Treating Borderline States in Marriage: Dealing with Oppositionalism, Ruthless Aggression, and Severe Resistance (The Library of Object Relations) [Hardcover]

Charles C. McCormack (Author)

Book Description

ISBN-10: 0765701901 | ISBN-13: 978-0765701909 | Publication Date: February 1, 2000

Personality disordered couples often seem impervious to change, leaving even the most skillful therapist frustrated, entangled, and at wit's end. Unable to tolerate their fear and pain, these couples reactively act out and engage in ruthless personal attacks against self, spouse, and therapist. Charles McCormack has constructed a new therapeutic approach to work with the acting-out, primitive defenses, and undifferentiated dyadic relationships characteristic of these troubled and troublesome couples.In therapy, the underlying dynamics and motivations of such provocative behavior are brought to awareness, as the therapist allows himself to identify with his own primitive self. McCormack describes this process with detailed clinical vignettes of both the verbal exchanges of the couple and the therapist's inner experience.

Editorial Reviews

Review

This book is a gift to all therapists who battle to help seriously disturbed couples. Charles McCormack provides a carefully crafted, original synthesis of theory drawn from object relations and self psychology and illustrates it with luminous clinical examples. At every step he describes the process through which patients' relational disturbances get inside the therapist and how the therapist can learn to contain them. Throughout, McCormack's own struggle to help patients grow, rather than destroy what they hold most dear, is the integrating force. All therapists who brave the storms of these turbulent marriage relationships will be grateful for McCormack's invaluable guidance as they navigate troubled shoals. It offers a lighthouse on the path to therapeutic survival and safe harbor. This book, which will enrich the work of both the most experienced therapist and the hopeful novice, is a must-read! (David Scharff, M.D. )

A therapist's faithful companion along a hard road, this book guides us toward finding a much wider scope for using ourselves as therapeutic instruments. It is that rarity, a 'how to' book that is also a 'why to' book, one that makes clear how ultimate the stakes are in therapy. McCormack's writing lives because he has lived what he writes. His anecdotes surge off the page, sometimes so charged with the elemental pain of being a person that it takes your breath away. He asks deep questions about the rules of engagement with couples in trouble and troubles in couples. This is a book to live with, to learn from, and to lean on. (Roger A. Levin, M.D. )

This spellbinding volume represents the accumulated wisdom of a gifted therapist who has developed an extraordinarily effective treatment approach to working with couples who have personality disorders, one that seamlessly integrates the interpersonal with the intrapsychic. A highly original and creative thinker, McCormack has synthesized the contributions of object relations theorists like Klein, Fairbairn, Winnicott, and Ogden to inform his understanding of, and approach to, these difficult and complex patients. Respectfully framing their unrelenting provocativeness as a desperate attempt to extract from the object (be it partner or therapist) a means of healing past unresolved traumas, the author encourages the therapist to put forth, for mutual observation and understanding, the countertransferential responses these patients elicit. McCormack's extensive use of clinical vignettes to illustrate his treatment method demonstrates that we are dealing with a master clinician who, with humility and compassion, is able to go where other therapists, less wise and courageous, fear to tread. Inspired and inspiring, this important book should be required reading for any practitioner who works with personality-disordered patients. (Martha Stark, M.D. )

About the Author

Charles C. McCormack, MSW, BCD, holds masters degrees from Loyola College of Baltimore in psychology and the University of Maryland in social work. Over the past twenty-six years, he has worked in a variety of outpatient settings and was the Senior Social Worker of Long-Term Inpatient Services at Sheppard and Enoch Pratt Hospital.

Product Details

• Hardcover: 376 pages
• Publisher: Jason Aronson, Inc. (February 1, 2000)
• Language: English
• ISBN-10: 0765701901
• ISBN-13: 978-0765701909
• Product Dimensions: 9.4 x 6.4 x 1.4 inches
• Shipping Weight: 1.8 pounds (View shipping rates and policies)
• Average Customer Review: 5.0 out of 5 stars  See all reviews (5 customer reviews)
• Amazon Best Sellers Rank: #1,796,025 in Books (See Top 100 in Books)

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Most Helpful Customer Reviews

17 of 18 people found the following review helpful:

5.0 out of 5 stars A Bridge Over Troubled Marriage, April 13, 2000

By 

Ronald E. Zuskin, MSW, DCSW (University of Maryland SSW) - See all my reviews

This review is from: Treating Borderline States in Marriage: Dealing with Oppositionalism, Ruthless Aggression, and Severe Resistance (The Library of Object Relations) (Hardcover)

If one is bold enough to attempt couples' therapy one lesson soon emerges: there are couples, and there are couples. The normal/neurotic couple incorporates communicative-interactive tips and interventions directed towards effective communication, conflict resolution, problem solving and enhanced intimacy. The personality-disordered marriage, even when managed with strategic skill and therapeutic acumen, too often seems impervious to change. The therapist is frequently left floundering and "at a loss." Charles McCormack navigates the reader around the reefs and through the doldrums that typically wreck or stall therapy with these couples. In doing so he also sheds light on the soft human underbelly of ALL marriages, reflecting , as they do, some degree of early trauma or impingement - now well-met in a partner. McCormack starts with the therapist's capacity to play and takes us on a journey of vigilance and courage to the recognition that, in working with borderline states in marital therapy, it is likely to be the THREAPIST'S resistance to understanding which may forestall - and then foreclose - the therapeutic process. McCormack uses exquisitely drawn vignettes which render the words as well as the "music" of sessions with these couples, transmitting the "feel" AND the "sense" of the sessions. In these couples we hear the echoes of their dreams and see the omnipresence of their nightmares wedded in their coupling. Each individual unabashedly - ruthlessly - uses the other as a self-object. Through resistance and oppositionalism the couple works to use the therapist as a self-object, too. McCormack makes the confusion in working with these couples clear. Using concepts derived from object relations, psychodynamics, self psychology and Ogden's theories of modes of human experience, McCormack sheds light on a unique treatment approach for working with borderline and other personality-disordered marriages. This light dawns gradually and not in a rushing flash of epiphany. What is unknown might not be unknowable; there may be a psycho-logic underlying what seems so "irrational." Therapy begins in the mind of the therapist. Through separate individual interactions within the dyadic context, Mr. McCormack works first to change each partner's relationship with the therapist, and THEN their relationship with one another. Sequential interactions with each member of the couple provide not only "role modeling," but create psychological space in the treatment room, allowing for the development of "thirdness," where the "Other" and "We" can come more fully into being. McCormack offers a myriad of techniques - such as the "deniable interpretation," the challenge to certainty, and teasing out and surfacing inconsistencies in narrative - all of which add to the therapist's armamentarium in this difficult but potentially rewarding process. A world that may seem unintelligible at the beginning of this book - the scorned world of the personality-disordered marriage - is made knowable by the end. Interventions rooted in "being" a therapist with a couple of Beings supplant the panicked urgency of "doing something, anything" about the couple's plight. McCormack's techniques create a pathway towards repair instead of annihilation, all the while reassuring us that "therapists are human, too." McCormack's book helps to bridge the obstacles impeding therapeutic work with these troubled and troubling couples. He lets us know, when we find ourselves "at wit's end," that this is a very good place to begin our work.

9 of 10 people found the following review helpful:

5.0 out of 5 stars A message from the author, March 28, 2000

By 

Charles C. McCormack - See all my reviews

This review is from: Treating Borderline States in Marriage: Dealing with Oppositionalism, Ruthless Aggression, and Severe Resistance (The Library of Object Relations) (Hardcover)

This book is a labor of love and the labor of my lifetime to this point. It's genesis dates from a time when society provided better for those in psychiatric distress, when long-term therapy wasn't a bad word. As a clinician I had received three years of formal training in structural and strategic family therapy. However, as my career passed through methadone maintenance clinic, to partial hospitalization, to long-term inpatient treatment, I found these approaches inadequate in helping me to help these patients with the difficulties they encountered. Nor, were these approaches any more helpful in helping me to understand the plight of individuals in spouse abuse and sexual abuse treatment programs for which I worked on a part-time basis. It was while working on a psychoanalytically oriented long-term inpatient unit that I was driven to the medical library in the attempt to develop a more in-depth understanding of the poignant plight of these individuals. I discovered Winnicott, Fairbairn, Sullivan, Balint, and others who had spent their lives considering just such questions. Slowly, very slowly, I gained bits and pieces of clinically useful understandings (the only kind that mattered to me) in the context of the continuing treatment of such patients. Gradually these moments of lucidity cohered into a greater whole. This book is the outcome of that quest for understanding. To my surprise, now it seems so naïve of me, my journey to understand also shed light on the difficulties encountered during regressive states (borderline states) in more normal/neurotic individuals and their relationships. I discovered that there is a personality-disordered self within each of us. The difference is that while some of us visit such mental states and skewed ways of organizing perception, others of us dwell there. I have always found the study of psychology helpful in shedding light on myself and my relationships. I often wondered why therapists didn't share their theoretical understandings more actively with their patients. After all, if we as therapists find them helpful why wouldn't our patients? In fact, many of us have been patients. With this in mind I took great pains to write this book in a way that will challenge and inform the most seasoned of therapists, while ensuring that it remained accessible to the lay person who has inclination to work his or her way through it. To this end, several of my readers were not psychoanalytically oriented. It was their job to ensure that I wrote in plain speak and in a way that made sense to them. In addition, I intentionally wrote this book in a way so as to induce within the reader some of the experience of working with individuals who are ensnared in borderline ways of being and relating. The book gradually induces within the reader the rawness of working with personality disordered patients. From initial enthusiasm, to the confusion of being confronted by the patients or their seeming impossible difficulties, to the therapist's use of his personal experience as it arises in the context of the sessions to better understand and work with the patient(s) in the collaborative effort that is therapy. The book then moves on to reach beyond common thinking, introducing such concepts as separate dyadic interactions, the use of deniable interpretations, the importance of "Not-Knowing," and of therapy as a full-contact endeavor of the therapist. I introduce such ideas as the importance of the therapist's use of aggression, the idea that the couple initially exists only in the mind of the therapist, and that the spouses first meet in the mind of the therapist. Finally, I speak to therapy as a recurring process, an upward spiral from the simple to the complex, from primitive development to whole relationship to self and other. Illustrative vignettes, often written in a manner that reveals the therapist's feeling and thinking, both spoken and unspoken, are liberally used throughout the text. Far from being the presentation of perfect sessions, these vignettes repeatedly reveal the therapist's flaws, biases, and mistakes, for I propose that it is exactly these human foibles that allows the therapist to be available to the patient and it is through our willingness to address our mistakes as therapists that we become available to and invite our patients to join us in real relationship and treatment alliance. Fortuitously, it is also the way through which the therapist's developmental capacities, particularly that of the capacity to make repair, become available for internalization by the patient. I sincerely hope that you, the reader, be you patient or therapist, gain at least a fraction of the benefit from reading this book as I did in writing it. Charles McCormack.

6 of 7 people found the following review helpful:

5.0 out of 5 stars excellent introduction to work with borderline couples, March 26, 2000

By 

jon frederickson (Washington, D.C.) - See all my reviews

This review is from: Treating Borderline States in Marriage: Dealing with Oppositionalism, Ruthless Aggression, and Severe Resistance (The Library of Object Relations) (Hardcover)

This book shows therapists how to help borderline couples begin to reflect on their feelings rather than act them out. The author uses clinical examples to show how clarification and confrontation of projections can help patients see each other, not just their fantasies. These patients often equate a spouse with a fantasy they have of the spouse; hence, they tend to be concrete and not curious. "No. That's not just how I see him. That's how he is!" McCormack shows how we can help these couples become less concrete, more reflective, and, as a result, more intimate. He talks honestly about how a therapist may 'drown' in the destructive feelings evoked in couples therapy. He shows how this happens, why, and how to work with that reality. The clinical examples he uses are raw, true to life, and, as a result, very useful. He is uncommonly honest and forthright in his discussion of when to share countertransference reactions with patients. He clearly does not see himself as an emotionally detached therapist. He likens work with borderline couples to psychological mud wrestling. His is a model of an emotionally engaged and relentless healer who tries to be as honest with himself as he is with his patients. As such, the book exemplifies the best of the existentialist and psychodynamic traditions.