A Horneyan analytic perspective on couple therapy: a case study

This paper describes the study, diagnosis, and course of treatment of a marital couple incorporating Horney theory as a basis for understanding. The case illustrates how fundamental features of Horney theory--character structure, pride positions, attacks on the idealized image, alienated aspects of self, externalization and counter-externalization-can be illuminated in the expanded context of a specific other, the spouse, as background. In a marriage characterized by conflict, omnipresent struggles for authority, and malignantly destructive communication, the wife adopts a position of self-effacement externalizing expansiveness to her husband while the husband adopts an expansive-detached position externalizing both expansiveness and self-effacement to the wife. Externalizations from the wife include a form that has not been described in the psychoanalytic literature of the Horney school: indirect active externalization. As shown, the wife attributes an idealization of her husband to third parties. We observe, too, that the husband's reasonableness and the wife's emotional stridency have the effect of attacking the idealized image of the other. Defenses are mobilized in order to repair hurt pride reactions: for the husband, the wife's stridency is an assault on his sense of himself as a principled, virtous man. For the wife, the husband's reasonableness is experienced as an assault on her sense of herself as a caring wife and mother. In order to block their pride responses and attacks on each other's idealized image, which made conjoint sessions antagonistic and unproductive for a time, a "glass wall" technique was employed for some months that enabled each to speak to the other through me. I struggled against the temptation of siding with the husband's rationality and seeing the wife as secondary. I came to understand that the husband's reasonableness was oppressive for the wife. In order for the wife to feel understood empathically, I needed to fill the role of witness to her suffering over a long period of time. At the time this paper was prepared, I was attempting to explore the wife's fantasies and fears while supporting the husband's emerging self-affirmation and gradual recognition of how certain compelling dictates within himself require that his wife behave in a way that justifies certain externalizations as described above. A Horneyan perspective proves to offer a rich and practical theoretical framework to understand this clinical case, both in terms of diagnosis and treatment process. It enables the varieties of defensive maneuvers, particularly those connected to externalizing and idealizing, to be recognized, elucidated, and worked through in a systematic fashion.(ABSTRACT TRUNCATED AT 250 WORDS)