Just what is a narcissist in the truest sense of the term? The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (APA, 1994) lists as its diagnostic criteria for the narcissistic personality disorder a pervasive pattern of grandiosity, need for admiration and lack of empathy, as indicated by at least
five of the following:
1. A grandiose sense of self-importance
2. A preoccupation with fantasies of unlimited success, power, brilliance,
beauty or ideal love
3. A belief that one is “special” and can only be understood by, or should
associate with, other special or high-status people (or institutions)
4. The need for excessive admiration
5. A sense of entitlement—that is, unreasonable expectations of especially favorable treatment or automatic compliance by others with one’s expectations
6. Interpersonally exploitative personality—for example, taking advantage of others to achieve one’s own ends
7. A lack of empathy and unwillingness to recognize or to identify with the feelings and needs of others
8. Envy of others or the belief that others are envious of one
9. A display of arrogant, haughty behaviors or attitudes
How do we know we are in the presence of a narcissist? Many describe the experience as feeling that they are speaking to those who believe that no one else in the room exists but themselves. In most cases, it is difficult to talk to narcissists because they talk only about themselves. As a colleague once quipped, “One nice thing about narcissists: They don’t talk about other people.” Some narcissists fall within a somewhat normal healthy range. Although these individuals, as are all narcissists, are preoccupied with self, feel extremely entitled and have an endless desire to achieve fame, power, wealth and success, they do not indulge in these behaviors to the exclusion of family and others in their lives. Some may even include their partners and families as extended mirroring part objects: “Let me introduce my beautiful wife and lovely children to you.”
Although Sigmund Freud did not discuss communication style pertaining to the narcissist, he was one of the first to bring our attention to the narcissistic personality disorder: his majesty the narcissist (Freud, 1957). He initially referred to narcissism as the state of self-directed libido, after the Greek leg-end of Narcissus, who fell in love with his own image, an admired infantile part of himself. Freud claimed that this type of person is highly infatuated with himself and becomes cathected (emotionally attached) to someone who has qualities that he or she wishes to have or once had and no longer pos-sesses (beauty, fame, success, wealth, brilliance, power). The narcissist then embarks on a lifelong journey to try to possess these qualities by attaching or fusing with others who offer some semblance of object love. As much as narcissists long for love, because of their omnipotence they attack and destroy those who can offer it. As Freud noted, the need for others and the need for love are very powerful emotions that pour an overflowing ego libido into the object. This mimics a psychotic state, a reunion of highly charged emotional and bodily experiences.
Heinz Kohut views narcissism as a state of development. He depicts a more highly developed narcissist whose primary and normal narcissistic phases were virtually unattended to at the phase-appropriate time. According to Kohut (1971, 1977), the most common archaic injury occurs during an empathic disruption, when the mother usurps this special baby from the “throne” or high chair to make way for a new sibling. Often the narcissist will spend the rest of his life in a kind of narcissistic nostalgia, yearning to recapture the time when mommy and baby were one, living in perfect synchronicity and symbiotic bliss. The narcissist is constantly and subconsciously reacting to the empathic disruption—commonly referred to as the original archaic injury, narcissistic injury or again what I term the V-spot (Lachkar, 2008). Any threat or reminder of this early trauma triggers profound feelings of not being special or not being the “only one”: “What do you mean you’re going to visit your brother? You put your brother before me! I’m your husband and I should come first!”
Narcissists have excessive entitlement fantasies and an inflated sense of self. They display a pervasive pattern of self-importance and often have an exaggerated illusion regarding their accomplishments and talents. They are dominated by such primitive defenses as idealization, omnipotent denial, omnipotent ideal, grandiosity, devaluation, isolation, projection, projective identification and splitting. They are often competitive and envious, will go to any extreme to win and will do anything to prove their specialness. When confronted, challenged or not properly admired or appreciated, they will go into a narcissistic rage or withdraw into a narcissistic retreat.
Narcissists are often frustrated in love relations as they search for the ideal mate, who does not exist for them in reality. Their most pervasive trait is a lack of empathy and insensitivity to the needs and feelings of their objects (Lachkar, 1992, 1998, 2004, 2008). They fuse with their objects exactly as they view the world—as an extension or appendage of themselves—and are unable to share anyone else’s good fortune.
In conjoint therapy, these dynamics and defenses become more explicit as we see movements flowing back and forth between guilt and shame, envy and jealousy, perfectionism and chaos, domination–control and submission, dependency and omnipotent control, and attachment and detachment. In many of my earlier contributions, I refer to these dynamics as “the dance,” which explains why couples stay in painful conflictual relations, interactions that go on and on, round and round, without ever reaching any conflict reso-lution (Lachkar, 1992, 1998, 2004, 2008).
Communicating with a narcissist requires special care. In general, the narcissist responds best to empathy and to self-object functions (i.e., appreciation, attunement, mirroring). The narcissistic defenses of isolation and withdrawal are typical responses when they feel personally injured, particu-larly when depleted of the narcissistic supplies that fuel them. When their personal sense of pride has been threatened, they will fly into a narcissistic rage or withdraw and isolate themselves. Basically, narcissists do not respond to confrontation. So what should therapists do when they need to confront the narcissist? The first step is to prepare for the onslaught. They need to be amply mirrored, praised and acknowledged before they are given even the smallest piece of constructive criticism: for example, “You look great! So wonderful the way you take care of your body and always watch what you eat,” as opposed to, “Gee, I think you gained weight. Are you on a diet again?”
Laurie, who came into treatment after reconnecting with her ex-fiancée, told how their conflict scenario repeated over and over again.
If I tell him I love him, that I want to make our relationship better, and to make a commitment, then he starts to attack me. He tells me I suffocate him, make too many demands, and my pressure turns him off. When I get close to him he acts as though he doesn’t need me. If I stay away, he becomes very loving and affectionate. No matter what I do it’s a no-win situation. I hate these confusing messages; he always makes me feel as though I’m walking on eggs!
Laurie’s fiancée disrupted communication by projecting his needy and vulnerable self into her, coercing her to enact the role of a suffocating, needy, demanding object while he was home-free to watch the L.A. Lakers or to go out on his sailboat. The bitter paradox was that as much as Laurie protested, she participated in the abuse by not setting boundaries or limits. She virtually became an appendage to him as she bonded with the pain that she vehemently disavowed.
An important step was to help Laurie get in contact with her internal “depriving” object to show her how she deprived herself. Before this could occur, I first had to sort out what kind of internal object she identified with. This can be quite tricky because often patients misinterpret and feel they are to blame: “Are you telling me he is not depriving me, and it is my fault because I deprive myself?” I had to help prepare Laurie—to find a meaningful and sensitive way to communicate with Laurie—to let her know that she was in no way deserving of the abuse and that in no way did her behavior justify the mistreatment.
He never pays when we go out. He deprives me of everything. He never offers to help around the house. When he goes to the market, he only buys things for himself. When we go to dinner I have to pay, although sometimes he leaves the tip.
When confronted about why she stayed and was encouraged to join a support group or to gather a group of friends to bolster her in the event of a breakup, she claimed, “Oh, I could never go out and make new friends, join a support group, or book club. My boyfriend would have a fit!” To this I replied, “Yes, there can be a boyfriend who deprives you of your needs, but do you also deprive you?” This becomes a dance of two people in complicity, or a folie à deux. Only the sensitivity of the therapist at this juncture can gently show Laurie that there is a part of her that identifies with her partner’s negative behavior, which makes it harder to set some limits with him.
In my assessment, I chose the depriving object as a major theme. Otto Kernberg (1995) noted that in normal love relations, expressing one’s intimate feelings engenders compassion and empathy as opposed to pathological relationships, whereby expressing one’s feelings engenders primitive and persecutory anxiety (see Kernberg’s four different kinds of love relationships, Chapter 2).
Narcissists cannot tolerate the kind of dependency needs an intimate relationship requires and unwittingly project this intolerance onto the other, typically a borderline partner, who makes a perfect target for the narcissist’s negative projections. (See the case of Mrs. Z in this chapter.)
On the surface, narcissists appear to have higher than average self-esteem, but, paradoxically, they are never really narcissistic enough to achieve real goals, aims and ambitions (see Chapter 8, “The Narcissist the Artist”). They are quite fragile and vulnerable to the responses and reactions of others. Because narcissists care more about being admired than being loved (Kernberg, 1995), they create an inner dialogue to maintain consistency with their grandiose or omnipotent self. It is almost like a Shakespearean monologue or soliloquy: Hamlet on a stage talking to a cast of inner characters orchestrated to meet and match his own self-object needs. In custody battles, the narcissist expects to have all the visitation rights, the house, all the money and all the furniture. Why? “Because I’m entitled.”
OVERLAP
When discussing narcissism, most clinicians today find the examination of narcissistic disorders quite confusing, for the narcissistic personality is not a clear and distinct entity; there is considerable overlap between narcissism and other disorders (e.g., borderline, obsessive-compulsive, histrionic, antisocial, schizoid, depressive). The grandiose and omnipotent self can invade and infect many other personality pathologies.
Different theorists have discussed the narcissistic personality disorder and have presented varying perspectives. Sam Vaknin (Vaknin, 2007), author of Malignant Self-Love: Narcissism Revisited, described different types of narcissists in detail, meticulously taking into account their distinctions. To further complicate matters, we must decipher which type of narcissist, theoretically speaking, we are dealing with: a Freudian narcissist? A Kleinian narcissist? A Kohutian narcissist? A Kernbergian narcissist? A Masterson narcissist? Furthermore, narcissistic states, traits, characteristics and symptomatologies are not clear, concise entities; they tend to vacillate widely (Lachkar, 1998, 2004, 2008). My colleague often uses the term Nar/Bor (S. Ventura, personal com-munication, 2006) to describe this mixed breed.
The case of Mrs. Z in this chapter presents many different theoretical frameworks, concepts abstracted mainly from classical psychoanalysis, self-psychology and object relations, particularly Kohut, Melanie Klein and Wilfred Bion. When Mr. Z responded impulsively to Mrs. Z, the works of Bion (1977) come to mind, stating that words are equivalent to empty thoughts—thoughts without a thinker. For Bion, the worst crime is to avoid truth (“analytic lies”), and the only recourse is to make sense out of senselessness, or what he referred to as moving from beta elements (–k) to alpha functions (k). Mr. Z was searching for what Bion referred to as the container offering, which he was able to receive but not give. This opens up a new space for the patient to face truth and reality. This is where Bion differs from Kohut, who has more belief in the patient’s subjective truth.
Bion believed that the process of detoxification—transforming the patient’s lies and distortions into something usable and palatable—creates the potential for a transformation to occur. His explanation was that when the object is not contained, thoughts become accessible for evacuation through projective identification. In terms of communication, Bion’s concept of con-tainment, reverie, transformation, detoxification and thoughts on thinking are invaluable constructs. Bion transformed Klein’s model of the “good and bad breast,” giving them an additional function besides teaching the infant to experience his world; they serve as a container to help sooth and detoxify bad thoughts into something digestible and meaningful.
Klein’s (1940) concept of a “toilet breast” is applicable for many patients who could not make use of mommy’s breast as a container to hold and con-tain baby’s innermost fears and anxieties. There must be an object that will contain the depth of the projection and the evacuation of painful effects (beta elements). Patients’ excessive demands, such as constant telephone calls and accusations that the therapist is a money grubber are ways of using the thera-pist as a toilet breast: “You attack me for being selfish and greedy because you feel your needs are dangerous and fatal to your health.”
I also thought of Bion (1961) when we tried to move Mrs. Z from the state of victimization to a state of action. Bion actually designed a grid to chart how patients move from beta elements (nonaction, meaningless talk) to alpha function, thoughts that lead to thinking, learning from experience and, finally, to action. In Mrs. Z’s case, we see how object relations and self-psy-chology make perfect companions rather than an “odd couple” relationship. Mrs. Z was able to mirror and empathically convey to her husband that she understood how he misconstrued her stress as his fault, reassuring him that her stress had nothing to do with him.
In the case of Mrs. Z, self-psychology offers the tools of mirroring and attunement to help meet her narcissistic husband’s objects needs. In contrast, object relations offers the therapist the opportunity for containment, reassuring Mrs. Z that she need not put up with her husband’s abuse and that she can take action, such as sleep in a hotel next time his anger flares up. This is a bit of a stretch from James Masterson’s concept that narcissists respond more to empathic responses and borderlines respond more to direct confrontation. Masterson (1981), however, did not include “action” as an adjunct to the empathy.
Women Who Choose to Stay With Narcissists
The type of woman (or man) who stays with a narcissist is often someone with a borderline personality. Women who choose narcissistic men are frequently dependent types who have a defective sense of self, do not feel entitled and are easy prey for internalizing the negative projections of the narcissist (Lachkar, 1992, 1998, 2004, 2008). Many lack self-esteem, are burdened with persecutory and profound abandonment anxieties, feel unworthy of being loved and are easily seduced by the narcissist’s omnipotent and grandiose qualities: “I’ll do anything; just don’t leave me.” Because narcissists cannot allow themselves the kind of vulnerability a love partner desires, they split off or translocate all their “neediness” into someone like a borderline, who is an easy receptacle or “toilet breast” for the destructive responses the narcissist projects: “Don’t give me this nonsense about marriage. It is only a piece of paper!” Often the women are in a constant quest for the unavailable man and attach themselves to them in the hope of repairing the lost object. These women become mesmerized by and idealize these narcissistic men, deluding themselves into thinking that their partners are “everything” and that they are “nothing.” Narcissists’ inflated sense of self and defenses of withdrawal and isolation make them emotionally and physically unavailable. This arouses such states as abandonment, victimization, unworthiness and shame in the borderline partner, who already has a thwarted sense of development. Thus, this makes for the perfect fit to feed one another’s needs.
Communicating with a Narcissist Isn’t Easy
Communicating with a narcissist commonly involves the problem of using or misusing the other as a toxic container or receptacle for one’s emotional toxic excretions. The therapist then has an opportunity to do a psychological makeover or what Bion (1965) referred to a transformation—an emotional operation detoxifying or converting what is felt to be “toxic” into something more palpable: “If you put your emotions for what you think is toxic into me, then you will be untainted, clean and pure, and I the dirty one.” This touches on couple transference (see Chapter 2), whereby the couple starts to project the same dynamic that occurs in the relationship onto the therapist. “Now you are withholding from me just like my wife.”
The narcissist and borderline enter into a psychological dance, consciously or unconsciously stirring up highly charged feelings that fulfill many 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. For the narcissist it is an affirmation of a sense of specialness, whereas for the borderline it proves one exists as a thing in and of itself. There is a bitter paradox between the two partners: The borderline woman feels she has needs but is not deserving of them; in contrast, the narcissist abandons his needs, feeling they are a sign of weakness and impotency. Consequently, the borderline woman becomes a perfect receptacle in which the narcissist can project his needy split-off self: “It is you who are the needy one. Me, I have no needs. I am Mr. Perfect. I have my own sailboat, my work, my own penis and can provide for myself.”
Within these beleaguered relationships are two developmentally arrested people who coerce one another into playing out certain roles as they bring into current relationships their respective archaic experiences embedded in
old sentiments. Because of the borderline’s false self and compliant, chameleon-like personality, for a short time he or she is able to playact at being the perfect mirroring object for the narcissist. In the ongoing relationship drama, the narcissist needs a borderline to worship and to fuel his nascent self, and the borderline needs a narcissist to stir up repressed development issues (Lachkar, 1998, 2002, 2004).
The following cases display many of the psychodynamics of narcissists and the partners who choose to stay with them.
Case of Mr. and Mrs. Z: The Special Language
Mrs. Z, like many patients who exhibit borderline personality traits, had a histrionic and dependent personality. This case is an example of a borderline wife attempting to communicate with her narcissistic obsessive-compulsive husband. Said Mrs. Z: “He is always working and when he is not working, he plays tennis. There just is no time for our kids or me.” Mr. Z deluded himself into thinking that because he was the main provider for the family he could spend the rest of the time doing whatever he wished without considering the needs of others, who are merely there to fuel his ego. Mrs. Z had a very hard time expressing how she felt to her narcissistic attorney husband because he interpreted her emotionality as a personal attack against him.
Unable to hold back any longer, and hoping to get some kind of empathy or compassion, Mrs. Z shared her feeling that she is about to go crazy, that the kids are stressing her out. Instead Mr. Z responded in the most attacking and punitive way: “So you think it is my fault. Why do you blame me for everything?” She replied, “I’m not blaming you. I’m telling you how I feel. Why can’t you listen to me for a change?” He shouted back at her, “Why can’t you ever stop thinking about yourself and think about how I feel?”
My response was, “What? You said that?” The patient was taken aback by my reaction, and in the next breath I caught myself saying, “Don’t you know how to talk to a narcissist?” I immediately recognized my harsh reaction. I calmly explained to her that she needed to learn the special language of narcissism, with its specific communication style. “Oh,” she replied. “I never heard of such a language.”
I explained that when she tells her “Mr. Perfect” husband that she is stressed because of the kids, his immediate reaction is guilt, identifying with the fact that he does feel guilty and has not spent enough time with his kids or wife and instinctively internalizing her emotional state as an attack.
“I never thought of that,” Mrs. Z replied. “What should I say?”
My response was, “Well, how about something like, ‘Honey, what I am about to say has nothing to do with you. I understand you have been very busy with court cases and are doing the best you can to support our family, so please don’t take this personally. I just need to tell you that I am very stressed out by the kids and want you to understand that it’s not your fault. I’m not blaming you.’”
Mrs. Z responded, “I have to say all of that? That is exhausting. It makes sense, but learning to speak that way will wear me out even more than the kids.”
To this I replied, “Ah, but it is more exhausting not to.”
In this way, I introduced an entirely new communication style while letting the patient know unequivocally that she is not deserving of the mistreatment.
Discussion
When I said, “You said what to a narcissist?” I was alluding to the fact that the patient did not prepare the stage for the “onslaught.” Mrs. Z was perfectly aware of what Mr. Z’s response would be and knew she would get attacked. What she could have said was, “What I am about to say has nothing to do with you. You are a wonderful husband, father, personal injury attorney, so please don’t confuse my feelings with a ‘personal injury’ against you.”
Communicating with someone like Mr. Z presents a complicated therapeutic challenge. Because of the grandiose self, many narcissists equate emotional surrender with weakness and impotence, and neediness with vulnerability. Obsessive-compulsives equate needs with dirt and filth, which perhaps explains why they are compelled to clean as a defense against intolerance for anything emotional: “My histrionic wife makes me sick with her hysteria and outpouring of emotions.”
Because of abandonment fears, it is not an easy task to help our patients move from “talk” to action. It is noteworthy that in a later session Mrs. Z skillfully moved back and forth between mirroring her husband’s grandiose self and then like a laser came in with a major confrontation: “Well, if you are going to yell and scream at me all night, then I will go stay at a hotel.” Most people would agree this is a good example of boundary setting or set-ting limits.
But how do we do this with a narcissist who is already prescripted and preprogrammed to distort Mrs. Z’s need to take care of herself as a personal attack? What words do we use to help the borderline wife begin to disidentify with the negative projections from her loveless husband? The first step is to help Mrs. Z realize that she is being mistreated and that she is not deserving of the abuse (see section on emotional abuse in Chapter 3). The second step is to help Mrs. Z disidentify with the negative projections and assure her that her emotions are healthy and normal (see Chapter 6 on the obsessive-compulsive narcissist and the tendency to bond with objects).
What follows is an example of a therapist having to confront her patient about a very sensitive issue.
The Affair: Mr. and Mrs. M
Mr. M was a pathological narcissist, very self-centered, with many obsessive-compulsive features. Mrs. M, his borderline wife, was a frustrated music teacher and mother of three. As is the case with many borderline patients, Mrs. M had a very strong histrionic and dependent side. After calling in crisis for an emergency appointment, she came in completely distraught and panicked. She had discovered that her narcissistic husband had been having an affair for the past year. She was completely out of control, crying, whining and wailing. Prior to the session, Mrs. M’s sister had called her to announce that her husband was a liar and a cheater and that she should have known that he had been unfaithful to her. Her sister had found out who the other woman was, and Mrs. M had called and confronted her. This is when all hell broke loose.
Although Mr. M displayed narcissistic features, he also had a proclivity to many obsessive-compulsive behaviors. He tried to justify the affair, claiming that his marriage became a reenactment of a suffocating childhood characterized by all work and no play: “My affair was fun. I’m sorry, but I have to admit that. Having such a dependent, needy wife does not leave much room for me.” He described a very rigid childhood in which life was all about taking orders and following rules set by his rigid, punitive, repressed father. His militant father was succeeded by a borderline histrionic wife, a woman who got so fused and dependent that he ended up feeling just as suffocated and repressed as he did as a child. Mrs. M recalled her own father’s affairs and how these led to the breakup of her parent’s marriage.
From the outside looking in, we see Mrs. M as a very hurt woman, traumatized by her husband’s transgression. But from the inside looking out we see an opportunity for Mrs. M to act out all her victimization and “poor me” fantasies and defenses. In spite of Mrs. M’s outrage and shock over the devastating news of her husband’s extramarital affair, this case illustrates how the communication style between the couple can lead to traumatic disruption in the marriage. From a theoretical perspective, empathic responses are usually called for in such cases. However, Mrs. M appeared more in need of “hard object” responses to hold and contain her enactments of lashing out and hysterical attacks on her husband.
I offered continuous legitimacy of Mrs. M’s hurt feelings, but not her aggression. I let her know that she had a right to be hurt and express that hurt but that she did not have the right to aggressively attack her husband, to call him names (e.g., “You little fucker”) and to just let him have it. Our work focused on allowing her to feel the pain rather than on becoming the pain. This eventually led to the biggest challenge: introducing her to her “internal betrayer,” showing her how she betrayed herself by not moving forward in her career. She had always wanted to open her own music education center but never had the courage: “Oh, well, guess I’m just stuck being a music teacher the rest of my life. Like my father says, ‘Music is just a waste of time’” (the betraying internal father).
THE CASE
Mrs. M (enters sobbing): I am completely devastated. I just found out my hus-band has been having an affair for the past six months. We’ve been married eight years and have three children. I should have known something was going on. My husband hasn’t touched me, looked at me naked, or even shown any affection. I thought it was because I was pregnant, nursing, and gained weight. Now I know.
Therapist (Th): (silent and listening attentively)
Mrs. M: My sister told me she saw them together last week, so I called the woman and confronted her. The other woman was angry with him as well and told me my husband is a liar and a cheater, that I should trust what I have been feeling, that they were having an intimate relationship. I can’t stop crying.
Th: This is very traumatic. The marriage has had a fatal attack.
Mrs. M (crying): I know, I can’t stop crying. I can’t believe he would put her before me. Now I have to have an AIDS test.
Mr. M: I really feel bad. I apologize to you. It isn’t anything I planned. It just happened.
Mrs. M: Your apology doesn’t mean anything because if it did you wouldn’t put her before me.
Mr. M: I mean it. I want to make things better.
Mrs. M: Like shit you do. You don’t feel bad about anything. How do I know it’s over? I found hotel receipts in his drawer. I knew something wasn’t right. He chose HER over me!! I can’t get over that.
(Mrs. M continues to sob and attack. Instead of evoking my sympathy she is beginning to annoy me. I feel like saying, “Cut out the whining and appreciate that your husband is here with you.” Is this an act of aggression? To him I feel like saying, “Where is your empathy? Can’t you see this woman is in severe emotional pain?”)
Th: Yet, he’s here now and she’s not.
Mr. M: That’s right. It’s over.
Th: Look, there are three reasons why people have affairs. One, they fall madly in love and even marry eventually. Two, there is something missing in the marriage. Or, three, it’s a one-night stand, something that “just happens.”
Mr. M: Mine fell in the second category. She was working with me. I found we had many interests in common. She had a great deal of com-passion and empathy for me.
Th: Thank you, that’s pretty straightforward. So let us talk about what was missing in the marriage.
Mr. M: She isn’t considerate of me. For years I’ve been telling my wife to leave soap in the kitchen. Every time I go to wash my hands there is no soap.
Th: So where is the soap?
Mrs. M: Oh, I don’t know. I just put it wherever.
Th: Yet, you are a musician, a teacher, and very structured and orderly at work. Do you just say, “Okay kids, come on in, sit down, take any instrument you like, and just start playing?”
Mr. M: (smiling as if there is momentary relief from the pressure). That’s what I don’t understand—how she is so different at home.
Th: So what is in the way of pleasing your husband and taking care of his request?
Mrs. M: Because I don’t think it is that important.
Mr. M: It would be as if I took out all the tools from the toolbox and spewed them all over the house.
Mrs. M: He is very structured, and I wasn’t raised like that.
Th: Structure. Doesn’t sound like a bad thing to me.
Mrs. M (to Mr. M): I don’t care about you and your structure. I can’t get over what you did. You hurt me and destroyed my trust. And, who knows, you can do this again. I thought you loved me.
Mr. M: I do love you.
Mrs. M: Bullshit! If you loved me you wouldn’t have strayed. He has a terrible temper. He yells, screams and humiliates me in front of others and always puts me down.
Th: Don’t get me wrong. There is no way I am saying your husband’s actions are justified. But you also need to take a look at how you provoke him, how you distort your own image and importance, claiming he chooses someone over you when you are the one who is here and the one he loves.
Mrs. M: But he’s always criticizing me. I know he’s right that I am sloppy at home. Home to me is not as important as my studio.
Th: He should not criticize or attack you, but maybe you are “sloppy” about taking care of your own needs.
Mrs. M: You mean the idea of opening up my own music center?
Th: Exactly. Others can always betray you, such as a husband’s infidelity. But we also have to look at how you betray yourself, keeping yourself stuck and on hold. [moving into the space of her internal betraying object]
Mr. M: Yes, you’re right about that.
Th: Still, that does not take away from the cleaning up we need to do here. Mrs. M, you need to separate from your internal betrayer and move into a new space, become more attuned to your own needs. And you, Mr. M, need more time for fun and play with your wife.
Mrs. M: What about his aggression toward me? He smashed all the dishes last week and threw my fine vase against the wall.
Th (to Mr. M): No, you cannot act out the contents in your toolbox—screw, hammer and bang away at your wife. That gets messy. As a couple you need to encourage and support each other in getting your real and legitimate needs met. In spite of everything, I feel very encouraged. There is a lot of love between you, and it is obvious you have a very deep emotional connection.
Mrs. M: (wiping her tears; shows me picture of her children) But I don’t know what to do. I think I should leave.
Mr. M: I’m not coming back here anymore. I’ve had it with her.
Th: It’s hard to know what to do while you are in this crisis and when so much blaming, attacking and shaming is going on. It’s best not to make any major decisions because things are unclear and you can’t have it both ways—being in the relationship and out of it at the same time, as well as in and out of treatment. [couple transference]
Mr. M: I see your point. We need new tools to communicate without threatening one another.
Th: We will continue with this next week.
Mr. M: Great. See you then.
Th: Bye, now. Have a good week.
Discussion
It took a great deal of sensitive therapeutic work to introduce Mrs. M to her internal betrayer. It is not easy to help someone who has been violently betrayed by a love partner move away from victimization to face defects within her own internal world. I had to move very cautiously at first, providing a strong therapeutic alliance and platform and validating her genuine hurt and betrayal. After bonding with Mrs. M’s legitimate pain, I was able to slowly move her away from the continual blaming and attacking stance against her husband to face her own internal betraying object (see Introduction). Mrs. M needed to be told, “Of course, there can be a betraying husband, someone you trust and believe in. But there can also be an internal betrayer, part of you that overidentifies with the betrayal.” Often the patient will offer a great deal of resistance. Mrs. M responded angrily at first: “Are you saying that because I betray myself that I am the cause of his affair?” Only after she was reassured that she indeed was not the cause of the betrayal and that our goal was to repair the damage that had been done was Mrs. M able to get in contact with the part of her that betrayed herself.
The therapist must convince the patient in very caring words that we are all subject to betrayal and that we cannot always control that. However, we can take charge of our internal betrayer, and that’s where the power is: “You are not a victim. You are a very capable and powerful woman.” In time we begin to see a gradual moving away from the external betrayer to taking control of the internal betrayer: “I will think about opening my new center.” Thus begins the healing process for Mrs. M.
