Learning to Love: Treatment of Disorders of Intimacy
by Mark Schwartz, D.Sc.
Recently, a client who had been having chronic affairs said to me, “I don’t think I have ever loved anyone, not my wife nor my son or daughter. I’ve never allowed myself to have many emotions.” As I worked with this client intensely, I cataloged my case conceptualization and the treatment modalities that eventually resulted in him experiencing and expressing emotions, including empathy for self and others. His desire for affairs was alleviated and his intimacy with his wife increased dramatically. This paper describes the conceptual and practical stages of that intervention.
Infants met with inconsistent, unreliable or absent caregiver attunement develop a sense of self that is “unworthy of attention.” They lack the confidence and sense of safety to explore and thus are hampered in developing a sense of mastery, competency, and identity. Caregivers who are over-involved often focus on making sure children comply. This results in the child feeling a need to please others rather than building an awareness of and healthy entitlement for knowing what they themselves desire. The development of the child’s true self becomes obscured, leaving the individual with a sense of hollowness — expressed as either a disconnection from others or an over-dependence on pleasing others. Impaired capacity for emotional tolerance, emotional expression, or control thereby results in the long-term indifference to the distress of others (avoidant) or excessive responsiveness to pleasing others (preoccupied). With both adaptations, there is injury to the capacity of the self to become coherent or cohesive, thereby injuring the capacity to bond.
With these voids in self-awareness, social awareness, emotional regulation, gender identity, and problem-solving, it is increasingly common that the young adolescent becomes over-involved with electronics and pornography. The unfolding of sexuality becomes impersonal, objectifying, and hardwired to the visual — as opposed to being prompted by touch and affection — further contributing to a shutting down of caring, close connections related to bonding.
When caregivers are overly focused on control, discipline, and punishment or are rageful without spending the quality time needed to express delight and affection, the child tends to have contradictory internal working models that fear closeness while craving emotional bonds. The result is structural with simultaneous, disassociated symptoms of unconscious and conscious avoidance of intimacy, along with a craving for closeness. For many, these contradictory systems result in an addictive-like craving for connection and a fear of abandonment or rejection. Emotionally, this can be navigated by numbness; behaviorally, by distancing strategies such as affairs, pornography, or preoccupation with work or substances. The child’s sense of self is corroded with shame, and his or her emptiness and self-injurious behaviors further contribute to self-contempt.
Rejection or unkindness from others results in misreading other’s intentions and in developing a core sense of defectiveness that further induces the need to create emotional distance. The person is unable to use others as a resource for emotional regulation; the result is increased anxiety and depression. Often, an impersonal or false adaptive-self unfolds that becomes overly occupied with things like routine, work, exercise, money, and achievements as a form of running away. The person lives as if being constantly chased by the ghosts of their early life, which was full of punitive and traumatic experiences.
A person’s Lovemap is drawn by age 5 or 6. The map organizes the self and functions in and facilitates relational choices. Opinions about what is attractive in oneself and in one’s potential partners are organized in the context of the Lovemap. John Money (1986) first introduced the concept of “Vandalized Lovemaps” to suggest that the brain can become hijacked by arousal patterns that come to represent either the desired or punitive object.
Early neglect or abuse injures the guidance system related to self-perception as well as the ability to read others, thereby influencing interpersonal attraction. Persons try to make sense of the confusing puzzle whose pieces are caregivers who pair their affection with rejection and punishment. Persons with Vandalized Lovemaps maintain a “confirming bias” by selective interaction with others in the environment. They choose relations that fit the existing core schemata and avoid or devalue relations that might refute central beliefs and effects of schemata. They often seek others who are avoidant, beginning the dance of “merger-seeker,” one running while the other chases with great intensity, passion and pain. They become locked into trauma bonds with a partner they think will help them reconcile the unreconcilable.
In this manner, the individual with intimacy disorder is held lost and captive by their damaged Lovemap until they can learn the new lesson: “Not all partners will hurt me. Only the partners I choose to actively re-create the chaos will hurt me. I can make a different choice.” If the injured individual finds a partner securely attached from childhood, the unfolding of repair can begin and move the individual toward what Mary Main (1995) defined as Earned Secure Attachment. Psychotherapy can often facilitate that process.
Moving Toward Earned Secure Attachment
Mary Main was a brilliant conceptualizer and developed the Adult Attachment Interview to assess the damage and needed repair of injured attachment systems. Her work spurred decades of subsequent research to identify structural deficits related to early abuse, neglect and misattunements, and their repair. Deconstructing the Adult Attachment Interview gives insight to the development of Earned Secure Attachment.
Secure Attachment results in the development of “metacognition” in which the individual is conscious of their shaming internal voices. He or she can identify their origins and recognize:
(1) their function as protectors,
(2) the potential destructiveness of self-hate,
(3) realistic corrections to such accusations, and
(4) how to be motivated by a sense of accomplishment, creativity, and mastery for more productivity.
Individuals who hear persecutory voices in their minds, telling them to work harder and achieve more, are often motivated by a fear of being lazy or incompetent, a failure and unlovable, stupid, fat, or ugly, for example. These voices often reflect what was inputted by their caregivers in a misguided attempt to “better prepare them for life.” Psychotherapy is aimed at reappraisal of affect and cognition, allowing for a “fresh” look at misattributions. Main’s recognition was that this repair is related to coherency, cohesivity, collaboration, and fluency.
The major block to those changes is loyalty to the family and the need to maintain the belief of “being loved” by the family, despite obvious indications of neglect and abuse. Coherence consists of clear, truthful conclusions based on actual experiences of cause and effect. Consistency is the flow of accurate ideas and thoughts that collaborate in recognizing one’s need for connection and partnership. Fluidity relates to segregated internal working models of self and others that coalesce to make the individual aware of the polarized thoughts and feelings that contribute to their out-of-control behavior. When extremely angry, for example, the individual can look within and identify past, intrusive factors rather than simply blaming others.
Once the internal working models become more integrated, the individual naturally moves to explore their environment and find balance. They move toward enactment, masking, and disciplined actions. As their value system becomes more explicit, they can recognize emotions signaling what they want, practice self-care, and surround themselves with like-minded others who also value self-care, rejecting those who are rejecting or critical. They become what Dr. Richard Schwartz (1980s) describes as “self-led.”
Dependency, Co-Dependency, and Independence
A major goal of Earned Secure Attachment is the capacity to be alone with, and at peace with, self. Addictions are conceptualized as blocking the individual from connecting with self and others. Obsessive-compulsive actions serve a similar function. When the self-system is fragmented, the individual may develop an “addictive personality,” which aids to remedy a bleak sense of emptiness that can’t be filled. The goal of psychotherapy is to integrate contradicting internal working models and coalesce the self and affect systems, resulting in present actions guided by past learning. Individuals with unfinished self-development are searching for another person to fill their aloneness and emptiness. They then often resent the person they have become dependent upon. Alternatively, they create lives filled with avoidance, distance, disconnection, and aloneness, which is also distressing. Many attachment- disorganized individuals move from being too needy to being avoidant. Similarly, hypersexual individuals can become hyposexual when involved in a close relationship.
Therapy encourages the use of internalized, positive parenting to nurture the injured parts of self and create a sense of internal safety that can restore the individual’s capacity for exploration. This allows injured parts to feel witnessed and less alone. With internal safety, the client becomes more capable of problem-solving and making changes that lead to a sense of mastery.
The mission of psychotherapy is to facilitate one’s capacity to observe and accurately perceive self while distinguishing past from present. It is also critical that therapy increase one’s capacity to accurately perceive others and consider other’s thoughts and motives as potentially different from one’s own. Finally, therapy should develop the individual’s ability to use one’s own thoughts and feelings and those of others to make decisions leading to constructive action.
Successfully achieving these goals is critical to moving toward Earned Secure Attachment. Monitoring disorganized speech patterns, incoherent thoughts, and the inability to think while speaking — so that speech is consistent with purpose or goals — while minimizing self-destructive or impulsive behaviors, is critical to secure attachments. Narrative therapy with regular homework assignments helps the individual organize thought-feeling-behavior cohesion.
Learning how to love does not necessarily change a person’s erotic template, which was likely cemented in childhood by operant and classical conditioning; however, in my experience, sexual fantasy patterns do frequently and spontaneously change as individuals develop Earned Secure Attachment and resolve traumatic events. Alfred Adler (2013) used the term “spitting in the soup” to depict that sudden awakening of the conscious mind to the ways that fear has twisted one’s thoughts and actions. Becoming abruptly aware of the horror of many of the Internet’s pornographic themes is an example of Adlerian “spitting in the soup.” The most essential component of the change process is developing empathy for others and self, so that getting one’s needs met at the expense of another becomes ego dystonic.
Erich Fromm said, “It is impossible to love one person without loving all people,” suggesting that consciousness-raising has a spiritual component that includes a greater awareness of universal suffering. Many spiritual traditions are dedicated to and helpful in healing trauma. Buddhist traditions can often be used successfully to awaken empathy and compassion.
As the individual recovers from feelings of numbness and dissociation, sexual arousal becomes more open to techniques to change arousal stimuli, including covert sensitization, fantasy satiation, or aversive odor pairing to extinguish images that are antithetical to bonding. Simultaneously, the individual is encouraged to move into intimate, healthy relationships and imagine their own partner when aroused. Fellowship in a 12-step group such as Sexaholics Anonymous, Sex and Love Addicts Anonymous, and Co-Dependents Anonymous is also critical to strengthening and sustaining their progress.
Pioneering Sex Researcher William Masters, MD, (1972) advocated strongly that, like eating and breathing, “Sex is a natural function.” Barring a severe defect, all humans are born with the capacity for sexual function. Love and bonding are also natural functions. Therapy is focused on removing the “roadblocks to natural function” to allow for the natural expression of sexuality, empathy, and compassion for self and others.
Skills For Intimacy
In a relationship with a sexually compulsive partner, the other partner often accommodates the absence of intimacy over time. Both partners should be involved in the restoration of intimacy. The client often has weak affect regulation and relational skills related to conflict resolution, intimate communication, problem-solving, and anger management. Love, however, is principally a verb, so therapy should teach the skills needed to move the couple toward intimacy. Practicing new behaviors in various scenarios is critical to both partners being able to nurture intimacy, even while dealing with real-world stresses related to the complexity of modern life.
Codependency tends to be another component of love disorders that impedes honesty and intimacy. It includes over-focusing on pleasing and not disappointing others due to fears of abandonment. Alternatively, the individual will be controlling and demanding to strip the partner of the will to leave the relationship. A healthy, intimate relationship requires that both members in a couple learn how to establish an egalitarian partnership with regards to finances, parenting, decision-making, employment and other core areas of a shared life.
Sexual arousal is closely tied to the capacity for bonding and attachment and the connections formed through a person’s earliest experiences with a caregiver. Sexual compulsions, and hypo- and hyper-sexuality are often the result of fear-based blocks to intimacy that spring from feeling hurt, punished, or abandoned in early caregiving relationships. Deviant sexual arousal patterns typically unfold in the context of trauma bonds, Disorganized or Avoidant attachment, and fear. As developmental trauma is resolved, bonding becomes more closely associated with intimacy, safety and connection. Sexual arousal patterns often then change spontaneously to reflect the desire for a healthy, authentic relationship with self and others.