Explanations of the core concepts and terms used in the Masterson Approach
People with a disorder of the self often carry their past experiences with their parents forward without realizing how much they generalize from them. They have developed a defensive system to protect themselves from the painful feelings associated with their childhood and with the lack of support they experienced in developing a real self. These underlying painful feelings make up the affects of the abandonment depression. Abandonment depression encompasses painful and difficult feelings such as suicidal depression, homicidal rage, panic, shame, guilt, hopelessness, helplessness, loneliness, and emptiness.
Analytic neutrality is a key component of the Masterson Approach. It does not mean that the therapist is cold or distant. Rather, it involves the therapist creating a therapeutic environment by being nondirective and taking care not to adopt a protective stance toward the client’s behavior. The therapist keeps the focus on the client and generally allows the client to take the lead, keeping out material such as the therapist’s personal characteristics or emotional reactions. The aim is to create a safe space in which clients can explore their own thoughts and feelings without having to worry about anyone else’s reactions.
Intrapsychic structure is a brain-based, encoded summary that emerges from an individual’s early experiences with significant caregivers. This summary comprises the individual’s self and object representations and the affects linked to them. Once formed, the intrapsychic structure organizes the way individuals perceive themselves in their relationships with others. In this way, early experiences with significant caregivers shape later experiences of the self and of others.
The term object relations refers to the internal representations of the self and of others and the affects associated with these representations, as well as to how these structures influence a person’s relationship with self and others. An important difference between people with and without a disorder of the self is that, because of failures in the developmental process, those with a disorder of the self lack whole object relations. That is, their internal representations of themselves and of others are split into two part-units. Each part-unit holds an extreme, unrealistic, and one-sided view of the self (the Self-Representation Unit) and an extreme, unrealistic, and one-sided view of others (the Object-Representation Unit). These units of self and other, together with their associated affects, emerge in various ways, but they are not integrated and are therefore not whole.
Self-activation refers to the emergence, expression, and awareness of the real self. Although self-activation leads to greater happiness and coherence, clients must first struggle to soothe their own inner conflicts. As children, clients experienced a particular, and usually unsupportive, pattern of relating with their parents each time they activated the self. Over time, the expression and awareness of unsupported states of the self became linked with anxiety, depression, guilt, and the other affects of the abandonment depression. In therapy, as clients begin to become aware of, heal, and express disowned parts of the self, they begin to feel the affects of the abandonment depression, which in turn lead to defenses. If the therapist intervenes successfully, however, clients begin to contain their defenses and continue their self-activation. They then experience the affects of the abandonment depression that the transference acting-out had kept them from being aware of. When the recurring cycles of the triad of self-activation, abandonment depression, and defense are followed with therapeutic interventions, the abandonment depression is worked through. This three-part cycle, in which self-activation leads to the affects of the abandonment depression, which are then followed by defenses, is known as the “Disorders-of-the-Self Triad.” The concept grew out of the observation that the therapeutic process does not proceed in a straight line. Awareness of the triad enables the therapist to understand, anticipate, and know how to handle a wide variety of difficult therapeutic situations.
Individuals with a disorder of the self lack whole object relations and have not developed object constancy. Instead of seeing the therapist and the therapeutic situation realistically, they project onto the therapist one of their part-object relations units: a part-self and part-object representation together with its linked affects. When the therapist does not act in line with these projections, the client is often shaken and reacts with disappointment, withdrawal, clinging, or even anger. Such reactions reveal that, without conscious awareness, individuals are re-enacting over and over again childhood interactions that were encoded intrapsychically through repeated interactions with parents and other significant caregivers. Such an intrapsychic structure limits individuals’ ability to see themselves and others realistically, to identify and express their real selves, and to activate themselves in pursuit of their real needs and wishes. As a result, their capacity for genuine intimacy is impaired. Because they see life and its countless possibilities in a constricted and difficult way, individuals engaged in transference acting-out often misjudge situations and fail to act in appropriate and constructive ways. In other words, the client walks into the therapist’s office and unconsciously begins to act out a particular interaction with a parent. The client projects the image of the parent onto the therapist and assumes that the therapist will feel and act much as the parents did. Without specific therapeutic interventions, the client does not recognize that the reaction emerging in the therapy session is not an appropriate one.
The therapeutic stance is expressed through a clear therapeutic frame. The therapist sets out clear and consistent rules regarding how payment will be handled and what will happen in situations such as missed sessions or lateness. Only against such a clear backdrop does the client’s transference acting-out become sufficiently visible, so that it can also be used as a focus of intervention in therapy. If a client is consistently late for sessions or “forgets” to pay the session fee, these are regarded as manifestations of transference acting-out and are addressed in the session.
The therapist needs to adopt a therapeutic stance that conveys, explicitly at times but mostly implicitly, that clients are adults who are expected to act in their own best interest. For this reason, when clients fail to behave appropriately, the intervention is aimed at clarifying the inappropriateness of defensive, regressive, and self-destructive behaviors.
Transference, based on whole object relations, is the capacity to see oneself and others as integrated, separate individuals, taking both positive and negative personality traits into account. Individuals with whole object relations also have object constancy and can therefore effectively maintain an emotional bond with the therapist despite fluctuations in their feelings toward the therapist. When individuals are capable of whole object relations, they can recognize whether their feelings toward the therapist are realistic. They may say things like “I wonder why I am reacting to you as if you were my mother” or “Why am I so angry with you right now, when you are only trying to help me?” In other words, such individuals can see the difference between feelings and reality for themselves.
