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Most of our patients live in an internal atmosphere chronically peopled by malignant introjects or selfobjects. The environmental failures that contribute to the creation of these internal figures compose a twofold trauma. First is the inadequate parental response to primary needs, which leaves the self in a state of vulnerability with varying degrees of deficiency in self-regulation and with a pervasive sense of frustration. The second, equally important, problem is a failure on the part of the early caregivers to help the child sufficiently in the management of intense affect states consequent to the failure to gratify primary needs for mirroring and tension regulation. Often, the critical step producing pathological character formation and constricted or “frozen” object relations is this secondary failure in the holding environment. The resultant crippling character defenses can be considered to be the product of heroic but distorted efforts to quiet the dangerously seething internal environment. This pathologic environment contains the presence of the caretaker who failed or was in some way unreliable as a good-enough object, that is, who was in some way unable to enhance the self of the child or to help it contain its painful affects.
If we are to alter this pathologic atmosphere, I believe the most vital issue to be the provision or creation of a “usable” object capable of modifying the nature of this pathologic state. This can best occur through the experience of an analytic relationship that differs in significant ways from one based on more traditional thinking. In the next section of this chapter I review, briefly, contributions by Winnicott, Kohut, and others, which highlight crucial ideas and background components for my thesis.