Advanced Psychopathology

Tuesday, March 28, 2006


Relational Theory on psychopathology, diagnosis and treatment

Relational theory has made a significant contribution to the evolution of psychoanalysis, particularly in North America. It has provided a distinctive view towards the diagnosis of mental illness, and established a revolutionary method of therapy. An obstacle for relational theory, however, is that it does not provide a coherent theory for distinctive disorders and is in a way, naïve in its assumption regarding the development of various pathology.
The assumption in relational theory, in regards to psychopathology, is that it is the result of considerable disturbance in a significant relationship. It is also assumed that when an infant’s relational needs are disrupted, this results in anxiety. This anxiety is specified to indicate the need for security. The individual will attempt to protect the self from the anxiety, by performing various security operations. However, in some cases, the individual is unsuccessful in his attempt to stymie the anxiety. This brings about negative feelings towards the self, preventing the integration the thoughts or memories of other relationships or interactions that did satisfy the needs of the individual. This splitting off or relationship memories, causes the individual to assume that all relationships will have the same, negative consequences. The individual develops an “illusory personification” in which all future relationships will be filtered through a relational template, causing the perception of present relationships to be impacted by, and comparable to the past, anxiety provoking relationships. This distorted view towards relationships and the maladaptive pattern of interaction that ensue, along with the rigidity of this pattern, essentially impairs relational and personality functioning. The relational pattern is said to be responsible for the development of the self. However, impairment in this area and disruptive relationships that follow, will cause parts of the self to be hidden and expressed, instead as various forms of neurosis.
The relational theory provides a distinctive approach to psychopathology, in that mental illness is essentially due to a disruption of needs, or provoked anxiety, from a significant relationship within a person’s life. Because the focus is on interpersonal patterns, there are no real diagnostic labels or criteria of symptoms that can be used as a guide to diagnose, and provide treatment based on that diagnosis. Instead, the relational assumption regarding the interpersonal pattern provides the information on development and course of pathology. This approach does have its holes, in that this particular theory does not account for individuals that have traumatic relationships, yet do not develop pathology. There is evidence of biological and genetic pre-determinants of mental illness, as well as biological motivation behind certain behaviors, thoughts and feelings towards relationships. The inability to assimilate these factors of human development into the theory causes some loss of credibility, although the contributions to the therapeutic process have been quite noteworthy.
An objective of treatment is to uncover the maladaptive relational pattern and improve interpersonal functioning, as well as increase the flexibility in the perception of relationships. The therapist is much more engaged in the therapeutic process, providing an authentic and collaborative interaction with the patient. Instead of interpretations of the analytic data, the relational model suggests the patient and analyst work together to infer the patient’s interpersonal reality. There are many variations on the general approach to treatment, but a significant feature is the analysis of the relationship with the analyst and its correlation with interpersonal patterns that would most likely occur with others in the individual’s social life. As the patient is made more aware of their relational patterns, and as the analyst provides an authentic form of interaction, the patient can experience his authentic self. Since there was once a rigid perception on relationships, the patient must be made aware that not all relationships will be as traumatic as was the original initiator of the anxiety. Through the authenticity of the analyst and the freedom to work through interpersonal relations in a safe setting, the patient gains confidence in his ability to interact with others

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