Developmental theories that influenced modern ...



Sanja Bratina

Developmental theories that influenced modern psychotherapy and supervision

It is accepted that relation between therapist and client, and supervisor and supervisee are analog and similar to the parent – child relation (Hans Strupp) in the way that these relations are reparative and that they can often heal in the present deficits of the past experience between child and caretakers. It's through relationships with caregivers and other people that children learn how to apply and use their emotions, expressions, and emotional understanding that influence their being in later periods of their lives.

In connection with this, for gestalt therapists is very important, considering theory of gestalt therapy, to be aware that there are other important and contributing factors except infant experiences, that also strongly influences our life and that we can not put exclusive emphasize on the early experiences. We believe that life is much more than past and that it is shaping in every moment of our life with present experiences, context and supposed future. Also, in gestalt therapy we believe that contact (relation) is in the hart of healing processes.

In An Integrative Relational approach to psychotherapy and supervision relation is seen as “a vehicle for psychotherapeutic change and the necessity of an effective supervisory alliance” (M. Gilbert and K. Evans, Psychotherapy supervision, 2000). The way relationship is established, the quality of relationship while it lasts and the way it ends is considered to be one of the major factors that influence outcomes of psychotherapy and, consequently, supervision. This is the main meeting point of gestalt and integrative approach. There are lot of researches that show how important is supervisory alliance based on characteristics of supervisors (Carey, Williams, and Wells 19895, Carifio and Hess 1987, Leddick and dye 1987, Carroll 1996).

Also, there are many models of supervision that consider recognition of developmental level of supervisee as crucial to successful supervision practice.

All above are the reasons for being familiar with developmental theories that are dealing with establishing contact (relaiton) in practicing psychotherapy and supervision. Having in mind that role of psychotherapy and especialy supervision is not only to heal, but also to educate, it is important to know some theories of developing learning processes too. So, in this paper, I am going to give short overview of several important developmental theories that contributed psychotherapy and possibly supervision in last decades, starting with Stern and Bowlby - the integrative relational model of supervision is inspired by developmental theories, particularly with works of Bowlby and Stern. I will exclude (with the respect to his importance) Freud’ theory. Reason for this is that most students are familiar with Freud’s theory of five stages, concepts of drives, libido, id, ego, superego… anaclitique thesis that show us how libidinal or sexual drive is depending on vital function of feeding…importance of transference neuroses in psychotherapy… I will exclude work of Piaget, for same reasons. And I will include short overview of Vygotsky’s believes considering that his theory could contribute educational aspects of psychotherapy and specially supervision.

D.Stern believes that children personalities are shaped more by everyday interactions with parents than by dramatic events or major developmental stages. He also states that a sort of attunement in which mothers somehow let their children know that they have a sense of their (child’s) feelings shapes relationship with the child. An infant begins to develop its “subjective self” trough these attunements, they develop sense that other people can and will share its feelings. Attunement gives infant the deeply reassuring sense of being emotionally connected to someone else. If parents fail to attune to their child constantly, it affects the child’s development, but psychological implications of early encounters are not irrevocably set. “Relationships throughout life – with friends or relatives, for example – or in psychotherapy continually reshape your working model of relationships, An imbalance at one point can be corrected later; there is no crucial period early in life – it’s on-going , life-long process (The New York Times, October 21st 1986, article by Daniel Goleman). Stern finds that there are discrete phases in development, and these phases are

1. from birth onwards infant develops “emergent sense of self and the major theme is security

2. around age of 2-3 months child develops “sense of core self” consisted of several capacities: self-agency, self-coherence, self-affectivity, self-history, major theme is identity

3. around 7th and 8th month infant develops “a sense of subjective self”, with three dimensions that form basic of affect attunement: intensity, timing and shape, major theme is contact.

4. around second year child develops a “sense of verbal self” linked with ability to create and share joint meaning of experiences with others, major theme is communication

5. a “sense of narrative (consensually validatable) self” , major theme is inclusion.

For supervisor is crucial to understand the developmental issues and phases triggered in the supervision by the client. That enables her to react and accordingly plane responses in supervisory session. The role of supervisor is to foster growth and development of “internal supervisor” of his supervisee, and supervisee reaches maturity when she is able to move between phases of development in new situations or under stress.

J. Bowlby (1973, 1976) concept “dependence of child from mother” replaces with concept of “attachment” and in that way he stresses importance of inborn mechanisms. He believes that child has inborn need for physical and psychical touch and relation with human being and that that need is quite independent from oral needs. According to Bowlby, there are four phases of attachment during infancy: preattachment phase, attachment-in-making phase, clear-cut attachment phase, and formations of reciprocal relationships phase.

Considering this, for supervisor is important to remember that need for attachment is life long and inborn and that quality of supervision highly depend on quality of attachment created in supervisor – supervisee relationship. The corrective role of therapist or supervisor speaking in that sense is to pass through all four phases of attachment with client/supervisee.

Ana Freud (1949, 1966) enriched psychoanalysis with studies of EGO and defense mechanisms, against anxiety and danger. She focused on strengths of will and awareness and more on real than unreal experiences of child. For her, in contrast to M. Klein fantasias are consequences of bed relation with object, duality and impossibility to reach the object and they are way to defense from unsatisfied need for object.

For client or supervisee is important to reach the object and satisfy that need in present, and role of psychotherapist/supervisor is to enable that.

M. Klein (1930, 1955) was among first who started working with children and she was innovative in her techniques (use of toys) and her theories of infant development. She believed that Ego is not only acquired, but also inborn and that Ego disposes very early with mechanisms of introjections, projection, projective identification, splitting and identification that are used to connect with objects. She discovered that parental figures played a significant role to the child’s fantasy life and that the chronology of Freud’s Oedipus complex is imprecise. She distinguished two major anxieties - persecute and depressive and two development positions depressive and schizoid-paranoid.

For supervision is important to recognize defense mechanisms of supervisee, to see what she uses in making relationship with supervisor and to distinguish development position of the supervisee.

K. Horney(1937, 1950) differ from other psychoanalysts of the time. She placed significant emphasize on parental indifference towards the child and on child’s experience of events as opposed to parent’s intentions. She believed that neurosis are continuous processes. She recognized ten patterns of neurotic needs divided in three cooping strategies

1. Moving toward people (children facing difficulties with parents often use this strategy)

- need for affection and approval

- need for partner

- need to restrict life practices

2. Moving against people (aggression, persons who often exhibit anger or basic hostility to surrounding)

- need for power

- need to exploit others

- need for social recognition

- need for personal admiration

- need for personal achievement

3. Moving away from people (if neither aggression nor compliance solve parental indifference, children become self-sufficient)

- need for self sufficiency

- need for perfection

She believed that self-actualization is the healthy person’s aim through life.

I supervision and psychotherapy is crucial to know that neurosis are continuous processes (for supervisors and supervisees, as for therapists and clients) and the way we coop with them influences relation between.

D.Winnicot (1965)described three stages in infant development and introduced some important concepts like good – enough mother, transitional object and false self. Stages of development are

- Undifferentiated unity where child feels omnipotent and in complete control of the mother if mother responds to its needs - holding

- Transition - child realizes its dependence and learns about loss. By moving away from the child in sensitive and well timed way, good enough mother helps her child to develop healthy sense of independence. Good enough mother allows the child to project in her bed objects and than re-introject them after she handles them well. Transition object substitutes mother and help child to develop sense of self - handling

- Relative independence – child develops healthy false self to present to the world – introduction of object

He also studied importance of body ego in development of psychic ego.

Role of psychotherapist and supervisors is to hold, handle and introduce transition objects, in supervision until stage of internal supervisor is reached, in psychotherapy until the reconstruction of self.

J. Lacan, similary to the Winnicot distinguished three stages of infant development, neonatal phase, mirror phase and phase of symbolic register.

H. Kohut (1971, 1979) rejected Freud’s theory of id, ego and super-ego, and developed his theory about tripartite (three part) self. This three – part self can only develop when the needs of one’s “self states, including one’s sense of worth and well-being, are met in relationship with others. He placed a grate emphasis on the vicissitudes of relationships. He introduced the concepts of self – object transference, mirroring and idealization. Child needs to “sink into” and identify with adult to have their self-worth reflected back (mirrored) by empathic and caregiving others that allows them to develop healthy sense of self.

Kohut says that therapist/supervisor becomes idealized parent and through transference the client/supervisiee begins to get the thing he has missed. Later in his life Kohut added concept of alter –ego/twinship. He also believed that need for self-object relationship lasts through all stages of persons life.

Firbairn stats that bond between child and parents creates strong attachments and determines emotional experiences that child will have later. In normal situation healthy parenting results in a child with orientation towards real people, real contact and exchange. If needs of child are neglected, if parents are unavailable, child internalizes unresponsive aspects of the parents and fantasizes those being part of him (splitting of the ego) to escape feeling ambivalence or hostility toward parents.

H.H.S. Sullivan’s (1936, 1937) understanding of individual is based on the network relationships in which person is involved. He pays much more attention to the “interactional”, than to “intrappsychic”.He believes that loneliness is the most painful of human experiences. He first mentioned “significant other” and developed concept of Self system – configuration of the personality traits that were developed in childhood and reinforced by positive affirmation and security operations developed in childhood to avoid anxiety and threats to self-esteem. That configuration can become rigid and limit actions and reactions toward the world of an adult person.

In psychotherapy/supervision, psychotherapist/supervisor becomes “significant other” that influences Self system configuration in present time.

E.Erikson (1950, 1969) postulated eight stages of development considering development to be a life long process. Each stage is marked by a conflict and successful resolution results in favorable outcome. Stages are:

1. Oral-sensory; from birth to one, trust vs. mistrust, feeding, virtue is hope

2. Muscular-anal: 1-3 years, autonomy vs. doubt, toilet training, virtue is will

3. Locomotor: 3-6 years, initiative vs. inadequacy, independence, virtue is purpose

4. Latency: 6-12 years, industry vs. inferiority, school, virtue is competence

5. Adolescence: 12-18 years, identity vs. confusion, peer relationships, virtue is fidelity

6. Young Adulthood: 18-40 years, intimacy vs. isolation, love relationships, virtue is love

7. Middle Adulthood: 40-65 years: generativity vs. stagnation, parenting, virtue is caring

8. Maturity: 65 years until death, integrity vs. despair, acceptance of one’ life, virtue is wisdom

Role of psychotherapist is to help person in solving developmental crises to reach virtue and support development.

L.Vygotsky believed that life long process of development is dependent on social interaction and that social learning actually leads to cognitive development. This phenomena is called the Zone of Proximal Development. Vygotsky describes it as "the distance between the actual development level as determined by independent problem solving and the level of potential development as determined through problem solving under adult guidance or in collaboration with more capable peers" (Vygotsky, 1978) The Zone of Proximal Development bridges that gap between what is known and what can be known.

According to Vygotsky, psychological phenomena are social in two respects: They depend on social experience and treatment, and they embody cultural artifacts

Appropriation is necessary for cognitive development within the zone of proximal development. It is essential that the partners be on different developmental levels and the higher level partner be aware of the lower level. If this does not occur, or if one partner dominates, the interaction is less successful (Driscoll, 1994; Hausfather, 1996)

Having in mind three primary foci of supervision (Hawkins & Shohet), educational, supportive and managerial, it is important to understand theory and processes that lay in the ground where this foci become figural. I believe that Vygotsky’s theory is important to deal with educational foci and it helps supervisor to be appropriate and supportive, and others mentioned theories deal with support.

Knowledge of both lead to managerial (quality control).

In spite of the developmental theory we are going to “adopt” in our work, concepts we are going to recognize and developmental stages are we going to search for, knowledge about this concepts and use of them is going to allow us better understanding of ourselves and persons that we professionally meet, recognition of their developmental needs and, in present moment, possibility of fulfillment of those. Lacking authentically developmental theory in Gestalt, we are choosing among existing theories hoping that in future there will be enough interested members of Gestalt community who would deal with this subject and contribute in development of our theory.

References:

1. PSYCHOTHERAPY SUPERVISION, Maria C. Gilbert and Kenneth Evans, Open University Press, Buckingham, Philadelphia, 2000

2. PSIHIJATRIJA DETINJSTVA I MLADOSTI, Nevenka Tadic, Naucna knjiga, Beograd 1989.

3. POREKLO COVEKOVE OSECAJNOSTI, Rene Zazo, Zavod za udzbenike I nastavna srededstva, Beograd, 1985

4. Texts about Karen Horney, E. Erikson, H.H.S. Sullivan, H. Kohut, Jacques Lacan, M. Klein, D.W Winicott, and Fairbairn – Wikipedia, the free encyclopedia,

5. DEVELOPMENT THEORY STRESSES SMALL MOMENTS, The New York Times, October 1986

6. HISTORICAL AND CONTEMPORARY SIFNIFICANCE OF VYGOTSKY’S SOCIOHISTORICAL PSYCHOLOGY, Carl Ratner,

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