FROM CASES OF HYSTERIA TO THE THERAPEUTIC SOCIETY
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remained essentially isolated from psychoanalysis in America. It was not
until Otto Kernberg in the seventies formulated and presented his object
relations theory based on the work of Mahler, Jacobson and Klein, that
British object relations theory became integrated into American psycho–
analytic thought. "Object relations theory" then, as defined by Kernberg,
studies how early interpersonal object relations (relations between parent
and child) are internalized into intrapsychic self and object representations
and internal object relations, which in turn form the internal structures of
ego and superego on the one hand, and impact on later interpersonal object
relations on the other. Kernberg arrived at his theories by working with
narcissistic personality disorders coming from his previous work with bor–
derline conditions. At the same time in the late sixties and early seventies,
Heinz Kohut, also working with narcissistic personality disorders, but
coming from the opposite direction, i.e. the unsuccessful analysis of sup–
posedly neurotic characters, found a need to formulate these more
primitive pathologies in terms of arrested development of the self due to
failure in early maternal empathy, leading to his theories of self-psycholo–
gy,
the formation of the supraordinate bi-polar self as the center of
initiative, and the importance of early parental empathy and the central
posi tion of empathy in psychoanalytic treatment.
To summarize briefly some of these changes and comparisons from
then to now:
In terms of the visualization of the model of the mind we have moved
from postulating a tripartite topographic model consisting of an uncon–
scious, preconscious and conscious to a structural model consisting of an
id, ego, and superego; to an emphasis on the dominance of the ego; to an
inclusion of internalized object relations-self and object representations
linked affectively-forrning the basic units within these psychic agencies;
and finally to the inclusion of a developing sense of self as an agent and
center of ini tiative, cohesion and esteem-the theories concerning the self
being the most controversial.
In terms of relation to reali ty, psychoanalysis has seesawed from an ini–
tial period of concern with objective reality trauma (infantile seduction) to
pathology based on unconscious internal drives, conflicts and fantasy, to a
return to traumatic real mother/child interaction traumas, cumulative and
shock, and failure of early supplies and empathy leading to developmental
ego arrests, as well as unconscious conflict and compromise formation .
Current preoccupation regarding the preponderance of actual early sexual
incestuous abuse vs. Fantasy wish are part of this still ongoing controver–
sy. Freud believed in objective external reality balanced by subjective
unconscious psychic reality which he equated with unconscious drives.
Current concepts of reality stress psychic reality as the only window
through which the individual can view and process the world, this psychic
