Identification as a Focal Point in Couple Therapy

It is impossible to speak meaningfully about a couple's relationship without giving full consideration to the way the partners' childhood experiences have influenced their identities. Each partner is affected by his or her relationships with both parents and by intimacy beliefs shaped through observations of the parents' marriage. Often, unconscious identifications underlie the interactions that lead distressed couples to seek therapy. This paper explores two concepts that can assist therapists in repairing the present in the context of the past—projective identification and disidentification. Consideration is given to the power of the parents' marriage and to identifications based on individual parents.     

Intertraumatic Dissociative Attachment

SUMMARY

This article focuses on the treatment of couples with a collective personal history of multiple traumatic experiences, and central related concepts. Referred to as the intertrauma couples therapy (InTCT) model, this article outlines an approach to treating trauma victim couples in which each partner has suffered one or more traumatic experiences (i.e., war, rape, criminal assault, incest, community violence, etc.). InTCT is a structured five-phase model of care, derived from a long trauma treatment tradition, and the author's clinical experience in the treatment of multitrauma persons for over 20 years.

This comprehensive, integrative approach to treatment is designed to resolve chronic interpersonal hostility, isolation in marriage, fears of intimacy and engulfment, and the persistent revivifications of partners' traumatic memories as a painful product of daily relational encounters. Unfortunately, these encounters represent trauma structures interacting with trauma structures, with no end or relief to the mutual pain-generating interactional patterns. The phases of the treatment takes the couple from disorganization and intense emotional reactivity to stabilization through integration to an end phase with a post-integration life skills building program for lasting results. Also presented are issues such as attachment, specific trauma responses to include interactive concepts of trauma bonding and systems theory in the context of trauma and dissociation. The article also presents a multitrauma couple case study, and discusses the critical role of therapist's functions.     

Love in Action: An Integrative Approach to Last Chance Couple Therapy

This article presents an integrative approach to the special challenges of therapy with couples on the brink of dissolution or divorce—who often describe this therapy as their “last chance.” In some, one partner is considering ending the relationship, and in others, both partners are considering ending it. Often, these couples have had prior dissatisfying experiences in couple therapy. Four types of last chance couples are described: high‐conflict couples; couples in which partners have differing goals for their lives or different timelines for reaching shared goals; couples in which one or both partners have acted in a manner that violates the values, expectations, emotional comfort, or safety of the other; and couples in which there has been a gradual loss of intimacy. The Therapeutic Palette, a multiperspectival, theoretically eclectic integrative approach, is enlisted as a general framework for selecting and sequencing use of particular theories and their associated practices, based on the three “primary colors” of couple therapy: time frame/focus, level of directiveness, and change entry point. An additional complementary framework, the creative relational movement approach, is proposed to provide an integrative frame encompassing both language‐based and action‐based practices, suggesting that meaning is held and expressed as much through interaction or “relational motion” as it is through language. Principles of change are described. Due to the couple's level of crisis and desire for immediate evidence of possible improvement, priority is given to action‐based interventions in early stages of therapy, by engaging couples in “experiments in possibility.” Typical action approaches are described. An extended vignette follows.     

Video playback,affective witnessing,and the mobility of trauma: Video evidence of violent crime in the criminal justice system

In today's technologically mediated society, video is increasingly relied upon as an objective and reliable source of evidence in the investigation and prosecution of violent crimes. The now pervasive presence of violent video in the criminal justice system, however, presents new challenges for understanding repeated work-related exposure to and witnessing of potentially traumatic material and its impacts. Thus, this project seeks to qualitatively examine the relational affective processes that occur among criminal justice professionals when violent crimes are captured on video. We present four key categories organized around the circumstances of exposure and its impacts: 1) playback in the investigative and pre-trial process; 2) sharing videos among colleagues; 3) playing videos for victims, witnesses, and families and; 4) transmission in the broader public. Findings suggest this work involves deeply embodied processes where video evidence of violent crime enables a virtual presence at scenes and an emotional proximity to events through new forms of witnessing. These affective experiences are one relational dynamic that keeps witnessing active, thus expanding the mobility of trauma, its reach and potential impacts.     

Meditative Dialogue: Cultivating Compassion and Empathy with Survivors of Complex Childhood Trauma

Complex childhood trauma often affects the capacities of survivors to experience empathy and compassion toward themselves and others. Recent mindfulness literature recognizes meditation as an evidence-based practice that is able to change the brain, increasing one's capacities for empathy and compassion. This article offers an exploration of selected literature on complex childhood trauma and on mindfulness practices related to the development of compassion and empathy. A case study illustrates the use of a meditative dialogue practice in psychotherapy with a survivor of complex childhood trauma that serves to increase her ability to have empathy and compassion for herself and others.     

The Importance of a Comprehensive Clinical Diagnosis for Group Psychotherapy of Borderline and Narcissistic Patients

This article presents a psychoanalytically oriented model of group treatment for female adult survivors of childhood sexual abuse. Two key treatment, issues—the survivor's struggle to trust her own mind and her tenacious allegiance to an omnipotent, all-bad self-representation—are used to illustrate ways in which the transference/countertransference matrix of the group permits members to enact, identify, and work through central internalized relational configurations. The group therapist's role is to maintain transitionality, a focus on process, and the capacity for play.     

A Kleinian view of psychoanalytic couples therapy: Part 2

With extensive case material, Part 2 continues to explore the psychoanalytic treatment of couples. Since most couples enter treatment operating in a more primitive paranoid‐schizoid stance, the author contends that it is best to initially focus on each partner's pathological projections and have the other partner witness their struggle to overcome personal issues that contaminate the couple's unified psychology. With continuous working through, the couple can gradually find a more depressive, integrative footing within themselves and as a couple. Again, the value of ‘witnessing’ and working through individual defensive reactions against thinking, pathological projective identifications and the breakdown of the container‐contained function are all examined in the clinical presentations. All these clinical elements are part of the establishment of analytic contact first with each party as individuals and later as a unified couple.     

A Dyadic Analysis of the Between‐ and Within‐System Alliances on Distress

To read this article's abstract in both Spanish and Mandarin Chinese, please visit the article's full‐text page on Wiley InterScience ( http://interscience.wiley.com/journal/famp ). This study examines the relationship between the therapeutic alliance and distress using the couple rather than the individual as the unit of analysis. One hundred and seventy‐three couples receiving treatment for relational distress at two university clinics participated in this study. The actor–partner interdependence model was used to analyze the relationship of each partner's between‐ and within‐system alliance scores and distress at session four. Results provide support for actor effects on relational distress for both male and female partners and for actor effects on psychological distress for female partners. Limited support was found for partner effects on distress. Furthermore, results indicate that the alliance between partners is a stronger predictor of improvement in early sessions in comparison with the alliance between the individual and the therapist.     

Hypoactive Sexual Desire in Heterosexual Women:

The problem of hypoactive sexual desire is the most common sexual problem that heterosexual couples and individuals present to sex therapists. Often it is a woman who reports that she has the problem, or her male partner brings her to therapy believing she has hypoactive desire. The treatment literature describes a variety of causes that contribute to the disorders of sexual desire. However, most of the literature looks primarily at the causes within an individual's history of within a couple's relationship. There does not seem to be adequate consideration given to the social and cultural limitations that have defined and prescribed a sexual role for women that is primarily oriented to the service of male needs rather than female sexual pleasure. This article will analyze some of the social and cultural forces that limit female sexual expression, and are a neglected factor when causes for low sexual desire in heterosexual women are given.     

A psychodynamic perspective on early childhood trauma in an adult: A case study

Abstract

This paper uses a long-term case to illustrate, from a psychodynamic perspective, a number of issues arising in working with an adult survivor of early childhood trauma. The paper takes an overview of the case study, identifying issues which are inextricably interwoven in the client's experience of trauma, and which impact on the working alliance. The therapeutic relationship forged with the client is discussed in terms of its intrinsic successes and failures together with the implications of early traumatic experiences for the termination of counselling.     

The effect of relational stage and intimacy on touch: An extension of Guerrero and Andersen

The effects of relational stage, intimacy, and gender on touch were examined. Participants were 270 partners from 135 couples involved in a heterosexual romantic relationship. Results indicated that touch varies as a function of relational stage. An examination of relational stage and subjects' perceptions of how much they touched their partner and how much their partner touched them generally indicated an asymptotic relationship. Specifically, men's and women's perceptions of how much they touched their partners, and women's perceptions of how much their partners touched them, increased from the casually dating to the seriously dating stage and then leveled off for seriously dating, engaged, and married couples. Men's perceptions of how much their partners touched them increased from the casually dating to the seriously dating stage then decreased from the seriously dating to the married stage. Relational intimacy was also curvilinearly related to self and partner perceptions of touch. Because there were no significant interaction effects between stage and gender, or intimacy and gender, the curvilinear effects of relational stage and intimacy on touch are generalizable to both men and women.     

Perceptions of War Trauma and Healing of Marital Relations Among Torture-surviving Congolese Couples Participating in Multicouple Therapy

Citizens of the Democratic Republic of Congo (DRC) experienced widespread torture during national wars between 1998 and 2003. Couples who survived and stayed intact suffered tremendous relationship stress. This study used a critical ethnography framework to explore the prewar, wartime, and postwar experiences of 13 torture-surviving couples who participated in a 10-session Torture-Surviving Couple Group in 2008 in the DRC. The group was designed to address the relational effects of torture and war trauma. Participants reported profound negative effects of the war on their relationships; mostly positive experiences during the group, including marital and peer connection and relationship growth; and a number of improvements in their relationship after the group. Implications include support for the use of relational interventions informed by both treatments for traumatic stress and couple approaches to promote trauma healing. Future directions call for increased funding, research, training, and clinical action to treat the effects of traumatic stress on relational family dynamics.     

Relational turbulence among military couples after reunion following deployment

Reintegration following deployment is a pivotal time for returning service members and at‐home partners. We test logic derived from the relational turbulence model about depressive symptoms, relational uncertainty, and interference from a partner as predictors of people's appraisals of turmoil during the post‐deployment transition. Participants were 118 military couples who completed an online questionnaire once per month for the first 3 months after homecoming. Multilevel models predicting people's appraisals of turmoil revealed (a) actor and partner effects of depressive symptoms, (b) actor effects of relational uncertainty, and (c) actor effects of interference from a partner that were apparent beyond people's appraisals of turmoil during the previous month. These findings advance both theory and practice.     

THE TEXTURE OF TRAUMATIC ATTACHMENT: PRESENCE AND GHOSTLY ABSENCE IN TRANSGENERATIONAL TRANSMISSION

Work on the transgenerational transmission of trauma refers to unspoken stories across generations, but the actual mode of transmission has remained somewhat mysterious. Utilizing examples from her own life, the author illustrates how attachment patterns are a primary mode of transmission of trauma. When trauma revisits a person transgenerationally through dysregulated and disrupted attachment patterns, it is within the child's empathic attunement and search for a parental bond that the mode of transmission can be found. This will become the texture of traumatic attachment: how it feels to this child to feel connected to the parent.     

Actor–partner interdependence of humility and relationship quality among couples transitioning to parenthood

The transition to parenthood is a challenging experience that often strains relationships, but perceiving one’s partner as humble (actor relational humility) and being perceived by one’s partner as humble (partner relational humility) were hypothesized to benefit couples during this transition. Married couples (N = 69) were tracked from the third trimester of pregnancy through 21 months postpartum. Husbands and wives provided ratings of relational humility and dyadic adjustment. Actor–partner interdependence models tested actor and partner effects of relational humility on dyadic adjustment across the transition. Although couples declined in dyadic adjustment over the transition at the same rate regardless of relational humility (counter to Hypothesis 2), those higher in relational humility reported greater dyadic adjustment at each time point during the transition (consistent with Hypothesis 1). These findings support the benefits of relational humility to relationship quality, and we call for further research into humility’s benefits during times of relationship transition.     

Understanding and Assisting Couples Affected by an Eating Disorder

This article reviews the existing literature on heterosexual intimate relationships in which the female partner has an eating disorder. These couples often have trouble in a number of areas, including communication, sexual functioning, relational boundaries, and emotional health. Not only do these problems contribute to lower rates of relational satisfaction but they also affect a woman's chances for recovery. An understanding of this literature can inform family therapy practice. Recommendations are offered for those who provide counseling to these couples.     

The Role of Religious Coping and Resilience in Individuals With Dissociative Identity Disorder

Survivors with dissociative identity disorder (DID) often report a history of traumatic events in their lives. Past studies indicated a link between trauma, resilience, and spiritual coping in both positive and negative aspects of a survivor's life. This article includes a review of existing literature salient to these constructs in relation to i ndividuals with DID, as well as results from a study examining the relationships between these constructs and individuals with DID (N = 52). Implications are discussed based on the findings for counselors treating individuals with DID.     

Social Trauma and Testimony: A Reading of Maryan S. Maryan’s Notebooks Inspired by Sándor Ferenczi

The purpose of this paper is to present the relational dimension of trauma according to Sándor Ferenczi, illustrating it by using the testimonial material produced during the analysis of Maryan S. Maryan, a visual artist, survivor of Auschwitz. Furthermore, a few formulations are proposed on being witness to traumatic experiences in psychoanalytic practice, as well as what can be considered as ethics and politics in psychoanalysis when facing situations of social trauma and violence.