What is Couple Therapy?

Couple therapy is a deep emotional experience, with intense communication and feelings that occurs among three persons (couple and the therapist). In Narcissistic/Borderline Couples, I define a specific type of a beleaguered love bond as two developmentally arrested people who coerce each other into certain roles as each brings into their current reality archaic experiences embedded in age-old sentiments. Together they play out a drama characterized by painful, never-ending patterns of behavior, and form a parasitic bond that leads not to growth and development but to destructive and repetitive patterns of behavior. It is often asked what is it about them that attract each other. It is not really important how they find each other; more important is what makes is the glue that makes them stay. Together they “do the dance” almost as if they have some extraordinary built-in sonar system or sniffing device like a bloodhound after a rabbit.

Someone with a narcissistic personality is inclined to attract as an “object choice” a borderline personality, how each one stirs up some unconscious or conscious unresolved developmental issue in the other, how a narcissist “needs” and borderline and how a borderline “needs” a narcissist. Ironically, two narcissistic or two borderlines do not make it, but when paired these oppositional types appear to maintain a bond.

Using the metaphor of “the dance,” I show how certain patterns of behaviors/interactions that are circular, on-going, never-ending are like a “dance” (a rondo), that go round and round without ever reaching any conflict resolution. In more technical terms this is known as the introjective/projective process or what I refer to as “dual projective identification” (how one partner projects some unwanted aspect of the self into the “other” and how the “other” then tends to identify or over-identify with that which is being projected).

In The Many Faces of Abuse (1989), I extend beyond narcissistic/borderline relations to illustrate how the grandiose self can infect and invade other disorders e.g., a histrionic with an obsessive compulsive, a passive-aggressive with a caretaker etc.

Why Do People Stay in Painful Conflictual Relations?

Integrating many different theoretical approaches, mainly concepts from classical psychoanalysis, object relations, self psychology, group psychology, I try to explain why is it that people stay bonded in painful conflictual relationships. There are certain individuals cannot feel a semblance of aliveness unless they are fused in a dysfunctional destructive attachment. It is really baffling when couples are happy why would they sabotage just when they are at the pinnacle of success? Together they repeat the same drama over and over again, without ever learning from experience. The most pervasive feature is that they are more bonded to pain to pleasure, and will repeat the same traumatic experience again. Why is it that partners involved in primitive bonds cannot take heed to our "good advise?" Why is it that even after a divorce or separation these individuals maintain a bond, albeit a destructive one? Are they crazy, perverse, and sadomasochistic? As Grotstein (1987a) has illustrated, any attachment is better than no attachment.

Pain stirs up an amalgam of unresolved developmental issues as each seeks out the other to play out their internal drama. (“V” spot). As bad as the pain is, it is still better than the emptiness, the nameless dread, the void, or facing the black hole. Because the pain is linked to the love object, it also becomes highly charged and eroticized. This is referred to as "traumatic bonding (Dutton, 1981). As least the pain provides one with some semblance of meaning (suicide bombers). At least I feel alive, I know I exist!"

Why do I stay with a woman who torments me, someone I wouldn’t wish on my worst enemy? She is exactly like my mother, but at least I feel a sense of aliveness instead of deadness!"

This creates ambivalence, the aggressor (the abuser/betrayer/depriver), who is cruel and sadistic is also the same who can be loving and kind. Because the pain is linked to the love object, it also becomes highly charged and sexualized. This is what is referred to as "traumatic bonding.” This helps us understand why couples stay forever bonded to the painful object. As bad as the pain is, it is still better than facing he abyss, the void, the black hole.

• People who have had traumatic experience are programmed to bond with a painful internal object that is familiar.
• It is better to bond in pain then to have to face the void, the black hole, the emptiness.
• Pain stirs up an amalgam of unresolved infantile issues
• Pain becomes highly eroticized/sexualized
• Pain is familiar (familiar internal bad object)
• Pain is confusing. The lover who can be cruel and sadistic can also be loving and kind.
• Pain is linked to internal part of self one wants to destroy/rid of Internal/External Abusers

Example

 We might speculate about Osama bin Laden that as much as he hates and wishes to destroy the insatiable, capitalistic, lustful “America," this is the needy split off part of himself that is disavowed.

THEORETICAL IMPLICATIONS

Drawing from many different theoretical frameworks, I have abstracted concepts mainly from self-psychology (Kohut) and object relations (Klein, Winnicott, Fairbairn, Bion, Kernberg). Although many see them as an "odd couple" relationship (strange bedfellows), I have found them to make a “perfect marriage” for couple therapy. Self-psychology with its mirroring and empathy techniques is more suitable for the narcissist, and object relations more suitable for the borderline in meeting the borderline's containment needs. On a more cautionary note many therapists have misunderstood, misused/abused self-psychology. We do not empathize with patient's aggression; we empathize with their vulnerability and pain.

No you cannot attack your wife, put her down, demean her, but given the way you were treated as a child I can understand why you do this.

Although both object relations and self psychology are important, I have found Klein's contributions invaluable in the treatment of couples therapy especially in helping couples face internal deficits, distortions, and projections. Klein offers us the concept the introjective/projective process (“dance”) a priceless construct essential in helping us how one partner tends or project a negative feeling and how the other tends to identify or over identify with that which is being projected. These are interactions that go round and round, are on-going, circular never-ending (like a "rondo). In conjoint treatment, we see how certain dynamic mechanisms of the narcissist (grandiosity, entitlement, guilt, withdrawal) can arouse states of unworthiness, non-existence in the borderline (shame, blame envy, abandonment and persecutory anxieties).

Example

A narcissistic husband projects a feeling into his borderline wife that she is worthless and not entitled to anything and should not need or want anything. He complains, “All you do is nag, nag, nag.” Not knowing how to legitimately express her real needs, the borderline wife continues to nag/demand even more. As she nags, he withdraws, as he withdraws she attacks. As she attacks, she hooks into his harsh punitive internalized superego (guilt). He ends up feeling guilty and she ashamed. Thus it becomes a dance between guilt and shame.

Kernberg's Different Kinds of Relationships

Kernberg's Aggression in Personality Disorders and Perversions (1992) describes four kinds of love relationships (1) normal, (2), pathological, (3) perverse, and (4) mature love. His premise is that in normal love, the relationship overcomes the conflict. Internal strivings do not interfere with the capacity to maintain an intimate loving connection. In pathological love, conflict overpowers the relationship, and internal conflicts do interfere with the capacity to maintain a loving relationship. It is love that goes in the wrong direction, implying that people who have been traumatized are like emotional cripples in relationships because they link idealization with eroticism (See Different Kinds of Relations).

When I first met her I feel in love because she had big breasts. Now I envy and want to kill any man who looks at her. (Envy dominates)

Object Relations vs. Self Psychology

Many have found object relations and self psychology are an "odd couple" relationship because both object relations and self psychology are vital in the treatment of couples, but are also in conflict. Object relations is extremely effective in helping partners face internal deficits, distortions, and projections especially for the more pathologically disturbed individual those more inclined to misperceive, distort the therapist's empathic stance as weakness or as being "too" kind or "unduly" understanding. This is important, not only because in fast moving pace, it is also more conducive in helping partners face responsibility.

Self psychology does not emphasize the internal world, nor does it assume the patient is distorting, and if disturbances do occur it usually is because of an arrested development or disruption between self and the self-object tie, and not because of the patients projections, distortions, or delusions. Both have different ways of finding "truth." The self psychologist finds truth via introspection/ and intra-subjectivity, and assumes the patients experience as 'truth," or the truth. In SP one strives to understand the subjective experience by putting aside ones own reality, whereas in object relations, the patient's distortions, projections and misperceptions are considered more at face value. So whose "truth" do we listen to? Who's telling the truth? The self psychologists say we find truth through the subjective experience, the Kleinians through interpreting the patient's distortions, I say within the "couple transference."

Fairbairn more than anyone helps us understand why couples stay in painful conflictual relationships, why they stay loyally bonded and attached to bad objects. He expanded Klein's notion of the "good and bad "breast, to the notion that the ego doesn't split into two parts but into multitude of d subdivisions (rejecting object, a tantalizing, tormenting, or unavailable objects). Of course there can always be a bad external abuser/betrayer, but there can also be an internal one.” The chart below illustrates the type of internal attachments one loyally and faithfully attach themselves to.

ATTACHMENTS TO BAD INTERNAL OBJECTS

Yes, there can always be an external bad object (abuser/betrayer/depriver/ withholder) but there can also be an internal bad object that ca abuse/deprive/ betray you.

Bad Internal Objects

• The Wronged Self
• The Insatiable Self
• The Craving Self
• The Lost Self
• The Betrayed Self

Bad External Objects

• Rejecting Object
• Depriving Object
• Unavailable Object
• Withholding Object
• Painful Object (The Mother of Pain)
• Idealized Object
• Sadistic Object

CROSS CULTURAL COUPLES

Today our consultation rooms are beginning to resemble a mini-United Nations. Our offices are filled with couples from various ethnic backgrounds (multicultural couples, cross-cultural couples, interracial and inter-ethnic couples, same-sex marriage, blended-family marriages, and step-family marriages. The influx of immigrants has led to many cultural and societal concerns. Living in a vast and ever-changing society, we as therapists must learn to cope with and adapt to these rapidly changing times.

A person who intermarries is not only marrying another person, they are also marrying a culture—tying religious, ethnic, and cultural knots. Treating emotional vulnerabilities must include understanding the cultural and qualitative distinctions within the dyadic unit. When we talk about different cultures, dynamics take on different meaning. What guilt, shame, dependency, might mean to a Westerner may not mean the same to an Asian or Middle Easterner. I tried to find treatment procedures in treating cross-cultural couples, found very limited material. So I made up my own.

In the treatment of cross cultural couples, the psychodynamics are extended to reach the impermeable membranes of indefinable borders. This comparative cultural analysis outlines how guilt, envy, jealousy, separation, dependency, and bonding experiences are qualitatively practiced and experienced. For example, it is not enough to analyze someone's anger or rage without considering the Korean concept of "Han" ("rage") as having deep historical significance. And it is not enough to understand shame without encompassing the concept of "saving face" in Asian or Middle Eastern societies. What dependency represents for a Westerner is in sharp contrast to what dependency represents for the Japanese (the mother/child bonding relationship known as amae (Doi 1985). Furthermore, to understand the concept of “self,” one must take into account the differences between an individual “self” and a group “self.” The same holds true for guilt, envy, jealousy, "true self" and "false self ("tatamae" and "honne"). There are hierarchical positions in many cultures where elders and parents come first and wives are last on the list. One can imagine, for instance, how this might impact a narcissistic/borderline couple, especially the narcissist, who needs to come first and be considered special.

The entire spectrum of psychoanalytic theory takes on a different shape when treating cross-cultural couples. Self psychology, with its mirroring and empathic techniques, appears to be most suitable for the treatment of couples of varying ethnic backgrounds, ideologies, traditions, and values. Because of its emphasis on intersubjectivity, self psychology appreciates that each society has its own unique roles and customs and that patients and the therapist have different subjective viewpoints. The intersubjective experience does not focus on right and wrong, but rather on understanding the depths of the conflict from a cross-cultural perspective. This does not mean we go along with the aggression, simply that we understand the etiology. Concepts from self psychology provide the perfect language for empathizing with the patient’s vulnerabilities.

Do the psychodynamics of the couple apply to cross cultural couples? shame/guilt, envy/jealousy. In cross cultural couples these dynamics carry a different flag, what shame means to a Westerner may not be what it means to a Middle Easterner or Asian. What dependency needs means to the Japanese is totally different that what it means to a Westerner. Consider the concept of “amae,” the intense relationship between (the mother/child bonding relationship). Also, it is not enough to understand shame without encompassing the concept of "saving face" in Asian or Middle Eastern societies. Furthermore, to understand the concept of “self,” one must take into account the differences between an individual “self” and a group “self.” The same holds true for guilt, envy, jealousy, "true self" and "false self ("tatamae" and "honne"). There are hierarchical positions in many cultures where elders and parents come first and wives are last on the list. For Koreans, it is not enough to analyze someone's anger or rage without considering the Korean concept of "Han” ("rage") as having deep historical significance and indefinable borders.

Treatment Points for Cross Cultural Couples

• Learn the fundamental dynamics of the culture; mirror and reflect.
• I have found Self Psychology to be the best mode of treatment to mirror and understand the subjective experience
• Know something about the foods, holidays and traditions. Learn a few words of the respective language, at least “hello” and “goodbye.” If the patient is Asian, serve tea and bow slightly)
• Be empathic to the cultural differences, not to the aggress
• Be aware of the differences between individual and group self.
• Be aware of special treatment needs. Try to bond through some common ground—e.g., “Oh I love Arabic music.” “ I would love to learn how to make Couscous.”
• Be aware of body language (with Asians, keep your distance; with Persians and Italians, stay close).
• Find pathology within the individual.
• Find pathology within the government
• Find pathology within the culture.
• Find pathology within the couple transference
• Find pathology within the government
• Remind the couple why they are in treatment.
• Mirror the conflict
• Empathize with the vulnerabilities, not the aggression.
• Use the cultural contrast hook

Make use of the “cultural contrast hook” (a technique I created to emphasize the dramatic differences between the patient’s culture and other cultures). For example, if a Middle Eastern man complains that his wife disobeys him and only listens when he beats her, the therapist has an opportunity to apply the cultural contrast hook, “Yes, I do understand how this is your tradition. But imagine if your wife came from a tribe in Central Africa where most the people were cannibalistic and their tradition was to eat the body parts of their fellow human beings? How would you feel if your wife ate you (and said it was customary)?”

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