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11-6-13

Primitive Defenses in Marital Therapy


Joan Jutta Lachkar, Ph.D.
NAOS-Institute
www.naos-institute.com
London

General
This 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 VSpot 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

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)
Basis of the workshop
This 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 Lachkars 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
Psychodynamic Approach on Conjoint Treatment Brunner/Mazel, New York, 1997)
Revision of Narcissistic/Borderline Couple Book 2nd Edition, Taylor and Francis
(Brunner/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.
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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)

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 information
Joan Jutta Lachkar, Ph.D.
5009 Woodman Ave, #205
Sherman Oaks, CA 91423
818-290-3390 (office)
310-413-9593 (cell)
Email: jlachkar@aol.com
Website: www.joanlachkarphd.com
Affiliate Member of the New Center of Psychoanalysis
Dr. Lachkar is available for consultation
Workshop Schedule
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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
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15:00-15:30

Empathic Listening
Introspection Listening
Intersubjective Listening
Listening to the Silence/Verbal Listening
Containment Listening (holding the thought without
response)
Listening to Bad Internal/External
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
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Common Complaints That Bring Couples Into Treatment


10:45-11:30

Spotlight Cases/Cases/Role Play

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
Thank you for inviting me here its 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
talking about them; they hardly have the time to have them. The capacity to fall in love is a basic
human 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 infects 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 fat


Then will describe the narcissist, then the borderline, the different kinds of N and Bs. 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 dont 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/Bs 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 Works
The 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)

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 wasnt until the end of the play when they
were able to profess their undying love.
The Myth
When 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 Freuds classical psychoanalysis, then
object 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,
Kernbergian?). Although this is an integrative approach, I focus mainly on Kleins concepts
because there is movement. Her approach is dynamic that helps us understand not only the
movement between the couples, but between their psychodynamics (the dance between
guilt/shame, envy/jealousy). 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 approaches, techniques, procedures offering specific guidelines including
various phases of treatment 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
patient because he fears the narcissist anger. Anna Freud feel Kohut does not address the
aggression.
DEFINING A NARCISSITIC/BORDERLINE RELATIONSHIP
I 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
out his or hers own personal relational drama. Within these beleaguered relationships are
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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 dont change he
could see himself having an affair. The borderline wife comes in crying feeling
devastated doesnt see how she can change since she came from a very strict religious
background. 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
undeveloped 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 Dance
I want to get married!
Married! Why do we need to get married? Isnt 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 now
Then why did you get divorced?
Because I didnt want to stay married.
But if it was just a piece of paper then why did you get a divorce?
If you dont stop badgering me. Im going to pack up and leave.
Thats what you always do you whenever we have this discussion
Well, I dont 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 upset
I then get upset that he feels upset
He gets upset that I am upset that I feel he is upset about me being upset.

The Dance the Bond the Drama


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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,
It is you that it the needy one. Me I dont 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
dont need you and I dont need this treatment!

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When narcissistically injured will withdraw. One can imagine how this arouses feelings of
unworthiness, abandonment, unworthiness, and shame in the borderline one who is the perfect
target 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
themselves 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
intentions 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
defective 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
unavailable. They perpetuate the cycle by staying in abusive, addictive or destructive
relationships enacting 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 sacrificial objects
Ill do or be anything you want me to be. Just dont 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 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 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

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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
internal conflicts center primarily around shame, abandonment, betrayal, deprivation, boundary
confusion and lack of identity.
When I burn myself with a cigarette, then I know Im alive. I exist! Anything is better
than abandonment! Drugs, alcohol, even this terrible abusive/addictive relationship! Ill
do anything just dont 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 couldnt. I was stuck to them.
In the dance with the narcissist, in order not to feel abandoned, borderlines learn to play into
narcissism/grandiose schemes. For a short time they play act atbeing the perfect mirroring
object. Ill do anything just dont leave me. But because of the lack of impulse control cannot
maintain, also are very seductive- the Don Juans 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 is
also a dance between their Psychodynamics (shame/guilt, domination/control)

Shame vs. Guilt


Envy vs. Jealousy
Splitting/Projective
Identification
Projective Identification
Dependency vs. Omnipotence
Control/Domination/Victimiza
tion

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Attachment/Withdrawal
Competition/Rivalry
(unresolved oedipal conflicts)
Dual Projective Identification
Cross-Cultural
Psychodynamics

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 Im putting a real guilt trip on him.

Shame

Shame 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!"

Guilt
Guilt is a higher form of development than shame. Guilt has an internal punitive
voice which operates at the level superego (an internalized punitive harsh parental
figure). There are two kinds of guilt: Valid guilt and invalid guilt.
(Show guilt cartoon)

Envy
Klein made a distinction between envy and jealousy. Envy is a part-object function
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 wifes ceremonial award dinner).

Jealousy
Jealousy, 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 disorder

Patient: Ive already done that! Tried that! There is nothing you can say or do that
can help me. Ive been there done that!

Therapist: Youre letting me know how hopeless and helpless you feel.
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Splitting

Patient: 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 Bowlbys work on attachment and loss (1982) notes the difference between
withdrawal and attachment. Detachment is not to be confused with denial or withdrawal.
Actually, withdrawal is healthier because 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,
murderers, 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
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The Antisocial Borderline (lie, cheat steal, against the social norms)
The Sociopath/ the Psychopath (charmers, users-(killers, murderers, cruel, sadistic, no
remorse)
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 Narcissism
One who is self-absorbed, overly preoccupied with self, has strong desires for
fame, achievement, power, but not to the extent of overpowering the relationship,
and yet still has the capacity to maintain a loving and intimate bond. Often form
relationships while they fulfill their momentary 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 Narcissist


There 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

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Similar to the narcissist, they the entitled ones with no conscience void of any
sense of morality or guilt. They dont 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.

The Depressive Narcissist


Unlike the narcissist driven by self-love the depressive narcissist is driven by selfhate self-hatred turned inward and always self-blame-hopeless as he makes
everyone around feel miserable and depressed. The narcissist is dominated by selflove the depressive by self-hate, The depressive narcissist is plagued by guilt,
embodied by a harsh and punitive superego and when life doesnt go their way
they blame. They have a sadistic superego that runs amok, is self-denigrating 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 withdrawn and isolated from others. A depressed narcissists
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 Narcissist


The 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 Narcissist


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The 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 Narcissist


An 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

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

The Borderline

Just 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 Borderline
Borderlines suffer from privation rather than deprivation, illusions rather than
delusions or hallucinations. Their internal conflicts center primarily around shame,
bonding and attachment. Borderlines 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,
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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/Prophet


The malignant borderline shares many qualities with the malignant narcissist with
antisocial tendencies. 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 superiorityI inflict pain; therefore I am
powerful, omnipotent, and almighty"the malignant borderline inflicts pain in
order to gain controlNow 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 (conscienceAllah or the Prophet) and is concerned 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,
and sexually abused them for absolute domination. At the domestic level they are
the wife-beaters, 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, Im so sorry. Dont cry. Here, come to daddy. Let me hold you. I

promise this
wont happen again and Ill 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.


19

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 doctors
appointment.
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 PassiveAggressive Borderline


The passive-aggressive Is a wolf in sheeps clothing. Although the passive
aggressive personality type no longer exists in the DSMIV, I have resurrected them
for the purposes of couple therapy. These are the couch-potato husbands and the
forgetful wives. Ill do it later; Ill do it tomorrow, I was going to do it today, but
the car broke down. They forget, delay, avoid, cajole, make an endless barrage of
excusesin short, do anything to protect the good little child from the screaming
mommy. The passiveingressives primary aim is to unconsciously coerce a
partner 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 couldnt 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 ObsessiveCompulsive Borderline


Compared to other borderline personalities, the obsessivecompulsive has a more
developed and well-integrated ego as well as a harsh restrictive punitive superego.
At the lower level of functioning, obsessivecompulsives 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
obsessivecompulsive 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 Borderline
The schizoid personality primary defense is a pervasive pattern of detachment,
have few close friends, and appear indifferent to the praise or criticism of others.
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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 Borderline
At 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 Borderline
Histrionic borderlines exaggerate cry easily, exhibit excessive parasitic
dependency needs, and display excessive emotionalism and exhibitionistic
qualities. In some instances, the histrionic may appear very narcissistice.g. the
need to be the center of attentionwhile, 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 Borderline


The 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 dont 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.
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
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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, Hannahs 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
worlds most magnificent art, music, and writing. When borderlines are able to
unleash their creativity, they are unstoppable. The chaos of their 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.

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Cultural Borderline
The cultural borderline will retaliate fight, become a freedom fighter, a terrorist, do
anything maintain the groups 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 groups 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 relationship


2. Self-Psychology vs. Object Relations
3.
4.
5.
6.
7.

Mirroring vs. Containment


Ego Psychology and Attachment Theory
Mirroring and Containment
Ego Psychology and Attachment Theory
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,


environmental/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)
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
23

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 discovered transference, the relationship between patient
and the analyst. He also proposed the Oedipus complex, which attaches the childs
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 mothers 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 ones mate. Before we go into the other theorists, lets
take a look at a Freudian analyst relating to a patient suddenly fleeing 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 Freuds defense of projection she saw this mechanism as a two way
process. In addition to this formation, she introduces 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
primitive defenses very rule). The latter is a whole and integrated position whereby
24

one takes responsibility for ones 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. Im sexy! Im 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 upset I dont 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 dont 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: Dont you see all the crime, the terrorism, the violence and destruction
around you?

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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 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 Objects


There 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 cant I get rid of her? She is like an albatross around my neck.
Why cant 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, insatiable, unavailable). Fairbairn extends beyond
Kleins 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.

26


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 cant make it, but baby
well 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 shes crazy. Steve,
the narcissist, lacks empathy, feels entitled to keep people waiting, puts his needs first,
acts like she doesnt 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?

W. R. Fairbairn
Bad Internal Objects

Bad Internal Objects


The Betraying Object
The Wronged Self
Depriving Object/Rejecting
The Insatiable Self
The Exciting Object
The Craving Self
Unavailable
The Lost Self
Object/Abandoning
The Betrayed Self
Withholding Object
The Rejecting Self
Painful Object (The Mother
of Pain)
The Abandoning Self
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 depriver that deprives yourself."

27

The Abandoning Object: You complain that your husband abandons you, but there is a
part of you that doesnt 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 dont see the part of yourself that is successful and has good qualities.
Sadistic Object: You complain that your husband is sadistic, but you dont 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 hes gone it
makes you feel like a nothing. This is the internal part of you that disappears and loses
object constancy."
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 enhanced 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 infants capacity to be alone. Winnicotts 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 Winnicotts 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-aggressive person will constantly try to recreate the parent28

child dyad by engaging in behaviors that essentially 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 Winnicotts ideas centers around his concept of good
enough and which may have particular relevance for someone like a narcissist who
imagines themselves as being perfect when in reality he or she can be just good
enough.
In addition to the contributions Winnicotts 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 Experiences
Winnicott

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The good breast and bad breast mother


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

Heinz Kohut

Heinz Kohut (1971), the pioneer or self-psychology is another theorist relevant to the
topic of intimacy and whose innovative approach cultivated a new theory of selfpsychology 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. Kohut doesnt believe the narcissist distorts
rather he is merely misunderstood. His approach includes introspection, validation, and
understanding the perceptions of others (not distortions rather perceptions that that come
from an operating system empowered by persons subjective experienceKohut is often
contrasted with that of Otto Kernberg. Kohuts by its very essence invites closeness and
intimacy. Kohut differs from Kernberg in that Kohut believed the subjective experience
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as truth that the patient does not distort or misperceive reality. To the distraught patient
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 dont 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: Im 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 always 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

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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 previous 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 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 childs tie to the mother. His work shows that a childs emotional attachment is
a reflection of a childs 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 healthier
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 detach. The childs 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. Doesnt he
even think about me? Doesnt he miss me? I cant believe 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 Think


Otto Kernberg

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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. Its 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.
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 patients 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 cant?
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 theyre not or
the borderline that acting the role of the victim will bring love or self-esteem. What
makes an obsessivecompulsive think that cleaning will clean up their act for desire for
intimacy.
THEORETICAL Perspectives

Classical 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.

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

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

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

Ego Psychology

Bowlby
Focus on the environment and adaptation to it; views the ego as an
entity powered by its own devises not in accordance with Freuds
Attachment theory
ego. Hartman claims that the ego is more environmentally driven
Withdrawal/Isolation
than instinctually driven,

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

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

Bion
Thinking, containment (beta/alpha elements)
Detoxification
Without Memory or desire
Finding meaning out of the meaninglessness

Behavioral/Cognitive
Focus on the partnership
Directive approach

Linehan
Dialectic Behavioral Therapy (DBT)
Mindfulness/Acceptance
Integrates transference and cognitive therapy (directive
approach)
Fonagy and Bateman
Mentalization
The reasonable mind
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, Cant you see Im tired? Do you have a clue as to
how many depositions I did today? You do nothing all day and youre asking me to take out the trash?
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Example of Empathology

Honey, 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 Dialectics

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

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. Im not stupid! Dont call me stupid!
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 analysts 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 husband says to the
therapist: Now youre just like my wife, selfish, greedy, and only caring about yourself.
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 devised when writing an article for Inspire on The Twisted Mind and Its
Reverse Superego (Kobrin 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 accomplishments. Instead of celebrating
my success, my promotion, my awards he goes out with the guys making me feel like a
nothing.
V-spot
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The V-Spot or vulnerable spot e term I devised for couple therapy to describe the
most sensitive area of emotional vulnerability. It is a term I originated I abstracted from
Heinz Kohuts 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 emotional chord in another. It is marked by the slightest
provocation one wrong word/movement and its 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 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 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.
No you are not suicidal; you feel hopeless and helpless.
No you are not stupid; you are feeling anxious.
Different Ways of Listening
When it comes to listening to the complaint, the road is endless. Klein would listen
through the patients projections and distortions, while Kohut would listen through the
empathic lenses whereas as Fairbairn would listen to the internal complainer. Wilfred
Bions (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)
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Different Ways to Listen


Objective Listening
The detached observer one who listens without preconceptions abandons all conscious
memory. My Mother Abused Me!

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

Empathic Listening
To 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
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 Listening
Most 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 Reiks superego can soothe, console and forgives unlike Unlike Kleins persecutory
superego Reiks superego can also soothe, console and forgiving.

Containment
My 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. Bions
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.
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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) Lets take a look at how this abuse
impacts your life.
Listening to the Silence and Non-Verbal Listening You either are lost for words or you
dont 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
anxious 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.

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
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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
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
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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 Objects


Fairbairn
There can always be an external betrayer/depriver/rejecter but there can also be an
internal one
W. 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
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 relationships and stay forever attached to a painful bad internal object
(rejecting, insatiable, unavailable). Fairbairn extends beyond Kleins 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 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.

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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 cant I get rid of
her?. She is like an albatross around my neck.

I dont 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 cant make it, but baby well 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/unavailable object. In the Disappearing Male book she is the Disappearing Female, one
who disavows and cannot trust her reality. Steve is the narcissist, lacks empathy, feels entitled to keep
people waiting, puts his needs first and acts like she doesnt 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 Kleins 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.

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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
dysfunctional, 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 remains attached to the bad object. Ill sue the hell out of him. As Grotstein (1987) reminds us, any
attachment is better than no attachment. Children who have had a history of physical and emotional abuse are
targets 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

(attachment 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
familiar (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.

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

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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 allconsuming experience 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 persons 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 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

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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 Affair
Another, 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
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 Affair


To 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.

44

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
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 booksuch as The Entitled
rather than The Narcissist, the Promiser rather than the Borderline, or The
Withholder rather than Obsessive-Compulsiveis 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 crossculture.)

45

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
others 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, inlaws, exs 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 youre making this more complicated than it is. It is about
sex, money and kids; thats it."

Defining a Complaint
The 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 youre 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 centuryalthough 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 cant it be like it was before?")
46

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 dont want to get married or have kids, yet I want to stay in the relationship!)

Stress (Hes always on the couch watching TV or getting loaded while Im working my
butt off.')

Threats (He keeps threatening me with divorce, but doesnt do anything to work on our
relationship.)

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

Control (I cant do anything without his watching over me and criticizing my every
move.)

Entitlement ("He feels entitled to everythinga 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. Its a turn-off.)

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

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 perfectall 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 wont 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.")
47

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 hes 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 doctors
appointment.
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 wont 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 dont 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

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
48

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 patients 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 Transference
The Couple Transference does for the couple what transference does for the individual,
but is slightly more complex. Couple transference interpretations are derived from the
analysts experience and insights and are designed to produce a transformation within the
dyadic relationship. The couple transference refers to the mutual projections, delusions,
and distortions, or shared couple fantasies, which become displaced onto the therapist.
The notion of the couple/therapist transference opens up entirely new therapeutic vista
or transitional space in which to work. It is within this space that real issues come to
life. Borderline husband says to narcissistic wife: Now youre just like my wife, selfish,
greedy and only care about yourself!
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. Im not stupid! Dont call me stupid!
49

First Session
What 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
(Dependent and Interdependent

Its 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 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 OneThe Phase of Darkness: A State of Oneness (Fusion/Collusion)


Its difficult to know what to do especially when there is so much
50


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 TwoTwoness: 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 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.

51

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 ones 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
anothers 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?

52

Therapeutic Functions
Empathy
Therapist as Bonding/Weaning Mommy
Listening
Therapist as Holding/Environmental
Mommy
Understanding
Therapist as "Being" vs. "Doing"
Mommy
Introspection/Thinking
Therapist as Interpreter
Therapist as Mirroring Object
Containment
Therapist as Self Object
Silence
Therapist as Container (Hard
Humor
Object)
Therapist 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
different.
3. The therapeutic alliance must be joined with a member who is pre-dominantly
narcissistic.
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
unfold within the context of the therapeutic experience and the transference.
Avoid self-disclosure, touching or consoling the patient, making unyielding concessions.

53

Listen and be attentive. Maintain good eye contact, speak with meaning and conviction.
Talk directly to the issues.
Use short clear sentences, keep responses direct, mirror and reflect sentiments with
simple responses and few questions.
Keep in mind a "normal couple" or "ideal couple." This image will sharpen your focus
and safeguard from getting lost within the couple's psychological "dance."
Explain how one may project a negative feeling into the other, but try and understand
why the other identifies with what is being projected (focus on the dual projective
identification).
Listen for the theme. Be aware of repetitive themes. The subject and feelings may
change, but the theme is pervasive (betrayal, abandonment, rejection fantasies).
Help the couple recognize "normal" and healthy dependency needs.
Recap the dynamics at end of each session aware of the qualitative differences
Avoid: You both feel betrayed, you both feel abandoned, 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 betrayal
How to Listen for a Theme
Good/Bad Internal Objects, Fairbairn
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 Male


This 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

54

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 indepth 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 wasnt 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 didnt I realize was that I was with a
man who was jaded, had been raked over the coals, bringing into our relationship
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 Male

The most common definition a male who purports to be madly in love then
suddenly disappears without any explanation. Ill call you, Poof not a word. Hes gone!
55

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 selfdestructive 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
Im 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 dont know. I dont care. Whatever! And if I pursue, he gets
mad at me for nagging or being too emotional.

The Eight Types of Disappearing Men


Disappearing Narcissist (the man who withdraws and isolates himself when
narcissistically 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 manna)
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 ethnic 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 individuals and couples with various backgroundsmulticultural
56

couples, cross-cultural couples, interracial 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 religion, 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 V-spots archaic traumatic injuries bonded through was, losses or a
lifetime of governmental violations 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.

Psychodynamics

There is a Dance between the Cultures but also a Dance between Their Psychodynamics
57

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 mans 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 dont have to tell you how I feel. You will just know.

Cultural Psychodynamics
There is a Dance between the Cultures But There is also a Dance between their
Psychodynamics
Psychodynamics 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
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
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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 Guilt
Asian 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 Self
Another 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 Self
Then, 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. 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 Promises
A 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.
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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 groups harmony (wa).

Hierarchical Positions

Who 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 Revolution
We 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 dont 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 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 Chinas \
military threat to them by .

Treatment Cross-Cultural Couples

Group Psychology

Group psychology is the study of group myths and group fantasies


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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 Bions two groups (1961)
The Work Group (thinking/task oriented)
The Basic Assumption Group (irrational dominated by primitive defenses)
Group Psychology
Group 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 didnt bow
the right way! Id 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 holocaustsomething 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.
Psychohistory
Psychohistory does for the group what psychoanalysis does for the individual. The
analyst interprets 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 concepts, psychohistory allows a better understanding of
individuals, nations, governments, and political eventsvery much as a therapist
analyzes the couple as a symbolic representation of a political 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
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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 cultures mental health is another cultures 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 development, 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 impermeable borders, we must take into
account certain aspects of culture such as religion, child-rearing 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 cultures 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 Years, 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 onuss 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.
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.

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The Cross Cultural Hook


The 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-Expression
In 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.
Summary
Couple 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 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

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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 Conclusion
Couple 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 isnt a day that goes by when he doesn't call me
to tell me how he cant wait to come home to me and our baby. I dont 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 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 dont 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 dont
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.

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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 husbands 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 doesnt 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 husbands 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: Whod like to start?
Mr. D. Why dont you start?
Mrs. D. Why dont you start?
Mr. D. Go ahead you start.
Mrs. D. Okay, Im here because my husband keeps threating me with getting a divorce.
Mr. D. No! I dont threaten her. I mean it I tell her if she doesnt stop complaining and
nagging I am out the door.
Mrs. D. See what I mean. I take that as a threat.
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Th: I hear what you are saying that if he is still here then he is still in the marriage and
states if you dont stop what you are doing hes out.
Mrs. D. Yes, now dont you call that a threat?
Th: No I dont 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 whats so wrong about that?
Th: Its wrong because it is not realistic.
Mrs. D. I hear what you are saying. I tell him that all the time he cant 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,
lets address these complaints.
Mr. D. Boy does she ever complain. Im Jewish and I know what a kvetch shes not but
she can outdo any of them. She complains when I dont put the dishes in the dishwasher,
she complains when I dont 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 dont
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: Thats 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 dont 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.
Mrs. D. Im thrilled he is here. I hope he continues to come.
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Th; The first step is to recognize that this relationship needs help.
Mr. D. But I really dont want to be here in fact Im 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 Im sure knows
that but the little boy part of you want to run and Im not even complaining. I am here to
express the needs of this relationship.
Mrs. D. Im 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 hes
still here!
Mrs. D. I guess if I dont 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.

Discussion
This 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 wifes 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 wifes
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.

Its not what your life can do for you, not what you can do for your life.

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

It doesnt 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 dont want to be here.
Th: But you are here.
Mrs. V: I feel stuck. I cant afford to get a divorce, and I want out.

Mr. V: She is no longer a wife. She doesnt 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 dont 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 thats 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 youre right I do love my wife and want things to work out.
Mrs. V: But Im not happy.

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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 dont 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
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 youre 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 crosscultural 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
daughters eating disorder as further motivation to function together play out their roles as a couple.

Summary
This 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 \wailing and weeping for a man they idealized and revered who started their
people. As psychoanalysts we cannot resist examining what is behind the tears. Are they
real or are they pseudo crocodile tears? To understand this further, let us now turn to
group dynamics mainly what we know about Asian cultures, group psychology and group
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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 author 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 severe, 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.
Imagine how that gets compounded over time when you are dealing with family ruling
dynasties such as we find here.

GLOSSARY

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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 musician 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) sensing the rhythm and timing of

the other.
Borderline Personality

This personality disorder designates a defect in the maternal attachment bond as an overconcern 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 order 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).

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 function. Containment connotes the capacity to transform the data of
emotional experience into meaningful feelings and thoughts. It is based on the mothers
capacity to withstand the childs 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/emotione.g.,
such as sexual attraction, hatred, envy, disgust and these feelings can create a negative
therapeutic alliance. At this juncture the therapist needs to seek consultation.
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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 analysts 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 husband says to the
therapist: Now youre just like my wife, selfish, greedy, and only caring about yourself.

Cultural VSpot

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

Depressive Position
This is a term devised by Melanie Klein to describe a state of mourning and sadness in
which integration 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 assumes more responsibility for ones 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. Im not stupid! Dont call me stupid!
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Ego

The ego is part of an intrapsychic system responsible for functions such as thinking,
reality testing, 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 exhausts external objects, and is destructive in nature. Envy is possessive,


controlling, and does not allow outsiders in.

Folie Deux

In general terms, folie deux refers to Melanie Kleins 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 believes 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.

Guilt

Guilt is a higher form of development than shame. Guilt has an internal punishing voice
that operates 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 dangerous, the infant internalizes the bad breast.

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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 triumph, 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 mothers eye, which
mirrors the childs exhibitionistic display and the forms of maternal participation in it.
Mirroring is a specific response to the childs narcissistic-exhibitionist displays,
confirming the childs 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 special relationship with their self-objects (others), they tend to withdraw
or isolate themselves by concentrating on perfection and power.

Narcissistic/Borderline Relationship

These two personality types enter into a psychological dance, in which each partner
consciously 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 personal relational drama. Engaging in these beleaguered relationships are
developmentally arrested people who bring archaic experiences embedded in old
sentiments into their current relationships.
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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, rejection, humiliation, or ambiguity. Klein viewed this position as the earliest
phase of development, 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 infants relation
to the breast. Klein believed the breast is the childs first possession. But because it is so
desired it also becomes the source of the infants envy, greed, and hatred and is therefore
susceptible to the infants fantasized attacks. The infant internalizes the mother as good or
bad or, to be more specific, as a part object (a good breast or bad breast). As the
breast is felt to contain a great part of the infants death instinct (persecutory anxiety), it
simultaneously establishes libidinal forces, giving way to the babys first ambivalence.
One part of the mother is loved and idealized, while the other is destroyed by the infants
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!

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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 imminent 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 object, 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. Under the influence of projective identification, one becomes vulnerable to
the coercion, manipulation, 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 concepts, psychohistory allows a better understanding of individuals, nations,
governments, and political eventsvery much as a therapist analyzes the couple as a
symbolic representation of a political group or nation. (DeMause 2002a, 2002b, 2006).

Reparation

The desire for the ego to restore an injured love object by coming to terms with ones
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 devised when writing an article for Inspire on The Twisted Mind and Its
Reverse Superego (Kobrin 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
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countries that encourage mistreatment of women. At the domestic level it might sound
something like, He is so envious of me and my accomplishments. 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 indifference to others. The schizoid, although difficult to treat, is usually motivated,
unlike the passive-aggressive. However, because of ongoing detachment and aloofness,
the schizoid personality 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 independence. The schizoid differs from the obsessivecompulsive personality in that the obsessive-compulsive 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 dont 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 interpersonal 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, empathic attunement, and had faulty responses with their children.
Kohut reminds us that psychological 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 patients subjective experience. Unlike with object relations, the
patients reality is not considered a distortion or a projection, but rather the patients
truth. It is the patients experience that is considered of utmost importance. Self77

psychology, with its emphasis on the empathic mode, implies that the narcissistic
personality is more susceptible to classical interpretations. Recognition of splitting and
projects is virtually non-existent among self-psychologists.

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 anxiety 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 persons 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 overidentify 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 youre 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. Freuds 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 dont. It is often the dos, donts, oughts, and
shoulds, and represents the childs compliance and conformity with strong parental
figures. Freuds superego is the internalized image that continues to live inside the child,
controlling or punishing. Kleins superego centers on the shame and humiliation of
having needs, thoughts, and feelings that are felt to be more persecutory and hostile in
nature and invade the psyche as an unmentalized experience.
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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 dont like being used; now I make you
into a user.

V-spot

The V-Spot is a term I devised to describe the most sensitive area of emotional
vulnerability that gets aroused when ones partner hits an emotional raw spot in the other.
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 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 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; 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 infants awareness of his
mother as a whole object. As the infant matures and as verbal expression increases, he
achieves more cognitive ability and acquires the capacity to love her as a separate person
with separate needs, feelings, 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 objects. One no longer seeks to destroy the objects or the

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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 because 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
childs 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).

REFERENCES

Bach, S. (1994). The Language of Perversion and the Language of Love.


Northvale. NJ; Jason Aronson.
Coche, Judith, (2111). Skill Loving: Couples and Intimacy, Paper presented at the AGPA
January 1, 2011).
Doi, T. (1973). The Anatomy of Dependence. Tokyo: Kodansha
Foster, R., Moskowitz & Javier, R. (1996). Reaching across boundaries of culture and
class. Northvale: NJ: Jason Arsonson.
Fairbairn, W.R. D. (1940). Schizoid Factors in the Personality: An Object Relations
Theory of the Personality. New York: Basic Books, 1952.
Grotstein, J. (198l). Splitting and Projective Identification. New York: Jason Aronson

Isay, J. (2008). Walking on eggshells: Navigating the delicate relationship between adult children
and parents.

Kernberg, O. (1990). Between conventionality and aggression: The boundaries of


passion. Presented at the Cutting Edge Conference, University of California, San Diego,
CA, April

Kernberg, O. (1991a). Aggression and Love in the Relationship of the Couple. Journal of
the American Psychoanalytic Association 39: 45-70.
80

Kernberg, O. (1991b). Sadomasochism, sexual excitement, and perversion. Journal of


the American Psychoanalytic Association 39:333-362.
Kernberg, O. (1992). Aggression in Perversity Disorders and Perversions. New Haven:
Yale University Press.
Kernberg, O. (1995) Love relations: Normality and Pathology. New Haven Yale
University Press.
Klein, M. (1957). Envy and gratitude. New York: Basic Books.
Kohut, H. (1971). The analysis of the self. New York: International Universities Press.
Kreisman, J., Straus, H. (1989). I hate you-dont leave me. New York. Avon Book
Lachkar, J. (1992). The narcissistic/borderline couple: A psychoanalytic perspective on
marital conflict. New York: Brunner/Mazel
Lachkar, J.(1998a). The many faces of abuse: Treating the emotional abuse of
high-functioning women, Northvale, N.J., and London: Jason Aronson.
Lachkar J. (1998). Narcissistic/borderline couples: A psychodynamic
approach to conjoint treatment. In The Disordered Couple, ed. L. Sperry and J. Carlson,
pp. 159-284. New York: Brunner/Mazel.
Lachkar J. (1998). Narcissistic/borderline couples: A psychodynamic
approach to conjoint treatment. In The Disordered Couple, ed. L. Sperry and J. Carlson,
pp. 159-284. New York: Brunner/Mazel.
Lachkar, J. (2004). The narcissistic/borderline couple: New approaches to marital
therapy. New York. Taylor and Francis.
Lachkar. J. (2008). The V-spot: Healing the Vulnerable spot from emotional abuse.
New York. Jason Araonson
Lachkar, J. (2008). How to talk to a narcissist. New York, Taylor and Francis.
Lachkar, J. (2012). The disappearing male. New York. Jason Aronson.
Lansky, M. (1987). Shame in the family relationships of borderline patients. In J.
Grotstein, M. Solomon, & J. Lang (Eds), The borderline patient: Emerging concepts in
81

diagnosis and psychodynamics and treatment (Vol. II, pp. 187-199), Hillsdale, NJ:
Analytic Press.

Linehan, M.M. (1993a) Cognitive Behavioural Treatment of Borderline Personality


Disorder. The Guilford Press, New York and London.
Mahari, A. J. The Borderline Dance and the Non-Borderlines Dilemma www.aspergeradults.ca

Levene, J. (1997). Couples therapy with narcissistically vulnerable


individuals. Canadian J. Psychoanalytic 5. 125-144.

Mason, Paul 1998). Stop walking on eggshells: Taking your life back when someone you
care
about has a borderline personality.
Martin, P. and Bird, H. (1959), The "love-sick" wife and the "cold-sick"
husband Psychiatry. 22. 242-246.
McCormack, Charles. (2000), Treating borderline states in marriage: Dealing with
oppositionalism, ruthless aggression, and severe resistance. Northvale, N.J: Jason
Aronson.
Ogden, T. H. (1986). The Matrix of the Mind. Object Relations and the
Psychoanalytic Dialogue. Northvale, NJ: Jason Aronson
Vaknin, S. (2007). Malignant Self Love-Narcissism Revisited

Winnicott, D.W. (1965). The maturational process and the facilitating environment:
New York: International universities Press.

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