11-6-13Primitive Defenses in Marital Therapy Joan Jutta Lachkar, Ph.D.

NAOS-Institutewww.naos-institute.comLondon

GeneralThis workshop draws from many theoretical perspectives including classical psychoanalysis, self-psychology, ego psychology, object relations, attachment theory, contemporary theorists and others. It offers specific treatment approaches, procedures and techniques to explain the psychodynamics of the couple to explain why couples stay in painful, conflictual, destructive, on-going circular behaviors that go on and on without reaching conflict resolution. Also known as traumatic bonding or “the dance.” Aside from this work, it has applicability to all kinds of couples including cross-cultural couples. It includes a six step treatment procedure, three phases of treatment, many clinical examples, and plenty of opportunity for role play and discussion as well as concise definitions. The new concept of the “V-Spot” is introduced as the epicenter of the most vulnerable area of emotional sensitivity, a product of early trauma each partner unwittingly holds onto (also known as the archaic injury).

Course Objectives

Increase understanding of the couples’ mutual projections and how each one tends to identify or over-identify with the negative projections of the other

Deepen awareness of how old archaic injuries (“V’ spot”) impairs the couples’ current perspective of reality (judgment, perception, reality testing)

Clarify of when and how to interpret, confront or intervene Explore how to confront, intervene or remain silent Increase your understanding of countertransference and couple transference

types Distinguish the defenses and dynamics between the various disorders within

their dyadic relationships

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Understand the mirroring and self- object needs of the narcissist as compared to the confrontational and supportive needs for the borderline and other disorders

Familiarize yourself with the recent research on males in relationships (The Disappearing Male, 2012)

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Basis of the workshopThis workshop is based on Dr, Lachkar's groundbreaking book, Common Complaints that Bring is based based on Dr. Lachkar's ground breaking book The Narcissistic/Borderline Couples. It draws  classical psychoanalysis, self-psychology, ego psychology, object relations, attachment theory, contemporary theorists and others.  It describes what happens when a narcissist and a borderline join together in a marital bond and how each one stirs up some unresolved unconscious developmental issue  in the other. Her  newest book, Common Complaints that Bring Couples into Therapy (2014) describes various kinds of "complainers" as it looks to when a complaint is used for evacuation, as well as how to "listen" to the complaints  as they link to various personality disorders. Also introduced is Dr. Lachkar's newest publication, The Disappearing Male, "disappearers"  who suddenly vanish either physically or emotionally. This workshop includes many treatment points, techniques and procedures as it offers specific guidelines to explain the psychodynamics the couple e.g., why they stay in painful destructive, on-going behaviors also known as traumatic bonding or "the dance."  Aside from this work, it has applicability to all kinds of couples including cross-cultural couples.  There is plenty of opportunity for role play and discussion as well as case presentations

“This new edition of Dr. Joan Lachkar’s work highlights her meticulous ongoing efforts to define a fascinating clinical entity from different clinical and theoretical vantage points. This is a highly well thought out word that is characterized by sound scholarship, considerable clinical experience and innovativeness. It is to be recommended to all mental health workers.”

- James Grotstein, M.D., Professor of Psychiatry, UCLA School of Medicine

Publications

The Narcissistic/Borderline Couple: A Psychoanalytic Perspective on Marital Treatment Taylor and Francis (Brunner/Mazel), New York, 1992

Treating the Emotional Abuse of High Functioning Women, Jason Aronson, New York, 1998

The Disordered Couple. Chapter in book, “Narcissistic/Borderline Couples: A Psycho-dynamic Approach on Conjoint Treatment” Brunner/Mazel, New York, 1997)

Revision of Narcissistic/Borderline Couple Book 2nd Edition, Taylor and Francis (Brun-ner/Mazel), New York, 2004

The V-Spot: Healing Your Vulnerable Spot from Emotional Abuse. Roman Littlefield, NY (2008)

How to Talk to a Narcissist, publishers, Taylor and Francis, NY (2008) The Psychological Make-up of a Suicide Bomber, J. of Psychohistory. The Psychopathology of Terrorism: A Cultural V-Spot, J. of Psychohistory and Rand

Corp (2008) How to Talk to a Borderline (2010) The Disappearing Male, Roman Littlefield, N.Y. (August 2012) Common Complaints that Bring Couples into Treatment (2014)

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Joan Lachkar, Ph.D is a licensed Marriage and Family therapist in private practice in Tarzana, California, an affiliate member for the New Center for Psychoanalysis, and is the author of The Narcissistic/Borderline Couple: Psychoanalytic Perspective on Marital Treatment, The Many Faces of Abuse: Treating the Emotional Abuse of High-Functioning Women, The V-Spot, How to Talk to a Narcissist, and How to Talk to a Borderline, The Disappearing Male, New Approach to Marital Therapy, and her new book, Common Complaints that bring Couples. Dr. Lachkar is also a psychohistorian, has published numerous publications on marital and political conflict in the Journal of Psychohistory, Frontpage, Family Security Matters, including her paper, "The Psychopathology of Terrorism" at the Rand Corporation.

Contact informationJoan Jutta Lachkar, Ph.D.5009 Woodman Ave, #205Sherman Oaks, CA 91423818-290-3390 (office)310-413-9593 (cell)Email: jlachkar@aol.comWebsite: www.joanlachkarphd.comAffiliate Member of the New Center of Psychoanalysis

Dr. Lachkar is available for consultation

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Workshop Schedule

DAY 1

9:30-10:00 Registration and Coffee

10:00-10:30 Introductory Comments Definition of a Narcissistic/Borderline Relationship Definition of the Narcissist Definition of the Borderline Different kinds Narcissists Different kinds of Borderlines

10:30-11:20 Theoretical Considerations (Overview)

Classical Psychoanalysis: the individual vs. the relationship Self-Psychology vs. Object Relations Mirroring vs. Containment Ego Psychology and Attachment Theory Mirroring and Containment Ego Psychology and Attachment Theory Kernberg Defining the Ego

11:20-11:40 Tea/Coffee Break

11:40-13:00 Introducing New Terms Dual Projective Identification Reverse Superego Language of Empathology Language of Dialectics Couple Transference Reverse Superego The V-Spot

13:00-14.00 Lunch

14:00-15:00 Different Ways of Listening How Different Theorists Listen Objective Listening/Subjective Listening Empathic Listening Introspection Listening

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Intersubjective Listening Listening to the Silence/Verbal Listening Containment Listening (holding the thought without

response) Listening to Bad Internal/External

15:00-15:30 Cases/Role/Play

15:30-15:40 Tea break

15:50-17:00 Bonding and Attachments Why Couples Stay in Painful Conflictual Relations Traumatic Bonding Pain/Sacrifice/Victimization Attachments to Bad/Good Internal/External Objects

(Fairbairn) Bonding With the Mother of Pain Different Mothering Experiences (Winnicott) Psychodynamics of the Couple: The Dance, the Bond,

the Drama

The Psychodynamics of the Couple Shame vs. Guilt Envy vs. Jealousy Splitting/Projective Identification and Dual Projective

Identification Dependency vs. Omnipotence Control/Domination/Victimization Competition/Rivalry (unresolved oedipal conflicts) Cross-Cultural Psychodynamics

DAY 2

10:00-10:45 About Love Different Kinds of Relationships (Kernberg) Other Kinds of Relationship The Affair Common Complaints That Bring Couples Into Treatment

10:45-11:30 Spotlight Cases/Cases/Role Play

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11:20-11:40 Tea/Coffee Break

11:50-13:00 Treatment Techniques and Therapeutic Functions The Couple Transference Dual Projective Identification Three Phases of Treatment Six Step Treatment Procedures Treatment Points How to Listen for a Theme

13:00-14.00 Lunch

14:00-14:45 Spotlight Cases/Cases/Role Play

14:45-15:30 The Disappearing Male

15:30-15:50 Tea break

15:50-16:45 Treatment of Cross-Cultural Couples Group Psychology Psychohistory Where East Meets West: Cross-Culture Treatment

Aspects

16:45-17:00 Ending seminar

NAOS WORKSHOP

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Thank you for inviting me here it’s an honor and a privilege to be with you and this great city of London! I really came here to buy affordable health care!

Welcome to N/B Couples: Primitive Defenses in Marital Therapy!Some Introductory Comments Brief

Talking about narcissism reminds me of a line in a Woody Allen movie when asked what religion he said, “I used to be an atheist but converted to narcissism”. Let me begin with an overview and some introductory comments.

Today People are Obsessed

Today people are obsessed talking about their relationships. In fact they are so busy talk-ing about them; they hardly have the time to have them. The capacity to fall in love is a basic hu-man experience, and when people fall in love it is felt to be related to be magical and we all look for the mysterious power of love. Relationships are not simple for they are comprised of many complex and interrelated aspects of love, shame, guilt, envy, jealousy, hatred, aggression, rivalry, control, domination, submission, victimization, perversion, pre-oedipal/oedipal conflicts, as well as many early unresolved infantile conflicts. When we talk about marital conflict, we are talking about a kind of love that goes in the wrong direction, primitive idealization that invades and in-fects the capacity to maintain a healthy loving relationship.

Sustaining a love relationship can be a full time job (Show Cartoon of Harem).

Today will be starting by defining a narcissistic/borderline relationship as What happens when a narcissist and a borderline join up in a marital bond or “ bind,” How each one stir up some undeveloped unconscious unresolved aspect in the other and

how Together they engage in behaviors that are destructive on-going, circular, never-ending

behaviors or what I refer to as “the dance.” I pay particular homage to the works of Melanie Klein, mainly her most invaluable tool

for couples therapy-introjective/projective process (projective identification), how one partner will project a negative part of themselves into the other and how the other then to identify for over identify with that which is being projected.

Like telling an anorexic she is fatThen will describe the narcissist, then the borderline, the different kinds of N and B’s. Here I took the liberty of extending beyond the DSM-IV (rather cheeky of me) to describe many different kinds of disorders. I found kind of justification doing this because N/B states, traits and characteristics are not clear and concise entities and tend to vacillate back and forth. Furthermore, the grandiose/entitled self seeps over and invade other types of relational love bonds. For example, what gives an obsessive compulsive the right to withhold time, money

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attention? What gives a co-dependent the right to feel others are to take care of them or the passive-aggressive to keep everyone waiting? I then introduce “The Narcissist the Artist/Borderline” and “The Cross Cultural Narcissist/Borderline (someone like Kim Jong-u and Obama bin Ladin) as a segue into my work on cross cultural couples and psychohistory. n this ever changing world of violence, domestic abuse and terrorism, and living in a diverse multicultural world we see couples from many ethnic backgrounds. Even though many of our patients we see in clinical practices are not terrorists do not don’t burn their brides over the coals or bury them in the sand) share the same inherent attributes of aggression (household terrorists).

THEN I REALIZED THERE ARE MORE THAN MY KIND OF COUPLE

Then I realized there are more kinds of couples beyond my N/B. I was asked to write a chapter in a book The Disordered Couple where they had all kinds of couples, The Eating Disordered Couple, the Psychosomatic Couple, the Psychotic Couple. So I ventured to explore a variety of types of dyadic configurations. For example, what happens when an obsessive-compulsive hooks up with a histrionic (Arthur Miller and Marilyn Monroe), a passive-aggressive with a perfectionist/caretaking type of personality, a schizoid with a borderline/dependent/histrionic.

So here I had all these N/B’s and all these couples and had to decide what to do with them. Do I just throw them into the chapters and let them fight among themselves? I had to find a way to communicate with them for they certainly could not communicate with each other. That is when I wrote How to Talk to a Narcissist and How to Talk to a Borderline where I employ two special languages.

The Language of Empathology and the Language of Dialectics

“The Language of Empathology" and “The Language of Dialectics." Both abstracted from the analytic literature to make communication more “user friendly.” The language of empathology I abstracted from Heinz Kohut's theory of self-psychology as more suitable for NPD and the language of dialectics I abstracted from the works of Melanie Klein, Wilfred Bion and Marsha Linehan, which I found more suitable to employ the splitting mechanisms within the structure of the borderline personality.

Newer WorksThe Disappearing Male describes eight types of men who suddenly vanish or disappear either physically or emotionally from a psychoanalytic/cross-cultural perspective how their defense mechanisms draw them away from love into a war against intimacy and commitment.

Common Complaints I discuss eight different kinds of "complainers" as they link various personality disorders focusing on how to listen to a complaint, when a complaint is a complaint or when it is used for evacuation,

How This Work came About (Two influences)

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Oddly enough my work with couples first began in an English Literature class at UCLA reading “As You Like It” I simply could not understand why the characters Beatrice and Benedict who seemed to be in love kept fighting and disavowing their feelings. Beatrice had been hurt before and fearful of being vulnerable. It wasn’t until the end of the play when they were able to profess their undying love.

The MythWhen Sarah saw that her handmaiden conceived a son while she remained barren and after she miraculous gave birth to her own son, Isaac. She abandoned both of the them to the desert.

Another influence resulted from my interest in psychohistory mainly the Arab-Israeli Conflict, which then segued into my work on cross-cultural couples. I started to see the Arab-Israeli Conflict as a Narcissistic/Borderline relationship (not a real couple of course, but a mythological one), a battle that goes on and one without reaching conflict resolution. I saw their "political dance" as a having its origins rooted in age-old archaic sentiments and injuries that never got resolved. I traced back to the biblical origins the oedipal rivalry between Ishmael and Isaac. Isaac the special child of child of Abraham, and Ishmael the rejected/displaced one abandoned into the desert. What a perfect fodder for a Kleinian interpretation. Isaac (Jews) got the “good breast” the Land of Milk and Honey, while Ishmael (Arabs) got the “bad breast/dry/desert. Without sounding too narcissistic myself, if figured I could understand Arabs and Jews why not other battling relationships? So in my analysis I saw the Jews has sharing a collective Group fantasy Jews as “The Chosen Ones” vis a vis the Arabs, “The Abandoned Orphaned Ones.”

The Theoretical

Then we will move to the theoretical beginning with Freud’s classical psychoanalysis, then ob-ject relations, self-psychology, attachment theory, DBT, Mentalization, a little pop psychology. The theoretical is important because when we talk about narcissistic and borderline personalities, it gets very confusing. Whose Nar and Whose Bord? (Freudian, Kleinian, Kohutian, Kernber-gian?). Although this is an integrative approach, I focus mainly on Klein’s concepts because there is movement. Her approach is dynamic that helps us understand not only the movement be-tween the couples, but between their psychodynamics (the dance between guilt/shame, envy/jeal-ousy). Another valuable contribution is that Fairbairn who helps us understand how couples bond with painful bad internal objects (the rejecting/unavailable). Then we move to treatment ap-proaches, techniques, procedures offering specific guidelines including various phases of treat-ment that couples move through. Finally Then we move to the cases (spot light case), and of course plenty of time for role play case illustrations, discussion and comments.

Kohut tries to mirror the grandiose self, Kernberg tries to smash it feels Kohut indulges the pa-tient because he fears the narcissist anger. Anna Freud feel Kohut does not address the aggres-sion.

DEFINING A NARCISSITIC/BORDERLINE RELATIONSHIPI define this as two personality types who enter into a psychological "dance" who consciously or unconsciously stir up highly charged feelings of many early unresolved conflicts as they coerce each other into playing certain roles. The revelation is that each partner needs the other to play

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out his or hers own personal relational drama. Within these beleaguered relationships are developmentally arrested people as they bring out early archaic experiences embedded in old sentiments into their current relationship (which I refer to as “The V-Spot”).

A couple comes in for first visit. The narcissist husband complains his wife is inhibited not sexual or passionate enough. Although he loves her, tells her if things don’t change he could see himself having an affair. The borderline wife comes in crying feeling devas-tated doesn’t see how she can change since she came from a very strict religious back-ground. Although her parents were loving, she never saw any display of affection (covert message sex was bad). So she became the dutiful wife. Since he was neglected as a child and not given much attention (upstaged by a younger brother), he would like for her to welcome him with passion and wild abandon. So they each bring treatment their undevel-oped parts (he the deprived self and she a with a sexually arrested inhibited self). So why would such a passionate man choose such an inhibited woman and why would she choose such a sexual man? Here we see how these oppositional types each arouse in the other some undeveloped part of the self. He could use some of her restraints and she some of his passion.

Examples of the DanceI want to get married!Married! Why do we need to get married? Isn’t us living together enough? It is as though we are already married.But we are not married.Marriage is just a piece of paper.No! It is not just a piece paper. I was married before and it is no different than nowThen why did you get divorced?Because I didn’t want to stay married.But if it was just a piece of paper then why did you get a divorce?If you don’t stop badgering me. I’m going to pack up and leave.That’s what you always do you whenever we have this discussionWell, I don’t want to get married.Then you do admit it is more than a piece of paper!

I told him I was upset.He then gets upset that I am upsetI then get upset that he feels upsetHe gets upset that I am upset that I feel he is upset about me being upset.

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The Dance the Bond the Drama Why Do People Stay in Painful Conflictual Relations

There are those individuals who confuse love with pain and cannot feel a semblance of aliveness unless they are fused in a dysfunctional destructive attachment. Together they repeat the same drama over and over again, without ever learning from experience (sabotage when happy). The most pervasive feature is that they are more bonded to pain to pleasure, and will repeat the same traumatic experience again. Why is it that partners involved in primitive bonds cannot take heed to our “good advice?” Why it is that even after a divorce or separation these individuals maintain a bond, albeit a destructive one? Are they crazy, perverse, and sadomasochistic? As Grotstein (1987a) has illustrated, any attachment is better than no attachment. Pain stirs up an amalgam of unresolved developmental issues as each seeks out the other to play out their internal drama). As bad as the pain it is linked to the love object, it becomes highly charged and eroticized. This is referred to as “traumatic bonding. Anything is better than the emptiness. “At least I feel alive! I know I exist!”

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

Defining the Narcissist

The narcissist is the entitlement lover, the special child of God (also known as “His Majesty the Narcissist). You know when you are around one because they only about themselves. They are dominated by a grandiose and exaggerated sense of self, believe the world owes them something, have excessive entitlement fantasies a sense they are superior to others and when they run out of narcissistic supplies will continue on the search for more mirroring objects. They value such things as success, fame, physical beauty, wealth, material possessions, and power. The narcissist cannot tolerate their own dependency needs and unwittingly project their needy selves into the borderline. The narcissist cannot allow themselves to have the kind of dependency an intimate partner requires so they choose someone like a borderline one they can project their “needy” selves into. The have a sense that they are superior to others, dominated by grandiosity, an exaggerated sense of self and the belief the world owes them something. They have excessive entitlement fantasies and when narcissistically injured or not properly mirrored with withdraw. They value such things as success, fame, physical beauty, wealth, material possessions, and power. . In court custody case they are the ones who feel entitled to all property, the entire visitation, the furniture and the money. The narcissist cannot tolerate their own dependency needs and unwittingly project their needy selves into the borderline,

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“It is you that it the needy one. Me I don’t need anything! I have my computer, my boat, my I-pad! It is you who is the needy one! Me I am as perfect as mother wants me to be. I don’t need you and I don’t need this treatment!

When narcissistically injured will withdraw. One can imagine how this arouses feelings of un-worthiness, abandonment, unworthiness, and shame in the borderline one who is the perfect tar-get for the narcissists projections. (a perfect target for the split off needy self of the narcissist). In treatment narcissists are the ones always asking for special favors, changing appointment times, asking for special favors when it suitable for them. Because the narcissist cannot allow them-selves the kind of dependency an intimate partner yearns for, narcissists they can project their “needy selves” into the borderline, one who does not have a sense of self, does not feel entitled, and is easy prey to the projections of the narcissist.

Defining the Borderline

Seal up the mouth of outrage for a while “til we can clear these ambiguities. ___William Shakespeare, Taming of the Shrew

Welcome to Borderland, a world that knows no bounds and breeds a most unique and complex group of individuals. Borderlines are extremely vulnerable live in constant pain and lack the emotional boundary to protect their inner self. People in Borderland make up their own rules, have a weak hold on reality are unpredictable, impulsive and often and misperceive the inten-tions of other. This term is not meant to be pejorative in any way but more to call attention to a most mysterious disorder that baffles not only the therapists who treat them but for those who live, love and interact with them. The borderline is the emotionally anemic failed narcissist. Any hint of abandonment or betrayal can trigger an intense outburst of rage. The borderline has a de-fective sense of self suffer from early trauma in the maternal attachment bond usually a product of abandonment parents who were absent, alcoholic, abusive, or physically/ emotionally unavail-able. They perpetuate the cycle by staying in abusive, addictive or destructive relationships en-acting the role victim (bonding by through pain either self-inflicted or other inflicted). They are the “as if” personalities and often develop an exquisite false self to manipulate and dupe people. In an attempt to defend against shame they turn to substance abuse, addictive relationships, promiscuity, deviant compulsive behaviors, addictions, suicide ideation, victimization and sacri-ficial objects

I’ll do or be anything you want me to be. Just don’t leave me!”

Unlike the narcissist, borderlines could care less about fame, success, how they look, how they dress. Typically they are co-dependent, those who solely exists through the existence of the other. Whereas the narcissists is more concerned about proving a special existence for they al-ready know they exist busy proving a special sense of existence, the borderline is trying to prove they exist as a thing in itself.

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Although Freud (1923) did not use the term borderline, he noted that there was a certain segment of patients who would go into a regression when treatment was progressing. He referred to these patients as having “negative therapeutic reaction,” Freud became baffled by these patients he noted that these patients are intolerant of any progression and would sabotage treatment when their conditions improved become deviant and react adversely to any praise or appreciation.

They are victims, the scapegoats, and when betrayed will spend the rest of their lives getting back, getting even, even at the expense of self, will sacrifice themselves, children, families, They exhibit poor impulse control and lack the self-regulatory mechanism; as their feelings are often disproportionate to the reality of their environment. According to Marsha Linehan (1993), they are tantamount to third-degree burn center patient in agony at the slightest provocation. Their in-ternal conflicts center primarily around shame, abandonment, betrayal, deprivation, boundary confusion and lack of identity.

When I burn myself with a cigarette, then I know I’m alive. I exist! Anything is better than abandonment! Drugs, alcohol, even this terrible abusive/addictive relationship! I’ll do anything just don’t leave me!

The main feature is they fuse with their objects like glue (separation anxiety).I had a dream that I was in an old broken-down home, with weird people all muttering nonsense, al stuck together with glues. I tried desperately to escape before they globed onto me. I know I had to run away but I couldn’t. I was stuck to them.

In the dance with the narcissist, in order not to feel abandoned, borderlines learn to play into nar-cissism/grandiose schemes. For a short time they play act atbeing the “perfect mirroring object.” I’ll do anything just don’t leave me.’ But because of the lack of impulse control cannot maintain, also are very seductive- the Don Juan’s and operate by an exquisitely formed “false self” (the self that belies the “true self). In conjoint treatment, therapists often get sucked into unwavering persuasion, their roles as victim, their seductive lures, making it difficult to not get sucked in.

“Dr. Lachkar, you are the most amazing therapist. Have been to so many, but……”

Psychodynamics of the Couple

Not only is there a dance between the couple, there isalso a dance between their Psychodynamics (shame/guilt, domination/control)

Shame vs. Guilt Envy vs. Jealousy Splitting/Projective Identifica-

tion

Projective Identification Dependency vs. Omnipotence Control/Domination/Victim-

ization

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Attachment/Withdrawal Competition/Rivalry (unre-

solved oedipal conflicts)

Dual Projective Identification Cross-Cultural Psychodynam-

ics

Margaret complains her “Mr. Perfect” husband is always on her case how she cooks, cleans, how she dresses, while he takes off for work without ever offering to help. He makes me feel such shame and when I ask him for help as though I’m putting a real guilt trip on him.”

ShameShame differs from guilt in that shame is between a person and his group or society the fear of humiliation or annihilation while guilt is a matter between a person and his conscious. Both are linked to having needs, for the borderline have needs are felt to dangerous and persecutory. "If I tell my boyfriend what I really need, he will abandon me!"

GuiltGuilt 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)

EnvyKlein made a distinction between envy and jealousy. Envy is a part-object function not based on love. Melanie She considers envy to be the most primitive and fundamental emotion. Envy is destructive and differs from jealousy (husband does not attend wife’s ceremonial award dinner).

JealousyJealousy, unlike envy, is a whole object relationship is based on love and is a higher form of development than envy. It is where one wants to be part of the group, the family, the clan. It is based on love and has an Oedipal component, and is a triangular relationship (girlfriend attacks boyfriend “your just jealous!).”

Projective Identification Projective Identification is displacing part of yourself onto another letting the other know how you feel without the use of words-like like an emotional Morse code.

Example: Helping a patient with an eating disorderPatient: I’ve already done that! Tried that! There is nothing you can say or do that can help me. I’ve been there done that!Therapist: You’re letting me know how hopeless and helpless you feel.

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SplittingPatient: I just want to divorce my wife, get rid of her. I am so bored no longer feel the excitement I used to have!Therapist: This is not about divorcing your wife this is about divorcing a part of yourself that you find boring.

Withdrawal vs. Detachment Patient: My husband has withdrawn from me. I feel so abandoned.

Therapist: No your husband has not withdrawn he has never attached to you in the first place.

John Bowlby’s work on attachment and loss (1982) notes the difference between withdrawal and attach-ment. Detachment is not to be confused with denial or withdrawal. Actually, withdrawal is healthier be-cause at least there is a libidinal attachment. 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. Apathy, lethargy and listlessness then become the replacement for feelings (anger, rage, envy, betrayal, and abandonment).

Different Kinds of Narcissists and Borderline

Narcissists The Pathological Narcissist (self-love overly aggrandized) The Malignant Narcissist (will act cruel to gain power/superiority over object) The Antisocial Narcissist (no conscience excessive entitlement to take things) The Depressive Narcissist (self-hatred turned inward) The Disappearing Male The Narcissist the Artist (My art comes first) The Cultural Narcissist (My country is better than your country)

Borderlines Pathological Borderline (how low level) The Malignant Borderline (have a cause not concerned what others think-killers, mur-

derers, terrorists) The Passive-Aggressive The Obsessive-Compulsive) (Pack Rats, hoarders, withholders) The Schizoid Borderline The Histrionic (use seductive powers to allure men) The Paranoid Borderline The Antisocial Borderline (lie, cheat steal, against the social norms) The Sociopath/ the Psychopath (charmers, users-(killers, murderers, cruel, sadistic, no

remorse)

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The Borderline the Artist (Wanna be artists others to support) The Cross-Cultural Borderline (fight for a cause, the cause a more pervasive thing

that life itself)

Different Kinds of Narcissists

General NarcissismOne who is self-absorbed, overly preoccupied with self, has strong desires for fame, achieve-ment, power, but not to the extent of overpowering the relationship, and yet still has the capacity to maintain a loving and intimate bond. Often form relationships while they fulfill their momen-tary needs, e.g., a good example of this is the married man and the single woman.

Pathological Narcissist The pathological narcissist is obsessed with and has an exaggerated sense of self, as well as a delusional sense of entitlement. They are overly preoccupied with self, and exhibit such defense mechanisms (guilt, idealization, and grandiosity) which overtake and overpower the capacity to maintain a loving and intimate bond.

The Malignant NarcissistThere is a fine line between a psychopath and a malignant narcissist. The later will kill because they were narcissistically injured whereas the psychopath kill to gain control over their victims. At the global level 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 under the guise of the “good cause” acts out his worst aggression. Sadism and paranoid features are the most common syndrome in the malignant narcissist, which drives them into fulfilling their own self-serving, political aspirations and becomes the rationale for destructive acts of aggression.Osama bin Laden, who claims the September 11 attacks were in defense of his own people, the “Will of Allah.”

The Antisocial Narcissist

Similar to the narcissist, they the entitled ones with no conscience void of any sense of morality or guilt. They don’t care about being perfect, more about getting away with stuff. They typically present more serious pathologies dominated by lack of superego functioning and the capacity for guilt and remorse. Their sense of entitlement is so excessive that it overrides any capacity for self-reflection. They steal, lie, cajole, get caught, even when they confess their crimes express no guilt, remorse, or concern. Their omnipotent entitlement fantasies delude them into thinking they can get away with anything.

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The Depressive NarcissistUnlike the narcissist driven by self-love the depressive narcissist is driven by self-hate self-ha-tred turned inward and always self-blame-hopeless as he makes everyone around feel miserable and depressed. The narcissist is dominated by self-love the depressive by self-hate, The depres-sive narcissist is plagued by guilt, embodied by a harsh and punitive superego and when life doesn’t go their way they blame. They have a sadistic superego that runs amok, is self-denigrat-ing and self-castigating. Yet, they are highly reliable, dependable, serious, and concerned about work, although they tend to judge themselves as they do others. They are totally self-often with-drawn and isolated from others. A depressed narcissist’s grandiose self turns self-hatred inward to such an extent that it infects and invades all those around her. I am no longer the beauty I used to be and I cannot tolerate the thought of anyone seeing me.

The Disappearing NarcissistThe disappearing narcissist at the onset flaunts their power, their success their superiority on a newly found love object. The object choice is often someone who idealizes and fuels the grandiose self. When the object no longer fuels their grandiose self as a self-object/mirroring/amorous/object when the object begins to make demands-poof their gone vanished.

The Narcissist the Artist (needs special treatment) Many artists are accused of being “too narcissistic.” But are they? Within the performing arts, narcissism takes on a different meaning. While clinical narcissism connotes pathology, there are also healthy aspects that one might call “aesthetic survival.” To kill narcissism is tantamount to killing the artist. Healthy narcissism allows room for grandiosity, pomposity, self-involvement and an obsessive investment in perfectionism; yet there is realization of the “need” for the object. There is a sense that the artist needs some transitional space to experience his art.

The Cultural NarcissistThe cultural narcissist brings to this country a certain about of nationalistic pride and will hold to relentlessly to try to prove his nationalistic or religious identity, and will not adapt and will do anything to maintain his sense of special identity. (My country is better than your country, our foods, our music, our culture).

Example of a Cultural NarcissistAn 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 Zionistic attitude which is inculcated the culture since childhood, aggression wears a different flag. This is our country!" The only religion is Judaism!

Different Kinds of Borderlines

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Just as there are different kinds of narcissists, there are different types of borderlines, As Grot-stein so aptly points out (personal communication, 2002) “The borderline is nothing more than a failed narcissist.”

The BorderlineJust as though there is different kind of narcissists there are different kinds of borderlines. Why do you suppose we have more borderlines listed than narcissists? Borderlines have their way of seeping into other disorders. Unlike the narcissist, the borderline could care less about fame, success, how they look, how they dress. Typically they are known as a co-dependent, one who solely exists through the existence of the other. Whereas the narcissists is more concerned about proving a special existence for they already know they exist busy proving a special sense of existence, the borderline is trying to prove they exist as a thing in itself.

Although Freud (1923) did not use the term borderline, he noted that there was a certain segment of patients who would become discontent when treatment was progressing. He referred to these patients as having “negative therapeutic reaction,” Freud became baffled by these patients he noted that these patients are intolerant of any progression and would sabotage treatment when their conditions improved. They become deviant and react adversely to any praise or appreciation got worse than better.

The Pathological BorderlineBorderlines suffer from privation rather than deprivation, illusions rather than delusions or hallu-cinations. Their internal conflicts center primarily around shame, bonding and attachment. Bor-derlines are often “as if” personalities or through an exquisitely formed false self. Their inability to deal with loss, face any internal deficits and their tendency to blame/shame keep them in an endless state of impoverishment. In an attempt to defend against shame they turn to substance abuse, addictive relationships, promiscuity, deviant compulsive behaviors, addictions, suicide ideation, victimization and sacrificial objects. Initially they start out with the desire for love, but sooner or later primitive defenses get in the way (envy, jealousy, control, victimation).

The Malignant Borderline Answers to a Higher Power-Allah/ProphetThe malignant borderline shares many qualities with the malignant narcissist with antisocial ten-dencies. Both tend to be malicious, cruel, ruthless and sadistic and find victims to inflict pain and punishment. The different is the malignant narcissist inflicts pain to feed his sense of superi-ority—“I inflict pain; therefore I am powerful, omnipotent, and almighty"—the malignant bor-derline inflicts pain in order to gain control—“Now you are the hopeless victim, and you will know what it feels like to have been abused.”

The difference between someone like a sociopath narcissist and a malignant narcissist is that the malignant narcissist answers to a higher power (conscience- Allah or the Prophet) and is con-cerned about what others think, whereas the sociopath or antisocial could care less. Psychopaths do not need attention more about control. Ariel Castro is an example of a psychopath, man who enslaved three women starved, tortured,

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and sexually abused them for absolute domination. At the domestic level they are the wife-beat-ers, child abusers, molesters, murderers, stalkers, and the terrorists. They are the revengers. They are ruthless, fearless, aggressive, and believe they are entitled to prey on innocent victims. Someone like O.J. Simpson, accused of murdering his wife after numerous attacks triggered by his bouts of uncontrollable jealousy.

Why do women stay?

“Oh baby, I’m so sorry. Don’t cry. Here, come to daddy. Let me hold you. I promise this won’t happen again and I’ll take care of you.”

On the political stage or at the global level the malignant borderline is personified by someone like Osama bin Laden, who with all his wealth was less concerned about fame, money, success than about destroying seeks revenge on the infidels in the West committing the most heinous crime against humanity.

”Now we are no longer victims; we are in control. Allah willed the September 11 attacks as a defense of his own people

He is abusive, a liar, and a manipulator. I had to call the police because he was abusing our daughter. To punish me he locked me in a room so I could not go to work or to my doctor’s ap-

pointment. After he beats me and apologizes, I believe him and again fall into the role of his victim. He is sadistic and has no sympathy for anyone. To punish me he refused to let me use the bathroom, so I had to pee in the sink..

The Passive–Aggressive BorderlineThe passive-aggressive Is a wolf in sheep’s clothing. Although the passive–aggressive personal-ity type no longer exists in the DSMIV, I have resurrected them for the purposes of couple ther-apy. These are the couch-potato husbands and the forgetful wives. “I’ll do it later; I’ll do it to-morrow, I was going to do it today, but the car broke down.” They forget, delay, avoid, cajole, make an endless barrage of excuses—in short, do anything to protect the good little child from the screaming mommy. The passive–ingressive’s primary aim is to unconsciously coerce a part-ner to behave in a certain way so as to recreate the parent-child dyad. They are very frustrating, manipulate other sot do their work for them. In treatment it is the only disorder where we encourage anger to come out.

I know I came late to the party I couldn’t find my keys.I know I was supposed to go to the market but by the time I got there it was closed.I know I was supposed to pay you today but I forgot my checkbook

The Obsessive–Compulsive BorderlineCompared to other borderline personalities, the obsessive–compulsive has a more developed and

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well-integrated ego as well as a harsh restrictive punitive superego. At the lower level of functioning, obsessive–compulsives are obsessed with orderliness, cleanliness, and perfectionism, devoid of feelings, are workaholics, and invariably put their partners down for having emotional needs or desires. They keep their partners on hold, and never have enough time for them. Because the obsessive–compulsive confuses needs and desires with dirt and disgust, he will find justification to work, work, work under the guise of efficiency or the “good cause.” They will also do anything to avoid intimacy. These are the pack rats, the clutterers who can't throw anything away.

The Schizoid BorderlineThe schizoid personality primary defense is a pervasive pattern of detachment, have few close friends, and appear indifferent to the praise or criticism of others. Unlike the narcissist who craves attention, the schizoid has retreated. They relate more to hard objects (computers, I-pods, aerospace, rockets, machines). Their detachment from their object relational world becomes so intense they block involvement with others keeping new experiences from emerging. The Depressive BorderlineAt first glance the passive-aggressive seem quite opposition, Both play the role as victim as they exhibit their self-defeating personas. Both are co-dependents and expect others to be feel compassion for their failed selves. Both are unaware how their moods, attiudes and behavior infuriate those around them. “Why us? Why is everyone so angry? We are merely victims of society!”

The Histrionic BorderlineHistrionic borderlines exaggerate cry easily, exhibit excessive parasitic dependency needs, and display excessive emotionalism and exhibitionistic qualities. In some instances, the histrionic may appear very narcissistic—e.g. the need to be the center of attention—while, on the other hand, their clinging behaviors and seductive, provocative sexuality denote very strong borderline characteristics. Some famous histrionics Marilyn Monroe, Robin Williams, Michael Jackson, Lindsey Lohan, Paris Hilton, Liberace notorious for having history of eating disorders, alcohol, inappropriate anger/mood swings. They need to be the center of attention exhibit provocative sexuality, while at the same time very clingy.

The Paranoid BorderlineThe most pervasive occurrence in love relations is the discontinuity between the self and the love object. Paranoid anxieties overshadow the capacity for a loving relationship. Suspiciousness, lack of trust, and inability to believe they can be loved. “You don’t really love me; you are just using me!” The attempt to sabotage is impulsive and precipitously (before the ego has the ability to organize the data of experience, the paranoid borderline jumps to an immediate assumptions). A woman tells her husband, “I just know you are having an affair; you have been coming home later and later.

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Antisocial Borderline (Bernie Madoff)People with antisocial personality disorder characteristically act out their conflicts and ignore normal rules of social behavior. These individuals are impulsive, irresponsible, and callous. Typically, the antisocial personality has a history of legal difficulties, belligerent and irresponsible behavior, aggressive and even violent relationships. They show no respect for other people and feel no remorse about the effects of their behavior on others. These people ware at high risk for substance abuse, especially alcoholism, since it helps them to relieve tension, irritability and boredom.

The Disappearing Narcissist

The one whose omnipotent grandiose fantasies cannot maintain a long lasting intimate relationship and has difficulty with intimacy and suddenly vanishes when under pressure.

Sociopath Borderline (James DiMaggio, Hannah’s kidnapper)Sociopaths will blow your money the psychopaths will blow buildings!They are the charmers the manipulators, the liars, ones who can convince others to trust them or do anything for their own self-serving purposes yet they have pervasive pattern of disregard for the rights others. They are the con artists, emotionally abusive, the users, are often cruel and lack feelings or empathy not only for their partners but for the people they have superego functioning, the moral guide that accesses the ability to distinguish right and wrong. Bob Filner, Mayor of SD a real sociopath, harass women without shame and believed therules did not apply to him.

The Psychopath Borderline (John Bundy) The psychopaths are the mass murderers, the killers terrorists. They thrive on controlling and having power over their victims. Adam Lanza the mass murderer who killed 26 children and six staff members teachers at Sandy Hook Elementary School, Saturday, Dec. 15, 2012, in Newport Connecticut (happened as I am writing this book). He was described as someone who felt “no pain” and whose school diagnosed with autism. Others include such notorious psychopaths such as David Berkovitz, Son of Sam who shot and killed 13 people in cold month, or the Colorado killer James Holmes. More recently Adam Lanza who shot to death his mother in their home and then slaughtered 20 children and six staff members in an elementary school killing then killing himself. Ann Rule, The Stanger Beside Me, was sitting next to Ted Bundy at a Clinical for Suicide Prevention, a rapist, serial killer, and necrophilia (obsessive fascination and erotic attractive with death and corpses)..The Borderline the Artist (Wannabe/The Starving Artist)In spite of all their pathology borderline artists are extraordinarily creative. Many have been able to carve out of the chaos of their borderline existence some of the world’s most magnificent art, music, and writing. When borderlines are able to unleash their creativity, they are unstoppable. The chaos of their

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internal world somehow finds a way for self-expression.. Some of the most disturbed artists have produced magnificent art. (Picasso and Van Gogh). One might venture to say that because they lived in a less inhibited of fantasy and disorder are less repressed, which allowed their artistry to flourish. On the other hand, there is also the victimized artist, those who

have long ago abandoned his art because of shame, feelings of inadequacy or being non-deserving, On the other hand there are the wannabe artist who feel because they are victims of society the world should support them.

Cultural Borderline The cultural borderline will retaliate fight, become a freedom fighter, a terrorist, do anything maintain the group’s collective identity (suicide bombers). He believes his lies are the truth (suicide bombers) some believe they are freedom fighters, terrorists will go to any extreme in order to maintain the group’s collective identity, will self-sacrifice themselves, families, or even their children for a cause or to adhere obsessively to family tradition (suicide bombers). Group identity is a more pervasive force than life itself. “Will kill for my country.”

Theoretical Considerations

1. Classical Psychoanalysis: the individual vs. the relationship2. Self-Psychology vs. Object Relations3. Mirroring vs. Containment4. Ego Psychology and Attachment Theory5. Mirroring and Containment6. Ego Psychology and Attachment Theory7. Kernberg Defining the Ego

The Theorists Sigmund Freud (Oedipus, drive/defense, aggression/instincts) Heinz Hartmann, Spitz, Jacobson, Ego Psychology Melanie Klein (object relations, splitting, projection, projective identification) Heinz Kohut (self-psychology, mirroring, empathy, self-objects) Otto Kernberg (aggression, drive/defense, and four different kinds of relationships). W. R. D. Fairbairn (attachments to bad internal objects) W. D. Winnicott (transitional objects, different kinds of mothering experiences, environ-

mental/background/holding mother) Wilfred Bion (therapist as the thinker, container, detoxifying mother).

Various Theoretical Perspectives Classical Psychoanalysis (Intrapsychic approach) Ego Psychology (adaptation, thinking, memory, perception, reality)

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Object Relations (focus on the internal, patients, distortions, projections, introjections Behavioral/Cognitive (focus is on the partnership, directive approach) Self-Psychology (external; need for mirroring, empathy, and self-objects Why Self Psychology is not enough Group Psychology Psychohistory Cross Culture/Transculture Perspectives Atkhtar, Salmon different ways to listen

Sigmund Freud

Although Sigmund Freud did not specifically focus on marital therapy, his entire emphasis was on the intrapsychic rather than the interpersonal. The interpersonal was intimated when he dis-covered transference, the relationship between patient and the analyst. He also proposed the Oedipus complex, which attaches the child’s love for the same sex parent with the parent of the opposite sex feelings, a psychodrama of pitting the son against the father in an uncompromising competitive position of jealousy, anger, revenge and rivalry for mother’s affection and affection. According to Freud, if the conflict ensues and the child never masters over the Oedipus complex, this lead to endless bouts of battles and competition especially with one’s mate. Before we go into the other theorists, let’s take a look at a Freudian analyst relating to a patient suddenly flee-ing from his wife. The Freudian analyst may respond something like:

No wonder you fled abruptly from your relationship. You never overcame the rivalry with your father, he knew how to be a committed married man, but you were not ready to step into his shoes went against his morality could not stand up to your wife, gave into your impulses to run away.

Melanie Klein

Although influenced by Freud, she broke new ground with her pioneer work on object relations, mainly her contributions such defenses as splitting, projection and projective identification. Her concept of splitting good and bad objects is known throughout the literature as the good and bad breast. If the infant has a good breast mother, then the infant will grow up seeing the world as good. If the infant has a bad breast mother it will grow up thinking the world is all bad and terrible..I show much gratitude to Melanie Klein for without her I would not have been able to understand the encounters that occur among couples, mainly narcissistic/borderline couples (20011992, 2010a, 2010b) the use and techniques of Melanie Klein. Her contributions are invaluable especially in helping individuals face internal deficits, distortions, and projections e.g., the introjective/projective process, a priceless construct in helping us understand the entangled web couples weave (dual projective identification or what I refer to as “the dance.”). This is very useful in understanding the misperceptions and miscommunications.

For Klein the primary experience with the breast shapes how the child will perceive the world. One of her most valuable idea was projective identification, expanding Freud’s defense of pro-jection she saw this mechanism as a two way process. In addition to this formation, she intro-duces us to two positions (1) The Paranoid-Schizoid position and (2) The Depressive Position. The first position is the earliest state of mind where primitive defense dominate. (shame/blame

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primitive defenses very rule). The latter is a whole and integrated position whereby one takes re-sponsibility for one’s own wrongdoings, one moves to stages of reparation a stage of mourning and sadness along with the desire to repair and make reparation for the damage that has been done.

The Bad Breast/Good Breast” The World is a Terrible Place VS. The World is a Wonderful

Place

Patient: Nothing I do is not good enough. I cook, I take care of the kids, I entertain family, his friends. I’m sexy! I’m passionate. I feel so devalued and unappreciated! Th: So no matter how much you try and please him he coerces you into being bad breast mommy.

The Schizoid Position/ The Depressive Position

Schizoid Position Everything is her fault. I blame her for everything that goes wrong. She gets me so up-set I don’t know what to do. Should I stay married or should I divorce her?

The Depressive Position I feel so sad all the time. I go around crying depressed. .Therapist: No1 You are not depressed you are dealing with normal states of sadness d taking more responsibility for your actions. This is a good time where growth and progress occurs and where reparation can be made. .

CASE OF MRS. P. THE “BAD BREAST WORLD”

Mrs. P. has three has three daughters, who are estranged from her. She presents a history of sexual, physical, and emotional abuse. Her mother was a product of depression, who in her own life suffered from severe deprivation. Mrs. P's emotional backdrop is a tapestry of darkness, despair, and gloom. “The world is a terrible place.”

Th: So you see the world as bleak and dark.Mrs. P: What do you mean “see the world”? Are you doubting my perception? (the borderline patient seeking what Linehan refers to as the “validating environment.”Th: I am just trying to understand your perception because I don’t see the world as all bad.Mrs. P: Then you're blind. Just look around you. The world is going to pot and people are monsters.Th: I see it as good and bad (addressing the splitting and enforcing “my reality”).Mrs. P: Don’t you see all the crime, the terrorism, the violence and destruction around you?Th: And yet people came from all over to offer help to survivors of the Boston Marathon and the devastating tornadoes in Oklahoma. Mrs. P: But those are caused by those terrible humanoids, who destroy the environment with their computers, cars, electronics. They could care less about the environment. They only care about themselves.Th: (At this point my blood pressure is rising.. So I turn to Mrs. Klein for consult). I think you are letting me know what you were feeling as a child, that no matter what you did or said your

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mother always made you feel unworthy, empty, and undeserving of anything good.Mrs. P. You are right. My mother was a horror, as was my father. All people are terrible. Look at my ex-husbands, and even my daughters, who turned out to be a mess because of them.Th: (Caught in a trap of either colluding to blame the mother the attempt to bond; I choose the latter and needing some soothing myself I turn to Dr. Kohut for empathy, the reminder to mirror and give up forcing my “reality” upon her.) Look, I know how you feel. You were an abused, terrorized as a child and had hardly any good people in your life.. It is understandable how you see the world as all dark, bleak and empty (a “bad-breast place” that cannot feed or provide for you.”Mrs. P. My mother was awful.

W. R. Fairbairn

Why Do People Stay in Painful Conflictual Relationships

Bonding with Bad Internal External ObjectsThere can always be an external betrayer/depriver/rejecter but there can 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.Why do I stay with a woman who belittles, attacks me abuses me? Why can’t I get rid of her? She is like an albatross around my neck.Why can’t I find a woman who excites me?

Fairbairn more than anyone helps us understand how and why people stay I painful conflictual relationships and why they stay forever attached to a painful bad internal object (rejecting, insa-tiable, unavailable). Fairbairn extends beyond Klein’s good and bad breast theory to the notion that people do not split into two parts, the good and bad objects, but into multitudinous ones, the attacking object, the unavailable object, the suffocating object, the abusive object, the rejecting object and how one will forever remain attached to these bad and painful internal objects. That as bad as bad as the pain is, it is familiar and preferable to facing feelings of emptiness the black hole. .Because pain is linked to the love object; it becomes extremely charged and eroticized, “traumatic bonding” (Dutton & Painter 1981, Lachkar 1998a). This creates ambivalence and confusion because the one who is cruel and sadistic is also one who can be loving and kind.

It is Saturday night Sandy calls me feeling desperate. I am waiting and waiting. It is 6, 7, 8 PM finally 9 PM Steve calls and says he got delayed and will be late. 9:30 comes. Steve calls again to say sorry something has come up and can’t make it, but baby we’ll do it next week.” Meanwhile, Sandy waits and waits and waits, but “next time” never comes. In this short vignette we can already see who the narcissist is and who the borderline is. S. is the borderline, dominated by abandonment anxiety, maintains a painful destructive attachment with a narcissistic/unavailable man, One who disavows her experience for when she gets mad he acts complains she acts as she’s crazy. Steve, the narcissist, lacks empathy, feels entitled to keep people waiting, puts his needs first, acts like she doesn’t exist. Later in treatment Sandy tells me that this is the first time in her life someone has told her that she is not deserving of this kind of treatment and that she is not imagining it!” “My mother used to say, what you have done to deserve this?”

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W. R. Fairbairn

Bad Internal Objects The Wronged Self The Insatiable Self The Craving Self The Lost Self The Betrayed Self The Rejecting Self The Abandoning Self

Bad Internal Objects The Betraying Object Depriving Object/Rejecting The Exciting Object Unavailable Object/Abandoning Withholding Object Painful Object (The Mother of Pain) Idealized Object Sadistic Object

Attachment to and Identification with Bad Internal/External Objects

The concept of how couples identify or over-identify with their internal/external objects is one of the most valuable in conjoint treatment, especially when couples are in phase one, the shame/blame stage of complaints, Yes, there can always be an external abandoner, betrayer, depriver that we identify or over-identify with, but there can also be an internal part of yourself that can deprive, betray, or mistreat. We have no control over the external demons, but we can control our inner abandoners, deprivers, complainers, and this is where the power lies.

Rejecting Object: “You complain your husband rejects you, but there is also a part of you that rejects yourself.”

Depriving Object: “I understand how you are trying to lose weight and how undeserving you feel about being attractive, and how you feel your husband deprives you, but there also is an internal de-priver that deprives yourself."

The Abandoning Object: “You complain that your husband abandons you, but there is a part of you that doesn’t listen to your feelings and abandons yourself.”

Unavailable Object: “You complain when your husband is unavailable, but there is also a part of you that is unavailable to yourself.”

Withholding Object: “You complain your husband is withholding, but there is also a part of you that is unavailable to yourself.”

Painful Object (The Mother of Pain): “You complain that your husband hurts you and abuses you, but there is also a part of you that bonds with the pain.”

Idealized Object: “You idealize your husband and see him as so great and powerful that you don’t see the part of yourself that is successful and has good qualities.”

Sadistic Object: “You complain that your husband is sadistic, but you don’t see how his sadism is a way of keeping you attached and offers you a sense of aliveness.”

The Disappearing Object: “Yes, your husband does disappear a lot, and when he’s gone it makes you feel like a nothing. This is the internal part of you that disappears and loses object constancy."

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The Insatiable Object: "Whatever your husband gives you is never enough. There is an internal part of you that is like a black hole that feels empty and cannot be filled.

Why am I always being rejected? Why am I always being abandoned? Why am I always getting involved with unavailable men? Why am I always getting betrayed? Whatever I get is never enough. How come everyone else gets more than I do? He used to tell me I was sexy and beautiful; now he is critical, picks on me and makes

me feel it is a big deal if he ever spends time with me.

Donald Winnicott (Importance of Mommy/Me Experience)

Winnnicott (1965) is another prominent figure whose unique ideas and language that have en-hanced and expanded the diversified field of object relations. His focus, like Klein, was on the importance of the early “mommy and me” relationship. . He introduced us varying kinds of mothering experiences, including the environmental mother, the containing mother, the being mother, the doing mother, and the holding mother, 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 both individual and conjoint treatment. In couple therapy the transitional space provides a new opportunity for partners to move from states of dependency and interdependency by making us of the transitional space and transitional objects.

It is clear from Winnicott’s work that if one does not have good enough mothering, the person cannot function as an adequate partner in intimate relationships. For example, a passive-aggres-sive person will constantly try to recreate the parent-child dyad by engaging in behaviors that es-sentially state, “I am the baby and you are the mommy/wife who is to take care of me!” Another clinical example demonstrating the utility of Winnicott’s ideas centers around his concept of good enough and which may have particular relevance for someone like a narcissist who imag-ines themselves as being perfect when in reality he or she can be just good enough. In addition to the contributions Winnicott’s concept of the false self, a self in constant battle with the true self or a self that lurks in the shadows and belies the true self. Bernie Madof (exquisite false self)f, the investor scam mogul bilked investors of million with the Ponzi scheme, and is an example of someone who could fool some of the people some of the time but not all the people all of the time! He acted as though he was our best friend. He was family to us. We trusted him completely. To distraught women who felt she found the love of her love when suddenly the man packed up his bags and left, a Winnicottian therapist might respond something like:

Different Mothering and Bonding ExperiencesWinnicott

The “good breast” and “bad breast” mother The “being and doing” mother

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The “holding,” “environmental,” “background,” mother The “containing” mother The “rejecting,” “absent,” mother The mother of “pain.” The “internal” mother The “facilitating “and “environmental” mother The “mirroring” mother The “self-object” mother The “idealized” mother The “castrated” mother The “introjected” mother The self-hatred” mother The “internalized” mother The average expectable or “good enough mother

Bonding with the Mother of Pain I hurt myself I punish myself but at least I know I exist but a least.

People who have had traumatic experience are programmed to bond with a painful inter-nal object that is familiar.

It is better to bond in pain then to have to face the void, the black hole, the emptiness. Pain stirs up an amalgam of unresolved infantile issues Pain becomes highly eroticized/sexualized Pain is familiar (familiar internal bad object) Pain is confusing. The lover who can be cruel and sadistic can also be loving and kind. Pain is linked to internal part of self – one wants to destroy/rid of

Heinz Kohut

Heinz Kohut (1971), the pioneer or self-psychology is another theorist relevant to the topic of in-timacy and whose innovative approach cultivated a new theory of self-psychology mainly for those with narcissistic personalities. He believed the narcissist responds more to mirroring and and empathic responses and interpretation in contrast to object relations theorists who believe they respond more to confrontation. He is one who embraced the important of mirroring, the need for self-objects, and empathic attunement to help fill the missing function of empathy. Ko-hut doesn’t believe the narcissist distorts rather he is merely misunderstood. His approach in-cludes introspection, validation, and understanding the perceptions of others (not distortions rather perceptions that that come from an operating system empowered by person’s subjective experienceKohut is often contrasted with that of Otto Kernberg. Kohut’s by its very essence in-vites closeness and intimacy. Kohut differs from Kernberg in that Kohut believed the subjective experience as truth that the patient does not distort or misperceive reality. To the distraught pa-

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tient who was suddenly is “dumped, a Kohutian therapist with the empathic mirroring stance might say something like:

Kohut: This was not your fault. You are not a trained highly skilled analyst that could diagnose his fragilities when you met. You had no idea that when he would go into fragmentation that he could not sustain a close bond an intimate relationship requires. You had not idea how he would just stomp off and leave you as he did the others. You don’t have crystal ball to predict the future. It is not your fault. Even though you saw the danger signs you fell in love so you must not blame yourself.Kernberg: The warning signs were there but you could not trust your mind because you were so busy idealizing him.

Wilfred Bion(Bion Most Empathic Sees PI as Not Negative

Wilfred Bion (1962), a follower of Melanie Klein, is one of the most profound. He helps us see projective identification and other primitive defenses as having a fundamental impact, not only in treatment, but in intimate relationships. He differs from Klein in that, instead of seeing the patient's negative projections as destructive, he saw them as a form of undigested words not yet suitable for communication. Bion's conception of projective identification is that it is a form of communication, or an unmentalized experience which is also referred to as a proto thought or a preconception not forms of communication as unborn or undigested thought not yet available for communication. Bion claims that the projector needs a projectee to contain these unmentalized enactments. This brings up the often asked question, “Hell no, does this mean I have to be his god dam therapist?” Unless in intensive treatment the answer is yes, but being a container: not a “toilet breast” someone to evacuate into but a more containing object that can lead to closeness. This is significant especially in intimate relations whereby one tends to disavow or not pick up these subtle covert messages. What follows is an example of the unmentalized experience.

A narcissist woman felt very offended when her boyfriend kept telling her that something in the house “smelled” that something was rotten. her A Bion analyst might consider this as a projection.

Th: You took it personally as if it was an attack against you. What he really talking about a part of himself he was out smelly, an internal world of him that feelings of vulnerability and weakness that made him feel bad and rotten inside. Patient: I’m not a therapist and would not have known that. I always take things personally.Therapist: Yes, but this is why you are here to understand that when someone attacks you, it is not al -ways about you!

For Bion the biggest offense is to avoid truth when the patient goes into –K-Link, -thinking or “thoughts without a thinker,” beta elements. The other offense is “knowing” for the analyst to know in advance what the patient will say or do or what he refers to as “Memory or Desire.” What follows is a personal experience of the danger of “knowing.”

I made an appointment with a new doctor. When I asked if he knew anything about me from my previ -ous doctor, my primary care physician, he responded, “Why yes I know everything about you your age and your birth date!”

Essentially every session must have no history no future; and nothing must be allowed to enter to

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contaminate the purity of the therapeutic canvas. For Bion the only importance is the unknown to yet to be discovered. Nothing must be allowed to distract from intuiting that. Memory brought into sessions can bring distortions and influence of unconscious forces. For Bion there can be no thinking from the past or future, but only from the moment and leaving from the experience within that moment. This is where truth lies.

John Bowlby/Attachment Theory(Withdrawal Vs Isolation)

A discussion of the early relationship to the mother and the separation-process as they relate to intimacy would be incomplete without discussing the work of John Bowlby (1973, 1979, 1980, 1982). He developed his theory of attachment from observations of severe disruptions in bonding among children. Bowlby used the term attachment to denote the child’s tie to the mother. His work shows that a child’s emotional attachment is a reflection of a child’s confidence in the availability of attachment figures. A secure attachment creates a foundation for both intimacy and autonomy. When individuals have the confidence that attachment and intimacy are available they can only tolerate aloneness but can feel longing and urges for the love object. Bowlby stresses the difference between withdrawal and detachment. He claims that withdrawal is health-ier than detachment because when one withdraws Children left alone for endless hours or babies crying in their cribs without anyone responding to them eventually become despondent and de-tach. The child’s active protestation of screams, wails and cries gradually ceases and the child no longer “care.” To a distraught women who cannot understand how all the love, good feelings and closeness just went away. “Doesn’t he even think about me? Doesn’t he miss me? I can’t be-lieve all the intimacy and experiences we had together just vanished in his mind.” Maybe Bowlby might respond something like

It was obvious he left the relationship abruptly and did not show any signs of missing you. From the onset he had difficulties in bonding. You even mentioned that he had no close ties to his children and had four different marriages. You were complaining he hardly called you or expressed missing you, and for him you were merely a love object.

Defining the Ego The Capacity to ThinkOtto Kernberg

The ego is an amazing apparatus. For Kernberg the ego is everything. It is a powerful structure responsible for thinking, judgment, and reality testing. Everyone knows what the ego is, but it is also a slippery concept. Even the most seasoned clinician loses sight of its impact. Although many authors offer accounts of “ego weakness” or ego fragmentation,” no one says it better than Otto Kernberg.. The ego is the superior agent responsible for memory, thinking, judgment, attention, perception, and the capacity for reality testing. Kernberg loves reality. It is the agent that provides entree to the unconscious. The function of the ego is to see the world by eliminating old memory traces left by unresolved early childhood conflicts or traumatic experiences. It is the capacity to discern the real from the not real. It’s like a computer with its own data bank and a spyware program to warn the danger sign (like a virus). As painful as it is to face the most unfaceable is the very essence an inner aliveness.

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“Even though my conflicts are difficult, when I face them head on I suddenly feel a sense of aliveness!”

The dysfunctionality of the ego helps us understand why people say and do stupid things and patient’s distortions, delusions and misperceptions. What makes an anorexic think he/she is fat? What makes shopaholic think they can afford to buy the things they can’t? What makes a makes a person with no talent or a “wannabe” think that they will become rich and famous? What makes narcissists think they are entitled to things they’re not or the borderline that acting the role of the victim will bring love or self-esteem. What makes an obsessive–compulsive think that cleaning will clean up their act for desire for intimacy.

THEORETICAL PerspectivesClassical Psychoanalysis

Focus on the individual, not the relationship Intrapsychic vs. interpersonal approach Oedipal rivalry Drive/defense Aggression Id, ego, superego (impulses vs. reality vs. moral restrictions.

W. R. D. Fairbairn Attachments to internal/external/objects)

Object Relations Focuses more on the relationship than the individual Splitting, projective identification Distortions/Delusions

W. D. Winnicott Different kinds of mothering experiences Transitional objects True and false self, Environmental/background/holding mother

Ego Psychology Focus on the environment and adaptation to it; views the ego as an

entity powered by its own devises not in accordance with Freud’s ego. Hartman claims that the ego is more environmentally driven than instinctually driven,

Bowlby Attachment theory Withdrawal/Isolation

Self-Psychology Need for mirroring self-objects Empathic attunement Intersubjectivity

Behavioral/Cognitive Focus on the partnership Directive approach

Kernberg Aggression, drive/defense Ego functioning Four different kinds of relationships)

Linehan

Dialectic Behavioral Therapy (DBT) Mindfulness/Acceptance Integrates transference and cognitive therapy (directive ap

proach)

Bion Thinking, containment (beta/alpha elements) Detoxification

Fonagy and Bateman Mentalization The reasonable mind

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Without Memory or desire Finding meaning out of the meaninglessness

The thinking mind vs. the emotional mind The dialectic ambivalent mind

Introducing New Terms

Language of Empathology Language of Dialectics Dual projective identification Couple Transference Reverse Superego The V-Spot

The Language of Empathology and the Language of Dialectics Both narcissists and borderlines require their own “special” form of communication. This led me to invent “The Language of Empathology” for the narcissist and “The Language of Dialectics” for the borderline. Motivated by the works of Heinz Kohut, Wilfred Bion, and Marsha Linehan, I originated these languages to fulfill the need for empathic understanding for the narcissistic and the splitting mechanism for the borderline and to make communication more “user friendly.” Inspired by these theorists, these two languages provide a wider range of therapeutic space, especially in addressing effective communication with eight different kinds of narcissists and the various types of borderlines, including "The Narcissist the Artist,” and the “Cross-Cultural Borderline.”

Example of Language of Empathology

Wife comes home comes home tell her narcissistic famous attorney husband what a difficult and grueling time she had helping her daughters take care of newly born twins and asked him to help take the trash cans out. He turns to her in dead silence and says, “Can’t you see I’m tired? Do you have a clue as to how many depositions I did today? You do nothing all day and you’re asking me to take out the trash?”

Example of EmpathologyHoney, I know how hard you work. You are the most amazing lawyer. I am so proud of you and appreciate how hard you work. What I am about to ask you is in no way to take away my appreciation for you, but if you can I would so appreciate if you could take out the cans.

Example of DialecticsMrs. B. I think it’s great the way you spoke to your husband, but we must also remember there are two sides to you. One that identifies with your husband’s rejection and devaluation and another side that knows you are deserving of better treatment.

Dual Projective IdentificationWhereas projective identification is a one-way process, dual projective identification is a two-way process that lends itself to conjoint treatment. One partner projects a negative feeling into

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the other, who then identifies or over identifies with the negativity being projected. “I’m not stupid! Don’t call me stupid!”

Couple TransferenceI devised this term to describe what happens during treatment when the couple jointly projects onto the therapist some unconscious fantasy. Couple transference does for the couple what trans-ference does for the individual, but is slightly more complex. “Now you are doing the same thing with me that you do with your husband!” 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 dis-tortions, or shared couple fantasies that become displaced onto the therapist. The notion of the “couple/therapist” transference opens up an entirely new therapeutic vista or transitional space in which to work. It is within this space that “real” issues come to life. A borderline husband says to the therapist: “Now you’re just like my wife, selfish, greedy, and only caring about yourself.”

Reverse SuperegoWhereas the healthy superego is a moral structure that goes through life distinguishing between right and wrong and good and evil, the reverse superego does the opposite. It is a concept I de-vised when writing an article for Inspire on “The Twisted Mind and Its Reverse Superego” (Ko-brin and Lachkar, 2011) to describe that what happens when one is praised for being bad and punished for being good. An example of this would be countries that encourage mistreatment of women. At the domestic level it might sound something like, “He is so envious of me and my ac-complishments. Instead of celebrating my success, my promotion, my awards he goes out with the guys making me feel like a nothing.”

V-spot“The V-Spot” or “vulnerable spot” e term I devised for couple therapy to describe the most sen-sitive area of emotional vulnerability. It is a term I originated I abstracted from Heinz Kohut’s narcissistic injury known in the literature as “the archaic injury.” It is a product of early trauma that one unwittingly holds onto throughout life that gets stirred up when one person hits an emo-tional chord in another. It is marked by the slightest provocation one wrong word/movement and it’s off. It blows! It is the epicenter of our most fragile area known in psychoanalytic literature as the “archaic injury.” It is the emotional counterpart to the physical G-spot. The V-spot is the heart of our most fragile area of emotional sensitivity, known in the literature as the archaic in-jury, a product of early trauma that one holds onto. With arousal of the V-spot comes the loss of sense and sensibility; everything shakes and shifts like an earthquake (memory, perception, judg-ment, reality). It is a way of meticulously pinpointing the precise affective experience..

No you are not depressed; you are feeling sad. No you are not insane; you are feeling ambivalence. No you are not angry, you are feeling betrayed and disappointed.

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No you are not suicidal; you feel hopeless and helpless. No you are not stupid; you are feeling anxious.

Different Ways of ListeningWhen it comes to listening to the complaint, the road is endless. Klein would listen through the patient’s projections and distortions, while Kohut would listen through the empathic lenses whereas as Fairbairn would listen to the internal complainer. Wilfred Bion’s (1967) would listen to alpha function versus beta elements to decipher to determine if there is a complainer without a complaint. Salman Akhtar (2013), who has transformed the traditional “talking cure” into a “listening cure.” Would listen through four different kinds of listening approaches which does require quite a simple therapeutic skill.

Objective Listening Subjective Listening Empathic Listening Introspection Listening Intersubjective Listening Containment Listening (holding the thought without response) Listening to the Silence and Non-Verbal Listening Transference and Countertransference Listening Language of Empathology Listening (Listening with empathy) Language of Dialectic Listening (splitting/listening to two sides) Listening to Bad Internal/External Objects (identification/bonding with bad internal objects)

Different Ways to Listen

Objective Listening The detached observer one who listens without preconceptions abandons all conscious

memory. My Mother Abused Me!

Subjective ListeningThe analyst paying attention to his own reactions, his body movements, (toe tapping, wiggling, sleepiness) responds through bodily empathy.

Empathic ListeningTo feel what the patient feels by getting a taste of his experience but then get back to the patient expressing how you know what the patient was going through. Kohut offers empathic understanding of how the patient feels and why he should feel that way. To feel what the patient feels what Kohut refers to as empathic immersion.

Intersubjective Listening

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Where two subjective realities come together but become as collaborative exercise in finding truth/reality. It is the point where two subjective realities come together in a collaborative effort, the final immersion with understanding when two unconsciousness meet. In couple therapy this can be most valuable.

Introspective ListeningMost valuable whereby one has the chance to reflect on how their traumatic childhood/experiences impacts current relationships. Theodore Reik (1939) has given special meaning to listening with his innovative work, Listening with the Third Ear and its relationship to the unconscious by recognizing its intuitive messages Reik’s superego can soothe, console and forgives unlike Unlike Klein’s persecutory superego Reik’s superego can also soothe, console and forgiving.

ContainmentMy Mother Abused Me! “Because you were abused as a child you left with feelings that are intolerable to rid yourself you to project them onto me as the container for your unwanted parts. Bion’s conception as a container is a very active process which involves feeling, thinking, organizing and thoughts that lead to an action. In a way this is a good thing because it enables me to get into the experience with you (detoxification and transformation for a new experience.

Silent (Non-Verbal) Listening - Listening to the Silences and Non-Verbal Listening

Different kinds of silences: Part of human mind that has no words, the un-mentalized experience or more commonly known as

“out of touch.” Part of human mind that has words but are hidden (repressed thoughts often associated with shame). Part of human mind that speaks through non-verbal communication.

How Different Theorists Would Listen

Here are some examples of the various ways to listen and respond to complaints: Objective “Your mother abused you.” Subjective “I believe your mother abused you but maybe you have other feelings about it.” Empathic “I can understand how traumatic this must have been for you.” Intersubjective “ Now you feel I am abusing you when I set limits and boundaries just as

your mother tried to do with you.” Introspective (Listening with the Third Ear (Reik) “Let’s take a look at how this abuse im-

pacts your life.” Listening to the Silence and Non-Verbal Listening “You either are lost for words or you

don’t want to talk about it.” Non-Verbal “I can tell by the way I get sleepy in session with you letting me know how you

feel a sense of deadness inside.” Body Language “I can tell by the way you tap your toe toward end of session you are anx-

ious to leave.”

“My Husband Loves Me but Likes to Wear My Underwear”Wife: I know my husband loves me. But what drives me crazy is that he likes to wear my underwear.

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Husband: But she should love me for who I am!

Freudian Therapist You are responding out of hysteria a defense against your own prohibitive fantasies and instincts.

Kleinian Therapist No, this is not who you are. This is a defense against your mother abandoning you since you could not possess so become her by wearing her underwear!

Kohut I totally empathize and understand how you must feel when you see your husband wearing your underwear that he is not giving you the mirroring and taking the attention away from you.

Kernberg I believe Dr. Freud and Mrs. Klein are right. Because of your own sexual inhibitions and repressed thoughts, you are projecting onto your husband your own guilt. Not a good time to consider getting a divorce while these primitive defenses are operative you should not make major decisions (ego dysfunctionality).

Fairbairn Yes, there can always be an external husband who acts inappropriately, but there can also be an internal part of yourself that identifies with the inappropriateness—the part of you that yells, screams, gets hysterical, and momentarily loses her mind. By not getting in contact with your own impulsive acts, you are over-identifying with his behavior.

Winnicott Your husband must feel very secure and safe with you, Mrs. C, because he is allowing himself to be his “true self,” not a self that is shamed or must hide (safe holding environment). He knows he loves you and you love him. How about becoming more of the “being mommy” for him?

Bowlby Perhaps this is a way of your husband detaching himself from you, even from his own body. Because of having a mother who neglected him as a baby, now he is disconnecting from you. You must not take this personally.

Linehan No you cannot change him, Mrs. C. you have to accept him for who he is and get into a state of mindfulness and acceptance.

Bonding and Attachment

Why am I always attracted to men who are unavailable?

Why Couples Stay in Painful Conflictual Relations Traumatic Bonding Pain/Sacrifice/Victimization

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Attachments to Bad/Good Internal/External Objects (Fairbairn) Bonding With the Mother of Pain Different Mothering Experiences (Winnicott) Psychodynamics of the Couple: The Dance, the Bond, the Dram

The Psychodynamics of the Couple

Shame vs. Guilt Envy vs. Jealousy Splitting/Projective Identification and Dual Projective Identification Dependency vs. Omnipotence Control/Domination/Victimization Competition/Rivalry (unresolved oedipal conflicts) Cross-Cultural Psychodynamics

Bonding with Pain

Better to bond in pain then to have to face the void, the black hole, the emptiness. Pain stirs up an amalgam of unresolved infantile issues Pain becomes highly eroticized/sexualized Pain is familiar (familiar internal bad object) Pain is confusing. The lover who can be cruel and sadistic can also be loving and kind. Pain is linked to internal part of self-one wants to destroy/rid of

Bonding with Bad Internal External ObjectsFairbairn

There can always be an external betrayer/depriver/rejecter but there can also be an internal oneW. R. Fairbairn

Bad Internal Objects (Fairbairn) The Wronged Self The Insatiable Self The Craving Self The Lost Self The Betrayed Self The Rejecting Self The Abandoning Self

Bad External Objects Rejecting Object The Abandoning Object The Betraying Object

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

Why Do People Stay in Painful Conflictual Relationships

W. R. Fairbairn (more than any helps us understand why people stay in painful conflictual rela-tionships and stay forever attached to a painful bad internal object (rejecting, insatiable, unavail-able). Fairbairn extends beyond Klein’s good and bad breast theory to the notion that people do not split into two parts, the good and bad objects, but into multitudinous ones, the attacking ob-ject, the unavailable object, the suffocating object, the abusive object, the rejecting object and how one will forever remain attached to these bad and painful internal objects. That as bad as bad as the pain is, it is familiar and preferable to facing feelings of emptiness the black hole. Be-cause pain is linked to the love object; it is also familiar and becomes extremely charged and eroticized, “traumatic bonding,” Such bonding creates ambivalence because the one who cruel and sadistic can also be threatens and be loving and kind.

Attachments to Bad Internal Objects

In treatment it is our job to gradually wean the patient away from external bad object to getting them to face their 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.

Why do I stay with a woman who belittles, attacks me, abuses me?. Why can’t I get rid of her?. She is like an albatross around my neck.

“I don’t feel the same excitement as before. I need a woman who excites me!”

”Why am I always attacked to men who are unavailable?”

It is better to bond in pain then to have to face the void, the black hole, the emptiness.

Example The Unavailable Object

It is Saturday night Sandy is waiting. 6, 7, 8 PM. Steve calls for the third time to say he will be late. 9:30 comes. He calls again something has come up and he can’t make it, but “baby we’ll do it next week.” Following week Sandy waits and waits and waits, but “next time” never comes. In this short vignette we can already see who the narcissist is and who the borderline is. Barbara. is the borderline, dominated by abandonment anxiety, maintains a painful destructive attachment with a narcissistic/un-available object. In the Disappearing Male book she is the Disappearing Female, one who disavows

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and cannot trust her reality. Steve is the narcissist, lacks empathy, feels entitled to keep people wait-ing, puts his needs first and acts like she doesn’t exist. Later in treatment Sandy tells me that this is the first time in her life someone has told her that she is not deserving of this kind of treatment and that she is not imagining it (the validating mother). “My mother used to say, what you have done to deserve this?”

W. R. FAIRBAIRN

Fairbairn (1952) helps explain why people stay in painful, conflictual relationships. In some ways Fairbairn has upgraded Klein. Fairbairn has expanded Klein’s concept of the good and bad breast to the notion that the ego splits into multiple objects (the rejecting object, the painful object, the insatiable object, the betraying object, the enviable object, the unavailable object). Certainly the Kleinian “bad-breast complainers” will grumble no matter how much gratification is achieved, for they perceive the world a place of privation and deprivation. In many of my previous works I have paid special tribute to W. R. Fairbairn for he has been a key contributor whose work has significance in understanding how and why people stay forever attached to painful bad internal objects. I am amazed at how easily his theories adapt to the topic of complaints and listening.

Object relations is a powerful theory that examines unconscious fantasies and motivations, reflecting how a person can distort reality by projecting and identifying with bad objects. There are those individuals who confuse love with pain and cannot feel a semblance of aliveness unless these concepts are fused in a dysfunc-tional, destructive attachment. They complain about the same thing again and again, without any awareness of how this can impact and provoke another person. Surprisingly, even after divorce or separation one re-mains attached to the “bad object.” “I’ll sue the hell out of him.” As Grotstein (1987) reminds us, any attach-ment is better than no attachment. Children who have had a history of physical and emotional abuse are tar-gets for this kind of “traumatic bonding.” Anything is better than the emptiness.

“At least I feel alive! I know I exit!”

In narcissistic conditions, the "entitled one" will complain because he or she never has enough (attach-

ment to the insatiable object.) In more several pathology such as borderline conditions, this feeling of "never

enough" equates with deprivation, where pain takes on a new dimension. Not only does the borderline bond

with pain, he or she “becomes” the pain. “I am my depression and my depression is me.” Pain is linked to

the internal part of the self that one wants to destroy or get rid of. There are many factors in play: First, it is

better to bond with pain than to face the void, the black hole, the emptiness. Second, pain stirs up an amalgam

of unresolved infantile issues. Third, the pain becomes highly eroticized and sexualized. Fourth, pain is famil-

iar (the familiar bad internal object). Fifth, pain is confusing and creates ambivalence. The lover who can be

cruel and sadistic can also loving and kind.

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Day Two

Welcoming Back Comments

Good to see you all. Hope you had a good night, today we will discuss treatment issues starting with Therapeutic. First let me say a few words about LOVE.

About Love

Two people begin their relationship with deep feelings of attraction and longing for each other, but lurking in the shadows in an incontrollable impulse to destroy, threaten, and sabotage, some kind of primitive unconscious interference that disrupts love because of an unruly past or early trauma

So what is This Thing Called Love Who knows about love? Keats? Shelley? Freud? Shakespeare? According to Freud (1914), love is a basically a psychotic state, a powerful, irrational and all-consuming ex-perience sometimes short-lived or can develop into a more mature love. He also talks about being in love with oneself, a kind of narcissistic love, being in love (some people never get over this). What Freud forgot to mention is what happens to the person’s ego when in this psychotic/blind state. The first thing that goes is the ego. Judgment reality testing, rationality, perception during the onset or intensity of a love relationship? This explains why smart people say stupid things.

KERNBERG DIFFERENT KINDS OF LOVE RELATIONSHIPS

In Kernberg's Aggression in Personality Disorders and Perversions (1992) describes four kinds of love relationships (1) normal, (2), pathological, (3) perverse, and (4) mature love. His premise is that in normal love, the relationship overcomes the conflict. Internal strivings do not interfere

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with the capacity to maintain an intimate loving connection. In pathological love, conflict overpowers the relationship (part object) where internal conflicts do interfere with the capacity to maintain a loving relationship. It is love that goes in the wrong direction, implying that people who have been traumatized are like emotional cripples in relationships because they link idealization with eroticism. In Perverse love it is the search for excitement. What kills a perverse love is love. Mature (whole object). Mature love coming integration of the good and the bad. Focus more on children, community, goals.

Four Types of Love Relationships (Kernberg)

Normal: Relationship more important; love takes over conflict. Pathological: Conflict takes over the relationship; part object functioning. Perverse: Search for excitement; partners reverse good and bad. Mature: Goal/task oriented; whole object functioning

Other Types of Love Relationships

Obsessive/Addictive Love Romantic Love Erotic/Exciting Love Idealized Love Unavailable Love Rejecting love Lost Love Abusive Love

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

The AffairAnother, often life-shattering, complaint that gets revealed in conjoint therapy is cheating and infidelity. In the back of every therapist's mind is the fear that lurking in the shadows is the discovery of “the affair.” There is not only the revelation of the affair, putting both therapist and the victim of the affair in a most uncompromising position; there is also the problem of what to do after the revelation. Mrs. F. comes into treatment calling for an emergency session. “When I saw his telephone number on my iPhone, I just knew he was confessing to a long-term affair. My heart began to pound as I listened to the confession!” After the revelation, there is the problem of how to deal with the initial shock, how to explore the reasons for the affair, and how to deal with the threats of divorce or the reparative process. “All these years I had no clue he was screwing another woman.” At the beginning of conjoint let the couple know that everything that happens outside of session can be shared during the conjoint except when I use my discretion. Some therapists terminate the treatment with the idea that the knowledge of the affair

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contaminates the treatment. My goal, being a therapist psychoanalytically trained is to go beyond the affair as a venue for emotional and psychological exploration.

Common Reasons for an Affair The person falls madly in love with someone else. The person feels something missing in the relationship. The person acts out of revenge or as an expression of anger. The person needs many different people for adulation and attention. The person is perverted and looks for excitement in lieu of love. The person has lost contact with his/her inner passion and turn to excitement as a

superficial substitute.

Stages of the AffairTo tell or not to tell that is the question

Disclosure of the affair process of discovery. Patient reveals to therapist out of session Partner finds out outside party reveals The actual shock of discovery-disbelief. Did this really happen? The aftermath of the affair one partner wanting to know all the details. To tell or not to

tell. The healing process and reestablishment of trust.

The Affair(See Case of Mrs. A.)

Common Complaints

Introduction

This book is about “complaints” ranging from the domestic, to the cross-cultural, to the global through the investigation through psychoanalytic lenses. Every individual, every patient, every couples every culture has their own way of complaining. When is a complaint a complaint or when is a complaint used a form of evacuation? This book has a different twist than my other publications. Rather than starting out by delineating the various diagnostic disorders (the borderline, the narcissistic, etc.) and illustrating how their corresponding defense mechanisms impede the capacity for intimate love relations and healthy object relations, I focus on the complaints themselves. Each chapter will revolve around a specific type of personality and situational conflicts that ensue. Individuals and couples often enter into treatment thinking their battles are over money, sex, children, and custody when they really are about betrayal, isolation, abandonment, entitlement, victimization, control, domination, and oedipal rivalry. Treating the

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emotional vulnerabilities within the context of these complaints makes it imperative to take account these qualitative differences. The treatment for these conflicts requires a broad grasp of the psychodynamics within the constructs of various personality disorders and corresponding environments. As it takes a serious look at the fine art of complaining, this volume delves beyond ethnic and religious borders to understand the dynamics of complaints from a clinical and cultural perspective. The descriptive titles outlined in this book—such as “The Entitled” rather than “The Narcissist,” the “Promiser” rather than the Borderline, or “The “Withholder” rather than “Obsessive-Compulsive”—is in no way intended to be pejorative. Rather, they are intended to make this book more accessible to a variety of readers. These titles are segues to understanding the kinds of conflict stirred up by various personality types and the reactions these individuals evoke in others. In some of the chapters, I give myself the liberty to speak in the voice of these actors. When examining the complaints that are presented, we need to be aware of the type of personality voicing the complaint. We need to understand “how to listen,” to tell when we are hearing a legitimate problem and distinguish when a complaint is not a complaint. Finally, we must learn how to listen with a “cultural ear” (See Chapter Eight on cross-culture.)These are two complainers that I describe as two personality types who enter into a psychological "dance" who consciously or unconsciously stir up highly charged feelings that fulfill many early unresolved conflicts in the other conflicts in the other as they coerce each other into playing certain roles. The revelation is that each partner needs the other to play out his or hers own personal relational drama. Within these beleaguered relationships are developmentally arrested people who coerce each other into playing out certain roles as they bring archaic experiences embedded in old sentiments into their current relationship (also known as “The V-Spot” (Lachkar 2008).Together they enter into a psychological drama that I refer to as “the dance.” The revelation is that each partner needs the other to play out his or hers own personal relational drama. embedded in old sentiments into their current relationship (also known as “The V-Spot” Interactions that are on-going, circular, never ending that go on and on, how each one stir up each other’s painful injuries without ever reaching any conflict resolution Lachkar (1934, 2004, 2008a, 2008b, 2010).

Couples often enter into treatment thinking their battles are over money, sex, children, in-laws, ex’s when they really are about betrayal, deprivation, isolation, abandonment, entitlement, victimization, control, domination, and oedipal rivalry. Treating the emotional vulnerabilities within the context of these complaints makes it imperative to take account these qualitative differences. The treatment for these complainers require a broad grasp of their defenses with their corresponding personality disorders.

The list that follows contains some typical issues that bring couples into treatment. When these issues are not addressed, they bring about lack of trust and failure to provide a safe and reliable holding environment. One of my daughters, who happens to be a clinical psychological, said, “Mom you’re making this more complicated than it is. It is about sex, money and kids; that’s it."

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Defining a ComplaintThe Merriam-Webster Dictionary defines a complaint as a means to express grief, pain, dissatisfaction, or discomfort, like complaining about the weather. A complaint also could involve a formal accusation or charge. Example: “If you’re unhappy with the service, you should complain to the manager." A complaint can also be a bodily ailment or a disease. The first known use of the word was in the fourteenth century—although I'm sure complaints date back to Neanderthal times. Synonyms for the verb complain include: beef, bellyache, crab, fuss, grip, groan, growl, grumble, grump, holler, kick up a fuss, kvetch, moan, nag, scream, squawk, wail, whimper, whine.

Complainers Lack of sex and romance Love and intimacy concerns (“Why can’t it be like it was before?") Control, power, domination

Competition, tit for tat

Failure to keep promises, false hopes, lying or cheating

Lack of trust

Boredom, loss of attraction, growing apart, isolation

Infidelity

Immaturity (“Why is he always the victim? He always gets into trouble, forgets his car keys, gets his car towed, and loses his wallet, and I have to take care of him.”)

Commitment, marriage, children, having kids (“I know her biological clock is running out, but I don’t want to get married or have kids, yet I want to stay in the relationship!”)

Stress (“He’s always on the couch watching TV or getting loaded while I’m working my butt off.”')

Threats (“He keeps threatening me with divorce, but doesn’t do anything to work on our relationship.”)

Money (“She’s a shopaholic; all she does is shop and spend." "He's not a good provider.")

Control (“I can’t do anything without his watching over me and criticizing my every move.”)

Entitlement ("He feels entitled to everything—a nice car, nice clothes, high-tech equipment, and when I need money to have my nails done, he makes me feel as though I am unrealistic.")

Withholding (“He has to count every penny. Thinks vacations, going out to dinner, redoing the house are just a waste of time and money.”)

Attention-seeking (“She always sick, tired or exhausted. If it is not one ailment it is another. It’s a turn-off.”)

Self-absorption (“All he does is work." "All she does is obsess over her body and her looks.")

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Lack of romance, not enough sex, exhaustion from work/kids

Lack of emotion (“He shows no emotion and has no desire to do anything; he is like a zombie.”)

Obsessiveness (“He threatens to kill me if I ever dare to throw any of his objects away, even a wire coat hanger. We can hardly get into the house anymore.”)

Perfection “(Everything has to be perfect—all the towels facing the same direction, perfect closets with everything labeled and covered with plastic. And if I have a hair out of place he won’t go out with me.”)

Nagging and blaming: ("All she does is nag, nag, nag, with one complaint after another non-stop.” "Everything is my fault.")

Lack of caring/not invested in relationship (“Why is it when things are going well he will always find excuses to sabotages our plans”)

Flirting ("He was such a charmer in the beginning, and I really felt that he/she loved me. But now he’s always on the prowl, looking for other men/women.”)

Addiction (“I feel so helpless; his addictions control our relationship.")

Manipulation ("He fools the world; he is a real con artist and the biggest manipulator.”) Psychopathology (“He has no regrets for any harm he has done to others except when he

gets caught.”) He is abusive, a liar, and a manipulator. I had to call the police because he was abusing our daughter. To punish me he locked me in a room so I could not go to work or to my doctor’s ap-

pointment. After he beats me and apologizes, I believe him and again fall into the role of his victim. He is sadistic and has no sympathy for anyone. To punish me he refused to let me use the bathroom, so I had to pee in the sink.

Legitimate Complaints:

It upsets me that you never want to celebrate holidays. It upsets me that you never sit down and eat dinner with us. It upsets me that when we go to dinner you flirt with the female server. It upsets me that you dump me at the last minute to go out with your adult kids. It upsets me that you won’t ever make plans and insist on doing things at the last minute. It upsets me that you let yourself get out of shape. It upsets me that you allow your mother to intrude into our relationship. It upsets me that you don’t say loving things to me. It upsets me that you make important decisions without me. It upsets me that you withhold money, time, and attention from

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Therapeutic Techniques and Approaches

Patients comes to therapy because they have fears and anxieties and are looking for someone to trust, someone who can offer a safe, containing environment that makes them feel secure. The persona of the therapist is of utmost importance, beginning with the initial contact on the phone or in person. The therapist should exude a feeling of confidence and professionalism that invites trust. It takes very little time for the individual or couple to get a sense that the therapist is in charge, has a sense of authority/confidence, is warm and inviting, yet is not an easy target to manipulate. Whether it is a student who is walking into a college classroom, a patient being seen in the emergency room for a broken arm, a music student going for a lesson, or a couple seeking help with their troubled relationship, the person in charge must radiate a sense of authority (not to be confused with grandiosity or omnipotence, but a little of that is good).

Introduction

I always think of therapeutic techniques as having a parallel to music or other art forms. Not just what one says, but how one says or orchestrates with the intent to make an impact. Voice tone, change in dynamics, eye contact and body language, awareness of the role we play within interaction between therapist, patient and the couple. The psychoanalyst is like a fine tuned instrument who can elevate the psychoanalytic experience to another level. Often supervisees will complain that if they perform these functions or enact within certain therapeutic roles as outlined in this chapter, they will lose their authenticity. Do we become Freud when we interpret patient’s aggression? Do we become Klein when we become the good or bad breast? Do we become Winnicott when we become the “being” or the “doing” object mother? Bach is always Bach, Beethoven is always Beethoven and whomever plays or interprets they remain Bach and Beethoven. Same holds true for our pioneer masters Freud remains Freud. Just as with art, music, dance and other art forms, therapy does require three four things. As the famous violin virtuoso Isaac Stern, said, “There are three qualities a musician must embody. The first is confidence, the second is empathic attunement and the third is enough arrogance to carry it off (Freud movie Dangerous Method)

Treatment Techniques and Therapeutic Functions

The Couple Transference Dual Projective Identification Three Phases of Treatment Therapeutic Functions Six Step Treatment Procedures Treatment Points and Techniques How to Listen for a Theme

Couple TransferenceThe 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,

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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” issues come to life. Borderline husband says to narcissistic wife: “Now you’re just like my wife, selfish, greedy and only care about yourself!”

Dual Projective IdentificationWhereas projective identification is a one-way process, dual projective identification is a two-way process that lends itself to conjoint treatment. One partner projects a negative feeling into the other, who then identifies or over identifies with the negativity being projected. “I’m not stupid! Don’t call me stupid!”

First SessionWhat is the presenting problem?What is their treatment goal?What is their individual diagnosis? What is their couple diagnosis?What are their defense mechanisms?What are their psychodynamics (characteristic, states, traits)What phase of treatment are they in?What is their “dance?”What are the prevalent themes (listen to the words)

Example:Borderline wife gets enraged with husband for buying fertilizer for back yard claiming

they did not have the money. He went ahead made a uniliaterial decision to not only buy it bgut to go ahead and plant it. She went ballistic. I interpreted to the couples (using the metaphor of fertilizer). “Look you have a choice you can either fight over “shit” or you can choose harmony. Which one is it?

Three Phases of Treatment

Phase One: The Phase of Darkness, A State of Oneness (Fusion/Collusion) Phase Two: State of Enlistment, a State of Twoness (Transitional Space) Phase Three: State of Reason, Awareness of Two Emerging Separate Mental States (De-

pendent and Interdependent

It’s difficult to know what to do especially when there is so much blaming and attacking going on…..Goethe

In many of my earlier publications, I discuss the three development stages that couples work through. These phases are based on the theoretical constructs of Melanie Klein (1967) Meltzer describing three stages of development primarily designed to show how couples work their way

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from the paranoid-schizoid position to the depressive position. Within these phases, there is continual movement back and forth from states of fragmentation to that of wholeness and integration. In couple therapy, the therapeutic task is to gradually wean the couple away from the relationship dominated by such primitive defenses as shame/blame, envy/jealousy, and domination/control to a position of self-development and responsibility (Lachkar, 1992, 2004b 2008a, 2008b, 2011, 2013).

Phase One−The Phase of Darkness: A State of Oneness (Fusion/Collusion)

It’s difficult to know what to do especially when there is so much blaming and attacking going on! -- Goethe

In this first phase of couple treatment, complaints run amuck. V-spots explode everywhere! It is a phase during which couples live intrapsychically, inside the emotional space of the other. It is a state of fusion or oneness: “I am you and you are me.” It is the shame/blame phase where attacks against the other are relentless, with each partner insisting the other is at fault for all the shortcomings in the relationship and seeking to retaliate. There is much stonewalling, blaming and shaming, and often envy or rivalry concerning the accomplishments of the other. It is a phase in which dual projective identification occurs, how one partner projects a negative feeling into the other and how the other identifies or over-identifies that which is being projected. There is little awareness of the inner unconscious forces that invade and intrude upon their relationships. Instead, primitive defenses such as splitting, projection and projective identification, magical thinking, and denial take center stage. Needs and feelings are often attacked and blown out of proportion. It is in this phase that the therapist has the opportunity to filter through the complaints to determine which is normal and legitimate complaint as opposed to those that is used for evacuation. “I do what my wife wants me to do but she still keeps complaining. If it is not one thing it is another. She is insatiable.” “I think your wife is telling us how deprived she feels and whatever you give her cannot satisfy her” (identification with the depriving object). This state of fusion is often expressed in the form of “the dance.”

I complained to my boyfriend that I was upset.He then got upset about my being upset.I then got upset that he was upset about my being upset.He then got upset that I was upset about him being upset.Then I started to feel guilty as though I never should have complained in the first place.

Phase Two−Twoness: Complaints as a Transition to Separateness

This second phase marks the emergence of “twoness,” a glimmer of awareness of two separate emotional states, a sense of more trust and dependency upon the therapist. In Phase Two, there is more tolerance for ambiguity, budding insights into unconscious motivations (internal objects), ability to see the therapist as someone who is helpful, and the beginning of bonding with the therapist and a weaning away from

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parasitic dependency toward mutual interdependence. The transitional space of Phase Two is where the partners become acquainted with their internal objects and become aware how these objects make one overreact or distort. This phase is also where detoxification and transformation occur. It is almost like Noah naming the animals. If the patient is angry, the therapist helps him see he is disappointed. If the patient is depressed, the therapist helps the patient to realize that he is in mourning. If the patient is feeling helpless, the therapist helps the patient become aware that he is feeling vulnerable or dependent.

Phase Three: A: State of Reason: Awareness of Two Emerging Separate Mental States (Dependent and Interdependent)

This phase marks the beginning of the depressive position; the ability and willingness to express sadness, feel remorse, and make reparation for one’s wrongdoings. There is the desire to “repair” the damage, to embrace guilt, mourn, and take responsibility. It is a time of diminished primitive defenses and greater tolerance for uncertainly, ambiguity, vulnerability, and healthy dependency needs. The complaints become transformative during this period of healing and listening non-defensively to one another’s hurts. It is important to let the couple know that feelings of sadness and remorse are normal.

Mr. W called and said he needed to come in for an urgent session that all the work he has done in conjoint therapy has made him feel worse. “I feel sad, I feel depressed. I go around teary-eyed. I feel terrible about how I made my wife suffer all these years.” To this the therapist responds, “Ah, Mr. W, what you are experiencing is healthy and normal. You are going through normal states of mourning and dealing with loss and coming to terms with some of your wrongdoings. You are sad, not depressed. Did you think things were better when you and your wife were attacking and blaming each other like to fighters in a boxing match?

Therapeutic FunctionsEmpathy Therapist as Bonding/Weaning MommyListening Therapist as Holding/Environmental MommyUnderstanding Therapist as "Being" vs. "Doing" MommyIntrospection/Thinking Therapist as InterpreterTherapist as Mirroring Object ContainmentTherapist as Self Object SilenceTherapist as Container (Hard Object) HumorTherapist as Transitional Object Creativity

Six Step Treatment Procedures

1. See the couple together in order to form a safe bond before transitioning ino individual therapy.

2. Be aware of the qualitative differences and how each partner experiences anxiety differ-ent.

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3. The therapeutic alliance must be joined with a member who is pre-dominantly narcissis-tic.

4. Address the importance of technique and qualities of the therapist.5. Be aware that the more primitive the couple, the more structure, simplicity and clarity

they need.6. Understand that when individual treatment occurs at the same time as conjoint therapy

with the same therapist, the therapist has the right to use discretion about what to share.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.

Eye Contact Not to talk too much Be awareness of separateness (you feel shame you feel guilt) Summarize the session Ask each what was meaningful to them Continually, reevaluate the treatment goals (why they came in the first place!). Avoid asking too many questions (interrogation and obtaining lengthy histories. Don't

waste time. Start right in. The history and background information will automatically un-fold 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 sim-

ple 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 identi-fication).

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, and 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 betrayalHow to Listen for a Theme

Good/Bad Internal Objects, Fairbairn

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Internal/External Complainer Internal/External Betrayer Internal/External Controller/Withholder Internal/External User/Abuser Internal/External/Abandoner Internal/External Complainer Internal/External Bankrupter Disappearing Betrayer

The Disappearing MaleThis book, based on my personal, clinical, and professional experience, motivated by the plight of a number of women I see in my clinical practice who have been wooed, charmed, and lured, then dumped and vastly confused by what I refer to as the “Disappearing Male Syndrome” (DMS). These are a number of women vastly confused and hurt by men who appear to be madly in love with them at the onset of a relationship only to have these men suddenly vanish without explanation. Many of these women come into session depressed and feeling traumatized or abused by the men who promise them the world, act as though they are the love of their life and then suddenly there is no voice, no call/no response

Essentially, the emotional intensity of these women was the inspiration behind this book. For the past several years, I have been overwhelmed by a plethora of emails and messages from women all over the world who have been hurt and abandoned, either physically or emotionally, by men who suddenly withdraw and wanted to find more in-depth answers. Their stories are similar and quite familiar: They involve men who at the onset appear to be madly in love and suddenly vanish without an explanation. These women cannot seem to make sense out of the senselessness, and need to know they are not alone and that they are not crazy. “How can a man “Who loved me so much could not keep his hands off me and suddenly disappear?

At first, I wasn’t sure I was attracted to him. He kept pursuing me until one day I decided that this guy really likes me and I would give him a chance. We did not share many common interests. I liked the arts, and he preferred sports. Nevertheless he got along with my family, and always brought presents to my family when invited. He was very successful, a well-to-do businessman, and seemingly a good family man type. I did not pay too much attention to the fact that he had been married four times and complained that each of his wives "took him to the cleaners.” One had affairs. The others “used" him, practically bankrupting him through their lavish spending habits. Then there were endless custody and alimony battles. He said, “Even though I lost everything to those bitches, I was able to rebuild myself.” Why didn’t I realize was that I was with a man who was jaded, had been raked over the coals, bringing into our relationship

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his “old baggage.” He appreciated that I was different than the others, that I loved to cook, and did not need to go to five-star hotels and restaurants.

Throughout our relationship he kept telling me how I was the only woman he could ever love and trust. He continually told me I was the love of his life. Everything was good until about a year later when I decided to talk about commitment. The next morning I walked outside of my house to get my newspaper and there on my doorstep were all and overnight belongings things that I kept at his place for when I stayed over. Not a word since! What did I do? Was I too demanding? Getting too old? Was there another woman? I was in shock. There was no note, no calls, nothing. I called and called, but to no avail. He refused to answer my calls, and I ultimately got a text message asking me never to contact him again. I can only assume that because he was married four times that the “C” word must have really hit him. I was devastated. I guess I will never know.

Defining the Disappearing MaleThe most common definition a male who purports to be madly in love then suddenly disappears without any explanation. “I’ll call you,” Poof not a word. He’s gone! Second, is the psychoanalytic view as an attachment disorder a war/vengeance against intimacy noting that disappearance does not necessarily constitute a physical withdrawal; also be an emotional one (avoidance, detachment, splitting, gas lighting deafening silence, isolation).

These men had their own unique way of “disappearing, The way a narcissistic withdraws when emotionally injured is different than an obsessive-compulsive who withdraws when in the face of emotionality. “Oh those dirty creepy things.” The way a borderline disappears from his own body when betrayed defends with shame/blame self-destructive behaviors (retaliation, revenge, sabotage, victimization, self-sacrifice,). This differs from the passive-aggressive who is very physically present often on the couch but disappears from his aggressive repressed self as he projects his anger onto others “Me I’m just a good little husband minding my business.” They never express anger everyone around him livid! Take for example the Robotic Male.

He never listens to me. Whenever I ask him what he would like to do or what he wants for dinner, his typically stoic response is “I don’t know. I don’t care. Whatever!” And if I pursue, he gets mad at me for nagging or being too emotional.

The Eight Types of Disappearing Men

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Disappearing Narcissist (the man who withdraws and isolates himself when narcissisti-cally injured).

Disappearing Borderline (he's invisible and feels he does not exist). Disappearing Schizoid (the man who withdraws and lives inside himself). Disappearing Obsessive Compulsive (exist in a state of perfectionism and cleanliness,

withdraws from need because he feels they are dirty and toxic). Disappearing Passive Aggressive (the man who will do everything manãna) Disappearing Depressive (who withdraws outwardly and turns inside himself). Disappearing Narcissist the Artist (he is married to his art). Disappearing Cross-Cultural Man his country come first).

Where East Meets West: Cross-Culture Treatment of Cross-Cultural Couples

My interest in cross-cultural couples began in clinical practice, treating couples from various eth-nic and cultural backgrounds and recognizing that globalization presents many new challenges. Today our consultation rooms are beginning to look like a mini United Nations filled with indi-viduals and couples with various backgrounds—multicultural couples, cross-cultural couples, in-terracial couples, inter-ethnic couples, same-sex marriages, blended family marriages, and step family marriages. Many people do not realize that when they intermarry they tying the knot with an entire culture and with them also bring their nationalistic flags includes their family, their reli-gion, ideology, childrearing practices, gender, and political heritages. I chose Asian and Middle Eastern mainly because their ideologies are so vastly different than ours (most other countries follow Judeo/Christian beliefs). How does a Western therapy deal with the various dynamics couples with different orientations where in many countries “I will die for my country” become the replacement for the American Dream.

The first real insight into cross-culture was at a Sushi bar with my daughter. When I received my meal, I complained to the manager that the server had misunderstood my order and that it wasn't what I wanted. A few moments later the manager appeared with a young man who bowed low then got on his knees and begged for forgiveness. He was newly arrived from Japan, and by sending the meal back I had unknowingly shamed him. Just as couples think their battles are over money, sex, children, and custody but really are about control, domination, victimization, rivalry, and unresolved oedipal issues, the same holds true with problems in the political arena. Countries think battles are over territory, religion, economics, and ideologies, but the real issues are over betrayal, entitlement, control, and domination. In order to effectively treat the emotional vulnerabilities within the context of the “complaints” among cross-cultural couples, it is imperative to take into account these qualitative differences.

Do Cultures Have a Cultural V-Spot?Do Cultures have a cultural V-spot? Do they blow at the slightest provocation? In noting the parallels between marital and political conflict Is that I do believe like couples, cultures also have

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V-spots archaic traumatic injuries bonded through was, losses or a lifetime of governmental vio-lations keeping them forever embroiled in endless feuds.I am reminded of Korean woman who would blow at the slightest provocation and hold onto her rage for months on end.. I learned, that inherent Korean women is a rage called han. Historically Korean women were the only Asian group that lost men to wars were abandoned and had to fend for themselves and develop more aggression than their sister neighbors.

PsychodynamicsThere is a Dance between the Cultures but also a Dance between Their Psychodynamics

Mental health professionals need to be aware of the differences across cultures. What dependency. shame, guilt, honor, peace means in one culture may have complete different meaning in another. Even words like “opportunity” and “honor” can be poles apart. In the West we associate the term “opportunity” with man’s freedom to flourish, in the Muslim world “opportunity” could mean the permission to stone, slaughter, or even behead a woman who exposes her arms or face or goes out in public unaccompanied. The same holds true for terms such as “honor” and “peace.” In Islamic regimes, only when all the infidels are destroyed can there be peace and harmony. Peace to them means getting rid of all infidels. It is not enough to understand shame without understanding the need to “save face.” the group self-vs. the individual self.”

I am reminded of a young Japanese graduate student who came in for treatment in my early years of clinical practice. He walked in with his head down, did not make any eye contact. After sitting silently for many minutes and obviously feeling very anxious, he said he was gay, and felt very fearful that his family was soon to discover his preference for men. I proceeded to tell him how he had to do what was right for him and not live his life for his family and friends, and how wonderful it was that he could come for treatment and begin to develop his own sense of self. He looked at me quizzically (as if I were from Mars) “What is a sense of self?”

Most Western psychotherapists assume that there are two individuals interacting together, “When we are a ‘we’ I don’t have to tell you how I feel. You will just know.”

Cultural PsychodynamicsThere is a Dance between the Cultures But There is also a Dance between their

PsychodynamicsPsychodynamics and Cultural Complaints

Just as there is dance between the cultures there is also a dance between their psychodynamics:

Dependency (Amae) Dance between shame and guilt Individual Self vs. Group Self

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True Self vs. False Self Truth, Lies and Promises Treatment Points Cross-Cultural Couples The Cross Cultural Hook

Dependency (Amae)A Western psychoanalyst will encourage the patient to express his/her needs as directly and openly as possible, but a Japanese patient will remain silent, waiting for the analyst to offer what he or she needs (amae). What dependency in our culture takes on a complete different mean in another. A Western psychoanalyst will encourage the patient to express his/her needs as directly and openly as possible, but a Japanese patient will remain silent, waiting for the analyst to offer what he or she needs (amae).

The Dance between Shame and GuiltAsian and Islamic cultures are known to be shame cultures In the West people are preprogramed to feel guilt. In Japan, shame is a major component of the culture, as many scholars affirm. Shame constitutes a major sanction, whereby people are humiliated and made fun of. The most common threat that a Japanese mother is to discourage behavior of which she disapproves in her children is to say Warawareru wa yo! (People will laugh at you!). In Japan people are encouraged to hide their feelings in order to save face. In Islam one will be isolated from the group or severely punished “honor killings.”

] Japan still has not come to terms with their war crimes unlike the Germans who have taken large measures to make reparation and come to terms with the sins of their fathers. In Islamic regimes shame and honor are the two of the most pervasive forces “To regain honor a man has a right to divorce, beat or even stone his wife.”

Individual Self vs. Group SelfAnother important dynamic to consider is the difference between an individual self and a group self. In many societies, particularly those in Asian and Middle Eastern countries, the individual self is virtually non-existent. Where American culture emphasizes uniqueness and self-expression, Asian societies stress the group self. If the individual defies the group he/she can be subject to humiliation, ridicule, and may even become an outcast.

True Self vs. False SelfThen, there is the true self and false self, terms originated by Donald Winnicott (1965). Most Western psychotherapists help struggling couples become more attuned to the true self, which is belied by the false self. The Japanese adhere to two selves: Honne represents the home self or private self while tatameo is the public self, which does not display emotions. This can cause a great deal of confusion when treating a Japanese person, who would be unlikely to free associate in a therapist's office. Winnicott encourages us to help patients get in touch with their true selves.

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In countries like the Middle East, this individual self is virtually non-existent. In Japan they have a public self (honne and a private self (Tatemae). Western therapists help patients be direct to assert themselves. The Japanese will go out of their way to avoid confrontation. Professor Peter Berton wrote in a paper how Japanese have 16 way to say yes when they mean no.

Truth, Lies and PromisesA cultural form of deception mean to disguise truth especially for “the greater cause.” Islam implements this through Sharia law (Taqiyya). This is in contrast to the Japanese form of “deception” where the intention is not to deliberately deceive but a form of politeness.

Harmony (WA)If we compare the cultural differences between Japan and the United States in the allowance for individuality or conformity, we would find that a Japanese person would be careful not to show negative emotions and have a tendency to pretend not to see the emotions or expressions in others. In contrast, the United States, a country that encourages individuality, would encourage both the expression and perception of negative emotions. Again, in Japan the emphasis is on conformity, so emotions would be considered a threat to the group’s harmony (wa).

Hierarchical PositionsWho comes first in the culture? In China deference is given to country, elders, big brother, and boss, while wives and children are last on the list. For example, Zhou Yan, a Chinese Olympic Gold Medal skater in 2000, was criticized for thanking her parents first and not her country. The same holds true for other Chinese athletes, such as basketball sensation Jeremy Lin, whose skill at basketball is not considered his own personal accomplishment but as giving honor to his country (Kaiman, 2012). In Middle Eastern societies deference is given to religion, prayer, and loyalty to prophets.

Pop RevolutionWe now have emerging in Japan a new pop Cultural Revolution which is in the rebellion against amae, against societal inhibitions, a society of imposed restraints that either a person conforms or is ostracized or shamed from the group. These girls don’t show any restraints. They are called The Kickboxers. “Here we are in your face! See Mom! Look at my short shirts between my legs no underwear!” From a psychohistorical perspective, one might interpret that these young girls have moved away from the image of the peaceful harmonious chrysanthemum to that of the vagina/sword, no longer as an object to compel men, but to repel them. They have relinquished old roles into an emerging new trend of women no longer wanting to stay home and raise children. In fact, the Prime Minister of Japan was brutally criticized when he referred to Japanese women as “birth machines I would interpret these extreme behaviors as a manic defense girls who envy “Hollywood starts, not only mimic them but “become them, their Hollywood making a caricatures of them (10 inch high heels, short mini shirts, huge red lips and even sewing their lips to resemble Hello Kitty, etc. Have these girls become the sword, the new implants a society of

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plastic women acting as robots in the attempt to relinquish a pacifistic society? What a bitter paradox, the disappearing male who depends on marriage and family for status and honor, is confronted with a segment of Japanese women who forgo marriage and children so as to not live the subservient life of their ancestors. ”Could this be a cry for help? “Wake up Dad we need you!” Current day Japan finds themselves going back to the Samurai mentality especially with the uprising of China’s \ military threat to them by .

Treatment Cross-Cultural CouplesGroup Psychology

Group psychology is the study of group myths and group fantasies Cult-like behaviors dominated irrational/delusional thinking, group myths Bond through collective group mutual fantasies Idealization and identification with destructive group leaders Form collusive/parasitic ties with one another. Wilfred Bion’s two groups (1961) The Work Group (thinking/task oriented) The Basic Assumption Group (irrational dominated by primitive defenses)

Group PsychologyGroup psychology has been a very important influence in understand the dynamics not only of groups but cross-cultural couples. The seminal works of Wilfred Bion has been most influentialr he explains why people in regressed groups have twisted minds as they form idealized bonds/attachments with destructive leaders/bosses/managers who collude with the group's collective fantasies and idealization of their leaders. “We know our leader is destructive, but he is our father and our savior and we worship him.” Do cultures have a “V-spot? I believe they do, where an entire nation adheres to certain group fantasies based on painful archaic injuries, myths, and sentiments handed down from generation to generation. Transposed to the cultural level, the V-spot might sound like, “How dare you dare insult our Prophet! You shook hands with a woman! You didn’t bow the right way! I’d rather die than give up allegiance to my country” (Lachkar, “The Psychopathology of Terrorism.”

Do we have a collective traumatic memory? I believe the answer is yes. The noted psychoanalyst Carl Jung (1973) referred to cultures as having a collective unconscious. This could be a biblical or historical past, a group genocide, a holocaust—something that evokes painful, injurious feelings and old memories. The cultural V-spot is a collective group fantasy, an area of vulnerability traumatically bonded through wars, loss, or a lifetime of governmental violations of human rights that keeps a group embroiled in endless feuds.  Unfortunately, this kind of traumatic bonding never reaches conflict resolution. It is an endless search for justification, identity, a need to find meaning from the meaninglessness.

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PsychohistoryPsychohistory does for the group what psychoanalysis does for the individual. The analyst inter-prets dreams in the same way the psyhohistorian interprets group fantasies. It offers a broader perspective from which to view cross-cultural differences. Using psychoanalytic tools and con-cepts, psychohistory allows a better understanding of individuals, nations, governments, and po-litical events—very much as a therapist analyzes the couple as a symbolic representation of a po-litical group or nation. The psychohistorian uses analytic tools to examine cultures, nations, and groups by exploring their religion, ideologies, child rearing practices, the leaders they identify with and their collective group fantasies and myths. As a psychohistorian specializing in the Middle East and Asia, I explored how we distinguish a “normal” conflict from a pathological one. Just as each personality type has its own unique way of expressing conflict so do cultures. One culture’s mental health is another culture’s pathology. Some say terrorists or jihadists are normal people who merely have been brainwashed to fight for a cause. Others have referred to this as a culture of intimidation, where repressed behavior is rewarded and individual rights are demonized. But according to Western psychological studies and standards of human develop-ment, they are not normal. If I went to Baghdad and reported abuse, I doubt it if I could find a doctor or therapist who specializes in domestic violence. To penetrate these seemingly imper-meable borders, we must take into account certain aspects of culture such as religion, child-rear-ing practices, ideology, mythology and psychodynamics such as shame, honor, saving face, guilt, dependency, envy, jealousy, devotion, and meaning

Cross-Cultural Couples Treatment Points Be familiar with the basics of the culture’s customs, music, foods, a few expressions,

greetings (Shalom, Salem, Buenos Dias, Au revoir) Try to familiarize with a few of the cultures basic tradition, customs and language (to say

hello and goodbye, the kinds of food they like, music, movies, etc. Be familiarize with their holidays e.g., Chinese New Year’s, Rosh Hashanah, Ramadan. Understand the fundamental differences in the dynamics of the cultures involved. Self-psychology and mirroring techniques are most effective. We empathize with the conflict

not with the aggression. “I understand how in your country one can beat onus’s wife, in our country it is a criminal offense.”

When stuck or in doubt “mirror” the conflict. “So in your country your parents and your family come first. In our country the wife and the immediate family comes first.”

Locate the cross-cultural hook to find hypocrisy within the respective cultures. “Your wife complains that you control all the money yet you tell us in your country (Japan), the wife takes care of all the finances!

In more difficult cross-cultural couples the focus is on coming to terms and recognizing their differences not on ‘the cure.”

Set treatment goals and continually remind the couple why they came in the first place. Make use of the language of empathology and the language of dialectics. “Part of you

wanted to marry an American woman and another part wants a woman of your culture.”

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Be aware of body language and position (sitting too close, shaking hands, etc.). Focus less on the cure and more on tolerance of cultural differences. Remember that all therapists are mandated reporters, and abuse and violations must be

reported regardless of what another culture dictates. Use humor to avoid sounding punitive or hooking into shame or guilt.

The Cross Cultural HookThe cross-cultural hook (Lachkar 2008b) is a means to find pathology within each partner's own culture and construct a platform for "negotiating" by pinpointing cultural contradictions and hypocrisy. For example, a Japanese wife finds solace in nursing her baby (sleeping with the baby in another room not having sex with her husband) giving the therapist an opportunity to point out the conflict within in her culture (subservience to husband). Or an American wife complains that her Japanese husband is cheap and cannot accept living in American materialistic society. Only to point out that Japan is a hub of materialism. Objects, in fact, often become the replacement for human contact.

Self-ExpressionIn many cultures people are not encouraged to express their basic needs and desires, let alone voice their complaints. In Japan, people are encouraged to conform and be in harmony with others. In the Middle East, people are also repressed, but suffer far graver consequences should they violate the rules of their society. It is only when they come to our country that we begin to hear the “real issues”

Typical Cross-Cultural Complaints

Spouse needs to be more communicative Spouse wants more respect Husband is more loyal to boss than to his wife Husband is more loyal to his mother and to his family than to his wife Person is more loyal to country than to spouse Husband treats wife like an object Spouse shows little emotion and expression of feelings Spouse is too controlling or too submissive Husband does not spend enough time with wife and children Spouse is too rigid; needs to be more flexible Spouse expects magical thinking, as if his/her needs should be evident without the need to voice them.

SummaryCouple Therapy at the cultural level takes on a unique form. Many couples bring with them to this country their nationalistic pride and nationalistic banners and pride to which they relentlessly hold onto. Often the refusal to adapt is linked to the desire to maintain one's sense of identity. What a complaint is to a Westerner may not be a complaint to someone from another culture, presenting the therapist with an additional challenge. To confront some of these challenges, I extended the V-spot concept I developed to encompass a cultural V-spot, an area of extreme

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national vulnerability and sensitivity. In conclusion, obviously psychoanalysis does not provide us with all the answers, but we can feel secure noting that most countries including Europe, Israel, and America and Asia (although with a different perspectives) are heavily invested in infant human development, research and behavioral studies -- concerning issues around separation/individuation, dependency, and self-expression as basic universal human needs. So as it stands considering the universal of the Oedipus complex, Al Qaeda can continue to fight battles but one battle they cannot win is the human spirit. So as it stands whose superego is more morally intact? I conclude. Ours!

Final ConclusionCouple therapy is a deep emotional experience between three people. Together they enter a drama which each one has the opportunity to play out their roles and how the therapist has an opportunity to effectuate a new experience. Hope this workshop has provided a better understanding how old archaic injuries (“”V”-spot) impairs the couples’ capacity to think and deal with the current perspective of reality (ego functioning, judgment, perception, reality testing). Hope this workshop has provided more in-depth awareness as to timing, how to listen, when to interpret, and how to listen. Whether couples are at the domestic or the global they all share the same needs for love and healthy normal human development.

Cases

Mr. & Mrs. A

Mr. and Mrs. A. have been married for six years. They have a new baby they both love and cherish. Mrs. A describes her marriage as a storybook tale. Mrs. A. Everything was perfect. We have loving and supportive families. We were childhood sweethearts. I am the love of his life, the one and only. When we are together he cannot keep his hands off me. There isn’t a day that goes by when he doesn't call me to tell me how he can’t wait to come home to me and our baby. I don’t know what got into me but somehow I had a premonition to check his email. I was shocked. For two years my husband has been fucking

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another woman! How is this possible? How can a man who loves so much suddenly be having an affair. Where is his conscience to home sleep with me and act as if nothing happened. Of course I checked out only to find the complete opposite of me, passive, compliant, needy, dependent. I am the alpha woman—independent, self-sufficient. I don’t need anything from anybody. Guess he must have felt that with all my strong attributes I was just castrating and cutting his balls off. I don’t know if I will ever take him back or forgive him, but if I do I guess I will have to take some responsibility for making him feel like a nothing.

Even if your behavior does play a part, it still does not justify his screwing around. What I am about to say in no way validates your husband’s betrayal, but we do need look at the dynamics in your relationship. How your husband loves but at the same time may have felt very threatened by your independence and inability to depend on him. .I think this affair has brought to the fore some of real issues, e.g., dependency, control, domination, and devaluation. You say your husband used to get upset when you never needed anything of him.

Mr. and Mrs. M.This case is an example of how a man lost contact with his passion, thinking that an affair would be the replacement. Mr. M., a very attractive, married man very frustrated with his marriage and obsessed with the idea of having an affair. His wife was mortified each time he would bring it up in sessions. As time went he revealed that he had been a composer left with numerous unfinished symphonies. I reminded him that unlike Franz Liszt, who is dead and no longer can compose, he does have the opportunity to work on his compositions. An affair doesn’t last, but music stays forever. Feeling uncertain that he could ever pursue this again, gradually he did. The irony he got so engrossed in his music that it almost became an obsession. His wife then quipped,” I was better off before because now he is having an affair with his music.”

Your choice is to withdraw be lonely and depressed or go out with your friends who you find boring.

Case of Mr. and Mrs. D.Example of Splitting

Mr. and Mrs. D, have been married for 15 years. Mrs. D. initiates the appointment concerning her husband’s constant threat about getting a divorce. This case brings up many therapeutic challenges. First, this illustrates how the therapist moves from dealing with “threats” within the relationship to how these emanating “threats” enter into the therapeutic couple transference. Secondly, it brings up the issues of splitting the idea of being in the marriage and out of it at the same time (as in the case with Mr. and Mrs. V.). Thirdly, the importance ego functioning and reality testing what a complaint may be to Mr. Y. may have entirely different meaning to what a complaints means to Mrs. Y.Th: Greetings: Who’d like to start? Mr. D. Why don’t you start?Mrs. D. Why don’t you start?

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Mr. D. Go ahead you start.Mrs. D. Okay, I’m here because my husband keeps threating me with getting a divorce.Mr. D. No! I don’t threaten her. I mean it I tell her if she doesn’t stop complaining and nagging I am out the door.Mrs. D. See what I mean. I take that as a threat.Th: I hear what you are saying that if he is still here then he is still in the marriage and states if you don’t stop what you are doing he’s out.Mrs. D. Yes, now don’t you call that a threat?Th: No I don’t call it a threat.Mrs. D. Okay then what do you call it.Th: In psychological terms this is known as splitting.Mr. D. Are you calling me schizophrenic?Th:S Oh heavens no! This means that there are two parts to you. One that stays married and the other that wants out of marriage.Mr. D. Okay so what’s so wrong about that?Th: It’s “wrong” because it is not realistic.Mrs. D. I hear what you are saying. I tell him that all the time he can’t be in and out of it at the same time. What am I am In and Out Burger?Th: (impressed by her wit). No you certainly should not be threatened either, but your husband did say that you complain too much. Since we are here and we are still married, let’s address these “complaints.”Mr. D. Boy does she ever complain. I’m Jewish and I know what a kvetch she’s not but she can outdo any of them. She complains when I don’t put the dishes in the dishwasher, she complains when I don’t bring her flowers, she complains when I forget to take out the trash. She complains when I pick the kids up late from school. She complains that I don’t give her enough attention.Th: Mr. Y. do you think there is any legitimacy to these complaints?Mr, D, No, I bring home the bacon and am a good provider.Th: That’s about money what about emotional needs?Mrs. D. Thank you finally someone is addressing my needs. He thinks because he brings home the bacon he is off the hook of being a caring and thoughtful husband.Th: I see two things going on. First, Mrs. Y. I don’t see anything wrong with your needs they sound perfectly normal to me. What does concern me is the communication. Out of frustration your voice sounds attacking and commanding and therefor hard to tell you are expressing your real and legitimate needs. Secondly, I am concerned about the roles you play. Suddenly you become the dominating parent and your husband an unruly child.Mr. D. Exactly, I am reduced to a nothing as if she has cut off my balls.Th: But then when you feel castrated your only recourse is to threaten or fun away like a lttle boy.Mr. D. Okay you got me there then doctor what do you want me to do?:Th: First of all I want you to know that you are not running away now. You are here and that is a positive sign.

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Mrs. D. I’m thrilled he is here. I hope he continues to come.Th; The first step is to recognize that this relationship needs help. Mr. D. But I really don’t want to be here in fact I’m not sure I will come next week.Th: Now you are doing the same with me threatening the work we are doing. Once cannot be in a marriage and out of it at the same time as your wife stated just as one cannot be in an out of therapy at the same time. The adult part of you I’m sure knows that but the little boy part of you want to run and I’m not even complaining. I am here to express the needs of this relationship.Mrs. D. I’m laughing because you really nailed it.Th: So in closing what was meaningful to you in this session?Mr. D. You go first.Mrs. D. Okay, I guess I will have to watch my voice tone and not come across like a kvetch (like his mother) or a nag and not take his threats too seriously because look he’s still here!Mrs. D. I guess if I don’t want to get my balls cut off any more guess I will have to keep coming.Th: (we all laugh). Great see you both next week.

DiscussionThis session had all the elements; how the therapist morphed into the couple transference showing how what Mr. D. does with Mrs. D. is reenacted in the treatment. The therapist was sure to throw in that unlike his wife she was not even complaining. This left a window of opportunity open to explore that something much deeper was going on than his wife’s barrage of complaints.

The therapist may have brought up the splitting mechanism of defense a bit too early to throw in an analytic term, but out of desperation knew she had to move away from the arena of complaints to defenses. Mrs. D. was more receptive than her husband. As conjoint treatment progressed Mr. D. became more and more aware how his withdrawal from the marriage had not so much to do with his wife’s complaints. In fact he even confessed having a mother who kvetched all the time he was used to it, but more about how he felt suffocated and stifled by his mother

Ms. B. is a 60 year old actress, who maintains she will get parts actually suitable for a far younger actress. She feels men of her age are too old for her and yearns for men in their late 30s or 40s. On weekends she complains of loneliness and is stressed out. She does not heed my advice about going to movies, operas, or the theater because she thinks that all movies, plays and performances are terrible and not what they used to be. She opts to be alone all weekends except when her daughter comes to pick her up to take her to dinner. But because Mr. B is a vegan, it leaves them very little choices of where to dine. Yet she complains of her life as restricted and isolation.

It’s not what your life can do for you, not what you can do for your life.

can dramatically influence the child’s capacity for intimacy and for maintaining healthy love re-lations (Lachkar, 2004). A Fairbairnian therapist might respond to the distraught women whose man has suddenly vanished something like:

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It doesn’t surprise me that your boyfriend vanished. Do you remember from the beginning he was in search for the unavailable/unattainable women, and you thought it would be different with you?

PAIN

Case of Mr. And Mrs. V

Mrs. V: I want out of this marriage.Th: Then why are you here?Mrs. V: I don’t want to be here.Th: But you are here.Mrs. V: I feel stuck. I can’t afford to get a divorce, and I want out.Mr. V: She is no longer a wife. She doesn’t cook or go out with me socially and is very withdrawn.Th: Oh!Mrs. V: I am withdrawn because he has a terrible temper. He always yells at me and attacks me over

the littlest thing.Th: So you get scared.Mrs. V: Scared! I get terrified. My parents used to yell, scream at me and even pull my hair.Th: Does your husband physically attack you?Mrs. V: No. He just gets angry and very controlling.Th: (to Mr. V) I hear your wife saying she is very afraid of you.Mr. V: Yes, I know, and that is why we are here.Th: So, are you willing to work on controlling your anger?Mr. V: Yes, but I don’t know how. In Iran where I grew up everyone in my family would fight, so I

never learned how not to.Th: Yet you say in your business as a contractor you show control and patience with your customers,

and that’s a tough job.Mr. V: Yes. People get very emotional when it comes to their homes, but I manage to keep my cool.Th: So it shows you have the capacity to control your emotions (the cross-cultural hook).Mr. V: Yes, but that is different. When I come home, I just want to relax and be myself.Mrs. V: Being yourself means taking out all your stress on me?Th: Well, if you can be patient and control yourself when you are with your customers, you can do it

at home. Your wife is just as important as your customers.Mr. V: Ummm. I think you’re right I do love my wife and want things to work out.Mrs. V: But I’m not happy.Th: What I am about to say may sound strange to you, but for now the focus should not be on “happiness.” I want you both to function as a couple, to concentrate on enacting your “roles” as husband and wife— just as when you play your contractor role I play mine as therapist). Mrs. V: I don’t want to do that. It sounds phony.Th: I can understand how it sounds phony. But what you are doing is more phony, withdrawing and behaving as though you are not here, wishing you were somewhere else. So what choice do you have?Mrs. V: (smiles for the first time as if there is a glimmer of hope). Yes, I will try. Because my

daughter has an eating disorder I will do it for her.Th: Sounds good. See you both next week.

Mr. V: Thank you, doctor

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Discussion

Whenever I ask a couple to focus more on their ability to function in their current roles rather than on their being happy, I'm often met with a response that I am suggesting that they act in a phony manner. “That just not me, and you’re asking me to play a role?” This kind of intervention can only take place when the therapist is convinced that the patient is acting defensively. In the case of Mr. and Mrs. V, I used the cross-cultural hook to show him that if he has the ego strength to perform his role and control himself with his customers he can also function the same way at home. Bonding with the couple allows them to use their daughter’s eating disorder as further motivation to function together play out their roles as a couple.

SummaryThis section on treatment techniques, procedures, and approaches draws mainly on object relations, self-psychology, and on newer contemporary theories such as Mindfulness, Mentalization, and Dialectic Behavioral Therapy as an integrative approach. Object relations is a most valuable construct for managing couples within the context of their primitive defenses offering the therapist the opportunity to get into “the dance” with the couple. Transforming the projective/introjective process to dual projective identification allows a further level of understanding how each complainer identifies or over identifies with the complaint of the other, making normal needs and feelings into bad foreign objects that assault and attack the psyche. During the three phases of treatment, the couple move from states of fusion to states of separateness, allowing healthy needs and feeling to replace primitive defenses.

At the end of the two-and-a-half-hour funeral procession, Kim Jong-un (deceased President of Korea) was carried by a huge Lincoln while thousands of people stood in the snow people \wail-ing and weeping for a man they idealized and revered who started their people. As psychoana-lysts we cannot resist examining what is behind the tears.  Are they real or are they pseudo croc-odile tears?   To understand this further, let us now turn to group dynamics mainly what we know about Asian cultures, group psychology and group psychosis -- how groups join and bond together in a trance-like state.  According Professor Peter Berton Japanese scholar notes that Asian cultures are basically shame/honor societies one that remains subservient to the leaders.  To protest or rebel is met with shame and humiliation. These are people who are dominated not by an individual self but by a group self, pre-programmed pre-scripted to revere and idealize their leaders? In psychological terms this is known as a collective group fantasy where people fuse and join together as one. This not a far cry from cult-like behavior where people join a pack in a collusive bond to die together, to sleep together, to marry only within the group. The first au-thor refers to this as paranoid anxiety, where they fear repercussions if they don't conform.  Just think of the power of one tiny image which helps to transmit this shame honor collective control from one generation to the next: the bonnet, all the leader has to do is bow  his head with its se-vere, short back-and-sides haircut so reminiscent of his grandfather, the Great Leader Kim Il-Sung who founded this political dynasty .Viewers watching on TV need to recognize the body language that ninety- five per cent of what we communicate, we do nonverbally, through image.

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Imagine how that gets compounded over time when you are dealing with family ruling dynasties such as we find here.

GLOSSARY

Attunement

Attunement is the rhythm of the heart and soul as it blends with another person. According to

Winnicott (1965), it is that beautiful moment of the motherinfant ecstasy of togetherness against

the backdrop of dialectic tensions of the dread of separateness. The infant and mother are one in

total harmony, bliss, and synchronicity. Whether it involve the dancer and the pianist, the musi-

cian and the conductor, the painter and his canvas, or the patient and the analyst, there are two

types of attunement to which I refer: (1) experiencing the moment of togetherness, and (2) sens-

ing the rhythm and timing of the other.

Borderline Personality

This personality disorder designates a defect in the maternal attachment bond as an over-concern

with the “other.” Many have affixed the term “as-if personalities” to borderlines, who tend to

subjugate or compromise themselves. They question their sense of existence, suffer from acute

abandonment and persecutory anxiety, and tend to merge with others in very painful ways in or-

der to achieve a sense of bonding. Under close scrutiny and stress, they distort, misperceive,

have poor impulse control, and turn suddenly against self and others, attacking, blaming, finding

fault, and seeking revenge).

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Containment

A term employed by Wilfred Bion to describe the interaction between the mother and the infant.

Bion believed all psychological barriers universally dissolve when the mind acts as receiver of

communicative content, which the mother does in a state of reverie by using her own alpha func-

tion. Containment connotes the capacity to transform the data of emotional experience into

meaningful feelings and thoughts. It is based on the mother’s capacity to withstand the child’s

anger, frustrations, and intolerable feelings and behaviors long enough to decode or detoxify

them into a more digestible form.

Countertransference

Countertransference refers to a process by which feelings toward a patient become distorted if

the patient stirs up some feelings that interfere with the therapist” ability to maintain technical

neutrality. The clinician suddenly develops a personal/emotion—e.g., such as sexual attraction,

hatred, envy, disgust— and these feelings can create a negative therapeutic alliance. At this junc-

ture the therapist needs to seek consultation.

Couple Transference

I devised this term to describe what happens during treatment when the couple jointly projects

onto the therapist some unconscious fantasy. Couple transference does for the couple what

transference does for the individual, but is slightly more complex. “Now you are doing the same

thing with me that you do with your husband!” 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 that become displaced onto the therapist. The notion of

the “couple/therapist” transference opens up an entirely new therapeutic vista or transitional

space in which to work. It is within this space that “real” issues come to life. A borderline hus-

band says to the therapist: Now you’re just like my wife, selfish, greedy, and only caring about

yourself.

Cultural V–Spot

The cultural V-spot is a collectively shared archaic experience from the mythological or histori-

cal past that evokes painful thoughts and memories for the group, e.g., burning of the temple,

loss of land to Israel, the expulsion of Ishmael to the desert with his abandoned mother, Hagar.

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Depressive Position

This is a term devised by Melanie Klein to describe a state of mourning and sadness in which in-

tegration and reparation take place. Not everything is seen in terms of black and white. There is

more tolerance, guilt, remorse, self-doubt, frustration, pain, and confusion. In this state, one as-

sumes more responsibility for one’s action. There is the realization of the way things are, not of

how things should be. As verbal expression increases, one may feel sadness, but one may also

feel a newly regained sense of aliveness.

Dual Projective Identification

Whereas projective identification is a one-way process, dual projective identification is a two-

way process that lends itself to conjoint treatment. One partner projects a negative feeling into

the other, who then identifies or over identifies with the negativity being projected. “I’m not

stupid! Don’t call me stupid!”

Ego

The ego is part of an intrapsychic system responsible for functions such as thinking, reality test-

ing, and judgment. It is the mediator between the id and superego. The function of the ego is to

observe the external world, preserving a true picture by eliminating old memory traces left by

early impressions and perceptions.

Envy

Klein made a distinction between envy and jealousy. Envy is a part-object function and is not

based on love. She considers envy to be the most primitive and fundamental emotion. It ex-

hausts external objects, and is destructive in nature. Envy is possessive, controlling, and does not

allow outsiders in.

Folie à Deux

In general terms, folie à deux refers to Melanie Klein’s notion of projective identification,

whereby two people project their delusional fantasies back and forth and engage in a foolish

“dance." The partners are wrapped up in a shared delusional fantasy, and each engages and be-

lieves in the outrageous scheme of the other. Usually the term applies to both oppositional and

collusive couples. In some cases there is triangulation, a three-part relationship in which two

people form a covert or overt bond against another member.

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Guilt

Guilt is a higher form of development than shame. Guilt has an internal punishing voice that op-

erates at the level of the superego (an internalized, punitive, harsh parental figure). There are two

kinds of guilt: valid guilt and invalid guilt. Valid guilt occurs when the person should feel guilty.

Invalid guilt comes from a punitive and persecutory superego.

Internal Objects

Internal objects emanate from the part of the ego that has been introjected.. They are part of an

intrapsychic process whereby unconscious fantasies that are felt to be persecutory, threatening,

or dangerous are denounced, split off, and projected. Klein believed that the infant internalizes

good “objects” or the “good breast.” However, if the infant perceives the world as bad and dan-

gerous, the infant internalizes the “bad breast.”

Jealousy

Jealousy, a higher form of development than 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, unlike envy, is a triangular relationship based on love, wherein

one desires to be part of or included in the group, family, clan, nation.

Manic Defenses

The experience of excitement (mania) offsets feelings of despair, loss, anxiety, and vulnerability.

Manic defenses evolve as a defense against depressive anxiety, guilt, and loss. They are based on

omnipotent denial of psychic reality and object relations characterized by a massive degree of tri-

umph, control, and hostility. Some manic defenses work in the ego.

Mirroring

This is a term devised by Heinz Kohut to describe the “gleam” in a mother’s eye, which mirrors

the child’s exhibitionistic display and the forms of maternal participation in it. Mirroring is a spe-

cific response to the child’s narcissistic-exhibitionist displays, confirming the child’s self-esteem.

Eventually these responses are channeled into more realistic aims.

Narcissistic Personality

Narcissists are dominated by omnipotence, grandiosity, and exhibitionist features. They become

strongly invested in others and experience them as self-objects. In order to preserve this “spe-

cial” relationship with their self-objects (others), they tend to withdraw or isolate themselves by

concentrating on perfection and power.

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Narcissistic/Borderline Relationship

These two personality types enter into a psychological “dance,” in which each partner con-

sciously or unconsciously stirs up highly charged feelings that fulfill early unresolved conflicts

in the other. The revelation is that each partner needs the other to play out his or her own per-

sonal relational drama. Engaging in these beleaguered relationships are developmentally arrested

people who bring archaic experiences embedded in old sentiments into their current relation-

ships.

Object Relations

Object relations is a theory of how unconscious internal feelings and desires, in dynamic interplay with current interpersonal experience, relate to and interact with others in the external world. This is an approach to understanding intrapsychic and internal conflict in patients, including projections, introjections, fantasies, and distortion, delusions, and split-off aspects of the self. Klein developed the idea of pathological splitting of “good” and “bad” objects through the defensive process of projection and introjection in relation to primitive anxiety and the death instinct (based on biology). Object relations

derives its therapeutic power by showing how unconscious fantasies/motivations can reflect the way a person can distort reality by projecting and identifying with bad objects.

Paranoid Schizoid Position

The paranoid schizoid position is a fragmented position in which thoughts and feelings are split

off and projected because the psyche cannot tolerate feelings of pain, emptiness, loneliness, re-

jection, humiliation, or ambiguity. Klein viewed this position as the earliest phase of develop-

ment, part-object functioning, and the beginning of the primitive, undeveloped superego. If the

child views mother as a “good breast,” the child will maintain good, warm, and hopeful feelings

about his or her environment. If, on the other hand, the infant experiences mother as a “bad

breast,” the child is more likely to experience the environment as bad, attacking, and persecutory.

Klein, more than any of her followers, understood the primary importance of the need for mother

and the breast.

Part Objects

The first relational unit is the feeding experience with the mother and the infant’s relation to the

breast. Klein believed the breast is the child’s first possession. But because it is so desired it also

becomes the source of the infant’s envy, greed, and hatred and is therefore susceptible to the in-

fant’s fantasized attacks. The infant internalizes the mother as good or bad or, to be more spe-

cific, as a “part object” (a “good breast” or “bad breast”). As the breast is felt to contain a great

part of the infant’s death instinct (persecutory anxiety), it simultaneously establishes libidinal

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forces, giving way to the baby’s first ambivalence. One part of the mother is loved and idealized,

while the other is destroyed by the infant’s oral, anal, sadistic, or aggressive impulses. In clinical

terms Klein referred to this as pathological splitting. Here a parent is seen as a function of what

the parent can provide, e.g., in infancy the breast, in later life money, material objects, etc. “I

only love women who have big breasts!”

Persecutory Anxiety

The part of the psyche that threatens and terrifies the patient. It relates to what Klein has referred

to as the primitive superego, an undifferentiated state that continually warns the patient of immi-

nent danger (often unfounded). Paranoid anxiety is a feature associated with the death instinct

and is more persecutory in nature. That implies the kind of anxiety from the primitive superego

that is more explosive and volatile than from the more developed superego.

Projective Identification

This is a process whereby one splits off an unwanted aspect of the self and projects it into the ob-

ject, which identifies or over-identifies with that which is being projected. In other words, the

self experiences the unconscious defensive mechanism and translocates itself into the other. Un-

der the influence of projective identification, one becomes vulnerable to the coercion, manipula-

tion, or control of the person doing the projecting.

Psychohistory

Psychohistory does for the group what psychoanalysis does for the individual. It offers a broader

perspective from which to view cross-cultural differences. Using psychoanalytic tools and con-

cepts, psychohistory allows a better understanding of individuals, nations, governments, and po-

litical events—very much as a therapist analyzes the couple as a symbolic representation of a po-

litical group or nation. (DeMause 2002a, 2002b, 2006).

Reparation

The desire for the ego to restore an injured love object by coming to terms with one’s own guilt

and ambivalence. The process of reparation begins in the depressive position and starts when one

develops the capacity to mourn, and to tolerate and contain the feelings of loss and guilt.

Reverse Superego

Whereas the healthy superego is a moral structure that goes through life distinguishing between

right and wrong and good and evil, the reverse superego does the opposite. It is a concept I de-

vised when writing an article for Inspire on “The Twisted Mind and Its Reverse Superego” (Ko-

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brin and Lachkar, 2011) to describe that what happens when one is praised for being bad and

punished for being good. An example of this would be countries that encourage mistreatment of

women. At the domestic level it might sound something like, “He is so envious of me and my ac-

complishments. Instead of celebrating my success, my promotion, my awards he goes out with

the guys making me feel like a nothing.”

Schizoid Personality

The central features of schizoid personalities are their defenses of attachment, aloofness, and in-

difference to others. The schizoid, although difficult to treat, is usually motivated, unlike the pas-

sive-aggressive. However, because of ongoing detachment and aloofness, the schizoid personal-

ity lacks the capacity to achieve social and sexual gratification. A close relationship invites the

danger of being overwhelmed or suffocated, for it may be envisioned as relinquishing indepen-

dence. The schizoid differs from the obsessive-compulsive personality in that the obsessive-com-

pulsive feels great discomfort with emotions, whereas the schizoid is lacking in the capacity to

feel the emotion but at least recognizes the need. Schizoids differ from the narcissist in that they

are self-sufficient and self-contained. They do not experience or suffer the same feelings of loss

that borderlines and narcissists do. “Who, me? I don’t care, I have my work, my computer, etc.!”

Self Objects

This is a term devised by Heinz Kohut. A forerunner of self-psychology, the term refers to an in-

terpersonal process whereby the analyst provides basic functions for the patient. These functions

are used to make up for failures in the past by caretakers who were lacking in mirroring, em-

pathic attunement, and had faulty responses with their children. Kohut reminds us that psycho-

logical disturbances are caused by failures from idealized objects, and for the rest of their lives

patients may need self objects that provide good mirroring responses.

Self Psychology

Heinz Kohut revolutionized analytic thinking when he introduced a new psychology of the self

that stresses the patient’s subjective experience. Unlike with object relations, the patient’s “real-

ity” is not considered a distortion or a projection, but rather the patient’s truth. It is the patient’s

experience that is considered of utmost importance. Self-psychology, with its emphasis on the

empathic mode, implies that the narcissistic personality is more susceptible to classical interpre-

tations. Recognition of splitting and projects is virtually non-existent among self-psychologists.

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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 of having

needs that are felt to be dangerous and persecutory. Shame is associated with anticipatory anxi-

ety and annihilation fantasies. “If I tell my boyfriend what I really need, he will abandon me!”

Single and Dual Projective Identification in Conjoint Treatment)

In single projective identification, one takes in the other person’s projections by identifying with

that which is being projected. Dual projective identification is a term I originated in which both

partners take in the projections of the other and identify or over-identify with that which is being

projected (the splitting of the ego). Thus, one may project guilt while the other projects shame.

“You should be ashamed of yourself for being so needy! When you’re so needy, I feel guilty!”

Splitting

Splitting occurs when a person cannot keep two contradictory thoughts or feelings in mind at the

same time and, therefore, keeps the conflicting feelings apart, focusing on just one of them.

Superego

The literature refers to different kinds of superegos. Freud’s superego concerns itself with moral

judgment, what people think. It depicts an introjected whole figure, a parental voice or image

that operates from a point of view of morality, telling the child how to follow the rules and what

happens if they don’t. It is often the “dos, don’ts, oughts, and shoulds,” and represents the child’s

compliance and conformity with strong parental figures. Freud’s superego is the internalized im-

age that continues to live inside the child, controlling or punishing. Klein’s superego centers on

the shame and humiliation of having needs, thoughts, and feelings that are felt to be more perse-

cutory and hostile in nature and invade the psyche as an unmentalized experience.

Transference

Transference is a process whereby the patient transfers an emotion, feeling or a past relationship

object bond to the therapist, gets re-creating it within the therapeutic process. It is often an

unconscious mechanism that can thwart or distort the patient's seeing the therapist realistically.

“You are using me and taking advantage of me just like my father.” Transference differs from

projection in that this is where the patient cannot tolerate some part of the self and projects onto

the therapist. “I don’t like being used; now I make you into a user.”

V-spot

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The V-Spot is a term I devised to describe the most sensitive area of emotional vulnerability that

gets aroused when one’s partner hits an emotional raw spot in the other. It is the emotional coun-

terpart to the physical G-spot. The V-spot is the heart of our most fragile area of emotional sensi -

tivity, known in the literature as the archaic injury, a product of early trauma that one holds onto.

With arousal of the V-spot comes the loss of sense and sensibility; everything shakes and shifts

like an earthquake (memory, perception, judgment, reality). It is a way of meticulously pinpoint-

ing the precise affective experience.

No you are not depressed; you are feeling sad.

No you are not insane; you are feeling ambivalence.

No you are not angry, you are feeling betrayed and disappointed; you are .

No you are not suicidal; you feel hopeless and helpless.

No you are not stupid; you are feeling anxious.

Whole Objects

The beginning of the depressive position is marked by the infant’s awareness of his mother as a

“whole object.” As the infant matures and as verbal expression increases, he achieves more cog-

nitive ability and acquires the capacity to love her as a separate person with separate needs, feel-

ings, and desires. In the depressive position, guilt and jealousy become the replacement for

shame and envy. Ambivalence and guilt are experienced and tolerated in relation to whole ob-

jects. One no longer seeks to destroy the objects or the oedipal rival (father and siblings, those

who take mother away), but can begin to live amicably with them.

Withdrawal vs. Detachment

Detachment should not be confused with withdrawal. Withdrawal is actually a healthier state be-

cause it maintains a certain libidinal attachment to the object. When one detaches, one splits off

and goes into a state of despondency. Children who are left alone, ignored, or neglected for long

periods of time enter into a phase of despair (Bowlby, 1969). The child’s active protest for the

missing or absent mother gradually diminishes and the child no longer makes demands. When

this occurs, the infant goes into detachment mode or pathological mourning. Apathy, lethargy,

and listlessness become the replacement for feelings (anger, rage, betrayal, abandonment).

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