Modern Kleinian Couples Therapy with Emphasis on Psychic Retreats and Pathological Organizations

Introduction

This paper offers a theoretical and technical view of how to understand, contain, and transform a couple’s chaotic and destructive ways of relating and non-relating by tending to each party’s individual phantasies and internal conflicts while also helping to work through the vicious cycle both parties often become enmeshed in as a mutual method of repeating archaic wishes and fears. This mutual system of destructive, repetitive, and static projective identification is often crystalized into a highly resistive and resilient pathological organization (Rosenfeld, 1987; Shafer, 1994; Steiner, 1990).

When this dysfunctional unconscious bargain breaks down, one or both parties in a couple often withdraw into individual psychic retreats (Shafer, 1997; Steiner, 1993), which leaves each of them embedded in highly resistant emotional impasses. As a result, one party or both may need more individual focus before treatment can resume on the couple as a relational unit. Modern Kleinian Therapy is considered to be a helpful method with such hard to reach couples and an approach to gradually working through the intrapsychic and interpersonal elements involved.

Modern Kleinian Therapy

Modern Kleinian Therapy (Waska, 2011a; 2011b; 2012a; 2013) is a contemporary hybrid of classical Kleinian psychoanalytic technique and a clinical approach for working with more disturbed or complicated patients in either individual or couples treatment. Modern Kleinian Therapy uses a psychoanalytic focus to understand and work with both internal resistances and external roadblocks to psychological integration.

In clinical situations we see many individuals and couples who tend to subsume whatever therapists do or say into their pathological organization (Spillius 1988) with its familiar cast of internal characters. Modern Kleinian Therapy focuses on the interpretation of this particular transference process by investigating the unconscious phantasy conflicts at play and by highlighting the more direct moment-to-moment transference mobilized by projective identification dynamics (Hinshelwood, 2004; Joseph, 1988, 1989; Segal, 1997). Bion’s (1962) ideas regarding the interpersonal aspects of projective identification, the idea of projective identification as the foundation of most transference states (Waska, 2004, 2010a, 2010b, 2010c), and the concept of projective identification as the first line of defense against psychic loss (Waska, 2002; 2010d) difference or separation, all form the theoretical base of this clinical approach.

Therapists strive to move the couple into a new experience of clarity, vulnerability, reflection, independence, change, and choice. We clinically support this psychic change (Feldman, 2004) by attempting to foster and fuel an ongoing level of analytic contact with each party in the couple and with the couple as a whole, creating a potential psychological moment of new, unrestricted, uncensored thinking and presenting the opportunity to approach the self and the other in new more creative ways. As such, analytic contact (Waska, 2007) is defined as the sustained periods of mutual existence between self and object not excessively colored by destructive aggression or destructive defense.

These are moments between couple and analyst, as well as between both partners of the couple, when the elements of love, hate, and knowledge and the life and death instincts are in sufficient balance as not to fuel, enhance, or validate the patient’s internal conflicts and phantasies in those very realms. These are new moments of contact between self and other, either in the mind of the patient or in the actual interpersonal realm between patient and analyst. These are found fragments of peaceful and pleasurable attachment providing proof and hope that need, change, and difference can be beneficial and worth risking. Internal dynamics surrounding giving, taking, and learning as well as the parallel phantasies of being given to, having to relinquish, and being known are all elements that are usually severely out of psychic balance with challenging patients. Analytic contact is the moment in which analyst and patient (or both parties of the couple) achieve some degree of peace, stability, or integration in these areas or at least allow for the possibility of calm, change, and learning.

Therefore, analytic contact is the term for our constant quest or invitation to the couple and individual for the found, allowed, and cultivated experiences that are less contaminated by the fossils of past internal drama, danger, and desire. These moments, in turn, provide for a chance of more lasting change, life, and difference or at least the consideration that these elements are possible and not poison. Paranoid (Klein, 1946) and depressive (Klein, 1935; 1940) anxieties tend to be stirred up as the couple’s safe and controlled psychic equilibrium (Spillius and Feldman 1989) come into question. Acting out, abrupt termination, intense resistance, and excessive reliance on projective identification are common and create easy blind spots and patterns of enactment for the analyst (Feldman 1994; Grotstein, 1994). When this situation continues unchecked, it is common for one or both members of the couple to flee to their own private psychic retreat.

Pathological Organizations, Psychic Retreats, and the Couple’s Treatment

Pathological organizations are rigid and complex systems of defense that couples use to avoid unbearable persecutory and depressive anxieties and to distance themselves from the internal and external reality of self and other. With pathological organizations, both parties exist within a projective identification system that provides a controlled and rationed degree of genuine connection, allowing for intense control over fears of the unknown. This results in a volatile yet stable mix of gratification and conflict without many moments of peace or contentment. It feels safe and familiar, matched to archaic, internal conflicts regarding love, hate, and learning. Therefore, limiting and confining patterns of pathological repetition bind the couple together in a known but suffocating web.

These emotionally locked and emotionally starved couples demonstrate highly destructive narcissistic cycles in which certain parts of the self act against other parts of their partners, resulting in a variety of sadomasochistic, perverse, or addictive relational profiles. These couples desperately attempt to create a fragile and precarious mutual avoidance of both paranoid and depressive fears but in the process eliminate any hopeful object relational balance that comes from the normal experiences of both positions. Pathological organizations are destructive states of psychic equilibrium, providing a temporary sense of control and respite but ultimately removing the couples from the healing aspects of relational reality and the working through of both paranoid and depressive issues.

If a couple’s pathological organization starts to be more overwhelming than secure due to excessive projective identification cycles, which create increasing paranoid or depressive anxieties, one or both parties will seek escape and defense. If the destructive unconscious relational bargains (Waska, 2005) that make up their bond seem to be collapsing, or if one party feels the other party has ceased to play their role in that familiar bargain, one or both parties will withdraw into their own private psychic retreat.

With psychic retreats, individuals will seek a protective shell, haven, or refuge from overwhelming phantasies of loss, annihilation, persecution, and guilt experienced in the relational bond. In treatment, we observe these patients embedded within their internal fortress and out of reach. They feel safely out of touch with reality and their threatening or threatened objects but also out of touch with the understanding and help of their partner and their analyst.

The pathological organization is an unhealthy system of paranoid and depressive functioning in which excess projective identification links the two parties into an eternal playing out of archaic trauma and imagined wishes and entitlements. Both parties are able to tolerate the mutual perversion of paranoid and depressive relating that form an unhealthy but functional relational system. When the paranoid or depressive phantasies and conflicts of the pathological organization become overwhelming, the system breaks down and one or both parties flee to their psychic retreats. Steiner (1987; 1992) described the psychic retreat as an inner limbo in which the patient hangs between the worst elements of the paranoid schizoid position and the depressive position.

The most common way we see a couple’s pathological organization break down is when the couple’s relationship becomes dominated by paranoid-schizoid anxiety and the associated defenses of splitting, idealization, devaluation, as well as the acting out of the death instinct, in which they seek to kill off any difference, need, growth, or change.

What we observe clinically with couples rooted within the paranoidschizoid position is an immature, primitive state of mind, in which objects and the self are experienced in one-dimensional, black-and-white chunks carved out by primitive splitting and excessive projective identifications. In fact, this state of mind is dominated by projective identification and splitting, and it leaves the subject feeling persecuted and abandoned by bad objects or united with and loved by idealized objects (Joseph, 1987; Segal & Britton, 1981; Steiner, 1989).

Klein believed the healthy transition from the paranoid-schizoid experience to more whole object depressive functioning had much to do with a constitutional balance of the life and death instincts and the external conditions of optimal mothering. The emotional struggle of the life and death instincts everyone experiences in life are intensified in the couple’s constant negotiation of need, dependence, separation, and difference. The results of this relational struggle are shaded by the manner in which each party becomes an adequate parental container for the other or an inadequate, fragile, or rejecting container/parent.

This often is very evident in couples in which the core of a particular crisis rests on states of need, how the needy partner reacts to these dependent feelings, and how the supportive partner responds to this show of need. Of course, issues of control, rejection, entitlement, shame, denial, and resentment all arise in this arena. If the couple’s primary mode of operating in their pathological organization is more paranoid, issues of need and desire will be felt much more dramatically because the primary anxiety in this position has to do with survival of the self rather than concern for the object.

On the other hand, the couple’s reactions of need, difference, or openness will be different if the pathological organization is dominated by more depressive position anxieties. This is a psychological realm characterized by the realization of dependent and hateful feelings towards the loved object, which produces guilt and fear of loss. When the depressive position anxiety is dominant in a couple, the subject faces the difficult reality of whole objects about which one has a variety of feelings, which is unlike the paranoid phantasies of ideal and loved objects versus other more persecutory and hated objects in paranoid-schizoid anxiety dominated couples. This creates ambivalence, anxiety, and the desire to repair, restore, and rescue the injured other. Anxiety is still about the survival of the self if abandoned or punished by the offended and hurt object, but now the anxiety is much more about the wellbeing of the object. Obsessive and manic defenses come into play, and projective identification phantasies are much more about the relationship to the object as opposed to the stark division of self and other found in the paranoid position.

Most couples in therapy are not yet able to access or participate in these more mature developmental stages. However, the predepressive states of persecutory guilt and annihilation anxiety are often encountered. It is common to see couples come seek help because their psychic equilibrium within the pathological organization has been disrupted by these types of anxieties. This leads to one or both parties becoming embedded in private psychic retreats, thus creating a severe imbalance or near collapse of the relationship. While therapists struggle in the counter-transference and hope to help the couple develop a more mature and mutually healthy way of living, the couple often unconsciously only wants help in returning to their pathological organization before terminating treatment.

When one party withdraws into a psychic retreat, he or she experiences a temporary escape at the cost of mental impairment. Steiner (1993) considers such withdrawal to be understood as a simultaneous expression of destructiveness and a defense against it. This serves as a temporarily protected space but at the price of impaired contact with reality

The psychic retreat is experienced by the patient as a safe haven and refuge from the unbearable persecutory and depressive anxieties of the pathological organization. What the patient does not like about himself or about his part in the couple’s problems is expelled by means of projective identification, leading to a vicious cycle of having to hide or withdraw from the oppressing elements of the other and the couple’s relationship (Feldman, 1992; Joseph, 1987; Rosenfeld, 1983). Steiner (1993) has noted how psychic retreats effectively block the reversal of projective identification. They prevent the painful mourning associated with regret, separation, and the ongoing evolution necessary in couples relating healthily.

Psychic retreats not only prevent change, mourning, and growth, they also involve sadomasochism. There is a sadistic pleasure in refusing and frustrating the analyst’s wish to be helpful or the other partner’s efforts at healing. Also, there is masochistic pleasure in depriving oneself of the possibility of improving and creating a mutual sense of never finding any hope of a better life. The workings of the death instinct is evident in psychic retreats and pathological organizations.

Psychic retreats create a moment frozen in time where growth is avoided and pain is never forgotten. When the pathological organization begins to break down, both parties feel trapped by either the near-psychotic anxieties of the paranoid-schizoid position or the fears of annihilation and eternal loss of the predepressive position, and they flee to the emotionally frozen sanctuary of the psychic retreat. Only when they feel in control of the object will they return to the familiar symmetry of the pathological organization—the combination of narcissistic perverse, addictive and sado-masochistic elements that not only infects the couple’s relationship but also serves to provide a dubious psychic equilibrium.

The internal dread that binds many couples together creates a mutual reliance on excessive projective identification processes that help them to avoid and escape various phantasies and anxieties, resulting in the establishment of a pathological organization that both parties believe provides them with security and sustenance. Separation, loss, difference, and individuation are unwanted, intolerable, and villainized in the pathological organization.

Without the excessive projective identification cycles that make up the pathological organization, these couples would not find any mutual gratification and sense of discovering the missing pieces of themselves. However, this sense of wholeness (by being with a partner) is in parallel to the matched repetition of numerous archaic conflicts and object relational impasses that not only provide familiarity and control, but also stagnation and corruption of the mind.

In a sense, this description fits many couples who live much happier lives in a healthy harmony with each other. The couples examined in this paper are existing in such cycles but with a far greater and graver intensity, which creates a much more ominous and perpetually painful relational bond.

The pathological organizations provide couples with a precarious psychic equilibrium by dismantling the more alive and porous bond that allows change, reality, and growth. Normal fluctuations and a healthy balance between paranoid-schizoid phantasies and depressive conflicts are avoided as the potential vibrancy of the relationship is put on hold in exchange for predictable, controlled repetition of ancient desires, unresolved battles, primitive fears, and intense entitlements. As a result, pathological organizations in couples are highly resistant to change and pose considerable technical challenges in analysis.

Couples Treatment

Sandler (1976) described the unconscious roles that patients assume for themselves and [about] others and the interpersonal and intra-psychic means they take to actualize those roles. Sandler (1976) described the induced counter-transference created by the patient’s relationship to an object that is both repeated and defended through the induced-role relationship with the analyst.

In understanding the unconscious processes that take place in the therapeutic setting with couples from a more Kleinian perspective, one can also consider the more subtle processes in which aspects of either party’s mind are defensively expelled into each other or into the analyst. The Modern Kleinian Therapy approach helps the analyst recognize the precise ways in which the couple’s intolerance for their joint or individual mind, and the conflicts within it, drive the creation and maintenance of the pathological organization, which, with its intense projective identification cycles, manipulate, alter, or corrupt the analyst’s capacity to think or to feel (Hinshelwood, 1999).

In examining the internal, interactional, and interpersonal roles couples are loyal to, therapists notice that these are not simply roles that signify a type of person with certain attributes, but are also an entire way of relating, thinking, acting, and feeling. One or more aspects of thinking or not thinking become highlighted through projective identification and enabled in the counter-transference. One or both parties of the couple show how locked in they are to certain loyalties or certain fears regarding love, hate, and knowledge as these phantasies unfold within the unconscious object relational phantasies that become apparent in the analytic setting.

This creates the intense, and often surprising, restrictiveness of the transference and the resultant rigid countertransference experience. Thinking of the complexity of this role-assignment process, the adding or subtracting of unconscious phantasy, and inner conflict to the actual external couple relationship as if there were no difference between internal and external or reality and phantasy, has far reaching impact on the clinical situation.

One is impressed with how affected we are as a result by the total transference situation (Joseph, 1985). Therefore, when working with couples so loyal to pathological organizations and so embedded in their psychic retreats, we must also manage and utilize the complete countertransference (Waska, 2011a; 2011b; 2012).

The clinical and theoretical stance of both classical and contemporary Kleinians in regard to the concept of projective identification and the life and death instincts is helpful in finding a clinical foothold when conducting couples therapy. This is especially true with fragile, primitive, and turbulent patients prone to paranoid-schizoid (Klein, 1946) anxieties. Analytic observations (Waska, 2012a), containment (Cartwright, 2010), and interpretive translation of the complex conflicts within the couple and within each party are vital technical tools in fostering the possibility for successful analytic contact and gradual resolution of complicated object relational phantasies regarding the danger of change (Waska, 2006). This is a phantasy of danger in each party and often a mutually shared couple’s fear of change that fortifies and verifies the pathological organization and their loyalty to it.

As a result, the more disturbed borderline and narcissistic couples require a great deal of therapeutic flexibility rooted in traditional psychoanalytic technique but honoring the additional complexity and chaos inherent in couples work. The analyst must alternate focus on each party’s phantasy of destructive, persecutory, or reactionary conflicts before ever being able to address the mental dynamics of the pathological organization that the couple has mutually established. When both parties are developmentally unable to take in and tolerate the idea of a “we, us,” or the more mature acceptance of a self-contribution or responsibility for the condition of the relationship, the analyst must first work with the primitive experiences and phantasies of masochism, injustice, persecution, entitlement, and action that occur in the private psychic retreats and the crudely assembled, but fiercely defended, pathological organization.

These are the internal aspects of psychic chaos that occur as a result of conflicts between life and death instincts as defined by Hanna Segal (1993). The life and death instincts, combined with excessive projective identification mechanisms, form the base of the pathological organization as a dysfunctional solution to intense internal conflict and cause the breakdown of the false, but familiar, security of the pathological organization. This leads to one or both parties fleeing to shelter in a psychic retreat.

Modern Kleinian Therapy considers this distinct anti-life, anti-growth, or anti-change force to have an upper hand in some patients. The death instinct seems to arise most violently in situations of need, envy, difference, separation, or with the risk of growth and change. The death instinct, in the form of an aggressive defense, is behind the enduring pathological organizations and destructive yet enduring and gratifying forms of psychic equilibrium found in more challenging couples.

Hanna Segal has defined the death instinct as the individual’s reactions to needs. Either one in the couple can seek satisfaction for the needs and accept and deal with the frustrations and problems that come with those efforts. This is life-affirming action or the actions of the life instinct. This is life promoting and object seeking. Eventually, this leads from concerns about the survival of the self to concerns about the well-being of the other.

The other reaction to needs is the drive to annihilate the self that has needs and to annihilate others and things that represent those needs, such as the very bond of the couple’s relationship. Kleinians see early external experiences of deprivation and trauma playing as big of a role as internal, constitutional factors in the ultimate balance between the life and death forces. These early phantasies and experiences of trauma are repeated in the couple’s pathological organization and these seem to provide a painful glue that keeps the couple together while also preventing them from changing or acquiring new ways of seeing each other and therefore themselves. In the Modern Kleinian Therapy approach to couple’s treatment each party’s reaction to need in himself or herself and in the partner is a critical area of focus.

Whenever possible, interpretation of the mutual projective-identification-based transference state, which creates a pathological organization, is critical, and those interpretations would include these conflicts between life-and-death instincts that either intensify the pathological organization or cause one or both parties to pull away into their only psychic retreats. Initially, and often for a very long time in the treatment, the interpretations have to be centered onto each party’s own psychic retreat, its defensive structure, and the unconscious phantasies regarding self and other that drive it.

In other words, the reality of most couple’s treatments involves spending long periods of time on either one or the other party and then often switching to the other party’s barricaded retreat before being able to explore the pathological patterns both usually share. The analyst is limited by the two psychic retreats to interpreting the separate components of the projective identification unit as opposed to the relational pattern and system. In other words, the individual psychic retreats that emerge in couple’s treatment must be dealt with alongside the pathological organization the couple has solidified over time. The transference to the analyst usually emerges in stronger detail when interpretations regarding defense or change are made, thus endangering the psychic equilibrium of the couple’s pathological organization or challenging the embedded psychic retreats.

The task of analysis is to work on these aspects of the couple. As a result, the couple slowly can elect to build a new and healthy psychological shelter that they both feel safe in together. When they wish, they can emerge individually or as a couple to face the world internally and externally in a different manner, no longer victims to archaic projective identification processes but traveling to and from their emotional “home bases” and enriching both places in an ongoing positive feedback loop.

To assist these more fragmented and skittish couples toward this potential psychic shift, the analyst must constantly be willing and able to move from moments of individual therapy with one party to moments of engagement with the pathological organization to which both parties are loyal, and then back to assisting one or both parties with the difficulties of emerging from their retreats. The analyst potentially can assist both parties in creating this new mutual membrane, a new healthy shelter that provides a growth-enhancing projective identification match and an island of gratification away from the day-to-day conflicts of the real world. Long-term, committed relationships have this respite and mutual support quality without the stagnant repetition of trauma so common in pathological organizations.

One form of resistance or acting out encountered with couples in therapy is the turning away from truly knowing each other in a new, complimentary way because it involves the depressive position realization of various truths about the nature of self and object. The fallibility, the availability, the limits of devotion, and the vast complexity of the object are all part of what most couples resist knowing. In the splitting of primitive unconscious object relational dynamics, each party is hateful of the bad internal objects they feel they know but can’t control, and thus they declare a pathological loyalty to the pleasure felt with the idealized archaic objects they feel they completely control. But, to truly know their partner, they have to exchange former, familiar phantasy objects for the actual person.

Issues of knowing, loving, and hating are always areas of conflict (Feldman, 2009; Hargreaves et al., 2004; Segal, 1981) but are particularly complicated with the difficult couples we see, usually within the borderline or narcissistic realm. These are individuals who cannot or do not want to face the exposure to reality that comes with emerging from their individual psychic retreats and giving up the psychic equilibrium of their mutual pathological organizations. Realizing one does not completely control or know a partner of many years is not only very frightening but also an exciting learning opportunity. This state of mind is often discovered toward the end of a successful couple’s treatment.

Case Material

I had seen A and B in analytic couple’s treatment twice a week for four years. Initially, their relationship was emotionally abusive, volatile, and sometimes violent. They had little ability to manage their impulses. Communication was almost non-existent. A and B simply reacted to each other and used each other as projective puppets. Their pathological organization was very destructive and often became so chaotic they both spent much of their time relegated to their psychic retreats, lobbing insults and ultimatums from their emotional bunkers. Much has changed and improved over the four years of treatment. However, there are many layers and degrees of conflict with which we still struggle.

With some couples, much of the work is focused on each party’s individual psychic retreat, its signature projective identification profile, and associated defenses. Other couples require the analyst to grapple with the mutually established pathological organization and its rigid themes of destructive relating and non-relating, and the perverse system of gratification neither party typically wants to give up.

For A and B, there had been an ongoing fluctuation from pathological organization to psychic retreat. When the psychic equilibrium of the pathological organization began to break down, each party entrenched him- or herself back into the psychic retreat. Gradually, as A and B would feel safe and more in control, each would elect to reestablish the pathological organization in which there were genuine aspects of caring, love, and a precarious ability to function together. They were able to give balance to each other in ways that were psychologically significant, but that almost healthy equilibrium would quickly shifts to a poisonous blend of mismatched conflict. For A and B, even the more stable aspects of their pathological organization easily drifted into patterns of sadomasochistic relating, bringing to life a destructive pattern that left them emotionally stagnant, broken, and hopeless.

This return to nothingness and emotional warfare is part of how the pathological organization is shaped by the death instinct. Life, change, need, and gaining new insight into self and other are all warded off by killing the opportunity for closeness, clarity, negotiation, acceptance, and by giving up what one wants in self and other for what really is and what potential really is possible can between self and other.

An example of the pathological organization A and B frequently assembled for themselves, and with which they engaged me in the transference, was a highly charged mother/child dynamic. A would tell her husband what to do in a very demeaning manner, and she was critical in tone and in message. She acted like a very controlling, hostile, and never-satisfied mother, scolding and ordering her child. B was silent and obeyed these orders, but later would explode in rage, leaving A devastated and feeling abused. Sometime B would react like a rebellious child who refused to do his homework, and was irresponsible. In the past, B would have “secret fun” which included alcohol, drugs, and affairs. This provided A with the weapon of righteous rage, masochism, and revenge, which seemed very important to her overall way of experiencing the world, but which left her in constant despair and anxiety.

Often in the sessions, I had to interpret the state of back and forth judgment, attack, and resentment. This continued, even as they grew and changed over time. Once B was able to contain his anger, he could admit to and apologize for his bad temper and selfish ways. However, when he asked A to consider her side in whatever dispute was happening, she was unable to participate in this move towards a more depressive position of healthy mutuality. Instead, she felt it was “unfair, an attack of blaming, evidence that he was lying and not being accountable,” and she reverted to feeling “devastated about all the horrible abuse over the years.” This last part was not angry grieving triggered by forgiveness or acceptance, but use of the past as a weapon to avoid the current challenge to her psychic retreat. At that point, I had to shift to a focus on her individual conflicts and defensive stance. In a projective-identification-based-transference moment, A managed to move the focus to her instead of on the threatening mutuality and potential growth that B had initiated and invited her to join.

An example of the normal pathological organization that kept A and B together (but which left them feeling empty and discontented) occurred fairly recently. For years, A had been working at a job that vastly underpaid her, and B felt it was a waste of time, energy, and money. Travel for the job has caused A to miss 10% to 20% of all our sessions. And because A can choose to travel or not, I have pointed out that she was placing the job over our sessions. I also pointed out that A never speaks about how her travel schedule leaves them both alone and separate for no apparent good reason. Because the business is owned by her father, she wants to be helpful in any way she can, and A insists the frequent travel is important. B pointed out that A’s father does not really need her help, and that B feels his wife often chooses her father and the dead-end job rather than being with him. So, they often fight about the job and her travel.

In this instance A was out of town on a business trip, and B was going to meet some friends for dinner. A called B, asking for his help in deciding what to do regarding a project she was handling. B ended up in his car on the phone with her, giving her advice while his friends started dinner without him. When she told B what she was going to do, he told her it was a very bad idea and recommended she do the opposite. A agreed and thanked him, and B went off to dinner. The next morning A told B she decided to use her plan, the choice B was so against.

In the session, B told me, “I lost it. I blew up. I couldn’t believe I had put all that work into it for her and then she didn’t do what I said. I started yelling at her, cursed, and hung up. Later, I called to apologize but she has not returned my call for days now. But, I still feel furious that she ignored my suggestions.”

I now had to address two areas in the couple that were suddenly in: the pathological organization and the individual psychic retreats. When A returned from her trip, I interpreted that they had slid into a very familiar pattern that they both were loyal to. But they also end up very angry and hurt from this conflict they settled into so readily: A asked B to be a part of something he thinks is wrong but he doesn’t voice his opinion, fearing conflict, so that he feels controlled. A became anxious-obsessive and controlling about the job problem, and she drew B into that endless what-to-do cycle. Yet, A demanded B only give her advice with which she agrees. B then says what he really thinks, and A ignores it. B is outraged, and he lashed out, and A felts abused and lashed back. They fight, and A sees the fight as evidence that B is “as bad as ever” and goes into hiding, refuses to talk, refuses to accept his apology, and refuses to look at her part in the problem.

Usually, this made B feel even more angry and helpless, and caused him to lash out some more. However, during the last six months, he has avoided this, thus creating a marked difference in his participation in the pathological organization. As a result, the couple had been operating in a healthier manner some of the time. But A, fearful and angry about this shift in their psychic equilibrium, has withdrawn more into her psychic retreat. I interpret that they both pull me into the pathological organization and react in predictable ways to ignore, pervert, or fight my observations.

The chance to work with them on their pathological organization system is usually short lived and choppy. It is a matter of time before one or both withdraw into psychic retreats. For B, this means he retreats to a paranoid-schizoid mode of being. He wants immediate recognition for what he says or gives and if he feels forgotten or used, he lashes out. He becomes ultra-sensitive to this phantasy of neglect.

In the couple’s session just reported, I turned my attention to working with B so that he could understand, contain, and translate how he put himself in a position to feel used or ignored. We explored why was it so crucial for him to be right and have his opinion be the one and only that A choose. Only when we found some clarity to this internal conflict could we look at why he was unable to see how A was using him or controlling him and why he did not speak out to protect himself in some way. I still had to help A consider her aggressive anxiety about having to solve her work problem immediately no matter what. She wasn’t really asking for advice; she was searching for the best weapon to battle her imagined at-work foe, while avoiding feeling as if she lost the war to know the perfect answer.

At this point in the couple’s analytic treatment, A and B still relied on their pathological organization much of the time. However, they have allowed themselves to mutually move a bit more into the realm of depressive functioning and its associated rewards of whole-object relating. These periods of new clarity, trust, commitment, and acceptance were not stable or lasting, but this new healthy “ask and offer” has begun to replace the more drastic and hurtful “give and take” of before.

Summary

The reason deep and lasting couples work from a psychoanalytic perspective is so complicated and difficult is that the analyst is working with two separate psychic retreats as well as a unified pathological organization. This is a rigid psychic equilibrium that both yearns for change yet dreads and resists it. The status quo is vital, even if defeating and constricting. If the phantasy is of one partner being unfair or mean, the pathological solution of the offended partner is to punish the other, to force fairness by being even more selfish than the other, or match detachment with even more severe distancing. The pathological organization in couples is maintained by this constant striving for pathological solutions to fears, wishes, and internal demands. And, in this ongoing standoff, the individual psychic retreats are maintained as escape hatches and fortresses of sealed off aggression and defensive retaliation.

The analyst is often seen as asking one or both parties to give in or give up methods of control and security, which is experienced as frightening, shaming, and unbearable. Therefore, work must be done at the level of each party’s unconscious phantasy state and existing object relational conflict perspective about self and other. Interpretations need to be aimed at this level of fear, narcissistic challenge, and control to be helpful and effective. The complicated therapeutic journey with couples involves this slow emergence from individual psychic retreats, a return to static chaos of the pathological organization, and a gradual transition to a new and healthy system of mutually beneficial projective identification in which need, difference, and separation are honored.