9:30 – 10:00 INTRODUCTORY COMMENTS & GENERAL OVERVIEW
- Theoretical Framework
- Importance of Object Relations in Couple Therapy
- Self Psychology vs. Object Relations (Mirroring vs. Containment)
10:00 – 10:30 THE DANCE THE BOND THE DRAMA
- Why Couples Stay in Painful Conflictual Relations
- What Is It That Bonds/Binds These Partners?
- Different Kinds of Relational Bonds (Fairbairn)
- Mother of Pain
- Rejecting Object
- Unavailable Object
- Insatiable Object
- Lost Object
- Different Mothering Experiences (Winnicott)
10:40-11:00 DEFINING A NARCISSISTIC/BORDERLINE RELATIONSHIP
- The Narcissist (different kinds of narcissists)
- The Borderline (different kinds of borderlines)
- The “V-spot”
11:00 - 11:15 DIAGNOSIS AND PRIMITIVE DEFENSES
“Not only is there a dance between the couple but there is also a
dance between their psychodynamics”
- Psychodynamics
- Shame vs. Guilt
- Envy vs. Jealousy
- Dependency vs. Omnipotence
- Withdrawal vs. Detachment
- Splitting, Projection, Projective Identification
- Dual Projective Identification
11:15 – 12:00 TREATMENT
- Transference/Countertransference
- The Couple Transference
- Three Phases of Treatment Couples Move Through
- Six Step Treatment Procedure
- Treatment Procedures, Techniques, Points
- Therapeutic Functions
- How to Listen for the Theme
12:00- 12:15 A GROUP EXERCISE/CASE ILLUSTRATION
12:15 - 12:30 QUESTIONS, DISCUSSION, CLOSING COMMENTS, EVALUATIONS
INTRODUCTION
When I first started writing about Narcissistic Borderline Couples, I
became obsessed. Suddenly everyone was a narcissistic/borderline couple
(friends, relatives, colleagues, etc.). In fact, whenever I give a
lecture/presentation, I can just see everyone thinking, "Hmm, I wonder
which one she is, Is she the N or the B?” I always think teaching this
workshop will be easy but it’s not because each time I do so many new
things come up.
The “V-spot.”
Expanding beyond Narcissistic/Borderline relationships to different
kinds of relational love bonds (cultural n/b, the narcissist the artist.
Strange man called said he read my book (new patient):
Hello Dr. Lachkar?
I just got through reading your book. I think I’m the borderline,
and I need to see you right away. (Not knowing who he was I called my
alarm service and asked them to be on the lookout, but under no
circumstances to enter the waiting area). When I went to get him, much to
my dismay I see the security guards standing there with my patient. He
enters and says, “Dr. Lachkar, I feel so safe here. How wonderful you
have your security guards are here to check on things. My wife is a
pathological narcissist, a shop-o-holic, she drove me to bankruptcy, I had
a nervous breakdown and had to be hospitalized."
So, welcome to Narcissistic/Borderline Couples! Although not all
couples fit into the paradigm of Narcissistic/Borderline configuration,
nevertheless think you will find the treatment techniques outlined here
useful for almost all aspects of conjoint therapy. Since we are discussing
Narcissistic/Borderline bonds, we will focus primarily on diagnosis and
treatment.
How This Work Came About?
Oddly enough, my interest in marital conflict/tensions began with my
interest in the Middle East, mainly in Psychohistory, wrote a paper, The
Arab-Israeli conflict: A PA Study, whereby battles between Arabs and Jews
were seen to have striking similarities to conflicts in marital disputes.
The marriage between these two disciplines led to a second contribution,
my book, Narcissistic/Borderline Couples: A Psychoanalytic Perspective
on Marital Treatment.
Beginning with the A/I Conflict, I discussed their "political dance" as
a narcissistic/borderline relationship, and as having its origins rooted
in age-old archaic sentiments, dynamics similar to couples in clinical
practice. Without sounding too narcissistic myself, if figured I could
understand Arabs and Jews why not marital relationships.
Based on the mythologies of Arabs and Jews, I use the myth of the Jews,
"the chosen ones," providing them with a narcissistic diagnosis: versus
the Arab/Muslim myth, as the abandoned/orphan-child, a borderline
diagnosis. In Kleinian terms, one might suggest that Issac was the
narcissistic entitled child, given the birthright, whereas Ishmael, the
abandoned one, sent off to the desert. So Jews got the "good breast" the
land of Milk and Honey, whereby the Arabs got the "bad breast," the dry
barren one, leaving both groups in a state of endless rivalry and
unsolvable conflicts.
Just as couples “think” they are battling over sex, money, custody,
children, unconsciously they are really fighting around issues related to
dependency, abandonment, entitlement and specialness. Similarly,
contention in the Middle East is not “really” over land or occupied
territories, moreover are issues around shame, saving face, betrayal,
dependency, entitlement, oedipal rivals, control/domination, emotional
boundaries, preservation of self and group identity (Nancy adds inability
to mourn the pain of loss and identity). So why would someone take their
own lives?
BACKGROUND
Since Narcissistic/Borderline Couple, (many laughed, made fun, but
since then many therapists have extended beyond narcissistic/borderline
relations). Within these thematic motifs, we now have narcissistic
vulnerabilities in couples, Masochistic-Narcissistic and Polarized Traits
in Couple, the Passive-Aggressive Couple, the dependent/narcissistic
couple, the psychotic couple. Others have gone beyond this malaise to
address a garden variety of maladaptive strains. Carlson and Sperry in
The Disordered Couple (1998) include the “Psychotic Couple” and the
“Eating Disordered Couple.”
Martin and Bird in (1959) was one of the first in their original work
to bring to our attention the first dysfunctional couple, the
“Obsessive/Histrionic couple,” how an obsessive husband would join up with
a histrionic wife, or the "Love Sick Wife and the Cold Sick" husband" (in
those days all histrionic women were married to obsessive compulsive men
especially Jewish doctors). Sperry and Maniaci in The Disordered Couple
(1997), has now restored the obsessive/histrionic couple, claiming
that this couple is now back in style and the narcissist/borderline has
been way overrated and "over-represented."
Henry Dicks, in Marital Tensions (1967), was one of the first to
describe collusive patterns in couples, and later Jurg Willi, In
Couples in Collusion (1962) expanded Dick's view when he used the term
"collusion." He saw love as "oneness in narcissistic collusion" (similar
to patterns I describe in narcissistic/borderline couples). Maggie Scarf
in Intimate Partners expands Willi's work and discusses two kinds of
relationships, the "symbiotic," and the "oppositional." The "symbiotic"
reflects the development themes of Mahler's symbiotic phase, and the
"oppositional," reflects unresolved developmental disturbances around
separation-individuation.
Although psychoanalysts have made significant contributions to the
field of marital therapy, a review of the literature that has appeared
during the last decade reveals that the most inspiring material, oddly
enough, has come from non-conjoint therapists. Behaviorists are too
directive and ask too many questions. The object relationists are too
confrontive and too focused on the internal world. The self-psychologists
are "too empathic" and focus too heavily on the external (self objects).
The difference between the psychoanalytic/psychodynamic model of
therapy and the cognitive approach is that the former holds the
relationship to be the number one priority while the latter holds the
individual to be the number one priority. My approach begins with
regarding “the relationship” as the patient, gradually weaning the couple
away from the relationship to that of self-development. Initially the
relationship stirs up many unresolved developmental issues. This new
approach holds that even when the therapist is confronted with the
"impossible couple," or when one partner throws up his hands at the
"impossible partner," a new window of opportunity appears to explore
virginal territory (the unconscious or repressed conflicts the "impossible
partner" arouses).
As most of you know this work is based on my book, The Narcissistic/
Borderline Couple, the most recent book, The Many Faces of Abuse,
and my newly revised 2nd Edition of N/B Couples. Here I venture to
beyond narcissistic and borderline vulnerabilities to explore a variety of
other dyadic configurations—such as what happens when a histrionic
personality hooks up with an obsessive-compulsive, a dependent with a
schizoid, or a passive-aggressive with a perfectionistic/caretaking type
personality. By the way this gets very confusing because not only are
there narcissistic borderlines, narcissistic obsessive-compulsives,
narcissistic passive-aggressives, but there are many faces and phases of
narcissism. Although they may all show the same pattern, they form
different modes of dyadic attachments (psychodynamics).
In Narcissistic/Borderline Couples, I describe what happens when
a narcissist and a borderline join together in a marital bond or “bind”?
It is suggested that these two personality types enter into a
psychological "dance" which stirs up many unresolved conflicts and that
fulfills each other's conscious and unconscious needs.
Although these are not clear entities, narcissistic states, traits, and
characteristics do tend to vacillate back and forth, it is suggested that
these two personality types enter into a "dance" that fulfills each
other's conscious and unconscious needs. It is suggested that an
individual with a borderline character is inclined to attract as an object
choice a narcissistic personality. I then speculate as to what bonds,
attracts or keeps these individuals together. One might speculate they
have some built in sonar system like two bloodhounds on the lookout for
each other, or some extraordinary system able to detect, like some sort of
sniffing device, but it is not important how they find each other, but
what it is that keeps them together. Two narcissists or two borderlines do
not make it, do not "do the dance," because of their dynamics and
defenses, but when paired, these oppositional types appear to maintain a
bond.
So today I will begin with some theoretical considerations, define a
narcissistic/borderline relationship, then I will define the narcissist,
the borderline, describe different kinds of narcissistic/borderline, what
happens when they get together, psychodynamics (guilt/shame,
envy/jealousy, domination/control), treatment (Six Point Treatment Steps,
Treatment Points, Three Phases of Treatment), Case material and
discussion.
Theoretical Considerations
Kernberg's understanding of aggression provides a valuable guideline in
treating regressive love bonds because even though couples, fight, abuse,
hate each other, if the ultimate goal is toward a loving relationship, it
is considered healthy. Perverse relations are different. In perverse
relations, it is the love that can kill the relationship. It is the
excitement that becomes the replacement for love. Here I have added some
more different types. Later I will discuss this more why we get to why
people stay in painful conflictual relations. (See Different Kinds of
Relationships).
Fairbairn is another valuable theorist who has made valuable
contributions to marital therapy. Fairbairn, more than anyone, helps us
understand not only the different kinds of attachments, but why people
stay 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.” “There
can always be someone who abuses you, but there can also be a part of
yourself that also mistreats and abuses you.”
This creates ambivalence, because the one who promises is also the one
who disappoints, frustrates the child. The parent who is cruel and
sadistic is also the same parent who can be loving and kind, because pain
is linked to the love object, it also becomes highly charged and
sexualized. He 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. 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" (Lachkar, 1998).
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. She is like an albatross
around my neck.
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 eroticiized. 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!"
ATTACHMENTS TO BAD INTERNAL OBJECTS
- 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
Donald Winnnicott (1965) is another prominent figure whose unique ideas
and language that have enhanced and expanded the diversified field of
object relations. His focus, like Klein, was on the importance of the
early "mommy and me" relationship providing us with different kinds of
mothering experiences (the "being" mommy, the "doing" mommy, the holding
mommy, the environmental mommy, the background mommy), the infant's
capacity to be alone. Winnicott's concept of the "false self"/"true self,"
also makes an important contribution to conjoint treatment. In couple
therapy the transitional space provides a new opportunity for partners to
move from states of dependency and interdependency.
Wife wants to come for treatment, husband refuses to join her.
Therapist encourages her to come by herself ( an example the her therapist
as a transitional object) .
Winnicott's belief was that the therapeutic environment becomes a
recreation of a holding environment of a new opportunity with therapist in
the role a "good enough mother" therapist, providing a good holding
environment. In couple therapy this transitional space helps partners move
from states between dependency and interdependency by making use of
transitional objects “particularly Winnicott who adds the dimension of the
transitional space as couples move from one phase to the next”). (See
Three Phases of Treatment on p. 161).
DIFFERENT MOTHERING AND BONDING EXPERIENCES
- The "good breast" and "bad breast" mother
- The "being and doing"
- The transitional mother”
- The "containing" mother
- The "rejecting," "absent," mother
- The mother of "pain."
- The "internal" mother
- The holding/facilitating/environmental/background" mother
- The "mirroring" mother
- The "self-object" mother
- The "idealized" mother
- The "castrating" mother
- The "introjected" mother
- The self-hatred" mother
- The "internalized" mother
- The average expectable or "good enough mothering."
- The playful mother within the transitional space of conflict
THE PSYCHODYNAMICS OF THE COUPLE
Not only is there a dance between the couple, but there is also a dance
between their Psychodynamics:
- Guilt/shame
- Envy/jealousy
- Blame/shame/retaliation
- Dependency/omnipotence
- Withdrawal/detachment and attachment
- Different Kinds of Narcissists
- Normal Narcissism
One who is self absorbed, overly preoccupied with self, has strong
desires for fame, achievement, power, but not to the extent of
overpowering the relationship, and yet still has the capacity to maintain
a loving and intimate bond.
Pathological Narcissist
One who allows their preoccupation with self, exaggerated sense of
entitlement, defense mechanisms (guilt, idealization, and grandiosity) to
overtake and overpower the capacity to maintain a loving and intimate
bond.
Malignant Narcissist (act out for “the cause”)
The malignant narcissist is usually a leader, someone who uses their
omnipotent sadistic fantasies to live out a cause. Someone like Mr.
Milosevic, the Serbian war criminal may fit this description. “We killed
the Albanians for a good cause.” Here the group usually supports the
pathology under the guise of “good cause,” man acts out his worst
aggression. Sadism is the most common syndrome in the malignant
narcissist. They have paranoid features, which drives them into fulfilling
their own self-serving, political aspirations and which becomes the
rationale for destructive/sadistic acts of aggression.
Antisocial Narcissist
Antisocial patients typically present more serious superego
pathologies. The antisocial narcissist’s most dominant feature is the lack
of superego functioning and typically lacks the capacity for guilt and
remorse. They still maintain the excessive attitudes of entitlement, as
within the domain of narcissistic proper, however their sense of
entitlement is so excessive that it overrides any capacity for
self-reflection. They may steal, lie, steal, conjole, get caught, even
confess their crimes, yet with no context of guilt, remorse, or concern.
There sense of omnipotent and entitlement fantasies are so extreme that
they delude themselves into thinking they can get away with it.
Cultural Narcissist
The cultural narcissist brings to this country a certain about of
nationalistic pride and will hold to relentlessly will not adapt and will
do anything to maintain his sense of special identity.
Cultural Borderline
Will retaliate fight, become a freedom fighter, a terrorist, do
anything maintain the group’s collective identity (suicide bombers).
The Narcissist “The Artist”
The healthy artist displays a certain amount of grandiosity, pomposity,
self-involvement, self-absorption, preoccupation with self, an obsessive
investment in perfectionism, but not does interfere with his creative
process or ability to have healthy object relations ("aesthetic
survival”). The pathological artist is the one who functions at the
extreme end of pathological narcissism are dominated by such defenses as
envy, control, competition, domination, where winning becomes more
pervasive that the joy of the creative process.
THREE PHASES OF TREATMENT
I have observed three distinct phases couple move through. These phases
are based on the theoretical constructs of Melanie Klein (1967) and Donald
Meltzer describing three stages of development. These phases are similar
to the infant as he moves through various positions (paranoid-schizoid to
the depressive) in relation to its experiences with the mother and later
to the environment. Within these three positions, there is continual
movement back and forth from states of fragmentation to that of wholeness
and integration. The effort of the therapist is "gradually wean" the
couple away from “the relationship” to that of self-development.
Phase One: A State of Oneness (Fusion/Collusion)
During the initial phase of treatment, the couple lives psychically
“inside” the psychic space of the other. It is a state of “oneness,”
fusion/collusion with the other whereby there is no differentiation
between self and other (paranoid-schizoid position). It is a shame/blame
phase, each one blaming the other for all the shortcomings in the
relationship (who is right who is wrong, finding fault, getting even, and
retaliation). There is much stonewalling, blaming and shaming. Each
partner shows little awareness of the inner forces that invade the psyche.
Instead, there is a preponderance of primitive defenses such as splitting,
projection and projective identification. As Goethe once said,
“It’s difficult to know what to do especially when there is so much
blaming and attacking going on!”
Phase Two: A State o Twoness (Transitional Space)
In this phase marks the emergence of “twoness,” a tentative awareness
of two separate emotional states, a sense that the therapist can be
useful. There is more tolerance for ambiguity, budding insights into
unconscious motivations (internal objects), and other compelling forces.
It is the beginning of bonding with the therapist and a ”weaning” away
from living emotionally “inside” the object toward mutual interdependence.
As the therapist emerges as a new self-object, there is an opening of a
new therapeutic space (transitional space). It is a hopeful stage with a
burst of new energy, and feelings of excitement. There is a profound
shift, movement away from blaming/attacking and “doing,” to that of
feeling/thinking and “being.”
Phase Three: Awareness of Two Emerging Separate Mental States
(Dependent and Interdependent)
This phase marks the beginning of the depressive position, the ability
and willingness for reparation to occur, the desire to “repair” the
damage, to embrace guilt, mourn, and express remorse and sadness. It is a
time whereby each partner comes to terms with uncertainly, ambiguity, and
healthy dependency needs. It is a time to heal and listen non-defensively
to one another’s hurts as well as diminishment of repetitive negative
projections. This is the “thinking and healing phase where the experience
of “being” becomes the replacement for the act of “doing.” There is an
added dimension, a richness, an awakening to facing individual issues, and
a window of opportunity for further psychotherapy treatment. The couple
begins to live psychically “outside” the object, as two separate, yet
connected states emerge. Healthy dependency needs are recognized as each
partner begins to respect the needs of the other.
SIX STEP TREATMENT PROCEDURE
Therapist must see couple together before transition into individual
therapy (to form a safe bond, and to caution the partner's not to move
into individual work until the couple is ready (too early separation can
induce a "rapprochement crisis").
Example
A new couple was seen conjointly and soon after individually. The wife
appreciated that I saw her and we agreed to see her husband. She had a
dream that she went into a woman’s house, but ended up getting raped by a
man, who urinated and "came" all over her. Both had their clothes on. Her
associations were with parent who would do things behind her back and a
mother who forced her to eat o eat contaminated chicken. I pointed out how
unconsciously she felt the treatment was contaminated that my seeing her
husband alone, made her feel .
Be aware that couple interaction can diminish individuality.
Therapist must be aware that each partner experiences anxiety
differently, and these differences must be respected (qualitative
differences).
Therapeutic alliance must be joined with member who is predominantly
narcissistic because of the tendency to flight/flee, isolation and
withdrawal can pose a serious threat to treatment. The borderline must be
provided empathic responses as the bonding with the narcissist is being
accomplished.
A narcissist husband is mortified to find out about the many affairs
his borderline wife is having. I try and be empathic toward her (the
borderline) by attempting to "understand" how she may need many "daddies"
to make up for the loss of her dead father. He leaves only to never return
liking my" empathic" stance as confirmation/validation" of her behavior. I
soon learned how important it is to bond first with the narcissist (his
damaged vulnerable self).
The more primitive the couple, the more structure, simplicity, and
clarity they need. Secure the frame, but not expect immediate results. It
may take time to develop clear treatment boundaries. As the resistance
unfold weave them into the relationships and gradually into the "couple
transference" (fears of being trapped, annihilated, betrayed). The deep
unconscious wisdom system appreciates the sound frame as a clear reference
point and offers strong support for the therapeutic work.
When individual treatment occurs in conjunction with conjoint
treatment, the same basic guidelines apply. The work must focus on
conflicts related to the relationship still under the umbrella and
guidelines of conjoint treatment.
TREATMENT POINTS AND TECHNIQUES
- Don't be afraid to confront the aggression. Speak directly to the
aggression with technical neutrality, by making clear, definitive
statements. Be empathic toward the pain and the patient's
vulnerabilities, but avoid getting drawn into the couple's battle.
- Continually set goals, reevaluating and reminding patients of
treatment goals (why they came in the first place!).
- Avoid asking too many questions and obtaining lengthy histories.
Don't waste time. Start right in. The history and background information
will automatically unfold within the context of the therapeutic
experience and the transference.
- Avoid self-disclosure, touching or consoling the patient, making
unyielding concessions.
- Listen and be attentive. Maintain good eye contact, speak with
meaning and conviction. Talk directly to the issues.
- Use short clear sentences, keep responses direct, mirror and reflect
sentiments with simple responses and few questions.
- Keep in mind a "normal couple" or "ideal couple." This image will
sharpen your focus and safeguard from getting lost within the couple's
psychological "dance."
- Explain how one may project a negative feeling into the other, but
try and understand why the other identifies with what is being projected
(focus on the dual projective identification).
- Listen for the theme. Be aware of repetitive themes. The subject and
feelings may change, but the theme is pervasive (betrayal, abandonment,
rejection fantasies).
- Help the couple recognize "normal" and healthy dependency needs.
- Recap the dynamics at end of each session aware of the qualitative
differences.
Avoid:
"You both feel betrayed, you both feel abandoned, you both feel
anxious.”
Prefer:
“You (N) feel anxious whenever your sense of specialness is
threatened, and you (B) feel anxious whenever you feel a threat of
abandonment or betrayal.”
HOW TO LISTEN FOR A THEME
- Listen to the Words (External/Internal)
- Robber (External Robber-Internal Robber)
- Judge (External Judge-Internal Robber)
- Policeman (External Policeman-Internal Policemen)
- Rapist (External Rapist-Internal Rapist)
- Betrayer (External Bankrupter-Internal Bankrupter
- Traffic (External Traffic-Internal Traffic)
"Yes, there can be an external robber, your husband whom you feel
robs you of time, attention, but there can also be an internal robber,
part of yourself."
Yes, there can be external husband judge, who controls and watches
over your every move, but there also can be a very harsh internal critical
judge who inhibits your every move and desire (the harsh superego).
Yes, there can be an external husband policemen, who tickets your
every move, but there can also be an internal policemen who inhibits your
every whim and desire.
Yes, there can be an external rapist husband, one who rapes your
mind, takes over your thinking, but there can also be an internal rapist,
one who disavows your thoughts, devalues your own ideas, goals, and
wishes.
SUGGESTIONS FOR THE COUPLE
- Don’t attack, retaliate or get into the battle.
- Wait for a quiet time to engage in discussion and be sure to follow
through.
- Don’t leave the room mad. If the person gets too “heated” reassure
that you will return in a short time when he/she calms down (do it and
mean it).
- Stay differentiated, don’t get hooked into the deception or the
manipulation.
- Trust that you have been manipulated and deceived, don’t question
it.
- Don’t wait for the “right time,” it is never the right time!
- If your partner withholds time, money, won’t let you, for example,
decorate the house. Go out immediately and hire a decorator, and spend
money (the “real relationship” will unfold).
- If your partner is a narcissist be sure to address issues his
strength, attributes and what you appreciate about him; gradually let
him know what he does that is hurtful to you. Don’t attack show him, you
understand, but don’t give up your own needs.
- If he’s a borderline and flies into a rage, do not move remain
absolutely still. Do not say a word. Agree to own up to the part he
might be right, and repeat again and again that even if he is right he
has no right to attack or verbally abuse you.
- If he gets angry, screams, yells complains that you are interfering
with his work, his friends, his family, remind him again and again that
you come first, that you and the relationship are most important.
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