 here. Okay, ladies and gentlemen, hurt people, hurt people, broken people seek to be completed, like pieces of a jigsaw puzzle, they keep looking for the jigsaw. Today I have the honor and the pleasure of hosting Joanne Utah Lachkar, the pioneer and the mother of the field in effect. If Kernberg is the father, he is the mother. And so first allow me to introduce Joanne. Joanne Lachkar, the PhD, she's a licensed marriage and family therapist in private practice in Encino, California. She's an affiliate member of the New Center for Psychoanalysis and she is the author of a few seminal books. First and foremost, the narcissistic borderline couple. 1983 was the first edition, if I'm not wrong. And then how to talk to a narcissist, how to talk to a borderline. The only the only one missing is why would you want to talk to these people? Then the v-spot v-spot v stands for vulnerability, we'll talk about we'll discuss this a bit later. The disappearing male, I can attest to this new approaches to marital therapy and common complaints and couple therapy and how to talk to an obsessive compulsive, which is the latest book published this year. So quite an impressive list. And many of these books have been groundbreaking. She has a second shadow career, but she's not so much in the shadow. She's pretty famous for it as well. She is a psycho historian. She had published numerous papers and articles on marital and political conflict in the journal of psycho history, front page, and family security methods. In addition, presenting a paper on the psychopathology of terrorism at the Rand Corporation, a paper I've read and cherished. So this is Joanne in less than a nutshell. There's a lot more to her than this. She is also a trained classical ballet dancer. And not surprisingly, it had impacted and informed her approach, as you will see further on. So this is going to be a fascinating journey. Joanne is one of my idols. She had affected my work considerably over decades. And as I said, I regard her as the mother of the new approach to cluster B personality disorder, Kernberg being the father, while the couple. And the first question I would like to ask is, Joanne, could you tell us about your pioneering work? And the people, the scholars who had influenced this work, who are the influencers? Well, first of all, I want to thank you, Sam. It's such an honor to be doing this discussion with you, especially presenting to the master. You have been a great influence in my life as well and in my groundbreaking work. Anyway, I was, I like to think of myself as a pioneer. But actually, there was someone before me. There was Henry Dix, who wrote on Marital Tunchons, way back in 1957. And then the first analytic couple in collusion was Martin and Bird, who actually introduces to the first analytic couple, the obsessive compulsive who hooks up with the histrionic, or also known as the lovesick wife in the cold sick husband. Actually, way back in 1957, it was pretty common for obsessive compulsive men who are void of emotions to hook up with histrionic women. Actually, as my mother would say, of all the disorders, the OCD is the best, at least they make the living. So when I first started this work, there was a lot of flak and a lot of criticism. No, you cannot analyze a couple. Psychoanalysis is meant for the individual and your stereotyping. And this was very discouraging. Then I went to a conference at UCLA, and it was on couple therapy. And the the presenter, we had a Q&A and I said, well, how about this dyad in terms of a relationship, a narcissistic borderline relationship? Oh, that's absolutely ridiculous. So I was so upset. I left the room and I went down to the UCLA cafeteria, and I'm sitting there in a solver state. And one of my colleagues came and said, what's the matter? And I said, I'm just very upset. And I'm writing these tragic notes about my couple. And she says, I think that's a wonderful idea. So I wrote it up and I sent it to England International University Press. Two weeks later, they gave me a contract. And then I was asked to teach at UCLA. Well, that's another story about how I happened to write the book. I'll stop right there. Yeah, and that's the narcissistic borderline couple. It's the second edition was published years later, if I recall correctly. There were two additions later. Apparently it caught fire or something. But this work is an expansion of the narcissistic borderline couple. As I was writing the narcissistic borderline couple, I tend to realize, hey, there's more than one type of narcissist and more than one type of borderline. Of course, you talked about the malignant narcissist and Kernberg talked about different kinds of narcissists. So I wrote about five different kinds of narcissists and five different kinds of borderlies. And of course, I got a lot of flack on that too. So I justified it by saying narcissistic borderline states, traits, characteristics are not clear and concise entities, where they do tend to flow back and forth and to seep into different disorders. For example, there can be a pathological narcissist, a malignant narcissist that you know very well, an obsessive compulsive narcissist and the same thing with the borderline. However, the difference is the pathological narcissist or the pathological one, they are not cruel and sadistic and necessarily abusive. They may lie, they may manipulate, they may force everybody to prove their superiority, that they have special entitlement, but they're not cruel. The malignant narcissist, then we get into the domestic abuser, even the global abusers, like leaders, which you probably read about in psycho history. When you mentioned the ballet, can I say a few words about the ballet? Sure. And then we will move on to the question. Okay. Well, being a frustrated ballet dancer, I realized I could use some of the concepts from ballet and apply them to psychoanalysis. So here is a couple that does the dance, a rondo, a waltz, interactions that go on and on, round and round that are circular and never stop. How each partner will project a negative feeling into the other like someone like a borderline and how the other then identifies or over identifies that which is being projected. You can imagine how someone like a borderline who already has low self-esteem, a thwarted sense of self can easily be the target for the narcissist's projections. Yeah, we will come to that a bit later when we will discuss your concept of the dance. I can repeat it. I'll do the dance with you. Well, maybe off-camera. I would like to start by mentioning something that has nothing or little to do with allegedly or stensibly little to do with narcissistic borderline couples, but actually, possibly it is at the core. Recently, there's been a lot of talk about prolonged grief disorder. And I had suggested that the narcissist is a grieving and mourning child, a child who is grieving and mourning and realize, not actualize potential and so on and so forth. But I wanted to ask you more generally. You keep saying that we should not confuse states of sadness, loss and mourning with depression. You should not confuse states of sadness, loss and mourning with depression. You even say that many therapists do that. You said that sadness is normal and healthy. Depression is not. Could you elaborate a bit on this and then we will go straight into the narcissistic borderline conundrum? I can't believe that you're bringing this up. This is such a huge point. I cannot tell you. I mean, I'm not a psychiatrist. I'm not an MD. I'm pretty well informed about psychopathology and diagnosis, but I know for sure that when a patient comes in and they say immediately they're on medication and they're depressed. And then I hear their background and the history of abuse, molestation, abandonment, terrible trauma, post traumatic stress disorder, which you make reference to. And then I say to the patient, I'm not really sure that you're depressed. What do you mean? I've been evaluated with depression. Well, can you sleep? Okay, yeah, I can sleep or do you have loss of appetite? I go through the whole criteria to criterion. No. But you say you feel so sad. Well, I feel sad because I'm depressed. Wait a minute. I think there is a confusion here between healthy, normal, normal feelings of mourning, grief and sadness and depression. Of course it can, it can augment and go into a depression. And to illustrate this point, I go through three phases of treatment. I'm not going to do that now because I don't think we have time. The first stage is shame, blame. The second is more of an enlightenment. And the third stage is awareness of the transgressions or wrongdoings. And with it comes guilt and more of it and and sadness. One patient comes back to me after being in the third grade of phase of treatment says, it's just terrible. You just ruined my life. I used to be so happy when I was in media in the first stage. And now I go around crying and miserable. Wait a minute. This is the healthy part of you. And this is the vulnerable part. That's why I wrote the V spot. I hate being vulnerable. Why do you hate it makes me feel weak, impudent, but this is the beautiful part of a man or a woman who can allow themselves to be vulnerable. Look at Schumann and Schubert, he was a musician by the way. And that that was my approach. And today, today I and other scholars, we are suggesting that perhaps many personality disorders, especially borderline and narcissistic, but not only are based on actually prolonged or extended reactions of grief, mourning what could have been mourning the potential and so on and so forth. And of course, Masterson and others, they had suggested that narcissism is a shame reaction, a reaction to shame, shame based reaction. So I think I think what you're doing is very important to distinguish depression, which is a clinical entity from utterly justified and healthy reactions of sadness and grief, which is a form of processing. So I wanted to I wanted to start with this, because there's a lot of pain, and a lot of hurt and a lot of shame, and a lot of brokenness in relationships between narcissists and borderlines and all other mentally ill people. It's a very, very spot on point, because as you and I very well known that narcissists have a very difficult time with introspection, looking into themselves that when they do and they even face grieving, they have to face a traumatic background. And I am the narcissist, I am perfect, I do not have any trauma in my life. And any bad feelings I have, I am going to project it out onto you. So they have a very hard time facing any vulnerability or any trauma that they've had in their lives, because they are so much into denial and so busy trying to protect the nascent self and face that they may have an imperfectionist, you know, the narcissist is the child of God, the child who was in the high chair with a crown on his head and cannot face any vulnerabilities. That's why I wrote the V spot, by the way, whereas that's very different than the borderline, who will use their brief in their traumatic childhood, and become the victim. And they form these parasitic attachments to other people through their victimization, even in court situations like you talked in your book about court and the narcissist, they know how to win the hearts of the judges and the mediators through victimization. So I don't know if I've answered your question. No, no, it was more of an exchange in the question. You definitely put your finger on something very important. I think de-medicalizing states of sadness and states of grief, de-pathologizing them is a crucial part of proper therapy. And we are not doing a good job there. We're not doing a good job there. We tend to medicalize and pathologize many totally healthy and normal processing reactions. So I want to move on. Yes, please go ahead. Well, that's the art of our work is to help the narcissist recognize that there's a distortion. He thinks he's wonderful if he is a manic and he denies and he refutes his vulnerability to get for the therapist to let him know that this is really the powerful part of him, not the weakness. And the people who are most susceptible to these interpretations are artists like musicians and composers. They come in with a grandiose self and then you let them know that it and you bond with your musicality. That's where that's where we get that. Yeah, the survivor part, the survivor part is the narcissist denies the survivor part. He says, I didn't need to survive. I was always omnipotent. I was always Godlike. I didn't have to survive anything. I'm environment. Okay, I want to go to your go back to your work. You're at the focus of the interview, not me. So I want to go back to your work. And what I want to do is tax your patients by reading extended excerpts from your work. So these are excerpts from things that you had written. But they're so on point. And they're so wonderful in their encapsulation of their disorders that I really must prevail on you and I must read them aloud. And they are absolutely wonderful texts. So we start with the narcissist. You say the narcissist be entitled. And this is Joanne Lachkar. This is her text. And I'm quoting from them. She says, the narcissist is the entitlement lover, the special child of God, also known as His Majesty the narcissist. You know when you're around one, because all they talk about is themselves. They are dominated by a grandiose and exaggerated sense of self. Believe the world owes them something and feel they are superior to others. They have excessive entitlement fantasies. In court custody cases, they are the most difficult. The other ones who feel entitled, they want all the visitation, the money or the furniture, et cetera. Narcissist value such things as success, fame, physical beauty, wealth, material possessions and power. The narcissist cannot tolerate having dependency needs and unwittingly project their needy selves onto the borderline. According to Kernberg in 1995, narcissists cannot tolerate the kinds of dependency needs in an intimate relation. And they unwittingly project their dependent and needy selves onto the other. Often a borderline with a perfect target for the narcissist's negative projections. In treatment, narcissists are the one who will quickly flee when they're injured, not appreciated, when confronted, not properly mirrored, or when their excessive demands are not met. They are always asking for special favors, changing appointment times coming in only when it's suitable for them. The narcissist cannot allow themselves the kind of dependency and intimate partner he earns. These are texts by John Lachkar, not my text to be clear. John says about the borderline, the victim, the abandoned one. She says, the key to handling borderlines when mediation with their partners works down is to understand the nuances and motivation of the borderline persona. Borderlines are often as if personalities and they have an exquisite false self. She's quoting Winnicox from 1965. They can dupe borderlines, can dupe the most seasoned therapists, let alone court officials with a facade of being the poor victims, the betrayed and the abandoned ones. To defend against shame, borderlines are determined to win and prove their self righteousness at any cost. They may appear normal, genuinely concerned about the welfare of the family. They are intelligent and often charming. But behind this facade, they scheme to coerce their partner into the bed parent role. In psychoanalytic terms, this is known as splitting and projective identification. So you distinguish between different kinds of narcissists and borderlines. And then you describe the dynamics of the narcissistic borderline couple, the narcissistic borderline relationships. Can you describe to us what happens when they get together? What happens when there's a bond? You called it the dance, drama, the mutual projective identification. Can you expand on this a bit? This is at the core of your I'm actually I'm actually going to read about what I wrote about the narcissistic borderline relationship. I think you find it right now. Don't worry, take your time. Okay, as you mentioned, this work is an expansion of my narcissistic borderline couple, where I describe what happens when the narcissist and a borderline get together in a marital bond, or should I say a bind? And together, they do this psychological dance that goes back and forth. Again, to repeat how each one projects a negative feeling into the other. And then the other one, just like a borderline, is a perfect target for the narcissist projection. The revelation is that each one needs part of the other to go on with their developmental drama. In other words, each one stirs up some unresolved developmental issue in the other. Because often people say, why don't you just leave them? Why do you just stay with the narcissist? Or why do you just stay with the borderline? It is not so much the glue that holds them together. They ask, how do they attract each other? God knows how they attract each other, like a fox tour rabbit. So it's not so much how they find each other. It's what makes them stay is the glue that holds them together. This is very important when they say, why do I stay with this person? The therapist has a wonderful opportunity. Well, it's not a matter of staying in the marriage, but this relationship stirs up many unresolved issues for you. Communication skills, many developmental skills. And of course, these stir remnants of old hurts and archaic injuries that they bring into their current relationship. Well, you're just doing exactly what my ex did or what my ex-husband did. This is called, in simple terms, old baggage. So again, these interactions get in to this dad's or rondo that are ongoing, never ending. They go round and round. And this is what keeps them in the court system so long because they never are able to reach a conflict resolution, which is most frustrating not only for people in the court system, but people who love and live with them. So if I were to say, what is the main, the main dynamic in treatment? I would say one thing and one thing only. The word is projection. How this is the heart of the matter. Again, how these projections move to and flow back, back and forth. For example, a narcissistic husband will project a feeling of shame into the borderline wife. You don't need a trip. You don't need vacation. You don't need to, we don't need to really, we don't need anything. What makes you think you're deserving of it? And making her feel that she's worthless and not deserving of anything. And then she then attacks and attacks him and then that hooks into his guilt, his harsh super ego. Oh, I'm less than perfect. Can I give you an example of the dance? Of course, yes. Absolutely. He complains to the borderline. All you do is nag and nag, not knowing how to legitimately express her real needs. The borderline continues to nag, demand. The more she nags, the more he withdraws. And you know what withdrawal and isolation stirs up in the borderline. Abandoned, obviously. The more he withdraws, she attacks. As she attacks, she hooks into his harsh punitive internalized super ego of guilt. He ends up feeling guilty and she shamed. Thus, it becomes a dance between shame and guilt. And then I want to ask you, John, he ends up feeling guilty because he has this harsh inner critic, this harsh super ego that she taps into and enhances. So he ends up feeling guilty. She ends up feeling ashamed, undervalued, unworthy because he taps into her sense of shame and so on. But shame and guilt are very negative effects. They're very negative emotions. Why do they stay together? They make each other feel very bad. Why do they need to feel bad? There's two reasons. There's internal factors and external factors. The external factors have to do with some semblance of reality. Children, sometimes they can't afford to leave business, their work, their community, their family. That is the ties, the glue that holds them together. And then there's an internal reality, how one identifies with an internal bad object that Fairburn talks about. Fairburn helps us understand why people stay in painful, conflictual relationships. As my supervisor, supervising analyst Dr. Jim Grotsen used to explain very clearly simply, it's better to feel the pain than to live in the abyss, the black hole, the emptiness. I'd rather flip my wrist, at least when I flip my wrist, I know that I'm alive, than face the abandonment. This is very, very severe borderline pathology, of course. So they stay because they bond to their internal objects. What is an internal object? The betraying object, the abusive object, the unavailable object. And so we could say, well, so what if they bond to an unavailable object? What has that got to do with the pain and staying in the relationship? What it really means is that they don't know how to internalize that. For example, what a therapist could say, yes, yes, that other person betrayed you because there's a part of you that feels that you betray yourself. We cannot control the external abusers or the betrayers or the unavailable people in our lives, but that's not where the power is. The power was getting in contact with their own bad internal objects, like the betrayal or the abuse, and that's where the power is. So the borderline and the narcissist render a service to each other. They cater to these bad objects and to what you call what you call the v-sport of the archaic wounds in psychonolithic terms. That is such a good point because it stirs up the new book that I'm writing. It sounds like a Harry Potter series, how to talk to a narcissist, how to talk to a borderline. Now I've just finished the book how to talk to an obsessive-compulsive and it goes back to that first pioneer who wrote about the histrionic couple and the obsessive compulsive husband. Well, I have reintroduced that in my new book because that is a beautiful example how each one needs some split-off parts of the other. The obsessive compulsive could use some of the histrionic emotionality of the histrionic and the histrionic could use some of his orderliness and routinelyness and ritualists of the other so they do they join together because each one needs some split-off part of the other. Now the dilemma is if I interpret that say to the obsessive compulsive you know you really need some parts some emotionality because your wife sees you as a cold fish. His response could be something like what and I don't want to sound hysterical like her she reminds me of my mother and then of course that's where the work would be well that's not what we're talking about we're talking about normal healthy emotions that you really feel are dirty and disgusting and that's probably why the obsessive compulsive cleans so much because that is this internal dirtiness that they're trying to vent and get rid of. Could we could we say that there is a process of merger or fusion between these two they outsource ego boundary functions to each other they kind of merge in some way they become one. They're already merged they're already merged in fact that's what I mentioned in the book there is in the first phase of treatment that is where the merger is there is no distinction or differentiation between self and other I am her and she is me and she is me and I am her. By the way I just want to I just want to say when I say he is the one who's the abuser or he is the one the reason I do that is because being female it's easy for me to say he did this and he did that but please the readers and the participants can always reverse it it's just easier for me to instead of saying he she or she he or he he she she I just say he so I don't want you to kill him. John this is the the end of part one so I'm going to to close part one I'm going to send you another link by email and you would have to click on it and we will continue okay that's that's owing to limitations zoom limitations okay so I'm going to I'm going to terminate this session I'm going to send you another link and you can log on log in with the other link okay okay do I close do I close you out you don't need to do anything I told you you just need to be I don't need to do anything no I will do everything I can just relax yeah you can just absolutely relax okay I'll I'll send you are you control are you controlling me yeah of course I'm a narcissist I love it I don't mind and I love it I will send you another link in about 10 minutes time and then you could click on this link and we will continue the conversation see you soon so John I wanted to ask you you you suggested the concept of v-sport or vulnerability sport and you had equated it with the old psychonolithic concept of archaic wound could you give us examples of the archaic wounds of the narcissist of the borderline translated from a abstract concept into kind of day to day to day experience I can't resist telling you how the v-spot came into being you're right as I was writing I kept talking about the early archaic injury of the narcissist the early archaic injuries of the borderline the archaic injury for the narcissist is that he was the king of the high chair until the second child was born and all of a sudden the mother abandoned him and made the superstar into the next sibling and the mother who does not know how to handle that that child will spend the rest of his life trying to prove that he is mother's special child and so the same thing with the borderline that the abandonment issue becomes such a pervasive force that any time there's any semblance of abandonment it provokes it is a provocation and it evokes an enormous traumatic reaction the same thing with the narcissist when they are when they are narcissistically injured their v-spot gets stirred up when somebody questions them or doesn't agree with them that is the v-spot so as I'm writing I'm writing the vulnerable spot the archaic spot how each one has their own archaic and I got so tired of writing the vulnerable spot the ball I finally abbreviated and said the v-spot very catchy so I thought in the middle of the night I was having a dream that I'm going to write a book called the v-spot and then I started laughing nobody would ever write a book called a v-spot so just for fun I have a very good relationship with my publisher in New York Jason Aaron Santelar and Francis and I sent Jason Aronson this proposal about the v-spot a week later he sent me a contract he thought I thought it was a great idea and I know I thought about it it is a huge spot that even my manicurist will talk to me and say you know my husband really stirred up my v-spot when he refused to you know take me out to dinner and thinks that said I was too needy so the question that comes up is do these individuals have their own specific v-spot as I just mentioned briefly that the narcissist gets injured at the slightest provocation and will blow but their defenses are different than the borderline when they when they get provoked they don't just lash out or attack they do sometimes but overall they do something even worse than attacking they withdraw they isolate themselves you can imagine what that does for someone like a borderline personality the provocation for the v-spot for the borderline is very very different that whenever their issues of betrayal or abandonment gets stirred up they attack they lash out they call each other all kinds of names sometimes they even get abusive and violent so the question is and this is the OCD in me is do each of these disorders have their own v-spot in fact I transferred this to my work with cause cultural couples do countries have a v-spot does one country say to the other you know turkey to grease or something you really hurt my feelings yes they do it's a collect through the collective group fantasies so the pathological narcissist has their v-spot the lignite narcissist they each have their own specific area of vulnerability that when provoked it blows like a tsunami and when we say and when we say provocation that leads me to the next topic and the next topic is communication now before we before we go into interpersonal communication I would like to read again an excerpt from Johan Lachkar's work an excerpt and so now that I had them talking to one another says Johan what do they talk about as almost every therapist can attest to complaints in common complaints that bring couples into treatment um published in 2014 chapter four discusses how each personality type has a proclivity to their own subjective type of complaint including various ways of listening or not listening couples think their issues evolve or revolve around sex money but more often they do about control domination audible rivalry the narcissist may complain when not being appreciated the borderline when she's feeling abandoned and the ocpd when things disrupt their sense of order these complaints trigger many hurt and repressed feelings old archaic injuries stir up many old unresolved archaic injuries and vulnerabilities so the v-sport the concept of the v-sport which is an extension an expansion of the old concept of archaic wound or archaic injury informs Joanne Lachkar's work when it comes to communication I mentioned at the beginning of the first part that Joanne had written a series of book how to talk to a narcissist how to talk to a borderline and the only book missing in the series is why would we want to talk to these guys but okay that's an next book I think but she she has she has dealt I think it's the most extensive body of work to deal with the issue of interpersonal communication when it comes to people with cluster B personality disorders how to communicate with these people and she came up with two languages can you describe these two languages for us Joanne well first of all I had all these narcissists now and all these borderlines and now all these ocd's so what do I do with them do I just throw them into a chapter and just let them fight among themselves so a good friend and a colleague said you know so much has been written about narcissistic borderline personality disorders and but not too many have actually talked about how to communicate with them how to talk to each other so that motivated me to write how to talk to a narcissist which is of course 200 blank pages or how to talk to to a borderline so it may sound very narcissistic of me but I developed two languages the first language is the language of empathology which I have abstracted from Heinz cohort work on self psychology addressing the self-object mirroring needs of the narcissist and for the borderline I refer to the language of dialectics which addresses the splitting the splitting needs of the of the borderline abstracted of course from the works of object relations mainly Melanie Klein and and beyond I'll give you an example of the language of dialectics patient comes in doctor doctor I don't know what to do I want to get down to this marriage I hate my wife she's a bitch she's a terrible mother she betrays me well then why do you stay oh because I love her so then there's two parts of you one part that loves her this is the dialectic and the other part that wants to get rid of her oh but I get so mad and I get I attack her and I fight with her so the response is that when all these when all of these defense mechanisms are operative it's very hard to know what to do because the ego goes into dysfunctionality and you're not clearheaded so the ego is responsible for judgment perception melody testing so it is not what while these defense mechanisms are operative it is not a good time to make a major decision and that is very soothing because then I mentioned that there's two I was going to say Sam so I'm going to use that name there's two Johns one side that wants to get married and the ambivalent that wants to get divorced and these ties size somehow need to integrate so the language of empathology there are a lot of patients who who really oppose that they think it's ridiculous it's just too much work for example I had a very patient who was married to a very very famous doctor world famous and he was always busy doing depositions going around the world and she called him one day and she had twins and she said honey could you please pick up some diapers and some formula for me are you out of your mind do you realize how busy I am and she says I just need some diapers and formula for these I've been up all night what do you mean you've been up all night you don't do anything I'm the one who works all you have to do is stay home and take care of these little twins so she started to attack him you're such an asshole all you do is think about yourself and I said using the language of empathology you said what she says well what am I supposed to say well what I'm about to say to you may not make me might make you feel sick oh honey you are such a famous doctor the world renown I am so proud and honored to be your life and I know how busy you are and I just need I didn't mean to disrupt your world or schedule but I just needed some takeout food and some diapers she says are you crazy that's too much work do I have to say all that I said you know what it's more work if you don't well I have been criticized for this and you can imagine why that I'm just giving a lot of BS and bullshit but if you want to communicate with a narcissist if something better comes along I'm open to it but this is addressing his self-object mirroring needs this is building him up you have to prepare him so he like a laser then you can come in and then of course this the same kind of approach would be for the borderline so in fact avoiding avoiding provocation avoiding triggering the v-sports that's the language of empathology yes and it brings up another point sometimes the borderline will lash out and say something you know you're just a piece of shit you're a terrible mother you need to I hate you and I want to divorce and I want to get rid of you and then the borderline will respond back how dare you call me all of those names I'm a good mother and look what I do and blah blah blah blah and I say you know I don't think you know the difference between borderline venting evacuation trying to get rid of a part of themselves as opposed to serious thought oh I never thought about that so what do I do about that here it goes again honey I don't think you really mean that I can see that you're very stressed over your work right now you don't really mean that I'm the terrible mother so using beyond's concept of detoxification to detoxify the contaminants that intruded to the relationship and to transform aggression anger hostility rage into problem I think that's beyond one of beyond's most amazing formulation about the concept of moving from what he calls beta L elements to alpha function well I won't get into beyond he's possible to understand but I've tried he's French what can you do but that would render the relationship functional do borderlines want a functional relationship do they feel comfortable in a functional relationship oh that is an amazing question I'm thinking about Freud Freud never knew or talked about the borderline personality disorder but he did notice there was a segment of patients that would reach the pinnacle of success and suddenly would go into a massive regression and in clinical practice we see I call that sabotage children like borderlines who've had a traumatic childhood who have been too deprived of their childhood proud deprived of fun activities have to have to be the caretakers for their families these children then sabotage all joy and all good things in other other person for example my husband is supposed to go with me to my sister's wedding and as typical at the last minute he says I'm not going to go well but I'm going to feel terrible without you there no I don't feel like going or there's a there's a a christening or a bar mitzvah or a trip to Israel this woman was planning for months at the last minute he says I don't feel like going well what do I do with the tickets what do I do with the kids I just base the word sabotage really should be highlighted this is key what happens in these in these relational dyadic bonds it's a it's a it's a parasitic attachment which is exactly and so I wonder I wonder if we should facilitate these these pairings these diets we can teach borderlines and nurses how to talk to each other definitely following your work we can teach them how to do that but should we that's a moral question that brings up another thing okay so here I have them them talking to each other so what do they talk about they talk about complaints and each each disorder have their own their own arena a venue of complaints they each the the narcissist will complain about this and the board so then after they complain who's going to listen to these complaints somebody has to listen or not listen so I didn't mention it in in my in my manuscript to you but the works of Salman Ashtar wrote a book called psychoanalytic listening and I integrated that into my work he talks about like 10 different ways of listening objective listening subjective listening interjective listening counter-transference listening so I I expand on that after I talk about the the the complaints yes but my question my question was more more ethical or moral should we encourage two people who are basically dysfunctional and feed each other's pathologies should we encourage them to stay together should we teach them communication skills and protocols could we or should we on the very contrary seek to to break this parasitic bond that just recently happened in my clinical practice this woman is so upset with his borderline husband because anytime there's the least provocation he leaves sometimes he leaves for three or four weeks and doesn't doesn't come back and you're seeing a family therapist and they all say you know you should just leave him well she has she has a little girl who has some you know challenges some physical challenges and these particular medical care and so she she just cannot leave for external circumstance circumstances so I said to her besides that you're not really ready to to leave until you practice these communication skills because when he calls you with a piece of shit or tells you to fuck off you then attack back you don't know how to soothe him or to mirror him and to let him know the difference between saying he's wants to leave and get a divorce as to a serious conversation about divorce he's just eventing and getting rid of a part of himself to project fear and threaten to you so until we practice these communication skills it's really hard to know what to do and to see the real relationship which is buried under all these defense mechanisms which leads to the dysfunctionality of the ego when the defenses are operative it's very hard to see reality in in my work I call I call narcissists I say that narcissists are selfless which is pretty ironic I said that they are selfless it's pretty ironic because what I'm trying to say is that they're selfless because they're so preoccupied with the self yeah and they're here is disabled is disabled by their defenses actually they don't have a functional ego and they outsource many ego functions and so on and and but you also need to mention the main trait is they have no empathy for the other person here the borderline is the victim she's crying she's upset you know they they they find that disgusting and to pay attention makes them feel like they're responsible they don't want to be they're perfect yes they're as perfect as mother wants me to be yes it's a it's a very big problem because you keep saying that smart people make stupid decisions and they make stupid decisions because essentially the ego is suspended or deactivated by overwhelming defenses and I would like you to describe this a bit more if you can it's a very fascinating process isn't it amazing how smart people say and do stupid things I mean we can all look into ourselves how we've all done that I contribute that to the works of Otto Karnberg who is a master of the ego most people don't even understand even the most well-seesome therapist it's a very slippery term it really doesn't mean that the person is full of themselves it really means that the ego goes into dysfunctionality especially when there's these defense mechanisms are operative or anxiety or post-traumatic stress disorder the when the v-spot is ignited vulnerabilities the first thing that goes is the ego so what is the ego responsible for number one thinking to perception intuition reality testing and most important judgment for example I'm having a minor fender bender and the police come and they say what's your name what's the name of your insurance my name my insurance I can't think my ego at that moment 10 minutes later oh yeah I'm Joe Lashkar my insurance is so-and-so and I get myself together but at that moment I can since I've had some analysis I can say hey I'm not stupid my ego is just flooded right now and I can't think this has been a very helpful concept with patients who who think that they're stupid or they can't think clearly and to point out the aspects of the ego is a very valuable tool that we need in our clinical practice in the footsteps in the footsteps of Henry Deeks and others you have been studying recently another diet another dysfunctional diet which is the obsessive compulsive and the histrionic can you elaborate on this a bit that's new that's a novel thing that's that's well to most most of the public even to me by the way that I'm well versed in literature and so on this was pretty new so yeah I free I free introduced that but I free versed it's not always that the that the man is the cold sick husband and the woman is the love sick wife sometimes now especially in today's world the woman can be the cold sick wife and the histrionic male and together they they do this this dance she has no feelings for me every time I mention the emotions she just says oh don't give me all that crap in fact one patient said to me in a session she was very OCD she said I said why don't you tell me about your feelings and how you feel about relationships and how you feel about dating and what what gets in the way are you dating she says what do you mean I should open up that can of worms so the OCD has a distorted image of what consists in their internal world this is the bonding with the bad object with the dirty internal world that's why OCDs are so preoccupied with orderliness and rituals and cleanliness and washing hands and isolation and don't touch because they feel they have a dirty that emotions are dirty so the question is why why do they feel they're dirty same thing getting back to ground zero the V spot to get emotional means to have feelings and that stirs up feelings of vulnerability my father was in the Marine Corps and he always told me boys don't cry so they put on a facade but after a while it no longer works for them and they do come to conjoint therapy I had one patient let's see I'm going to disguise this he was let's stay an engineer and he was obsessed with cleanliness and orderliness and everything had to be just perfect and he would treat his relationship just like he was doing a engineering structure and so when we talked about he would say things like well that's not that did it with my work well this isn't about work this is about an intimate relationship and there's a difference between being vulnerable in an intimate relationship and being an engineer you don't need any feelings but you do feel that that your your wife or vice versa your husband then contaminates you with her emotionality so that is the bomb that keeps them together he needs some of her emotionality and as I mentioned before she desperately needs some of his orderliness to calm her crazy histrionic outburst so he experiences emotions by proxy vicariously through her what do you mean I'm asking the obsessive compulsive he experiences emotions vicariously by proxy through the histrionic yes I need at least she becomes the emotional compass for me and as she becomes the emotional compass which I desperately need which I have abandoned long ago or maybe never had as much as I need it I have to repudiate it and refute it because it disgusts me she disgusts me so she disgusts me she's she's dirty she's emotional she's dirty and then the next step would be to say that she's not she's not your histrionic mother that you identify with normal emotions people do not get out of out of line with them they are able to just express them very simply like an engineer I feel this way I feel that way and you could use your engineering approach to organize your emotions and you don't have don't have to act them out because I can understand there is this fear that you're going to sound like your wife I want to stray to stray off scripts for a minute and to ask and of course there's the counter transference yes I express emotions to you but I don't yell I don't scream and yet I have expressed many emotions to you oh well I like that I wish my wife could do more of that so that's where the counter transference and maybe some of the work can develop you believe in leveraging transference and counter transference in therapy you don't regard them as contamination of the therapy something that should be shunned and avoided and well most analysts would be appalled that I use counter transference and analytic approaches but we can't help it because a patient will come in and say you're just like my mother you just use me all you want is my is my and my time and you take advantage of me and then I have to interpret the counter transference so that you see me like your mother someone who just uses me but then you don't see the other part of me that generally cares about you so there's an opportunity to move beyond the counter transference but the counter transference sometimes I'm just very open about it sometimes I'll just say I'm having a counter transference reaction I mean no and then I I get invited in so I do use transference and counter transference yes I think these are extremely useful things and it's it's unwise to discard them I want to stray off script and ask you a question that had not been agreed between us ever since the 1960s we I mean the profession is trying to medicalize psychology to say that all these ideas about childhood and mother and upbringing and separation individuation and and old conflicts and all this is nonsense it's actually all about genetics biochemistry and conditioning some kind of behavioral thing you know even CBT even cognitive behavior therapy is a form of form of you know automated automated approach to psychology so I want to ask you do you why do you believe that early childhood bringing parental figures matter why do you believe they matter because overwhelmingly unfortunately the whole thing is being discarded in universities and so on we are we are told not to teach these things they're not scientific they're not established they're not they can't be true it's total nonsense it has to do with chemicals and with neurons and with genes and with everyone wants to be a medical doctor suddenly also every psychologist wants to be a medical doctor why do you think parents matter why do you think childhood matters well first of all there's two approaches the old school approach was to get a gigantic history the genealogy of the family how this first began and do a whole psychiatric evaluation but things have changed now now we start with the material what the person presents if they don't mention childhood genetics we don't bring it up we only deal with the material at hand beyond refers to this is the patient coming in without preconception or memory or desire and then something repetitive happens with the patient feels rejected or they have failure and then we might say well where does that come from oh it comes from my mother who reject now we start inviting in the childhood but we don't start with that and then they bring up genetics and they bring up the DNA maybe it's inheritance you know this all may be true but that's not my job my job is to deal with the psychological aspects and any of that you can deal with a neurologist or a psychiatrist or a psychopharmacologist you can deal with medication but my job is just to deal with the material that you present which reminds me of the most frightening thing that terrifies us most therapist is the affair that is always very scary but I start the beginning of every session before oops the gods of the internet had cut us off I'm afraid that I can't hear you John just a second let's see what's going on oh we've been cut off it did right John your entire answer had been cut off could you start from the beginning the the connection fell could you start from the beginning the affair the connection fell must be very weak oh this is ever I'm not sure why but I can't hear you I don't know why but there's no connection it's the morality police can you hear me I can hear you now yeah can you hear me yes I can hear you now the affair is every therapist's nightmare someone calls man or woman no John I'm sorry but again you'll be disconnected I don't know why I can't hear you I'm having an affair and I don't want my wife John just a second let's hold on for a second until the connection is stabilized and let's try again from the beginning maybe maybe I should no I hear you I hear you well now let's try again let's try again I can hear you well now there is every therapist's nightmare somebody calls out of session and can you hear me yes I can hear you can you hear me I can hear you now I can imagine this during the session but I'm having an affair well the first thing I say to every patient or the patients before they start therapy is that anything that you tell me of I will not disclose in fact I have the privilege as your therapist to disclose anything that you tell me under the rubic conjoy therapy however I don't disclose anything I only fill with the material that goes on in the session okay the affair there's three reasons white people have an affair number one it could be a one night stand one man even went to a massage pallor had a blow job felt very guilty should he tell his wife well that that was not very significant or he went on a business trip and some gorgeous babe walks in and they have sex the second one is that he meets somebody and falls madly in love and he may be eventually even marries her or has this affair and then it ends eventually the third reason is that they feel insecure they're not getting the satisfaction the feeding the nourishment the intimacy the sexual gratification at home and because they feel neglected and they will reach out the narcissist will have affairs because they are always looking for external self-objects to make them feel that they are really big and grandiose and wonderful the borderline will often have an affair out of revenge retaliation so those are the three basic ideas and I present this to the person who finds out that the husband of so many patients just come in horrified and crying and it's very reassuring to know you're the queen of the household and this affair really meant absolutely nothing and it's very reassuring but it's still extraordinarily painful they feel so abandoned and it's I have so many stories about why doesn't the affair why doesn't the affair do this to people even one night stands why do they have this inordinate effect on the partner on people it's interesting there are some women who say oh no it wasn't a big deal you know I love my husband he's a wonderful husband he's a great provider and uh you know I was thinking of of Clinton you know Hillary Clinton you know he had affairs but he he was a great provider and she really enjoyed being first lady the same thing with the southern president I I guess maybe Kennedy but there are other women who will take it as such a rejection of themselves so I have to remind them you're still the mother you're still his wife and you are the queen of this palace this is your palace and he right now is acting like a baby husband but that's not to take away from the importance of your role as a mother and as a wife that is a such an important role they love when I say you were the queen because they're so used to the narcissist being the king now I'm the queen I'm just giving you an outline of how I deal with the there but I do not ever report again the voice again the voice is couple out of session first of all it gets distorted can you hear me can you hear me yeah I can hear you know but you are a couple of people okay John I think we are losing the connection and maybe it's a good time to to say I think we covered almost everything anyhow can you hear me well I really want to thank you for inviting me into this indeed it's a it's a couple therapy is a drama it is it is an experience between the three people and we're always performing and we're always on stage and which means we have to really deal with our own counter transference and the curtain opens the drama begins and we hope that we can effectuate a new experience and what all we said about narcissistic and borderlines many of them do amazing accomplishments in music and science and so we respect those to live work and love with thank you thank you thank you Sam for inviting me in your most inspiring book thank you thank you for your kind words and it's been a privilege and maybe we'll do it again we have a lot more to talk about I would I would love that thank you thank you hopefully with a better connection take care thank you good to see you