Treating Borderline States in Marriage: Dealing with Oppositionalism, Ruthless Aggression and Severe Resistance (Book Review)

Author:  McCormack, Charles
Publisher: Northvale, NJ: Jason Aronson, 2000
Reviewed By: Andrea Katin and Stuart Hockenberry, Spring 2001, pp. 36-37

All too often, conventional approaches to couples therapy have been relegated to symptom relief by emphasizing communication skills building, contractual negotiation of roles and expectations, conflict-resolution tactics, and the like. Although these approaches undoubtedly address some of the critical problems that are predictive of divorce, the sad fact remains that skills level interventions alone add precious little to awareness of the deeper meaning of marital conflict or improving the long-term vitality of these relationships. Moreover, application of many of these traditional approaches fails to adequately grapple with the entrenched rancor and defensive reactivity that therapists find themselves commonly confronting with couples. What is needed is change at both the interpersonal and the intrapsychic levels. Over the years, psychoanalytic perspectives which arguably could best provide a meaningful map of this terrain, have primarily focused upon the intrapsychic world of the individual and only secondarily on the individual’s external relational world, the marital relationship being a principal example.

One recent notable exception is Charles McCormack’s contribution to the understanding and treatment of personality-disordered couples in Treating Borderline States in Marriage: Dealing with Oppositionalism, Ruthless, Aggression and Severe Resistance. This book is destined to join the canon of seminal psychoanalytic texts on couples therapy such as Dick’s Marital Tensions and the Scharff’s Object Relations Couples Therapy. In a work that provides an intricate, but clearly understandable theoretical integration of relevant object relations concepts as well as rich clinical illustrations of proposed therapeutic methodology at work, McCormack takes the reader to new levels of psychdynamic depth and creative possibility in the treatment of couples.

McCormack’s theoretical approach is largely informed by the British Object relations perspectives of Klein, Fairbairn, and Winnicott. A portion of the book is devoted to re-telling their most vital concepts. His recapitulation of these theories, even when dealing with familiar concepts such as projective identification, developmental positions and splitting, is very compelling and organizing. McCormack’s eloquence and depth of feeling about theory and practice makes this come alive and rivals other efforts at synthesising object relations theory. In one colorful case example McCormack describes splitting between libidinal and anti-libidinal ego states (Fairbairn’s theory) to a patient who has subjected him to years of disparagement despite reliable attendence and now complains that McCormack should see her without charge. His response is that he should instead increase her fee because of his willingness, as he phrases it, “to marinate in her piss” - “Even though I’ve been marinating in your piss for two years, I still like you, and you can’t stand it” (p.122).

In this integration of object relations theory within the frame of couples therapy, McCormack demonstrates how couples who rely on primitive defenses interpersonalize the intrapsychic in an attempt to master individual issues. They try to control and change each other, all the while ironically and unconsciously, they recreate the traumas and frustrations of their childhood. He explores the paradigm of a relationship between a partner with borderline features and one with schizoid features by way of example of “a polarized and complementary part-object relationship” in which each partner uses “the other to fill fundamental deficiencies in the sense of self” (p.50).

McCormack conceives the task of couples’ therapy as developing a mature self-structure with more adaptive capacities to identify, articulate, and tolerate one’s life experiences, especially as they are encountered within intimate relationships. The desired outcome is for each partner to more objectively observe their relationship, each other, and their respective roles within the relationship. To accomplish this, the therapist first seeks to create a holding environment in which he or she actively intervenes in containing and defusing impinging dynamics and to move the couple from this primitive, polarized manner of relating to one another as projected part-objects (e.g. by projective identification, the use of shame and aggression).

Separate dyadic interactions in which the therapist alternately focuses attention individually on each partner in the presence of the other proves key here. Departing from the traditional marital therapy approaches which emphasize direct dyadic exchange, McCormack advocates focusing upon one partner at a time whenever there are signs of a breakdown in communication. Each partner is encouraged to identify, articulate, and reflect upon maladaptive exchanges as they take place and to explore with the therapist the underlying affect and meaning. The therapist makes use of his or her self as an additional transference object for each partner and a parallel relationship in which the most basis issues of trust, attachment, and narcissistic self-regularion are also engaged.

Throughout this process McCormack seeks to fully avail himself and his couples of his own countertransferential reactions. In the object relations tradition, he regards the countertransference as a means by which his unconscious is in contact with the unconscious of his patients. He returns denied and projected aspects of the patients self to the patient in a more manageable form that benefits from the therapist’s greater development and greater capacity for containment. He also views working with the countertransference as a way of modeling what he is asking that patients to do: “As the therapist abides with her confusing experience in relationship to the couple, rather than trying to get away from it by excessive activity or organizing of the session, the experience percolates and is filtered consciously and unconsciously, though the therapist’s psychological matrix” (p. 189). In sessions, he selectively shares with couples his own experiences of puzzlement and struggle toward understanding them and their respective needs and perceptions. As conceived by McCormack, “the spouses meet not only in direct interaction or in observing each other in relationship to the therapist, but also in the mind of the therapist” (p. 192).

To convey just how therapy occurs in the mind of the therapist, McCormack, takes his readers into his sessions from the vantage point of his own internal narrative of encounters with some of the most troubled couples one is every likely to meet. Writing in the tradition of Casement in Learning from the Patient, McCormack shares his thoughts and feelings as they occur in the therapeutic process. We get a first-hand look at how an experienced therapist conceptualizes and identifies the critical dynamics of these relationships as they are unfolding in the session. The reader is privy to the therapist’s evolving impression, reactions and sentiments. Through his many excerpts from sessions both with couples and with individuals, McCormack is candid and humorous about himself, as he lets the reader in on the good, the bad, and the ugly of his innermost thoughts, reactions, and prejudices. He may get angry, act out, avoid understanding and utterly lose perspective; yet from his reactive gain greater perspective and understanding. He demonstrates how with the right balance of sensitivity and transparency, seeming therapeutic blunders can be turned to therapeutic opportunities for strengthening the alliance and deepening the work.

McCormack warmth, genuineness and compassion both for his patients and for the emotionally strenuous nature of the therapist’s work shines through his writing. This makes for a particularly supportive stance to those who conduct or are thinking about expanding their practice to include psychoanalytic work with couples. McCormack minces no words in showing that the greatest challenge of couples work is that it requires the therapist to contain traumatic and primitive emotional states, states that can evoke unresolved, primitive and chaotic aspects of the therapist’s relational world and guilt charged memories of the therapist’s own misbehavior in intimate relationships. In an even larger sense this book offers encouragement about the shared human journey towards greater subjectivity which McCormack describes as becoming more able to think thoughts and feel feelings, to approach the “never-ending road of growing up” with a spirit of mystery and curiousity and to assume greater responsiblity (tempered by realism) for the choices with which we shape our lives. Regardless of whether one works with couples or only with individuals, with severely disordered or relatively neurotic clientele, or whether one is looking for insight into oneself and relationships, there is something here to inform and enrich the repertoire of every psychotherapist.

Reviewer Note

Stuart Hockenberry, PsyD and Andrea Katin, MSW, J.D. are both in private practice in the Philadelphia area. They are also board members of the Philadelphia Society for Psychoanalytic Psychology, a local chapter of Division 39.

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