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by David P. Celani
Columbia University Press, 2010
Review by Terry Burridge on Dec 14th 2010

Fairbairn's Object Relations Theory in the Clinical Setting

"'Psychological meaning is either regarded as inherent and brought to the relational field, or as negotiated through interaction.'(Mitchell 1988:5) "This comment sums up Fairbairn's work and thinking-and the radical import of it. As Celani points out throughout his book, the dominant analytic model of thinking in the movement's early days was that of the Freudian drives-which may be simply understood as a set of hardwired motivators which shape our behavior. (Rather like a computer which comes with a pre wired set of material which determiners how it works. Whilst these drives can be added to or modified, they remain essentially as the machine's "givens".) Fairbairn's contribution was to emphasize "... the central importance of individually constructed meanings based on unique relational experience, a complete repudiation of Freud's notion of universal, instinctually based meanings." (Celani p.208)

From the standpoint of the early 21st Century, this seems an unremarkable statement. We are used to the whole idea of individual and personal narratives which are chosen over a pre-determined set of givens. (One clear example of this process may be found in the field of psychiatry where numbers of individuals choose to tell a different story about their experiences to that told by the givens of the medical model.  Thus "breakdown" becomes re-interpreted as "breakthrough" and "psychotic" phenomena become spiritual rites of passage.)

Fairbairn's work took a long time to come to any acceptance in the analytic community. He seems to have been dismissed as a slightly precocious child trying to talk to grownups on equal terms. Very amusing but eventually tiresome and of no lasting value. Some of this reaction seems to have been a consequence of his living in Scotland-a view doubtless shared today! Had he been in London where the majority of analysts met and worked, he might have had a different response to his work- although the International Journal of Psychoanalysis did publish his work. The other factor that seems to have caused his work to be overlooked was that he was writing during the war between the Kleinians and the Freudians.  "'There was relatively little notice taken of Fairbairn's work in the British Psychoanalytical Society ... Melanie Klein was not enthusiastic about it, though valuing his observations, while  Anna Freud gave no idea that she had noticed it... (Sutherland 1989:144)' " (Celani p.208) It seems that the two dominant "mothers" of early psychoanalysis had blithely castrated one more of their "sons". Small wonder that Fairbairn emphasized the importance of a loving, nurturing bond between a child and at least one of its parents! (A role that Celani and others are now taking on.)

Celani describes his own long years of clinical practice with Borderline patients inn terms that are instantly recognizable to all clinicians. He writes "As a clinician, I was struck by the fact that many of my patients were preoccupied, (if not consumed) either by the rejection they wee receiving from their 'new' relational objects or by past rejections they had received from their parents, and yet they were unable to separate from the people who were rejecting them. In many cases, their sole purpose in life was focused on winning the love of people who appeared to hurt them endlessly." (Celani p.2)

This theme of rejection and of the importance of subsequent reparative echoes Bowlby's work-and the dogged clinging on to a bad object was demonstrated so clearly in Harlow's work. It is also the emphasis on the importance of a reparative relationship with a therapist that makes Fairbairn's work so hopeful; and appealing. A long quote from Celani illustrates this-as well as making it clear how much pressure may be applied to the therapist.

"The therapist must be willing to be transformed repeatedly and yet remain calm while applying his or her master narrative to the scenario that has just been reenacted between them. The next question is: What aspect of transference interpretation is mutative? The answer, I believe, is the therapist's ability to tolerate the pressure from the patient's projecting of one of his internal structures onto the therapist without completely disallowing it..." (Celani p.124)

We are here in the realm of the mother-baby dyad and Winnicott's work on the mother's containing function of both her baby's love and its hate. (Much easier to mange with a baby of six months than a "baby" of thirty years!)

Some of Fairbairn's work is technical and esoteric-does the baby internalize both Good and Bad objects?  Are we born as an emotional tabula rasa to be written on by our experience of the world around us or do we come pre-packaged with drives, instincts and the like which pre-determine our responses to the world-and its response to us in turn. And from this philosophical base, what kind of interventions do we make with our patients?

And from a nursing perspective, at least, these questions can seem irrelevant. If my patient is disturbed on the ward, my task is to manage that. And to keep everybody safe. To muse about that person's inner world can seem a luxury that we cannot -- and need not-afford. Yet an understanding of what it was that prompted my patient to respond in a particular way is crucial. If past behavior is an indicator of future patterns of behavior, then an understanding of that "presenting past" is essential if we are to see any change.

I am pleased to have discovered Fairbairn-and to have had his work presented so well and so sympathetically by Celani. Fairbairn comes across as a very contemporary thinker who has a clear and caring view of human hurts.

 

© 2010 Terry Burridge

 

 

Terry Burridge is a Senior Lecturer in Mental Health Nursing at Buckinghamshire New University. He has spent most of his professional life as a psychiatric nurse and now spends considerable time and energy trying to inspire future psychiatric nurses to be the best kinds of nurses that they can be! He is very much influenced by psychoanalytic thinking and sees analytic theory as offering a valuable critique to many other areas of human activity. He can be contacted at Terry@dancingbears.co.uk