Thérapie brève difficile avec un couple chinois

Difficult Brief Therapy with a Chinese Couple

Jill Savege Scharff^*
[Received: May 20, 2025 – accepted: June 15, 2025]
DOI: https://doi.org/10.69093/AIPCF.2025.32.08
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY).

  

David Scharff and I were invited to a five-day teaching conference in China as a couple of senior therapists to offer a live demonstration of a 5-session couple therapy intervention , in a program directed by Professor Fang Xin of Beijing. We were to demonstrate and discuss our psychoanalytic technique, based on our integration of British Object Relations theory.

In this article, however, I do not give a comprehensive literature review because I need the space to tell the story of the intervention. I want to provide readers with a lush clinical process narrative of a difficult case, which can serve as a piece of clinical research into couple dynamics, a teaching resource for couple therapy students, and a corrective to the habit of presenting only “good” cases. Nevertheless, I do preface the story with a summary of the building blocks of the theory of our technique, and as the story of the process proceeds, I do cite references relevant to moments of therapeutic interaction.

 

Theory and technique

David Scharff and I developed our way of working with couples in the object relations tradition (D. Scharff & J. Scharff, 1992). Our approach is based on the concept of the joint marital personality (Dicks, 1967) which forms when two individual endopsychic structures, described by Fairbairn (1944) as a dynamic system of internal object relationships, intertwine in intimate relationship at conscious and unconscious levels through the unconscious mental mechanism of projective identification for defense and communication (Klein, 1946). We consider the couple relationship as a secure base to which the partners have complex attachment (Clulow, 2012; Fisher & Crandell, 1997). We work with the couple to take back and be accountable for parts of themselves that they have projected into the spouse who was demeaned or absurdly cherished; we free a blocked couple state of mind, or work to develop it anew (Morgan, 2018); and we set the couple in their sociocultural context using Pichon Riviere’s theory of the link (Losso & al., 2017; D. Scharff, 2016). Pichon Riviere held that the infant is born into a set of pre-existing links to the couple, the family, the social worlds of school, work and community, all of which impact the growing child; and the development of the child affects the links which change to accommodate the needs of the child. These links occur on a vertical axis connecting the child to previous generations of experience and on a horizontal axis connecting the child to the social world and culture. The couple stands at the cross of both axes, a vulnerable point and a fulcrum for transformation of the family’s future.

The couple and the treatment/teaching setting

An attractive Han Chinese couple in their mid-thirties, married for four years, gave us permission to share the process of their couple therapy to contribute to the education of clinicians and the field of couple therapy. To protect their privacy further, I have changed identifying details and given them the names Dr. Zhou and Mrs. Wu. They each kept their own family names as Chinese couples do. My co-therapist and I were to meet them for an hour on each of five days during the teaching conference. We were seated together with an interpreter between us and a large group of mental health professionals in the audience. As we began, Dr. Zhou greeted us saying, “It is an honor to meet you and to help you with your education program! Then I hope you give us some help for ourselves.” Mrs. Wu said: “We have high expectations of this.”

We experience these comments with some dread. Visiting experts are often loaded with honor and sunk without trace. It felt like a warning of what was to come. Instead of dealing directly with this, we moved too quickly to engage in inquiring about them.

First session

David Scharff began. When he asked the couple to tell us about themselves, Dr. Zhou stared at us, leaning forward in his chair; Mrs. Wu removed the enormous purse she held on her lap and took out her notebook and pen, as if ready to receive a lecture. We felt pressured to provide specific questions and instruction. So, David inquired how long they had been married. And when they said they’s be married for four years, he asked if they had a child. That seemed premature. Why would he take a shot in the dark like that? However, it turned out that he had divined an important issue. We learned that Dr. Zhou and Mrs. Wu are in their mid-thirties and although she had wanted a child, he did not, and now she does not want a child either. The couple displayed no emotion about this topic, but we felt tension in the room as they kept waiting for us to speak.

We realize that this situation is as strange for them as it is for us. We feel pushed into verbal action. But our denial of our discomfort with the setting prevents us from simply commenting on the strangeness and the difficulty of figuring out our roles. More exploration of the teaching context and a slower start might have helped us all get going with greater ease.

David asked again if they could tell us more about themselves. Dr. Zhou said Mrs. Wu should speak. Mrs. Wu obliged: “We’re both working in research.”

The couple goes on to establish their credentials in their respective fields of research. Perhaps, they view the consultation as a research project too.

Mrs. Wu continued: “After we were married in our thirties, he didn’t want to have a child. He gets into a bad temper over trivial things, and he doesn’t get over it. So he would find a child annoying. He doesn’t sleep well, but you can’t say anything to him about it. He says I don’t understand him, and I don’t. I don’t understand why he isn’t close to his family. When his parents stayed with us, of course I was preparing breakfast, and he felt pressured by me doing that for them! I don’t get it. He didn’t give his mother a present on her birthday, and he doesn’t want to speak to her on the phone. She isn’t allowed to tell him that she misses him.”

Dr. Zhou said: “She’s right. It’s all true. I’m trying, and I’ve improved 20% to 55% but it’s not enough.”

Mrs. Wu said: “He always has a goal. Why can’t he relax and enjoy being together? He puts too much emphasis on work. He finds fault with everything — my cooking, my laundry, and he gets angry about it. Then we quarrel, and he stays unhappy for a long time over a small thing. It’s painful to look at him.”

The couple defines the husband as the problem. He has an insecure dismissive attachment style, pushing his wife away and keeping us at arms’ length. He feels pressure to achieve and get things right. We sense that our attention must stay with Dr. Zhou before a focus on the couple may become possible.

Dr. Zhou agreed that he got upset like that, but he’s not like that all the time. He claimed that lately he has been feeling good.

“So, what makes you angry?” David asked.

“Different things,” he answered. “Soon after we met, we realized we were both quite old, and so there was pressure to marry. I’d been independent for years, even from my parents, for thirty years. So, I’m used to taking care of myself, and I’m not used to being with someone, and I’m not satisfied with this someone’s standards. She has a poor understanding of facts, and she does not do things properly. Her cooking and housework are much worse than mine.”

Dr. Zhou thinks of himself as competent and self-reliant but if Mrs. Wu does anything, such as cook for his parents, he contemptuously dismisses her (and the part of himself that he has projected into her). There is no differentiation between self and other.

Mrs. Wu disagreed. “My friends and family enjoy my house and my cooking. The problem is that he is too picky. And the other reason I can’t understand him is that he cannot explain properly what he wants. My mother was visiting one time, and she did his shirts. She put on stain remover and scrubbed the collar as usual. He said harshly, “Don’t rub it like that!” And that was the first time I understood how he thinks you should clean a collar — just let the stain remover soak in.”

David said to Dr. Zhou, “You are very unhappy with your Mrs. Wu’s caretaking of you, and you don’t want the food she offers you or the care she gives you and your work clothes.”

Dr. Zhou said it was worse than that. “She doesn’t understand me. She can’t tell whether I’m happy or angry, and then she reacts the wrong way at the wrong time. If I am happy, the food will taste good.”

David said: “Dr. Zhou, you complain that Mrs. Wu is not a good mother to you, but you describe yourself as a self-sufficient man who doesn’t want a mother.”

Dr. Zhou said: “I’d want myself to do these things well, myself.”

David asked: “Do you want a Mrs. Wu at all, or would you rather be alone?”

Dr. Zhou said: “No, I don’t want to be alone. But if a person can’t help me, then I’d be better off alone. I like being alone a lot, watching television, surfing the internet, meditating.”

David asked: “Has anyone ever understood you?”

Dr. Zhou answered: “All my friends understand me, and so do my colleagues. It’s in marriage that the anxieties began.”

We begin to worry about the intensity of the focus on Dr. Zhou. We want to hear more from Mrs. Wu but we wonder if we can build an alliance with her now without losing him and ultimately the couple. We remind ourselves that we have four more days to work toward our goal of a comprehensive couple assessment and, hopefully, an intervention..

I noted: “Although we are here to understand the couple, the two of you have defined the problem as Dr. Zhou’s problem, and that leaves Mrs. Wu out of our discussion.”

“No problem”, said Mrs. Wu. “His problems are bigger than mine. I want a child, but he doesn’t. My family and his family all agree the problem is him. I recover, but he stays upset. We took a personality test. He tests higher in the cognitive dimension, but he can’t control his emotions. I test high on emotional intelligence, not as high on cognitive. He has a doctoral degree, whereas I only have a Masters, but that is not so bad. I’m a very good driver but I lose my way whereas he’s very good at directions, and then he picks at me for not knowing the way. He’s not so picky with his friends. He’s a listener with them. He finds no fault with them. But he does find fault with his parents, and he doesn’t want to talk to them. So, they call me, and I speak to them, and only if he’s in a good mood will I dare to hand the phone to him.”

Dr. Zhou and Mrs. Wu engage in a comparison of their relative value to their research jobs, to family and to each other. She has contempt for his dismissive style, and she pushes him away too. They are drawn together by this valency and at the same time frustrated by this distancing joint marital personality (Dicks, 1967). Now we can see the projective identification that they are caught in, but we are still focused on Dr. Zhou. We feel the need for more information about his family history.

I asked Dr. Zhou: “What’s wrong with your parents?”

Dr. Zhou replied: “When I was 20, we had a big fight. They rejected my first love over a ridiculous reason, a piece of superstition, too stupid to mention.”

I persisted: “Like what?”

“Something silly. What they said was as silly as if they said that she was born in the year of the wrong animal. I fought them over it, and I left the house. I didn’t speak to them for eight years.”

Mrs. Wu said: “I think you should always solve things by negotiation. You don’t have to prove your parents are wrong. They love you anyway, and that’s what matters.”

David said: “There’s a mystery about what happened. You’ve told us they rejected your first love but not what was unacceptable about her.”

Dr. Zhou stiffened.

I said: “Perhaps you don’t want to speak of something so stupid, as if giving words to it would validate the reason they gave, and that you didn’t agree with. Perhaps it’s more important to know what happened to you and your love.”

Dr. Zhou replied: “I dropped my parents. And the woman and I agreed to break up.”

I asked: “Why did you give your parents so much power over your love?”

Dr. Zhou argued: “It was not their power over me. It was my piety to them.”

David said: “We’ve learned it’s very bad to go against your parents in China.”

Dr. Zhou replied: “In fact, I’ve been a good child financially. I’m just against them emotionally. I was weak back then, and I gave up. But they mistreated me and hurt me”

David asked: “And do they approve of Mrs. Wu?”

“Oh yes”, Dr. Zhou answered. “They were more than willing to accept her.”

Being acceptable to Dr. Zhou’s parents was a huge strike against Mrs. Wu. Unlike the earlier love, she does not express his rebellion against them. In China breaking family ties is unacceptable, but he refused to explain what had happened. He left the woman to honor his ideal of filial piety, a cherished value in Chinese society, but then he broke with his parents anyway. He did not want to cede power to them, but he did. We feel confused by the double message here. We feel impotent and redundant, much as his wife must feel. Dr. Zhou is married to a sense of injustice, which marriage to Mrs. Wu confirms for him.

David asked: “You’re still angry at them. Dr. Zhou, you’re angry at Mrs. Wu because she is acceptable to them. You’d rather hang on to your old love and your sense of injustice at its loss, than love the woman you have, a woman your family likes.”

Dr. Zhou said: “If this were two years ago, I’d say you were right. But that is behind us. I talked to friends about it, friends who are counselors, and they helped me. In fact 95% of the old problem is over.”

David said: “I hear that you’d like to move on, but I feel that you have not mourned the loss.”

Dr. Zhou argued: “Yes, I have. The only thing that keeps me back is an old habit and unconscious stuff.”

Here is a glimpse of awareness of unconscious factors we might be able to get to and work with to unlock the couple’s bind. We are thinking that the couple’s unconscious desire has been bound up in Dr. Zhou’s first love, and that if we could know more about that first love we might have the key to the couple relationship.

David said: “You are mad at your wife for not understanding that. But you don’t understand it yourself. Then she can’t wash that first love out of your heart or give you food to help your love of her grow.”

I said: “It is so sad. In its own way it’s as ridiculous, as incomprehensible, as your parents’ objection to your first love.”

Dr. Zhou shot back: “There’s no sense in going back over that. I’m happy now.”

We feel confused. The degree of disorganization in our thinking and manner of proceeding that we experience in our countertransference revises our hypothesis of Dr. Zhou’s dismissive attachment style as a disorganized attachment and their couple relationship as a complex attachment (Fisher and Crandell, 1997). David now finds a way to speak to our puzzlement over the double message we receive from Dr. Zhou.

David said: “You’ve been telling us you’re not happy. It feels as though you want us to understand but you won’t let us understand. That must be what happens with your wife. We say perhaps your parents’ actual words will help us understand their way of thinking and that would help us understand you, but you say you won’t discuss it. You say to Mrs. Wu: ‘Don’t touch the spot remover. That’s not the way the clothes are made clean.’ You say to us: ‘It’s not worth discussing it. That’s not the way it’s done, even though you’ve come to us as experts.’

Dr. Zhou said: “You can’t rub it like this. It’s just not crucial.”

I said: “Okay, we won’t rub it. We’ll soak it, and wait.”

Dr. Zhou said: “I could tell you their words right now. But it’s not important.”

Dr. Zhou wants perfect understanding, but he has not yet let us into his mind. It feels as if he settles for compliance, because understanding is so out of reach. We work on his sense of not being understood by his family and his wife, and we point out the contradictions, but he blocks us with his denial and keeps returning to the beginning with his repeated complaint. We realize that he needs time for his inner feelings to come out and for our way of thinking to soak in. At least for now, Dr. Zhou is unable to have a new experience with us, and we are unable to move beyond him to make space for the couple. The bad object in the marriage looms large and is projected into Dr. Zhou, but in his mind, Mrs. Wu becomes the bad object to be attacked and denigrated. She has a valency for this as a child of domestic violence. Is this a persecutory object that they eject into each other? Or is there a merger between their bad objects in which all is supposed to be known without being said?

Second Session

 

Mrs. Wu arrived at 1:50 pm but Dr. Zhou was not there. She called and he said he was at home because they were not due until 2:30 pm when in fact they appointment was set for 2:00 pm. We expected him to be late, but then he arrived on time after all. Ignoring his lateness and our inquiries about it, Dr. Zhou confronted us, “Was this counseling or demonstration? Are you here to teach, or to try and help us with our problems? The limit on time puts on a pressure to get it right.”

I agreed: “True, the time pressure may have made us go too fast yesterday.”

Dr. Zhou interrupted: “Or too slow. What if we don’t get anywhere? What happens after this week?”

I continued: “These sessions give you a chance to see if couple therapy can benefit you. Then one of our Chinese colleagues in this room will be available to meet with you if you choose to continue.”

Mrs. Wu asked: “Can you provide a way of dealing with our problems?”

I said that one way we help is by learning how experiences in their families of origin affect their view of each other in marriage. They argued about the importance we put on learning about their families of origin and said they could cover that topic in two minutes.

We think about Dr. Zhou’s lateness. It is a contradictory pattern we recognize as typical of his way of behaving, and one that keeps us feeling thrown off balance, too stupid to understand his meaning. We feel as if we always get things wrong with him. But he will not discuss it with us. Perhaps, he cannot tolerate our observations concerning the working of his mind because he does not know his own mind. Dr. Zhou and Mrs. Wu are together in putting us on the spot and in dismissing our expertise when we ask for family history to help us understand their relationship. They offer to give us a potted history but that will not help us. But the contradiction persists: Mrs. Wu expands on her family; and, then Dr. Zhou, first taking us on a detour, tells us about his. We will learn more than we expected.

Mrs. Wu took the floor: “As for my family, I’m the eldest girl, and I have a brother and a sister. My parents often quarreled, and when they did, I felt sympathetic to my mother. I had a bad impression of my father, but then he died, so I have to forgive him. My mother supported me all through my growing up. After the marriage I had a good relationship with my husband at first. Then, suddenly, he refused to get close to family members, but he worked on that, things improved, and he became his old self. He says that others don’t understand him, but I think something is wrong with his thinking style. He always blames me for not being able to understand but he has the wrong attitude about communicating. For example, today if he’d called earlier it would have been easy to sort out the time of the appointment.”

Dr. Zhou: “Everything she says is full of misunderstanding. Right here she said it would take only two minutes to describe her family but then it took longer as she got to other things. So, ask me anything about my family and I’ll tell you in two minutes.”

I explained: “If I ask a question, I will only get an answer. I’d rather hear about you and your family in depth, whatever you want to say.”

Dr. Zhou insisted: “I will give a two-minute history.” But then he changed the subject to enter into a prolonged argument with Mrs. Wu about his lateness and who misunderstood whom, until we were all confused.

Mrs. Wu asked: “What are you saying? No-one can follow your reasoning.”

I said: “Dr. Zhou wants to organize everything his own way, and he wants Mrs. Wu to do everything for herself. I don’t know how the two can go together.”

Dr. Zhou complained: “I’ve been trying to fix this problem my entire marriage. She is very poor at everything, and I keep hoping her ability will improve.”

David said: “I understand you feel that way. Now do you want to tell us about your growing up?”

Dr. Zhou complied: “I grew up in a rural setting, the eldest boy, with one brother and one sister. So, I had a similar family background, except that my parents didn’t fight and my father didn’t die. In school I was a perfect student. My education continued until I got a Ph.D. I now have important work in a research lab. I was over thirty when I met her. It was a good time to marry, and she was a good person. We married four months later but then I discovered her shortcomings. She was disorganized: her cognitive ability was poor, and she couldn’t do housework.”

Dr. Zhou’s discovery of Mrs. Wu’s faults after marriage is a projection of his own mental failings that he wants to clean up. We still need more family history to understand this.

David encouraged him to continue.

Dr. Zhou responded: “My family was like hers in that my parents didn’t know how to communicate with their children. My part is like my father’s. I wasn’t good at communicating or socializing but I have my own ideas, and I work hard.”

David asked: “What did your father do?”

Dr. Zhou said: “He was an engineer. He was very smart, and his academic record was excellent in high school. But when he took the national exam, the Cultural Revolution began; so there was no opportunity for him. He was a good guide for me, and he helped me with my exams for university. He always behaved nicely, but he never expressed himself. He suppressed his thoughts. So, he couldn’t deal with society.”

Mrs. Wu said: “My father-in-law was a good person but a poor communicator. At the family reunion he sat by himself all alone. All of us were eating dumplings, and he would only eat noodles. He never ate the same food as others. My husband has the same problem. In addition, he can’t sleep. We wanted to sleep together but we couldn’t; he was under so much strain.”

Dr. Zhou says that the families are similar, but he emphasizes the difference. He elaborates on cultural history as well as family history. In the years of the Cultural Revolution there was danger to the academics and no access to education for the youth of his parents’ generation while the government values the simple agrarian, domestic life (Scharff, 2021; Shi & J. Scharff, 2011). There was a prohibition on communication of dissenting opinion or desire for knowledge, and no trust in the help of others because the government might force them to betray you or your family (D. Scharff & J. Scharff, 2011). Against this background, we could imagine how Dr. Zhou learned to be so self-reliant, to compete with his wife for recognition of academic and domestic excellence, and to go off alone or with the gang of peers for self-soothing. He has also identified with a regime that wanted to control the functions of others as seen in his attempts to get his wife to comply with his demands. Mrs. Wu recognizes Dr. Zhou’s identification with his father. She goes on to associate the father’s habit of eating alone and eating different food from the family to her husband’s difficulty in sharing her bed.

We learned how the Cultural Revolution had affected his father. Turning to Pichon Riviere’s description of the link into which a person is born, we see Dr. Zhou’s connection to his father’s disappointment and isolation on the vertical axis of the link to the previous generation and we see the effect of disappointment on the horizontal axis of the link to his wife and his parents now (D. Scharff, 2016).

I said: “Not being able to sleep together is a strain on both of you.”

Dr. Zhou. said: “I need time on my own to think.”

I asked: “For self-reflection, or work, or personal concerns?”

Dr. Zhou said: “Personal.”

I suggested: “It sounds as though you’re doing your own treatment. How can Mrs. Wu take part in that?”

Dr. Zhou replied; “The way I reflect on these personal things includes how to improve our relationship”.

I objected: “But you’re reflecting on it without her.”

Dr. Zhou said: “That’s why I came here. I’ve been trying to pull her into my reflections for two or three years but she doesn’t want to.”

David said: “You don’t want her to join you at night, though you do want her to join the nightly reflection. It sounds impossible.”

Dr. Zhou said: “What I want her to understand is — what I think.”

David said: “But what you think occurs when she’s not there.”

Dr. Zhou said: “If she wants to hear what I think, then I need her not to participate. I could tell her what I have been thinking, but she would say it was strange and difficult. She is just not that smart.”

I said: “Dr. Zhou, you are thinking things that are hard for all of us to follow, not just your wife.”

We were contemplating the possibility of an organic illness with a thought disorder in Dr. Zhou. making it hard for Mrs. Wu to understand him and for us to reach the couple (Wanlass, 2014).

Desperate to break the impasse of the confusion, David asked suddenly, “Do you have any dreams?” He was feeling that dreams might give us a clearer picture.

Dr. Zhou said: “Yes, often.”

David suggested: “Tell us one, and let’s see if we can work on it together.”

Dr. Zhou replied vaguely, “I have lots of dreams. It depends on my mood and what I did that day. If I’m in a good mood, I have a good dream. If I am in a bad mood, I have a bad dream.”

David persisted: “Just tell us one.”

Dr. Zhou said: “I don’t have just one dream. I have it twenty times. I am working in the dream. I’m doing experiments, writing articles, and doing research. So, if this kind of dream happens frequently, it means I’m anxious about my work. I dream frequently about quarrelling with her, and that means the relationship isn’t so good.”

David turned to Mrs. Wu: “Do you have any dreams?”

Mrs. Wu replied: “I often dream, sometimes about work. I dreamt I was going to take an exam, and I couldn’t find the classroom. I dream about my father and my grandmother who died.”

David asked: “What about your grandmother?”

Mrs. Wu said: “My grandfather died when my mother got married, so my grandmother was a widow by the time I came along. She was a nice person, open-minded, and not quick to anger. The first five years I lived with her, and she took care of me because my mother worked. I was her favorite. She died at 88, the same year as my father. She was a lovely person, but my father was really difficult. He beat my mother, but not the kids.”

Dr. Zhou has dreams, many of them, but he does not want to tell them. Then he does tell one of them, but then does not want to play with it. He does not want to let us into his unconscious. To maintain balance, we switch focus to correct the skewing of attention on Dr. Zhou. Pursuing the royal road to the couple’s unconscious, David asks if Mrs. Wu has dreams. She summarizes two of them. She does not play with them either, but she does go on to give useful information about the death of her grandfather, and later of her father and grandmother who died the same year. Her grandmother was a good object for her. It’s common for a Chinese child to be raised by a grandparent until the child is ready for school. Her father was an ambivalent object who had been violent to her mother.

I noted the double loss of father and grandmother and was about to ask more about it, but Mrs. Wu went on to the topic of her parents and David got caught up in the image of the beating. He said: “It must have been frightening when you were a child to see your mother beaten.”

Mrs. Wu said: “It was very painful. They fought a lot. I kept silent about it because I didn’t want to draw attention to myself as a child with the family name of a quarreling parent which made me feel ashamed.”

I said: “So now you have a husband with a bad temper. Does he beat you?”

Mrs. Wu responded at length. “Only once last year,” she replied. “He said the refrigerator was dirty. I was always cleaning, and he was always blaming me for not cleaning well enough. He said: ‘You are 5% effective.’ This time, I said to him, ‘You have compulsions!’ He was so angry that he beat my bottom with his slipper. It wasn’t all that painful, but it was frightening. I said: ‘How could you beat me?’ He said: ‘So what!’ and pushed me onto the sofa. I said: ‘If this happens again, I will divorce you.’ For a week he didn’t want to go out. He said he wanted to change, and he promised he would never do that again. He invited my mother for Chinese New Year. So, things were better but I couldn’t forgive him. I’m afraid he’ll beat me again. He said it would never happen again. But he also said it was only a slipper, so it wasn’t important. I said it was dangerous. He said it was just a light push. I said I could have hit my head. The worry has faded now.”

I said hopefully, “So, he has earned your trust again?”

Mrs. Wu said cautiously, “I trust him a bit, and I hope he can control his emotions. Once when he was angry, he smashed a laptop.”

David said: “That’s a sobering story. Like his father and your father, anger is a big problem.”

Seeing the link on the vertical axis to Mrs. Wu’s parents’ marriage and on the horizontal axis its resonance to her marriage to Dr. Zhou, David mentions the connection. There might be an opening here to show the couple how Dr. Zhou’s violence proceeds from feeling violated and shamed, but it is near the end of the session, and in any case, Dr. Zhou now throws it back at us.

Dr. Zhou laughed and challenged David: “So what are you going to do about it?”

Dr. Zhou has no idea how to use us as attachment objects to help him feel safe and work with Mrs. Wu to understand the impact of their histories and resolve their issues. So, he resorts to magical self-reflection that takes no account of her, and he is demanding that we exercise magic for him. Mrs. Wu’s shame at her heritage where she bears the name of a family known for violence and drunkenness, her helplessness, and her inability to cure her family leaves her with an impaired ability to express or receive emotion. Now she is ashamed to find herself repeating the same scenario in her marriage (Levene, 1997) might have been describing the couple and our work: «The marital system becomes deprived, recapitulating the deprivation that each partner may have previously experienced with early caregivers” and our interventions consist of “repeated non-optimal responses of the sort that are reminders of traumatic failures from primary objects» (p. 125-126).

Dr. Zhou and Mrs. Wu do not have a ‘couple state of mind’ to help them reflect on their relationship, solve problems, show empathy and concern for each other, and plan for their future (Morgan, 2018). The closest they come to intimacy is to share rage over feeling persecuted and silenced by their family members, leading to inability to think. The privacy of the family is the only place where they can vent their grievances as if they were about personal failings and disorganized attachments rather than about the total disorganization of their culture. As Pichon Riviere would put it, their personal problem expresses the link on the horizontal axis to the sociopolitical dimension (D. Scharff 2016; Losso, Setton & Scharff, 2017). In our countertransference which becomes skewed toward Dr. Zhou, we are responding to a telescoping of cultural issues through each family of origin, to this couple, and from the couple into Dr. Zhou as the one with a weird way of looking at things and into Mrs. Wu as the repository for all that is ineffective. The sessions are a disorganizing, disarming experience for us.

Third session

The couple had not discussed the second session in their time at home together. Dr. Zhou wanted to think by himself and tell Mrs. Wu what would happen, instead of working it out together. She continues to feel that everything she thinks is wrong.

Dr. Zhou explained his theory. “When two people meet for the first time, the one will not know what the other is thinking. When they have been together for a long time, the one should know what the other wants and is thinking.”

Mrs. Wu said: “I’ve cooperated. I have a good attitude. I’m willing to communicate about everything, if he will just tell me what is on his mind.”

I associated to an earlier topic. “Mrs. Wu you mentioned having a child is on your mind.”

Mrs. Wu said: “Both parents wanted us to have children and I’m willing, but my husband said I’m not ready. I ask, ‘What bad thoughts can come from having children?”

Dr. Zhou said: “Can I say? One year ago I would have said for sure I never wanted children absolutely, ever. There are a lot of reasons I’m against it. But now 60-70% I do wish for a child.”

I asked: “What changed?”

Dr. Zhou said: “I listed all the reasons against, then all the reasons for. I was trying find more for and less against. It took time to work it out, but it was worth it. I’ll make sure that we have a child next year. But she keeps bugging me about it and that pisses me off.”

David inquired: “What are the reasons against it?”

Dr. Zhou redirected the conversation. “I need a longer time to explain that. I want to talk about my childhood. I was the cleverest one and I studied at the top university in China. After my Master’s, I found a job but I wasn’t fulfilling my potential so I pursued my Ph.D. but I was only using 20% of the energy on my research. I didn’t need to study a lot. So, I had time to think about things. I pushed my physical, mental, and social limits to see how far I could go – I was drinking beer and wearing clothes I never washed. I pursued my fantasies, writing articles about how society and the university could function better. I never thought about my personal interests. Then I married her.

Dr. Zhou values his command over himself. But to us, it seems regressed and out of control. Yet he was able to graduate.

“Our marriage can be divided into two phases,” Dr. Zhou continued. “First, I was never angry, but my resentment was building. I thought, ‘Why do we have this bad relationship?’ But I’m a nice person. I just was out of control sometimes. Second, I want to make changes — be more successful in my career, be better with others, and be more sophisticated socially. Being sophisticated is more important in China than in the United States.”

I asked: “What is important about being sophisticated?”

Dr. Zhou explained: “You have to know the social rules. So, all my interests have been focused there. What we’ve discussed in the past two sessions, our relationship, is only part of the story. What I am saying now is far more important. It is what’s in my mind. My wife can’t understand the changes in my mind.”

Dr. Zhou values his mind more than his relationship and feels cut off from his wife. We feel hopeless about dealing with the narcissistic issue at the core of the marriage in our few sessions.

Mrs. Wu said: “I know he has changed in the last two years, but he can’t control his temper which is painful and destructive to the family. He needs limits. He needs to learn that if you’re holding a cup, you can’t smash it. What you destroy is important. For instance, yesterday after the session he went to our room and got in bed with me. He was looking at the open courses at Yale on psychology.”

There is movement toward the bedroom, with potential for a sexual encounter, For a moment, I felt hopeful they would enjoy a rapprochement, but Dr. Zhou was there for study, not romance! We conclude that Dr. Zhou is looking for information from a more respected American source. Perhaps he feels that it is easier to get it from the Internet than from the live therapists before him.

Mrs. Wu continued: “I put a desk in front of the bed for him, and at that moment the plug for the laptop came out. I was sorry because this made the computer restart. He didn’t say anything about it. I thought it was a good sign that he had come into our room. I saw him lying on a wooden part of the bed, and so I gave him a cushion because I thought he was tired.”

Again, I feel encouraged that the sessions might be having an effect. He looks for information to learn more about psychology: She feels concern for him.

Mrs. Wu continued sadly, “His mood changed suddenly, and he said “Shit, you c–, motherf—–!” He refused to talk about it.”

Dr. Zhou said: “She can’t understand more than 5% of my thoughts.”

My hopes were dashed again. The movement had threatened Dr. Zhou. Is he worried about impotence in the sexual realm? Why must he destroy a good moment over a small mishap? Both of them seem hurt and misunderstood.

David said: “Dr. Zhou doesn’t feel understood, and Mrs. Wu doesn’t feel respected.”

Mrs. Wu said: “I didn’t want to have a child until there was respect. It would be irresponsible.”

David said: “Well the two of you act like the husband is the child.”

Dr. Zhou said: “There’s a misunderstanding here. I think things that others never thought. I tried to talk to her, but it was useless. She couldn’t understand me. I work it out on my own, then I manipulate her, and she doesn’t even realize it. Being angry with her wasn’t the only means of dealing with her. I think she’s too slow.”

David continued: “Take the episode last night. You came to bed, and she welcomed you and tried to make you comfortable. Then she makes one mistake, everything turns to shit, and she feels like shit.”

Dr. Zhou said: “I want to discuss my temper. My temper is like an equation. It reaches a peak and it blows, but it is much less severe that it used to be.”

Trying to forge a link with him via math, I said: “It’s an iterating equation.”

Dr. Zhou said: “Yes it iterates a hundred thousand times, but the threshold is raised, the severity and the frequency have diminished. I work hard, and I control it. My first love understood my mind, but my wife gets only 5% of it.”

I added: “But you don’t understand it. Understanding it is what we’d like to do with you.”

They live in two different worlds: he in the world of mathematics; Mrs. Wu in the world of family relationships and domestic comforts.

Turning to David, Dr. Zhou said: “Are you afraid my changes would be too slow for her, and so she would go? Why don’t you ask where she would go?”

Complying, David turned to Mrs. Wu, “All right. Where would you go, if he can’t change, or if change comes too slowly?”

Suddenly the discussion took a deep dive.

Mrs. Wu said: “Every day he fights, he makes my life miserable.” Crying, she nevertheless dared to say her thoughts. “I hope he can move out of the apartment, and I can live alone for a while.” She accepted a Kleenex from her husband. “The way you treat me hurts me and makes me feel like I’m a failure. Whether we can be happy together I don’t know. You think I am not capable, but I’m not your student — you don’t need to train me. Sometimes separation is not a bad thing.” Her eyes were red with tears.

I said: “I agree, separation is not always a bad thing. But here is another example of just one person thinking about your shared issue. This time that person is you, Mrs. Wu. I haven’t heard Dr. Zhou discuss separating.”

Dr. Zhou said: “Separation has two meanings — temporary separation or divorce. Because she’s sitting there, I would say that we won’t divorce.

Mrs. Wu takes the stage to communicate her hurt more fully. Her tears elicit a comforting response from Dr. Zhou, and yet the theme of the session shifts to separation as the only hope for creating enough space to allow for reconciliation on a new basis.

Fourth session

Dr. Zhou challenged us, “What do you think we should discuss?”

I began, “Yesterday we arrived at how seriously damaged the relationship is, and that you, Mrs. Wu, are considering separate apartments. Perhaps, that is what is on your mind.”

Dr. Zhou said in a challenging way, “How can you know what is on my mind? There will be only five sessions. I’d like to know what you have in mind.”

I said: “It depends on what you both want, and the Chinese therapists here will know what they can offer you.”

Suddenly Dr. Zhou became dismissive again. “Tomorrow is the last session. We don’t have time to continue in treatment. I’ve only heard questions, never suggestions.”

David said: “I feel puzzled. We do give suggestions. At this moment, we’re suggesting returning to considering the seriousness of the question of your marital separation.”

Again, we fail to deal with the pain of the situation and the ambiguity as to whether we offer teaching or therapy. We do not confront how each of them feels as they face separating from us. We simply cannot believe losing us is an issue for this man who seems as dissatisfied with us as with his wife. We do believe that putting things in words will allow for clarity. But what is becoming clear is that the avoidant relationship structure of the marriage is a cover for the disruption of the relationship, a defence against that calamitous object (Ezriel, 1950).

Dr. Zhou said: sighing, “Before I came here, I knew nothing about a separation. I just wanted to get her participation. After coming here, I don’t like Freud and psychoanalysis.”

I asked: “Mrs. Wu, was it an exaggeration to say that you prefer a separate apartment?”

Mrs. Wu answered: “No, it wasn’t an exaggeration. But the problem for him is that you ask questions to help us reflect and find a way out, but he wants suggestions from you. So do I, and you did give suggestions yesterday, and I felt it was really helpful”.

Dr. Zhou turned to Mrs. Wu and suddenly demanded: “Do you want to separate from me tonight?”

Mrs. Wu said patiently, “We’ve been discussing this for three hours in a café.”

We are interested in this development. How unusual for this couple to talk together for three hours about their couple relationship. The three sessions must have had some impact. We see Dr. Zhou and Mrs. Wu as individuals, each of whom has an intolerance of emotional separateness and who have concretized this into a discussion about separate apartments. We feel hopeful, but we walk a tightrope between analyzing the emotional detachment as a defense against the underlying desire for fusion and helping the couple contemplate the concrete proposal under discussion.

I asked: “Can you say more about it?”

Mrs. Wu continued: “He was aggressive to you because he was under pressure. I accept that his ideas are different from ours and from most people. He doesn’t want to hurt me, but he does hurt me but without understanding how much pain he causes.” Turning to her husband, she continued: “I don’t want to give up on you though you’re very angry with me. I know you don’t want to abuse me but there’s something in your mind that controls you. We should separate for several days, and you can observe what happens in our relationship when we get together, just as the two teachers have been observing us.”

Mrs. Wu speaks of the possibility of approaching the process with the couple therapists from separate positions to create space and hopefully movement, but Dr. Zhou quickly reverts to a ‘Me-Not-You’ attitude.

Dr. Zhou said angrily, “It’s not about you giving up on me. It’s how I tolerate you and give up on YOU! I would have given up on you, if I didn’t pity you a thousand times.”

Speaking first to Mrs. Wu, I said: “I understand that being told that you’re 5% effective is deeply hurtful” and turning to Dr. Zhou, I said: “And it’s intolerable to be stuck with a wife who understands only 5% of you.”

David responded to Dr. Zhou’s anger by drawing it into the transference: “Dr. Zhou, are you angry with us because you think that if you didn’t come here, this wouldn’t have surfaced?”

Dr. Zhou denied it. “No. I knew these things. You know very little about our marriage. It’s only been three sessions.”

I wanted to return to my thought. “I’d like to finish what I said. You find 5% satisfaction is intolerable. For you both, it’s important to stay together despite that much dissatisfaction and hurt.”

Dr. Zhou said: “I think your questions are very destructive. I haven’t given up on her. I know why I stay. You can ask her why she stays.”

Mrs. Wu said: “In his mind, he decided to never give up.”

Dr. Zhou said loudly, “Talk for yourself! You discuss me? You’re all wrong.”

Mrs. Wu said quietly and firmly: “I’ll discuss my reasons for staying or not. This marriage is almost unbearable. I’m not saying, ‘I’m staying.’ I’m saying, ‘I’m considering it.’”

Turning to Mrs. Wu, I said: “You have conditions that would make it bearable. Mainly, you want the anger and the complaints to stop. But you’d still have a husband whose energy is taken up in his own thoughts, and I wonder if you can stand that?”

Mrs. Wu replied: “I can tolerate that part, if he can stop blaming me and interrupting me.”

Mrs. Wu does know how he thinks and senses that it is out of his control. In psychoanalytic terms, Dr. Zhou is controlled by a traumatizing internal object the origin of which he does not reveal in full. It breaks up his thinking and drives him to traumatize his wife by demeaning her. Mrs. Wu is willing to accept the way his mind works provided it does not give rise to abusive speech and actions against her. But Mrs. Wu’s conditions give rise to anxiety, anger and even panic about the threat of marital separation and the possibility of becoming two separate individuals who might or might not then choose to be together as a couple. Mrs. Wu becomes more reflective and more able to explain herself. She tells him that she does not want to give up on him; she wants to get away from the ungovernable part of him until he can bring it under control. Dr. Zhou has taken losses and felt rejection in an earlier relationship, and he does not want to lose again, and so he has to seize control.

Dr. Zhou looked at his phone for a moment as though he had an incoming phone call or a phone call he had to make. Suddenly he announced: “I’m going to leave, and I’m not coming back.”

He walked out, and Mrs. Wu got up and followed him. We wondered if they had both left the interview. After a moment Mrs. Wu returned.

Mrs. Wu said. “That’s what he does. He thought you were all intelligent. Yesterday he even said he hoped the two teachers would give us a chance and after five sessions he would bring it to a good end. But you’ve seen the kind of incidents that happen. I’m not surprised.”

I said: “We are surprised, and we are upset by it, but you are not surprised perhaps because you’ve been through it many times before.” (Mrs. Wu nods). I continued: “What do you think triggered his departure?”

Mrs. Wu said: “He can’t take suggestions and can’t listen to the opinions of others. He learns from reading psychology, not from people. He thinks he knows everything!” I’m flexible. I accept a lot of things.

I said: “He was angry at us for taking what you said seriously. When he walked out, I was reminded of his impulsive move away from his parents when he stopped speaking to them for eight years.”

Mrs. Wu said: “Probably, he is going away to control himself through self-reflection. His leaving today like that is his normal behavior.”

The more we learned about what is intolerably stressful for Dr. Zhou, the more he had to push us away, and the more difficult it became to relate to Mrs. Wu and him as a couple. His excessive emphasis on rationality broke down in the face of overwhelming emotion. Dr. Zhou did not return for the final session. Mrs. Wu used that final session to sort out her thinking in peace. We left her with the name of a Chinese couple therapist in case Dr. Zhou was willing to try again, but we also gave her a referral for individual therapy with a Chinese therapist in case he did not pursue the couple therapy referral.

 

Conclusion

I am still learning as I think about this couple, and I only hope that each of them has something worth thinking about from us. Still, we felt we had failed to do what was needed, no matter how hard we tried. How could we have helped Dr. Zhou face what was unbearable, and how we could have focused more fully on the couple? Would it have been better to go much more slowly without trying to accomplish a demonstration of interpretive couple therapy? What if we made no comments or links and simply asked them what they are interested in? What if we merely worked on building an alliance and waited for them to be referred to a Chinese therapist who would do the interpretive work with the couple over time? We might have felt less destructive to their projective identificatory system, but we guess that the couple would still feel unsatisfied with us and our denigrated attempts. We revealed a thought disorder in the brilliant husband, connected to his unprocessed trauma as a young man not allowed to think for himself and make his own choices. What if we were more attuned to separation anxiety as an issue in the transference? Having processed and reviewed our efforts, we regretfully concluded that in four sessions we could not help Dr. Zhou and Mrs. Wu develop a couple state of mind. We were able to demonstrate the concept of a creative couple state of mind in its absence and generate useful class discussion, but not to jumpstart the process of repair for the couple. Object relations theory has the explanatory power to detoxify traumatic experience of childhood, but our limited commitment as visiting experts could not provide a secure trusting relationship in which to do that work with this couple. This process and review of the experience in the light of the outcome and the countertransference is an expression of the ethical stance in psychoanalytic couple therapy.

Dr. Zhou’s words hung in the air: “Was this counseling or demonstration? Are you here to teach, or to try and help us with our problems?” We felt sad that our work made a difference to the wife and not to the husband, to the students and not to the couple. Our insights gave her space to contemplate her subservience but they drove the couple apart, hopefully temporarily, until they could get into ongoing treatment with a skilled Chinese therapist.

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Bibliography

Clulow, C. (Ed.) (2012). Adult Attachment and Couple Psychotherapy: The ‘Secure Base” in Practice and Research. Abingdon, Oxon: Routledge.

Dicks, H.V. (1967). Marital Tensions: Clinical Studies towards a Psychoanalytic Theory of Interaction. London: Routledge & Kegan Paul.

Ezriel, H. (1950). A psychoanalytic approach to group treatment. British Journal of Medical Psychology 23, 59-74.

Fairbairn, W.R.D. (1944). Endopsychic structure considered in terms of object-relationships. International Journal of Psychoanalysis 25, 70-92.

Fisher, J.V. & Crandell, L.E. (1997). Complex attachment: Patterns of relating in the couple. Sexual and Marital Therapy, 12(3), 211–223. https://doi.org/10.1080/02674659708408165

Klein, M. (1946) Notes on some schizoid mechanisms. International Journal of Psychoanalysis, 27, 99-110

Levene, J.E. (1997). Couples therapy with narcissistically vulnerable individuals: Contributions from Self Psychology. Canadian Journal of Psychoanalysis, 5, 125-144.

Losso, R, Setton, L. & Scharff, D. (2017). The Linked Self in Psychoanalysis: The Pioneering Work of Enrique Pichon Riviere. Abingdon, Oxon: Routledge.

Morgan, M. (2018). The Couple State of Mind: Psychoanalysis of Couples and the Tavistock Relationships Model. Abingdon Oxon: Routledge.

Scharff, D.E. (2016). The contribution of Enrique Pichon Rivière: comparisons with his european contemporaries and with modern theory. Couple and Family Psychoanalysis, 6, 153-158.

Scharff, D.E. (2021). Marriage and Family in Modern China: A Psychoanalytic Exploration. Abingdon, Oxon: Routledge.

Scharff, D.E. & Scharff, J.S. (1992). Object Relations Couple Therapy. Northvale NJ: Jason Aronson.

Scharff, D.E. & Scharff, J. S. (Eds.) (2014). Psychoanalytic Couple Therapy. London: Karnac.

Scharff, J.S. & Scharff, D. E. (2011). The impact of Chinese cultures on a marital relationship. International Journal of Applied Psychoanalytic Studies 8(3), 249-260.

Shi, Q. and Scharff, J.S. (2011). Cultural factors and projective identification in understanding a Chinese couple. International Journal of Applied Psychoanalytic Studies 8, 207-217.

Wanlass, J. (2014). But my partner is the problem: addressing addiction, mood disorders, and psychiatric illness in psychoanalytic couple treatment. In D. Scharff and J. Scharff (Eds. et al.) Psychoanalytic Couple Therapy (pp. 310-322p, London: Karnac.

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* Jill Savege Scharff MD, FABP, MRCPsych is a supervising child and adult analyst and psychotherapist, couple and family therapist, author and editor. She is the co-founder of the International Psychotherapy Institute and its psychoanalytic, couple and family, and child training, teaching, group leading and clinical supervision programs. She is clinical professor of psychiatry at Georgetown University School of Medicine in Washington DC, and her private practice is in Chevy Chase MD. She is a recipient of the 2021 Sigourney Award in psychoanalysis. jillscharff@scharffmd.com

I would like to thank David Scharff for his collaboration, Professor Fang Xin and Gao Jun (China) for their support, and Christopher Clulow (UK) and participants of the Foundations of Psychoanalytic Couple Therapy Videoconference course at the International Psychotherapy Institute (USA) for helpful comments that are included in my discussion of this case.