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Mr. A is a 22-year-old university student who sought treatment because of his “addiction” to pornography. He lives with his girlfriend of two years, whom he describes as “beautiful and good.” He is very concerned, however, about the volatility of his feelings toward her. His admiration often vanishes. At these moments, he thinks of her as a “nag,” dull and oppressive. So many others would be better for him: smarter, sharper, sexier, more adventurous. What he means by “better for him” is that they would have what it takes to make him feel better about himself. Concerns about his own standing preoccupy him: his goodness, his intelligence, his sexual attractiveness, his income, the loyalty of his friends and family. He is an exceptional student. Departments already have begun competing for his future at the university. He is proud of his intellectual accomplishments and feels triumphant when those accomplishments are recognized via awards and scholarships. The triumph is particularly satisfying in relation to his father. His father is also an academic, whose achievements, though substantial, have not won him national recognition. Patient and father agree that the son is on a path to far outdo him. They also agree that the son's girlfriend is herself a “better woman than my mom ever was.”
From a recent session:
My wife and I were sitting at an outdoor café. We were barely speaking. There were all these other women I could see, beautiful and talking. They seemed intelligent, full of ideas. My wife said maybe we should find a better café. It wasn't the café, though, it was her. She had nothing to say. I shouldn't be with her. Someone else. She doesn't have the edge, the smarts, the wit I need. It's like not getting enough compensation. I'm worth more.
(Your wife ought to provide you with what is otherwise missing.)
That's right. Like that girl from a few years ago. She had it. She'd walk down the street and you could see how everyone wanted her. She'd walk into a room and guy