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How To Talk to Narcissist, Borderline, OCD (with Joan J. Lachkar)

Uploaded 3/4/2022, approx. 47 minute read

Okay, ladies and gentlemen, hurt people, hurt people, broken people, seek to be completed, like pieces of a jigsaw puzzle, they keep looking for the jigsaw.

Today I have the honor and the pleasure of hosting Joanne Yuta Lachkar, a pioneer and the mother of the field, in effect.

If Kernberg is the father, he is the mother.

And so, first allow me to introduce Joanne.

Joanne Lachkar is a PhD, she is a licensed marriage and family therapist in private practice in Encino, California. She is an affiliate member of the new Centre for Psychoanalysis.

And she is the author of a few seminal books.

First and foremost, The Narcissistic Borderline Couple. 1983 was the first edition, if I'm not wrong.

And then How to Talk to a Narcissist, How to Talk to a Borderline. The only one missing is, why would you want to talk to these people?

Then the V spot, V stands for vulnerability. We'll talk about, we'll discuss this a bit later.

The Disappearing Mail, I can attest to this.

New approaches to marital therapy and common complaints in couple therapy and How to Talk to an Obsessive Compassion, which is her latest book published this year.

So quite an impressive list. And many of these books have been groundbreaking. She has a second shadow career, but she's not so much in the shadow. She's pretty famous for it as well. She is a psychohistorian. She had published numerous papers and articles on marital and political conflict in the Journal of Psychohistory, front page and family security methods.

In addition, presenting a paper on the psychopathology of terrorism at the Rand Corporation, a paper I've read and cherished.

So this is Joanne in less than a nutshell. There's a lot more to her than this.

She is also a trained classical ballet dancer. And not surprisingly, it had impacted and informed her approach, as you will see further off.

So this is going to be a fascinating journey.

Joanne is one of my idols. She had affected my work considerably over decades. And as I said, I regard her as the mother of the new approach to cluster B personality disorder, Kernberg being the father.

Quite a couple.


And the first question I would like to ask is, Joanne, could you tell us about your pioneering work and the people, the scholars who had influenced this work? Who are the influencers?

Well, first of all, I want to thank you, Sam. It's such an honor to be doing this discussion with you, especially presenting to the master. You have been a great influence in my life as well and in my groundbreaking work.

Anyway, I was, I like to think of myself as a pioneer, but actually there was someone before me. There was Henry Dix who wrote on marital tansions way back in 1957.

And then the first analytic couple in collusion was Martin and Bird who actually introduced us to the first analytic couple, the obsessive compulsive who hooks up with the histrionic or also known as the lovesick wife and the cold sick husband.

Actually way back in 1957, it was pretty common for obsessive compulsive men who are void of emotions to hook up with histrionic women.

Actually, as my mother would say, of all the disorders, the OCD is the best. At least they make the living.

So when I first started this work, there was a lot of flack and a lot of criticism.

No, you cannot analyze a couple. Psychoanalysis is meant for the individual and your stereotyping.

And this was very discouraging.

Then I went to a conference at UCLA and it was on couple therapy. And the presenter, we had a Q&A and I said, well, how about this dyad in terms of a relationship, a narcissistic borderline relation?

Oh, that's absolutely ridiculous. So I was so upset. I left the room and I went down to the UCLA cafeteria and I'm sitting there in a sober state. And one of my colleagues came and said, what's the matter? And I said, I'm just very upset and I'm writing these frantic notes about my couple. And she says, I think that's a wonderful idea. So I wrote it up and I sent it to England International Universities Press. Two weeks later, they gave me a contract. And then I was asked to teach at UCLA. That's another story about how I happened to write the book.

I'll stop right there.

Yeah, that's the narcissistic borderline couple.

The second edition was published years later, if I recall correctly. There were two editions later.

Apparently it caught fire or something.

But this work is an expansion of the narcissistic borderline couple.

As I was writing the narcissistic borderline couple, I tend to realize, hey, there's more than one type of narcissist and more than one type of borderline.

Of course, you talked about the malignant narcissist and Kernberg talked about different kinds of narcissists. So I wrote about five different kinds of narcissists and five different kinds of borderlines.

And of course, I got a lot of flak on that too. So I justified it by saying narcissistic borderline states traits, characteristics are not clear and concise entities, for they do tend to flow as back and forth and to seep into different disorders.

For example, there can be a pathological narcissist and malignant narcissist that you know very well, an obsessive compulsive narcissist and the same thing with the borderline.

However, the difference is the pathological narcissist or the pathological one. They are not cruel and sadistic and necessarily abusive. They may lie, they may manipulate, they may force everybody to prove their superiority, that they are, they have a special entitlement.

But they're not cruel. The malignant narcissist, when do we get into the domestic abuser, even the global abuser like leaders, which you probably read about in psycho history.

When you mentioned the ballet, can I say a few words about the ballet?

Sure. And then we will move on to the question.

Okay. Well, being a frustrated ballet dancer, I realized I could use some of the concepts from ballet and apply them to psychoanalysis.

So here is a couple that does the dance around them, a waltz interactions that go on and on, round and round, that are circular and never stop.

Each partner will project a negative, a negative feeling into the other, like someone like a borderline and how the other then identifies or over identifies which that which is being projected.

You can imagine how someone like a borderline who already has low self-esteem, a thwarted sense of self can easily be the target for the narcissist projections.

Yeah, we will come to that a bit later when we'll discuss your concept of the dance. I can repeat it. I'll do the dance with you.

Well maybe off camera.

I would like to start by mentioning something that has nothing or little to do with allegedly, ostensibly little to do with, with narcissistic borderline couples, but actually possibly it is at the core.

Recently, there's been a lot of talk about prolonged grief disorder. And I had suggested that the narcissist, what kind of disorder? Morning? Long grief disorder.

And I had suggested that the narcissist is a grieving and mourning child, a child who is grieving and mourning, unrealized, not actualized potential and so on and so forth.

But I wanted to ask you more generally, you keep saying that we should not confuse states of sadness, loss and mourning with depression. You even say that many therapists do that.

You said that sadness is normal and healthy. Depression is not. Could you elaborate a bit on this?

And then we will go straight into the narcissistic borderline conundrum.

I can't believe that you're bringing this up. This is such a huge point.

I cannot tell you. I mean, I'm not a psychiatrist. I'm not an MD. I'm pretty well informed about psychopathology and diagnosis, but I know for sure that when a patient comes in and they say immediately they're on medication and they're depressed. And then I hear their background and the history of abuse, molestation, abandonment, terrible trauma, post-traumatic stress disorder, which you make reference to.

And then I say to the patient, I'm not really sure that you're depressed.

Well, what do you mean? I've been evaluated with depression.

Well, can you sleep?

Okay.

Yeah, I can sleep.

Are you at loss of appetite?

I go through the whole criteria criterion.

No.

But you say you feel so sad.

Well, I feel sad because I'm depressed.

Wait a minute.

I think there is a confusion here between healthy normal feelings of mourning, grief, and sadness and depression. Of course, it can augment and go into a depression.

And to illustrate this point, I go through three phases of treatment.

I'm not going to do that now because I don't think we have time.

The first stage is shame, blame.

The second is more of an enlightenment.

And the third stage is awareness of the transgressions or wrongdoings.

And when it comes guilt and more of it and sadness.

One patient comes back to me after being in the third grade or phase of treatment says, it's just terrible. You just ruined my life. I used to be so happy when I was in middle school.

And now I go around crying and miserable.

Hey, wait a minute.

This is the healthy part of you. And this is the vulnerable part.

That's why I wrote the V spot.

Well, I hate being vulnerable. Why do you hate?

It makes me feel weak, impotent.

But this is the beautiful part of a man or a woman who can allow themselves to be vulnerable.

Look at Shuman and Sheba. He was a musician, by the way.

And that that was my approach.

And today, today I and other scholars, we are suggesting that perhaps many personality disorders, especially borderline and narcissistic, but not only are based on actually prolonged or extended reactions of grief, mourning what could have been, mourning the potential and so on and so forth.

And of course, Masterson and others, they had suggested that narcissism is a shame reaction, a reaction to shame, shame based reaction.

So I think what you're doing is very important to distinguish depression, which is a clinical entity from utterly justified and healthy reactions of sadness and grief, which is a form of processing.

So I wanted to start with this because there's a lot of pain and a lot of hurt and a lot of shame and a lot of brokenness in relationships between narcissists and borderlines and all other mentally ill people.

It's a very, very spot on point, because as you and I very well know that narcissists have a very difficult time with introspection, looking into themselves, that when they do, and they even face grieving, they have to face a traumatic background.

And I am the narcissist. I am perfect. I do not have any trauma in my life and any bad feelings I have, I am going to project it out onto you.

So they have a very hard time facing any vulnerability or any trauma that they've had in their lives, because they are so much into denial and so busy trying to protect the nascent self and face that they may have an imperfection.

As you know, the narcissist is the child of God, the child who is in the high chair with a crone on his head and cannot face any vulnerabilities. That's why I wrote the V spot, by the way, whereas that's very different than the borderline who will use their grief and their traumatic childhood and become the victim. And they form these parasitic attachments to other people through their victimization.

Even in court situations, like you talked in your book about court and the narcissist, they know how to win the hearts of the judges and the mediators through victimization.

So I don't know if I've answered your question.

No, no, it was more of an exchange than the question.

You definitely put your finger on something very important.

I think, medicalizing states of sadness and states of grief, depathologizing them is a crucial part of proper therapy.

And we are not doing a good job there. We are not doing a good job there. We tend to medicalize and pathologize many totally healthy and normal processing reactions.

So I want to move on.

Yes, please go ahead.


Well, that's the art of our work is to help the narcissist recognize that there's a distortion.

He thinks he's wonderful if he is manic and he denies that he refutes his vulnerability for the therapist to let him know that this is really the powerful part of him, not the weakness.

And the people who are most susceptible to these interpretations are artists like musicians and composers. They come in with a grandiose self and then you let them know that it and you bond with your musicality. That's where that's where we get that.

Yeah, the survivor part. The survivor part is the narcissist denies the survivor part.

He says I didn't need to survive. I was always omnipotent. I was always godlike. I didn't have to survive anything. I'm involved.

Okay, I want to go to your go back to your work.

You're at the focus of the interview, not me. So I want to go back to your work.

And what I want to do is tax your patients by reading extended excerpts from your work.

So these are excerpts from things that you had written, but they're so on point and they're so wonderful in their encapsulation of their disorders that I really must prevail on you. I must read them aloud. And they are absolutely wonderful takes.

So we start with the narcissist.

You say the narcissist be entitled. And this is Joanne La Chouchou. This is her text. And I'm quoting from them. She says the narcissist is the entitlement lover, the special child of God, also known as his majesty, the narcissist.

You know when you're around one, because all they talk about is themselves. They are dominated by a grandiose and exaggerated sense of self.

Believe the world owes them something and feel they are superior to others. They have excessive entitlement fantasies.

In court custody cases, they are the most difficult.

The other ones who feel entitled, they want all the visitation, the money or the furniture, narcissists value such things as success, fame, physical beauty, wealth, material positions and power.

The narcissist cannot tolerate having dependency needs and unwittingly project their needy selves onto the borderline.

According to Kernberg in 1995, narcissists cannot tolerate the kinds of dependency needs in an intimate relation. And they unwittingly project their dependent and needy selves onto the other, often a borderline with a perfect target for the narcissist negative projections.

In treatment, narcissists are the one who will quickly flee when they're injured, not appreciated, when confronted, not properly mirrored, or when their excessive demands are not met. They are always asking for special favors, changing appointment times, coming in only when it's suitable for them.

The narcissist cannot allow themselves the kind of dependency and intimate partner yearns. These are texts by Joanne La Chouchou, not myJoanne Lachcar, not my text to be clear.

Joanne says about the borderline, the victim, the abandoned one. She says, the key to handling borderlines when mediation with their partners bogs down is to understand the nuances and motivation of the borderline persona.

Borderlines are often as if personalities, and they have an exquisite false self. She's quoting Winnicott from 1965. They can dupe, borderlines can dupe the most seasoned therapists, let alone court officials with a facade of being the poor victims, the betrayed and the abandoned ones.

To defend against shame, borderlines are determined to win and prove their self-righteousness at any cost. They may appear normal, genuinely concerned about the welfare of the family. They're intelligent and often charming, but behind this facade, they scheme to coerce their partner into the bad parent role.

In psychoanalytic terms, this is known as splitting and projective identification.

So you distinguish between different kinds of narcissists and borderlines, and then you describe the dynamics of the narcissistic borderline couple, the narcissistic borderline relationships.

Can you describe to us what happens when they get together? What happens when there's a bond? You called it the dance, drama, the mutual projective identification. Can you expand on this a bit?

This is at the core of your time. I'm actually going to read what I wrote about the narcissistic borderline relationship. I can't seem to find it right now. Don't worry, take your time.

Okay, as you mentioned, this work is an expansion of my narcissistic borderline couple, where I describe what happens when the narcissist and a borderline get together in a marital bond, or should I say a bind, and together they do this psychological dance that goes back and forth.

Again, to repeat how each one projects a negative feeling into the other, and then the other one, just like a borderline, is a perfect target for the narcissist projection.

The revelation is that each one needs part of the other to go on with their developmental drama. In other words, each one stirs up some unresolved developmental issue in the other.

Because often people say, why don't you just leave them? Why do you just stay with a narcissist? Why do you stay with a borderline?

It is not so much the glue that holds them together. Actually they ask, how do they attract each other? God knows how they attract each other, like a fox to a rabbit. It's not so much how they find each other. It's what makes them stay is the glue that holds them together.

This is very important when they say, why do I stay with this person? The therapist has a wonderful opportunity. Well, it's not a matter of staying in the marriage, but this relationship stirs up many unresolved issues for you, communication skills, many developmental skills. Of course, they stir up remnants of old hurts and archaic injuries that they bring into their current relationship.

Well, you're just doing exactly what my ex did or what my ex-husband did. This is called, in simple terms, old baggage.

So again, these interactions get into this dad's or rondo that are ongoing, never ending. They go round and round. And this is what keeps them in the court system so long because they never are able to reach a conflict resolution, which is most frustrating not only for people in the court system, but people who love and live with them.

So if I were to say, what is the main, the main dynamic and treatment, I would say one thing and one thing only, it's projection.

How this is the heart of the matter. Again, how these projections move to and flow back, back and forth.

For example, a narcissistic husband will project a feeling of shame into the borderline life. You don't need a trip. You don't need vacation. You don't need to, we don't need to, you don't need anything.

What makes you think you're deserving of it and making her feel that she's worthless and not deserving of anything. And then she then attacks and attacks him. And then that hooks into his guilt, his harsh superego.

Oh, I'm less than perfect. Can I give you an example of the dance?

Of course, yes, absolutely.

He complains to the borderline. All you do is nag and nag, not knowing how to legitimately express her real needs.

The borderline continues to nag demand. The more she nags, the more he withdraws. And you know, withdrawal and isolation stirs up in the borderline, abandoned, obviously. The more he withdraws, she attacks. As she attacks, she hooks into his harsh punitive internalized superego of guilt. He ends up feeling guilty and she shamed.

Thus, it becomes a dance between shame and guilt.


I want to ask you, John, he ends up feeling guilty because he has this harsh inner critic, this harsh superego that she taps into and enhances. So he ends up feeling guilty. She ends up feeling ashamed, undervalued, unworthy, because he taps into her sense of shame and so on.

But shame and guilt are very negative effects. They're very negative emotions.

Why do they stay together? They make each other feel very bad. Why do they need to feel bad?

There's two reasons.

There's internal factors and external factors.

The external factors have to do with some semblance of reality.

Children, sometimes they can't afford to leave business, their work, their community, their family. That is the glue that holds them together.

And then there's an internal reality. How one identifies, how one identifies with an internal bad object that Fairburn talks about.

Fairburn helps us understand why people stay in painful, conflictual relationships.

As my supervisor, supervising analyst Dr. Jim Grotstein used to explain very clearly and succinctly, it's better to feel the pain than to live in the abyss, the black hole, the emptiness. I'd rather slit my wrist, at least when I flip my wrist, I know that I'm alive, than face the abandonment.

This is a very severe borderline pathology, of course. So they stay because they bond to their internal objects.

What is an internal object? The betraying object, the abusive object, the unavailable object.

And so we could say, well, so what if they bond to an unavailable object? What has that got to do with the pain and staying in the relationship? What it really means is that they don't know how to internalize that.

For example, what the therapist could say, yes, that other person betrayed you because there's a part of you that feels that you betray yourself. We cannot control the external abusers or the betrayers or the unavailable people in our lives. But that's not where the power is. The power was getting in contact with their own bad internal objects, like the betrayal or the abusive. And that's where the power is.

So the borderline autonomies render a service to each other. They cater to these bad objects and to what you call what you call the visport or the archaic ones in secondary terms.

That is such a good point because it stirs up the new book that I'm writing is it sounds like a Harry Potter series, how to talk to a narcissist, how to talk to a borderline.

Now I've just finished the book, How to Talk to an Obsessive Compulsive. And it goes back to that first pioneer who wrote about the histrionic couple and the obsessive compulsive husband.

Well, I have reintroduced that in my new book, because that is a beautiful example how each one needs some split off parts of the other.

The obsessive compulsive could use some of the histrionic emotionality of the histrionic and the histrionic could use some of his orderliness and and routineness and ritualists of the other. So they do they join together because each one needs some split off part of the other.

Now, the dilemma is, if I interpret that say to the obsessive compulsive, you know, you really need some parts some emotionality because your wife sees you as a cold fish. His response could be something like, what? And I don't want to sound hysterical like her. She reminds me of my mother. And then of course, that's where the work would be.

Well, that's not what we're talking about. We're talking about normal healthy emotions that you really feel are dirty and disgusting. And that's probably why the obsessive compulsive cleans so much because that is this internal dirtiness that they're trying to get and get rid of.

Could we say that there is a process of merger or fusion between these two? They outsource ego boundary functions to each other. They kind of merge in some way, they become one. So I could already there are already merged. In fact, that's what I mentioned in the book. There is in the first phase of treatment, that is where the merger is. There is no distinction or differentiation between self and other. I am her and she is me and she is me and I am her.

By the way, I just want to say when I say he is the one who's the abuser, he is the one. The reason I do that is because being female, it's easy for me to say he did this and he did that. But please, the readers and the participants can always reverse it. It's just easier for me to instead of saying he, she or she, he or he, she, I just say he.

Yeah, I don't want John. This is the end of part one.


So I'm going to close part one. I'm going to send you another link by email and you would have to click on it and we will continue.

OK, that's owing to limitations, zoom limitations.

OK, so I'm going to terminate this session. I'm going to send you another link and you can log on, log in with the other link.

OK, do I close? Do I close you out? You don't need to do anything. I told you you just need to be. I don't need to do anything. No, I will do everything. I can just relax.

Yeah, you can just absolutely relax.

OK, I'll send you. Are you controlling me?

Yeah, of course. I'm a narcissist. I love it. I don't mind it. I love it. I will send you another link in about 10 minutes time and then you could click on this link and we will continue the conversation.

Soon.


So John, I wanted to ask you, you suggested the concept of V sport or vulnerability sport and you had equated it with the old psychoanalytic concept of archaic wound. Could you give us examples of the archaic wounds of the narcissist, of the borderline, translated from an abstract concept into kind of day to day to day experience?

I can't resist telling you how the V spot came into being. As I was writing, I can talk about the early archaic injury of the narcissist, the early archaic injuries of the borderline. The archaic injury for the narcissist is that he was the king of the high chair until the second child was born and all of a sudden the mother abandoned him and made the superstar into the next sibling. And the mother who does not know how to handle that, that child will spend the rest of his life trying to prove that he is mother's special child.

And so the same thing with the borderline that the abandonment issue becomes such a pervasive force that any time there is any semblance of abandonment, it is a provocation and it evokes an enormous traumatic reaction.

The same thing with the narcissist. When they are narcissistly injured, their V spot gets stirred up when somebody questions them or doesn't agree with them, that is the V spot.

So as I'm writing, I'm writing the vulnerable spot, the archaic spot, how each one has their own archaic and I got so tired of writing the vulnerable spot. I finally abbreviated and said the V spot.

So I thought in the middle of the night I was having a dream that I'm going to write a book called the V spot and then I started laughing. Nobody would ever write a book called a V spot.

So just for fun, I have a very good relationship with my publisher in New York, Jason Aronson and Taylor and Francis. And I sent Jason Aronson this proposal about the V spot. A week later he sent me a contract. He thought I thought it was a great idea. And I know I thought about it. It is a huge spot that even my manicurist will talk to me and say, you know, my husband really stirred up my V spot when he refused to, you know, take me out to dinner and said I was too needy.

So the question that comes up is, do these individuals have their own specific V spot? As I just mentioned briefly that the narcissist gets injured at the slightest provocation and will blow, but their defenses are different than the borderline when they get provoked. They don't just lash out or attack. They do sometimes, but overall, they do something even worse than attacking. They withdraw. They isolate themselves. You can imagine what that does for someone like a borderline personality.

The provocation for the V spot for the borderline is very, very different that whenever their issues of betrayal or abandonment gets stirred up, they attack. They lash out. They call each other all kinds of names. Sometimes they even get abusive and violent.

So the question is, and this is the OCD in me, is do each of these disorders have their own V spot?

In fact, I transferred this to my work with coscultural couples. Do countries have a V spot? Does one country say to the other, you know, Turkey to Greece or something, you really hurt my feelings? Yes, they do. It's a collective through the collective group fantasies.

So the narcissist, the pathological narcissist has their V spot. Lignant narcissist, they each have their own specific area of vulnerability that when provoked, it blows like a tsunami.

And when we say provocation, that leads me to the next topic. And the next topic is communication.

Before we go into interpersonal communication, I would like to read again an excerpt from Joanne Lachkar's work, an excerpt.

And so now that I had them talking to one another, says Joanne, what do they talk about?

As almost every therapist can attest to complaints, in common complaints that bring couples into treatment, published in 2014. Chapter four discusses how each personality type has a proclivity to their own subjective type of complaint, including various ways of listening or not listening. Couples think their issues evolve or revolve around sex and money, but more often they do about control, domination, edible rivalry.

The narcissist may complain when not being appreciated, the borderline when she's feeling abandoned, and the OCPD when things disrupt their sense of order. These complaints trigger many hurt and repressed feelings. Old archaic injuries steer up many old unresolved archaic injuries and vulnerabilities.

So the concept of the visport, which is an extension and expansion of the old concept of archaic wound or archaic injury, informs Joanne Lachkar's work when it comes to communication.

I mentioned at the beginning of the first part that Joanne had written a series of books, how to talk to a narcissist, how to talk to a borderline. The only book missing in the series is, why would we want to talk to these guys?

But okay, that's in her next book, I assume. But she has dealt, I think it's the most extensive body of work to deal with the issue of interpersonal communication when it comes to people with cluster B personality disorders.

How to communicate with these people?

And she came up with two languages. Can you describe these two languages for us, Joanne?

Well, first of all, I had all these narcissists now, and all these borderlines, and now all these OCDs.

So what do I do with them? Do I just throw them into a chapter and just let them fight among themselves?

So a good friend and a colleague said, you know, so much has been written about narcissistic borderline personality disorders. But not too many have actually talked about how to communicate with them, how to talk to each other.

So that motivated me to write, how to talk to a narcissist, which of course, 200 blank pages, or how to talk to a borderline.

So it may sound very narcissistic of me, but I developed two languages.

The first language is the language of empathology, which I have abstracted from Heinz Kohut's work on self psychology, addressing the self object mirroring needs of the narcissist.

And for the borderline, I refer to the language of dialectics, which addresses the splitting, the splitting needs of the borderline, abstracted, of course, from the works of object relations, mainly Melanie Klein, and beyond.

I'll give you an example of the language of dialectics. Patient comes in, doctor, doctor, I don't know what to do. I want to get out of this marriage. I hate my wife. She's a bitch. She's a terrible mother. She betrays me. Well, then why do you stay?

Oh, because I love her.

So then there's two parts of you, one part that loves her. This is the dialectic and the other part that wants to get rid of her.

Oh, but I get so mad and I get, I attack her and I, I fight with her.

So the response is that when all these defense mechanisms are operative, it's very hard to know what to do because the ego goes into dysfunctionality and you're not clearheaded.

So the ego is responsible for judgment, perception, reality testing. So it is not what, while these defense mechanisms are operative, it is not a good time to make a major decision.

And that is very soothing because then I mentioned that there's two, I was going to say, Sam, I can use that name. There's two Johns, one side that wants to get married and the ambivalent that wants to get divorced. And these ties size somehow need to integrate.

So the language of empathology, there are a lot of patients who really oppose that. They think it's ridiculous. It's just too much work.

For example, I had a patient who was married to a very very famous doctor, world famous. And he was always busy doing depositions going around the world. And she called him one day and she had twins and she said, honey, could you please pick up some diapers and some formula for me? Are you out of your mind? Do you realize how busy I am?

And she says, I just need some diapers and formula for these. I've been up all night. What do you mean you've been up all night? You don't do anything. I'm the one who works. All you have to do is stay home and take care of these little twins.

So she started to attack him. You're such an asshole. All you do is think about yourself.

And I said, using the language of empathology, you said, what?

She says, well, what am I supposed to say? Well, what am I about to say to you may not make me might make you feel sick.

Oh, honey, you are such a famous doctor. The world renowned. I am so proud and honored to be your wife. And I know how messy you are. And I just need I didn't mean to disrupt your world or schedule, but I just needed some takeout food and some diapers.

She says, are you crazy? That's too much work. Do I have to say all that? I said, you know what? It's more work if you don't.

Well, I have been criticized for this. And you can imagine why that I'm just giving a lot of BS and bullshit. But if you want to communicate with a narcissist, if something better comes along, I'm open to it.

But this is addressing his self object mirroring needs. This is building him up. You have to prepare him so he like a laser, then you can come in. And then of course, this is the same kind of approach would be for the borderline.

So avoiding, avoiding provocation, avoiding triggering the V spot. That's the language methodology. Yes. And it brings up another point. Sometimes the borderline will lash out and say something, you know, you're just a piece of shit. You're a terrible mother. You need to I hate you. And I want to divorce and I want to get rid of you. And then the borderline will respond back. How dare you call me all of those names? I'm a good mother and look what I do and blah, blah, blah, blah. And I say, you know, I don't think you know the difference between borderline venting evacuation, trying to get rid of a part of themselves, as opposed to serious thought. Oh, I never thought about that. So what do I do about that?

Here it goes again. Honey, I don't think you really mean that I can see that you're very stressed over your work right now. You don't really mean that I'm a terrible mother.

So using beyond concept of detoxification to detoxify the contaminants that intrude into the relationship and to transform aggression, anger, hostility, rage into Pavlov. I think that's beyond one of his most amazing formulations about the concept of moving from what he calls beta elements to alpha function.

Well, I won't get into beyond. He's impossible to understand, but I've tried. He's French. What can you do?

But that would render the relationship functional. Do borderlines want a functional relationship? Do they feel comfortable in a functional relationship?

Oh, that is an amazing question I'm thinking about Freud. Freud never knew or talked about the borderline personality disorder, but he did notice there was a segment of patients that would reach the pinnacle of success and suddenly would go into a massive regression.

And in clinical practice, we see, I call that sabotage. Children like borderlines who've had a traumatic childhood, who have been deprived of their childhood, deprived of fun activities, have had to be the caretakers for their families. These children then sabotage all joy and all good things in other person.

For example, my husband is supposed to go with me to my sister's wedding. And as typical at the last minute, he says, I'm not going to go. Well, but I'm going to feel terrible without you there. No, I don't feel like going. Or there's a there's a christening or a bar mitzvah, or a trip to Israel.

This woman was planning for months. At the last minute, he says, I don't feel like going. Well, what do I do with the tickets? What do I do with the kids? I just base the word sabotage really should be highlighted. This is key.

What happens in these in these relational dyadic bonds. It's a it's a it's a parasitic attachment, which is exactly.

And so I wonder, I wonder if we should facilitate these these pairings, these diets. We can teach borderlines and narcissists how to talk to each other definitely following your work. We can teach them how to do that.

But should we? It's a moral question.

Oh, that brings up another thing.

Okay, so here, I have them. They're talking to each other. So what did they talk about? They talk about complaints. And each, each disorder have their own, their own arena, a venue of complaints, they each, the narcissist will complain about this and the board.

So then after they complain, who's going to listen to these complaints, somebody has to listen, or not listen. So I didn't mention it in my, in my manuscript to you, but the works of Salman Ashtar wrote a book called psycho analytic listening. And I integrated that into my work.

He talks about like 10 different ways of listening, objective listening, subjective listening, interjective listening, counter transference listening.

So I, I expand on that after I talk about the, the, the complaints.

Yes, but my question, my question was more, more ethical or moral. Should we encourage two people who are basically dysfunctional and feed each other's pathologies? Should we encourage them to stay together? Should we teach them communication skills and protocols? Should we, or should we, on the very contrary, seek to, to break this parasitic bond?

That just recently happened in my clinical practice.

This woman is so upset with his borderline husband, because anytime there's the least provocation, he leaves, sometimes he leaves for three or four weeks and doesn't, doesn't come back. And you're seeing a family therapist and they all say, you know, you should just leave him. Well, she has, she has a little girl who has some, you know, challenges, some physical challenges, and these particular medical care. And so she, she just cannot leave for external circumstances.

So I said to her, besides that you're not really ready to, to leave until you practice these communication skills. Because when he calls you a piece of shit or tells you to fuck off, you then attack back. You don't know how to soothe him him or to mirror him and to let him know the difference between saying he's wants to leave and get a divorce as to a serious conversation about divorce. He's just eventing and getting rid of a part of himself to project fear and threat into you.

So until we practice these communication skills, it's really hard to know what to do and to see the real relationship, which is buried under all these defense mechanisms, which leads to the dysfunctionality of the ego. When the defenses are operative, it's very hard to see reality.

In my work, I call narcissists, I say that narcissists are selfless, which is pretty ironic. I say that they are selfless. It's pretty ironic because what I'm trying to say is that they're selfless because they don't have, they're so preoccupied with the stealth.

Yeah. And they're disabled, is disabled by their defenses. Actually, they don't have a functional ego and they outsource many ego functions and so on.

But you also need to mention the main trait is they have no empathy for the other person.

Here the borderline is the victim, she's crying, she's upset. They find that disgusting and to pay attention makes them feel like they're responsible. They don't want to be, they're perfect. Yes. They're as perfect as mother wants me to be. Yes. It's a very big problem because you keep saying that smart people make stupid decisions and they make stupid decisions because essentially the ego is suspended or deactivated by overwhelming defenses.

And I would like you to describe this a bit more if you can.

It's a very fascinating process. Isn't it amazing how smart people say and do stupid things?

I mean, we can all look into ourselves how we've all done that.

I contribute that to the works of Otto Kernberg, who is a master of the ego. Most people don't even understand even the most well seasoned therapist.

It's a very slippery term. It really doesn't mean that the person is full of themselves. It really means that the ego goes into dysfunctionality, especially when there's these defense mechanisms are operative or anxiety or post-traumatic stress disorder.

When the V spot is ignited, vulnerabilities, the first thing that goes is the ego.

So what is the ego responsible for?

Number one, thinking to perception, intuition, reality testing, and most important, judgment. For example, I'm having a minor fender bender and the police come and they say, what's your name? What's the name of your insurance? My name, my insurance. I can't think. My ego at that moment. 10 minutes later, oh yeah, I'm Joan Lashkar. My insurance is so-and-so and I get myself together.

But at that moment, since I've had some analysis, I can say, hey, I'm not stupid. My ego is just flooded right now and I can't think.

This has been a very helpful concept with patients who think that they're stupid or they can't think clearly and to point out the aspects of the ego is a very valuable tool that we need in our clinical practice.


In the footsteps of Henry Diggs and others, you have been studying recently another diet, another dysfunctional diet, which is the obsessive compulsive and the histrionic.

Can you elaborate on this a bit? That's new. That's a novel thing.

Well, to most of the public, even to me, by the way, that I'm well-versed in literature and so on, this was pretty new.

Yeah, I free-introduced that, but I free-versed it.

It's not always that the man is the cold sick husband and the woman is the love sick wife. Sometimes now, especially in today's world, the woman can be the cold sick wife and the histrionic male and together they do this dance. She has no feelings for me. Every time I mention emotions, she just says, oh, don't give me all that crap.

In fact, one patient said to me in a session, she was very OCD. She said, I said, why don't you tell me about your feelings and how you feel about relationships and how you feel about dating and what gets in the way of you dating? She says, what do you mean? I should open up that can of worms.

So the OCD has a distorted image of what constitutes in their internal world. This is the bonding with the bad object, with the dirty internal world. That's why OCDs are so preoccupied with orderliness and rituals and cleanliness and washing hands and isolation and don't touch because they feel they have a dirty that emotions are dirty.

So the question is, why do they feel they're dirty? Same thing, getting back to ground zero, the V spot.

To get emotional means to have feelings and that stirs up feelings of vulnerability.

My father was in the Marine Corps and he always told me, boys don't cry. So they put on a facade. But after a while, it no longer works for them and they do come to continuing therapy.

I had one patient, let's see, I'm going to disguise this. He was, let's stay an engineer. And he was obsessed with cleanliness and orderliness and everything had to be just perfect. And he would treat his relationship just like he was doing an engineering structure.

And so when we talked about, he would say things like, well, that's not that with my work. Well, this isn't about work. This is about an intimate relationship.

And there's a difference between being vulnerable in an intimate relationship and being an engineer. You don't need any feelings. But you do feel that your wife or vice versa, your husband, then contaminates you with her emotionality.

So that is the bond that keeps them together. He needs some of her emotionality. And as I mentioned before, she desperately needs some of his orderliness to calm her crazy histrionic outbursts.

So he experiences emotions by proxy vicariously through her.

What do you mean?

I'm asking the obsessive compulsive. He experiences emotions vicariously by proxy through the histrionic.

Yes, I, at least she becomes the emotion, the emotional compass for me. And as she becomes the emotional compass, which I desperately need, which I have abandoned long ago, or maybe never had, as much as I need it, I have to repudiate it and refute it because it disgusts me. She disgusts me. So she disgusts me. She's, she's dirty. She's emotional.

And then the next step would be to say that she's not, she's not your histrionic mother that you identify with.

Normal emotions. People do not get out of line with them. They are able to just express them very simply like an engineer. I feel this way. I feel that way. And you could use your engineering approach to organize your emotions and you don't have to act them out. Because I can understand, there is this fear that you're going to sound like you're wife. I want to stray off scripts for a minute.

And of course, there's the countertransference. I express emotions to you, but I don't yell. I don't scream. And yet I have expressed many emotions to you.

Oh, well, I like that. I wish my wife could do more of that.

So that's where the countertransference and maybe some of the emotions are going to be.

The countertransference and maybe some of the work can develop.

You believe in leveraging transference and countertransference in therapy. You don't regard them as contamination of the therapy, something that should be shunned and avoided.

Well, most analysts would be appalled that I use countertransference and analytic approaches, but we can't help it because a patient will come in and say, you're just like my mother. You just use me. All you want is my name and my time and you take advantage of me.

And then I have to interpret the countertransference so that you see me like your mother, someone who just uses me, but then you don't see the other part of me that generally cares about you.

So there's an opportunity to move beyond the countertransference.

But the countertransference, sometimes I'm just very open about it. Sometimes I'll just say, I'm having a countertransference reaction. Let me know and then I get invited in.

So I do use transference and countertransference.

Yes, I think these are extremely useful tools and it's unwise to discard them.

I want to stray off script and ask you a question that had not been agreed between us.


Um, ever since the 1960s, the profession is trying to medicalize psychology, to say that all these ideas about childhood and mother and upbringing and separation, individuation and, and old conflicts and all this is nonsense. It's actually all about genetics, biochemistry and conditioning, some kind of behavioral thing, you know, even CBTeven cognitive behavioral therapy is a form of, form of, you know, automated, automated approach to psychology.

So I want to ask you, do you, why do you believe that early childhood are bringing parental figures matter? Why do you believe they matter? Because overwhelmingly, unfortunately, the whole thing is being discarded in universities and so on. We are, we are told not to teach these things. They're not scientific. They're not established. They're not, they can't be true. It's total nonsense. It has to do with chemicals and with neurons and with genes. Everyone wants to be a medical doctor suddenly. Every psychologist wants to be a medical doctor. What, what, why do you think parents matter? Why do you think childhood matters?

Well, first of all, there's two approaches.

The old school approach was to get a gigantic history, the genealogy of the family, how this first began and do a whole psychiatric evaluation, but things have changed now.

Now we start with the material, what the, what the person presents. If they don't mention childhood genetics, we don't bring it up. We only deal with the material at hand.

Beyond refers to this is the patient coming in without preconception or memory or desire. And then something repetitive happens with the patient feels rejected or they have failure. And then we might say, well, where does that come from? Oh, it comes from my mother who we did.

Then we start inviting in the childhood, but we don't start with that. And then they bring up genetics and they bring up the DNA. Maybe it's inheritance.

You know, this all may be true, but that's not my job. My job is to deal with the psychological aspects and any of that you can deal with a neurologist or a psychiatrist or a psychopharmacologist. You can deal with medication, but my job is just to deal with the material that you present, which reminds me of the most frightening thing that terrifies us.

Most therapists is the affair. That is always very scary, but I start the beginning of every session before.

Oops, the gods of the internet have cut us off. I'm afraid that I can't hear you, John. Just a second. Let's see what's going on.

Oh, we've been cut off. John, your entire answer has been cut off. Could you start from the beginning? The connection fell. Could you start from the beginning, the affair? The connection fell must be very weak. I'm not sure why, but I can't hear you. I don't know why, but there's no connection. It's the morality police. Can you hear me? I can hear you now, yeah. Can you hear me? Yes, I can hear you now. The affair is every therapist nightmare. No, John, I'm sorry, but again, you're being disconnected. I don't know why. I'm happy with the affair, and I don't want my wife. John, just a second. Let's hold on for a second until the connection is stabilized, and let's try again from the beginning. No, I hear you. I hear you well now. Let's try again. I can hear you well now. There is every therapist nightmare. Somebody calls out of session, and can you hear me? Yes, I can hear you. Can you hear me? I can hear you now. During the session, but I'm having an affair. Well, the first thing I say to every patient or the patients before they start therapy is that anything that you tell me, I will not disclose. In fact, I have the privilege, as your therapist, to disclose anything that you tell me under the root of conjoid therapy.

However, I don't disclose anything. I only deal with the material that goes on in the session. Okay, the affair. There's three reasons why people have an affair.

Number one, it could be a one-night stand. One man even went to a massage parlor, had a blowjob, felt very guilty. Should he tell his wife? Well, that was not very significant. Or he went on a business trip, and some gorgeous babe walks in, and they have sex.

The second one is that he meets somebody and falls madly in love. And he maybe eventually even marries her, or has this affair and then ends eventually.

The third reason is that they feel insecure. They're not getting the satisfaction, the feeding, the nourishment, the intimacy, the sexual gratification at home. And because they feel neglected, and they will reach out.

The narcissist will have affairs because they are always looking for external self-objects to make them feel that they are really big and grandiose and wonderful. The borderline will often have an affair out of revenge, retaliation.

So those are the three basic ideas.

And I present this to the person who finds out that the husband of so many patients just come in horrified and crying. And it's very reassuring to know that you're the queen of the household. And this affair really meant absolutely nothing. And it's very reassuring, but it's still extraordinarily painful. They feel so abandoned.

Oh, I have so many stories about it.

Why does an affair do this to people? Even one night stands. Why do they have this inordinate effect on the partner, on people?

It's interesting. There are some women who'll say, oh, no, it wasn't a big deal. I love my husband. He's a wonderful husband. He's a great provider. And I was thinking of Clinton, Hillary Clinton. He had affairs, but he was a great provider. And she really enjoyed being first lady.

The same thing with this other president, I guess, maybe Kennedy. But there are other women who will take it as such a rejection of themselves. So I have to remind them you're still the mother. You're still his wife. And you are the queen of this palace. This is your palace. And he right now is acting like a baby husband. But that's not to take away from the importance of your role as a mother and as a wife. That is such an important role.

They love when I say you were the queen because they're so used to the narcissist being the king. Now I'm the queen. So I'm just giving you an outline of how I deal with the affair.

But I do not ever, again, the voice tells me out of session.

First of all, it gets distorted. Can you hear me? Yeah, I can hear you now.

But you are a couple of people.

Okay. John, I think we are losing the connection. And maybe it's a good time to say goodbye.

I think we covered almost everything. Can you hear me?

Well, I really want to thank you for inviting me into this.

A couple of therapy is a drama. It is an experience between the three people. And we're always performing and we're always on stage, which means we have to really deal with our own countertransference. And the curtain opens, the drama begins. And we hope that we can effectuate a new experience.

And with all we've said about narcissistic and borderlines, many of them do amazing accomplishments in music and science. And so we respect those to have to live, work and love with them.

Thank you. Thank you. Thank you, Sam, for inviting me in your most inspiring book.

Thank you. Thank you for your kind words. And it's been a privilege. And maybe we'll do it again. We have a lot more to talk about.

I would love that. Thank you. Thank you. Hopefully with a better connection. Take care. Thank you. Good to see you.

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