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from Clinical/Therapeutic Issues
Clinical Issues:
Grief Work
Interview: Joseph Nicolosi, Ph.D.
Dr. Nicolosi (JN): In our continuing
investigation of the clinical material, some
recent work on the Narcissistic Family has added a
deeper dimension to our understanding of the
prehomosexual boy's experience. And so during the
last three years, we've developed a new dimension
of Reparative Therapy.
This expanded model gives us a better
understanding of male homosexual development and
leads us to a more effective treatment.
A good way of understanding this dimension is to
envision lifting the reparative-therapy model up,
and then putting a subfloor beneath it.
Linda Nicolosi (LN): A subfloor?
JN: Yes. The "house" of Reparative Therapy was
built with the concepts of gender-identity
deficit, defensive detachment and reparative
drive. Now we are underlaying the structure of
the house with our understanding of a deeper
trauma experienced by a significant group of
clients--the narcissistic family, along with the
necessary treatment of that trauma, which is the
grief work.
I've developed these ideas by integrating the
concept of the narcissistic family with the work
of psychoanalyst Martha Stark. Her books are A
Primer on Working With Resistance, and Working
With Resistance (both 1994). Dr. Stark's therapy
requires getting the patient to look back on the
experiences of his early family life to resolve
grief around what is known in psychoanalytic terms
as "abandonment."
LN: How does this fit the Reparative Therapy
model?
JN: Reparative Therapy has long recognized the
Classic Triadic Family model to understand the
most common pathway to male homosexuality. But
when we combine that model with the Narcissistic
Family and grief work, we gain a fuller
understanding of our clients' childhood
experiences. Our expanded model is the Triadic
Narcissistic family.
This model will not fit all clients, of course,
but it resonates with many.
We've always known that homosexuality is not a
sexual problem, but a symptom of an underlying
problem of gender identity. But the deficit
typically goes deeper than that; there's also a
damaged sense of identity. This damage to the
self is the integral part of the gender problem.
LN: Can you describe the Classic Triadic Family?
JN: Irving Bieber's 1962 study established this
family type empirically. It has been repeatedly
shown to be the foundational model in male
homosexuality, although there is more consistency
in findings about fathers than about mothers.
In the classic triadic family we have a sensitive
boy who did not get the close, affirming
relationship with his father that would have
confirmed him in his gender identity, and a mother
who is likely to be over-close and standing in the
way between father and son. The father was not
supportive enough in affirming, recognizing and
reinforcing the boy's maleness. If there is an
older brother, he usually had a fearful-hostile
relationship with him.
LN: How would temperament play a role in this
model?
JN: Some boys--particularly those with a
resilient, extroverted temperament--were not so
vulnerable to being emotionally hurt by a distant,
rejecting father or molded by an over-involved
mother, so the classic triadic family caused no
gender-identity injury.
But the sensitive, compliant son was not so
fortunate. He couldn't move beyond the comfort and
security of the mother-son relationship to
establish his own masculine autonomy. He
experiences a narcissistic hurt and eventually
surrenders his natural masculine strivings. I say
"natural," because gender strivings are grounded
in the biology of human design.
LN: How does the triadic model work together with
the narcissistic family model?
JN: The two models can be seen as fitting
together in a compatible overlay. In the
narcissistic family, the boy grows up with a
parental dynamic in which the son is perceived as
a self-object. Now, both parents, it should be
said, are often good people who were consciously
very loving, self-sacrificing and well-meaning.
There is no conscious intent to hurt the child.
But on some level, they have a need for the child
to be "for" them, meeting their needs and
expectations that he be a certain kind of child.
In the psychoanalytic literature on the
narcissistic family, the child (either a boy or a
girl) was not seen for his True Self. He was seen
or not seen, responded to or not responded to,
depending on whether particular aspects of his
True Self gratified or did not gratify the
parental team's narcissistic needs.
When the boy's spontaneous expression of self
conflicts with the parents' needs, he finds
himself in a no-win, double-bind situation. If he
holds onto and expresses his True Self, he is
overtly or covertly punished by being ignored by
his parents--which at his young age means he
simply ceases to exist. The expression of his true
self, which must involve his gendered self, is met
with what is called the abandonment-annihilation
trauma. In other words, "When my parents cease to
reflect me, I cease to exist." And so as a
survival tactic, he develops the False Self as a
way of complying with his parents' vision of who
he must be. That False Self is typically "The Good
Little Boy."
LN: How common is the narcissistic family?
JN: As parents, we probably all exhibit some
narcissism in our parental expectations. So the
narcissistic family, then, exists on a broad
continuum. But when the parents' narcissistic
expectations combine with the Classic Triadic
Family pattern, the family produces a genderless,
non-masculine, "Good Little Boy." For some reason,
this parental team had a vested--if, in fact,
quite unconscious--interest in this particular boy
not developing his masculine identity.
Perhaps this was the son who was born sensitive,
introspective and unathletic, so the mother chose
him as her confidante. And perhaps the mother's
needs meshed with the boy's own fears--that he
could not compete with his male peers on their own
level. Staying close to his mother would feel very
natural and comfortable to him.
And so this particular son abandoned the natural
striving to achieve masculine autonomy, which is
to say, he gave up developing the side of himself
that would have been rambunctious, mischievous,
active, independent, and aggressive. He becomes
his mother's best friend...sitting in the kitchen
and watching her cook, hearing her stories and
hopes and dreams and maybe even her complaints and
disappointments about his father.
LN: Does the narcissistic family model also
involve both parents?
JN: Yes, because the father--at least
unconsciously--went along with the arrangement
with this particular son by allowing his wife to
interact with the child as a husband-substitute.
It may have fit the father's needs because it
allowed him to escape some of the emotional
responsibilities of marriage that he considered
burdensome. And maybe there was another son he
could be close to, with whom he had more in
common. So both mother and father would have
participated in producing the non-masculine son.
Of course, the Narcissistic Family syndrome by
itself, without the Classic Triadic relationship,
will have a damaging effect on the child's sense
of self, but not likely affect the child's gender
identity.
But any time a parent's love is mediated through
narcissistic expectations, the child will be left
with a feeling of weakness, vulnerability,
sadness, emptiness, a deep suspicion of never
having been truly "seen" for who he was, and
loved. These feelings are common complaints of the
homosexual client that go beyond the feeling of
gender deficit, and can be explained by the
narcissistic family.
LN: How common is this combined family model?
JN: Most of my clients report experiencing it to
some extent, but it would be inaccurate to lay the
blame solely on the parents for the child's
homosexuality. However, we can say that when we
see this model in its fullest expression--when the
child knows that his existence needs to be
gratifying to his parents--he experiences what
object-relations theorists call "abandonment," and
that brings up a flood of sorrow and grief about
not having been seen or known for who he really
was. The client will need to understand and mourn
that loss.
LN: Does this also happen in the same way with
lesbianism?
JN: We may see a scenario in which the girl's
authentic expression of self, including her
femininity, was met with disapproval. Sometimes
the narcissistic need of her parents required her
to renounce her feminity, to "be strong" and take
care of her mother.
In some family histories I am aware of, the girl
was expected to be feminine in a stylized way that
did not suit her. These young women describe
themselves as having been tomboyish, spontaneous,
assertive girls whose mothers' narcissitic need
required them to adopt a caricatured "girlish"
femininity which meant expressing no opinions and
conforming to a very narrow vision of gender.
This feminine straitjacket of their mothers'
envisioning did not match their own internal sense
of who they really were.
But there are other pathways to lesbianism which
don't involve the narcissistic family system.
Maternal inadequacy is one common finding. When
the mother is inadequate as an emotional resource
or a feminine model (she was depressed,
unavailable, abused by the father, alcoholic), the
girl is left with a maternal nurturance deficit
which later leads to a craving for love and
intimacy with women.
LN: Returning to the boy, how does he protect
himself from a narcissistic parent's expectations?
JN: The child is made to feel shame regarding his
true, gendered self. The "Shamed-Damaged" self
will defend itself through two mechanisms. One is
narcissistic pride, which we see so commonly in
the homosexual condition, and in the service of
which the homosexual condition develops. The other
defense is the False Self which originated from
the "Good Little Boy." The homosexual condition
is characterized by these two defenses.
One client said to me recently, "I always tried to
make my mother happy but I could never keep her
happy for very long. So she was very disappointed
in me." This is what many of our men are grieving.
They are grieving the fact that so much of their
life was spent trying to live up to an expectation
that was never really verbalized, yet clearly
understood. Much of their life was spent trying
to gratify and please, to seek the approval of
others.
The grief work penetrates the two defenses of
narcissism and the False Self and focuses the
client on fully feeling and expressing the
Shamed-Defective Self. He discovers that, as an
adult, he need not fear the primal threat of
abandonment-annihilation, and he can begin to
surrender the defenses of homosexuality,
narcissism and the False Self.
The Narcissistic Triadic model explains other
clinical features we see besides the narcissism
and the false self. It also explains the
pervasive sense of not belonging, of never having
felt understood or connected, and of an inner void
and emptiness.
Homosexuality is more than a "pull" toward
connection with the masculine (through the pursuit
of male attention, affection and approval).
Homosexuality is also a "push" from the gut sense
that "I am defective."
I recall years ago a client whose wife had just
discovered his many anonymous sexual encounters.
She tearfully asked him, "How could you have done
such a thing?" The client said to me, "From the
depth of me came an answer that surprised even me;
I said, 'Because it hurt too much not to.'" This
man was looking for much more than male attention,
affection and approval. He was seeking relief from
the void in his heart which had existed since
early boyhood.
And so we see that this Shamed-Defective Self goes
much deeper than a deficit in gender. We gain a
fuller understanding of it through the established
literature on self psychology and object-relations
theory.
Gay theorists also recognize this
"Shamed-Defective Self," and many gay men admit
that no matter how liberated they are, they always
struggle, on some deeper level, with a sense of
inferiority. They point to this as evidence of
homophobia that's been internalized from society.
But I attribute this feeling to an internal
process, unrelated to social stigma, which
precedes same-sex attractions. The awareness of
social stigma is later layered on top of the
Shamed-Defective Self.
LN: How does this "deep grief" fit with the
sadness described by other clinicians who
deemphasize family dynamics and focus on peer
rejection?
JN: When you begin the grief work, the peer
memories usually arise as the first source of
pain. But as you keep the client focused, we find
the sadness often goes deeper to memories of the
mother and father. As much as the parents tried
to love their son in their own way, the clients
harbors the felt memory of not having been
understood, not having been "seen," not having
been loved for who he really was.
LN: How does the client get in touch with this
grief?
JN: We start out by focusing on his emotional
state in the here-and-now. He will periodically
express the feeling of being "stuck"--weak, hurt,
hopeless, blah, depressed, lonely, not belonging,
and feeling forlorn and self-pitying.
These feelings are what we call the Black Hole,
which is a cluster of thoughts and feelings that
permeate his consciousness. Our earlier strategy
was to bounce the client out of the Black Hole
through a change in self-talk. We applied van den
Ardweg's concept that these men were caught up in
a state of self-pity. We "called them on it,"
challenging them to move onward.
But now we are realizing that the Black Hole can
offer a doorway into a deeper grief that lies
beneath it.
LN: A doorway?
JN: It's a feeling-level opening through which
the client confronts dreaded memories which may
include rejection and even victimization.
LN: How do most clients deal with "The Black
Hole"?
JN: When our men fall into it, their first impulse
is to run away and to connect with a man sexually.
We always ask the client--and this is a very
important factor in the therapy--"What was the
feeling that preceded your homosexual enactment?"
They report the complex of the Black Hole: "I felt
alienated, disconnected, empty...I felt inferior,
not good enough." These are the common feelings
that precede homosexual acting out.
So every time they go to those feelings, any time
something in their lives stimulates those feelings
of not belonging and not being good enough, having
been slighted or rejected...this stimulates the
defense of homosexual enactment. But what they
are actually doing there, is unconsciously
avoiding the deep grief. Experiences of hurt,
failure, feeling let down and disappointed
stimulate an affective memory of that early
trauma. As soon as they get the slightest hint of
that old feeling, they move away from it into
homosexual behavior.
But instead you take them by the hand and walk
them into the deep grief, let them stay there, let
them experience it, let them realize the anguish
is not going to annihilate them. They need to feel
it more deeply, and not to be afraid of it. They
now have enough ego strength, enough insight,
enough emotional resources to transcend it.
Grief work inevitably includes feeling the anger,
often even rage at having lived a lie to please
others. It includes the pain of surrendering the
illusion of homosexuality. Same-sex
relationships--as this client already knows,
because this is why he has sought out Reparative
Therapy--never worked for him. But now he faces
this realization squarely, powerfully, without
defenses. So much of the appeal of a gay
relationship has been the illusion that someday
when that certain best friend and lover comes
along, this new man will alleviate that sadness,
but then each relationship disappoints him.
Once he "goes there" into the grief and
acknowledges what he sees...with enough of an
observing ego to allow him to integrate it...he
can finally start to come out on the other side.
The hurt no longer has such compelling power; he's
faced that reality down and survived.
When I first read Martha Stark's grief work, it
struck me that this was a dimension to which we
had not been paying enough attention. For many of
her patients, she finds this to be a core element
for a complete therapy. I have come to a point
where I believe that a comprehensive Reparative
Therapy must include this grieving.
Maybe for my own reasons I hadn't gone into it,
because these feelings--sometimes murderous rage
and deep, agonizing grief--are so uncomfortable
and so primitive that many therapists, including
myself, might shy away from it.
But as I've had more experience with grief work,
I've come to see its often fundamental importance
to the healing of homosexuality.
Updated: 3 September 2008
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