Gary and Sandra were referred to us by their family doctor. They arrived together, twenty minutes early for their appointment. They were in their late twenties, and she appeared well groomed and dressed in a subdued fashion, while he presented well dressed but slightly disheveled. During the introduction, she was social and polite compared to his impatient and brusque manner. He was in a hurry, as his business needed his attention that day and he wondered out loud several times why we did not start earlier and dispense with preliminaries. She tried briefly to soothe him, and then gave up and sat quietly while we completed the paper work. In response to our inquiry, they stated that they were coming for counseling to help them recover from a marital separation following Gary's affair with another woman. They had been basically separated for most of the last twelve months, with two brief periods of reconciliation.
Their story unfolded, with Sandra telling the initial history of their twelve-year relationship. They had experienced a fairy-tale courtship, by meeting and summering at their families' cottages on the same lake. Both families approved of and fostered their relationship. Sandra and Gary attended the same university. Sandra studied health care and Gary economics. They agreed that they were very close and supportive of each other, and spent a great deal of time together. They shared the same values, particularly around family. They got married four years after they met, immediately after college graduation. They reported that things remained good between them as newlyweds, even through a major crisis, when Gary's father refused to support him financially in doing a master's degree at a prestigious university. Sandra was supportive and worked to financially support them while Gary went to school full time and started his own business.
By age 26, Gary had become a financial success. Sandra continued to pursue her career in health care and was somewhat less available to him as she worked shifts and weekends. Gary's career and financial goal were the major focus for the couple. Gary frequently made "killer deals" and was rewarded with a great deal of money. However, Sandra described the success as feeling precarious because he rushed into things and risked everything in these situations, and they roller-coasted on these highs and lows. They became incredibly successful and acquired a lavish and expensive home. This home was very important to Sandra, as her parents were divorced and she had grown up never feeling that she belonged anywhere.
Sandra worried about their security, and they began to fight about the risks that Gary took. They never came to any conclusions about this risk taking and their fighting. Sandra became very focused on her own work and the pride and enjoyment of her home. They said that they both wanted children but Gary felt strongly that they should wait until their mid-thirties and his first million dollars. They never resolved this issue either.
The couple had agreed that things had been rocky in the relationship for the past two years. During one of the financial down times, Gary had risked all of their personal assets, including the house, on a deal that was still in progress. That had started a cold war; they would fight, withdraw from each other for several days or weeks, and then make up when Sandra started speaking again and apologized. During this cold war, Gary began an affair with someone he met on a plane during a business trip. The couple agreed that what happened next was a rapid series of events where they both reacted badly and said things that they didn't mean. Gary was frantically busy and Sandra was more withdrawn and distant. Gary eventually felt he couldn't take the pressure and told Sandra about the affair. He left for a month and moved in with his girlfriend, who pressured him to end the marriage.
During the initial few weeks of separation, Sandra's gynecologist confirmed that she was eight weeks pregnant with their first child. Gary and Sandra talked briefly on the telephone and during one of these conversations Sandra told Gary that she was almost three months pregnant. However, she did not want him to return just for the baby's sake. His reaction was a mixture of joy and rage. He was furious with Sandra that she contravened his directive and felt manipulated. Yet at the same time he was overtaken by thoughts of having a child of his own. He returned briefly to the marriage for six weeks, and then left again until just prior to the baby's birth when he returned again for ten days. He remained under pressure from his girlfriend, his business, and his family. Sandra remained resolute that she wanted him back, but only on certain terms: give up the girlfriend, and get some professional counseling for their marriage. Twelve months after the initial separation, Sandra and Gary were living together again and wanted to enter into counseling. They felt that there was still a commitment to the relationship and they wanted to give it a try. They agreed to the assessment process with us, and we next arranged to see them individually.
Sandra was tearful as she told her story during her individual assessment session. She began by saying that she was still in love with Gary and felt a strong commitment to the marriage and her family. Her hurt and anger at his betrayal were evident as she spoke of the events of the past year. She described why she no longer felt part of the fairy-tale relationship. She felt she could get over these emotions and would eventually be able to trust Gary again. We explored her needs and what she envisioned her marriage and relationship would look like in the future.
However, she had spent a great deal of time thinking about this on her own in the last year. She needed the relationship with the other woman to end, and for Gary to have no further contact with this woman. She was willing to accept his word about this, and needed no further demonstrations. She wanted at least one conversation, to be able to discuss the affair and what had happened, and then she didn't want to discuss it again. She needed our help to do this in a safe way, as previous attempts had resulted in terrible fights between the couple. She needed them to become a family and she hoped that Gary would become more involved with the baby. She was not sure what this would look like in a practical sense. When asked about the business, she felt that she could be more supportive if she were treated as a partner and there were some limits on the amount of personal risk involved in Gary's business plans. Above all, she needed to feel safe and secure in the relationship. Sandra had grown up in a family with a fair amount of chaos. She was a middle child with two older brothers and one younger brother. Her parents fought frequently and finally divorced when she was eight years old. Sandra saw herself as being totally "written off" by her father, who lavished attention on the older boys and virtually ignored her. She saw her role as that of a substitute mother in the family, particularly when her parents were fighting.
She briefly gained her family's attention when Gary began to date her and everyone approved of the relationship. Her father was particularly pleased with Sandra and told her "not to lose this one." Indeed Sandra felt she had done everything possible not to lose Gary and in the long run it seemed to have had the opposite effect. She demonstrated some bewilderment but also some appropriate insight into her fears and behaviors in the marriage. There were no individual issues around her health, alcohol or drug use, or physical violence.
Gary was guarded and somewhat angry during his individual assessment session. He related that he felt pressured and cornered during the past two years by Sandra, his girlfriend, his family, and his business. He felt that he had the ability to do great things in his career if those close to him would be supportive or at the very least get out of his way. His grandiosity was mainly connected to his plans and abilities related to his business.
He stated that he and Sandra had been a great team initially and he didn't really understand her fears around the business, and took this as a personal reflection on his abilities, and therefore a great insult. He had relied on her enthusiasm and support and he had been very angry at her withdrawal. His angry stance was much more available to him than any guilt or remorse. Gary was willing to make a personal commitment to completely end the affair with the other woman. Although he had moved back home, he was still talking to the girlfriend each day by telephone. We told him that therapy could not proceed until he had acted on the decision to end the relationship and informed Sandra and us of the outcome. He was told that his decisions and personal responsibility for fidelity were critical to the success of his marriage and the therapy. He realized that at times the stress of his business was high, but that he thrived on being in high gear. He felt most alone when he didn't have anyone with whom to share his successes. He had alienated both Sandra's and his family in the last year, and had been frequently lonely but very reluctant to admit to these feelings. He had difficulty accepting his anger, although this was somewhat more comfortable than his loneliness.
He felt that he had been let down by those close to him, his father around supporting him in school, and Sandra when she questioned him about his business decisions. This was an old theme for him in that he was convinced that his family had never really appreciated him or his unique talents and abilities. He also felt that Sandra had withdrawn her support of him by focusing on her job, their home, her pregnancy, and the birth of their child. Gary thought that they had agreed to wait until later to have children, until they had established themselves and could offer more to their family. He considered this a joint decision, and thus Sandra deceived him. When asked about the future, Gary felt that they would have to revise their plan in order to reestablish their marriage, define their goals, and negotiate some of the things that he needed to accomplish. There were no other health, drug, or alcohol issues. His natural enthusiasm and energy were evident, and he was willing to enter into a contract with us for marital therapy. He phoned the office two days later to let us know that he had ended the affair and was not going to be contacting his girlfriend in the future.
Although their behavior over the past year had taken its toll on the relationship, we were struck by this couple's commitment to work on their marriage. We thought that with some education and fine-tuning the couple would be able to rework the relationship and meet their needs. We decided, therefore, that they were appropriate for couple therapy. Gary had a narcissistic personality disorder. He had initially made a good match with Sandra when he was more needy and she was rewarded by the caregiver role. Gary was vulnerable and could be easily wounded by Sandra's withdrawal, however slight or justifiable. He felt a major wounding by his father's refusal to support his education and, therefore, career plans and future. He also felt on shaky ground around the issue of his role and ability as a father. He had acted out in his business and in the affair some of his anxieties and showed behaviors that had caused him to be less accepted by, and connected to, those he needed. He demonstrated some guarded insight into these issues during the feedback session.
Sandra was very attached to Gary and was committed to the relationship. Her care giving of him in the relationship had been adversely affected by Gary's acting out. Sandra rightly felt that her needs around safety and security had to be addressed in order for her to maintain her critical caregiver role in the relationship. We encouraged her to be more clear about her needs and how Gary could meet them, and to set boundaries and expectations. We suggested that she clarify her other important roles, for example, her professional role and her role as mother. She needed help to get Gary's endorsement of the importance of the balance of these roles. We also encouraged her to articulate what should be done to help her recover from the affair and to reestablish her trust in Gary. True to form, Gary felt his needs had to be addressed first in order to move forward. Fortunately Sandra and the cotherapists were agreeable to attending to him first.
Once we had a therapy contract, the couple proved to be able to work effectively with us and able to struggle at home with each other to make significant gains. Gary and Sandra worked out the balance of individual needs and couple needs. It remained important to Gary throughout the therapy to have his concerns and needs addressed first. In fact, it became impossible to set the agenda any other way. However, this seemed to work, and Gary was able to address the acting out around the extramarital relationship and the risk taking in his business. Sandra was reassured and became more confident about balancing her own needs and those of Gary for her support. Gary's needs seemed to become much more realistic and the couple worked out the necessary emotional and financial boundaries. Their sexual relationship and physical intimacy improved and became more rewarding once their other needs were addressed in a more practical sense. The issue of family and parenthood had to be addressed and once Gary was clear about the importance of his needs being met by Sandra and her positive response, they became more able to discuss their vision of the future and parenthood.
Toward the end of the initial six sessions, they began to work out a new plan for their marriage. They agreed that they would postpone more children until the end of the five-year plan, and they would both be responsible for this boundary and for birth control. The couple agreed that Gary's career would be a priority, however, large decisions regarding their financial situation would be made together. It was important for Sandra that their home and living allowance be kept separate from business decisions and the risks involved, to give her own sense of security and the family stability.
The couple was seen in follow-ups at six months and one year. They continued to work at the balance that they had achieved in the relationship and felt satisfied with the marriage.
Although Gary had a narcissistic personality disorder, Sandra was basically a good match because of her more submissive caregiving personality. Our role was to educate them and help them identify their needs and to develop a realistic way of balancing them in the relationship. The strong commitment and attachment that Sandra demonstrated to the relationship, and her ability to attend to Gary's needs aided our efforts. He also matured during his "nearly lost it all" experience, slowed down his pace, felt gratified by his young child, and satisfied his attachment needs enough to process them through the framework of their relationship.
The couple felt that our positive approach had made them more hopeful initially, and once the crises had stabilized, that the safety of the sessions had allowed them to have a place to practice their new skills. Our decision to characterize their differences and complementarity had allowed them to keep perspective over the course of time and their maturation.
- Links PS, Stockwell M; The role of couple therapy in the treatment of narcissistic personality disorder; American Journal of Psychotherapy; 2002; Vol. 56, Issue 4.
Reflection Exercise #4
The preceding section contained information
about a narcissism case study. Write three case
study examples regarding how you might use the content of this section in your
How was Sandra a good match for Gary? Record the letter of the correct answer the .