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The Effects of Prematurity on Development: Process Studies: An Object Relations Perspective

By Michele Bell

The ability to form a selective and enduring bond is considered a fundamental feature of human experience and according to some theorists, plays a pivotal role in the process of personality development (Mahler, Pine & Bergman, 1975). Present theories of bonding behaviours stem from observational research and in general, poorly developed infant bonding with the main caregiver is thought to negatively impact on children's later attachment and explorative behaviours (Ainsworth & Bowlby, 1989).

Attachment has generally been understood as ones working model or bonding quality of relatedness to specific significant others such as the mother and later romantic relationships (Bowlby, 1973). Given the emphasis on processes that determine the quality of interpersonal relatedness, many researchers suggest that attachment theories clearly overlap into Object Relations theory (Buelow, McClain & McIntosh, 1996; Murray, 1991; Fishler, Sperling & Carr, 1990; Behrends & Blatt, 1985). Pertinent to the current investigation however, is the subtleties between attachment and object relation's perspectives on relatedness. Whereas attachment bonds are present in some but not all relationships, object relationships are global and encompass virtually all relationships (Fishler, Sperling & Carr, 1990; Buelow, McClain & McIntosh, 1996).

Object Relations theory as represented empirically by Mahler's, Pine and Bergman (1975) work concerning the psychological birth of the human infant generally assumes that, although the infant has an innate relational capacity, the developmental sequence which progresses through various phases of attachment culminates in individuation and personal autonomy. Emerging from interactions with the primary caregiver, the infant develops a capacity for relating to self, others and world. Thus, the capacity for human relations becomes an important indicator for social and emotional functioning (Mahler & Kaplin, 1977 Behrends & Blatt, 1985; Levine, Green & Millon, 1986; Murray, 1991).

The developmental sequences Mahler, Pine and Bergman, (1975) outline, involve six phases: normal autism, symbiosis, differentiation, practicing, rapprochement and the consolidation of individuation and personal autonomy. Pertinent to premature children however, are the first two stages (i.e., normal autism and symbiosis) which may well be operative during the neonatal stay. In the first few weeks of life, the infant exists in a very dependent state, unable to make symbolically meaningful discriminations between self and environment. The mother's role in this phase is to attune herself to her infant's signals of crying, cooing, smiling grimacing and the like. These signals are thought to arouse the mother's identification with her infant, enabling her to attribute to the infant the pleasure or distress she would be feeling if she herself were to behave in such a way. The establishment of the mother-infant unity represents the first developmental prerequisite for internalisation. If, all needs are gratified by the primary caregiver the infant experience's security, protected from anxiety.

Following normal autism, the infant begins to differentiate self from primary caregiver. This developmental stage, termed symbiosis, is where the primary caregiver and child both contribute to the relationship. Intuitively, the mother actively begins to foster the child's separation, due to her sense that a dual unity is no longer warranted or necessary for either infant or mother. If such disruptions do not exceed the infant's adaptive capacities, the child is endowed with the ability to manage the losses of the mother-infant dual unity through the process of internalisation resulting in the psychological birth.
According to this developmental model, the child's ongoing transactions with the mother are internalised in the form of self and object representations. Object representations are theoretical constructs used to describe cognitive and affective schemas resulting from mother-infant interactions that organise current interpersonal perceptions. Although this developmental model has certain commonalities with Bowlby's (1973) theory of attachment, its adherence to later global relational functioning gives it particular relevance to the psychosocial development of prematurely born children who may have remained in hospital during these developmental stages.

Although Object Relations theory concerns itself with speculations about early development, most empirical literature focuses primarily on adult experiences with few exceptions investigating relatedness in early childhood. One such study however empirically tested the relationship of social and emotional functioning to the level of object relations in a normative sample of children aged 9-12 (Avery & Ryan, 1988). In this study, children with greater object relation's maturation perceived themselves as more socially confident, reported greater self-esteem and were less likely to present with internalising problems reflecting anxiety and depression than children with low object relation's maturity.

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