Monthly Archives: January 2019

Splitting and Triangulation in couples

“It has been very well researched that many gay male couples have open relationships. Discussing openly the guidelines and experiences adds to the trust they have in one another. However, open relationships sometimes lead one member to fall in love and think that he has found a better partner. Comparing a new and exciting partner to the old, reliable and established mate seems to be a form of splitting and triangulation. This often leaves one member devastated and the other guilty but moving on anyhow. How could ISTPD be used for both the couple and the individuals involved?” Good question!
The idealization in love is well known. We see what we love in our partner and have not yet met what we don’t like in our partner. And for a few days or weeks or months our partner “appears” to be the same as our fantasy. No wonder he or she is SO exciting. But then reality shows up eventually, and that ideal partner turns out to be real. Then we have the chance to divorce our fantasy and love our real partner, or divorce reality and keep looking for our fantasy. In this sense, the repeat “lover” is in love with a fantasy, unable to bear the mixed feelings that arise with a real partner and the inevitable disappointments that arise when we love the real and let go of the unreal.
When a couple is having conflict about this kind of arrangement, clearly we must examine what feelings are coming up that led them to split sex off from the relationship. What conflicts are they avoiding? Is the partner who is going out of the relationship feeling angry with his partner for withholding sex? Is the search for more “exciting” sex a sign of decreasing emotional closeness, an avoidance of conflict in the relationship? Is the search for sex outside the relationship a way to act out anger? Is the search for sex outside the relationship a desire for an ideal relationship? Is it a way to split apart love and sex? For the supposedly sexless partner, is agreeing to this arrangement a way to avoid the greater emotional intimacy that comes with sex? Is this detaching a way to avoid complex mixed feelings toward the partner? Is withholding sex a way he is expressing anger toward his partner? There are many possibilities here.
To find out where the conflicts are, the ISTDP therapist would look at areas of conflict for the patient or for the couple and then explore the feelings which they avoid. As the therapist explores those feelings, he will note what defenses the patient or the couple use to avoid feelings, bring those defenses to their attention, point out the cost to the relationship, and encourage them to face the avoided feelings as deeply as possible.
When the partner who leaves says he feels guilty, does he just have guilty thoughts, or does he really feel guilty and try to repair the damage he has done to the relationship. The idea of “moving on” can cover a multitude of reactions, most often denial, dismissal, and detachment. When the other person feels “devastated”, could that also be a way to avoid feeling rage toward the partner who left him? We can certainly understand “devastation” as one of his reactions. Don’t get me wrong. But if it’s not accompanied by anger at the lost partner, we would want to examine that absence. When the partner is merely “sexless”, is he also “emotionless”? Are there other ways he distances from his partner and from his own feelings? As we watch the responses to intervention, we will get a clearer idea of the conflicts in the patient and in the couple.
Rather than rely on our ideas about how relationships ought to be, we rely on the patients’ unconscious responses to our interventions. After all, every time we intervene, we invite an emotionally close relationship. The couple’s responses of feelings, anxiety, and defenses will let us know where their conflicts are, what their unconscious longings are, and who they really are underneath their professed theories.

How do I understand the anxiety symptoms in this patient?

“I have a question about the level of anxiety of one of my patients. He had a traumatic childhood, with a father who beat him regularly. He has had some jobs, but nothing stable, and he has lived a good part of his life in the criminal world. He abused various drugs, which triggered some psychotic episodes.
In therapy he has stopped using drugs while we have been building his capacity and confronting self-destructive defenses. We used to see dissociation, disturbed thinking and visual disturbance with just a low level of emotional focus. Now there is only a slight tendency to dissociation (which he is able to stop) and no disturbed thinking. He sighs and seems more solid with no regressive defenses like projection and splitting.
But he still reports visual problems at low levels of feeling, similar to what he experienced when he was beaten by his father (together with dissociation). So, I see signs of striated anxiety (sighs, tension) on the one hand and signs of C/P-disruption (the visual disturbance) on the other.
This apparent mixture of anxiety-levels confuses me. Could you could comment on that?” Great question!
Clearly, this patient has been fragile, given the dissociation, projection, visual disturbances, and disturbed thinking you saw in the initial phase of therapy. Working gradually to build his capacity, you have helped him improve. Now at low to moderate levels of feeling he sighs and, presumable, can also intellectualize.
However, when you go to higher levels of feeling you will cross the threshold of anxiety tolerance and at that moment he will begin to disrupt cognitively and resume the use of dissociation and other regressive defenses such as splitting and projection. It is not that he has these signs of striated and cognitive perceptual disruption at the same time. It is that his anxiety will move out of the striated muscles back into cognitive perceptual disruption when he crosses the threshold of anxiety tolerance. It’s just that this threshold is higher now than it used to be, and the words and feeling levels that trigger him to go over threshold are different than what they were earlier in treatment.
As an analogy, think about your work this way. Before, at 5% of feeling he would disrupt and dissociate. You regulated his anxiety, and you helped him bear 5% of feelings without dissociate. Bravo! But now, when you up to 10% or 20% of feeling, he will disrupt again and use dissociation again. Again, you will regulate anxiety and help him bear mixed feelings inside without dissociating. You will keep repeating this process at successively higher levels of feeling until he can bear 100% of his feelings without dissociating or projecting or disrupting. At that point, the resistance system of projection and the anxiety pathway of cognitive/perceptual disruption will be completely restructured.
Until that point, each time the patient crosses the threshold of anxiety tolerance, you will see the anxiety shift back into cognitive/perceptual disruption and the defenses of dissociation, projection, and splitting will occur again.
When reviewing your videos, examine the thirty seconds of video before the patient dissociates or has visual problems. Then you will learn either what you said or what the patient said that pushed him over the threshold. Now you will know the precise words or descriptions of feeling that he has to bear now without dissociating. Use bracing using those specific words until he sighs again.
When we are confused in these matters, it is because we don’t notice when the patient went over threshold and what triggered that shift. Study of your videos will allow you to analyze this in detail so that you become more attuned to the specific “dosage” of feeling he is able to manage and the “dosage” where he starts to have trouble. Then you can work at the edge of his capacity, while building it gradually.
He still has a fragile character structure, most likely. And that will remain so until he can bear 100% of his feelings without c/p or projection. Keep up the good work! Keep working slowly. Given the severity of his past symptoms and his past behaviors, I would guess that this will take a while. Be patient. Keep building capacity. He has a long way to go.
Take home point: the issue is not whether he is “in” striated or “in” cognitive/perceptual disruption. The issue is at what level of feeling does he cross the threshold of anxiety tolerance and shift into cognitive/perceptual disruption. This threshold is higher than it was, but it needs to be raised a great deal until he is able to bear 100% of his feelings.