Although the child's primary love objects figure, more or less, in the thinking of all psychoanalytic schools, there is considerable divergence in how their role is conceptualized, in their importance relative to the drives, and in their impact as real people on the child's development. Most theories recognize the role of mental representations—that is, internalized versions of human interaction based on the patient's key relationships in the past that determine relationships in adulthood. Whether these representations are shaped by the patient's internal fantasy and drives or by the actual experience of primary love objects is another point of divergence, although many have argued that ego psychologists, who are seen as diminishing the importance of the parents' real input, were cognizant of and attentive to the contributions of the actual parents all along (e.g., Tolpin 1978).
As noted earlier, many other psychoanalytic schools draw attention directly to the child's actual lived experience with parental figures. Despite considerable differences among them, these theories all assign special significance to the nature of the other and how it shapes mental development. These schools include contemporary British object relations theorists, American interpersonalists and relationalists, intersubjective theorists, attachment theory integrationists, and psychoan-alytically informed infant observers and researchers. These schools do differ in their ideas about the way the mind is structured around managing the early impact of the caretaker and how these effects live on in adult psychopathology. For example, attachment research shows the disorganizing impact of traumatic early experience on adults' capacity to think and self-reflect, to form intimate adult relationships, and to create secure attachment in their own children (Hesse and Main 2000). Analysts from a range of contemporary schools look to the present-day therapeutic relationship to understand these problematic mental representations in vivo, and many suggest that therapeutic effect can only take place in the herc-and-now interaction. Prominent thinkers have suggested that recovered childhood events are "therapeutically inert Therapeutic action lies in the conscious elaboration of preconscious relationship representations, principally through the analyst's attention to the transference" ¡Fonagy 1999, p. 218|.
Thus, contemporary psychoanalysts are deeply concerned with the patient's actual experience of childhood primary objects and even with the mental life of those objects. Issues related to the childhood process of differentiation from objects, die quality of environmental nurture during childhood, parental capacity to self-reflect and mentalize, and parental attunement and misattun-ement are part of most analysts' thinking about adult patients. Moreover, almost all contemporary analysts agree on the huge importance of transference for treatment efficacy; even among those who disavow the importance of linking transference paradigms to childhood experience, it is evident in their clinical material that the defining context of the past remains a central feature of their work, whether or not childhood memories themselves are deemphasized (Gilmore 2009; Govrin 2006).
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