RELENTLESS HOPE: The Refusal to Grieve

by Martha Stark, MD / Faculty, Harvard Medical School 

Friday, November 19, 2021 – 5:00 – 7:30 pm (PT)

The Psychoanalytic Group @ The Chicago School

of Professional Psychology (Los Angeles)

 

Two of my favorite psychodynamic concepts are “optimal stress” – not all stress is “bad” and “relentless hope” – not all hope is “good.”

 

With respect to “stress”: “Traumatic stress” is “bad” but “optimal stress” creates “impetus” and “opportunity” for transformation and growth.

 

With respect to “hope”: “Realistic hope” is good – it’s “relentless hope” that’s the problem.

Please note – I am saying that people “refuse to grieve” and not that they “can’t grieve.”

 

Fundamentally, I am all about accountability, empowerment, and capacity

– that people have the “capacity” to grieve but are “refusing” to exercise it

– because the pain goes so deep.

 

Overview

 

relentless pursuit of the unattainable

the masochistic defense of relentless hope / the sadistic defense of relentless outrage

Fairbairn’s “a bad object is infinitely better than no object at all”

Fairbairn’s “bad” object is a seductive (exciting / rejecting) object

the therapist’s unwitting seductiveness

the co-creation of therapeutic impasses

the therapist’s refusal to relent

accountability on the parts of both patient and therapist

grieving – as creating “impetus” and “opportunity” for adaptive internalization of “good”

the underlying theme throughout – evolving, by way of grieving, from relentless hope to realistic hope; to sober, mature acceptance; and to appreciation and gratitude

 

Throughout my presentation, I will be offering lots of brief and extended clinical vignettes – although, in order to contextualize things, there will be a fairly substantial theoretical piece about Fairbairn. But then I will get back to vignettes – including, near the end, an extended vignette about My Mom and Me.

 

“Pretending that it can be when it can’t is how people break their hearts.” – Elvin Semrad (Rako and Mazer 1980)

 

Today I will be talking about a concept that I have developed and to which I refer as relentless hope, the hope a defense to which the patient clings in order not to have to feel the pain of her disappointment in the “object of her desire,” the hope a defense ultimately against grieving.

 

More specifically, the patient’s relentless hope speaks to her refusal to confront – and grieve – the reality of the object’s limitations, separateness, and immutability (the fact that it cannot be forced to change).

 

It is the patient's refusal to deal with the pain of her grief about the object (be it the infantile, a contemporary, or the transference object) that fuels the relentlessness with which she pursues it – both the relentlessness of her hope that she might yet be able to make the object over into what she would want it to be and the relentlessness of the outrage she experiences in those moments of dawning recognition that, despite her best efforts and most fervent desire, she might never be able to make that actually happen.

 

In essence, what fuels the patient's relentlessness – both her relentless hope (think “libido”) and her relentless outrage (think “aggression”) – is her refusal to sit with the pain of her disappointment in the object – an object she experiences as bad by virtue of the fact that it is not all that she would want it to be.

 

Even more fundamentally, however, what ignites the relentlessness of the patient's pursuit is the fact that the disappointing object is separate from her, is outside the sphere of her omnipotence (think Winniccott), and is therefore unable to be either possessed or controlled. Indeed, underlying the patient’s relentless pursuit is an “illusion” that she has “omnipotent control” over the object of her intense desire – an illusion often accompanied by an entitled sense that something is her due.

 

And so it is that when a patient complains bitterly about feeling helpless, generally what underlies that feeling is her desperate desire to force the object to change in some way – in some way that the object could, technically, change. For example, needing / wanting the therapist to hug her or needing / wanting the therapist to become her friend. Technically, the therapist “could” – but is not going to and has let the patient know this.

 

So when a patient protests that she is feeling helpless, this often speaks to the outraged frustration she experiences when confronted with the separateness and the immutability of the object and the limits therefore of her power to make that object change.

 

Paradoxically, such patients are never relentless in their pursuit of a good object. Instead, their relentless pursuit is of the bad object. In other words, it is never enough that the patient simply find a new good object to compensate for how bad the old one had been. Rather, the compelling need becomes first to create or, more accurately, to recreate the old bad object – and then to pressure, manipulate, prod, force, coerce this old bad object to change.

 

A popular song that speaks directly to this issue of the patient's relentless need to recreate the early-on traumatic failure situation is a rock song by the late Warren Zevon (2007) entitled "If You Won't Leave Me I'll Find Somebody Who Will."

 

The patient can refind the old bad object in any one of three ways: (1) she can choose a good object and then experience it as bad (projection); (2) she can choose a good object and then exert interpersonal pressure on it to become bad (projective identification); or (3) she can simply choose a bad object to begin with!

 

Again, choosing a good object is not a viable option; a good object simply will not satisfy. Rather, her need (fueled by her repetition compulsion) will be to re-encounter the old bad object – and then to compel this bad object to become good, which will then symbolically correct for the unmastered relational traumas experienced by the patient early on at the hands of her infantile object.

 

For example: A woman who has suffered terribly in relation to an alcoholic parent will not simply resolve to choose a partner who does not drink. Rather, she will find herself unwittingly drawn to men who are alcoholic. In Stephen Mitchell’s words – “…the lure of the familial and therefore familiar.” She will proceed to focus her relentless efforts first on forcing them to own the fact of their alcoholism and then on forcing them to give it up, although they might well never do this and a panel of 10,000 objective judges would probably have been able to predict that.

 

Again, the patient’s refusal to deal with the pain of her grief about the object fuels the relentlessness with which she pursues it – both the relentlessness of her entitled sense that something is her due and the relentlessness of her outrage in the face of its being denied. Hoping against hope, she pursues the object of her desire with a vengeance, refusing to relent, refusing to accept, refusing to forgive.

 

I would like now to present a clinical vignette (written several years ago) that speaks poignantly to this issue of a patient's unwillingness – or, perhaps, inability – to forgive.

 

Clinical Vignette: Sara – My Unforgivable Mistake

 

At the time I had written: I have been seeing Sara, an extremely gifted 55-year-old therapist, four times a week for the past five years.

 

Five years ago, at the very beginning of our work together, I said something to Sara that made her feel that I did not want to work with her. (I apologize for not being able to share with you the specifics of what I had actually said, but Sara asked me, please, not to. And you will see that the “specifics” do not really matter. Sara did, however, give me permission to share with you what follows.) 

 

Sara considers what I said to her in our third session those five years ago to have been a mistake for which she will never be able to forgive me, although she wishes desperately that she could. 

 

At the time, I was horrified that Sara would have so misunderstood what I was saying; but, given what I have since come to know about her, I can now appreciate why what I said was indeed deeply hurtful to her. 

 

Over the course of our years together, Sara has spent much time trying to decide whether or not she feels safe enough to continue our work. But, because of the unforgivable mistake that I made those five years ago, she fears she might never be able to trust me.

 

Although periodically I have attempted to clarify (rather defensively, I'm sure) what I had thought I was trying to say in our third session those five years ago, understandably Sara has not been all that interested in listening and has held fast to her experience of me as untrustworthy and of the therapy as a place that is not safe – certainly not safe enough to bring her despair, her heartbreak, her loneliness, or her tears. 

 

Over time, what Sara and I have come to understand about our dynamic is that we have unwittingly recreated, between us, the mutually torturing relationship that she had had with her toxic mother. At times, Sara is her bad mother and I am Sara who, as a little girl, was tormented by her double-binding mother. At other times, it is I who am her bad mother and Sara who is tormented by me as she was once tormented by her toxic mother. 

 

In my work with Sara, it has been extremely important to her that I be able to confirm her experience of things – not just that I validate (or “empathically resonate with”) her perceptions as plausible constructions of reality (Hoffman 1983) but that I actually confirm them. In other words, Sara needs me to agree that her reality is the truth. Otherwise, she begins to feel crazy. 

 

Almost without fail I have been able to confirm Sara's perceptions, most of which have seemed to me to be uncannily on target. 

 

Unfortunately, some of her uncannily accurate perceptions have been about me. Although it is more difficult when the focus is on me and my vulnerabilities, ultimately (with the one exception to which I have already made reference) I have been able – and willing – to confirm these perceptions as well. 

 

As an example of how Sara will zero in on me: When recently she came to a session and asked to schedule a number of extra sessions, I was obviously very pleased (I actually said something to the effect of "Yes!  Yes!  Yes!"). Indeed, it meant a great deal to me that she would want the extra time, particularly in light of her experience of me as having failed her so unforgivably early on in our relationship.

 

So we scheduled the extra sessions and then I said, gently, "You know that I am so pleased to be scheduling the additional appointments, but it occurs to me that I should be asking you how you feel about having these extra sessions." 

 

Sara did not answer for a long time. After what seemed like an eternity, however, she said finally, and with much sadness, that she was now not sure the extra sessions were such a good idea after all, because she was suddenly feeling that maybe I did not really want her to be coming for the additional appointments. (And you will recall that my original “mistake” had been in saying something to Sara that made her feel I did not want to work with her.)

 

Although I was initially stunned by her response, in time she helped me to understand something that I had not previously understood, namely, that by asking Sara to share with me how she felt about having the extra sessions, I was, in a way, humiliating her. Obviously she would not have asked for this extra time if a part of her had not wanted the additional contact with me. So for me to be now asking of her that she admit to wanting more time with me was to shame her for having desire in relation to me. Indeed, had I, in advance, thought more about my somewhat formulaic question, then I would probably have known not to ask it. 

 

What I now understood was that in asking of her that she tell me how she was feeling about getting the extra time, I really was more going by the book than coming from my heart (Irwin Hoffman again). You see, I had been taught that it is always important to explore whatever underlying expectations, hopes, and fears the patient might be having whenever she asks for something from her therapist. So I really was more going by the book than by what – deep inside of me – I did know, namely, that despite Sara's deep reservations about me, a part of her was beginning to trust me a little more and was wanting me to know this without her having to say it right out.

 

Indeed, I came to see that Sara's experience of me as having shamed her was not just a story about her but also a story about me. I was able to understand that I really was shaming her by asking of her that she acknowledge wanting to have the extra time with me.

 

Parenthetically – more generally, I have come to appreciate that almost everything that happens in the therapeutic relationship is co-created – with contributions from both participants – whether therapeutic ruptures or their repair, therapeutic impasses or their resolution, failed therapies or successful ones – always co-created.

 

Sara has been a wonderful teacher – she has devoted considerable time and energy to teaching me to be a better therapist to her and, in all honesty, a better therapist period. I am so much wiser for my time with her. I am increasingly coming to see how I will sometimes unconsciously fall back on going by the book instead of coming from my heart – not always in big ways, but in little ways (some of the rituals, some of the routines that I will find myself doing, without really thinking them through).  

 

Over the course of our five years together (four times a week), we have accomplished a tremendous amount – and, in Sara’s life on the outside, she has been able to make some fairly dramatic, and impressive, changes.

 

But there has been between us this ongoing issue that we have not yet been able to resolve, namely, what to do with respect to the unforgivable mistake that I had made those numbers of years ago – about which I feel absolutely terrible and for which I have apologized many times over from the bottom of my soul. 

 

Periodically, Sara will turn to me and ask, point-blank, that I confirm her perception of me as having failed her unforgivably in that third session those five years ago. And, over the years, she has made it very clear that were I to confirm that perception, she would have no choice but to terminate her treatment with me. On the other hand, when I do not confirm that perception, she feels she has no choice but to continue to feel unsafe, desperately disappointed, and angry.

 

When Sara and I get into this place, as we have so many times over the course of our years together, my mind almost snaps from the pressure of how crazy-making the whole thing is. Sara, by asking of me that I confirm her perception of me as untrustworthy and of my early-on mistake as unforgivable, puts me in an untenable position. But by the same token, I, by wishing that Sara would someday both trust me and forgive me, put Sara in an untenable position. Sara asks of me something that I cannot possibly do; but then I ask of her something that she cannot possibly do. 

 

It is indeed agony for us both, yes, and, periodically, we do both get very angry at each other – but it is also telling, telling us a great deal about the toxic relationship that she had had with her mother. And I believe we are doing the work that needs to be done, namely, attempting to negotiate our way through and out of this convoluted, mutually torturing, hopelessly enmeshed relationship that is, in actual fact, a recreation of the double-binding, no-win relationship that she had had with her mother. It is a mutual enactment – in which both of us are participating.

 

This “is” the work – not this is what we need to get through so that we can contiue our work – no, this “is” the work. 

 

…because by way of the drama that is being re-enacted between us, Sara is enabling me to experience, firsthand, what the experience must have been like for her in relation to her mother. We will need someday to find our way out of this Catch-22 situation – but, for now, we must both sit with the uncertainty of not knowing what will ultimately unfold. 

 

The other day, however, something different did happen. Sara was once again begging me to admit that what I had said to her those numbers of years earlier was unforgivable. As I listened, too exhausted to feel angry, I found myself feeling so sad, so trapped, so anguished, and so tormented that I suddenly burst into tears. I rested my head in my hands and just sobbed. Sara sat there very still, barely breathing, watching, waiting. Eventually I stopped, and we continued our talking. This time I knew not to ask her the formulaic question, "How was it for you, my crying?"

           

Later in the session, however, I think Sara did show me what it must have been like for her. She herself began to cry – she put her head in her hands and wept. Now it was I who sat there, very still, barely breathing, watching, waiting. But what made it particularly poignant for me was my knowing that she – as an adult – had never before cried in front of anyone. 

 

Literally and figuratively, a watershed moment for us both. Our work continues.

 

Fairbairn’s Intense Attachments

 

In order better to appreciate what fuels the intensity with which relentless patients pursue the objects of their desire, we turn now to W.R.D. Fairbairn, who is perhaps best known for “The libido is fundamentally object-seeking not pleasure-seeking” and "A bad object is infinitely better than no object at all" – this latter a concept that I believe accounts in large part for the relentlessness with which patients pursue the unattainable – both the relentlessness of their unrealistic hope and entitled sense that something is their due and the relentlessness of their unwavering outrage in the face of its being denied. 

 

Over the years, many theorists have written about internal bad objects (or pathogenic introjects) to which the patient is fiercely attached; but few have addressed the critical issue of what exactly fuels these intense attachments.

 

It is to Fairbairn (1954) that we must look to understand the specific nature of the patient's attachment to her internal bad objects, an attachment that makes it difficult for her to separate from the infantile object and, when projected, to extricate herself from her relentless pursuits (Model 2) and her compulsive re-enactments (Model 3).

 

Let me review what Fairbairn has to say about how bad experiences at the hands of the infantile object are internally recorded and structuralized.

 

Fairbairn writes, when a child's need for contact is frustrated by the parent, the child deals with her frustration by defensively introjecting the bad parent. It is as if the child finds it intolerably painful to be disappointed by the parent; and so the child, to protect herself against the pain of having to know just how bad the parent really is, introjects the parent’s badness – in the form of an internal bad object.

 

Please note that in the psychoanalytic literature, “introjection” is the term used to describe “taking in bad” (as in “pathogenic introjects” or “internal bad objects”), whereas “internalization” is the term used to describe “taking in good” (as in self psychology’s “transmuting internalizations”). So the distinction is between “defensive introjection of bad” and “adaptive internalization of good.”

 

Fairbairn is writing about “defensive introjection” of the “bad object.” And he is saying that the heartbroken child, more object-seeking than pleasure-seeking, takes the burden of the parent's badness upon herself in order not to have to feel the pain of her grief.

 

Defensive introjection of the parent's badness happens all the time in situations of abuse. The patient will recount episodes of outrageous abuse at the hands of a parent and then report that she feels not angry at the parent but guilty – for having somehow provoked it, for having gotten in the way, for having had too many needs, for having been too difficult, or, even, for having been born. After all, it is easier to experience herself as bad (and unlovable) than to allow herself to know the horrid truth about her parent as bad (and unloving). Easier to experience herself as having deserved the abuse than to confront the intolerably painful reality that her parent should never have done what she did.

 

And more generally, a child whose heart has been broken by her parent will defend herself against the pain of her disappointment by taking on the parent's badness as her own, thereby enabling her to preserve the illusion of her parent as good and as ultimately forthcoming if she (the child) could but get it right.

 

In essence, by defensively introjecting the bad parent, the child will be able to maintain an attachment to her actual parent and, as a result, can then hold on to her hope that perhaps someday, somehow, some way, were she to be but good enough, try hard enough, and suffer deeply enough, she might yet be able to compel the parent to change.

 

Again, says Fairbairn, a relationship with a bad object is infinitely better than no relationship at all – because although the object is bad, the child can at least still hope that the object might someday be good.

 

Ambivalent Attachment to the Seductive Object

 

But, to repeat, what does Fairbairn suggest is the specific nature of the child's intense attachment to this internal bad object – badness that, once projected, becomes the filter through which external objects are experienced.

 

Moments ago, I had suggested that, according to Fairbairn, a bad parent is a parent who frustrates her child's longing for contact. But, Fairbairn writes, a seductive parent, who first says yes and then says no, is a very bad parent.

 

Fairbairn's particular interest is in these very bad parents – these seductive parents.

 

Therefore, when the child has been failed by a parent who is seductive, the child – as her first line of defense – will introject this exciting but ultimately rejecting parent. 

 

Splitting is the second line of defense.

 

Once the bad object is inside, it is split into two parts – the exciting object that offers the enticing promise of relatedness and the rejecting object that ultimately fails to deliver. Two questions for you – one of which is a trick question. Is the rejecting (depriving) object a good object or a bad object? Yes, a bad object. Is the exciting (enticing) object a good object or a bad object? That was the trick question! Actually, it too is a bad object!

 

Splitting of the ego goes hand in hand with splitting of the object.

 

Note that Fairbairn does not conceive of the id as separate from the ego. Rather, he posits the existence of an ego that has not only internal objects but also its own reservoir of energy – both libido and aggression. So Fairbairn’s ego is a dynamic structure – a structure with its own energy.

 

The so‑called libidinal ego attaches itself to the exciting object and longs for contact, hoping against hope that the object will be forthcoming. The antilibidinal ego (which is a repository for all the hatred and destructiveness that have accumulated as a result of frustrated longing) attaches itself to the rejecting object and rages against it. Fairbairn describes this antilibidinal ego as an internal saboteur.

 

So what, then, is the specific nature of the patient's attachment to the bad object? It is, of course, ambivalent – it is both libidinal and antilibidinal (or aggressive) in nature. The bad object is both loved because it excites (which is why it is libidinally cathected) and hated because it rejects (which is why it is aggressively cathected).

 

Parenthetically, Fairbairn and Kernberg use the concept of splitting very differently – Fairbairn is writing about patients whose attachments are ambivalent, whereas Kernberg is writing about borderlines whose attachments are pre-ambivalent.

 

More specifically, Fairbairn’s good object is an object that gratifies and is therefore libidinally cathected. But when that object frustrates, it becomes a bad object that is still libidinally cathected but now also aggressively cathected. Fairbairn’s bad object is indeed ambivalently cathected, which explains the patient’s reluctance to relinquish her attachment to it. Although devastated and relentlessly outraged when frustrated, the patient is still relentlessly hopeful that the bad object might yet come through for her.

 

By contrast, Kernberg’s good object is an object that gratifies and is therefore libidinally cathected. But when that object frustrates, it becomes a bad object that is then aggressively cathected – because of the borderline’s impaired capacity to hold in mind simultaneously both good and bad – in other words, because of the borderline’s tendency to “split.” After all, borderlines have tenuously established “libidinal object constancy” – tenuously established “evocative memory capacity” – which means that, in the moment of upset, the once all-good object becomes all-bad. Pre-ambivalence.

 

By the way, splitting explains the borderline’s notoriously defective capacity to internalize. In the moment of upset, the good object becomes all bad because the borderline cannot evoke the memory of the good that had been – she cannot remember it – and can therefore not internalize it.

 

To illustrate Fairbairn’s conviction that bad objects are ambivalently cathected –

A story that Guntrip (1973) recounts is that Fairbairn had once asked a child whose mother would beat her cruelly, “Would you like me to find you a new, kind Mommy?” to which the child had immediately responded with, “No, I want my own Mommy!” Fairbairn interpreted the child’s response as speaking to the intensity of not only the antilibidinal (or aggressive) tie to the rejecting (bad) object but also the libidinal tie to the exciting and potentially forthcoming (bad) object.

 

In any event, the third line of defense is repression, that is, (unconscious) repression of the ego's attachment to the exciting / rejecting object.

 

According to Fairbairn, then, at the core of the repressed is not an impulse, not a trauma, not a memory; rather, at the core of the repressed is a forbidden relationship – an intensely conflicted relationship with a bad object that is both loved and hated. Such a relationship involves both longing and aversion, desire and revulsion – although, because the attachment is repressed, the patient may be unaware that both sides exist.

 

What this means clinically is that patients who are relentless in their pursuit of the bad – exciting / rejecting – object must ultimately acknowledge both their intense longing for the object and their outraged hatred of the object in the aftermath of its failure of them.

 

It was therefore to Fairbairn that we turned in order better to appreciate that the intensity of the patient’s attachment to the bad object is fueled by ambivalence.

 

The Relentless Pursuit of the Sadomasochist

 

Although Fairbairn's claim is that he is writing about schizoid personalities, I believe that the manner in which he conceptualizes the endopsychic situation of these so-called schizoid personalities captures, in a nutshell, the psychodynamics of sadomasochistic patients.

 

In fact, my contention will be that the patient's relentless pursuit of the bad object has both masochistic and sadistic components.

 

Parenthetically (and importantly), my interest is not specifically in how sadomasochism gets played out in the sexual arena. Rather, I conceive of sadomasochism as being a dysfunctional relational dynamic that gets played out, to a greater or lesser extent, in most of the relentless patient’s significant relationships.

 

The patient's relentless hope (which fuels her masochism) is the stance to which she desperately clings in order to avoid confronting certain intolerably painful realities about the object of her desire; and her relentless outrage (which fuels her sadism) is the stance to which she resorts in those moments of dawning recognition that the object is separate and cannot be forced to be something it isn’t.

 

The masochistic defense of relentless hope and the sadistic defense of relentless outrage go hand in hand – and both speak to the patient’s refusal to confront the truth about the bad (immutable) object.

 

More specifically, masochism is a story about the patient's hope, her relentless hope – her hoping against hope that perhaps someday, somehow, some way, were she to be but good enough, try hard enough, be persuasive enough, persist long enough, suffer deeply enough, or be masochistic enough, she might yet be able to extract from the object (sometimes the parent herself, sometimes a stand-in for the parent) the recognition and love denied her as a child – in other words, that she might yet be able to compel the immutable object to relent.

 

And so even in the face of incontrovertible evidence to the contrary, the patient pursues the object of her desire with a vengeance, the intensity of this relentless pursuit fueled by her entitled conviction that the object could give it (were the object but willing), should give it (because that is the patient's due), and would give it (were she, the patient, but able to get it right). 

 

Please note that the patient's investment is not so much in the suffering per se as it is in her willingness to suffer (if need be) – because of her passionate hope that perhaps this next time...

 

Sadism is, then, the relentless patient’s reaction to the loss of hope she experiences in those moments of dawning recognition that she is not actually going to get what she had so desperately wanted and felt she needed to have in order to go on, in those moments of anguished heartbreak and outrage when she is confronted head-on with the inescapable reality of the object’s separateness and refusal to relent.

 

The healthy response to the loss of hope is to confront the pain of one’s disappointment, grieve the loss of one’s illusions about the object, and adaptively internalize whatever good there was in the relationship – a growth-promoting process described in self psychology as transmuting – or “structure-building” – internalization.

 

But the relentless patient does something else.

 

With the dawning recognition that the object can be neither possessed and controlled nor made over into what she would want it to be, the relentless patient reacts with the sadistic unleashing of a torrent of abuse directed – whether in actual fact or in phantasy – either towards herself (for having failed to get what she had so desperately wanted) or towards the disappointing object (for having failed to provide it).

 

She will alternate between enraged protests at her own inadequacy and scathing reproaches against the object for having thwarted her desire. 

 

In essence, sadism is the relentless patient’s reation to the loss of hope.

 

Clinical Vignette:  How Have I Failed You?

 

So if, during a therapy session, the patient suddenly becomes abusive, what question might the therapist think to pose?

 

If the therapist asks the patient, "How do you feel that I have failed you?" at least she will have known enough to ask the question, but she is also thereby indirectly suggesting that the answer will be primarily a story about the patient (and the patient's distorted perception of having been failed).

 

It is better, therefore, that the therapist ask, “How have I failed you?"

 

Now she will be signaling her recognition of the fact that she herself might have contributed to the patient's experience of disillusionment and heartache, perhaps, say, by not fulfilling an implicit promise earlier made or by refusing to acknowledge her unrelenting commitment to a certain perspective or by failing to admit to an error in judgment or by not admitting that perhaps she had mistimed an interpretation.

 

Indeed, the therapist must have both the wisdom to recognize and the integrity to acknowledge (certainly to herself and perhaps to the patient as well) the part she herself might have played in the drama being re-enacted between them.

 

The Sadomasochistic Cycle

 

In any event, the sadomasochistic cycle will be repeated once the (seductive) object throws the patient a few crumbs. The sadomasochist, ever hungry for such morsels, will become once again hooked and revert to her original (masochistic) stance of suffering, sacrifice, and surrender in a repeat attempt to get what she so desperately wants and feels she must have.

 

EMPATHIC GRUNTS ~ A Clinical Vignette

 

This vignette is about a patient who was relentless in his pursuit of that which, at least on some level, he knew he could never have but to which he nonetheless felt entitled – a man who had not yet confronted the pain of his early-on heartache in relation to his father. 

 

The patient, Mark, is a man who sought me out for a consultation several years ago.

 

He is a psychiatrist, had been in analysis for some eight years with a well‑known and highly respected local training analyst, and was feeling very stuck in his treatment. He explained to me that he was becoming increasingly dissatisfied with his analyst because he was not getting the kind of support he wanted and felt he deserved.

 

By way of illustration, Mark cited a time when he had gone to his analyst's office, had lain down on the couch, and had told his analyst in some detail about the very difficult day he had been having – he had had three admissions to write up, he had been reprimanded by the attending, when it came time to leave for his analytic hour he had found that his car had been blocked in by other cars so that he had had to take a taxi in order to be on time, in the confusion he had lost his wallet and had therefore needed to beg the cab driver to accept a check, and so on and so forth.

 

In his consultation with me, Mark expressed his outrage and his bitterness, protesting that all he had wanted from his analyst was an empathic grunt, some acknowledgement by the analyst of how frustrated and angry he (the patient) must have been feeling because of the horrid day he had been having. The patient demanded to know: "Was that too much to ask? All I wanted was a little kindness, a little compassion!"

 

Mark went on to talk about how his colleagues had confirmed his belief that if his analyst could not give him even this, then he (the patient) had no business remaining in such a disappointing relationship, that it was masochistic for him to be continuing in the treatment.

 

But as Mark’s story unfolded, I came to see things in a somewhat different light. Admittedly, it does not seem unreasonable to be asking for a bit of support, understanding, and comfort at a time when you are feeling overwhelmed and agitated. But for the patient to be looking for such support from someone whom he knew did not give that kind of support (although the analyst did offer many other excellent things), for the patient to be looking still, even after these eight years, for support from someone whom he knew had never given that kind of support – this is what caught my attention! This is what seemed to me to be masochistic.

 

Parenthetically, all of us in Boston who know and revere this highly respected training analyst know that he would never simply offer empathic grunts – Brilliant interpretations? Yes. Empathic grunts? No. That is not who he is!

 

So whereas Mark was thinking that it was masochistic for him to be staying in a relationship with someone who was not giving him what he so desperately wanted, I was beginning to think that it was masochistic for the patient to be wanting still that which he was clearly never going to get – and that the solution lay not necessarily in severing the relationship with his analyst but, first, in facing the reality that he was never going to get exactly what he would want and, then, in grieving this. The patient would get other good things from his analyst (and, in fact, over the course of their eight years together, had gotten all sorts of wonderful insights from his analyst) – but never the empathic grunts. 

 

Admittedly, I did also wonder a bit about the analyst's seeming refusal to relent, refusal to allow himself to be influenced even a little by the patient's impassioned entreaties. But, in this particular instance, I decided not to focus on what I suspected was the analyst's contribution to the stalemated situation between them. My fear was that were I to speak too much to the part I sensed his analyst might be playing, the patient might use this to reinforce his own rather entrenched position, which would then obscure the more important issue of the patient's accountability for his own relentlessness, fueled by his refusal to confront the reality of his analyst’s limitations.

 

And so I said that, at this point, I believed the work of the analysis involved Mark’s confronting, head-on, the excruciatingly painful reality that his analyst was never going to give him exactly what he wanted. I also said I suspected that the analyst was perhaps a stand‑in for one or both of his parents and that his experience of thwarted longing in relation to his analyst was the recapitulation of an early‑on (and never grieved) heartbreakingly painful relationship with a parent. 

 

Although in the first of his three consultation sessions with me Mark had said that (as a result of the work he had done over the course of the previous eight years) he felt he had pretty much made his peace with his parents' very real limitations, when I now framed the stalemated situation in his analysis as speaking perhaps to frustrated desire and unrequited longing with respect to one of his parents, he began to resonate with this. 

 

Somewhat shaken, Mark now (in the third and final session of our consultation) finally acknowledged that, indeed, he had always been frustrated in his desire to get recognition from his father, a narcissistic man who was chronically depressed and totally unavailable for support or comfort. As the patient now talked about his father, he began to express what he said he had always known (on some level) but had never really been able to let himself think or feel – namely, that his heart had been broken by his father's failure of him, his father's inability to respond to his desperate pleas for attention and love.

 

As our session continued, it became very clear that although Mark had given lip service during the eight years of his analysis to acknowledging how devastated he had been by his father's emotional remoteness, the patient had never really let himself feel just how traumatizing his father's inaccessibility had actually been for him.

 

Furthermore, the patient’s refusal to grieve that early-on failure was forcing him to relive it in the here-and-now of the transference and intensifying that early pain.

 

As we explored other areas of Mark’s life, we came to see that it was a recurring theme for the patient to be ever wanting from his objects the one thing they would never be able to give, a recurring pattern for the patient to be ever in a state of frustrated longing and thwarted desire in relation to the significant people in his life.

 

I suggested to Mark that before he made a decision about whether or not to continue with his analyst, he should use the analysis to make his peace with just how disappointed he was in his analyst. I told him I thought that in the process he would also be doing some important, even if belated, grief work around the emotional unavailability of his father.

 

In essence, I suggested that instead of immediately rushing off to another analyst in order to pursue elsewhere his relentless search for gratification, Mark should stay in the relationship with his current analyst at least long enough to gain insight into why he was always in the position of trying to extract the right thing from the wrong person, that is, why he was ever in relentless pursuit of the unattainable. 

 

Basically, I was telling Mark that I thought he would need to take some responsibility for the part he was playing in the unfolding of his life's drama, that he would need to take some ownership of his relentless hoping against hope that his analyst might someday turn out to be someone whom the patient knew (in his heart of hearts) the analyst would never – and could never – be, and that the patient would need, eventually, to confront the pain of his grief about his father and those he had then chosen to be parent substitutes.

 

In sum: It could probably be said that a patient's relentless pursuit of the right things from the wrong people is the hallmark of a patient who, refusing to grieve, clings to his relentless hope, his relentless entitlement, and his relentless outrage.

The Therapist’s Unwitting Seductiveness / Relenting

 

Over time, I have come increasingly to appreciate that when a patient is in the throes of her relentless pursuit of the therapist, it is usually a story about not only the patient but also the therapist. The patient's contribution has to do, admittedly, with her refusal to take no for an answer. But the therapist will often have been inadvertently contributing by way of her unwitting seductiveness – whereby she initially offers the enticing promise (whether explicitly or implicitly) of yes only later (whether directly or indirectly) to rescind that offer with no.

 

The therapist’s unintended seductiveness will have stoked the flames of the patient’s desire and then devastated the patient through her (the therapist’s) failure, ultimately, to deliver.

 

In other words, the patient's relentlessness is often co-created, with contributions from both patient and therapist.

 

The clinical vignette that follows is about an extremely gifted therapist whose unfortunate refusal to recognize her contribution to what became a tragically stalemated situation between her and her patient had disastrous consequences for the patient.

 

Clinical Vignette:  Heartbreak

 

Mary Nelson is a PhD psychologist whom I have known for a long time. Many years ago, Mary came to me for a one-shot consultation – at which time she presented with many borderline features and a dreadful early-on history of multiple traumas. But most striking was Mary's desperate desire to get better.

 

Twelve years later, Mary returned to me for a second consultation. She reported that for most of that time she had been working intensively in treatment with Dr. Rose – a wonderful therapist whom she had adored.

 

Over the course of their time together, they had done extraordinarily good work and were obviously an excellent match. Mary had gained considerable insight, had learned to tolerate intense affect and internal conflict, and overall had developed a much more solid sense of herself and her own capacity.

 

But Mary reported that her world had been shattered when, ten and a half years into the treatment, Dr. Rose had announced that in six months she would be returning to school for several years of postgraduate education, a time-consuming proposition that would require Dr. Rose to cut back significantly on the frequency of their sessions. It also meant that Dr. Rose would be much less available to Mary between sessions.

 

Dr. Rose and Mary did the best that they could to plan for the disruption to their work. But once Dr. Rose's rigorous training program began and she found herself consumed with her many new clinical responsibilities, Dr. Rose pulled back her involvement with Mary – and Mary began to come undone. In desperation, Mary kept reaching out to Dr. Rose for help – just as she would have done in the past. Dr. Rose attempted as best she could to respond to Mary's pleas for help; but eventually, as Mary's demands continued to escalate, Dr. Rose – unable / unwilling to devote either the time or the energy – became more and more defensive, angry, and withholding.

 

Dr. Rose told Mary that she would need to face the reality that Dr. Rose could simply no longer be available to Mary in the ways that she had once been; she suggested that Mary's relentlessness spoke to Mary's refusal to confront the reality of this – and that Mary needed to grieve this and let go of her unrealistic expectations. 

 

But Mary, unable to contain either her devastation or her outrage, was in and out of psychiatric hospitals over the course of the next year (for alcohol and drug abuse) – amazingly enough continuing, all the while, her own private practice of psychotherapy (admittedly with frequent interruptions).

 

After 10 hospitalizations, however, it became pretty much the general consensus that Mary and Dr. Rose, at least for the time being, should have only occasional touch bases. 

 

It was in this context (and with the encouragement of Dr. Rose) that about six months ago Mary – broken, frantic, enraged, confused, and desperate – returned to me. Although Mary was in a rage at Dr. Rose and in excruciating pain, it was obvious to both Mary and me how much she had grown as a result of the intensive therapy that she and Dr. Rose had done together. 

 

Since then, Mary has checked in with me from time to time. It has become clear that Mary's outrage at this point has to do not so much with the fact of Dr. Rose's decreased availability as with Dr. Rose’s refusal to acknowledge that she is no longer emotionally (and lovingly) available in the ways that she had once been. Whereas Dr. Rose's interpretive efforts continue to be directed primarily to Mary's relentlessness (as a story about Mary), Mary's enraged protest is that what she most wants – at this point – is for Dr. Rose to relent and to admit that Dr. Rose is simply no longer as invested in Mary as she had once been (and that Mary’s relentlessness is therefore a story about the relentlessness of them both).

 

Mary had kept a journal about her work with Dr. Rose – and her heartbreak. What follows are a few “snippets” of what she had written.

 

I remember your telling me that it would be safe to deliver to you what I feared the most.

 

I remember your saying over and over again so many times, "I'm not going anywhere; I am here to see you through all of this."

 

You said I would never again have to cry alone. 

 

You made the space between us so safe that I could deliver to you what so badly needed to be said and experienced. 

 

You wrote me notes that I could carry with me if I forgot that you were there. 

 

You said I could call, especially when the pain got to be too much.

 

But then came all the changes. I lost my balance and fell. 

 

Suddenly I couldn't hold on to you anymore. And the depression and the terror went so deep that I kept ending up in the hospital. 

 

People didn't understand why I couldn't just leave my therapy. "Simple," they said. "If it causes pain and it isn't working, then leave!" 

 

But I couldn't forget how it had once worked. I couldn't forget about all the time, the energy, and the effort that had gone into our therapy. 

 

But now I can't find you anymore. I don't know who you are or where you went. 

 

I have pulled inside and don't reach out to you anymore. And you don't lean forward in your seat to listen to me anymore. 

 

I do cry, alone – I cry because of all the pain. You promised that you would always be there for me, but you aren't. 

 

I am so worn out and panicked that you, as I knew you, are never coming back. 

 

I tear apart inside trying to get back to the place where we once were. I keep trying to find you but you are not there. I cry out – but you no longer listen.

 

I am broken and my heart is shattered. 

 

Are you gone from me? Trust me, this is not something casual – this is something so serious. It is the core of the work that needs to be done – but you are nowhere to be found. 

 

Again, it is not simply the fact of Dr. Rose’s decreased availability and emotional withdrawal that has broken Mary’s heart. Rather, at this point, it is Dr. Rose's refusal to relent and to acknowledge that she is no longer as invested in Mary that is so excruciatingly painful and enraging for Mary.

 

The Therapist’s Capacity to Relent

 

If therapeutic impasses are ever to be resolved, then ultimately not only the patient but also the therapist must be able, and willing, to relent… – and the therapist might well need to do it first.

 

…which is what I think I inadvertently did with Sara (the vignette that I had presented at the beginning), when I finally relented, broke down, and cried… – which then enabled Sara to relent – and she began to cry.

 

THE STRUGGLE TO ACCEPT AND FORGIVE

My Mom and Me

 

I present now a case vignette written in 2012 and entitled “The Struggle to Accept and Forgive.” It is actually a rather vulnerable story about me and it is a story about acceptance and forgiveness. It took me years to understand that the capacity to relent is ultimately a story about acceptance and forgiveness.

 

It is only somewhat with tongue in cheek that I offer the following, rather sober reflection: It’s because of the way my mother loved me that I feel I need to work as hard as I do, but it’s because of the way my father loved me that I can.

 

So what follows is a story about me and my mom, who died in 2003 at the age of 93. Parenthetically, my dad died in 2011 at the age of 98 – we kids all think he died of a broken heart, from missing our Mom so much.

 

So – to my story. On some level, I don’t think our mom ever really wanted to be a mother. It took years and years for Susan (my sister), Doug (my brother), and me to put our finger on it; but, ultimately, the three of us agreed that it was probably Mom’s reluctance to be a mother that made her so difficult. It was not so much that she did bad stuff as that she didn’t do enough good stuff.

 

Mom had started out in a promising career. An undergrad at UCLA, she had gone on to earn a master’s degree from Columbia University and had then worked, for a number of years, with the anthropologist Margaret Mead. But in her late 30s, after she had given birth to the three of us kids (we’re all two years apart and I’m the middle child), Mom decided by her own choice to shift to a less demanding job and to work only part-time so that she could have more time to devote to us.

 

Well, Mom performed her motherly duties, but we sensed that there was no real pleasure for her in taking care of us. She didn’t like cooking, she didn’t like doing the laundry, she didn’t like making the beds, she didn’t like housecleaning, she didn’t like picking us up after school. She did these things, but she didn’t like doing them. She didn’t necessarily say that she didn’t like doing them, but we knew that she didn’t. We did everything we could to help her out, but that still left a lot for Mom to do. And Dad had an extremely demanding job – which meant that most of the parenting responsibilities fell on Mom’s shoulders.

 

Mom was especially reluctant to take care of us when we were sick, so we soon learned not to get sick. I learned that lesson so well that I have never missed a day of work or school because of illness – except when I was seven and had chickenpox. Susan and Doug have held themselves to that same high standard. We did not want to burden Mom. Or, perhaps more honestly, we did not want to run the risk of being sick and feeling the pain of having Mom be only begrudgingly available.

 

Meanwhile, Dad, with whom I had always had a very special connection, was gently, kindly, and lovingly present but he was not a very dynamic presence in the household. He was either at work or, when not working, busy with his chess matches, his bridge tournaments, or his “contests.” So it was indeed Mom who assumed most of the “childcare” responsibilities, although she was also very involved in the community, the church, the school – for example, she was President of the PTA for many years.

 

Somewhat surprisingly for us kids, Mom and Dad actually had a very sweet, tender, and loving relationship. Of course the three of us kids gave Dad (and his capacity to accommodate) the credit for that. But Mom and Dad had a pretty wonderful 65 years together including their daily “Happy Hour” before dinner (always half a glass of wine for each and their 65 years of Scrabble for which they kept a running tally – in the earlier years Mom the high scorer, in the later years Dad the high scorer – and ultimately, by the time Mom died, a tie) and always their hour of reading to each other before bed.

 

But again back to my story. Meanwhile, and this was the killer, all the neighbors loved Mom, the mailman loved Mom, the cashiers at the bank loved Mom, everybody loved Mom. Particularly annoying for me was the fact that all my friends loved Mom. But that’s because they didn’t have her as their mom. She was, admittedly, a wonderfully interesting woman with a broad range of experience and interests and lots of fascinating stories that she was able to recount in a very engaging and often hysterically funny manner. And she was a good listener, remembering details about people’s lives and always interested in hearing more. People would confide in her, and she would offer them wise counsel. She was charming and gracious all right, but mostly to other people. On the home front, well, not so much. Susan, Doug, and I found her to be a difficult woman.

 

Yes, we knew she loved us very much – but she was so not warm-fuzzy…  

 

Fast forward many decades: Susan, Doug, and I have all created reasonably satisfying lives for ourselves. We all have life partners (at that point I had been with my dear sweet Gunnar for 33 years) but, sadly and tellingly, none of us ever wanted to have children.

 

During my 20s and 30s I spent years and years, in first therapy and then analysis, struggling, amongst other things, to make my peace with Mom’s limitations as a mother. But even after all my years in treatment, Mom was still an enigma to me. Unanswered was the question: “Does Mom know that she is more generous to the neighbors than she is to us?” Susan, Doug, and I just couldn’t figure that one out.

 

I worked extremely hard in my therapy to grieve the reality of my Mom’s failures as a mother but I’m not entirely sure that, even after all those years, I ever really came to terms with the pain of my heartache about Mom and the pain of my loneliness in the face of her lack of warm-fuzzy availability. Nor, sadly, did I ever really get to a place of wanting to open my heart to her or of enjoying my time with her. Fortunately for me, I guess, I was also working on, and accomplishing, other things in my therapy – but never did I really master the pain of the grief I felt about my mom’s reluctance to be a mother.

 

Again fast forward to 14 years ago and a weekend during the summer of 1998, when there was a big family reunion at Ogy, my family’s summer cottage on Keuka Lake, one of the Finger Lakes in western New York State. Mom was 88 at the time. Most of the extended family were staying at the cottage but Mom and Dad were staying at a small bed and breakfast close by, and Gunnar and I were staying at a hotel within minutes of their bed and breakfast.

 

Upon Gunnar’s encouragement, bless his soul, Saturday evening he and I made a surprise visit to Mom and Dad at their bed and breakfast. I had already spent time at Ogy with Mom and Dad and everybody else, during the day and all evening on Friday and during the day on Saturday. But Gunnar wanted me to have some extra, special time with my parents. I didn’t want that particularly, but my dear wise sweet Gunnar said he thought I should do it anyway. So I did. I just about always do what my Gunnar tells me to do.

 

Somewhat surprisingly, the visit, which lasted for hours, was wonderful. The four of us settled into a cozy parlor at their bed and breakfast and ended up having an absolutely fabulous time of it. We shared stories, reminisced, laughed, giggled, teased each another, talked about living, commiserated about dying; it was unusually intimate, delightfully enjoyable, and deeply healing. Afterwards, I held Gunnar close and thanked him from the bottom of my heart for having had the wisdom to know what I needed, and, perhaps, what Mom and Dad needed as well. 

 

The next morning Gunnar and I got up. Our plan had been to head directly back to Boston. But Gunnar said he thought I should visit my Mom again; this time it would be extra special because it would be just Mom and me (Dad was wrapping things up at Ogy) – and so unexpected. Gunnar dropped me off at the bed and breakfast and headed on to Ogy to join Dad and the few remaining others.

 

When the owner of the bed and breakfast appeared at the door and I told her that I had come back to spend some more time with Mom, this kind-hearted woman almost wept for joy and whispered excitedly, “Oh, I know your Mom will be so happy that you have come back to visit her again!” as she whisked me upstairs to my Mom’s room at the top of the stairs.

 

I’m not sure if it happened when I stood in the doorway to my Mom’s room or if it happened over the course of the next several hours of hanging out together and relaxing into each other, but what I do know is that as a result of our time together that wonderful day, something inside of me shifted and that, after years and years of holding it against my Mom that she had had so little desire to be a mother – especially during my younger, more vulnerable years – I softened inside. I guess I finally relented.

 

I might never have had this opportunity but for Gunnar’s wise intervention. It really was he who got me to the threshold of her room. But what happened next was something that I did, perhaps something that Mom and I did together. I stood in that doorway, looked at Mom’s frail frame in the overstuffed chair by the window, beheld her absolute amazement and delight at seeing me there, felt that something inside of me yielding, and, much to my surprise, I rushed over to Mom and enveloped her frail body in my arms. I think we both wept as we held each other close.

 

Mom and I then proceeded to have one of the most precious, most intimate, most loving, most profound conversations that I have ever had with anyone. For reasons not entirely clear to me, I think I was able, for the first time in my life, to step back from my need for her to be my mother. I had always looked at her through the eyes of a young and vulnerable child wanting a good Mommy to take care of her. Not unreasonable, I suppose, although, with respect to Mom, it wasn’t really her thing. As Karl Menninger once suggested, wanting the right things is reasonable but wanting the right things from the wrong people is unreasonable and a setup for heartbreak.

 

And remembering Elvin Semrad’s cautionary words – “Pretending that it can be when it can’t is how people break their hearts.”

 

But that warm, brilliantly sunny day in August 1998, I let go of my need for my Mom to be something she wasn’t and, after five decades of relentless pursuit, began to look at her through more loving and accepting and forgiving eyes. I had never really looked at her as the deeply wise and wondrously complex woman that she was, even if she was damaged in certain ways. I had always been filled with longing and she was the object of my relentless desire. Sadly, I had spent a lifetime wanting her to be something she wasn’t and would never be. 

 

But that amazing, transformative day in August 1998, when I stood in the doorway of that room, looked at my beautiful and vulnerable Mom, seated in her overstuffed chair by the window, the summer breeze billowing through the lace curtains, I guess I kind of fell in love with her. To think that she had been there all along, waiting to be found, and I had never guessed! I had been so caught up in needing her to be what I needed her to be, that I had lost sight of who she really was.  A little limited to be sure, certainly with respect to enjoying the mothering part, but an amazing woman nonetheless. And I felt so blessed to have found her. I had been so busy wanting and needing what wasn’t that I had lost track of what was. Thank goodness she lived as long as she did so that I could have that opportunity!

 

Gunnar and Dad returned. Mom and Dad, their bags packed, were in the car, ready to leave. We had already exchanged wonderful hugs but as Dad was about to back out of the driveway, I impulsively ran over, leaned in through the open window on my Mom’s side, and kissed her again, this time on the lips. It was a very, very sweet and memorable moment. I had finally made my peace with who my Mom was – I was finally accepting her – I had finally forgiven her. It had been years in the making, but the moment of relenting happened in a heartbeat. And it was amazingly easy.

 

For 50 years I had been searching for my Mom. But it was only once I had let go of my need for her to be a certain way that I was actually able to find her and accept her and forgive her and understand and appreciate what an amazing woman she was. And to think that I almost missed it because I was looking for something that wasn’t.

 

Mom died five years later. But she and I savored every moment of time that we had together during those last precious years.

 

Mom, I am so proud of you for having been, so unapologetically, who you were. Yes, you were pretty difficult during those earlier years, but I did always know how much you loved me – and how much you believed in me – and how proud you were of me. You always steadfastly advised me to shoot for the moon, reminding me that if I missed, I would still land amid the stars. 

 

Mom, I love you so much – and am so grateful to you for all that you did give me. You were always so much your own person – confident, strong, empowered, fearless, and wise. You paved the way for me by your courageous example, which has made my own pilgrimage through life so much easier.

 

I am reminded of a beautiful poem by Will Allen Dromgoole called “The Bridge Builder” (Doud 1931). It is about an old man who is nearing the end of his life’s journey and a fair-haired youth following behind him. For the purposes of my story here, I am using the old man to represent my Mom and the youth to represent me.

 

An old man going a lone highway

Came, at the evening cold and gray,

To a chasm vast and deep and wide.

Through which was flowing a sullen tide

The old man crossed in the twilight dim,

The sullen stream had no fear for him;

But he turned when safe on the other side

And built a bridge to span the tide.

 

“Old man,” said a fellow pilgrim near,

“You are wasting your strength with building here;

Your journey will end with the ending day,

You never again will pass this way;

You’ve crossed the chasm, deep and wide,

Why build you this bridge at evening tide?”

 

The builder lifted his old gray head;

“Good friend, in the path I have come,” he said,

“There followeth after me today

A youth whose feet must pass this way.

This chasm that has been as naught to me

To that fair-haired youth may a pitfall be;

He, too, must cross in the twilight dim;

Good friend, I am building this bridge for him!”

 

And by the time the end came and Mom looked back, I think she had few regrets. Over the years, when I, struggling as I was with this business of getting older and trying to create something meaningful along the way, when I would ask Mom if she would ever want to do it all over again, without fail Mom would say that she was so glad to be exactly where she was in her life, that she had no regrets, that were she to be able to do it all over again, she would have lived her life in the very same way, doing the very same things she had chosen to do the first time ’round. 

  

But there came a time, several months before her death, when, knowing that she was nearing the end of her life’s journey, Mom told us that she was ready to die. Though her mind was as sharp as ever, her body had become old and frail. She told us that she wanted to die – but that she was afraid. 

 

Mom, who had never before been afraid, was now frightened. But somehow, bless her, over the course of those several months prior to her death, she managed to overcome her fear of dying, eventually finding within herself the faith and courage to face her death bravely. And so she ultimately welcomed death, once she had decided that the time was right to go, and she let herself die.

 

It has been said that “Courage is not the absence of fear but rather the judgment that something else is more important than fear...” 

 

So, in the end, Mom was able to die as she had lived, with grace, dignity, and courage. I am so proud of her. When you’re able to do something that makes you afraid, that is truly what constitutes real courage. And Mom had that. 

 

For me, living has been so much less scary because of the way Mom was able to do it. And so, too, the thought of dying is now so much less scary because here as well Mom showed me how it can be done in a way that preserves one’s dignity. 

 

And because Mom was able to let us know that she was going to let herself die, it gave all of us the opportunity to say good-bye to her, to thank her, and to give her permission to do what she wanted to do, which was to choose the time when she would actually die. She and I had a beautiful last visit before her death. Thank you, Mom, for being you – for living the way that you did and for dying the way that you did – and for gifting me all that you did along the way.

 

Oscar Wilde (1998) once said, “Children begin [life] by loving their parents; as they grow older, they judge them; and, [when they become older still], sometimes they forgive them.”

 

Yes, it took me years to understand that the capacity to relent is ultimately a story about acceptance and forgiveness.

 

Internal Versus Relational Sadomasochistic Dynamics

 

And now to shift gears a bit (and to introduce a final concept) –

 

To this point, my focus has been on the way in which sadomasochism manifests itself relationally and we had used Fairbairn to help us understand the underlying endopsychic situation, namely, that the patient has both a libidinal and an aggressive attachment to the bad object (thus the ambivalence of her attachment and the relentlessness of her pursuit). This is a story about what I call “relational sadomasochism.”

 

I hypothesize that these same patients often have both a libidinal and an aggressive attachment to the bad self, manifesting as self-indulgence on the one hand and self-destructiveness on the other. This latter is a story about what I call “internal sadomasochism.”

 

As an example of internal sadomasochism, consider, if you will, a patient with a seemingly intractable eating disorder, one that compels her sometimes to binge (thereby gratifying her libidinal need to self-indulge) and sometimes to restrict (thereby gratifying her aggressive need to self-punish).

 

The vicious cycle might then go as follows: After the patient has been on a calorie-restricted diet for a while, she will begin to feel deprived, will become resentful, and will then feel entitled to gratify herself by indulging in compulsive overeating, which will then make her feel guilty and anxious and prompt her to punish herself by severely restricting her caloric intake once again, which will then make her feel deprived, angry, and entitled to indulge in yet another eating binge, and so on and so forth. A roller-coaster ride – iterative cycles of calorie restriction and anger prompting self-indulgence and bingeing / but then guilt and anxiety prompting self-punishment and calorie restriction – and so the self-sabotaging cycle of the perpetually dieting patient will continue.

 

In other words, sadomasochism can be played out either relationally (in the form of alternating cycles of relentless hope and relentless outrage) or internally (in the form of alternating cycles of self-indulgence and self-destructiveness) – and, of course, relational and internal sadomasochism often co-exist.

 

On the one hand, when our focus is on what gets played out in one’s relationships with others, we speak of the masochistic defense of relentless hope and the sadistic defense of relentless outrage; on the other hand, when our focus is on the what gets played out in one’s relationship with oneself, we speak of the masochistic defense of relentless self-indulgence and the sadistic defense of relentless self-torment. 

 

When sadomasochism is played out relationally, the patient must ultimately confront – and grieve – the reality of the object’s limitations and arrive at a place of serene acceptance of the object’s flaws, imperfections, and inadequacies – having made her peace with the reality that, at the end of the day, the object is “good enough” – and having arrived at a place of appreciation and gratitude for who the object really is.

 

And when sadomasochism is played out internally, the patient must ultimately confront – and grieve – the reality of her own limitations and arrive at a place of humble acceptance of her own flaws, imperfections, and inadequacies – having made her peace with the reality that, at the end of the day, she herself is “good enough” – and having arrived at a place of appreciation and gratitude for who she, herself, really is.

 

CONCLUSION

 

In conclusion: Roberta Beckmann (1990) has suggested that “Grieving is nature’s way of healing a broken heart.”

 

A patient who is caught up in the throes of needing her objects to be other than who they are must be given the opportunity to confront – and grieve – the excruciatingly painful reality that no one will ever be for her the good parent for whom she has spent a lifetime searching – the good parent she should have had early on but never, consistently and reliably, did.

 

Before I wrap up – I wanted to say a few words about “grieving” itself.

 

Only more recently have I come to appreciate that genuine grieving requires of us that, at least for periods of time, we be fully present with the anguish of our grief, the pain of our regret, and the intensity of the rage we will experience when we are confronted with sobering, shocking, and devastating realities about ourselves, our objects, and our world.

 

We must not absent ourselves from our grief; we must enter into and embrace it, without turning away.

 

We cannot effectively grieve when we are dissociated, missing in action, or fleeing the scene.

 

We need to be present, engaged, in the moment, mindful of all that is going on inside us – grounded, focused, and in the here-and-now.

 

If, instead, we are in denial, unwilling to confront, closed, shut down, retreating, refusing to feel, protesting, or refusing to accept, then no real grieving can be done.

 

When people “refuse to grieve,” what they’re left with will often be simply their “grievances.”

 

So if all goes well, it will be within the context of safety provided by the relationship with her therapist that the patient will be able, at last, to feel the pain against which she has spent a lifetime defending herself, in the process gradually transforming both her relentless need to possess and control and, when thwarted, her retaliatory need to punish and destroy into the adaptive capacity to relent, to grieve, to accept, to forgive, to internalize what good there was, to separate, to let go, and to move on – and ultimately to evolve to a place of appreciation and gratitude for all the good that was (and is). 

 

Very much to the point here is a Japanese saying – True happiness is not getting what you want but coming to want <and appreciate> what you have.

 

The little bit of bad news will be the sadness the patient experiences as she begins to accept the sobering reality that disappointment is an inevitable and necessary aspect of relationship.  The good news, however, will be the wisdom she acquires as she comes to appreciate ever-more profoundly the subtleties and nuances of relationship and begins to make her peace with the harsh reality of life’s imperfections. Sadder perhaps, but wiser too – and more accepting, more forgiving, and more grateful.

 

Harold Searles (1979) has suggested that realistic hope arises in the context of surviving disappointment.

 

I close with the following –

 

I am here reminded of my favorite The New Yorker cartoon in which a gentleman, seated at a table in a restaurant named The Disillusionment Cafe, is awaiting the arrival of his order. The waitperson returns to his table and announces, "Your order is not ready, and nor will it ever be."

 

 

REFERENCES

 

Beckmann R. 1991. Children Who Grieve: A Manual for Conducting Support Groups. Learning Publications.

 

Fairbairn W.R.D. 1963. Synopsis of an object-relations theory of personality. International Journal of Psychoanalysis 44:224-225.

 

Guntrip H. 1973. Psychoanalytic Theory, Therapy, and the Self. New York, NY: Basic Books.

 

Kernberg O. 2000. Borderline Conditions and Pathological Narcissism. Northvale, NJ: Jason Aronson.

 

Rako S. 2003. Semrad: The Heart of a Therapist. Bloomington, IN: iUniverse.

 

Searles H. 1979. The development of mature hope in the patient-therapist relationship. In Countertransference and Related Subjects: Selected Papers, pp. 479-502. New York, NY: International Universities Press.

 

Stark M. 2017. Relentless Hope: The Refusal to Grieve. International  Psychotherapy  Institute  eBook – https://www.freepsychotherapybooks.org/ebook/relentless-hope-2/

 

Winnicott D.W. 1965. The Maturational Processes and the Facilitating Environment. Madison, CT: International Universities Press.