Some thoughts on the concept of the internal parental couple

Some patients are incapable of engaging in a relationship with a partner on a long-term basis. To explain these relationship issues, they invoke reasons that have to do with external reality rather than with their own internal reality. The authors present several clinical examples that have given rise to an initial attempt at theorizing the concept of the internal couple: some patients fail to internalize a positive representation in which they can see themselves as part of a couple. Psychoanalysts tend to think of the father and mother (or their internal representatives) as separate entities, differentiated and complementary, and not in terms of a single object that brings them together as an internal couple. In the author’s view, an internal parental couple is also internalized by the infant under the guise of various internal objects. The internal parental couple thus appears as a complex construction that goes beyond the mere addition of father plus mother. Underneath their neurotic veneer, these patients have severely damaged representations of internal parents and of the internal parental couple. Unable to identify with a stable and procreative internal parental couple, they tend also to attack the psychoanalytic couple. Early distortions in the oedipal sphere may be one cause of the stumbling-block they encounter on the way to introjecting a well-attuned couple-as-object and the idea of parenting.     

An entire life in one glance: a psychoanalytic reading of Revolutionary Road

This article, starting from an analysis of the film Revolutionary Road (2009; director, Sam Mendes), addresses the topic of conflictuality in relationships between couples, especially in those characterized by intense violence and a relational configuration of the sadomasochistic type. In particular, the film – in highlighting sequential moments in the couple’s life, from its formation through to its tragic conclusion – seems to strengthen the hypothesis that the specific quality of falling in love is a contributing factor in determining the dramatic unfolding of a couple’s relationship. The relationship is characterized by an experience of intense, erotic sensoriality, and by the nature of the unconscious fantasy underlying the bond between the couple that began with the moment of falling in love, a bond in which deep needs for fusion predominate. The presence of this neediness impedes a more adequate working through of the conflicts and the transition to more satisfying ways of relating.     

Self‐concept clarity and relationship satisfaction at the dyadic level

Self‐concept clarity is an individual resource that is associated with couple relationship well‐being. In two dyadic studies, the authors investigated whether and how self‐concept clarity has implications for both partners' relationship satisfaction. Study 1 tested and supported the hypothesis that self‐concept clarity concurrently predicts own and partner's relationship satisfaction through couple identity in a sample of 202 dating couples. Study 2 tested and supported the hypothesis that self‐concept clarity predicts longitudinal change in own and partner's relationship satisfaction through positive (i.e., supportive and common) dyadic coping behaviors in a sample of 97 married couples. The findings clarify and expand the benefits of self‐concept clarity for partners' relational well‐being.     

Is three a crowd? A perspective on countertransference challenges in psychoanalytic couple psychotherapy

Two seemingly unrelated characteristics of psychoanalytic couple psychotherapy may be better understood when juxtaposed. First, countertransference in psychoanalytic couple psychotherapy holds particularly strong intensity. Second, format decisions are central to couple psychotherapy. The use of conjoint and concurrent formats, or variations thereof, has been key in the historical development of couple psychotherapy and remains an area of much debate. Some couple psychotherapists use the format of couple psychotherapy flexibly, using variations of conjoint or concurrent couple psychotherapy, while others adhere strictly to working conjointly. Decisions regarding whether to undertake concurrent or conjoint therapy are not generally linked to countertransference; this article demonstrates that reading decisions regarding format through consideration of countertransference offers a needed perspective for the therapist. Case studies published by psychoanalytic couple therapists are analysed through this prism to demonstrate that changing the format may serve to dilute countertransference. One particular manifestation of countertransference, linked to oedipal dynamics, is explored: countertransferential intensity for couple psychotherapists potentially relates to being faced with their internal parental couple and their unresolved Oedipal strivings. Possible unconscious motivations to change the format of couple psychotherapy need to be carefully considered, as format changes may mask an avoidance of bearing the countertransference.     

Groundhog day: The individual,the couple,the group and the space between

Abstract

The film Groundhog Day first came out in 1993. Five years later, it is still cited in a variety of contexts. The author proposes that this is because the film is a cultural artefact which both elucidates and frustrates the ideal of romantic love in the couple as the agent of internal change.

The author also proposes a re-viewing of the meaning of the concept of couple. The convergence of object relations theories with group analysis suggests that the mind works by repeating and externalizing internal group structures in social relationships. The couple, then, becomes an intermediary structure between the individual and the group where intimacy facilitates a re-working of group internal structures. It is the collapsing and the opening of the ‘space between’ which is the agent of change. This process creates strength, power and a feeling of wholeness. But it also implies the expression of anger, pain and disappointment. The author illustrates these points with an interpretation of the Groundhog Day film and with a clinical case study of a couple in therapy.     

When the analyst is physically ill: Vicissitudes in the analytical relationship

Something that happened to one of the authors recently led them to refl ect upon what the analyst's falling ill may represent and the problems it may give rise to in the analytic relationship. Such an eventuality injects a massive dose of the analyst's personal reality into the analytic space, thereby allowing the patient a glimpse of images of vulnerability, frailty and loss, and mobilizing emotions, fantasies and defences in both the analyst and the patient. The authors' survey of the literature ranges between two different theoretical perspectives intrapsychic and intersubjective that, in their most radical formulations on technique, call for maintaining either the strictest neutrality and anonymity or symmetrical relationality. In both cases, that which is denied is the unconscious communication that enables the analyst, irrespective of his conscious intentions, to allow either parts of himself or inner objects of the patient to act in the relationship. In closing, the authors shall illustrate the concept discussed through three clinical vignettes.     

Towards a relational framework for pathological gambling (Part I): Five circuits

Relationship patterns before and after pathological gambling were investigated qualitatively using eight in‐depth clinical case studies in which one partner met Diagnostic and Statistical Manual of Mental Disorders‐IV pathological gambling criteria. Five circuits of couple interactions are described: (i) fault‐lines; (ii) pressure points; (iii) escalation; (iv) relapse and (v) congruence. The exploration of these circuits is developed in two complementary articles. This first article delineates the first four circuits as recursive self‐perpetuating cycles of couple distress in systemic interaction with pathological gambling development and relapse. The second article delineates how a couple can be helped to extricate themselves from these recursive circuits through ‘congruence’. Implications of this relational formulation of pathological gambling for conceptualization, assessment and treatment are discussed.     

Partners' internal stress and well-being: The role of dyadic coping and problem resolution

Couples' experiences of daily stress can be detrimental for partners' individual and relational well-being, specifically their identity as a couple, their relational satisfaction, and their life satisfaction. Grounded in the Systemic Transactional Model, this study aimed at analyzing factors that may safeguard partners and their relationship from detrimental effects of internal stress (i.e., stress that originates inside the relationship). We examined the buffering effect of partners' positive dyadic coping and internal problem resolution. Daily diary data were collected across 7 days from 82 heterosexual couples. Multilevel dyadic analyses showed that internal stress was negatively associated with partners' individual and relational well-being. Positive dyadic coping moderated the association between partners' internal stress and couple satisfaction for both partners, but not life satisfaction and couple identity. Moreover, for partners who reported a resolution to the internal problem, the negative associations of internal stress with life satisfaction, couple satisfaction, and couple identity were significantly lower than for those who did not resolve the internal problem. This study confirms the negative role of internal stress on well-being, shows the associations between internal stress and couple identity, and highlights the protective role of dyadic coping and internal problem resolution in couples' daily lives.     

Resolving defence mechanisms: A perspective based on dissipative structure theory

Theories and classifications of defence mechanisms are not unified. This study addresses the psychological system as a dissipative structure which exchanges information with the external and internal world. When using defence mechanisms, the cognitive‐affective schema of an individual could remain stable and ordered by excluding psychological entropy, obtaining psychological negentropy or by dissipating the energy of self‐presentation. From this perspective, defences can be classified into three basic types: isolation, compensation and self‐dissipation. However, not every kind of defence mechanisms can actually help the individual. Non‐adaptive defences are just functioning as an effective strategy in the short run but can be a harmful approach in the long run, while adaptive defences could instead help the individual as a long‐term mechanism. Thus, we would like to suggest that it is more useful for the individual to use more adaptive defence mechanisms and seek out social or interpersonal support when undergoing psychic difficulties. As this model of defences is theoretical at present, we therefore aim to support and enrich this viewpoint with empirical evidence.     

Infertility: Couples' experiences and the use of counselling in treatment centres

Abstract

Infertility can have profound effects on couples, who may spend years in an increasingly stressful quest for conception; by law, counselling must be offered to those undergoing licensed treatments. This study found that such couples relied on their own partnership as their main resource for managing stress. Predominantly the partnership was organized in a psychological division of labour -the woman experiencing emotional pain, the man supporting and seeking positive solutions. Normally a functional joint defence, this could become a dysfunctional split under excessive stress. Where counselling was offered directly, with a couple approach, couples who took it up were enabled to re-establish their own defences more adaptively. However, where access to counselling was by clinical referral - often of a distressed woman partner alone - the couple approach was more difficult to apply though apparently no less relevant. The counsellor-clinician partnership could mirror the ‘division of labour’, with a similar tendency towards dysfunctional splitting under stress.     

“What matters to us”: The portrait values questionnaire to measure couple values

No previous studies have analyzed values as qualities of relational microsystems, such as the romantic couple. Based on Schwartz's Theory of Human Values, this study examines the psychometric properties of the Portrait Couple Values Questionnaire (PCVQ). It measures four couple value dimensions: conservation, openness to change, self-enhancement, and self-transcendence. Five hundred and forty-six Italian respondents (54.1% women), aged 41.52 years (SD = 7.19; range 23–63) and having a couple relationship, have filled in an anonymous online questionnaire. The results show the good psychometric properties of the PCVQ. The Confirmatory Factor Analysis Magnifying Glass Strategy shows good indexes of fit for each value dimension, except for the Root Mean Square Error of Approximation (RMSEA) for openness to change, thus confirming that the PCVQ measures the four values with satisfactory internal consistency. The Multidimensional Scaling results, by showing a Stress-1 index of 0.07, confirm the circular structure of values because the four value dimensions are in the position predicted by Schwartz's model. Participants' personal and couple values are highly but not perfectly correlated, suggesting that couple values are a related but distinct construct compared to personal values. This study's contribution lies in introducing an innovative construct into the literature on values and couples, proposing a scale to assess it.     

Reading Susan Isaacs: toward a radically revised theory of thinking

The author views Isaacs's (1952) paper, The nature and function of phantasy, as making an important contribution to the development of a radically revised psychoanalytic theory of thinking. Perhaps Isaacs's most important contribution is the notion that phantasy is the process that creates meaning, and that phantasy is the form in which all meanings - including feelings, defense 'mechanisms,' impulses, bodily experiences, and so on - exist in unconscious mental life. The author discusses both explicit formulations offered by Isaacs as well as his own extensions of her ideas. The latter include (1) the idea that phantasying generates not only unconscious psychic content, but also constitutes the entirety of unconscious thinking; (2) the notion that transference is a form of phantasying that serves as a way of thinking for the first time (in relation to the analyst) emotional events that occurred in the past, but were too disturbing to be experienced at the time they occurred and (3) a principal aim and function of phantasy is that of fulfilling the human need to get to know and understand the truth of one's experience. The author concludes by discussing the relationship between Isaacs's concept of phantasy and Bion's concepts of alpha function and the human need for the truth, as well as the differences between Fairbairn's and Isaacs's conceptions of the nature of unconscious internal object relationships.     

Further developments of the concept of fantasy

After the Isaacs' seminal work on the nature and function of unconscious phantasy (1948), several authors (mostly in the British Society) have reflected on the topic and tried to extend the concept of fantasy. In this paper I shall examine the contributions of Winnicott, Gaddini, Joseph and Anne Marie Sandler that aim at broadening this psychoanalytic concept. The authors that I have considered share a focus mostly on the early stages of child development. Both Winnicott and Gaddini belong to a line of thinking that explores the vicissitudes of the primary emotional development of the infantile self (in the mother‐infant relationship) involving the earliest processes of holding and bodily and kinaesthetic fantasy that form the bodily integrity of the person. The Sandlers focused mostly on the concept of the past unconscious understood as a place of primitive vicissitudes with a deficit in figuration where the process of repression is missing. The present unconscious phantasy (that is located in the here and now) has the function of rendering the past unconscious phantasy partly accessible; otherwise it would remain unknowable.     

The Materiality of the Abstraction Voice

The comment on Bertau's paper underlines the importance of the internally social character of the dialogical self, which is not trivial and can not be taken for granted. A consistent theory of this internal character demands specific theoretical means native to a tradition of Leibniz' philosophy. In consequence the concept of dialogical self is presented as a non-empirical one based in an ethos. We, and not nature, are responsible for the modes of conceptualising.     

Current developments in the practice of individual psychoanalytic psychodrama in France

The authors present the history of individual psychoanalytic psychodrama and its current developments as practised in France. They put forward the technique, objectives and rules, along with the indications, limits and risks that ensue from the specific nature of this therapeutic approach. Through its technical adjustments, individual psychoanalytic psychodrama provides a therapeutic option that is appropriate to the defences prevalent in many patients that cause classical psychotherapies to fail: massive inhibition, operative functioning far removed from affects or in false self mode; phobias, disavowal or splitting of the internal psychic life and emotions; prevalence of short discharge circuits in acted-out behaviours and bodily or visceral complaints and expressions. Psychodrama utilizes these defences not in order to eliminate them but to 'subvert' them so that they can continue to carry out their protective role, in particular ensuring narcissistic continuity. At the same time, psychodrama relaxes these defences and facilitates a possible filtering through of the repressed material. Through the number of actors and the diffraction of transference that this allows, psychodrama provides a possibility of adjusting the potentially traumatic effect of the encounter with the object and the instigation of the transference in the regressive dimension induced by any psychotherapeutic process.     

The self in the couple relationship: part 1

This paper discusses the importance of the ‘good-enough’ development of the core self in the couple relationship. It argues that difficulties in the development of the self lie behind a significant number of troubled couple relationships. Part 1 focuses on individual psychotherapy and how changes to the core self are often attended by shifts in the marital relationship. It traces how this occurs through clinical material and analyses what kinds of changes to the self are needed for the couple relationship to function well. Psychodynamic theory is used to understand the core changes over time and how these are related to significant second-order change in the couple relationship. The construct of the ‘transitional space’ is used to theorize the couple relationship. Implications for the practice of individual psychotherapy are discussed. In Part 2, the significance of change in the experience of the self of one or both partners for a successful outcome of couples therapy is discussed, along with the place of work with individual partner(s) in the course of conjoint couples therapy.     

Searching for the facts in the clinical setting with couples

This paper describes a research proposal to examine whether or not the underlying analytic concepts behind the couple psychoanalytic psychotherapy model used at the Tavistock Marital Studies Institute in London are sufficiently coherent, both conceptually and clinically, to be used as the basis for a system of audit which respects the unique data produced in analytic psychotherapy. This 'psychoanalytic' system of audit is one which is characterized particularly by the use of the therapists' subjectivity, rather than attempts to be objective and gather data through such things as random controlled trials or generic outcome questionnaires. The paper describes the approach to the subject and the mix of qualitative and quantitative methods used. As the Tavistock Marital Studies Institute has a history of contact with Jungian analysts from the Society of Analytical Psychology, Jungian concepts are included in the model. The research is part of a professional doctorate in couple psychoanalytic psychotherapy at the Tavistock Marital Studies Institute in conjunction with the University of East London, entitled 'Conceptualizing audit in Couple Psychoanalytic Psychotherapy'.     

Transformations in hallucinosis and the receptivity of the analyst

Bion describes transformation in hallucinosis (TH) as a psychic defence present in elusive psychotic scenarios in which there is a total adherence to concrete reality: as the hallucinatory activity which physiologically infiltrates perception and allows us to know reality, setting it off against a background of familiarity; and then, surprisingly, as the ideal state of mind towards which the analyst has to move in order to intuit the facts of the analysis. When hallucinosis is followed by ‘awakening’, the analyst gains understanding from the experience and goes through a transformation that will inevitably be transmitted to the analytic field and to the patient. In this paper I illustrate Bion's concept and underline its eminently intersubjective nature. Then I differentiate it from two other technical devices: reverie, which unlike hallucinosis does not imply the persistence of a feeling of the real, and Ferro's transformation in dreaming, i.e. purposeful listening to everything that is said in the analysis as if it were the telling of a dream. Finally, I try to demonstrate the practical utility of the concept of transformation in hallucinosis in order to read the complex dynamics of a clinical vignette. Though not well known (only two references in English in the PEP archive), TH proves to be remarkably versatile and productive for thinking about psychoanalytic theory, technique and clinical work.     

Varying Levels and Types of Engagement in an Online Relationship Enhancement Program for Couples Following Breast Cancer

Engagement in online interventions, defined as the extent to which participants are involved in and attentive to the contents of the intervention, has been shown to predict treatment outcome. However, participant engagement and program completion are often quite low. Aiming to provide insights that could help improve engagement, this study explores engagement in an online intervention for young couples with breast cancer, Couplelinks, by describing the development of a method to assess engagement, presenting a framework for understanding varying engagement levels, and discussing strategies used by Couplelinks facilitators to work with participants of differing engagement levels. The measure of engagement developed for this study was a composite consisting of indices of average completion time, accountability, and attitude. Utilizing this composite measure, the following distinct “couple types,” with varying levels of engagement, were discerned: (a) “keen” couples, (b) “compliant” couples, (c) “apologetic” couples, and (d) “straggling” couples. Facilitators’ approaches to working with each type of couple and suggestions for potential therapeutic applications are discussed. The finding that couples vary in terms of engagement level, and not solely based on facilitator skill and/or involvement, supports the need to better understand the concept of engagement in order to make online interventions more effective.