T R E A T M E N T OF N A R C I S S I S T I C A N D B O R D E R L I N E

D I S O R D E R S IN M A R I T A L T H E R A P Y : S U G G E S T I O N S
T O W A R D AN E N H A N C E D T H E R A P E U T I C A P P R O A C H

M a r i o n F. Solomon

A B S T R A C T : This paper examines a psychodynamic model of marital ther-

apy that has been found to be useful when one or both partners suffer from disor-
ders of the self. The theories of Heinz Kohut and recent self psychologists give in-
sight into ways of understanding and treating each partner's narcissistic
vulnerabilities. Some specific aspects of borderline and narcissistic disorders are
described and discussed within the context of a marital relationship. This method
of marital therapy not only helps couples to learn how to be selfobjects for each
other, but also may facilitate rebuilding of damaged structures of the self. A case
example is provided along with a discussion of why certain specific therapeutic
interventions were made.

I have no hesitation in claiming that there is no mature love in which the

love object is not also a selfobject. Or, to put this depth-psychological formu-
lation into a psychosocial context: There is no love relationship without mu-
tual, self-esteem enhancing, mirroring and idealization (Kohut, 1977, p.
122).

T h e purpose of this p a p e r is to i n t e g r a t e some of the r e c e n t develop-

m e n t s in a n a l y t i c t h e o r y w i t h conjoint t h e r a p y , and to suggest some w a y s
t h a t m a r r i a g e and f a m i l y systems which h a v e been u n d e r m i n e d by nar-
cissistically r e l a t e d issues can be more quickly identified a n d t r e a t e d .
U n d e r s t a n d i n g the d y n a m i c s of self disorders and a p p r e c i a t i n g t h e i r
p r e v a l e n c e can lend a new perspective to the t r e a t m e n t of m a r i t a l disor-
ders. Indeed, new perspectives seem all the more i m p o r t a n t as we witness
g r o w i n g n u m b e r s of people seeking t h e r a p y for m a r r i a g e - r e l a t e d prob-
lems. A r e c e n t s t u d y by S a g a r a n d Associates (1977) d e t e r m i n e d t h a t 50%
of p a t i e n t s r e q u e s t i n g t h e r a p y did so because of m a r i t a l problems, and a n
a d d i t i o n a l 25% were e x p e r i e n c i n g some m a r i t a l r e l a t e d difficulties.
W h e r e one or b o t h p a r t n e r s in a m a r i t a l r e l a t i o n s h i p suffer from a
selfdisorder, the m a r r i a g e (including a n y children) is likely to be c a u g h t
up in a narcissistic or b o r d e r l i n e pathological system. T h e complex rela-

141 9 1985 Human Sciences Press

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tionships in unhappy familites have been the subject of many studies by

conjoint family therapists. While psychoanalytic researchers are doing
much of the current writing about the causes and treatment of self disor-
ders, social workers, who have been in the forefront of the treatment of
marital problems, tend to emphasize a systems-theory approach.
Marital bonds are the nearest adult equivalent to the original par-
ent-child relationship (Dicks, 1967). All marriages bring out infantile
feelings; happy marriages allow freedom for deeply repressed feelings
without loss of dignity or security (Nadelson, 1978). In troubled mar-
riages, the need to express repressed infantile feelings results in harmful
interactions; the marital relationship becomes a battleground covered
with pain and disillusionment.

Conjoint Therapy
Many practitioners of conjoint therapy base their approaches on a
systems theory in which major attention is given to the "field" in which
behavior occurs. The focus is on understanding the whole, from which the
component parts are then differentiated. In this paradigm, individual
psychopathology is viewed mainly in terms of its role (through individual
adaptation) in maintaining the homeostatic equilibrium of the family
system. Thus, treatment is often directed toward changing the system's
"balance," through approaching the family as a whole rather than focus-
ing on an individual patient identified as the family's "problem." Systems
theory has been studied intensively and described in the pioneering work
of the Mental Research Institute in Palo Alto (Ackerman, 1965; Bowen,
1966, and his NIH researchers; Haley, 1963; Jackson, 1967; Minuchin,
1974; Satir, 1967; Watzlawick, Beavin, & Jackson, 1967).
Early work by systems theorists concentrated on communication and
interactional patterns in families with schizophrenic members. The Palo
Alto group focused particularly on communication as a form of interac-
tion. Using their theoretical framework as the basic perspective of treat-
ment, therapeutic energy has been directed toward the study of com-
munication inputs and outputs. Even noncommunication has been
identified as a behavior to be studied and changed, because, as Watzla-
wick, Beavin and Jackson (1967) have argued, it is impossible not to
behave.
According to this model, it is assumed that communiction within a
field (e.g., a family) functions to maintain t h e s y s t e m ' s homeostasis.
Therefore, the therapist's interventions must primarily address change
in the context of the family system as a whole. Individuals, while ac-
knowledged in the therapy, are given no special priority. In fact, it is be-
lieved that the thoughts and feelings of the individual may actually func-
tion as distractions from the far more useful data regarding inputs and
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outputs of the whole system. As Steinglass (1978) puts it, speculations

about fantasy life, motivation, or structural organization of the mind are
interesting intellectual exercises, but they may confuse or even destroy
attempts to describe and understand the rules that govern h u m a n inter-
action in family systems.
Since communication within therapeutic sessions is viewed as an ex-
ample of a couple's or a family's typical pattern of interaction, the thera~
pist seeks to identify the "pragmatic" aspects of the system's communica-
tion pattern (Watzlawick et al., 1967). For example, the therapist will
attempt to make explicit the strategies a family employs to maintain
homeostasis, or the hidden rules of behavior that exist within a particu-
lar marriage. Attention is then devoted to effecting change in the identi-
fled communication-behavior pattern.
While such an approach has proven quite helpful in reestablishing
the well-being of some unhappy marriages, the shortcomings become evi-
dent when confronted with collusive family patterns rooted in individual
psychological pathologies, particularly those based on narcissistic and
borderline self-disorders. Therefore, an eclectic therapeutic approach in-
corporating insights from systems theory and from self psychology is
more likely to meet successfully the therapeutic challenges of contempo-
rary families and relationships.

Self Psychology
Today, therapists acknowledge that although more and more of their
patients are successful occupationally and have many acquaintances,
they m a y actually despise their very existence and feel alienated from
some integral part of themselves. These individuals constantly seek ap-
proval and attention from others but have difficulty sustaining any inti-
mate contact, Many of these people suffer from a fundamental defect in
the structure of the self.
Kohut (1971, 1977) explains the etiology of such "self disorders" as
follows. At the time of early development, the child may be unable to rec-
ognize any distinction between self and mother. In normal development,
mother's tender mirroring and echoing responses confirm the infant and
endow him or her with a sense of self. As the infant matures, there devel-
ops a recognition that the mother, and others in the environment, are
powerful and separate. While this is a blow to self-esteem, the infant m a y
react by transferring to the mother the grandiosity previously attributed
to himself or herself. If the mother is reasonably available to the child
and separations are not too prolonged, the functions of the idealized
mother are internalized and the infant develops a secure, cohesive self.
However, if the mother is chronically out of touch with the child, ei-
ther physically separated or emotionally distant, development of a cohe-
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sive self becomes problematic. Repeated parental absences from the vul-
nerable child will eventually be experienced as traumatic. At the same
time, there evolves an increasing distrust of the ability or willingness of
anyone outside of the self to meet basic needs. In an effort to survive emo-
tionally, parts of the psyche that are perceived by the child as dangerous
m a y "split off." These split-off parts henceforth do not grow or develop;
they survive instead as primitive, archaic remnants hidden away in the
psyche. Unless offset by a specifically corrective relationship with the fa-
ther or with others later in life (Kohut, 1977), the child may be unable to
develop a capacity to love or even to recognize others as separate individ-
uals, treating them instead as selfobjects.
Furthermore, an intense inner longing grows within the child
throughout his or her life. There is a constant effort to overcome perva-
sive feelings of emptiness, lethargy, and low self-worth. There eventually
ensues an ongoing search for ways to repair and fill up emotional deficits
through contact with people and through involvement in activities.
It is no surprise that individuals suffering from self disorders seem to
find each other. The mythology that "love is blind," "love conquers all,"
"two become one," encourages relationships in which the purpose be-
comes joining together for the perpetuation of fantasies of wholeness, to-
tal acceptance, and approval. Mutual give and take of painful, angry feel-
ings is another way that couples reexperience old, unresolved,
unconscious borderline and narcissistic disorders.
What we observe in the treatment of couples very often may be a
camouflage of a more basic struggle, on the part of one or both partners,
between individuality and separateness, on the one hand, and the wish to
maintain a fantasy of perfect togetherness, an illusion of oneness, on the
other. Each partner demands change in the other in order to repair dam-
age to the self. Over the course of therapy, such couples must begin to
change their expectations of one another by, in essence, establishing a
new "contract."
Therapeutic change requires a focus on the latent messages in com-
munication. In this way, feelings and fantasies that are only dimly per-
ceived, or not perceived consciously at all, but that profoundly affect all
interactions, can be acknowledged and confronted in therapy. By observ-
ing how individuals interact and communicate with one another and with
the therapist, it is possible to define rather quickly the important narcis-
sistic and/or borderline vulnerabilities at issue for a particular couple.
It is assumed in analytically oriented therapy that through develop-
ment of the transference in the therapeutic relationship there will be re-
vealed patterns of interaction that were established early in life; that ba-
sic early conflicts and unresolved emotional issues are reenacted in later
relationships. Even more so than within therapeutic relationships, mari-
tal pairings, particularly those involving children, reactivate emotional
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MARION F. SOLOMON

wounds of early origin. Many couples continue to replay old patterns for
years, demanding from their partners what was unobtainable from their
parents. Failure to obtain the needed response may result in feelings of
fragmentation, enfeeblement, or uncontrollable rage.
Persons with self disorders sometimes regard their spouse and their
therapist as selfobjects, people simply to be used for sex, caretaking, etc.,
rather than as separate individuals with needs and feelings of their own.
In order to treat such patients effectively in conjoint therapy, the thera-
pist must understand and respond to the individual's needs in ways em-
pathic to the conscious and unconscious messages sent. Through an ex-
ploration of the vulnerabilities, misunderstandings, and resulting attack
and defense tactics associated with reactivation of primitive needs, cou-
ples can be helped to work through some of their old, unresolved problems
and to learn to tolerate the pain and anxieties that surface in the rela-
tionship. Changes in internal structure of the self through what Kohut
(1977) calls "transmuting internalizations," may result in each partner
becoming more capable of giving and receiving selfobject functions. In
fact, it is possible in conjoint marital therapy to produce changes in inter-
nal structure of the self based upon a patient's increasing ability to toler-
ate narcissistic frustrations.
Through the therapist's understanding, empathy and resulting
t r a n s m u t i n g internalizations, the ihdividual with narcissistic wounds
learns to understand the excruciating sensitivity he or she feels in the
face of failures to elicit empathic responses from others. Slowly, the pa-
tient becomes aware of the pain he or she has felt at the "failures" of oth-
ers, feelings that once had to be blocked out and disavowed. By alleviat-
ing what has often been experienced as intolerable frustration, affect
reemerges and there grows an increasing tolerance of the shortcomings of
others. This can be accomplished if the narcissistic wounds are confronted
in small increments, and if the damage is not too great or too enduring.
Structural transformations are produced, according to Kohut, not by in-
tellectual insights but by "the gradual internalizations that are brought
about by the fact that old experiences are repeatedly relived by the more
m a t u r e psyche" (Kohut, 1977, p.3).
In conjoint therapy, couples are helped to formulate messages that
more accurately describe their needs, and to receive messages from the
partner with fewer distortions. The therapist translates or decodes con-
fusing messages and, in so doing, provides a safe containing environment
in which painful communications can be comprehended and tolerated.
Successful application of self psychology in conjoint therapy can result
in the gradual disintegration of the rigid barriers that impede loving
contact in a relationship, thus allowing the partners to give and receive
growth-inducing functions in a more mature manner.
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Narcissistic and Borderline Disorders

Kohut (1977) made a clear distinction between narcissistic and bor-
derline patients, believing the latter too disturbed to treat with self psy-
chology. This tenet, however, has been questioned recently by practicing
self psychologists (Brandchaft & Stolorow, 1981). Increasingly, the two
disorders are being viewed as quite closely related, and there is now some
question even as to which is the more severe pathology (Grotstein, 1981,
Masterson, 1981).
Both narcissistic and borderline patients manifest a confused sense
of identity and are unable to integrate the contradictory aspects of their
self image. Patients with narcissistic personality disorders continue to
live in pathological "symbiotic relationships" with early life figures. They
seek in marriage a fusion with "other," a relationship in which "two be-
come one," each being certain that they are the one.
Patients with borderline disorders may be able to differentiate be-
tween self and others but lack the ability to integrate. Borderline pa-
tients alternate between doing as they wish and a conscious or uncon-
scious terror of the consequent separateness from others as a result of
acting independently. "The borderline has separated from the symbiotic
relationship with mother and is fixated at the stage of separation-individ-
uation" (Masterson, 1981, p. 71). Relationships may become chaotic as
separateness leads to defensiveness, frustration, anger, verbal and physi-
cal attacks, or other forms of acting out. Thus, it is not unusual for thera-
pists to see these two varieties of self-disorder in work with a given cou-
ple: one partner seeking wholeness through fusion, fearing that the loss
of the object will lead to fragmentation and disintegration; the other re-
playing repeatedly an unresolved conflict between the wish for separa-
tion and autonomy and the fear of disapproval and rejection.
Patients with the most severe forms of borderline disorder rarely
achieve an intergration of self strong enough to sustain in a long-term
couple relationship, and they are unlikely to be good candidates for con-
joint marital therapy. The narcissistic patient appears on the surface to
be much more sure of himself or herself than the borderline patient.
When dissatisfied, he or she attempts to change the world according to
the specifications of internal grandiose needs. When the partner resists,
the relationship usually begins to crumble.
I have observed in my practice several partnerships in which a bor-
derline and a narcissistic personality precariously coexist. The narcissis-
tic individual is attracted to the borderline's ability to cater and to be re-
sponsive. The latter, denying his or her compulsion toward servitude and
blaming himself or herself for any breaks in the relationship, deals with
problems through acting out, overeating, alcoholism, or somatic disor-
ders. He or she m a y be very unhappy but chooses to perpetuate the rela-
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MARION F. SOLOMON

tionship. Borderline patients, for their part, are often drawn to the appar-
ently perfect facade of the narcissistic defense. There is often a lack of
clear delineation between the two.

The Therapeutic Alliance

Psychotherapeutic treatment of marital couples requires a special
form of therapeutic alliance. In individual, analytically oriented therapy,
this alliance evolves in such a way that the observing part of the patient's
ego identifies with the therapist in order to modify the pathological de-
tenses being used to ward off internal danger. The ability to ally oneself
with rational and caring parts of the therapist's self requires that the pa-
tient have a firm sense of self and a recognition of the therapist as a sepa-
rate person. Persons with self disorders lack this ability, because their ob-
ject relationships are at a primitive, need-gratifying level.
Narcissistic and borderline pathologies are engendered by an accu-
mulation of prior experiences too painful or too fearful to allow into con-
sciousness. The result is a splitting off of feelings, perceptions, and fan-
tasies, a distancing from the cause of painful exposure to needs, and/or
abrupt fleeing from momentary warm close feelings because of fear of be-
ing lost with no way to return. In fact, a major drawback to the develop-
ment of a working alliance in conjoint therapy of self disorders is the
greater risk of exposure to narcissistic failures resulting from insuffi-
ciently empathic response on the part of the therapist or the partner. On
the other hand, some patients with self disorders are more fearful of too
much closeness, and they may find conjoint sessions a less anxiety-pro-
voking entry into a therapeutic relationship.
The conjoint therapist, recognizing that the patient feels vulnerable
both to response from the spouse and to therapeutic intervention, must
translate potentially threatening statements into expressions of need,
wishes for a mirroring or an idealized other, and/or fears of rejection and
abandonment. This is a difficult task for the therapist and requires an
awareness of countertransference reactions that may affect the working
relationship with the couple.
Rigorous self-observation and self-control on the part of the therapist
are necessary precautions in two areas in particular. First, despite the
best of intentions, the demandingness, the outbursts, the emotional re-
treats of borderline or narcissistic patients often produces reactions in
therapists that can lead to withdrawal of patients in therapy. Second, the
common background of many middle-class therapists, still the largest
pool from which therapeutic practitioners are drawn, often produces a
discernible set of individual and cultural values and beliefs. By assuming
these values, the therapist can, without realizing it, convey a message
that causes one or both partners in therapy to observe values that may
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differ from t h o s e t h e y h a d p r e v i o u s l y held. W h e n one m e m b e r of a couple

accepts a n e w o r i e n t a t i o n in a l i g n m e n t w i t h the t h e r a p i s t , t h e p a r t n e r
m a y come to see t h e t h e r a p i s t as a n e n e m y who is d a n g e r o u s to the m a r -
riage.
F u r t h e r m o r e , p e r s o n a l history, m a r i t a l status, gender, and/or v a l u e s
m a y cause a t h e r a p i s t to u n k n o w i n g l y align h i m s e l f or h e r s e l f w i t h one
spouse at t h e expense of t h e other. R e p e a t e d failure of the t h e r a p i s t to re-
spond to t h e needs of either p a r t n e r will u s u a l l y r e s u l t in a n a n g r y , frus-
t r a t e d , w i t h d r a w n p a t i e n t who is soon "too b u s y to come to the sessions."
S u c h a p a t i e n t is t h e n often m i s t a k e n l y labeled " r e s i s t a n t " a n d identified
as t h e " d i s t u r b e d " p a r t n e r . I n d i v i d u a l sessions w i t h the o t h e r m a y ensue,
b u t e i t h e r the m a r r i a g e or the t h e r a p e u t i c r e l a t i o n s h i p will be n e g a t i v e l y
affected.

Steve and Lisa: A Case Example

The following case provides an example of marital treatment where each
partner exhibits signs of a self-disorder. After a short background, I present a pro-
cess recording of a session in the left column. Parallel to this, in the right column,
is a discussion of the therapeutic intervention.
Steve and Lisa are a couple who have been in treatment for over a year. Steve
is a moderately successful businessman; Lisa is a housewife. They are both in
their mid-30s and have been married 14 years. This couple was seen in conjoint
sessions every week and individually at various times. During the course of ther-
apy, Lisa had formed an idealizing transference; making me the perfect mother
that she always wanted; Steve had been frightened of losing himself in the inti-
macy of a close relationship, whether marital or therapeutic. Steve had one prior
therapeutic experience, which he found very upsetting. In that situation, he felt
that the therapist took sides. This therapist supposedly said to them, "Why don't
you get a divorce?" Steve terminated treatment and did not agree to begin again
for 3 years. Despite these misgivings and a history of unsuccessful therapy, Steve
granted that he wanted to learn to communicate with Lisa about his feelings and
hers. Steve had several individual sessions very early in the treatment, but
stopped them, explaining that facing me one-to-one made him extraordinarily
self-conscious and uncomfortable. He was quite fearful at first of what he later de-
scribed as angry, violent fantasies. As treatment progressed, Steve agreed to indi-
vidual sessions during periods of crisis.
Steve's inability to tolerate intense feelings, his own or his wife's, was evi-
dent from the beginning of therapy. His fear of being engulfed by too close a rela-
tionship emerged as the conjoint sessions moved from immediate problems of
daily living to discussions of the needs and vulnerabilities of each partner. In con-
joint sessions, Lisa always attacked. Steve would try to express his complaints
but never seemed to react to what Lisa said. Steve said that when he was hurt by
Lisa, he controlled himself, got her to stop being angry and withdrawn, and when
it was over, wanted to kill her. He never assaulted her physically, however, real-
izing that she would leave him forever if he did. This dilemma obviously required
Steve to keep a very tight reign on his feelings. Lisa's rage at Steve's failure to
meet her constant demands for some response, and Steve's fear of intimacy and
his low capacity to feel, represent the primary indications of the self disorder of
each partner.
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MARION F. SOLOMON

Steve and Lisa: Some Therapeutic

A Case Example Considerations

Lisa began this session by say-

ing t h a t she and Steve had en-
joyed themselves the previous
evening, but in the morning,
for no apparent reason, Steve
started picking on her. She
pleaded t h a t she doesn't under-
stand what makes him do things
like that.
1. [I responded to her wish to un- 1. My strategy in therapy with
derstand and turned to Steve, Steve and Lisa has been to help
saying "What appears to have no them hear each other's needs
explanation undoubtedly has a more clearly and to examine in-
reason. But Lisa doesn't know stances where each distorts what
what it is. Perhaps we can talk is said and heard. Here I became
about it and clarify it a little."] the model for listening and the
Steve said t h a t Lisa had com- interpreter/decoder of the many
mented on his clothes, which re- messages being sent but not
minded him t h a t he needed received. First, I responded to
clothes: "I hate to shop, but she Lisa's complaint; then I turned to
never buys anything for me." Steve to check Lisa's statement
Lisa then very angrily re- with his feelings.
sponded t h a t just a short time
ago Steve had complained that
she spends too much money on
clothes.

An argument then ensued,

which prompted Lisa to say, "I
think you are crazy, Steve."

2. [I listened and noted silently 2. I am careful to make no com-

Steve's failure to react when ment that can be interpreted as a
Lisa attacked. I commented t h a t wish to support the position of ei-
their fights weren't really over ther spouse. Here I remain silent
money and clothes, but rather as Lisa attacks and Steve numbs
over love, hurt, anger, and himself. At this point I do not
squashed feelings.] comment upon how they defend
Lisa agreed t h a t she always against narcissistic wounds, but
feels squashed when she's with focus r a t h e r upon the needs that
Steve: "I am afraid to say any- each wishes the other to respond
thing. Everything I do is wrong. to.
He thinks ! don't try. He never
notices what I do right." She de-
scribed her frustration at
tidying a messy room and then
finding t h a t Steve notices the
one thing that is out of place.
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CLINICAL SOCIAL WORK JOURNAL

3. [I respond, "He ignores w h a t 3. Each i n t e r p r e t a t i o n includes a

you do a n d your feelings. A few comment about both partners. If I
m i n u t e s ago he complained t h a t fail to respond to the ongoing re-
you ignore his feelings about actions of e i t h e r one d u r i n g t h e
clothes."] course of the session, it could be
experienced as a narcissistic
wound and inflame existing vul-
nerabilities.

4. [I w e n t on to comment t h a t 4. I note how unfulfilled needs

t h e y were a p p r o a c h i n g a r e a s a are a r e m i n d e r to each of"messy"
good deal deeper t h a n m e s s y feelings t h a t m a y lie deep and
r o o m s - - t h a t p e r h a p s t h e y were emerge when narcissistic wounds
t a l k i n g about messy feelings. are touched.
There was silence.]

5. Steve t h e n r e m a r k e d t h a t 5. Steve's c o m m e n t is a clue t h a t

w h e n he complains, he doesn't he is t a l k i n g about p a s t h u r t s
expect L i s a to change. He j u s t and a n g e r in t e r m s of the pres-
w a n t s h e r to acknowledge t h a t ent. He w a n t s Lisa and me to un-
these t h i n g s m a k e h i m a n g r y d e r s t a n d how a n g r y and upset he
and upset. Lisa countered t h a t gets.
she no longer knows how to re-
spond. She can n e v e r seem to do
w h a t Steve w a n t s - - " I t ' s never
enough."

6. [! r e m a r k e d to Lisa t h a t 6. Here I model the e m p a t h i c re-

"Steve is a s k i n g you to be a w a r e sponse by s t a t i n g to Lisa w h a t
of how a n g r y he i s - - n o t to do Steve is seeking, and t h e n I go on
w h a t he wants. Steve, if I'm to m a k e an i n t e r p r e t a t i o n about
right, Lisa can n e v e r do all you the profound w e a k n e s s t h a t
want. You j u s t w a n t h e r to un- Steve feels.
d e r s t a n d y o u r feelings of not be-
ing responded to."]

7. [I w a t c h e d Steve carefully as I 7. As I listen, I carefully a w a i t

said this, a n d continued only as confirmation of m y s t a t e m e n t s
I saw h i m nodding his agree- before going on. By s p e a k i n g
ment.] A t this point, Lisa still slowly and quietly, and by watch-
didn't u n d e r s t a n d a n d continued ing both closely, I a m able to de-
to t a l k of Steve's u n r e a l i s t i c ex- t e r m i n e w h e t h e r ! have s u m m e d
pectations. up feelings accurately. If I notice
h e s i t a t i o n or a b l a n k stare, I
m i g h t add, "I m a y h a v e missed
something; let's t a l k a b o u t it a
little more."

8. [I respond to Lisa, "You don't 8. A g a i n I t r y to ensure t h a t em-

know w h a t to do with all of p a t h i c l i s t e n i n g techniques are
his demands. You t r y to meet applied evenly to both. I m a k e a
them, and he doesn't seem to no- specific effort to listen to each
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MARION F. SOLOMON

tice; or you miss something and p a r t n e r and to m a k e s t a t e m e n t s

he gets upset. Then you get an- about the needs, feelings, and
gry and get even w i t h h i m by not vulnerabilities expressed by
t a l k i n g . A n d you have l e a r n e d both. Here I point out how each is
how to get back at him."] f r u s t r a t e d by the other's failures,
Lisa agreed t h a t in situa- and add t h a t the u s u a l response
tions like this she does w a n t to to injury is r e t a l i a t i o n . Defenses
h u r t Steve, and she is able to ac- are e x a m i n e d in a n o n t h r e a t e n -
complish this by not s p e a k i n g to ing w a y in an effort to under-
him. [As she said this, I nodded s t a n d the experience as it is felt
m y h e a d to let h e r know t h a t I by each individual.
understood and was not j u d g i n g
h e r for feeling this way.] Steve
a g r e e d t h a t Lisa enploys this
technique v e r y e f f e c t i v e l y - - a n d
it feels j u s t awful. He said he
would u s u a l l y do a n y t h i n g to get
t h i n g s back to normal, b u t when
it is over and Lisa is t a l k i n g to
h i m again, t h e n he h a t e s h e r
and looks for an o p p o r t u n i t y to
retaliate.

9. [I said, "I'll bet you always 9. I a s k often for details of how

succeed in finding a way." I each p a r t n e r r e t a l i a t e s when in-
watched to see if my comment jured, because revenge and re-
caused discomfort to e i t h e r of t a l i a t i o n are very common
them. W h e n Steve nodded know- responses when one feels narcis-
i n g l y and Lisa said nothing, I sistically v u l n e r a b l e and at-
continued.] tacked. The escalation of the
process of self-protection t h r o u g h
c o u n t e r a t t a c k i n g the " h u r t i n g
other" is a n i m p o r t a n t cause of
d i s i n t e g r a t i n g relationships.

10. [I t h e n asked Lisa if Steve's 10. Sometimes I m u s t form t h e

description corresponded to her link in communication t h a t oth-
u n d e r s t a n d i n g of these situa- erwise would not occur. By help-
tions.] She nodded in a g r e e m e n t , ing Steve and Lisa e x a m i n e how
looking sad b u t a d d i n g n o t h i n g t h e y a t t a c k each other, m y goal
further. is to present these situations in a
w a y t h a t m a k e s t h e m safe to t a l k
about. I a m careful, however, to
go no f u r t h e r t h a n t h e y choose to.
F r o m t h e response, it a p p e a r s
t h a t it is not safe for Lisa to dis-
cuss these issues further.

11. [I r e m a r k e d to Steve t h a t his 11. I move a w a y from the tense

descriptions of a n g e r t o w a r d feelings t h a t have surfaced, t u r n -
Lisa r e m i n d e d me of problems ing from Lisa to Steve, from
he discussed e a r l i e r in our work "here and now" to p a s t sessions.
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CLINICAL SOCIAL WORK JOURNAL

together. We t a l k e d t o g e t h e r Sometimes I use p a t i e n t history

a b o u t his childhood a n d his con- to defuse p r e s s u r e a n d to help
cern over his i n a b i l i t y to feel each p a r t n e r realize t h a t t h e i r
v e r y m u c h emotionally.] difficulties a r e rooted in situa-
tions t h a t precede t h e i r relation-
ship. I accomplish this by point-
ing out t h a t long-established
p a t t e r n s of i n t e r a c t i o n a r e in-
volved in p r e s e n t cycles of at-
t a c k - i n j u r y - c o u n t e r a t t a c k ; by in-
q u i r i n g about the v a l u e s of
mothers, fathers, and g r a n d p a r -
ents (as V i r g i n i a S a t i r [1967]
demonstrates), by e n c o u r a g i n g
the couple to consider how t h e i r
own values are s i m i l a r or dissim-
i l a r to those of t h e i r p a r e n t s and
g r a n d p a r e n t s ; by reflecting about
which of t h e i r own values are
nonnegotiable and which m a y be
open to change.

12. [I s u g g e s t e d to Steve t h a t 12. I m a d e a connection t h a t did

one of t h e "fringe benefits" of his not y e t fit for Steve. A t t h a t
fights w i t h L i s a m a y be t h a t he point, w h e n I realized it, I ac-
is able to experience intense knowledged t h a t I h a d missed the
feelings: "Your a n g e r m a k e s you m a r k . Steve responded in deriva-
feel more alive. There is passion tive form, while t a l k i n g about his
in your h a t i n g . " Steve looked parents, t h a t I was going too fast,
tense and seemed to w a n t to pull expressing m y concerns, not his,
b a c k from this idea. I said, "I r a i s i n g issues and m a k i n g con-
don't t h i n k I a m t u n e d in to nections t h a t were f r i g h t e n i n g
where you are r i g h t now." ] and uncomfortable for h i m by
He confirmed this interpre- t e l l i n g me in encoded fashion
t a t i o n w i t h his n e x t comments, (Langs, 1976).
describing his a t t e m p t s to t a l k I consider this a n uncon-
to Lisa a n d to his p a r e n t s b u t be- scious expression of the w a y
ing u n a b l e to get much of a re- Steve was experiencing me a t
sponse beyond t h e i r own con- t h a t point in the session. He
cerns. He said t h a t he often felt shifted to a series of encoded mes-
he would be b e t t e r off by s a y i n g sages t h a t said s o m e t h i n g was
nothing. wrong with m y responses to h i m
and he didn't w a n t to t a l k about
it.

13. [I a n s w e r e d t h a t "sometimes 13. ! moved back, giving t h e m

feelings a r e so powerful t h a t it both a chance to regroup. I now
seems safer to let t h i n g s be."] w a i t e d for t h e m to choose a direc-
Steve said t h a t this was the w a y tion.
it h a d a l w a y s been for him.
T h e r e was a period of silence.
 153

MARION F. SOLOMON

14. Steve t h e n recalled some- 14. There is a shift from the "here
t h i n g we had discussed before: and now" discomfort to an e a s i e r
t h a t e v e r y t h i n g was fine when w a y to discuss a difficult issue.
he was a child, b u t now he h a d They focus t o g e t h e r on some of
no r e l a t i o n s h i p w i t h his parents. t h e i r history: Steve's recent and
He h a d l e a r n e d when growing p a s t r e l a t i o n s h i p with his par-
up t h a t when s o m e t h i n g is ents. The interactions in the ses-
wrong, he should forget i t - - s a y sions are b r i n g i n g up m e m o r i e s
nothing. I said, " P e r h a p s you are and wishes for a more s a t i s f y i n g
s a y i n g t h a t you w a n t your feel- relationship.
ings to be heard, understood, b u t
the old m e s s a g e says, 'forget it,
ignore it, don't t a l k about it.'"
Lisa added t h a t Steve's par-
ents are loving, b u t t h e y a l w a y s
w a n t e v e r y t h i n g to be nice.
"They h a d m o n e y problems
when Steve was a child, b u t t h e
c h i l d r e n were k e p t from know-
ing."

15. Steve said, "But I was not in- 15. Steve identifies an e a r l y pat-
t e r e s t e d in knowing. My life was t e r n t h a t was a d a p t i v e in holding
sports and friends. I j u s t grew on to the acceptance of parents:
up. I d i d n ' t feel I was missing ~'When s o m e t h i n g is wrong, for-
a n y t h i n g . " [I observed t h a t "so get it." F e e l i n g s have a l w a y s
long as you didn't have too m a n y been h a n d l e d by avoiding them,
feelings, you got along fine."] by i m m e r s i o n in sports and other
Steve t h e n b e g a n to de- actions. If Steve and Lisa h a d not
scribe how he h a d l a t e l y been sought help for m a r i t a l problems,
t r y i n g to tell his f a t h e r t h a t he Steve m i g h t have gone t h r o u g h
w a n t s more of a r e l a t i o n s h i p life quite comfortably w i t h o u t
w i t h him. Steve said his f a t h e r feelings, w i t h o u t even an aware-
d i d n ' t seem to know w h a t he was ness t h a t he was m i s s i n g some-
t a l k i n g about. He h a d asked his thing. It was only after becoming
father, "Are you satisfied? Don't involved in the t h e r a p y t h a t he
you have a n y t h i n g you are an- was able to perceive the differ-
gry a t me for? Don't you feel dev- ence b e t w e e n being alive w i t h
a s t a t e d sometimes by w h a t is feelings a n d the "deadness" he
missing?" He described a n o t h e r h a d lived w i t h for so long. He be-
t i m e w h e r e he t r i e d to t a l k w i t h gan to recognize t h a t he w a n t e d
his p a r e n t s together. His moth- more out of life in t e r m s of feel-
er's response was, " W h a t ' s the ings and intimacy.
m a t t e r ? H a v e n ' t we given you
e v e r y t h i n g you needed?"
Steve was now very choked
up and close to tears. Our t i m e
was almost up. [I advised t h a t
once feelings such as these come
to the surface, t h e y would con-
t i n u e to a p p e a r more and more. I
s u g g e s t e d t h a t Steve was t r y i n g
154

CLINICAL SOCIAL WORK J O U R N A L

to change a lifetime pattern

with his parents, that they
didn't understand right now,
and that more time was needed
to talk.]

16. ]I felt unsure about Lisa's 16. I try here to draw Lisa into
ability to absorb all of this. I the interactional process. Know-
turned to her and said, "Do you ing that the second half of this
understand what Steve is asking session focused on Steve, I antici-
for, what he needs, why it is so pated her feelings of not being at-
hard to live with him right tended to. I also try to help her
now?"] Lisa answered that she understand what seemed like
understood a little, but that confusing responses from Steve.
when Steve talks about his love,
"I don't feel it. The more I want
his attention, the more alone I
feel. I need more."

17. [I let Lisa know that I under- 17. Lisa brings up the other side
stand her feelings by asking of the problem. She has a great
Steve if he now recognized that need to be touched emotionally.
what seemed like demands are The pattern in the past has been
actually expressions of Lisa's that, as she tries to send her mes-
needs. I added that the feelings sage, it comes out sounding to
of love and anger that they both Steve more like a demand. He
talk about are very important is- protects himself from what he
sues, and we would be looking at perceives as her overwhelming
these more closely in future ses- demands. Lisa experiences his
sions. We would also look at the need to defend himself as aban-
need to be loved, to fill up with donment of her. She becomes
something the other can give, frightened and desperate, trying
something that each believes the harder to get him to meet her
other can give.] needs. The relationship contin-
ues unsatisfying and frightening
for both. I let them know that un-
derstanding and getting beyond
this pattern would be the direc-
tion of our future work together.

Discussion
Some m a r i t a l b r e a k u p s are the r e s u l t of i n s u r m o u n t a b l e p r o b l e m s in
living together. Some are caused by defects in self-structure, in such a
w a y t h a t positive selfobjects are not experienced by the p a r t n e r s in the
relationship. I n e i t h e r event, issues r e l a t e d to self-esteem are f u n d a m e n -
tal in m a r r i a g e a n d p l a y a significant p a r t in m a r i t a l success or failure.
I n t h e p r e c e e d i n g session, as in m a n y o t h e r conjoint t h e r a p y sessions,
b o t h p a r t n e r s a t t e m p t to receive c o n f i r m a t i o n of t h e i r own perceptions
a b o u t w h a t is w r o n g w i t h t h e i r relationship. It is n e c e s s a r y to r e s p o n d in
w a y s t h a t are n o n j u d g m e n t a l , avoiding a n y response t h a t m i g h t depreci-
 155

MARION F. SOLOMON

ate the self-esteem of either partner. Emphasis should be given to clari-

fying their customary patterns of communication and the underlying
needs of each. Even when I recognize that one partner is behaving in
ways detrimental to the relationship, I avoid confrontation or instruction
on how to control the problem behavior. I have found it almost impossible
to modify behavior effectively in marriage through responses that implic-
itly or explicitly undermine the self-esteem of one person or that identi-
fies either one has having "the problem." This insight is an important by-
product of understanding how narcissistic disorders "work" in marital
relationships. I have found that the key to dealing effectively with narcis-
sistic vulnerabilities in marital therapy lies in listening closely for con-
flicting needs, and then confirming the validity of the different percep-
tions.
The precise manner in which each partner experiences the other as a
selfobject who has failed to gratify and has been disappointing must be
examined. I do not usually share my own awareness of"phase appropri-
ateness" of the narcissistic structures expressed in feelings, since such an
observation is generally experience-distant and is likely to be perceived
as a negative judgment, causing possible injury to the self-structure of a
narcissistically vulnerable individual. Judgmental interpretations by the
therapist, whether correct or not, if made too early, are often seen as tak-
ing sides in the triad of the conjoint-therapy situation.
In a highly charged conjoint-therapy session, I will inevitably, at
times, fail to make the correct intervention. However, my inability to re-.
spond "correctly" or empathically sometimes produces a sort of"construc-
tive disappointment." Such disappointment often can raise new issues be-
tween the couple, or between either of the partners and me, supplying
additional information about the couple, the marriage, and the quality of
the relationship.
Although there is often much emphasis in conjoint therapy on com-
munication and teaching empathic listening, empathy alone cannot im-
prove an unhealthy marital relationship. Some couples demonstrate
great empathic understanding of each other's needs and vulnerabilities,
but they then use this knowledge in an escalating battle to destroy each
other.
The ultimate goal of conjoint therapy, as described in this paper, is
not only to promote a greater degree of empathy in the relationship, but
slowly to rebuild the structures of the self. Each partner comes to trust
the marital relationship and the therapist as a safe environment where
intense feelings such as frustration and rage may be experienced without
fear of devastation and destruction, and where emptiness and numbness
can be identified without shame. The partners learn new ways to respond
to each other constructively, and they then use this knowledge to en-
hance their environment between sessions and upon termination. Argu-
156

CLINICAL SOCIAL WORK JOURNAL

ments and fights m a y still occur of course; values m a y still differ, but
such differences need not always result in injury, fragmentation, retalia-
tion, and w i t h d r a w a l - - p r o b l e m s so common in narcissistic and border-
line relationships. In short, an essential ingredient in treating troubled
marital relationships is a firm understanding of each partner's narcissis-
tic vulnerabilities, and how each succeeds or fails in the giving and re-
ceiving of essential mirroring and idealizing object functions.
Wallace (1979) has pointed out that some individuals who are quite
clearly disturbed nevertheless have successful marriages, whereas other
individuals who display no evidence of severe emotional problems are in-
volved in disastrous marriages. The factors that make marriages success-
ful or unsuccessful are complex. Some have been closely studied; others
still need to be defined. The purpose of this paper has been to elucidate a
few of these factors and to suggest ways that an understanding of self psy-
chology can be an important asset in conjoint therapy treatments.

REFERENCES

Ackerman, N. (1965). The family approach to marital disorders. In B.L. Greene (Ed.), The
psychotherapies of marital disharmony. New York: Free Press.
Bowen, M. (1966) The use of family theory in clinical practice Comprehensive Psychiatry, 7,
345-374.
Dicks, H.V. (1967). Marital tensions. New York: Basic Books.
Grotstein, J. (1981). Splitting and projective identification. New York: Jason Aronson.
Haley, J. (1963). Marriage therapy. Archives of General Psychiatry, 8, 213-234.
Jackson, D. D. (1967). The individual and the larger contexts. Family Process, 6, 139-147.
Kohut, H. (1971). Analysis of the self. New York: International Universities Press.
Kohut, H. (1977). Restoration of the self New York: International Universities Press.
Langs, R. (1976). The bipersonal field New York: Jason Aronson.
Masterson, J.F. (1981) The narcissistic and borderline disorders: An integrated developmen-
tal approach. New York: Brunner Mazel.
Minuchin, A. (1974). Families and family therapy. Cambridge: Harvard University Press.
Nadelson, C.C. (1978). Marital therapy from a psychoanalytic perspective. In T. Paolino &
B. McCrely (Eds.), Marriage and marital therapy. New York: Brunner Mazel.
Sagar, C.J., Gundlach, & R., Kremer (1968). The married in treatment. Archives of General
Psychiatry, 19, 205-217.
Satir, V. (1967). Conjoint family therapy. Palo Alto, CA: Science and Behavior Books.
Steinglass, P. (1978). The conceptualization of marriage from a systems theory perspective.
In T. Paolino & B. McCrely (Eds.), Marriage and Marital Therapy. New York: Brunner
Mazel.
Wallace, M. (1979). A social conflict model of marital disorders Social Casework, 60, 424-
429.
Watzlawick, P., Beavin, J.H. & Jackson, D. D. (1967). Pragmatics of human communication.
New York: W.W. Norton.

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