Disorders of the Self – New Therapeutic Horizons: the Masterson Approach – James F. Masterson and Ralph Klein
Also see Clinical psychology info on schizoid personality disorder.
Part I. The self-in-exile: a developmental, self, and object relations approach to the schizoid disorder of the self
Chapter 2: Description (Ralph Klein)
The most common presenting issue for the schizoid patients I treat is the wish for connection and relatedness. Specifically, the wish is either to have a relationship or to have a family and children. It is very common for schizoid individuals to present for treatment in their 30s and 40s, at a time when the possibility of a relationship is growing more tenuous and that of companionship seems to be getting more and more distant. The wish and hope for intimacy and generativity seem to be approaching a last-chance period in the person’s life.
[…]
Guntrip defined regression as “representing the fact that the schizoid person at bottom feels overwhelmed by their external world and is in flight from it both inwards and as it were backwards to the safety of the womb.”
Such a process of regression encompasses two different mechanisms: inward and backwards. Regression inward speaks to the magnitude of the reliance on primitive forms of fantasy and self-containment, often of an autoerotic or even objectless nature. Specifically, these kinds of regressive phenomena involve preoccupation with body parts (fetishes and perversions), hypochondriacal preoccupations, and somatic concerns. Some examples are a middle-aged man’s preoccupation with prostitutes, an older man’s focus on the feet of his companions, a young woman’s continual but vague somatic discomfort and numerous visits to doctors, an older woman’s preoccupation with her breath. The presence of sadomasochistic fantasies, and their occasional enactment in reality, is another aspect of this regressive phenomenon. Examples of these can be found in many cases of erotomania and spousal abuse, as well as in delimited sadomasochistic sexual encounters/relationships.
Regression backwards to the safety of the womb is a unique schizoid phenomenon and represents the most intense form of schizoid defensive withdrawal in an effort to find safety and to avoid destruction by external reality. The fantasy of regression to the womb is the fantasy of regression to a place of ultimate safety.
Chapter 3: Developmental Theory (Ralph Klein)
The question remains: Is the concept of developmental levels a prerequisite to the concept of a spectrum or range of pathology? The answer is No. An equally suitable explanation is one that utilizes a multifactorial contribution to the clinical manifestation of any particular dimension of psychopathology, whether narcissistic, borderline, or schizoid. Masterson has summarized this multifactorial contribution with the notion of nature, nurture, and fate (1988). All three factors must invariably play a role in the final clinical manifestation of self structure and organization. What unique constitutional or temperamental factors contribute to the genesis of the schizoid disorder of the self? It is unclear. There can be no simple one-to-one correlation; for example, between the “slow-to-warm-up” infant and child and the later manifestations of schizoid pathology. But equally clearly, temperamental and constitutional factors do play a role. What these are remains to be discovered.
Fate plays its inexorable role in the final organization of self-identity; such factors as illness, loss, injury, coincidence, and luck play powerful parts in defining one’s personal and interpersonal worlds.
Nurture is most compelling to the psychodynamically oriented clinician. The nature of the attachment, the conditions of relatedness, are surely also properties of the parent-child relationship. But a specific working model of attachment is not a homogeneous phenomenon. Any working model, or interpersonal contract, has an endless number of variations. A working model of attachment is not a contract chiseled in stone, rigidly defined and unalterable. Whether one has more or less intrapsychic structure laid down may be less important than the qualitative aspects of those structures. Are they totally rigid and unbending or flexible and malleable? Are they reinforced structures or temporary havens? Have they been used repeatedly and habitually or are they episodically and sporadically mobilized? The answers to these questions (along with the factors of nature and fate) may have as much explanatory value for the variety and range of clinical manifestations within a dimension of pathology as does the concept of developmental arrest.
Chapter 6: Shorter-Term Treatment (Ralph Klein)
[…] he reported the following dream at the beginning of the next session, the 11th: “I was digging and digging through a pile of manure until I finally found what I was digging for, which was a deeply hidden piece of gold.”
[…]
By the next session (session 15), Mr. C. reported “being afraid, being much more afraid, having deeper fears than I have ever experienced. It is like an endless reservoir of fears.” Briefly he wondered why he was so afraid, but he responded to his own question by stating that his reservoir of fear had filled over all the years of his life. It had been, he said, not one specific event that did it; it had filled day after day after day. I commented at this point that it had been my observation in life that often other people can play a role in helping to bail out a sinking ship or to drain an overflowing reservoir. I wondered aloud if there were not perhaps a better place between the prison of enslavement by capricious authority and the loneliness of the minefield. His response came from deep within the self-in-exile: ”’’m afraid of myself. I’m afraid of living, afraid of growing. My fears are primal. It is like I have a reptilian brain and other people are malignant to me, malicious, capricious.”
The three months were drawing to a close. Realizing that work remained to be done, I hoped that Mr. C. would continue in treatment after his probation period. I told him that over the next two sessions, but despair seemed increasingly present, and my interpretations had little impact. In the last session, his final words were, “I can make no peace with the world. I cannot fit myself into the world.” He called me several weeks later to tell me that the final decision had been made at work, and he had been fired. He was going on unemployment and would spend some time at home thinking about what he wanted to do next. He ignored my invitation to call me to set up an appointment whenever he wished, and I have not heard from him since.
The contrast between Mr. R. and Mr. C. seems particularly striking and important. Mr. R. had been able to use the therapist as a participant in a potential, new object relations unit, one that stood in a realistic, healthy place between the master/slave and the sadistic object/self-in-exile units. The therapy could be an anchor for a new compromise between the extremes. As the therapist occupied a new place between the master and the sadistic object, so Mr. R. occupied a new place between slave and self-in-exile. For Mr. R., a better compromise was achieved, one that was not free of the vulnerabilities associated with the schizoid conflict, but was functionally able to transcend it. Mr. C., however, could not use the therapist or the therapy in this fashion. For a moment, I was that nice man who could potentially occupy a position between master and sadistic object. And for an equally brief period, he could occupy a position between slave and self-in-exile by reaching deeply within himself and experiencing the possibility of finding gold. Nonetheless, the therapy could not provide more than a momentary anchor for the hope of change. Why? For one thing, Mr. C.’s reservoir [of fears] was filled to overflowing. Second, the time was too brief for the kind of work that Mr. C. needed to effect a better compromise. Third, the internal motivation for change had not been strong. Initially, it had been almost nonexistent, as Mr. C. had been responding only to his supervisor’s referral. Still, the therapy had stirred some of the latent hope that lived deep within Mr. C., although it was too little and too late.