An X-ray, or CAT scan, is designed to show what’s invisible to the naked eye. An X-Ray of a couple, in the therapeutic setting, exposes the anatomy of the couple, revealing what’s beneath the surface in the relationship. Sometimes the patient doesn’t like the results.
Amy: Periodically I have a session in my office that acts like an X-Ray of a couple or family, where the relationship patterns appear transparent. This case demonstrates a couple’s “complementarity”, or how they help to “create” each other. And what happens when something new tries to break through:
The Case: Mary and Alec first came to see me nearly two years after Mary had been diagnosed with an early stage breast cancer. Mary described the ordeal of her illness as a “wake-up” call, an urgent invitation to change whatever felt unhealthy in her life: She left her stressful job as a company CEO, and was considering leaving her husband of twenty-two years. They had two teenage daughters.
Mary, an attractive, carefully-groomed, big-boned woman in her mid-fifties, felt that she had been carrying a heavy load, and it was now time to lay her burdens down. According to her, she had always been the engine in her relationship with her husband; she said, “If I don’t initiate it, it doesn’t happen.” Her mantra became, “I’m done.”
Alec, on the other hand, was a highly competent guy, running his own software company, but with his wife he became like the proverbial ostrich-y, head-in-sand kind of husband. His wife’s breast cancer acted as a wake-up call for him too: He talked about how he needed to be more of aware of what Mary needed from him, and he emphasized his commitment to doing what he could to make her happy.
It became obvious pretty quickly how this couple created each other: Alec’s “forgetfulness”, i.e. not making dinner reservations as promised, not extending himself for Valentine’s Day or her birthday, all added up to making Mary feel unloved and worse, exploited. Yet these behaviors sounded strange, because in the session, Alex listened attentively to Mary, anticipated her thoughts, gave every indication that he was–-if anything–- overly tuned-in to her.
Their duet emerged as one where Mary’s relentless competence contributed to Alec’s negligence, and Alec’s neglect spurred Mary’s hyper-competence. They were both trapped in this cyclical pattern where Alec became convinced that he couldn’t live up to Mary’s standards so he “didn’t try”–or fought passive/aggressively. Meanwhile, Mary kept kicking him to “man up.” You get the idea.
Over the months I worked to make these patterns more explicit, sometimes challenging Alex for faking laziness in the relationship, which kept his “lovely wife”–as I called her at these moments– feeling uncared for and unloved. Or I tried to get Mary to see how her mistrust of Alec, her constant questioning of his competence, made it difficult for him to feel successful with her.
The first two months of therapy things seemed to improve slowly. Then I didn’t see them for several months since Mary assumed a new, demanding job which initially required a lot of travel. Eventually they returned to the couple’s therapy. Mary remained aggrieved at Alec, and still seemed quite ready to throw him under the bus if he messed up. “Man up!” was her favorite expression. She kept a long list of hher husband’s deficiencies, and he apparently cooperated by confirming her low expectations of him.
There was an additional, though largely hidden problem in this marriage: Mary had been in individual therapy for many, many years. Her therapist always felt like a strong presence in the room. Mary appeared to idealize this guy. When she talked about him, it sounded like love, like this was the guy who gave her what she needed. And, unlike her husband, Mary totally trusted this therapist. I thought to myself; “He’s ‘the good husband”; loyal, understanding, caring, totally there for you. A tough act to compete with.” (Mary’s husband was paying for these sessions.) I gingerly approached this topic, though Mary shut me down when I dared raise concerns about the impact these sessions on the marriage. As part of a professional reaching- out, I did try to contact the therapist, after securing Mary’s permission. She was sure he’d take my calls, “day or night”. He never returned my call.
The couple came back to to see me after several months absence due to Mary’s travel schedule. She began by talking about how one of their daughters broke her leg at a family retreat and had to be taken to the hospital for surgery. Though the vignette she described sounded extremely stressful, she recounted these events like an in-charge, high-powered executive, no pause for breath, no indication that she was exhausted from the weekend. I called a halt to the proceedings…”Stop!” I then said, “Mary, you must be exhausted, but I’d never know it by looking at you or listening to you.”
This was the first x-ray. Mary, talking non-stop, not missing a beat, holding up the house by herself while Alec sat quietly at her side. I asked, “Alec, can you help your baby relax? Can you help her to be off-duty?” Then something unexpected happened.
Alec–-haltingly, awkwardly–began to try to connect with his wife. Silent… at first hesitant to move closer to her…slowly, over the course of ten minutes or more…he put his arm around her. He stroked her arm. He leaned his head next to hers and kissed her on the forehead. Then he showed her his heart: He began talking about how “lonely” he is, how he wants her to lean on him, how he knows he can help her. He said, “I feel so useless with you sometimes. I love you and want to take care of you–I just want you to let me.” While he talked he held kept his arm around her, his head leaning into hers. Here was this big, emotionally shy guy, bearing his soul to his wife.
I learned more about Mary in this last twenty minutes that I had in all the previous sessions combined. She did not allow herself to bend, sitting stiff, guarded, not trusting her husband’s efforts, seeming to calculate the value of what he was giving her. But then–-just for one minute–-a smile, a real smile passed over her face, making her look twenty years younger, without armor; she looked like a completely different person. And then it was gone, replaced by the slightly disapproving mask.
All of the individual therapy in the world did not–-probably could not-–reveal what I just saw in that snapshot of the couple. Alec went out on an emotional limb and exposed his most vulnerable self. And Mary could not use it. Even a little bit. Well, maybe a little bit. This was something she did not know about herself, REALLY know. She did not know that, no matter how much she said she wanted Alec to take care of her, she had a great deal of trouble receiving love. She’s good at giving love, lousy at receiving it.
Mary responded with some psychological “explanation” from her individual therapy–fear of abandonment, fear of betrayal but she recited these explanations more as a shield, as a way to stay out of touch with her feelings.This is a strong example of what I see often; intellectual self-knowledge has limited value, especially in relationship. Words and intellect would never have revealed the depth of this problem for her. Words and intellect have in fact acted to prevent understanding, real understanding of how she much trouble she has allowing herself to be loved. And how this plays out in the real world, with a real husband.
I only saw them for a single meeting after this. Mary invoked her “travel schedule” to end our sessions, but I think she wanted out. Perhaps our therapy sessions felt too dissonant from her individual therapy experience. I felt sorry that I hadn’t helped these deserving people more, at least in the way I hoped to. I’m not sure what they got, if anything, from our meetings. Sometimes I find out later from a couple or family that our sessions resonate even when I feel like “nothing happened.” So there’s no way of knowing.
But, for me, the vivid imagery of this office x-ray is imprinted my memory. This couple was pushed to deal with each other beyond their usual limits, exposing the interpersonal illness beneath the surface. I hope they’ve found a way to use this experience, to deepen their understanding of themselves, and each other.