The Many Faces of Abuse
Treating the Emotional Abuse of
High-Functioning Women (HfW)
by Joan Lachkar, Ph.D.
Course Proposal For
Southern California Psychoanalytic Institute
INTRODUCTION
I'd like to welcome you all here to "The Many Faces of
Abuse!" This course is about couples who never lay a hand on each other. It
is a about a segment of women who have not been given much attention in
psychological literature, which I refer to as the High-Functioning Women.
These women are successful, and because they are successful are often
envied, idealized, and tend to draw less sympathy from other (often
ridiculed). "What? you a lawyer, a judge, a psychoanalyst and you are
abused! You of all people should know better!"
Even though these women are not living in Saudi Arabia, nor are they Burmese
Brides being burned to death over the coals, they are still the targets of
men's aggression. According to recent surveys, men are more often the
perpetrators, and it is more often the women who fall prey to this form of
psychological domination (women more masochistic/ men more sadistic). So
unless someone is beaten, raped, or physically assaulted, it is difficult
for most women to admit or even realize they are being abused, especially
when they identify with it, feel "deserving" of it.
As most of you know this work is based on my first book, The Narcissistic /
Borderline Couple, and my most recent book, The Many Faces of Abuse:
Treating the Emotional Abuse of High-Functioning Women. In
Narcissistic/Borderline Couples, I describe what happens when a narcissist
and a borderline join together in a marital bond or "bind" how each one
stirs up many unresolved conflicts that fulfill each other's conscious and
unconscious needs. The revelation is that each partner needs the other to
play out their drama that is an individual with a borderline character is
inclined to attract as an object choice a narcissistic personality. Although
these are not clear entities narcissistic states, traits, and
characteristics do tend to vacillate back and forth.. I then speculate as to
what bonds, attracts or keeps these individuals together (why couples stay
in painful conflictual relations).
This has not been as easy book to write. It is difficult enough to write
about. It is difficult enough to discuss "normal couples" let alone abusive
ones. Even "normal couples" will from time to time "abuse" each other, the
only difference is with normal couples, conflict and aggression (envy,
jealousy, money) does not interfere with the capacity to maintain a
loving/intimate relationship. In pathological bonds, conflict DOES interfere
with the capacity to maintain an intimate relationship (this is where
envy/jealousy, cruelty/sadism, pain/pathological excitement festers, and
becomes the replacement of love.
So today I will venture to go beyond Narcissistic and Borderline relations
to encompass a variety of different kinds of dyadic configurations such as
what happens when a histrionic personality hooks up with an
obsessive-compulsive, a narcissist with a borderline, or a dependent with a
schizoid.
Today I Will Begin By:
(1) Defining emotional abuse (how if differs from physical
abuse;
(2) Define the High-Functioning Woman;
(3) List of Warning Sings;
(4) Theoretical Considerations,
(5) Describing five types of male abusers (the
narcissistic abuser, the borderline abuser, the passive-aggressive abuser,
the obsessive-compulsive abuser, and the schizoid abuser);
(6) Psychodynamics, "the Dance of the Couple; " the idea
that there not only a "dance" between the couple, there is also a dance
between their psychodynamics (guilt/shame, envy/jealousy
Example
A narcissistic husband projects a feeling into his borderline wife that she
is worthless/not entitled. He complains:
"All you do is nag, nag, nag." Not knowing how to
legitimately express her real, the borderline wife continues to nag even
more. The more she nags, the more he withdraws, as he withdraws she nags.
As she nags, she hooks into his harsh punitive superego (guilt), and he
into her persecutory primitive one. He ends up feeling guilty and she
shame (it becomes a dance between shame and guilt).
TREATMENT SECTION
TREATMENT
Psychoanalytic technique and theory are meaningless unless
they are artistically, emotionally, and creatively executed. Every
psychological movement, like every step of a dance must be sensitively
expressed with meaning, purpose, and conviction. The therapeutic task is to
link what occurs externally with the internal life of the patient(s). Let
begin with transference and couple transference.
Central to our concerns are the narcissistic/ borderline bonds, and here we
will focus primarily on diagnosis and treatment. There are three qualities a
couple therapist must have: The first is empathic attunement, the second is
confidence, and the third is enough arrogance to break through resistance's
and defenses. Creativity, good technique, clear boundaries add greatly to
bonding with couples, but it is primarily the frankness and directness of
the therapist that provides the basic tenor and brings a breath of fresh
light into conjoint analytic endeavor.
Transference and Countertransference
How to confront the aggression, weave in the "couple
transference;" to identify the internal/external abusers; how to make use of
the mutual projections (dual projective identification); Three Phases of
Treatment; Treatment Steps/Points; Then I will introduce the "V" spot, the
tricky part is (how we help the woman understand her participation in the
abuse without making her feel she is RESPONSIBLE FOR IT.
(1) The Couple Transference (how couple conflict gets
transferred onto the therapist;
(2) Projective/Introjective Process;
(3) Dual Projective Identification (a term devised to
describe the couple's mutual projections);
(4) Internal/External Abusers; There can always be an
external abuser, but also an internal abuser. This becomes a very tricky
thing. How do we help her understand that although she is not responsible
for the abuse, she is an active participant;
(5) Six Point Treatment Steps, Treatment Points, Three
Phases of Treatment Couples go through, suggestions for the Couple, Case
Material, and Questions/Discussion.
In treatment, one of the most important things is to confront the
aggression. Some therapists have a tendency to confuse empathy with
kindness or sympathy. We do not empathize with the aggression, but with
the vulnerability.
"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."
DEFINING EMOTIONAL ABUSE
Emotional abuse is defined as an on-going process and
differs from physical abuse in that one person psychologically, either
consciously or unconsciously, attempts to destroy the will, needs, desires
or perceptions of the other. Although emotional abuse has been inextricably
linked to physical abuse, it is viewed as a separate entity. The most
salient feature of emotional abuse is its insidious nature. Physical abuse
is usually cyclical and intermittent, whereas emotional abuse is often
continuous and omnipresent. Psychological abuse has been defined by as
including verbal and behavioral means to undermine someone's sense of self,
resorting to such tactics as ridiculing, shaming, blaming, criticizing,
threatening and neglecting the partner's emotional needs.
According to Loring (1994), there are two types of psychological abuse:
overt and covert. Overt abuse is openly demeaning and defacing (e.g., verbal
remarks, put-downs, constant criticisms), but covert abuse is more subtle,
hidden, but no less devastating. Until now, we have not had a clear
definition of what constitutes emotional abuse or therapeutic guidelines for
treating the distinct problems as it impacts on the high-functioning woman
who is verbally and psychologically mistreated.
DEFINING THE HIGH-FUNCTIONING WOMAN (Exposed)
Not every emotionally abused woman exhibits the same level
of early trauma or a proclivity toward developmental arrest. So I have
divided into two categories: (1) the "higher level" HFW and (2) the "lower
level" HFW. The level of functioning is in accord with the level of
splitting or regressive mechanisms ranging from the degrees of impulse
control, acting out, addictive or compulsive behaviors, capacity for reality
testing, and the structure and level of defense mechanisms.
The "higher level" HFW operates at a more advanced level of ego functioning.
She is AWARE that she is being abused, does not feel deserving of it, has a
resilient and intact ego and superego. She may not have been exposed to
early trauma, and reality does offer her relief. Her judgment is not
obscured or impaired. But because of her high functioning status she may
feel too shameful to admit she is being abused; when she does, she is either
ridiculed or not believed. Her external life often reveals a highly
motivated, energetic, well-educated, and career-oriented woman using many
creative capacities to achieve status and to become successful. In her work,
she may be decisive, comfortable with her autonomy, and extremely competent
in the fulfillment of her decisions and responsibilities, but in her
personal and family life, she may operate at many different levels of ego
functioning.
The Lower Level High-Functioning Woman (HFW)
The "lower level" HFW, theoretically operates at a more
primitive level of superego functioning, is characterized by many unresolved
preoedipal struggles, and dominated by such primitive defenses as splitting,
projection, projective identification, envy, shame/blame, magical thinking,
omnipotent denial, and persecutory anxieties. She has been exposed to
traumatic experiences, and reality testing DOES NOT offer relief. These
women often feel deserving of the abuse and imagine that everything is their
fault. "Is this really happening to me or am I imagining." These women have
often played the role of caretakers or parentified children, those forced in
early years to relinquish their childhood and to perform adult functions for
their parents or siblings. They are the "little adults," the mediators, the
children who grew up too early and much too soon (Lachkar, 1992, 1997,
1998).
Kathy and Tim
One of my first HFW was Kathy who contacted me while living in Alabama in
June 2000. Her concerns were over severe depression and anxiety exacerbated
by a torturous painful and abusive relationship with Tim an ex convict. She
complained that although her relationship was tumultuous, combative, it was
also enormously wild and intense. Tim would replay her worse nightmare of an
unavailable/betraying father, e.g. make plans on major holidays, birthdays
and then at the last minute, not show up (out drinking beer out with the
guys).
When she first contacted me she was in the process of completing her
psychiatric residency. Kathy was an unusually attractive, personable, bright
young woman with a great analytic mind. She had an aversion to perfunctory
forms of therapy such as those she encountered in prior treatment. One
therapist advised her to simply break up. Another offered hypnotherapy.
Another terminated her on the basis she was “resisting therapy.” Another
claimed it all had to do with repressed memories. Another said she didn’t
need treatment just need another relationship. None of them seemed to
recognize that the kind of treatment Kathy needed which required a highly
specialized form of treatment.
Kathy first met Kurt at a halfway house where Chris was held for robbery and
drug charges while she was doing her internship. “It was love at first
site.” They lived together for two years. Later, Kurt was in jail for
hitting a police officer. Kathy became more withdrawn, depressed, and
shamed. “What would happen if my friends/colleagues/interns found out about
him. ”I let her know it was hard for her to imagine that anyone could be
empathic to her dilemma, how one can get sucked into the private madness of
a love bond. While in jail they continued their relationship through
correspondence upon his release they broke up.
Father left home when Kathy was two years old, always cancelled plans
because he had to be with his girlfriends. Mother depressed, drinking and
sexually abused her when she was seven years old (asked to tickle her
vagina). She went to her father’s house only to find his girlfriend in the
dead in pool drunk.
Meanwhile, Kathy excelled in school, was a straight A student and performed
extremely well in all different areas. Eventually she listed personal ads,
started dating and developed a new relationship with Mark, a clinical
director of a hospital where she was interning. Although Mark, was a marked
improvement over Kurt, he still reenacted similar unavailable daddy dynamics
(later we will read a case of Kathy and Mark).
The other therapist never helped Kathy understand that she really wants love
but that she was in an addictive obsessive relationship which served as a
cover to mask things Kathy was avoided in her life dissertation, social
contacts, parents).
They offered “advise” but failed to over a transitional space to help her
deal with her shame and withdrawal. They lacked the attunement with her
psychological state of mind. Kathy read my book on N/B Couples and said
“Aha”, this is what I needed. We proceeded with telephonic sessions on a
twice a week basis.
Letter from Spain
Sometimes I feel like Dear Abby, received an email from a University
Professor in Spain bitterly and brutally emotionally abused by her German
boyfriend.
"I have been trying for nearly a year and a half to
recover from an extremely abusive relationship with a man who I classify
as a malignant narcissist." She recounts the most horrific event after
visiting his sister at her house in Germany." In middle of the night I
asked my boyfriend where I could use the toilet. He vehemently refused and
warned me that I dare not awaken his sister" (they were in the basement
that had only a sink). "I got desperate that I jumped on the sink and
peed. He then yelled and screamed at me and blamed me for breaking the
sink. As it turned out there was no damage but he would not stop blaming
and furthermore he never apologized."
THEORETICAL IMPLICATIONS (didactic)
I am amazed since writing N/B Couples, the amount of
therapists who have extended beyond narcissistic/borderline relations.
Within these thematic motifs, we now have "Narcissistic Vulnerabilities" in
Couples (Levene, 1997), the Narcissistic Couple (Kalogjera, et al.), the
"Masochistic-Narcissistic and Polarized Traits" in couples (Glickauf-Hughes,
Cheryl (1994), "Narcissistic-Overgiving Couples," Borderline-Codependent
Pairs" (Nelsen, Judith. 1995), The Narcissistic Disorders and
Dependent/Narcissistic Couple (1998). Others have gone beyond this malaise
to a garden variety of maladaptive strains. Carlson and Sperry in The
Disordered Couple (1998), include "the Psychotic Couple," the "Eating
Disordered Couple." (These authors really narcissistically injured me when
they remarked, "Lachkar makes made to much of a big deal about her N/B
Couples!"
Expanding beyond narcissistic/borderline relations, I have come to recognize
narcissistic vulnerabilities in other disorders. Not only are there
narcissistic/borderlines, narcissistic obsessive-compulsives, narcissistic
passive-aggressives, but there are "many faces' and phases of narcissism,
the grandiose self is the emotional virus that infects and invades the
relational love bond. There is nothing worse than a grandiose borderline or
obsessive-compulsive. This gets confusing because when we speak of
narcissistic and borderline disorders, which narcissist or borderline are we
talking about? A Freudian narcissist? A Kernbergian narcissist? A borderline
narcissist, an obsessive-compulsive narcissist, an antisocial narcissist, a
histrionic narcissist, a depressive narcissist, or a malignant narcissist?
So although they may all show the same "face," they form different modes of
dyadic attachments. We must remember there are also narcissistic therapists
who think they know it all, are blessed with special therapeutic powers, and
refuse to seek out treatment or further training or supervision.
So whose narcissist or whose borderline are we talking about? We must also
keep in mind there is such thing as healthy narcissism, pathological
narcissism, malignant narcissism, antisocial, cultural narcissism. In my
country we do it this way!" The worst kind is the antisocial. Why?
In reviewing the literature, I have not found anything too innovative. The
most inspiring material oddly came from non-conjoint therapists.
Behaviorists, too directive, ask too many questions, the object
relationship, too confrontive, focus too much on the internal world. The
self psychologists are "too empathic," focus too much on the external (self
objects). The difference between the psychoanalytic/psychodynamic model and
the cognitive approach is that the COGNITIVE holds the RELATIONSHIP to be
number one priority. The PSYCHODYNAMIC approach holds the INDIVIDUAL to be
number one priority. Who is the patient? Is relationship the patient or the
individual the patient? My approach begins with the relationship as the
patient and to gradually weaning the couple away from "the relationship" to
that of self development. Initially the relationship stirs up many
unresolved issues. This approach holds that even when the therapist is
confronted with the "impossible "couple" or when one partner throws up his
hands to the "impossible partner," there is a new window of opportunity to
venture into virginal territory never before explored (the unconscious or
repressed conflicts the "impossible partner" arouses.
Drawing from many different theoretical frameworks, I have abstracted
concepts mainly from mainly classical psychoanalysis, self-psychology and
object relations. Although many think that SP and OR are an "odd couple"
relationship, they can work together beautifully. Klein's contribution is
invaluable in the treatment of couple's therapy especially in helping
couples face internal deficits, distortions, and projections. This includes
the introjective/projective process, a priceless construct in helping us
understand the entangled web couple weave, or what I have referred to as
"the dance" (how one partner projects a negative feeling into the other, and
how the other then tends to identify or over identify with that which is
being projected. These are interactions that go round and round, are
on-going, painful, circular never-ending (like a "rondo). In conjoint
treatment, we see how certain dynamic mechanisms of the narcissist
(grandiosity, entitlement, guilt, withdrawal) can arouse and stir up states
of anxiety in the borderline (unworthiness, non-existence, shame, blame
envy, abandonment and persecutory anxieties).
Otto Kernberg on his work on Perversion and Aggression focuses on the use
and misuse of aggression as he describes four different kinds of love bonds
distinguishing between normal, pathological, perverse and mature.
Different Kinds of Love Relationships: people are obsessed talking about
their relationships. In fact they are so busy talking about them, they
hardly have the time to have them. This is because relationships are not
simple, for they are comprised of many complex and interrelated aspects of
love, hate, envy, jealousy, aggression, rivalry, submission, perversion,
pre-oedipal/oedipal conflicts, as well as many early unresolved infantile
conflicts issues His premise is that in normal love even couples may fight,
abuse, hate each other, the relationship overcomes the conflict. 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. It perverse love, it is the
excitement that takes over and in mature love the focus is more on mutual
goals/tasks.
A man falls in love with a woman with big breasts only to find he wants to
destroy any man who looks at her. This would fall into the category of
pathological love, for it is the envy that becomes the dominant force as the
replacement for love
In perverse relations one seeks excitement, because pain is often linked to
the love object, it also becomes highly charged and sexualized, and this is
what I have referred to as "traumatic bonding" (Lachkar, 1998). Because the
pain is linked to the love object, it also becomes highly charged and
sexualized. This is what I have 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."
Other Theorists
Arnold Rothstein (1992), although a hard-core psychoanalyst who entered
conjoint treatment through the back door (treated a couple as a favor),
views couple therapy as a defensive operation camouflaging internal
conflicts. Hew views success occurring when partners gradually are
transformed into analytic patients. Without relinquishing his classical
training, he remains faithful to the psychoanalytic model. Although, I may
not agree completely with his stern position, I cannot help but hear his
voice guide me as I consistently ask myself, "What is being covered Up?"
"What is the couple defending against?"
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
(often 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.
Fairbairn
I am very grateful to Fairbairn more than anyone help us understand why
couples stay in painful relationships, forever attached to a painful
internal objects to "bad" internal objects (rejecting, insatiable,
unavailable).
Pain stirs up an amalgam of unresolved developmental issues as each seeks
out the other to play out their internal drama. As bad as the pain is, it is
still better than the emptiness, the nameless dread, the void, or facing the
black hole. As least the pain provides one with some semblance of meaning
(suicide bombers). At least I feel alive, I know I exist!"
Fairbairn expanded Klein's notion of the good and bad breast, to the idea
that the ego doesn't split into merely, two parts but into much different
subdivisions (rejecting object, a tantalizing, tormenting, the aggressor,
unavailable object). So in treatment it is our job to gradually wean the
patient away from her external abuser to that of her internal one. Yes,
there can always be an external abuser (controller, withholder, betrayer,
attacker), but there can also be an internal of, some part of yourself that
holds you back "You say your husband doesn't want to spend time with you,
but you are also telling me that you don't want to spend time with yourself.
When alone you feel miserable, persecuted, sad, depressed…….."
I am reminded of a scientist married to a very borderline wife involved in
an interminable court custody battle. It almost became a "cult-like"
experience where everyone turned against him. They all saw him as "bad
parent" and she as the poor victimized "good parent" (turned against him,
giving way to other siblings). He spent years, time and money, trying to
prove them wrong, he wanted to be viewed by the court of judges, lawyers,
mediators as the "good parent." For years he was obsessed trying to figure
out how "all these people," couldn't see the problem was with his borderline
wife. Emotionally he remained forever attached to the his internal abusive
family, the "family court of pain."
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
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 (See Momma Cartoon)
• Envy/jealousy
• Blame/shame/retaliation
• Dependency/omnipotence (See Dep. Cartoon)
• Withdrawal/detachment and attachment
Shame
Shame is a matter between the person and his group or society, while guilt
is primarily a matter between a person and his conscious. Shame is the
defense against the humiliation for having needs which are felt to be
dangerous and persecutory. Shame is associated with anticipatory anxiety and
annihilation fantasies. "If I tell my boyfriend what I really need, he will
abandon me!"
Guilt
Guilt is a higher form of development than shame. Guilt has an internal
punitive voice which operates at the level superego (an internalized
punitive harsh parental figure). There are two kinds of guilt: Valid guilt
and invalid guilt.
(Show guilt cartoon)
Envy
Klein made a distinction between envy and jealousy. Envy is a part-object
function, is not based on love. Melanie She considers envy to be the most
primitive and fundamental emotion. It is a part object process that is not
based on love, it exhausts their external objects, and is destructive in
nature. Envy is destructive, possessive, controlling, and does not allow
outside intruders in.
Jealousy
Jealousy, unlike envy, is a whole object relationship whereby one desires
the object, but does not seek to destroy it or the Oedipal rival (father and
siblings, those who take mother away. Jealousy has is based on love, has an
Oedipal component, and is a triangular relationship. Jealousy, unlike envy,
is based on love, wherein one desires to be part of the group, family, clan,
nation. included in the group, the clan, the family. Jealousy has an Oedipal
component, is based on love, and is a higher form of development than envy.
It is a triangular relationship, in which one seeks the possession of the
loved object and the removal of the rival.
Withdrawal vs. Detachment
John Bowlby's work on attachment stresses the difference between withdrawal
and attachment. Detachment is not to be confused with denial or withdrawal.
Actually, withdrawal is healthier because it maintains a certain libidinal
attachment to the object. When one detaches, one goes into a state of
despondency. Children who are left alone, ignored, neglected for over long
periods of time enter into a phase of despair. The child's active protest
for the missing or absent mother gradually diminishes when the child no
longer makes demands.
PSYCHODYNAMICS OF THE COUPLE
Narcissistic/Borderline
• Guilt/shame
• Attack/blame/withdrawal
• Entitlement/victimization
• Omnipotence/dependency
Passive Aggressive/Obsessive-Compulsive
• Shame/guilt
• Withdrawal/Dependency
• Caretaker Role/baby husband
Obsessive Compulsive/Histrionic/Dependent
• Control/domination
• Guilt/Shame (Internal dirt)
• Obsession with order (internal dirt)
• Schizoid/Histrionic/Dependent
• Clingy/detachment
• Abandonment/dependency
• Different Kinds of Mothering Experiences
Donald Winnicott (1965) is another prominent figure whose unique ideas and
language have enhanced and expanded the diversified field of object
relations. His focus, like Klein, was on the importance of the early "mommie
and me" [change this mommie to mommy] relationship by providing us with
different kinds of mothering experiences, through the "being" mommy, the
"doing" mommy, the holding mommy, the environmental mommy, and the
background mommy, the infant's capacity to be alone. (add play). He
developed the idea of false self vs. true self and transitional objects (the
desire to fuse with mommy and hold on to image to make new contacts
I remember my first abusive couple. I was a little nervous because the woman
was a training analyst and had seniority over me. They came in, sat down,
and immediately she offered a barrage of complaints. "He doesn't do anything
for me. I want to go to the movies and he hates movies, I want to go to
dinner, and he wants to eat home, I want to go on a trip and he tells me he
has already traveled the world and is not interested. He is only interested
in himself, his work, his writing, his football." He then says, "the problem
with you is that you are too demanding all you do is want things from me.
Why don't you just leave me alone and give me my space". You know, she says,
"you're full of shit", he responds, "no you're full of shit, you just don't
know how to leave me alone". Then moments later, she perks up, becomes calm,
analytic, perceptive, and makes for very clear and confrontive statements. I
mention the sudden shift and say something stupid like, "I can see one part
of you functions so magnificently, and the other part of you looses it and
becomes a little girl. After all you are a doctor, a training analyst". Then
she lets me have it. "I am not an analyst, when I'm here you are the
analyst." I leave that to you. My whole life I have been the caretaker,
having to take care of others. Now I want to be taken care of.
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. This will be discussed further in the "Three Phases of Treatment."
DIFFERENT KINDS OF ABUSERS
The Narcissistic Abuser
The narcissist is the special child of God ("His Majesty The Narcissist"),
has excessive entitlement fantasies, exaggerated sense of self, is
preoccupied with self, is dominated by such defenses as guilt, idealization,
omnipotence, grandiosity, and when not properly mirrored will withdraw or
isolate themselves. They value such things as fame, physical beauty, wealth,
material positions, and power. When narcissistically hurt or injured they
will relentlessly hold on ("archaic injury" or the "V" spot). The most
common archaic injury is the mother who usurped this special baby from his
"thrown," his baby high chair position to make way for a new sibling, Often
the narcissist will spend the rest of his life in a kind of narcissistic
nostalgia, yearning/longing to recapture the time when mommy and baby were
one (living in harmony and symbiotic bliss). Any threat or reminder will
trigger narcissistic injury.
The Narcissistic Partner
What kind of a woman chooses a narcissist? Usually a borderline woman.
Borderline women are often attracted to narcissistic men who stir up old
archaic injuries, those who make them feel insignificant, unimportant, and
forever shameful for having needs or desires (see chart). These women do not
feel deserving, do not have a sense of self, and do not feel entitled. Even
though she may be high functioning at one level, she operates at the most
primitive level at the other. Because the narcissist cannot allow himself to
be dependent or needy, he unwittingly projects his needs into her.
"It is you who are the needy one!"
You can imagine what this does to the borderline partner who
already has a thwarted sense of development. So together they "do the
dance," as he projects his split-off "needy" self into the borderline, she
then identifies or over identifies with The idea it is bad to have needs.
She's too needy, all she wants is more! More! More! More!
This can be a wonderful segue into the couple transference
when he (the narcissist) enacts the same scenario, making the analyst feel
worthless and shameful.! Me! I don't need your either, not your or this
treatment!"
"So now I am the needy one like your wife. I can see now
why you are so attacking, you feel it is bad to be vulnerable, makes you
feel little and small as when you were a baby. So now I am the one needing
you”.
Suggestions for the Woman
Do not confront. Narcissists do not respond to confrontation. Find the same
way to express yourself through use of empathy, bit do not let your
“understanding” become the replacement for action. Perhaps you are too
demanding, but you are never too needy. If you are told you are too needy,
then go out immediately and do things, buy things, join things, make
friends, don't sit around. Do what ever you have to do to make yourself feel
worthy. This shift will make you feel more entitled and important. You will
start to feel a new inner vitality. Do not withhold from yourself. When you
start acting like you are entitled you will feel different and people will
treat you differently. When he withdraws, don't sit around and mope or
attack, tell him that you will return and talk when he has calmed down. Go
out - see friends, go to the theater, have an alternate plan - like
earthquake planning. When he comes back - he'll have to wait for you! Return
happy and satisfied, like your own needs have been met. Begin development
your own new space of entitlement (the transitional space).
The Borderline Abuser
The borderline is the one dominated by shame/blame defenses, persecutory
anxiety, profound abandonment anxiety, and such primitive defenses as
splitting, projection, projective identification, and omnipotent denial.
They form parasitic attachment through seduction, manipulation,
victimization and pain. Unlike the narcissist, they do not have a sense of
self, do not feel entitled, and will do anything to establish some semblance
of bonding or relatedness. As a consequence have poor impulse control, poor
judgment, and distorted sense of reality. Often they are the Don Juan's and
operate by an exquisite "false self" (the self that belies the "true self).
In conjoint treatment, therapists often get sucked into unwavering
persuasion and seductive lures, making it difficult to keep reality
straight. Typically, borderlines have been abandoned, either by absent
parents, alcoholic parents, abusive parents, or emotionally unavailable
parents. They frequently perpetuate the cycle by enacting the role victim by
bonding with their objects through pain (either self or other inflicted).
The inability to face any internal deficits, tendency to blame/shame keeps
them in an endless state of impoverishment.
"I'll do anything, just don't leave me!"
"When I mutilate myself, it hurts, but at least I know I'm alive!"
The Borderline Partner
What kind of a women who chooses a borderline partner? Typically a
narcissist. Someone who needs a great deal of attention, a lot of mirroring
and who becomes easily seduced by the borderline's exquisite false self and
seductive powers. The borderline is pre-scripted and pre-programmed to do
what others have done in the past. He is to first seduces and then betrays.
He promises and then he lets down. His inflated rhetoric and seductive
qualities makes initially makes her feel like as though she is the only
woman in the world. He will promise her the world, only in the end to bring
disappointment and emotional pain. Because of product early trauma he
emotionally has learned how to brilliantly stir up and tap into the most
vulnerable area ("V" Spot), a deep reservoir of unrequited "mirroring.
Suggestions for the Woman
Unlike the narcissist, who is in need of empathic responses, the borderline
responds more to confrontation. Be prepared, remember, at any given moment,
he will attack, insult, or betray you. You feel confused because only
moments ago he has promised you the world. He is a wonderful lover and knows
exactly how to please you, is aware that you need a great deal of love
attention, and admiration. You are a perfect target for his ammunition.
Suddenly out of the blue he will insult you, tell you your breasts are too
small, start comparing you to other women, sabotage your plans, not show up,
embarrass you, etc. Do not play into this. Set boundaries and limits. Tell
him exactly what you expect will or will not tolerate. Remember if he
doesn't show up, tell him next time you will take your own car. If you start
to feel abandoned, remind him of his past hurt, that he is that he is really
projecting. Remember, do not personalize it, do not withdraw, this will
exacerbate abandonment issues even more. Most of all don't collude with his
craziness. Be strong. confrontive, set boundaries, limits and stick to them.
This will help you keep things straight and from your "V" spot
narcissistically wounded again and again.
Passive Aggressive Abuser
There is nothing worse than being married to a passive aggressive. The
passive-aggressive is one of the most difficult to treat, for he is always
trying to recreate the parent/child dyad. They are the couch husbands, the
forgetful ones "I'll do it later, I'll do it tomorrow, the car broke down, I
forgot, I lost the keys, check book, couldn't go to the market, the store
was closed, couldn't do the taxes because the number of the accountant got
lost." He forgets, delays, avoids, conjoles, make endless barrage of
excuses, or do anything. "I'm a good little boy and you are the bad mommy!"
In therapy will repeat the same patterns. PA express their rage but they do
it in silence, often coercing their partners to become punitive parent. In
therapy will repeat the same patterns.
Passive-Aggressive Partner
What kind of a woman would hook up with a passive-aggressive? They are often
obsessive-compulsive, with perfectionistic qualities (with
borderline/masochistic tendencies), often woman who have been pre-programmed
to take on the role as caretakers. Since they have been caretakes all their
lives, they move easily into this role, but they are angry and they resent
it. These are the women who had to relinquish their childhood became thee
"little adults," or the parentified child), little girls who had to grow up
much too fast and much too soon. Often they had to be in charge of younger
siblings to be parents to their own parents. The passive-aggressive
unconsciously stirs up anger and resentment in his partner by manipulating
her into the never-ending role of the caretaker, the "little adult," these
are the children who grew up much too quick and much too soon.
Suggestions for the Woman
Stop enabling him. If he continuos to forget to go to the market, then there
will be no food. If he forgets his check book, then there will be no bills
paid. Have alternate backups that can protect you. Do only the things you
can follow through. Do it and mean it. To continue to relieve him will
continue to stir up your "V" spot and make you angry. Remember even though
you are a FHW (being the caretaker may work for you at work, but not in your
relationship). You a not his caretaker! You are an equal partner!
Example
Wife asks what he wants for dinner. He replies, "Anything,
I don't care." She says, "How about fried worms!" No response, he falls
asleep on the couch!" Then cook for yourself or for you and the kids.
Obsessive Compulsive Abuser
Another difficult character to live with is the obsessive-compulsive, one
obsessed with orderliness, cleanliness, perfectionism, void of feelings, a
work-a-holic, and invariably puts his partner down for having emotional
needs or desires. He is pre-programmed to be withholding, always making work
come first. He keeps his partner on hold, waiting and never has enough time
for her. Under the guise of efficiency or doing things for "the good cause,"
he will find justification to work, work, work. These are also the pack
rats, the clutterers who can't throw anything away. Think of Jack Nicholson
in "As Good as it Gets," under the guise of self-righteousness, they can act
out their most anal fantasies, usually to cover their own mess (projected
dirty unwanted parts of themselves). The obsessive-compulsive has a more
integrated ego, has better tolerance for anxiety, impulse control, and even
though he may be harsh, strict, he has a well integrated superego. His
conflicts center more around repression rather than primitive defenses as
with borderlines dissociation, splitting, projection. How do these traits
affect the couple's love bond?
Obsessive Compulsive Partner (stable, makes good living)
The obsessive-compulsive has a more developed and well-integrated ego, has
better tolerance for anxiety, impulse control, and a harsh, has a strict but
well-integrated superego. He may be more neurotic than the borderline where
conflicts with the obsessive-compulsive center around repression rather than
primitive defenses.
Obsessive-compulsive men often hook up with histrionic women initially find
her exciting and bubbly personality an immediate attraction, part of himself
he has ago abandoned (free-spirit, bubbly/lively). For her, his stability
and semblance of order provides a feeling of security. But as time goes the
dynamics change. Her bubbliness is experienced as mess and dirt, and his
withholding qualities injure her self worth as a woman. Together they
desperately seeks some missing aspects of themselves in the other.
When an obsessive-compulsive hooks up with histrionic hook up they play
common scenario. Initially, the obsessive compulsive is drawn to histrionic
women, only later to become repulsed by her because she represents the messy
dirty part of himself. Initially she exhibits an emotional presence he has
long abandoned. He finds her jubilance, warmth outgoing personality
attractive, later he finds her too clingy, need, and later disgusting and
dirty. As time goes by she begins to represent more and more the "dirty"
needy part of himself which he guards against by obsession with cleanliness
and order. Histrionic women are always prone to some emotional crisis;
immature talkative, showy, exhibitionistic, highly emotional, cries easily,
yet very sentimental and romantic. They are outgoing and excessively
dependent on others. At the very core they want to be loved, to be the
center of attraction, are seductive, provocative and use their sexuality to
engage men. Typically they choose as an object men who are unavailable or
involved with other women.
Example
An obsessive-compulsive lawyer married to a histrionic wife. His
preoccupation with order and cleanliness took precedence over giving his
wife time and attention. The more he turned to his drawers and files, the
more it stirs early abandonment feels and anxieties (archaic injuries of
abandonment, the father that always had more important things to do).
Whenever she wants sex, he dismisses her, accuses her of being "too needy"
and out of control.
The Schizoid Abuser
The schizoid abuser is the one who at the onset is very charming, seductive,
and appears quite sexual. It is only later that we find out how frightened
and vulnerable he is. These are the hollow men, the iceberg, the affectless
men, cold, aloof, and indifferent, aloof (Misogynist men).He is
pre-programmed to fear intimacy and often feel suffocated/ engulfed as soon
as the dance of intimacy begins. Women's vagina's are felt to be dangerous
and threatening. At this point they often want to run or withdraw/detach,
for they cannot maintain an intimate bond. Women are often shocked or
stunned, without warning or notice they will suddenly flee. In the midst of
lovemaking, for example, just before penetration, a schizoid man abruptly
pulls away, puts on his clothes and leaves. The woman is left puzzled and
confused, Gee, we were having such a good time. Oddly enough the schizoid
will commit (to marriage), but his indifferentness, coldness and aloofness
pervail).
The Schizoid Partner
What kind of a woman is attracted to schizoid men? Often they are histrionic
personality types, highly emotional, talkative, showy, exhibitionistic,
women who cry easily yet are very sentimental and overly romantic. They are
seductive, provocative and use their sexuality to engage or lure men. One
can imagine what this does to a woman like a histrionic who has much of her
self esteem tied to her sexuality and seductive powers.
Suggestions for the Woman
His behavior will stirs up in a histrionic woman the most sensitive area of
her "V" spot, her not being desirable or sexual to a man. Since she has been
pre-scripted her entire life to "get excess mileage from her seductiveness
and sexuality, she will feel very abandoned and rejected by the schizoid
detached man. It may be a reenactment of a father who never acknowledged her
as a young woman growing up and developing or maybe gave her "too much."
Your new response will be to act in a new way that will trigger new
behaviors and responses.
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 (Defenses overcome capacity for love)
One who allows their preoccupation with self, exaggerated sense of
entitlement, defense mechanisms (guilt, idealization, 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 (lack guilt)
Antisocial patients typically present a more serious superego pathology.
Instead of valuing the qualities of what the self can provide, to excite, to
entertain, etc. antisocial narcissistic lacks the capacity to experience
guilt. They may steal, lie, steal,, conjole, get caught, even confess their
crimes, yet with no guilt, remorse, or concern. Both are omnipotent in that
they think they can get away with it.
One patient was a loving husband and father. He did all the "right" things,
He was devoted, a hard worker, loved his family and would do anything to
make his wife happy (big lavish Bar/Bat Mitzvahs, Mercedes, Beemers, private
schools). Secretly embezzled money appearing to be the all time "giver" and
donator to "good causes." Yet, when caught by the IRS for income tax
invasion was not able to experience any remorse.
Depressive Narcissist
Unlike the antisocial narcissist, the depressive narcissist is plagued with
guilt embodied by harsh superego. They are dominated by enormous guilt, self
hatred turned inward, are overly perfectionist, the one who knows it all,
when life does not go the way they imagine superego runs they become self
punitive. They are serious, concerned about work, performance, and
responsibilities. Highly reliable and dependable but tend to judge
themselves as they do others harshly. These are the children of parents who
demanded perfection, are totally self absorbed and lost in their sadness,
mourning, and are withdrawn and isolated from others.
p. 257
Multicultural Couples: Narcissistic Vulnerabilities in 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 couples,
inter-ethnic, let alone intermarriage, same sex marriages, blended family
marriages. and step family marriages. The influx of immigrants has lead to
many cultural and societal concerns. Living in a vast and ever-changing
society we as therapists need to learn to cope and adapt to these rapidly
changing times. Today, clinicians must be aware of some of the
cross-cultural and interracial differences (Japanese/American;
Muslim/Israeli). Doesn't take much.
When a person intermarries, they are not only marrying a person they are
marrying a culture (means tying religious, ethnic, and cultural knots).
Treating emotional vulnerabilities is not enough without understanding the
cultural and qualitative distinctions.
You can drink Turkish coffee in Turkey and call it Turkish coffee, but if
you are in Greece drinking Turkish coffee you’d better not call it Turkish
coffee.
These points are examined from a psychological/psychoanalytic viewpoint
incorporating both the intersubjective and objective experience. It is not
enough, for example, to analyze someone's anger or rage (especially if they
are Korean) without considering the Korean concept of "Han" ("rage"). For
the Japanese, it is not enough to understand shame without understanding the
concept of "saving face." The same holds true for guilt, envy, jealousy,
"true self,"/"false self ("tatamae" and "honne."). Consider hierachial
(Middle Eastern and Asian societies) where deference to elders and parents
come first (wives are last on the list). Consider also dependency needs,
mother bonding relations known in Japan as "amae.” In Japanese cultures what
dependency represents for a Westerner is in sharp contrast to what
dependency represents for Japanese (Doi,1985).
A Japanese scholar comes to visit the United States for the first time. He
is invited as a guest to a home of a colleague. He was asked by his
colleague's wife if he was hungry, and would like something to eat. He
responded by telling her he was not hungry, humbly, bowed and thanked her
graciously for her kind offer. Shortly after, he began to feel a burning
rage festering and realized that she (the hostess) did not offer "amae." If
she cared about me she would just know I was hungry and would have offered
me food." In Japan guests are always offered food even if they claim they
are not hungry."
Narcissistic Vulnerabilities in Cross Cultural Couples
How much is cultural and how is pathological? Where do culture and pathology
meet?
We live in a multicultural society, our consultation rooms are beginning to
look like a mini United Nations. Today, clinicians must be aware of some of
the cross-cultural and interracial differences (Japanese/American;
Muslim/Israeli). Doesn't take much. There some good books, For example, if
you get Japanese patient, learn the meaning of "amae" (Japanese for
dependency).
I know I am getting "amae" when he gives me what I need
without having to ask.
Example of Israeli Married to Irish Catholic
Israeli man married to Irish Catholic woman insists she give up her religion
without any consideration of what is important to her. One could argue well
what's the big deal, this can happen with an American Jewish man as well.
The difference is cultural. The Israeli man takes on nationalistic Zionism
attitude which is inculcated the culture since childhood, aggression wears a
different flag.
This is our country!" The only religion is Judaism!
Cross Cultural Issues in Couples
How much is cultural and how is pathological? Where do culture and pathology
meet? We live in a multicultural society, our consultation rooms are
beginning to look like a mini United Nations. Today, clinicians must be
aware of some of the cross-cultural and interracial differences
(Japanese/American; Muslim/Israeli). Doesn't take much. For example, if you
get Japanese patient, learn the meaning of "amae" (Japanese for dependency).
I know I am getting "amae" when he gives me what I need
without having to ask.
THE AMERICAN HUSBAND THE JAPANESE WIFE
Bert: I always ask my wife what she would like to do on
the weekend, where she would like to go, but she doesn't respond. Or else
she tells me anywhere I would like to go is fine.
Th: Then what happens?
Bert: Well, we either stay home or I take her to a movie.
Yuki: Listening attentively.
Bert: I ask her if she is hungry after the movie, and she said she was
fine so we came home. This is when the shit hit the fan. She wouldn't have
sex with me, she withdrew, and would talk to me for days. I can't take it
anymore!
Yuki: But he doesn't offer me "amae."
Bert: What is this crap about amae? All she talks about is amae! I am a
red blooded American male and I don't need this crap about self-
sacrifice. I'm not a mind reader, let her just tell me directly what she
wants. Enough of this shit!
Yuki: In Japan, it is quite common for others to just "know" what the
other needs without asking. To ask appears greedy, self-serving, a
betrayal to our culture. We look carefully into the eyes of others and the
eyes communicate. Bert should have known I was hungry, he should know I
don't like movies. This was a big insult to me!
Bert: But this is not Japan. This is America!
Example of Israeli Married to Irish Catholic
Israeli man married to Irish Catholic woman insists she give up her religion
without any consideration of what is important to her. One could argue well
what's the big deal, this can happen with an American Jewish man as well.
The difference is cultural. The Israeli man takes on nationalistic Zionism
attitude which is inculcated the culture since childhood, aggression wears a
different flag.
This is our country!" The only religion is Judaism!
TREATMENT
TREATMENT
Psychoanalytic technique and theory are meaningless unless they are
artistically, emotionally, and creatively executed. Every psychological
movement is like every step of a dance which must be sensitively expressed
with meaning, purpose, and conviction. The therapeutic task is to link what
occurs externally with the internal life of the patient(s). Let begin with
transference and couple transference.
V A. Transference and Countertransferenc
The psychotherapist faces five major challenges: (1) How to remain empathic
to the abuser while confronting the aggression, (2) How to teach and educate
the couple without falling into the trap of the "quick fix?" "Tell us what
to do? Do we stay do we get a divorce?"); (3) How to introduce the victim to
the "internal abuser" without making her feel responsible for the abuse, (4)
How to we gradually "wean" the couple away from "the relationship" to that
of self development (5) How to make use of the couple transference, (6)
Where do these two pathologies meet?
We obviously won't be able to touch on all these challenges for therapists
face, but it is important to briefly describe the dialectic relationship
between the "internal" and "external "abuser and the couple transference.
These issues are described below.
Psychoanalytic technique and theory are meaningless unless they are
artistically, emotionally, and creatively executed. Every psychological
movement, like every step of a dance must be sensitively expressed with
meaning, purpose, and conviction. The therapeutic task is to link what
occurs externally with the internal life of the couple). Let begin with
transference and couple transference.
Transference and Counter Transference
(See Transference and Couple Transference)
Transference
Three Kinds of Transferences
The couple transference does for the couple what
transference does for the individual, but is slightly more complex. Couple
transference interpretations are derived from the analyst's experience and
insights and are designed to produce a transformation within the dyadic
relationship. The couple transference refers to the mutual projections,
delusions, and distortions, or shared couple fantasies, which become
displaced onto the therapist. The notion of the "couple/therapist"
transference opens up entirely new therapeutic vista or transitional space
in which to work. It is within this space that "real" issue to come to life.
Example
Both partners rebuff any attempt on the part of the therapist to be helpful.
Both partners cannot allow themselves to rely or be dependent. For the
narcissist it means feeling vulnerable, less than perfect, for the
borderline it means abandonment/betrayal.
Psychodynamics and Primitive Defenses
Couple Transference
Three Phases of Treatment
Six Step Treatment Procedure
Use patient’s language
Example
Patient accuses me of not having a clue or understanding of what it took for
him to finally stand up to his wife. Instead of engaging in a battle of “oh
yes I do, and he then “oh no you don’t,” I responded by mirroring and bonded
with sports. I said, I don’t think anyone can understand the difficulty, the
years of suffering and agony, reminds me of the Olympics (Winter Olympics
2002), those skiers, in one moment they display years of work, no one can
understand the work, the years of devotion, just as you in one moment you
confront your wife, looks/sounds simple, but for you every moment was lime
stepping on a mine field.
Treatment Points and Techniques
Suggestions for the Couple
Therapeutic Functions
Case Examples
References
Read Cases Linda and Bob, Kathy and Mark
How would you diagnose them?
What are Their Psychodynamics
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 of 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.
CONCLUSION ONE
I have tried to explain the dynamics and interactions of
what occurs when a High-functioning Woman hooks up with her emotional
abuser. The uncertainties of diagnosis have been acknowledged. We have noted
the dance that occurs between the projective and introjective process, how
one projects and how the other tends to identify or over identify with that
which is projected. I have tried to explain why partners in these
beleaguered relationships are in complicity with one another through their
psychological "dance." Couple therapy is an experience that occurs among
three persons. It is a deep emotional experience of intense communication
and feelings that begins with the profound challenges of a primitive
relationship and matures into the awareness of healthy dependency needs and
mutual respect. With each session, the curtain opens, and the opportunity
for a new experience begins.
CONCLUSION TWO
I think the world has seen the most abusive couple ever, the
pathological love dance between Osama Bin Laden and the United States. In
this "love affair" Osama forms a pathological abusive relationship with
America. Osama views the US as the Great Satan, the evil partner responsible
for all the wrong doings in the world. So envious is Osama of America that
he confuses (his wife America) with a piece of property to be owned and
controlled. But America has her own life, and because she chooses not to be
submissive, suicide bombers and terrorists must destroy her. Because she is
the exciting object she is also the "threatening" one (the dangerous
enviable domineering materialistic America who intrudes and disrupts Arab
unity). Osama submitted his holly self to Allah, yet his other self
maintains a lustful attachment with "HER" America. This is not a far cry
from couples traumatically bonded in marital conflict.
DEFENSES, DESIRE AND CONFLICT
Archaic Injury
"V" Spot
Defenses
Splitting
Projection
Projective Identification
Persecutory Anxiety
Internal/External Abuser
Rejecting Object
Unavailable Object
Insatiable Object
Psychodynamics
Shame/Guilt
Envy/Jealousy
Dependency/Omnipotence
Attachment/Withdrawal/Detachment
Needs and Desires
I don't deserve
I don't know what I want
It is you that is the "needy" one not I
I want so much, nothing is enough
If I go after what I want I will be abused/abandoned/attacked
Conflict
Ambivalence
What to do
To stay not to stay
To get treatment not get treatment
Ego
Impairment in judgment, thinking, reality testing
Impulsively ("the quick fix')
"I know I am an adult but when in the face of him I become fearful"
Well it's hard to know what to "do" when there is so much _______ going one
(guilt/attachment to bad object, shame, and persecutory anxieties)
Example
"My believer can't handle success. If I am a success I will die of heart
attract. I therefore screw up, choose the wrong people. I cannot trust
others, or depend or rely on anyone, if I do they will only betray me."
Example
A husband complains that his wife is insatiable. Whatever I do it is never
enough. She is a shopoholic! All she wants is more, more, more! She drove me
to mental illness. It is because of her I was hospitalized. She broke me
down. Worse, than the injury was the fact, that she didn't even care. Even
when I was in the hospital all she could think about was money, bills, her
image, how she would get her new Mercedes fixed. Her insatiability centered
around materialism to offset an impoverished childhood, his entered around
low self-esteem.
Her insatiability is easier to find, but his is more subtle.
Upon rehabilitation he kept denigrating himself complaining that he wasn't
his old self, any progress was dismissed. He compared himself to others,
then persecuted himself for not doing enough (more, more, faster, faster
recovery!).
But then so what. So what now we know where the fusion lie?
Now what. This important, because the next step is to show how the grandiose
self affects the thinking process, reality testing judgment.
Maybe I should just get myself a new wife. Why would I
stay with such a person?
So where do their pathologies meet? He wanted more but in
the reverse direction, against the self. They both had insatiable needs,
both felt emotionally bankrupt. Although his insatiability was in reverse,
it is still the spot that joints them together in a twinship tied to the
borders of victimization and persecution. We can do this with any theme
(betrayal, withholding, controlling, submission , entitlement).
Finding the Archaic Injury
Bob is upset because her boyfriend B. never wants to go
anywhere, do anything, nor initiate anything. Susan says she is confused and
doesn't know if she is too demanding when she insists her boyfriend spend
time with her on weekends. . Feeling rejected by inattentiveness, she
increasingly feels more and more abandoned and worthless. The archaic injury
is father leaving home when she was four, with subsequent visits very
scattered and rare. On her fourth birthday he didn't show up but later
stopped by with girlfriend.
Now I understand why you are confused; you are not sure if
what you need or asking for is within normal bounds or if you are just
being demanding.
Let's find Bob's s Archaic Injury
Bob claims that he doesn't have any needs, that Susan. is the needy one, the
one who has huge lists of needs. He only has one need, space..
Me, I'm happy to stay home and watch TV. .
Susan claims, she doesn't know how to get her needs met, because if she if
she expresses them she gets rebuffed, if she doesn't bring she feels
frustrated. What is the injury? As a child his parents made him feel bad for
having needs, they would leave him in his room for long periods of time,
finally he gave, he detached, become "needless."
So in the dance, as Bob withholds, Susan persists, Bob withholds more, Susan
becomes confused and angry. Bob unconsciously coerces Susan to becoming the
punitive mother, as he plays out her rejecting unavailable father).
Pamela Case Study
Emotional Abuse of the Therapist
The session to be reported began when Pamela picked up a brochure that
described my practice.
P: "Oh! You're in such bad shape that you need to advertise? How pathetic,
it makes me lose even more respect for you." As she continued in this vein,
she slowly tore the brochure into tiny pieces. She took smug satisfaction in
destroying it as she said, "I'm going to throw this paper on the floor and
I'm not going to pick it up." Head down, focused on her work of destruction,
she peeked at me carefully to gauge my reaction. When I did not rise to the
bait, she escalated her provocation. "There's nothing you can do about it!"
She looked at me directly and defiantly, but with what to me seemed a
humorously mischievous manner. After a moment of hesitation, she tossed the
bits of paper into the air, they descended upon us, a sun-struck cloud of
confetti as the paper captured the light from the window, I was privately
delighted with the ironic symbolism, enjoying her mischievousness and her
apparent playfully flirting with her father. She was surprised and
frustrated that I was not upset, finally commenting in a more seriously
challenging vein, "I'm really tired of the shit. I've been seeing you for
two years and I'm not getting any better, I'm getting worse."
T: "I agree."
P: "You agree?!" Then how can you charge me for these sessions? I know I
don't pay anyway (she had accrued a balance on her account), but still how
can you charge me? I think you ought to see me for free."
T: At this time, two years into treatment, I made comments to Pamela that I
would never have made before, and I do not recommend them as standard
practice. Nevertheless, they demonstrate that the timing and nature of some
comments arise within the spontaneity of the moment in the relationship. "I
think I should increase my fee."
P: (in total surprise and confusion): "Increase your fee?! But… but … you
just agreed that I was getting worse, not better. Why would you increase
your fee?!"
T: "Because I have been marinating in your piss for two years and I think
that's worth something."
P: "I can't believe you just said that. What kind of therapist are you?"
T: One that's good at marinating in piss. You know what your problem is?"
P: "What?"
T: Even though I have been marinating in your piss for two years, I still
like you, and you can't stand it."
Pamela was quiet for several minutes.
P: "How have I been pissing on you?"
T: "How have you not? Every time I make a comment or try to think about
something with you, you piss all over me, embarrass me, and humiliate me.
And every time I try to explore your need to do that, you simply do more of
it. That's why we're not getting anywhere."
P: "I'm not going to allow you to talk to me that way. I'm leaving." She
jumped up and headed for the door.
T: I wish you would stay so we could talk it through."
P: "Are you crazy? I'm leaving and I'm never coming back."
T: I'm sorry you don't feel able to stay and I hope you change your mind
about coming back. I'd like to understand why you can't stand my liking
you." Pamela exited, slamming the door behind her. In fifteen minutes, as I
worried that she would not return, the telephone rang. It was Pamela.
P: "I'm sorry for walking out. I was just confused. And I'm sorry for
throwing the paper on your floor. I want to work with you, too, and I want
to make sure you don't give my time away for next week."
T: I'm glad you had the courage to call. I know it wasn't easy. I'll see you
next week."
P: "Okay."
This interaction was a turning point in Pamela's therapy. The fact that such
comments came to mind and that I felt free to say them, two years into
treatment, reflected the time and relationship necessary for establishing a
sufficient holding environment and building a treatment alliance vital to
such a communication. By my identifying and articulating her wish for
relationship, evident in her reliable attendance and acting out in the face
of my absences, and her fear of relationship, evident in her acting in ways
designed to be rejecting and rejected, Pamela felt both recognized and
understood. As her libidinal and anti-libidinal elements were brought to
awareness, without the feared rejection by the object (the therapist), she
was able to decrease her reliance on primitive defenses. She painstakingly
developed a capacity for self-observation and reflection. |
