughly American, but she looks exotic. She is a high-achieving pre-med student now taking a gap year after college, before medical school, so that she can study for the Medical College Admission Test and volunteer in areas related to medicine. She asks for help in dealing with feeling lost, unhappy, anxious, judged, and uptight because of constantly performing to meet the standards she imagines others have for her. Her main emotional symptoms are unhappiness, anxiety and a lack of confidence in her self. She fluctuates between assessing herself as exceptional or fraudulent. Her physical symptoms include heart palpitations and a knot in her throat, and she is preoccupied with feeling fat even though she is of normal weight. Her speech is fluid, expressive, and anxiously obsessive. Her agreeable demeanor covers any upset or irritation.

After having been the only adored grandchild for 7 years, she was very upset to lose her place in the spotlight when twin baby brothers were born. She developed temper tantrums that she felt helpless to control. As an adult, she is determined to suppress her anger and will not let anyone see when she is unreasonably upset over tiny things. Her parents, who are successful professionals in another town not an hour away from Washington, want Orchidea to visit weekly but she often feels anxious about meeting their needs and is afraid that she will get angry at how dependent and entitled her teenage brothers are.

Orchidea explained herself to me: “I’m on a pedestal and I’m acting to please people, and it’s exhausting. I tell myself that no one is judging me, things are up to me, but I don’t listen to myself. I keep thinking about whether what I’m saying coincides with what another person thinks. There’s no reason to think here’s someone looking over me and judging me—I realized this from the last time I was here for the final session of the consultation. I am my own worst enemy. That’s what I need to work on.”

As an infant, Orchidea had received love, nurture, safety, and knowing her place in the world. She was her parents’ first, much-wanted child and the first grandchild of both parents’ families, three of whom had been forced to emigrate from Russia, and happened to land in Argentina. She knew who she was in relation to her close and adoring family. A gorgeous little girl, she was showered with compliments from passersby.

In object relations terms, Orchidea was an exciting object for her family and their warm response filled her central ego with good feelings, and a sense of being special. Having such a special child filled her parents with pride. She represented the hope of leaving behind the cruel history in favour of life in the new land, free from the oppression suffered by her grandparents.

After her twin baby brothers were born, she felt dropped and not listened to anymore. Her protest took the form of temper tantrums, which did nothing to encourage her mother’s expressions of love. She went from being the perfect child on the pedestal to being a monster. She did not know who she was anymore. She hated herself and the body she could not control.

When she expressed her outrage at her mother’s attachment to the twin boys, the ideal child became a rejecting object to her family, and she felt rejected by them. She envied the attention given to the boys and began to hate herself for feeling less than they were, and for hating them and her mother. As an adult, Orchidea attacks the feminine aspects of her body. At the vertical level of the link, she is connected to her grandparents as the proof that life goes on and families survive after trauma and loss but, at the same time, her connection to their history continues to be expressed in her feeling of neglect and persecution by the authority in her life—her mother.

Orchidea said, “This must have to do with my childhood—this thinking the only way to be liked is to fulfil others’ expectations.” But, rather than tell me about her childhood, she changed the topic to that of her adolescence, reviewing her trauma when the family had to move to the United States when she was 13. She was traumatized by the move and its assault on her identity. “Trying to do what they expected was the only way to fit in with the kids in school when we moved from Argentina to here. I didn’t know the language. I didn’t have the words for what I was feeling. I was so insecure. I hated my accent and I hated how different I was from those skinny blonde girls. Now I do express myself, and I sound like a North American but I’m still so aware of others, and I still feel insecure. If I could lift this, I’d no longer feel this knot in my throat all the time! This feeling has got me to hate myself. Whenever I’m not everything to everyone at once, someone will be disapproving, and because I’m not fitting someone else’s standards, I’m not enough. I’m not unattractive but any little flaw I have I examine through other people’s eyes, and it’s no longer about me as I really am.”

Like Orchidea, the grandparents lost their country and their language. As an adolescent two generations after the original move, Orchidea had to move as a teenager to an unfamiliar culture. Orchidea’s vertical link to past generations is expressed in her feeling lost, in feeling like a fake, and in bodily experiences of emotions that get stuck in her throat. The link is not expressed in her dreams, at least not yet, but it is expressed in her anxious speech and the knot in her throat, and in her attempts to fit in. This link has taken over her personality to the point that she seems to be reliving her grandparents’ dislocation, whereas her parents, who were fluent in English, actually chose to relocate to the United States and did not suffer directly for it, nor did they fully sense her pain. They felt that they were getting away from a culture of fear and taking their family to a new land of opportunity, as their parents had done before them. But for Orchidea, the move involved the loss of personal and family ties and a rejection of the Argentine culture that was all she knew.

Orchidea continued, “What I hate in myself is what I hate in others. I’m self-conscious regarding my weight but I don’t think other women my age who look a little heavy like me are bad. It’s me feeling afraid others will hate me as they did when I was in school my first year in the United States. I’m conditioned to care what others think before I care what I think, as if the world revolves around me. Maybe people don’t think of me at all! It feels like big brother is watching all the time. I’m so aware of my surroundings, new groups, that I’m trying to gauge them, and I don’t have fun, and it’s exhausting.”

In object relations terms, Orchidea is suffering a rejecting internal object attack on her exciting object. She projects the rejecting object into her environment and feels a threat from every quarter. The exciting object was overdeveloped by excessive adoration in infancy. The rejecting object attacks exciting object so as to keep it hidden and therefore safe inside. The rejecting object also attacks her central ego with all the hatred she felt for the new exciting objects projected by her family into her brothers.

In terms of link theory, in her vertical link, Orchidea is reliving both her parents’ wish to escape the fear of the regime in Argentina and her grandparents’ fear of the pogroms in Russia. She feels that the world will hurt her if she is not constantly on the look-out. She takes on the hope of being an exciting object for her parents but fears her potential to disappoint those hopes when she cannot adapt. Similarly, her grandparents had carried the hopes of their parents when they escaped with their blessing 50 years ago.

Orchidea continued, “I have an interview tomorrow for a receptionist job at a free clinic, and I’m already freaking out if the job will be a place where I’m under pressure to prove something. I’m only going to be happy if I do my best, and if I do it without feeling someone is watching me. I was even thinking how are they going to accommodate this treatment for which I have to get out twice a week? I’m worried what they’ll think about my needs. I’m worried if I express my need for accommodation, they won’t want me anymore. My Mom thinks I’m crazy to worry. Work seems so easy for her and I try to do as well as she did, but really she doesn’t give herself proper recognition for what she does. I don’t value what I need enough, or rather I don’t think of it first. Even with my friends, I think of what they want of me. I have a lifetime ahead of needs and desires, and they won’t be fulfilled if I’m too preoccupied with fitting the world’s standards. I’m afraid of having needs that are unfulfilled and feeling shitty all the time.”

Orchidea’s exciting object is constantly in a state of longing and her rejecting object makes her feel bad all the time. She has identified with hate and neglect she perceives as if they emanate from her mother, as a way of maintaining attachment to her. Her horizontal link is seen in her anxious connection to her mother with whom she shares an emphasis on professional success, to the friends that she wants to retain, and to her possible employers.

“What is most comforting to me is to feel that I’m caring for myself. Right now I am: This is why I’m doing this therapy. I wish I’d strike a balance, so at a job interview I can say this is what I want and need rather than fit to what they need. I actually think they’re looking for someone like me. They want someone who can be versatile, bilingual, a multi-tasker, and someone with their interests.

Objectively I’m fine for it. Yet I’m always scared of disappointing. I hadn’t even considered that they could accommodate my need to leave for therapy. I don’t want to feel superior and have my needs be treated as special: I just hope that there’s room for me to get what I want. All I need is time to study for the MCAT, to enjoy exercise, and come to therapy. It’s all preparation for striking the balance in my life as a person with a career and a being a mother. It’s so unnecessary to think of life as hard and horrible. But right now I’m worried about pleasing everyone on all I have to do. It’s a pessimistic outlook.”

I asked, “Is that operating here?”

I wonder how the transference might give me an opening to elucidate the themes.

Orchidea replied, “Your opinion should be, ‘Good for you!’ but I am self-conscious and uptight with myself, and so I feel I’m falling short here, even when I’m doing all I can. I hate what I do to myself with this mentally, and at the same time I feel sorry for myself. The judge inside me pushes me to do my best and also undermines me because I get more nervous at a task and I’m not at ease around people, and maybe people can pick up on that, but whether they do or not, I feel bad. I feel fake.”

“I feel I’m performing. I hate that. I feel there’s something wrong with me, and yet I second guess myself, thinking I don’t have enough problems to warrant therapy. It’s crazy to doubt my need, when I feel so lost. I need to be able to realize what I need and give it to myself. I settle for things that aren’t good enough, like one-sided relationships with charismatic, selfish men, and I think I can adapt to them, to almost anything. I think, I can take this job, be with that person, even though I don’t like the job or the man.

Orchidea knows that she is needy but she does not want anyone to see that, and yet she wants her needs recognized by the world and by me. The rejecting and exciting objects are in conflict. The libidinal ego is trying to free itself. Orchidea has not expressed her horizontal link in a long-term love relationship, but in choosing men to date, she looks for men that other people admire even though she repeatedly finds them to be shallow and unreliable. There is hope that in therapy she can rehabilitate her link before making a lifetime choice. Hopefully she will then select a mate on the basis of fit with her good objects rather than one like the men into whom she projects an exciting and rejecting object.

Orchidea may be performing for me like a good patient, free-associating and seeming to tell her history, her problems, and her shameful feelings but not facing deeper feelings of which she is ashamed or guilty. She fears that I will find her shallow and unworthy of my being with her, just as she feels about the men whom she dates. She worries that she cannot make reparation to her family for past damage.

“It’s a scary thing to feel that a part of me was lost when I came here as a teenager. I felt so ashamed of my background, and that was so crazy. It was crazy to feel ashamed of my family. It’s crazy now that I am ashamed to have forgotten how to be Argentinian. My family in Buenos Aires doesn’t know me anymore. I am ashamed to be so Americanized. It’s sad. I’m afraid I’m going to lose myself. I just want to be myself.”

In this talk of shame, Orchidea seems not to be judging herself but expressing regret for how she handled her dislocation as a teenager, and for how she has allowed separation from her extended family and her culture to affect her. She is at the mercy of persecuting internal objects that magnify her potential to disappoint parental expectations, and there will be much work ahead to detoxify these objects. However, it seems to me that she has already begun the mourning that could not take place in childhood.

In the case of this woman patient, the trauma was not of a degree to cause splitting so severe as to create a dissociative identity disorder. The woman’s trauma occurred once as a young child when her mother turned her affection to babies, and again as an adolescent when she lost her holding environment at a social level. This double trauma has caused splitting into good and bad parts of the self, conversion of self-hatred into bodily symptoms, and the formation of an adapted self. Concepts from Fairbairn, Sutherland and Pichon-Rivière generate a psychoanalytic vantage point from which to assess the structure of mind and heritage, interpret the forces against self-functioning, and give hope of creating an adaptive self.

Jill Savege Scharff, MD, MRCPsych - Supervising analyst and founding chair, International Institute for Psychoanalytic Training at the International Psychotherapy Institute in Chevy Chase, Maryland, USA, Teaching Analyst, Washington Center for Psychoanalysis and Clinical Professor of Psychiatry at Georgetown University, Washington DC; author of Projective and Introjective Identification and the Use of the Therapist's Self (1992), and co-author of The Interpersonal Unconscious (2011); psychoanalyst in private practice with adults, children, couples and families.

Co-author of Tuning the Therapeutic Instrument: Affective Learning of Psychotherapy (2000), Object Relations Individual Therapy (1998), Object Relations Therapy of Physical and Sexual Trauma (1996), The Primer of Object Relations: Second Edition (2005); editor of The Autonomous Self: The Work of John D. Sutherland 1994), Foundations of Object Relations Family Therapy 1992) and The Psychodynamic Image: John D. Sutherland on Self and Society (2007); co-editor of New Paradigms in Treating Relationships (2006) and Self Hatred in Psychoanalysis (2003).

References

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Klein, M. (1946). Notes on some schizoid mechanisms. In Envy and Gratitude and Other Works: 1921-1963, pp. 1-24. London: Hogarth, 1975.

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Scharff, D. E. and Birtles, E. F. (Eds.) (1994). From Instinct to Self, Vol 1. Selected Papers of W. R. D. Fairbairn. Northvale, NJ: Jason Aronson.

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Scharff, J. S. and Scharff, D. E. (1996). Object Relations Therapy of Physical and Sexual Trauma. Northvale NJ: Jason Aronson.

Scharff, J. S. and Scharff, D. E. (Eds.) (2005). The Legacy of Fairbairn and Sutherland. London: Routledge.

Setton, L., Varela, Y. Scharff, D. E., and Scharff, J. S. (2005). Teaching object relations theory with the Group Affective Model. In The Legacy of Fairbairn and Sutherland, ed. J. Scharff and D. Scharff, pp.271-282. London: Routledge.

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This article was first published in New Therapist: http://www.newtherapist.com/

In this article, I bring together the ideas of Fairbairn on object relations, Sutherland on self and society, and Pichon-Rivière on the link, and then illustrate them in a vignette from individual psychotherapy with a young woman. Fairbairn’s theory of object relations has been most useful for understanding individual patients and their significant attachments (Fairbairn 1952, 1963; Scharff and Birtles 1994; Grotstein and Rinsley 1994). In the late 1960s, Fairbairn’s major expositor and biographer John D. Sutherland (1963, 1989) introduced me to object relations theory and showed me that it could be applied to working therapeutically not only with individuals (1963) but also with couples—thanks to Henry Dicks’s (1967) integration of Klein and Fairbairn—and even with communities (Sutherland 1966; Savege 1975; J. Scharff 1975). Since then, I have continued to find object relations theory a flexible, powerful, full-spectrum analytic theory for working in psychoanalysis, couple, sex and family therapy, and psychoanalytic education (J. and D. Scharff 2000; J. Scharff 2005; Setton, Varela, D. and J. Scharff 2005). In the last five years, I have found a valuable extension of Fairbairn and Sutherland’s ideas in Link Theory, which stems from the social-psychological approach of Argentine psychoanalyst Enrique Pichon- Rivière (1985).

Fairbairn’s object relations theory: Splitting and repression

Fairbairn recognized the effect of dissociation, a defence that, although ubiquitous and normal, is overused out of necessity in trauma-related mental, emotional and behavioural disorders (Fairbairn 1952). It is not surprising that Fairbairn was so attuned to dissociation, and chose it as the topic of his doctorate in medicine, because he had encountered it in his clinical sessions. He worked in a clinic for children who were sexually and physically abused, in a hospital for men who returned from war with war neuroses, and in private practice with adults who suffered from hysterical neuroses and schizoid defences (Birtles and D. Scharff 1994). In these clinical populations, Fairbairn noticed the prevalence of dissociation in addition to repression as defences, but he went beyond simply delineating dissociation as a pathological defence. He realized that dissociation in those cases was simply an exaggeration of normal defensive processes and went on to build his theory on dissociation as a normal defensive mechanism for actively protecting the mind as it traversed the course of development from infantile dependence to independence.

Fairbairn believed that the infant self is whole at birth, already competent to seek its mother. The vulnerable infant uses all his instinctual competence—rooting, clinging, sucking, crying, and gazing—to appeal to the mother for food, comfort, security, and love. Most importantly, the infant looks to find meaning for his existence by mattering to the mother. As she responds to his needs and attunes to his emotional states of mind, she gives meaning to his experience. He gives meaning to her existence as a mother, and together they create a mutually gratifying relationship. Nevertheless, there will be expectable moments of misattunement that are a challenge to both mother and child, although not usually of sufficient degree to cause trauma. These moments of frustration upset the infant and he reacts by erecting defences against the pain that threatens to overwhelm his immature mechanism for self-regulation.

The infant takes in the uncomfortable experience with the mother (the external object) to control the unsatisfactory perception (the internal object) and feeling (the affect) inside his mind. He splits the internal object into two pieces: the part that felt good enough, and the part that felt uncomfortable. What is good enough remains in the conscious part of the self. What is overwhelmingly uncomfortable is split off from what is felt as good, and is repressed deep in the unconscious layers of the mind. There it is sorted into two major categories of internal object according to whether the associated feeling of discomfort is one of longing for more than is given to meet the needs (the exciting object) or angrily feeling that the needs are being pushed away (the rejecting object).

Fairbairn recognized, in a moment of creative genius, that the ego, the executive aspect of the infant self, splits itself in relation to these internal objects. It does so in order to release a part of itself to accompany the object and the affects associated with it into the unconscious and maintain its repression there, thus creating internal object relationships consisting of ego and object bonded by the specific affect that has been overwhelming. These are sorted into two main categories—the libidinal (exciting) and antilibidinal (rejecting) internal object relationships. The antilibidinal ego is connected to the rejecting object and its feelings of anger at abandonment and rejection, while the libidinal ego is connected to the exciting object and its feelings of longing and craving. This creates a mind with a conscious area consisting of a central part of the ego relating with feelings of satisfaction to the ideal object from which the uncomfortable aspects have been shorn, and an unconscious area consisting of exciting and a rejecting internal object relationships. The central ego actively keeps the split-off internal object relationships in repression, aided by the rejecting internal object relationship, which further represses the internal exciting object relationship. The overstimulation of an elusive external object that creates longing is even more painful than an absent one that abandons the infant to his needs or actively refuses to accept them, and that is why it is kept so thoroughly split off and repressed. But the split off and repressed parts of the self always seek to return in various ways, such as symptom, gesture, speech, and choice of partner.

In health, the libidinal constellation is not too rigidly repressed and it can come forward to support the central ego in feeling desire and responding to others who are expressing need. The anti-libidinal constellation comes forward to assert the will, set limits, and support the ego’s need for separateness within a committed relationship. This is normal. We find pathology only when the exciting object is excessively exciting and evoking feelings of desperate craving and when the rejecting object is excessively persecutory and evokes terror of abandonment and rage at rejection, especially when these are also turned against the libidinal constellation. A pathological endopsychic situation occurs when splitting and repression are severely maintained, and the system loses its dynamic flux. We then find an adhesive tie to the bad object (whether of the rejecting or exciting variety) that leads to self-destructive organizations, dysregulated behaviour, and disorganized attachments.

In summary, splits in the self form as a result of pulls towards and away from object relating. The central ego is the organizing, executive function of the self. It splits and represses the other parts of the self, but, learning from experience, allows the return of the repressed to remodel its structure and enrich its functioning in the light of new experience. In health, the boundary between conscious and unconscious is flexible enough to allow communication between the conscious and unconscious parts of the self, and secure enough to prevent psychotic eruptions. In neurosis, psychosis and personality disorder, the boundary is more tightly maintained. After trauma, the boundaries are even more rigid, and occur not only on the horizontal divide between conscious and unconscious but vertically as well between all parts of the self. At the extreme, this splitting encapsulates fragments of self and object and leaves empty spaces behind in the mind. Extreme splits in the self occur in survival mode to permit going-on-being in the face of great damage from betrayal, sexual overstimulation and aggression in the holding environment. Such a dissociative pattern serves the function of clearing the way for a resilient response. It provides for a part of the self that is able to carry on, but the resulting fragmentation causes vulnerability to flashbacks, poor sleep, somatic symptoms, learning disorders, and relationship difficulties.

Fairbairn: Physical and sexual trauma in childhood

The term childhood trauma refers to any early experience such as parental divorce, loss of a parent, and life-threatening illness, which leads to psychological stress and symptoms of anxiety and depression. But because this kind of trauma is not secret, there is not severe splitting. Adults can help the child put the experience into words, mourn for what might have been, and work through to an adjustment. In contrast to those types of childhood trauma, physical and sexual trauma refers to a cumulative experience, or to an egregious single shock of an aggressive or sexual nature that overwhelms the self, either because the trauma is severe or because the self is weak, and because the child is helpless to change what is happening.

Fairbairn’s theory of the endopsychic situation is particularly helpful in understanding children whose parents were victims of physical and sexual trauma. Instead of providing ordinary parental holding with good attunement and clear limits that provide safety and stimulating growth, these parents may intrude on and impose their will on the child, and stifle independence. According to Fairbairn, the child builds mental structure out of experiences primarily with the parent. When the parent breaks the physical and mental boundaries that the child uses to protect body and mind, the disturbed adult mind enters and shatters the child’s mind. The self of the child has been used as the object of the parent’s unmetabolized needs to be aggressive or inappropriately sexual.

The parent has related to the child’s self not as a unique self but only as the parent’s object. No autonomy is allowed the child, and so there is no healthy interplay. There is no gap between adult and child across which to relate. The transitional zone of relatedness is eliminated (Winnicott 1951). When that interpersonal space collapses, the transitional space inside the child’s mind is collapsed (J. and D. Scharff 1994). There is no room for dream, imagination, and creativity all of which promote growth and independent reflection.

The traumatized child splits off, buries, and seals the traumatic experience in encapsulated traumatic nuclei (Hopper 1991). In some cases, the central ego may be aware of these encapsulations and the gaps that they leave behind. In other cases when the trauma was severe or the ego weak, the ego may have totally lost contact with the encapsulations, which then operate as totally dissociated parts of the personality with separate memory banks, as seen in patients with Dissociative Identity Disorder. If the capsule weakens, traumatic material threatens to escape, and then the person may panic, desperate to avoid stress and prevent activation of trauma.

When parts of the mind are sequestered, thinking becomes restricted, preoccupied with the mundane, and language becomes somewhat literal and concrete because creativity has been stifled (J. and D. Scharff 1996). So, rather than communicate verbally, these parts of the self convert themselves to somatic symptoms, such as a cough, a tic, a pain, dysregulated food intake, obsessional behaviours, and self-harm by cutting or addiction to substances as a means of representing the traumatic experiences that cannot be recalled and cannot be expressed verbally but do, in a displaced way, express the trauma without allowing it to come to mind. These bodily symptoms convert an unbearable mental structure based on an unbearable relationship into a situation that can be recognized as being in need of help.

Trauma happens to adults too. Studies of traumatic war neurosis in World War II, post-traumatic stress disorder after the Vietnam War, and sorrow and guilt among Shoah survivors show that stress can overwhelm even the mature, well-functioning person. The new trauma resonates with any pre-existing loss or trauma, aggravates any residual pain and damage left after the person coped with it reasonably well originally, and compounds the trauma.

Sutherland: Self and society

Sutherland’s bio-social concept of the self makes a useful contribution to understanding development in various human environments, including those in which trauma has intervened. He defines the self as “a dynamic organization of purposes and commitments whose behaviour is governed by conscious and unconscious motives, and whose developments and functioning are inseparably linked to the social environment” (Harrow et al 1994, p xxv). At the centre, the person is a responsible free agent, both separate from and in connection to others. That person’s mind is an innately patterned process that drives the baby to seek others and build a self from that interaction. The self is a dynamic, affect-driven matrix, an open system, its interconnecting parts being in flux in relation to other minds. For the self to fulfil its potential and grow into the shape it can become it needs its own intention and it needs feedback from other minds. The infant self learns to recognize the states of mind of those others and to monitor its own self-states in relation to the impact on others. Above all, the self needs love if it is to hold the developmental differentiation together and enjoy a sense of wholeness and autonomy (Sutherland 1979). Within the loving context, its urge to maintain the wholeness of its shape can be realized. Sometimes, it is necessary to fight fiercely for that level of integrity to ensure continued vitality. “The organism’s life becomes the dynamic process of preserving its autonomy within the heteronomy of relatedness with its social group and the physical environment” (Sutherland 1990 in Scharff 1994, p.376).

But what happens if the loving context is not there? The child has no good mother experience to take in at the core of the self. The bad object is installed in its place ever more securely. The child withdraws internally and is forced to appear to conform to the adult’s pathology in order to maintain the necessary attachment, in this case to a bad object. In locking up his true self far from further harm, the infant cripples the object-seeking function that is so necessary for encountering other minds and experiences with potentially loving people. To make life possible under impossible conditions, “the child develops an adapted self, adapted to the mother’s excessive influence whether this be from intensive over-control or neglect, or unreliable, inconsistent responsiveness, rather than an adaptive self which good mothering fosters” (Sutherland 2005 p. 196). In a traumatizing context, the emerging potential of the self is denuded and hidden by a false self. Hatred for what has happened and identification with the hated mother locks in the adaptation and prevents new experience to avoid the possibility that the hopeful, object-seeking part of the self, if ever released, should again meet with rejection and be filled with despair.

Sutherland (1980) is highly invested in the metapsychology of the self as “the essential organizing principle” (p. 10) of each unique individual, but he is also invested in thinking of the person as part of humanity undergoing the evolutionary process. He repeatedly places the self in that context. Sutherland says that, over the centuries, the self has fostered “the flexibility, resilience and persistence of human groups by maximizing the potential resources within each individual, and did not confine communities to rigid hierarchical organizations (Sutherland 1980, p.25).

Clinical usefulness

I have found Fairbairn and Sutherland’s theory particularly helpful in clinical work with survivors of sexual and physical abuse (J. and D. Scharff 1994). Having the endospychic situation in mind, we can take up a therapeutic position of benign concern that does not impose our will on the patient. For instance, therapists who remember that literal thinking is a feature of the collapsed transitional space will not become impatient with patients’ preoccupations with the mundane and their inability to discuss sexual material and family history. They will value the resilience that is supported in this way of attaching to the ordinary as a relief from ongoing episodes of trauma. We work to establish a safe context in which therapy can proceed before attracting transference to ourselves.

Within that context, we will be experienced as a new version of those who helped or hurt the patient, and those who were bystanders to the abuse. The transference-countertransference exchange may be so painful and frightening that we need to respect the slow pace with which it becomes specific. The patient’s defensive preoccupation with going-on-being serves to protect the therapy, just as it protected the child. We must wait until we are ready to be misperceived as abusive or neglectful, or worst of all as a void, and ready to speak to it and work through it with the patient. Therapy proceeds along a rhythm of dipping into trauma and returning to going-on-being until gradually more of the trauma can be tolerated and put into words. From our experience with the patient, we put the images and themes together as a narrative of the patient’s self, from which to continue our shared reflection, exploration and eventual understanding. Then the spaces are filled in as we create new experiences in the therapeutic relationship, genera that heal the contents of the traumatic nuclei (Bollas 1992).

Transgenerational transmission of trauma

To understand how trauma is transmitted, we need to look beyond Fairbairn’s theory of dissociation. At the individual level, trauma is transmitted to children by projective identification, a mental mechanism of defence for protecting the self from its innate fear of annihilation and for protecting its good and vital functions in early life (Klein 1946). In ordinary good-enough mother-infant relationships, the infant projects rage, fear and death wishes into the mother to get rid of these unpleasant affects and stop them from disturbing the good and lively parts of his self. He misidentifies them as emanating from her feelings towards him, which causes similar pain now experienced as coming from a persecutory external source. The infant copes, as Fairbairn said, by taking in, splitting and repressing this monster aspect of the good mother. The infant also projects good feelings towards the mother and takes in a positive view of her coloured by those feelings too. In health, good and bad internal objects are in balance. After trauma, the bad object is dominant, and that is what the infant is attached to, even if it is unhealthy.

In marriage, the woman deals with her spouse as if he were the source of the part of her that she has re-found in him. Her husband has his own valency to project into her, and if the couple relationship cannot absorb and modify these mutual projective identifications, the marriage gets stuck in an unsatisfactory state, or divorce may follow. Either way, the stuckness or the divorce upset the children, who in turn may be at risk for divorce, or staying in an abusive marriage in order to avoid the trauma of divorce. When the couple cannot metabolize their mutual projective identifications, they may resort to identifying all the bad objects in a child, as if that child’s behaviour is the cause of the relationship difficulties. The child who is the object of the projective identification and who identifies with it then develops behaviours that further justify the perception of the child as bad, and so the projective identification is cemented and not amenable to modification in light of new experience.

Trauma happens to adults too, and even though they are already mature, they may resort to severe splitting and encapsulation of the trauma to help them carry on, manage their pain, and deny their fear of disaster striking again. The adult must find a way of coping with the bad internal object to the extent that it has not been balanced by the good internal object. She projects it into her own self, where it fills her with a sense of badness, devaluation, and destructiveness or she finds another object to project it into – friend, teacher, authority, spouse or her own child. She then experiences the object of her projective identification as persecutory and treats him or her accordingly. Some parents identify with their own aggressor, and do to their children what was done to them. Others are determined to spare their children but if they inhibit all excitement and rage the child has no opportunity to learn the appropriate management of sexuality and aggression. Either way, trauma affects the next generation.

At the societal level, trauma is transmitted to the next generation when social trauma such as war and natural disaster have created huge losses in segments of the population and left behind mass depression, post-traumatic disorder, and the desire for revenge. The mind of the whole society may dissociate from the pain and wall off the traumatic material. In the 1960s, we saw this in Germany when East Germany walled itself and the Eastern Bloc off from West Germany by a wall built through the middle of Berlin. East Germany wanted to keep out Fascist/Nazi elements that would interfere with its socialist vision and at the same time keep in unhappy citizens who might otherwise choose to emigrate to West Germany and Europe. The Berlin Wall was a rock hard boundary to keep out the bad Nazis from the West out and to keep in the good socialist people from the East. I’ve thought of this splitting of good and bad as a diversion from the main example of splitting good and bad in Germany before World Wars ll. The post-war generation refused to acknowledge and take responsibility for what the previous generation had done or allowed to happen to Jews onto whom they projected all that was dirty and defiling to the nationalist ideal. In 1990, when the wall came down, the trauma could begin to be acknowledged, reconciliation and repair could occur, and healing of splits could begin, not just in Germany, but in Europe at large.

Similar trauma recurred in Argentina. In the 1930s, some of the Jews who emigrated from Europe and Russia to avoid pogroms and concentration camps sailed to the Americas looking for safety. Some of them landed at Buenos Aires. In the 1970s, these Argentine immigrants lived through another period of social trauma (and some of them had to flee their country again, while others who thought they were free were secretly taken away and disappeared). The military in power in Argentina created hundreds of concentration camps to which anyone could be abducted, illegally detained without evidence, and hidden so that they were outside the protection of the law—all in the name of anti-communism. Detainees were tortured and often murdered, in which case their bodies were disposed of at sea so that they could be said to be desaparecidos, missing, not dead, and the government could deny any knowledge of their whereabouts or of what had happened to them.

Pichon-Rivière’s Link Theory

In terms of Link theory, internal and external object relations are constructed by the interaction of the twin pillars of development—individual influence and social interaction. Fairbairn described the individual infant as taking in experience with the mother to make its psychic structure, consisting of a dynamic system of internal object relationships. By contrast, Sutherland looked at the reflection of those individual object relationships in the functioning of parts of communities. Pichon-Rivière began his theory building by looking at the space between individual and society, the space into which the individual is born. Link theory looks closely at the overarching organization of internal and external world into which the infant arrives and within which he grows and develops to adulthood.

What exactly is the link? It connects the individual to previous generations and a social history of the past and to current relationships with family and social groups. The baby is born into the link. He arrives among past and present social influences. He accesses the link by expressing his need for safety, nurturance, love and knowing. He lives and grows in the network of influences and connections that constitute the link. Pichon-Rivière distinguished vertical and horizontal axes in the link. On the vertical axis, the infant connects to good, bad, and downright traumatic experiences in the previous generation, and may be dreaded as living proof of their awfulness or welcomed as a hope for the future. On the horizontal link, the infant relates to the mother and other family members, extended family, and social groups, who carry the link within them in their conscious and unconscious minds. Through the link to social experience, the individual mind is shaped in both conscious and unconscious dimensions and reciprocally shapes the groups of which the individual is a part. The quality of the link is expressed in the adult individual in dreams, individual actions, speech, symptoms, and bodily experiences. In therapy, working with manner of speech, dreams, physical and mental symptoms, behaviour revealed in attitude to work and play, and quality of relationships, we can detect the quality of the link and its impact on the individual.

Here is a clinical illustration of Fairbairn’s description of the endopsychic situation, Sutherland’s emphasis on self in society, and Pichon-Rivière’s theory of the link.

Clinical example from individual therapy

Orchidea, a beautiful, olive-complexioned, curvaceous young woman with long dark hair enters my office for her first session of psychotherapy. She sounds thoroughly American, but she looks exotic. She is a high-achieving pre-med student now taking a gap year after college, before medical school, so that she can study for the Medical College Admission Test and volunteer in areas related to medicine. She asks for help in dealing with feeling lost, unhappy, anxious, judged, and uptight because of constantly performing to meet the standards she imagines others have for her. Her main emotional symptoms are unhappiness, anxiety and a lack of confidence in her self. She fluctuates between assessing herself as exceptional or fraudulent. Her physical symptoms include heart palpitations and a knot in her throat, and she is preoccupied with feeling fat even though she is of normal weight. Her speech is fluid, expressive, and anxiously obsessive. Her agreeable demeanor covers any upset or irritation.

After having been the only adored grandchild for 7 years, she was very upset to lose her place in the spotlight when twin baby brothers were born. She developed temper tantrums that she felt helpless to control. As an adult, she is determined to suppress her anger and will not let anyone see when she is unreasonably upset over tiny things. Her parents, who are successful professionals in another town not an hour away from Washington, want Orchidea to visit weekly but she often feels anxious about meeting their needs and is afraid that she will get angry at how dependent and entitled her teenage brothers are.

Orchidea explained herself to me: “I’m on a pedestal and I’m acting to please people, and it’s exhausting. I tell myself that no one is judging me, things are up to me, but I don’t listen to myself. I keep thinking about whether what I’m saying coincides with what another person thinks. There’s no reason to think here’s someone looking over me and judging me—I realized this from the last time I was here for the final session of the consultation. I am my own worst enemy. That’s what I need to work on.”

As an infant, Orchidea had received love, nurture, safety, and knowing her place in the world. She was her parents’ first, much-wanted child and the first grandchild of both parents’ families, three of whom had been forced to emigrate from Russia, and happened to land in Argentina. She knew who she was in relation to her close and adoring family. A gorgeous little girl, she was showered with compliments from passersby.

In object relations terms, Orchidea was an exciting object for her family and their warm response filled her central ego with good feelings, and a sense of being special. Having such a special child filled her parents with pride. She represented the hope of leaving behind the cruel history in favour of life in the new land, free from the oppression suffered by her grandparents.

After her twin baby brothers were born, she felt dropped and not listened to anymore. Her protest took the form of temper tantrums, which did nothing to encourage her mother’s expressions of love. She went from being the perfect child on the pedestal to being a monster. She did not know who she was anymore. She hated herself and the body she could not control.

When she expressed her outrage at her mother’s attachment to the twin boys, the ideal child became a rejecting object to her family, and she felt rejected by them. She envied the attention given to the boys and began to hate herself for feeling less than they were, and for hating them and her mother. As an adult, Orchidea attacks the feminine aspects of her body. At the vertical level of the link, she is connected to her grandparents as the proof that life goes on and families survive after trauma and loss but, at the same time, her connection to their history continues to be expressed in her feeling of neglect and persecution by the authority in her life—her mother.

Orchidea said, “This must have to do with my childhood—this thinking the only way to be liked is to fulfil others’ expectations.” But, rather than tell me about her childhood, she changed the topic to that of her adolescence, reviewing her trauma when the family had to move to the United States when she was 13. She was traumatized by the move and its assault on her identity. “Trying to do what they expected was the only way to fit in with the kids in school when we moved from Argentina to here. I didn’t know the language. I didn’t have the words for what I was feeling. I was so insecure. I hated my accent and I hated how different I was from those skinny blonde girls. Now I do express myself, and I sound like a North American but I’m still so aware of others, and I still feel insecure. If I could lift this, I’d no longer feel this knot in my throat all the time! This feeling has got me to hate myself. Whenever I’m not everything to everyone at once, someone will be disapproving, and because I’m not fitting someone else’s standards, I’m not enough. I’m not unattractive but any little flaw I have I examine through other people’s eyes, and it’s no longer about me as I really am.”

Like Orchidea, the grandparents lost their country and their language. As an adolescent two generations after the original move, Orchidea had to move as a teenager to an unfamiliar culture. Orchidea’s vertical link to past generations is expressed in her feeling lost, in feeling like a fake, and in bodily experiences of emotions that get stuck in her throat. The link is not expressed in her dreams, at least not yet, but it is expressed in her anxious speech and the knot in her throat, and in her attempts to fit in. This link has taken over her personality to the point that she seems to be reliving her grandparents’ dislocation, whereas her parents, who were fluent in English, actually chose to relocate to the United States and did not suffer directly for it, nor did they fully sense her pain. They felt that they were getting away from a culture of fear and taking their family to a new land of opportunity, as their parents had done before them. But for Orchidea, the move involved the loss of personal and family ties and a rejection of the Argentine culture that was all she knew.

Orchidea continued, “What I hate in myself is what I hate in others. I’m self-conscious regarding my weight but I don’t think other women my age who look a little heavy like me are bad. It’s me feeling afraid others will hate me as they did when I was in school my first year in the United States. I’m conditioned to care what others think before I care what I think, as if the world revolves around me. Maybe people don’t think of me at all! It feels like big brother is watching all the time. I’m so aware of my surroundings, new groups, that I’m trying to gauge them, and I don’t have fun, and it’s exhausting.”

In object relations terms, Orchidea is suffering a rejecting internal object attack on her exciting object. She projects the rejecting object into her environment and feels a threat from every quarter. The exciting object was overdeveloped by excessive adoration in infancy. The rejecting object attacks exciting object so as to keep it hidden and therefore safe inside. The rejecting object also attacks her central ego with all the hatred she felt for the new exciting objects projected by her family into her brothers.

In terms of link theory, in her vertical link, Orchidea is reliving both her parents’ wish to escape the fear of the regime in Argentina and her grandparents’ fear of the pogroms in Russia. She feels that the world will hurt her if she is not constantly on the look-out. She takes on the hope of being an exciting object for her parents but fears her potential to disappoint those hopes when she cannot adapt. Similarly, her grandparents had carried the hopes of their parents when they escaped with their blessing 50 years ago.

Orchidea continued, “I have an interview tomorrow for a receptionist job at a free clinic, and I’m already freaking out if the job will be a place where I’m under pressure to prove something. I’m only going to be happy if I do my best, and if I do it without feeling someone is watching me. I was even thinking how are they going to accommodate this treatment for which I have to get out twice a week? I’m worried what they’ll think about my needs. I’m worried if I express my need for accommodation, they won’t want me anymore. My Mom thinks I’m crazy to worry. Work seems so easy for her and I try to do as well as she did, but really she doesn’t give herself proper recognition for what she does. I don’t value what I need enough, or rather I don’t think of it first. Even with my friends, I think of what they want of me. I have a lifetime ahead of needs and desires, and they won’t be fulfilled if I’m too preoccupied with fitting the world’s standards. I’m afraid of having needs that are unfulfilled and feeling shitty all the time.”

Orchidea’s exciting object is constantly in a state of longing and her rejecting object makes her feel bad all the time. She has identified with hate and neglect she perceives as if they emanate from her mother, as a way of maintaining attachment to her. Her horizontal link is seen in her anxious connection to her mother with whom she shares an emphasis on professional success, to the friends that she wants to retain, and to her possible employers.

“What is most comforting to me is to feel that I’m caring for myself. Right now I am: This is why I’m doing this therapy. I wish I’d strike a balance, so at a job interview I can say this is what I want and need rather than fit to what they need. I actually think they’re looking for someone like me. They want someone who can be versatile, bilingual, a multi-tasker, and someone with their interests.

Objectively I’m fine for it. Yet I’m always scared of disappointing. I hadn’t even considered that they could accommodate my need to leave for therapy. I don’t want to feel superior and have my needs be treated as special: I just hope that there’s room for me to get what I want. All I need is time to study for the MCAT, to enjoy exercise, and come to therapy. It’s all preparation for striking the balance in my life as a person with a career and a being a mother. It’s so unnecessary to think of life as hard and horrible. But right now I’m worried about pleasing everyone on all I have to do. It’s a pessimistic outlook.”

I asked, “Is that operating here?”

I wonder how the transference might give me an opening to elucidate the themes.

Orchidea replied, “Your opinion should be, ‘Good for you!’ but I am self-conscious and uptight with myself, and so I feel I’m falling short here, even when I’m doing all I can. I hate what I do to myself with this mentally, and at the same time I feel sorry for myself. The judge inside me pushes me to do my best and also undermines me because I get more nervous at a task and I’m not at ease around people, and maybe people can pick up on that, but whether they do or not, I feel bad. I feel fake.”

“I feel I’m performing. I hate that. I feel there’s something wrong with me, and yet I second guess myself, thinking I don’t have enough problems to warrant therapy. It’s crazy to doubt my need, when I feel so lost. I need to be able to realize what I need and give it to myself. I settle for things that aren’t good enough, like one-sided relationships with charismatic, selfish men, and I think I can adapt to them, to almost anything. I think, I can take this job, be with that person, even though I don’t like the job or the man.

Orchidea knows that she is needy but she does not want anyone to see that, and yet she wants her needs recognized by the world and by me. The rejecting and exciting objects are in conflict. The libidinal ego is trying to free itself. Orchidea has not expressed her horizontal link in a long-term love relationship, but in choosing men to date, she looks for men that other people admire even though she repeatedly finds them to be shallow and unreliable. There is hope that in therapy she can rehabilitate her link before making a lifetime choice. Hopefully she will then select a mate on the basis of fit with her good objects rather than one like the men into whom she projects an exciting and rejecting object.

Orchidea may be performing for me like a good patient, free-associating and seeming to tell her history, her problems, and her shameful feelings but not facing deeper feelings of which she is ashamed or guilty. She fears that I will find her shallow and unworthy of my being with her, just as she feels about the men whom she dates. She worries that she cannot make reparation to her family for past damage.

“It’s a scary thing to feel that a part of me was lost when I came here as a teenager. I felt so ashamed of my background, and that was so crazy. It was crazy to feel ashamed of my family. It’s crazy now that I am ashamed to have forgotten how to be Argentinian. My family in Buenos Aires doesn’t know me anymore. I am ashamed to be so Americanized. It’s sad. I’m afraid I’m going to lose myself. I just want to be myself.”

In this talk of shame, Orchidea seems not to be judging herself but expressing regret for how she handled her dislocation as a teenager, and for how she has allowed separation from her extended family and her culture to affect her. She is at the mercy of persecuting internal objects that magnify her potential to disappoint parental expectations, and there will be much work ahead to detoxify these objects. However, it seems to me that she has already begun the mourning that could not take place in childhood.

In the case of this woman patient, the trauma was not of a degree to cause splitting so severe as to create a dissociative identity disorder. The woman’s trauma occurred once as a young child when her mother turned her affection to babies, and again as an adolescent when she lost her holding environment at a social level. This double trauma has caused splitting into good and bad parts of the self, conversion of self-hatred into bodily symptoms, and the formation of an adapted self. Concepts from Fairbairn, Sutherland and Pichon-Rivière generate a psychoanalytic vantage point from which to assess the structure of mind and heritage, interpret the forces against self-functioning, and give hope of creating an adaptive self.

Jill Savege Scharff, MD, MRCPsych - Supervising analyst and founding chair, International Institute for Psychoanalytic Training at the International Psychotherapy Institute in Chevy Chase, Maryland, USA, Teaching Analyst, Washington Center for Psychoanalysis and Clinical Professor of Psychiatry at Georgetown University, Washington DC; author of Projective and Introjective Identification and the Use of the Therapist's Self (1992), and co-author of The Interpersonal Unconscious (2011); psychoanalyst in private practice with adults, children, couples and families.

Co-author of Tuning the Therapeutic Instrument: Affective Learning of Psychotherapy (2000), Object Relations Individual Therapy (1998), Object Relations Therapy of Physical and Sexual Trauma (1996), The Primer of Object Relations: Second Edition (2005); editor of The Autonomous Self: The Work of John D. Sutherland 1994), Foundations of Object Relations Family Therapy 1992) and The Psychodynamic Image: John D. Sutherland on Self and Society (2007); co-editor of New Paradigms in Treating Relationships (2006) and Self Hatred in Psychoanalysis (2003).

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This article was first published in New Therapist: http://www.newtherapist.com/