A Case Conceptualization within a Jacobsonian Object Relations Framework

1. A Case Conceptualization within a Jacobsonian Object Relations Framework Brianna M. Blake

2. Summarizing Statement • Emily* is a reserved, timid, 21-year-old White female currently pursuing a bachelor’s degree in Communications at a prestigious New England university. • She has voluntarily sought treatment in a residential eating disorder facility to manage her bulimia nervosa, purging type. Emily has returned to treatment for the second time over the course of a year after a failed suicide attempt and an intensification of binge-purge behaviors. • She is the middle child of three female siblings; her eldest sister, Amber*, also has an eating disorder diagnosis, more specifically, anorexia nervosa, restricting type.

3. Summarizing Statement • The mother-daughter dyad is characterized by frequent verbal altercations yet mutual reliance for support. The mother’s depressive symptoms make it difficult for Emily to more intimately connect with her mother. • The father is reported as “virtually nonexistent,” mostly due to his alcohol dependency—an issue that is largely avoided by the family. • Both caregivers are characterized as critical and quite rigid in their expectation of scholastic success. • Emily expresses often feeling “invisible” in her family and resents that much of her mother’s attention is dedicated to Amber.

4. Description of Nondynamic Factors • Genetic predisposition may have served as a contributive factor in the development of Emily’s eating disorder. A common familial vulnerability can be observed in the manifestation of eating disorder symptomatology in both Emily and her older sister. • Risk factor: paternal alcohol dependence (Wade, Bulik, & Kendler, 2001). • Family systems: Emily’s eating disorder symptoms may have emerged as a means of serving a larger family function, shifting focus away from the marital discord and inciting structural change.

5. Psychodynamic Explanation of Central Conflicts • Formulated from a Jacobsonian framework • Emily’s development in infancy, according to Jacobson’s theoretical model, was the result of the interplay of biological potentials and the immediate, social environment; from this early interaction, a representational world emerged that contributed to all subsequent development (Mitchell & Black, 1995). • Through repeated experiences of pleasure and unpleasure stemming from the mother-child interaction, images were formed respectively of the gratifying and frustrating mother. • Shaped by these experiences of satisfaction and dissatisfaction was the quality of Emily’s object relationship.

6. Psychodynamic Explanation of Central Conflicts • Due to Emily’s mother’s depressive symptoms, she was unable to adequately respond to Emily’s needs in infancy, inciting feelings of frustration and disappointment. • In the context of frustrating and deficient caretaking responses from the mother, resulting disappointment prompted the release of aggressive drives; in turn, this led to Emily’s devaluation of the mother representation. • Devaluation of the maternal object prompted Emily’s desire to eject the object—to separate and distance from it. • Since disappointments seemed to characterize the mother-infant interaction quite early in life (i.e., before Emily’s self and object representations were solidified and sufficiently differentiated), this aggressive devaluation was attributed not only to the maternal object but the undifferentiated self as well.

7. Psychodynamic Explanation of Central Conflicts • Feelings of pleasure were also experienced in the mother-infant relationship as a result of instances in which Emily’s mother adequately satisfied Emily’s needs. Stemming from these feelings was a valuation of the maternal object. • As a function of merger fantasies, admired elements of the maternal object were introjected into Emily’s wishful self image. • In adulthood, this translated into shared traits between the mother-daughter pair (i.e., shyness, depression) and Emily adhering to the perfectionistic expectations espoused by her mother.

8. Psychodynamic Explanation of Central Conflicts • The parallel processes of merging with and separating from the maternal object, and thus representations of the self, are demonstrated by Emily’s binge-purge behaviors (gratification and deprivation as orally-focused). • Pleasurable, libidinally-driven, experiences achieved in infancy through maternal closeness and nourishment, are symbolized in adulthood by food. • Emily’s bingeing on food is analogous to the “taking in” of the mother (experience of pleasure). • Ingestion of the maternal object concurrently gratifies aspects of the idealized self that remain merged with the idealized maternal representation (ego-ideal).

9. Psychodynamic Explanation of Central Conflicts • Unable to manage conflicting feelings of pleasure and unpleasure, Emily exorcises the maternal representation through purgative behaviors. • The internal tension caused by bingeing, in conjunction with the relief granted by purging, is promoted by the pleasure principle. For Emily, this cycling of pleasure and pain is her way of maintaining homeostasis, albeit skewed and maladaptive • Punitive superego rigid self-monitoring of body shape/size • Inability to cope with developmentally critical periods (disillusionment experienced in infancy upon the discovery she lacked a penis difficulty with puberty and adopting a woman’s body).

10. Predicting Responses to the Therapeutic Situation • Emily’s inability to affectively integrate images of self and other has diminished her capacity to identify and tolerate co-occurring feeling states. Resistance will predictably be met when attempting to strip Emily of the mechanisms employed to regulate painful affect (i.e., eating disorder behaviors). • As the therapeutic process challenges her self- and other-representations, the increased tension between Emily’s ego and superego will also exacerbate feelings of guilt (particularly as her sister maintains her eating disorder). • In the way Emily largely devalues her mother, she is expected to project this representation onto the therapist. She is initially likely to “take in and spit out” the therapists care and goodness through the oral expression of degradation.