Where the Analysts Went Wrong: Part II

In the introduction to this post, I mentioned that a major problem with psychoanalytic formulations concerning the origins of personality dysfunction is that they presume that problematic interactions with parents and other family-of-origin members are only powerful in shaping personality functioning with young children.

When I first started getting interested in family systems ideas and started asking my adult patients about their current interactions with their parents and other members of their families of origin, it soon became clear that some of the interactions followed certain patterns than recurred again and again, and that these patterns served as triggers and reinforcers, as a behaviorist therapist might say, for the very feelings and behaviors that the patients were coming to therapy to try to change. 

Until I started asking about these interactions, as I described in my post Don’t Ask Don’t Tell, the patients had not described them in much detail. When they broke out in tears while telling me about them, however, it became hard for them to deny that the interactions were at least part of what was making them feel bad.

These were patients in individual psychotherapy, so I was not a first hand witness to these interactions, although later I found ways to see them in person. And my psychoanalytic and behaviorist psychotherapy supervisors had not discussed what to do about them.

It seemed to me that if my patients were just more assertive with their families, they might be able to change these problematic family interactions. The behaviorists had taught me about something called assertiveness training, so I tried that. The first time I tried it, I tried to teach a Chicana woman to stand up to her father. She wanted none of that. Wouldn’t even really discuss it. So, I thought, maybe it’s some sort of cultural force that I was up against in this particular case.

So how about with a patient from a somewhat more egalitarian culture? I taught an Anglo woman with traits of borderline personality disorder (BPD) to be assertive with her family. Her parents seemed to be subtly sabotaging her efforts to establish independence from them. When she was doing well, they ignored her. Or more like gave her the silent treatment and a cold shoulder. When she was in financial trouble, however, they were always right there to help out -although strangely they gave money to her teenage son rather than to her!

Every week in therapy she would dutifully practice assertiveness techniques, and would leave the session confident that she could address the issues with her family. The very next week, however, she would come back with her tail between her legs.  Her best efforts seemed to have been totally defeated, and she became even more unhappy than she had been, and even less self-confident.

I discovered that as a therapist I was absolutely no match for this woman’s parents in affecting her behavior, either for good or for ill. And it was not just her. I found out – again and again - that parents were way more potent influences on the patient than I as a therapist could ever be.

Behavior therapists do not seem to have figured out that the interactions of a patient and his or her family of origin are important triggers to many of the complaints that patients come to therapy with. Nonetheless, their behavioral interventions do often change certain aspects of a patient’s behavior, and therefore they feel that their patients are responding to treatment. In fact, if a patient’s family of origin is not too dysfunctional, they are correct. The patients change their behavior and the family basically accepts the change, so everything is cool.

But in significantly dysfunctional families? Not so much. The family therapists were right. The entire family will confront the patient in a variety of ways that all boil down to the message, “You are wrong, change back.” Many times I have even seen relatives such as aunts and uncles who previously had had little involvement with the patient come out of the woodwork screaming, “How can you do this to your mother?!?”  

Sometimes the situation would escalate to incredible extremes, with parents figuratively sticking their heads in the oven threatening suicide in response to the patient’s meager attempt at self actualization, or doing what they want and not what the parents seem to want. 

The psychoanalyst Karen Horney once opined that “basic anxiety” requires a sense of isolation from others, helplessness, and of being surrounded by hostility. Such perceptions and cognitions are closely related to attachment to others in one’s family system. The human brain encodes social events from the family exceptionally well, and is exquisitely sensitive to them.

“But,” I hear you protest, “a lot of patients with personality disorders are highly oppositional to their parents, seemingly doing the exact opposite of what the parents say that they want. So that theory can not be right!"

My answer to that: these people are oppositional to their parents because that’s what they think the parents need from them. The parents seem to need them to be black sheep. For a further discussion of this point, I refer you to my post about the role of the spoiler.

New developments in neuroscience are consistent with the proposition that parents can have strong effects on their children even as adults, even if they do not want to. Studies have shown that the perception of faces activates specific cells in the amygdala, which is the part of the brain responsible for fear reactions. Different cells there respond to different facial features, and certain cells respond only to one parent or the other. 

The amygdala is also strategically located for generating a rapid and specific autonomic nervous system and endocrine pattern in response to complex social signals. Lesions of amygdala in primates cause an inability to appraise social signals from other members of same species. An afflicted individual cannot distinguish whether another member of their species is coming towards them to fight with them or to mate with them. And again this is in adults, not juveniles.

In general, the attachment system seems to be one of the most important regulators of overall arousal. The amygdala is the first responder within fractions of a second; one’s initial fear orientation is not affected by conscious cognition. However, the signals then go to the other areas of the brain for further evaluation. Information regarding social context directly affects this appraisal process.

Attachment research indicates that the brain regions that compose the limbic system use input from the emotional states of attachment figures to regulate both internal and external responses. Individuals exhibiting so-called disorganized attachment have been found to have parents who display both frightened and frightening responses. 

In a sense, rage and panic are both communicated to and conditioned within the offspring of such parents. According to attachment researcher Mary Main, if parenting generates multiple, contradictory models of attachment, this creates a sense of insecurity in the offspring.

Complex limbic system reactions to the social environment have been found to be specific to important individuals within the family. Problematic reactions such as rage attacks can be seen to occur with one parent but not the other! If interactions with primary attachment figures are highly stressful over prolonged periods, this can have a profound effect on the development of a child’s brain that last a long, long time.

Early learning may be particularly difficult to inhibit. In general, it is much harder to unlearn fear than to learn it in the first place – a fact highly consistent with the experience of psychotherapists trying to extinguish chronic anxiety, particularly chronic interpersonal anxiety. 

Extinction of fear responses has also been found to be context specific. If a fear response is extinguished in one context, it may come right back if an animal is moved to a somewhat different environment. If the new environment is similar to another one such as the early family environment, fearful patterns of behavior learned early in life but inappropriate for the new environment may therefore be seen.

So, early influences are very powerful, but that does not mean that later experiences are inconsequential. When individuals grow up, their parents usually continue to act in ways that recapitulate social interactional sequences from the patient's early life experience. This parental behavior automatically both cues and reinforces old but engrained role relationship schemata (mental models of how to respond to different social cues).  

In turn, these reinforced schemata become more likely to be activated in the patient's current social interactions. This leads to reenactment and recapitulation of these patterns in other relationships. This is the basis of what Freud referred to as the repetition compulsion.

As I have described, parental behavior seems to be an extremely potent environmental trigger for previously learned social behavior. This most likely stems from the survival value of coherent group structure in evolution. As psychoanalysts have hypothesized, children internalize the values and role behaviors of their social system, and conformity to the group has in the past continued to have survival value throughout the life cycle.  

Parental behavior has such a powerful effect in triggering old schemata that it does not have to occur with any great degree of frequency in order for its effects to continue. In adults, the reinforcement of schemata occurs in a manner analogous to the learning theory paradigm of a variable intermittent reinforcement schedule. That is, the powerful parental behavior may be witnessed infrequently but unpredictably, leading the patient to continue to react rigidly in ways consistent with old role-relationship expectations.  

Final Destination: The Net Effect of Behavior

Continuing some of the themes of two of my previous blog posts, (Mad, Bad, Blind or Stupid from 7/27, and Is It Live or Is It Memorex: the Actor’s Paradox from 8/7 about the repetition compulsion, I would now like to discuss two other concepts. I refer to them as the Net Effect of Behavior and the Principle of Opposite Behaviors.


In the previous post, I brought up the question of why people would continue with the same disastrous behavior patterns over and over again with the exact same disastrous results if they are not mad, bad, blind or stupid. To answer this, we first must figure out exactly what the self-destructive or self-defeating behavior patterns are designed to accomplish. I previously used the example of narcissists who continues to make most other people think they are assholes. They seem to feel entitled and superior to everyone, but that may be a manifestation of just how good actors they are, because of the Actor’s Paradox.

To answer the question, one must look at the end result of their repetitive behavior. It is usually something that is absolutely obvious to everyone but them and the people who form intimate, romantic relationships with them. The spouses, lovers, etc are, I submit, co-conspirators, who continually make lame excuses for the seemingly nonsensical behavior of their partner. This idea is analogous to the AA concept of the co-dependent.

The fact that their excuses are so obviously lame – again to everyone outside of the couple – tells me that the co-conspirators are also engaged in the repetition compulsion, because I believe that they too are neither mad, bad, blind, or stupid.

The upshot, if you will, of seemingly irrational behavior is what I refer to as the behavior’s net effect. If the net effect of the narcissists' behavior is that most everyone thinks they are assholes, and if they are not mad, bad or stupid, then that must be what they are trying to accomplish. They must want, at some level, to be thought of that way.

Actually, in therapy we always find that they are in fact ambivalent about the net effect of their behavior. They seem to compulsively act in ways that produce the desired final result, but at the same time the results make them miserable, and they are well aware of that as well!

So why would anyone want to be thought of that way? Are such people masochistic? Actually, I do not really believe in masochism either, and would add masochism to the list of things that people are not, in addition to mad, bad, etc. Pain is meant to be a warning device that should in most circumstances lead to a decrease in the behavior that caused it. For pain to be pleasure in some people is not only Orwellian doublespeak, it makes no sense from the standpoint of evolution.

In order to answer the question of why compulsive repeaters act in seemingly masochistic ways, I would have to discuss the whole concept of kin selection, which I do in my books but will have to save until some later post to discuss in this blog.

First, a little more about the counterintuitive conclusions one must draw if one follows this line of thinking. In western cultures where other options are available, if a woman stays in an abusive relationship, or moves from one to another to another, at some level she is aiming to produce this result. OOH, how non politically correct of me! This does not mean, however, that it is all her fault that she is being abused, or that the abuser should get a "Get Out of Jail Free" card. It just means that it is also not true that she has nothing at all to do with her plight. Yes, of course the abuser may stalk and even kill her if she leaves, but he may also kill her if she stays. The longer she stays in the abusive relationship, the higher the risk.

I recommend listening to the lyrics of the Eminem/Rihanna song I Love the Way You Lie, a link to which is posted on my Facebook fan page.

A corollary to the Net Effect of Behavior is something I refer to as the Principle of Opposite Behaviors. One can accomplish the net effect of behavior using a wide variety of different strategies. There is always more than one way to skin the proverbial cat. Some of these strategies may on the surface appear to be completely opposite or contradictory. For instance, if you are trying to make sure that other people never give you what you need from them – the mark of counter-dependency – you can accomplish this by never asking anyone for anything. That way no one really knows what you need from them, so you never get it.

You can also accomplish the exact same net effect or end result by asking for way too much, way too often. If you are a bottomless pit who is constantly demanding the moon from others, they get angry with you. When they are angry like that, they will run from you, unless they are prone to being co-conspirators. That way, you never get what you need from these people. The exact opposite behavior produces the exact same net effect.

Well, what about the co-conspirators? Does the counter-dependent get what he or she needs from them? A third strategy to not get what you need from others is to ask for what you want from people who are unable to provide it for you: alcoholics, deadbeats, sociopaths etc. Oh, and narcissists! These people do not end up giving you what you need either; hence, once again you have accomplished what you have set out to do: not get what you need from others.

This dynamic may be what is behind a common type of couple seen by couples therapists, the narcissistic male married to the female with borderline personality disorder. But that too is a subject for another post. Watch this space.

Mad, Bad, Blind, or Stupid

A long time ago in a galaxy far far away, a Viennese Jewish man by the name of Sigmund Freud noticed that some of his patients would engage in the same unproductive behavior over and over again with the same bad results each time.  He called this phenomenon the repetition compulsion, and it has been observed over and over again by psychotherapists from a lot of different theoretical perspectives.  Some of them may have called it something else, but they were all observing the same baffling phenomenon.  Readers may have heard of the oft-told tales of, say, a woman with abusive parents who runs away and marries an abusive man, leaves him and then marries another abusive man, and so on over and over again.  Or another who keeps ending up with alcoholics, but only tries to meet men in bars.  Not to pick on women of course; some men have trouble, say, keeping a job because they keep picking a fight with a succession of different bosses.

Einstein said that doing the same thing over and over again but expecting a different result is the definition of insanity.  Are people who repeat the same self-defeating behavior over and over again insane?  I'm not talking about people who are psychotic here, so presumably they are somewhat sane.  Maybe they are just incredibly stupid?  If what they do hurts other people as well as themselves, maybe they are just evil.  Mad, bad, stupid.  Unfortunately most theoretical answers to the question of the reasons for the repetition compulsion presume that those who engage in it are one of these three things.  Interestingly, when the offspring of abusive parents talk about their parents' motives, they usually also attribute the parents' horrid behavior to one of these three factors.  Forgive them, for they know not what they do.

Freud thought that people repeated self-defeating behavior patterns because of unconscious motives, and were somehow not aware that they were contributing to their own misery.  The feelings were too frightening to think about and so, he opined, the feelings and accompanying thoughts became unconscious. I always wondered how people could miss the fact that their behavior was repeatedly having the same negative results.  Oh, you might rationalize what happened away the first couple of times, but then?  I would think that these results would make the consequences of specific behavior patterns rather salient.  Maybe it does make you nervous to think about it, but on the other hand, if your behavior repeatedly leads to your being hit over the head with a two by four, I think you would just have to notice.

This issue came up in a recent debate I got into on another blog called the Last Psychiatrist over the behavior of people labeled with narcissistic personality disorder (NPD).  Such people bully, dominate, and control other people, demand to be given special treatment by everyone regardless of anyone else's needs, and are constantly seeking admiration and approval.  Many posters to the blog thought these people were actually trying to get their way all the time, and were constantly striving to gain the admiration of other people.

Here is the DSM description of NPD:

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:


(1) has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)

(2) is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

(3) believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).

(4) requires excessive admiration


(5) has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations

(6) is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends

(7) lacks empathy: is unwilling to recognize or identify with the feelings and needs of others

(8) is often envious of others or believes that others are envious of him or her

(9) shows arrogant, haughty behaviors or attitudes.


Gee, if your starved for admiration, can you think of a worse way to obtain it than by exploiting people, being completely unempathic for the plight of others, and acting arrogant and unjustifiably self-important?  I can't.  The English language has a word for people that behave like that:  Assholes.

So, are NPD's too blind to notice all the people around them referring to them as assholes?  Too stupid to see how their behavior contributes to that designation?  Masochists who like to be thought of as assholes?  Wait, I thought they wanted admiration.  Well maybe that part shouldn't be part of their description.  Maybe they are just evil mofo's who want to bully people to get their way because they are selfish and sadistic.

Mad, bad, stupid.  A long time ago, but in this galaxy, and more recently than Freud, I began to wonder how I might be able to explain the repetition compulsion if I assumed that people are neither mad, bad, blind, nor stupid.  What a concept!  In the case of NPD, that could only lead to one conclusion.  For some reason, NPD's were making themselves look like assholes on purpose.  Eww.  Masochists, huh?  But how can someone really enjoy pain?  Pain is supposed to be a physiological danger signal that says, "Get your finger away from the hot stove!"  It is supposed to be unpleasant, almost by definition.  Emotional pain serves a similar function.  How on earth could people have evolved to be masochists?  That trait should have been killed off, as people who cannot feel pain frequently are killed precisely because they don't have a physiological alert symptom.

What a mystery, huh?  It is also very true that people who engage in self defeating behavior do not seem to understand that their behavior is getting them into trouble.  But can they really be that stupid?  Could it be that they are just pretending to be stupid?  But they are so convincing at it!  And why would anyone want to do that? 

Some of my earlier blog posts have hinted at what I believe the answers to these questions to be.  Stay tuned.  In later posts, I will discuss more about hidden altruism, something else I call the Actor's Paradox, and another something else I call the Net Effect of Behavior.  (Or you can read my first book, A Family Systems Approach to Individual Psychotherapy, in which I spell out the early versions of some of my ideas).