Heinz Kohut and Virginia Satir: Strange bedfellows?

HEINZ KOHUT AND VIRGINIA SATIR: STRANGE BEDFELLOWS?

Shir ley B r a v e r m a n

ABSTRACT: Both Heinz Kohut, the psychoanalyst, and Virginia Satir, the family therapist, are products of the humanistic influence in psychology that developed after World War II. Both have had an important influence on the practice of psychotherapy. Kohut expanded the scope of psychoanalysis so that more different kinds of people could be treated by psychoanalysis than had been possible heretofore, while Satir taught a whole generation of therapists what it means to be experience-near to their clients. This paper deals with some of the sim- ilarities and differences in their work.

Heinz Kohut, the European-born psychoanalyst who challenged traditional psychoanalytic thinking, and Virginia Satir, the American family therapist who took her message to the mental health masses - -wha t can these two consummate professionals possibly have in common?

Kohut, a Viennese trained physician who took his psychiatric and psychoanalytic training in Chicago, was president of the American Psychoanalytic Institute, and went on to make a major contribution to psychoanalytic theory and practice. His work altered psychoanalysis enough so that it was considered by many to be a dissent from tradi-

Shirley Braverman, M.S.W., is Associate Professor, School of Social Work, McGill University and Assistant Professor, Department of Psychiatry, McGill University. Re- prints should be addressed to her at the Institute of Community and Family Psychiatry, 4333 C6te Ste-Catherine, Montr6al, (Qu6bec), H3T 1E4.

This paper was prepared at the invitation of John Banmen and Virginia Satir for in- clusion in their forthcoming book entitled Applications of Virginia Satir' s Theories and Practice of Family Therapy and was submitted to this journal with their courteous agree- ment.

Contemporary Family Therapy 8(2), Summer 1986 �9 Human Sciences Press 101

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tional analytic practice. An international psychoanalytic meeting was called in Chicago in 1978 to discuss the issues raised by his challenging work. His development of the psychology of the self was clearly at odds with classical psychoanalysis.

Virginia Satir is the Chicago trained psychiatric social worker who left all institutional affiliations and become the best known family therapy teacher in the western world. She combined gestalt tech- niques with sophisticated psychodynamic theory more than any other non-medical practitioner has ever done to date. She did not restrict her teaching to the university or the clinic but took it out into the field, (e.g. agencies, schools, community groups) where mental health practi- tioners were struggling with severe problems and high caseloads. She has had high exposure in the media, giving talks and demonstrations on television as well as countless interviews to the press in many parts of the world. What do these very different people have in common?

BACKGROUND PHILOSOPHICAL INFLUENCES

Both Kohut and Satir are products of the humanistic influence in psychology that developed after World War II. This approach was an outgrowth of Existential Philosophy which began with Kierkegaard in the 1840s and was further developed by Martin Heidegger, Karl Jaspers, and Manuel de Unamuno after World War I. Martin Buber, Albert Camus and Jean-Paul Sartre further developed existential ideas after World War II. Existential philosophy is the system of ideas that explores issues of being, choice, freedom, responsibility, isolation, and death. It had an influence on European psychiatrists who did not like Freud's model of psychic functioning, finding it too mechanistic (Yalom, 1980). They objected to Freud's reductionism, which traced all behavior to a few basic drives and explained higher levels of behavior in terms of lower ones. They did not accept his determinism, which stated that all mental functioning is caused by identifiable factors al- ready in existence. As a reaction to Freud's model of man, the Existen- tial analysts, as they became known, tried to bring back man's unique- ness in their understanding and treatment of human beings. In order to do this, they thought that the therapist had to enter the patient's experiential world and listen to the phenomena of that world without the presuppositions that distort understanding. The objective distance of the scientific observer, uninvolved with his observations, was not use- ful in the field of human behavior, they thought.

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It was not until after World War II when Rollo May and Victor Frankl's work began to be known in the United States that the Exis- tential ideas influenced American psychologists. In 1950 a group of ab- normal and social psychologists established a new ideological school and called it Humanistic Psychology. Among them were Gordon All- port, Henry Murray, George Kelly, Gardner Murphy, Abraham Mas- low, and Carl Rogers. They were dedicated to appreciating the unique experiential world of each individual and they focused on issues of man's freedom, choice, values, responsibility, and purpose. However, where the Europeans were essentially pessimistic and tended to em- phasize human limitations, the Americans were optimistic. They emphasized the development of one's potential, interpersonal encounter, and peak emotional experiences. A whole host of therapies began to develop as a result; gestalt therapy, encounter groups, holistic medicine, psychosynthesis, etc. Humanistic psychologists believed in the existential position that man participates in the construction of reality, hence they placed great emphasis on his self-awareness as a tool to- ward his self-actualization. Their underlying thesis was a great belief in man's perfectability.

KOHUT'S EXPERIENCE-NEAR APPROACH

Although he was trained in the medical and Freudian models, Kohut's experience of working in the classical psychoanalytic tradi- tion caused him to become aware of its limitations and the need for a change. There were two basic tenets of classical analysis with which Kohut disagreed.

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Classical analysis emphasized the primacy of drives, hence the therapist's most important task was to tame them and deal with the conflict between them. It postulated a single line of development from narcissism to object love; heightened forms of self-esteem were considered fixations on earlier stages of development. The assumption was that one could only develop one's capacity for object love once narcissism had receded. Kohut disagreed with this completely. He looked upon narcissism as essentially healthy, part of normal personality development (Kohut, 1966). He was interested in the defects of the self and not in the drives or conflicts between them.

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In his technique Kohut emphasized the importance of the therapist's affective experience of the patient; he called this approach experience-near, as contrasted with experience distant, and stressed the importance of empathy for data gathering about the patient's inner life. However, the therapist's function did not end there:

After he has collected these data with the aid of empathy, he orders them and gives the patient a dynamic or genetic inter- pretation. In arriving at his formulations he does not employ empathy . . , even though he continues to deal with that aspect of reality that is accessible only via introspection and empathy (Kohut, 1980, p. 483).

P S Y C H O L O G Y OF THE SELF

Kohut developed a theory to explain human functioning called the psychology of the self. The self was conceptualized as having a variety of functions dealing with self-esteem regulation. He postulated two separate but intertwined lines of development, narcissism and object love; love of the self and love of the other. He believed that healthy narcissism is an essential element in our enjoyment of life, ability to function and capacity to love others. It does not interfere with our capacity for object love; on the contrary, it enhances it. From the begin- ning of the baby's life the drives are less important than his experience with his primary caretaker, whom he experiences as a self-object. (i.e. something outside which he takes in, to be part of himself). The baby's narcissistic development is strongly influenced by how in tune the primary caretaker has been with his needs; whether he/she has responded with proud mirroring to the development of the infant's first skills and his strivings for separateness, or not. The responsiveness of the whole milieu of caretakers to the growing child is vitally important for the development of his self-esteem and it continues to be important throughout life. "We need mirroring acceptance, the merger with ideals and the sustaining presence of others like us throughout our lives" (Kohut 1980, p.495).

The essential interaction between a child and his parents, Kohut believed, was more important in understanding pathology than partic- ular traumatic events in a child's life. If an event in a child's life becomes traumatic, it is due more to the preceding relationship between the child and his self-object, which was fragile and disturbed, than to the nature of the event itself (Kohut, 1977).

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SATIR'S VIEWS

Satir, also, believes that healthy narcissism is a prerequisite to the capacity for object love. For her, the core of every human being is self-worth (Satir, 1964). However, her language is more concrete and folk-like than is Kohut's. In her book, Peoplemaking, (Satir, 1972) she speaks of "pot" i.e. self-worth, and not narcissism. The person who ap- preciates his own worth is able to appreciate and value others. Because we are born helpless and small, we are dependent on our primary caretakers for survival. The quality of the parent-child relationship is the most important vehicle for personality development and learning to relate to others. "It is there we learned to handle our selfing, pairing, and triading" (Satir, 1980).

Both Satir and Kohut focus strongly on the healthy aspects of mental functioning. Self psychology, more than classsical psychoanalytic theory points out inherent developmental potentialities even though they may be intertwined with pathological manifestations. Both Satir and Kohut view infantile demands which emerge from re- pression not only as a source of malfunction but also as energy which can be used for productivity and health.

D I F F E R E N C E S BETWEEN KOHUT AND SATIR

Since Satir's approach is primarily developmental, she focuses on the interpersonal communication to explain how one "learns" one's identity. If a person is exposed to a different communication, Satir teaches, his self-esteem can change. Self-awareness is important and the responsibility for making a choice regarding his own life change, is paramount for the client. She emphasizes in her teaching the necessity of being aware of the client's communicational style. The therapist's task is to make him aware of how dysfunctional his style is in getting his needs met and to provide an empathic, nurturing, non-blaming environment which will enhance the client's self-esteem. As a conse- quence, he will be able to learn a more adaptive way of relating. She does not discuss the issue of the therapist as a transference object in any great detail. She does imply that the therapist is providing a holding environment and a model of certain psychological functions for the client. Satir is an active therapist: She speaks often, she gets physi- cally close, and often touches her clients. She actively sets about estab- lishing a soothing, nurturing, safe environment for the re-learning process she believes therapy to be.

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Kohut, on the other hand, thinks that repeated exposure to positive stimuli will not have the desired salutory effect for the individual because his bad internal objects prevent him from benefitting from positive experiences. It is only after a therapeutic experience with an empathic and introspective therapist who understands 1) the nature of the individual's self-objects as they have emerged in the transference, 2) what experiences trigger his feeling of fragmentation and panic, and 3) the necessity for the therapist to function as a corrective self-object until the patient has internalized parts of him, will it be possible for the individual to continue on his developmental path. Kohut (1971) goes into far greater detail about the complexity of the internal world of the individual in order to explain personality development. He also does not believe that the analyst should actively soothe. "He interprets the analysand's yearning to be soothed, he does not actively soothe . . . . he does not actively mirror: he interprets the need for confirming re- sponses." (Goldberg, 1978 p. 447).

A N A L O G O U S C O N C E P T S

While Satir does not use the term self-objects, she has an analogous concept. She calls it "parts." For her, these parts are the different identities each of us carries around intrapsychically; they are a result of our learning from our primary caretakers, which we have taken in and made our own. Her description of the concept is not as sophisticated as is Kohut's but its essential meaning is the same. These are our internal objects and if we wish to change our personalities these "parts" will have to change. She has developed a technique called the "parts party" in which the client is made aware of the internal conflict that is occurring among his parts. In her teaching, Satir gives the im- pression that these parts can change by an act of will, once we are made aware of them and how we would like them to change, yet she is too sophisticated a therapist to accept that. Her concept of change is based on learning theory: she does not address the issue of how intrapsychic change comes about, other than the aforementioned learning theory.

INTROSPECTION AND E M P A T H Y

Another essential similarity in understanding an approach between Kohut and Satir is their view of the central importance of empa-

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thy in the development of the self and as a requisite tool of therapy. By empathy they do not mean merely a sensitivity to another person. Rather, they mean a capacity to experience what the other is expe- riencing and an ability to understand it (Kohut 1959). Empathy makes the difference between a parent-child relationship in which the parent is in tune with the child's needs and thus fosters a healthy sense of self, and one in which he is unresponsive emotionally (although we may re- spond instrumentally) leading to the development of a child with a fragile sense of self.

The language they use to describe the child's experience is different. Kohut goes into great detail about the process of the child's psychic development. He traces the importance of the mother's mirroring response to the child's exhibitionism, the development of self-objects which are the precursors of psychic structures, and then the development of permanent psychic structures through a process he calls trans- muting internalizations. If there is not an adequate empathic response on the part of the parent, and if there is too much frustration for the de- veloping child, the personality will not attain a sufficiently firm cohe- siveness and will be prone to temporary but reversible fragmentation (Kohut, 1977).

Satir's language is different: her ideas are very similar. She places great emphasis on non-verbal communication between mother and child in the development of self-esteem; mother's availability to touch, look, and listen to the child. Her approach to therapy also stresses the importance of non-verbal communication, giving feedback, and the central importance of process (Bandler, Grinder, & Satir, 1976). The process she talks about is the process of an interview. It communicates the affective experience, the content does not. The therapist acts as a model for clear communication, but she is much more than that; she is an empathic parent who understands, does not blame, and contains the client's anxiety until he is ready to find alternative ways of coping.

We want to make it clear that this process of change would be an inhuman endeavor without human caring and empathy and without an eye to the soul and person of the individual in front of you as well as y o u r s e l f . . , without the humanity it (technique) becomes just brainwashing (Bandler, Grinder, & Satir, 1976, p. 178).

Satir implies that empathy is not merely a tool for understanding the client, it also embraces sympathy and compassion as well. Satir's con- tainment of the client's anxiety is analogous to Kohut's holding environment.

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In treatment Kohut stresses introspection far more than does Satir. As an analyst he deals with unconscious material more directly and states: "We take for granted that introspection and empathy are the essential constituents of psychoanalytic fact finding (Kohut, 1959, p. 465). He is trying to understand the inner experience of another person and believes this is only possible in the transference, during which the patient relates to the analyst as he did to his parents. There are two components to this understanding, Kohut believes (Kohut 1977 preface): the therapist's experience of what the patient is projecting onto him and the intellectual process of trying to understand the nature and antecedents of this experience as a part of the patient's psychological development.

Satir's ideas about how change happens do not give as much prom- inence to the intellectual as to the experiential component. It appears from her teaching that for her, empathic experience is more important than introspection. The task of intellectual understanding, introspection, belongs to the therapist in the main. She does not demand it of the client to any great extent. While not denying the value of explana- tion to the client, she minimizes its effectiveness in producing change. Satir does conceptualize the client as modeling himself after aspects of the therapist, but she does not go more deeply into the process of iden- tification or the transference. She tends to place more emphasis on will and choice as such; she insists that the client has a responsibility for choosing to behave differently once he is freed from feelings that prevent him from making a choice. By the development of certain tech- niques (e.g. guided fantasy, journal keeping) she helps the client use the therapist as a holding environment. Although her work is intense, she does not operate in such an extended time frame as does Kohut.

T H E I N F L U E N C E OF K O H U T A N D S A T I R

As a family therapist Satir's client population and her goal is different from Kohut's. Although she views individual development in terms similar to those of Kohut, her aim is to help the family produce the appropriate empathic and nurturing environment for its growing children. Her concern is for the parents as well, but she cannot lose sight of the fact that her child clients are in the process of their development and she can thus have a very direct impact on it. Her lens is wider; her task is both more difficult yet simpler than was Kohut's.

Kohut's detailed description of the way in which defective psychic

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structures come about in the individual has provided great depth to our understanding of what Satir calls "very needy people" and what he called narcissistic personality disorders. What Satir has done is to combine her profound understanding of the development of the individual with her understanding of the family system, and add a great emphasis on empathic understanding. She has taught her approach to a generation of family therapists in a way that was simply not possible for Kohut. Because Satir is comfortable with the media and with groups, she has been able to teach in a unique way. The experience- near emphasis which they both have in their work has been expressed by Satir in actually living with a group of therapists during her month long process communities. There, she lives the concepts she teaches to- gether with her students.

Both Kohut and Satir were better teachers than they were writ- ers. Satir's ability to take abstract concepts and concretize them (i.e. parts party, triad) in order to teach their essence by having people experience them, has been her greatest gift. Her values as a person are clear and open.

She has taught a whole generation of therapists what it means to be experience-near to their clients. Just as Kohut revolutionized and energized the practice of psychoanalysis, so Satir took family therapy out of the confines of clinical institutions and made it visible to therapists in the Americas, Europe, Israel, and parts of Africa.

Kohut expanded the kinds of people who could be treated by psychoanalysis. Psychoanalysis had developed as a treatment of neuroses and neurotic character disorders. People who suffered from narcissistic personality disorders and borderline states were outside that range. With the development of the psychology of the self and the modifica- tion in analytic technique which it brought, Kohut truly widened the scope of psychoanalytic understanding and treatment. This had an impact on all mental health professionals dealing with people who had disturbances of the self. It helped to increase their understanding of all psychological development and provided clues to non-analytic treatment as well.

Because they have so many points of similarity, Kohut and Satir complement each other very well. If one is interested in studying the development of the individual, Kohut's psychology of the self gives a detailed picture, especially of those suffering from narcissistic personality disorders and borderline states. If one wishes to understand families and learn ways of intervening effectively when one is assaulted by a mass of data by the family, Satir's approach provides a humanistic

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developmental model that makes these complex phenomena workable. Her genius in concretizing abstract concepts and both intrapsychic and interpersonal conflicts by using sculpture, props, role-playing, etc., has given us a whole technology for intervention. From the family perspec- tive her approach comes closest to the model presented by Kohut in his work. These two creative, innovative clinicians have given us the understanding and the tools to treat many suffering people whom we could not previously help.

R E F E R E N C E S

Bandler, R., Grinder, J., & Satir, V. Changing with families. Palo Alto, CA: Science & Behavior Books, 1976.

Goldberg, A. The psychology of the self. New York: International Universities Press, 1978.

Kohut, H. Introspection, empathy, and psychoanalysis. Journal of the American Psycho- analytic Association, 1959, 7, 459-483.

Kohut, H. Forms and transformations of narcissism. Journal of the American Psychoan- alytic Association, 1966, 14, 143-272.

Kohut, H. The analysis of the self. New York: International Universities Press, 1971. Kohut, H. The restoration of the self. New York: International Universities Press, 1977. Kohut, H. Reflections. In A. Goldbert (Ed.), Advances in self psychology. New York: In-

ternational Universities Press, 1980. Satir, V. Conjoint family therapy. Palo Alto, CA: Science & Behavior Books, 1964. Satir, V. Peoplemaking. Palo Alto, CA: Science & Behavior Books, 1972. Satir, V. Month Long Process Community, Bracebridge, Ontario, 1980. Yalom, I. Existential psychotherapy. New York: Basic Books, 1980.

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Heinz Kohut and Virginia Satir: Strange bedfellows?