Examining jacky's case: the use of modern attachment theory, self psychology and neurobiology

This case involves a 34 years old Asian male named “ Jacky,” who comes from a low-income family in Hong Kong. He has two sisters, both of which are older, and he expressed feeling loved by his mother growing up but not by his father, who did not like children and divorced the mother when Jacky was two years old. As a result, Jacky and the oldest sister went to live with the father and stepmother, and he was not permitted to see his mother. His father sent him to the United States to live with an aunt when he was 13 years old. Jacky worked two jobs to support himself through school, and he remains independent. He is able to form relationships with others, but he lacks trust in others and thinks that he is the only person who can help himself. At times, Jacky experiences outbursts of anger and frustration when in situations he cannot control. He cut off any ties with his father, and while he cares for his mother, he maintains he does not really love her. He does not like to show emotion, and he has tremendous fears of being vulnerable. In trying to form a better understanding of Jacky and his affective life, this paper will use modern attachment theory, neurobiology, and self-psychology paradigms to examine his case.

Modern Attachment Theory and Neurobiology

Jacky shows high levels of stress when he thinks about the possibility of lasting attachments to others. He lacks trust in people, which stems from his childhood and the fact that his father did not support him when Jacky was sent to the United States. Jacky still feels great disappointment when he talks about his father, and this emotion has carried over into some of his other relationships. Jacky was also mistreated by his aunt, and his father quickly stepped out of the picture. His sister rejected him when he asked to live with her, and as a result of all of this, Jacky does not trust others to care for him. From the perspective of modern attachment theory, the relationships of his early stages of life have shaped his survival functions and his defensive posture toward fulfilled human experience (Schore & Schore, 2008). That is, this theory posits that emotional transactions with primary objects of affect shape the development of the person’s psychic structure as well as the maturity of the neurobiological systems that impact self-regulation (Schore & Schore, 2008).

This is an integrative approach to understanding a person’s affective communications and attachments such that a therapist can attempt to form a picture of psycho-biological development issues (Schore & Schore, 2008). Life stressors that pertain to these problems of early attachment tend to reappear in a client’s developmental experience, and the case of Jacky confirms this in light of his own questioning of whether he can rely upon any real sustained relational attachments. In addition, the added stress of having to calculate the degree to which any tentative bond is worth preserving creates pronounced psychic conflicts in Jacky’s perspectives on moving forward in life. Jacky’s childhood experiences have clearly affected the ways in which he communicates with others. He has not fully developed an empathetic self because he remembers that he was not shown empathy as a child. As such, he transfers that experience onto his present relationships, and he exhibits outbursts of anger when he feels misunderstood.

In fact, the case of Jacky demonstrates a need to examine his regulation mechanisms and habits. He tightly controls his emotional displays, and when he speaks about his feelings for his parents, in particular, he tends to be dismissive. For example, Jacky will downplay the affect that his absent parents have on him, and he maintains that his past is not that important to him. Emotion in an individual’s early life is often regulated by others, but it becomes more self-regulated with neurophysiological development (Schore & Schore, 2008). Jacky exhibits high levels of self-regulation and a desire to avoid placing emotional regulation in the hands of others. It is likely that this is both a biological phenomenon and also a socio-cultural one. Jacky’s social and cultural environment is relatively separate from his heritage, and he does not belong to a strong community based in his culture. For these reasons, beginning with an understanding of attachment experiences is key for this case, and Jacky’s developed survival functions can be explored and underpinned by this recognition of how socio-physiological connections impact self-regulation (Schore & Schore, 2008). This would include some reflection on cultural diversity issues at hand and also Jacky’s experiences in terms of being culturally and socially uprooted from his early life environs.

Maternal stress is also a potential complicating factor, especially if there is fetal exposure to exogenous glucocorticoids (Lupien et al., 2009). While this condition may be uncertain in the case of Jacky, it does seem likely that he may have experienced increased basal HPA axis activity, since there are major disturbances in his childhood and with his mother, who experienced depression (Lupien et al., 2009). The stress system of the brain involved a coordinated response to threats, involving autonomic, neuroendocrine, metabolic, and immune system components (Lupien et al., 2009). The HPA axis is crucial to this response, and stressors in childhood can alter this function (Lupien et al., 2009). Jacky shows signs of not being able to properly regulate his response to stress. He is often anxious, especially when thinking about his relationships, and therefore his brain may be underdeveloped in terms of its stress system responses.

The psychobiology of child maltreatment posits that emotional constriction, anxiety, and rage are byproducts of early stress on the nervous system (Whitsett, 2006). Findings from psychopathological research suggest that childhood trauma has negative effects on a person’s ability to regulate emotions (Whitsett, 2006). These neurobiological advances have aided greatly in the transformation of attachment theory, especially in light of findings that attachment communications are crucial for the development of right brain systems that regulate emotion and stress (Schore & Schore, 2008). A person’s ability to cope with life’s stressors and unpredictable events is tied to the quality of the support systems surrounding that person (Corzolino, 2014). Typically, a person will need to feel connected in order to find healing, but if that persona is too afraid to trust, then relationships become dysregulated (Corzolino, 2014). This is a situation that Jacky finds himself in because his fears of abandonment overwhelm him at times and trap him. The development of his right brain system is probably weak because his childhood is filled with attachment issues that still plague him. Therefore, it is key to understand his developmental context through attachment theory.

Attachment theory is derived from the work of Bowlby, who held wide and interdisciplinary interest in psychoanalysis, evolution, and developmental psychology (Levy, 2013). In considering cases such as Jacky’s, one can move toward a more integrative understanding of affectional bonding, caregiving, and the long-term effects of his early experiences of attachment (Levy, 2013). Jacky does not have affectionate relationships in his life, and he has avoided forming strong bonds with others. The lack of true caregiving in his childhood is an area that needs explored in sessions with him. Levels of bonding between the child and his caregivers shape interpersonal functioning and potential psychopathologies that often recur throughout life if there is not thoughtful therapy (Levy, 2013). Basic biological principles of regulation operate through approach-avoidance behavior (Corzolino, 2014). Jacky shows a high degree of avoidance in his behaviors, and it makes sense that he would do so considering how his parental relationships were cut off early.

Jacky mostly feels safe when he is either in control or when he experiences a feeling of self-reliance. He did not have much control over his childhood situation since he was removed from his parents, and because he was forced to work from an early age, he has grown accustomed to relying upon himself primarily for support. Much of this is a defensive posture related to the issues of abandonment he has experienced and internalized. His patterns of attachment and detachment can be examined through therapeutic techniques tailored to his needs, his personality, and the therapist’s own interpersonal style (Levy, 2013). Defenses against letting others in may lead to a client merely using the sessions as a sounding board for his own ideas (Diamond & Meehan, 2013). Jacky needs to work on his affective communications and his tendency to focus on his own disappointments in others. He has experienced psychological trauma with respect to his primary relationships in life, and so attachment theory can open up a window onto this situation for him.

In this case, it would be critical to establish a base from which to secure internal trust and support for Jacky (Levy, 2013). This opens up a path for exploring attachment experiences from the past, and it provides a channel for the client to re-consider difficult or painful elements of life that may have a strong impact upon present relationships (Levy, 2013). By attempting to create links between past and present attachment experiences, Jacky can work to foster a more heightened sense of self-awareness (Levy, 2013). A primary goal here would be is for Jacky to revise his internal models in terms of how his feelings and thoughts about the past can be re-worked or re-conceptualized (Levy, 2013). This may lead to a productive and safer ‘ place’ that Jacky can go to when faced with overwhelming stress and defensiveness about attachments. Jacky becomes agitated most when he feels he is in situations outside of his control. He often does not know why he becomes so angry, and so he is not able to regulate his emotions in these situations.

Self-Psychology

Kohut’s self-psychology model has likewise remained influential in therapeutic and social work dealing with a lack of parental empathy at the time of early development (McClean, 2007). Much of this centers on the individual’s lack of a capacity to regulate self-esteem, which can lead to a kind of narcissistic view of one’s self (McClean, 2007). An adult, viewed from this framework, may vacillate between irrational overestimations of the self and feelings of inferiority (McClean, 2007). Oftentimes, such a person will depend upon others to regulate self-esteem and create value for his experiences (McClean, 2007). Adopting this model means attempting to experience Jacky’s point of view in an empathetic fashion (McClean, 2007).

In this self-psychology model, the formation of self-objects is determined by the evolving process of the child and parent relationship (McClean, 2007). As such, a self-object is made up of the developing child in addition to the people who provide the child with self-structure and an internal sense of cohesion (McClean, 2007). The infant remains unaware that the objects of self are not part of himself, and these objects provide functions that the person will learn to do on his own and incorporate into the adult psychic structure (McClean, 2007). Jacky’s early relationship with his parents as self-objects was brief, and since these relations were ruptured, he was likely not able to develop in the way that most people who have healthier parent relations do. Therefore, when specific self-object needs are not met, development can become arrested such that the person develops a personality disorder and potentially heightened feelings of narcissism (McClean, 2007). While it may be uncertain to what degree one could describe Jacky’s outlook as narcissistic, there are certain clues in his responses that lead one to see that he has not developed a full capability for empathy and that he perhaps overestimates his own ability to control his experiences with others (McClean, 2007). He remains confident in many ways, but he has created a life wherein he sees himself as the primary center of control and determination. This is a critical recognition for this case because Jacky continually abandons relationships when he feels that he will be ultimately disappointed by them according to his past failures or situations.

Muhlbacher (2003), working from a Kohutian framework, writes about the importance of psychological transfers, which are typically repetitions or renewals of old object relationships. That is, there is a transfer of old feelings and perceptual patters from an individual’s past into his present, which is deeply tied to the success or failure of the parent-child relationship (Muhlbacher, 2003). The fractured relationship between the parent and child in Jacky’s case is projected onto new relationships with others, and a lack of acknowledgement by the parents of the child may have halted his development of a realistic self-image (Muhlbacher, 2003). At first, the child or young adult will oscillate between the need for love and acknowledgement and the idealization of parents or others in terms of wishing to become how they are (Muhlbacher, 2003). There are various deviations within this patterning, which may move significantly away from a healthy or positive ideal (Muhlbacher, 2003). Jacky needed greater acknowledgement from his parents, but he focuses on the fact that his father refused to provide him with support. Jacky did not have a solid role model in this respect, and so he tends to view relations with others in a more calculating fashion. That is, Jacky understands relationships in terms of what he might gain out of them or with respect to what he thinks they are worth. His family was driven by money and gain, and Jacky has in some sense adapted this to his calculations about relationships.

Role-modeling is key to the developmental process, and the personality that longs for ideals, particularly after early childhood disillusionment, tends to try to fill voids by idealizing other figures, who usually end up not fulfilling those ideals (Muhlbacher, 2003). In the case of Jacky, it became evident that he lacks positive role models in his life that he could look to for some idealization. Moreover, the fact that his early parental ideals were quickly shattered suggests that he indeed transfers this experience onto his relationships, as evidenced in his questioning of whether his relationship with his girlfriends was worth the investment. This perspective does not necessarily need to be termed pathological; rather, it is unhealthy in terms of how he regulates his affect and attachments (Muhlbacher, 2003). It is important to explore some potential positive role models in Jacky’s life so he might understand how they may change the ways he internalizes disappointments and repeats them. One goal in this respect would be to understand exactly what Jacky’s idealizations consist of if they are present in his everyday psychic life.

The language of self-psychology is therefore critical for conceptualizing some of these ideals in Jacky’s case (Stolorow & Atwood, 2012). Discussions of ‘ the self’ and the Jacky’s own experiences of selfhood can help expose to what degree it is fragmented or cohesive (Stolorow & Atwood, 2012). However, one must be careful not to hold this language as the only means for successful intervention or let it override the relationship (Stolorow & Atwood, 2012). Nevertheless, it is difficult to practice this kind of work without some theoretical notion of the self, as Kohut proposed (Stolorow & Atwood, 2012).

Empathy and introspection, again, remain crucial to this process of finding a language for the emotional self (Stolorow & Atwood, 2012). Kohut maintained that one must recognize that the experience of selfhood is always carried out in the context of emotional interrelations, both in development and in treatment (Stolorow & Atwood, 2012). Jacky does not have a solid basis for emotional expression, and his childhood and adolescence was filled with uncertainty about who would care for him and for whom he cared. When Jacky speaks of a former girlfriend, for example, he does not show signs of love and affection. Instead, he focuses on how she might focused too much on her needs. He relates these experiences back to himself and his own disappointments. In trying to understand the emotional and affect context of the individual’s understanding of the self, the clinician can begin the important work of unfolding some of the situational and psychological determinants of the person’s self-experience (Stolorow & Atwood, 2012). In Jacky’s case, this might mean a discussion of how his perception of the self has not only been shaped by his parental relations, but also by his awareness of his own cultural diversity. While this may or may not be an overriding, shaping force on his self-perception, it is important to remain sensitive to this since he has not exactly had positive role models or ideals specifically related to his experience as an Asian American. In fact, Jacky tends to avoid discussions of his ethnic heritage or he dismisses it as unimportant to his life.

Maintaining this analytic sensitivity to Jacky’s specific developmental context is key because it not only fosters a greater, empathetic relationship, but it can lead to a more nuanced understanding of the self-object functions at work (Carr & Cortina, 2011). Carr and Cortina (2011) write about the mirroring self-object function as an intersubjective ability that permits people to recognize and validate the characteristics of others. Developing this capacity is tied to the ability to understand others from their own perspectives and to empathize with them (Carr & Cortina, 2011). This ability is critical both for the individual’s formation of positive relationships and also for building trust and acceptance. It would be important in the case of Jacky to make certain that there is validation of his point of view and an open dialogue about how others can empathize with his outlook. That is, the notion that everyone shares a common humanity and some similar experiences is a main part of how the self-psychology model works from a Kohutian perspective (Carr & Cortina, 2011). Jacky’s mirroring capacity remains limited insofar as he does not empathize much with others. He tends to see himself as unique or far removed from most others’ experiences. As a result, he does not think that people quite understand him, and he retreats back into his strong feelings of self-reliance.

Stern (2004) examined the emotional cues of everyday, social life, and pointed out that humans are distinct in understanding that others have minds like one’s own and imagining how those minds might work. The mind, or the self, is therefore a construct that is social and relational, and one’s experience of it is deeply impacted by emotional and communicative attachments (Stern, 2004). Jacky’s lack of positive emotional attachments is again rooted in his feelings of abandonment. He does not feel comfortable communicating these feelings. Rather, he stresses how his social life is filled with people coming and going. He conceives of these relationships as transient. His fear of abandonment in this respect has altered how he conceives of his own self as a social construct. For this reason, Jacky does not pick up the emotional cues of others because he assumes that they are not like him or that they would not understand how he thinks.

The self, however, is also a neuroscientific construct, and certain traumas or past disillusionments can alter the pathways of inhibition, excitement, or affective regulation (Stolorow & Atwood, 2012). A person typically objectifies his or her experience of selfhood so that a more solid sense of personal identity is achieved (Stolorow & Atwood, 2012). In the absence of strong self-object relations, a person may begin to experience discontinuities, fragmentation, or uncertainty (Stolorow & Atwood, 2012). In recognizing this, through theories of attachment and self-psychology, the clinician can better locate new pathways of self-understanding for someone in Jacky’s position.

Conclusion

The case of Jacky, when viewed in the context of these theoretical frameworks, begins to make sense in terms of how and why he has structured his sense of self and its defenses. It is clear that his early childhood experience has affected his relations and his emotional expectations as he relates to others. He is not doomed to repeat these tendencies to detachment, however, because he can be brought to a better understanding of the patterns that make up his everyday affective experience. His case has complexions that may not be easily solved through theory alone, but using these frameworks is a good starting point for engagement so that neurological and socio-cultural factors are considered.