Alcoholics Anonymous: A self-Psychological Perspective

By Noah Kass, LCSW

AA 1 year chip

Self-psychology, developed by Heinz Kohut, is a psychoanalytic theory that views psychopathology as being the result of unmet or disrupted developmental needs. Essential to understanding self-psychology is the concept of selfobjects. Self-objects are persons or things physically existing outside the self, experienced as part of the self, and that function in service of the self (Kohut, 1984). Self-objects fulfill mirroring, idealizing and twinship needs.

The mirroring need allows the infant to confirm his own specialness and establishes excitement for existence. The infant craves appreciation and responsiveness from the caregiver. In an optimal caregiving environment, he will feel comfortable displaying his grandiose self, highlighting innate talents and potentialities.

Suppressing the child’s unrealistic fantasies and ambition would diminish development of productive energy and self-confidence .If the caregiver responds adequately to the mirroring need, the child gradually accepts the loss of infantile grandiosity and begins formulation of realistic goals.

The idealization need allows the child to draw strength from a caregiver’s power and calmness .Most noticeable between ages of four and six, this need focuses on the desire to be part of and protected by another. Kohut suggested children go through an evolution from idealizing their parent to viewing them as individuals with imperfections. Parallel to that process, the child evolves to recognize her own multi-dimensionality. If the idealization selfobject need is fulfilled, the individual can handle disappointment without impacting self esteem .Having parents not attuned to this need or not worthy of idealization could result in narcissistic vulnerability, with the self being overly affected and distorted by the slightest discouragement or setback.

The twinship need helps individuals feel less isolated in the world by matching them up with another person like them .It becomes most relevant during the latency period (adolescence), a time when security in numbers is vital. Fulfillment of this need provides separation from the nuclear family, and formation of a consolidated sense of self .The goal is development of a person’s ability to form mutually gratifying relationships with others, and concepts of connection and belonging to the world.

Although these three selfobject needs have specific ages where they appear most relevant, they are consistently evolving and seeking gratification throughout the life cycle. In addition, the extent to which these selfobject needs are satisfactorily internalized in childhood becomes a strong predictor of overall mental health in adulthood.

Heinz Kohut’s self-psychological perspective supports participation in 12-step programs such as Alcoholics Anonymous (AA). Participation in AA often brings a sense of connectivity, safety, and support.

Membership in this community can provide an opportunity for an addict to acquire a substitute selfobject, filling an unmet need from infancy and childhood.

AA may serve as an “omnipotent transitional object”, an integral ingredient in helping make the transition from ingesting self soothing compensatory substances to sudden abstinence bearable. When AA members speak about their unwavering devotion to “working the program,” they may be speaking less about AA principles and more about finding an object (AA) strong enough to compete with their drug of choice.

The theory of self-psychology emphasizes the need for others to help maintain self-esteem, control anxiety, and provide self-soothing functions .Long-term AA membership combined with significant immersion in the fellowship may partially fulfill the idealization, mirroring, and twinship needs not properly internalized in addicts during childhood. Since it is difficult to fully meet needs that were unmet in childhood, many recovering addicts feel an almost “addictive” relationship with AA. Perhaps the more one attends, the more the needs of the tripolar structure (idealization, mirroring, twinship) will be fulfilled. Veterans of AA suggest newcomers attend 30 meetings in 30 days, supporting this hypothesis.

AA attempts to fulfill the addict’s mirroring need through admiration and validation. Designated time periods (30 days, 90 days, 180 days, 365 days, etc.) are constructed to acknowledge members have achieved significant abstinence from their drug or addictive behavior of choice. At these times, members explicitly reflect and voice recognition of the individual’s growth during the recovery process; a coin may be given representing the amount of sober days; and the individual may be given new membership responsibilities.  The celebrated member is recognized, validated, and admired by peers.

In AA, the addict is given the time to freely share thoughts, feelings, and experiences without interruption. This promotes, rather than represses, a natural grandiosity often unacknowledged by the individual’s primary caregiver. It is a relief from the repression of emotions that often occur during active addiction.

The mirroring self is seen as the addict begins to recognize like minded individuals inside the various AA rooms. Often he is surprised by the lack of judgment from fellow addicts. This experience may have a transformational impact. They have located others in the world who have shared experiences, and with that comes a unique sense of acceptance and familiarity. These like-minded individuals help lessen the shame associated with previous addictive behaviors.

Peers begin to see how voicing their own experiences can help each other. They become sponsors to newcomers, helping guide them through the AA traditions and principles. This continues an everlasting mirroring process, allowing the sponsor to continue having his own thoughts, feelings, and experiences, recognized and reflected back to him by the sponsee.

Alcoholics Anonymous attempts to fulfill the idealization need by providing an organization to admire and identify with. It serves as a re-parenting mechanism substituting for the original idealized parental imago. In the program’s principles and procedures, members recognize organization and productivity. In its focus on simplicity and consistency, members recognize calmness and rationality. These features were usually not seen in the addict’s relationship with his primary caregiver.

The hopefully productive sponsor/sponsee relationship makes vivid the often-problematic relationship of the caregiver/child. It is the hope that the sponsor, through example, can provide the addict with what the caregiver could not: the ability to be simultaneously productive and free from destructive anxiety. The prescriptive nature of AA, including working the steps, attending meetings regularly, getting a sponsor, and abstaining from drugs/alcohol, is reminiscent of a parental figure giving practical and compassionate advice to a child.

The focus on a higher power, sponsor, group members, and the entire collective could help mirror selfobject functions previously attempted by the isolated individual.

The power of the fellowship is recognized as existing beyond any individual room, extending across states and countries. Individuals are given a common language to communicate with a diverse population whose similarities bind them together. The addict feels less isolated in this world, the exact opposite of what she may have felt when in the cycle of active addiction.

References Provided Upon Request

Noah Kass, LCSW, MA is a psychotherapist specializing in addiction treatment. He is a doctoral candidate at the University of Pennsylvania’s school of social policy and practice. Noah received an MSW in clinical social work and a master of arts in education from New York University. Noah has been Clinical Director at The Dunes East Hampton and Realization Center in New York City.