Common Complaints in Couple Therapy

New Approaches to Treating Marital Conflict

Joan Lachkar

• Publisher: Routledge
• Year: 2014
• Print ISBN:
  9780415836050
• eBook ISBN:
  9781135044169
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Marriage and couple therapists see clients with broken relationships and bonds all the time; those who were once madly in love can grow indifferent, people change, and couples go into sessions feeling depressed, traumatized, and sometimes abused by their partners. Joan Lachkar examines the vicissitudes of love relations by taking into account aspects of aggression, cruelty, sadism, envy, and other primitive defenses lurking in the shadows of love and intimacy. Each chapter revolves around a specific situational conflict, with guidelines and treatment suggestions offered to the therapist. Numerous vignettes and detailed descriptions of theoretical technique, methodology, and diagnostic distinctions are included throughout the book to help readers see theory in action. The theoretical concepts drawn on include psychoanalysis, object relations, self-psychology, attachment theory, DBT, mindfulness, and others, with a heavy emphasis on listening and non-verbal and verbal communication throughout.

Chapter 1
Complaints and the Art of Listening

According to Merriam-Webster’s Dictionary, a complaint is a means to express grief, pain, dissatisfaction, or discomfort. A complaint also could involve a formal accusation or charge. It could also refer to a bodily ailment or a disease. The first known use of the word was in the fourteenth century—although I’m sure complaints date back to Neanderthal times. Synonyms for the verb complain include the following: beef, bellyache, crab, fuss, gripe, groan, growl, grumble, holler, kick up a fuss, kvetch, moan, nag, squawk, wail, whimper, and whine.

This may seem quite odd, but one of the most significant influences for my study of complaints began in a French restaurant that was owned by my ex-husband and his two brothers. While sitting there eating and sampling various wines, I began to observe the behaviors and interactions of different personality types that frequented the restaurant. As a new graduate with psychoanalytic training in marital therapy, I started to write down my observations of frequent customers as if I were doing a mental status evaluation. I noticed that each personality type would exhibit his/her unique way of complaining. The narcissistic customers would come in and complain about the seating, the chairs, and the noise, among other things, and whatever we did to accommodate them was never enough. The borderline personalities would come in and show extreme impatience, demanding to be seated and fed right away; if the server did not respond to their needs immediately, they would act out aggressively.

In doing my customer evaluation, I realized that the server became the bad-breast, non-feeding mommy, unresponsive to the borderlines’ on-demand needs. In contrast, the passive-aggressive typically would come late, keeping everyone waiting with a barrage of excuses (got lost, forgot the directions, couldn’t find his keys), then comply with the server’s recommendations, return the food, and blame his wife for forcing him to go out when he really wanted to eat at home. The obsessive-compulsive would insist that the portions of fish, potatoes, green vegetables, and so forth should not touch one another; these foods had to be served on separate plates or set far apart to avoid “contamination.” The schizoid customer would take forever to order, and when asked what he or she would like responded with “Whatever!” or “Well, I’m not sure; let me think about it some more.” It didn’t take much for me as an observer to note that this type of customer was not only disconnected to his emotional needs but his feeding ones as well.

Food is one of the earliest experiences the infant has with the maternal object. Through my psychological lens, I witnessed how the server became the mommy and the customers the children acting out their unconscious childhood fantasies. Who would ever have imagined that the confluence of my experience in a French restaurant would lead to a psychoanalytic study of complaints that appeared as an article, “Restaurant Theatrics,” published in the 1983 View section of the Los Angeles Times?

How to Listen to Complaints

In clinical practice, we get an “earful.” As a good friend and colleague quipped, “Why don’t you put up a Complaint Department shingle?” It might be taken for granted that analysts listen to their patients’ complaints: One person has the complaint, and the other listens to it. However, it’s not quite that cut and dried. When is a complaint a complaint, and when is it an evacuation or a legitimate need? Listening analytically is an essential skill that takes the analyst years to learn. One of the most common complaints of patients entering treatment is, “He/she never listens to me.”

Theodor Reik (1948) has given special meaning to listening with his innovative work, Listening with the Third Ear, and its relationship to the unconscious. Reik’s third ear is inextricably linked to the unconscious and recognizes its intuitive messages. Unlike Klein’s persecutory superego (1957), Reik’s superego can also soothe, console, and forgive. It does not necessarily only punish, criticize, and admonish; it can also be benevolent and understanding. He contrasts this to the ego, which is an organ of perception capable of observing the self.

The road to listening is endless. Klein would listen through the patient’s projections and projective identification, whereas Kohut would listen through the lens of empathic attunement. Most relevant, however, is how Wilfred Bion (1967), the champion of thinking, formulates and describes the concepts of alpha function versus beta elements. The beta element complaint might be conceptualized by Bion as a complaint made without thinking, used solely for evacuation, like idle whistling.

Kohut’s self-psychology stance (1971, 1977) stresses the patient’s subjective experience as reality and does not consider it to be a distortion or a projection. For Kohut, empathy is the ability to put oneself in the shoes of the other person, to see the world through the eyes of another for the purpose of understanding as a precondition to interpretation. To feel what the patient feels and to understand why the patient feels that way is what Kohut refers to as empathic immersion.

Klein and her followers, on the other hand, believe that patients with more severe symptomologies tend to distort reality, misperceive, deny, and do not see the objective reality. Although these two disciplines may sound worlds apart in the way they “listen,” they miraculously are quite compatible in clinical practice.

Although the two languages I created—the language of empathology and the language of dialectics—were initially designed primarily for narcissistic and borderline disorders, they are broad enough in scope to have relevance for listening and responding to other types of complainers and complaints. Motivated by the works of Heinz Kohut (1971, 1977), I employed the need for empathic understanding and attunement in speaking with the narcissist, and I used Wilfred Bion and Marsha Linehan’s (1993a, 1993b) concept of dialectics to address the splitting mechanism for the borderline in order to make communication more “user friendly.” Without trying to sound too narcissistic myself, it is my hope that these concepts will also enhance the response methodologies used in the “listening and talking cure.”

Is it fair to teach patients to “listen like an analyst?” At one time, I would have considered that to be an extra burden. My encouragement comes from well-known Indian analyst Salman Akhtar. In his latest book, Psychoanalytic Listening (2013), Akhtar does not specifically reference patient’s complaints, but his listening techniques have profound application to this subject. Akhtar goes beyond “the talking cure” to the “listening cure,” based on the premise that listening with no talking or talking with no listening can only go so far. He believes the analytic community has been short-sighted about the importance of listening. He believes that both talking and listening are crucial elements in effective clinical work. I would like to broaden this concept to include our patients; if it is good enough for us, it is good enough for them.

Akhtar describes four different kinds of listening approaches: (1) objective listening, (2) subjective listening, (3) empathic listening, and (4) introspective listening, which he outlines in Psychoanalytic Listening. To these, he also adds silence and non-verbal communication, as he demonstrates with great proficiency the multifaceted aspects of what seemingly is a simple therapeutic skill. In the following list, I have taken the liberty of expanding the various ways of listening that Akhtar laid out:

• Objective listening
• Subjective listening
• Empathic listening
• Introspective listening
• Intersubjective listening
• Listening to the silence; non-verbal listening
• Containment listening (holding the thought without response)
• Transference and countertransference listening
• Language of empathology listening (listening with empathy)
• Language of dialectic listening (listening to two sides)
• Listening to bad internal/external objects (identification/bonding with bad internal objects)

What follows are various ways of listening and responding to a common complaint, noting the distinctions and qualitative differences based on the type of listening that is being used.

The Sample Complaint: My Mother Abused Me!

Objective Listening

“I believe your mother abused you. Maybe this is why you are so hard on yourself and why you transfer to me the idea that I am abusive to you.” The objective listener functions as the neutral, detached observer who listens without preconceptions and abandons all conscious memory—as opposed to the subjective listener who listens with preconceptions. The best way to describe this difference in listening is to discuss the differences between self-psychology and object relations. Self-psychology, including the field of intersubjectivity, offers a variety of listening stances. Self-psychology takes the position that the patient’s reality is the “truth.” It does not consider the patient’s reality as delusional or distorted. In object relations, the patient’s “distortions” and “misperceptions” are considered as part-object functioning, split off and projected.

Subjective Listening

“What did you do to make her so angry?” The therapist is aware that he is annoyed with the patient and can understand why someone would abuse her. “Even if you behaved in the way you said you did as a child, still no one has the right to abuse you.” The subjective listener pays attention to his own feelings, overreactions, body movements and intuitions.

A therapist was getting extremely weary of dealing with one particular patient, who was constantly yawning. When not yawning, he would talk in slow, excruciatingly long, drawn-out sentences, to the extent his analyst could hardly keep his eyelids open. The therapist finally interpreted what was going on and gave his insights to the patient: “You are letting us know what it feels like to have an empty, internal world where there is nothing going on.”

Empathic Listening

“That was a violation and a terrible thing to go through. You have a right to feel everyone is going to be cruel and mean to you because that was what your early experience was.” The empathic listener feels what the patient feels and understands why the patient feels that way.

Introspective Listening

“You need not be so hard on yourself because your mother abused you as a child. Now as an adult you abuse yourself.”

Intersubjective Listening

“There is something that you do that makes people angry with you, but even so, no one has the right to abuse you. You feel that I am as abusive as your mother, but you are confusing my attempt to create boundaries and discipline here with abuse. My intent is not to punish or attack you, but to make the environment safe for both of us” (abuse within the experience of two). This is the point where two subjective realities come together in a collaborative effort, the final understanding when two unconscious minds meet. This type of listening can be most valuable in couple therapy.

I remember a couple that came into session at the clinic, complaining about moving a box in the middle of their living room. They went on and on about who was to remove the box. I later discovered what moving the box meant for each partner. For the one more inclined toward narcissistic personality, it represented a sense of entitlement. “I’m a professional drummer and practicing is far more important than moving some goddam box.” The other partner was more inclined toward borderline organization and felt, “I am always the one kowtowing to this narcissist! I’m fed up and won’t do it anymore!”

Silent (Non-Verbal) Listening

“I can tell each time you think about the abuse because you start to wiggle your foot.”

Different kinds of silence include the following:

• Part of the human mind that has no words, the unmentalized experience, or more commonly known as being out of touch. “You may be silent because you have something difficult to share or you don’t know how to express the feelings about the abuse you experienced as a child.”
• Part of the human mind that has words that are hidden (repressed thoughts often associated with shame). “For many years you thought you had to remain silent about your mother’s abuse, but now you know you are not alone and should not be ashamed.”
• Part of the human mind that speaks through non-verbal communication. This kind of listening requires response to gestures such as toe tapping, nail biting, avoidance of eye contact, as well as body position and movements.

Containment Listening

“Because you were abused as a child, you were left with feelings that are intolerable. In order to rid yourself of these feelings, you project them into me as the container for your unwanted parts.” Bion’s conception of containment is a very active process that involves feeling, thinking, and organizing, which leads to an action. For Bion, silence does not play a part within the reverie experience because it blocks the opening of a therapeutic alliance. In a way, this is a good thing because it enables the therapist to get into the experience with the patient (detoxification and transformation for a new experience).

Transference and Countertransference Listening

“When I told you about the increase in the fee, I knew you were not complaining about money. It is more about the feeling that I am going to be like your mother and abuse and take advantage of you. You have accumulated much wealth, and now you feel people take advantage of you.” (Meanwhile therapist is struggling with his/her own financial issues.)

Language of Empathology Listening

“What I am about to say in no way invalidates the abuse you received as a child from your mother. No parents have the right to abuse their children, and I can understand how this affects your ability to trust in an inti...

Table of contents

• Cover
• Title
• Copyright
• Contents
• About the Author
• Acknowledgments
• Introduction
• Chapter 1 Complaints and the Art of Listening
• Chapter 2 The Psychodynamics of Complaints: Theoretical Contributions
• Chapter 3 It Takes One to Tango
• Chapter 4 Promises, Promises
• Chapter 5 The Robotic Relationship
• Chapter 6 The Self-Saboteurs
• Chapter 7 A Life of Lies
• Chapter 8 When East Meets West
• Chapter 9 Taking Complaints to the Professional Level
• Chapter 10 Treatment Suggestions and Techniques
• Closing Thoughts
• Glossary
• Bibliography
• Index