Inside out,or outside in: meeting with couples

The complex difficulties often faced by couples require a range of models for effective help. Relational intensity is heightened in therapy by the ease with which the therapist can be triangled into the couple's relationship and by the influence of the emotional triggers from their respective internal worlds. This article draws on systemic and psychodynamic models and a transgenerational perspective for gendered stories. Different time frameworks link interpersonal and intrapersonal themes. In this sense, the therapist works ‘inside out’ and ‘outside in’. A framework of behaviours, emotions, feelings, meanings and beliefs is proposed to help link these perspectives. ‘Invisible contracts’ and the sense of there often being an unconscious ‘pact to disappoint’ are described. Clear models are not enough, for it is the intimate encounter between client and therapist that is the bedrock of therapeutic change and growth. There is no short cut to this sense of intimacy in the unique encounter between therapist and each new couple. Brief examples from practice describe how the issues discussed may be addressed in couples work.     

The therapeutic object relationship

This paper introduces the concept of the therapeutic object relationship in order to clarify our understanding of the nature of fully analytic work with the more regressive patient, which has unsystematically developed over the last 30 or 40 years. The need for such a clarifying concept seems to arise from several sources. Our analytic work with the more regressed patient appears to entail a relationship demand factor which cannot be usefully treated only as resistance to the development of the transference. These are patients with what may be described as object hunger emanating from faulted ego development and a disordered internal object world. This object hunger cannot be adequately met within the framework of the tacit, ordinary, good-enough environment of the concerned and nonjudgmental analyst. In addition, the literature on this subject still dichotomizes the relationship factor of treatment from the transference. The concept of the therapeutic object relationship appears to offer the possibility of a clinical and theoretical unification between transference and relationship. The major point of the paper may be described in terms of the manner in which we have progressed from Eissler's parameter paper of 1953 to the widened scope of analytic work made possible by object relations theory, developmental theory and observation of infant and child development. The face of analysis seems to have undergone profound modification from the early classical model to one in which developmental maturation, in addition to making unconscious conflict conscious, has become a matter for our concern. This change seems to require seeing the analyst as a special form of real object with whom the patient passes through a revised version of certain developmental pathways. The therapeutic object relationship is viewed as a potentially unifying concept which may make possible higher degrees of generalization about the variously unsystematized approaches to analyzing the more regressive, but nonpsychotic patient. Some history of definition of the analytic relationship in terms of transference or relationship is presented. In the course of the paper the therapeutic object relationship is gradually defined as one of: primal intimacy; increased permeability of boundaries between self and other; intensive empathic interaction; the evolution of self and object definition in a context of intimate relation with an object that is instrumental in this process; and the activation of transcendant forms of symbolic-creative intercommunication.(ABSTRACT TRUNCATED AT 400 WORDS)     

Methods for Connectedness

SUMMARY

There are prerequisites that must be achieved developmen-tally before individuals are capable of co-creating healthy intimacy in adult relationships. Thus, therapists often have to work to help client systems overcome failures of maturation. In these kinds of therapeutic encounters the therapist acts as a developmental partner. By designing compensatory experiences, the therapist can help partners fill gaps in early development and education that operate to sabotage loving relationships. This paper offers examples of how levels of moral development and social-perspective taking can be utilized within a transpersonal approach to help couples achieve more satisfying intimate connections.     

The impact of child sexual abuse on adult interpersonal functioning: A review and synthesis of the empirical literature

The many studies that have examined the long-term impact of child sexual abuse (CSA) on adult functioning have primarily focused on the personal distress of survivors, largely ignoring the impact of CSA on interpersonal relationships. This article reviews empirical findings concerning the interpersonal distress of survivors as expressed in their intimate and sexual relationships. First, current conceptualizations of the relationship between CSA and interpersonal relationships are reviewed, with a focus on the theoretical models that appear to have implications for the long-term interpersonal sequelae associated with CSA. This is followed by a review of the research conducted on intimacy within the area of social psychology and a summary of the empirical findings related to intimacy functioning in CSA survivors. A hypothesized typology of intimacy functioning for survivors is suggested. The effects of CSA on three components of sexuality—sexual dysfunctions, underlying psychological components of sexuality, and sexual orientation—are discussed. Finally, the interpersonal issues believed to be most salient for CSA survivors in the therapeutic setting are discussed, along with implications for the client–therapist relationship. Methodological, assessment, and conceptual issues are discussed throughout. Recommendations for future research and clinical endeavors are suggested.     

Difficulties,skills and therapy strategies in interventions with court-ordered batterers in Spain

As a consequence of its coercive context, psychological interventions with men convicted of intimate partner violence in Spain involve a series of challenges in the design and development of the therapy program. This article reviews the main international contributions that have considered the difficulties produced by the context and analyzes the most important skills that the therapist can utilize in order to facilitate the therapeutic process. The difficulties have been grouped in accordance with origin: (a) difficulties derived from the context of the intervention; (b) the characteristics of the offender; (c) the therapist. The principal skills and strategies of the therapist seem to be related to the clear definition of the intervention context, the management of therapeutic relationship and the therapist's capacity for analysis and reflection. Finally, this work recognizes the need for research projects that focus on the therapist and aspects of the therapeutic process that could optimize the implementation of therapist training actions and improve treatment results.     

Dreaming up the patient in supervision: from the concrete to the symbolic*

This paper discusses the importance of parallel processes within the therapeutic and the supervisory context of therapy with an eight-year-old boy diagnosed with Asperger’s syndrome. During the first months of the therapy, through powerful projective identification, the therapist found herself in the ‘clothes’ of the ‘dead mother’. She was unable to think and feel in the sessions. Deadness could not be symbolised – it was enacted in the sessions. The therapeutic encounter had to start elsewhere: the supervisor’s reverie brought to life the patient’s material in the context of the supervision, allowing thinking to occur, first within the supervisory relationship and only then in the therapeutic relationship. In the context of supervision, the encounter of two mentally alive people could contain anxieties, metabolise them and open the way to mental connections. This encounter facilitated the development of creative thinking of both the therapist and the young patient in the consulting room, which allowed the child to become the subject of his existence and to evolve.     

The issue of sexuality in group psychotherapy

Sexuality is an underlying, but often unspoken and ignored issue in group psychotherapy. Within the context of how a group reacts to and uses sexuality, the authors focus on three relationship areas: client/client, client/therapist, and therapist/therapist. Some of the hazards of failing to deal with sexually laden conflicts and intimacy issues in these relationships are explored. Some of the advantages of an open and honest approach to uncovering sexrole related stereotypes and behaviors are proposed. The authors attempt to demonstrate that recognition of therapists' and group members' sexuality must be appreciated as an important element in the therapeutic process.     

Stages of Intimacy

In this essay, the authors have noted the common awareness in our culture of the "staging phenomenon" in intimacy relationships ("the end of romance," "the seven-year itch") and concluded that it must be possible to outline a framework which describes the developmental processes of intimacy against the background of the partners' individual developmental issues. In this context, many symptoms or troubles in a relationship can be seen as predictable crisis or impasses in normal relationship development. Even the emergence of bitter "warfare," resolute withdrawal, reduced sexual desire within the intimate relationship, or the sudden awareness of a new sense of one's own sexuality outside the marriage is both predictable and explainable as the growth of intimacy. The developmental framework outlined is reminiscent of Erikson's stages of identity-development and, in fact, acknowledges that it is the interaction of two or more evolving Identity-configurations that generates the predictable unfolding of intimacy itself. Attention is focused on the sequencing of critical tasks and common complaints normative to the first and second stages of intimacy-development, and casework illustrates the use of this construct as an approach to marital therapy.     

Intimacies: An Integrative Multicultural Framework for Couple Therapy

Implicitly or explicitly, our ideas about intimacy are the most fundamental notions giving direction to the process of couple therapy. Yet, as a field, we have spent little time conceptualizing intimacy and even less time considering the diversity of priorities and meanings couples bring to our offices. In Part One, Varieties of Intimacy, I describe a kaleidoscope of contexts—socio‐historical, cultural, gender, life cycle, and developmental—that inform our ideas and expectations for intimacy in couples’ relationships. I highlight different spheres in which intimacy may take place such as the emotional, sexual, intellectual, or familial. I propose a starting point in which the therapist, in a collaborative manner, helps the partners articulate their yearnings and priorities in order to negotiate a shared vision. In Part Two, Conceptualizing Intimacy, I suggest an experiential definition that gives room for each partner's subjective meanings, yet consider diverse relational processes that may need to be addressed for a resilient ebb and flow of intimate experiences. In Part Three , Sexual Intimacy, I outline conditions in which sex is more likely to be experienced as intimate rather than nonintimate. Finally, in Part Four, I describe Therapeutic Principles to guide the therapist in taking couples from reactivity to dialogue to negotiations of intimacy. The integrative framework proposed here discourages monolithic a priori notions of intimacy and highlights instead: nuanced meanings, relational processes to be considered differentially, present and past emotional blocks, and a flexible clinical approach to foster conditions for the creation and resilience of intimate experiences.     

Peter McHugh 1929–2010: The Unique Gesture

In thinking of my relationship to Peter McHugh as an intimate collaboration, I take some reactions elicited to a most recent unpublished writing of his on intimacy as an occasion for discussing both intimacy and collaboration as a notion in-itself and as applicable to us in particular, treating that space between the general and particular of intimacy as its zone of fundamental ambiguity. I try to being to view a story of the imaginary of community, its elemental stirrings, that Peter might appreciate. In this, I reorient Arendt’s notion of communicating with the dead to the problem of the intimate collaboration and of how each might be a practice that mirrors the other, intimate collaboration being one way of confirming the vow in communicating with the dead to witness, and reciprocally, such communication being a way of practicing intimate collaboration. This leads me to bring to view a range of unstated resonances of the discussion that have applicability to our shared history. First, is intimate collaboration possible in organizations such as the university and how does it coexist among adversarial exchanges, factitious coteries, alliances, and collegial networks? Second, is communicating with the dead another way of speaking of tradition and dissemination in any context as such and what could the manner and method of orienting to this desire say about the quality of life in commemoration per se?     

Information Seeking Beyond Initial Interaction.

This essay extends previous work on uncertainty and information seeking within close relationships by considering how relationship parameters correspond with the directness of people's information‐seeking strategies. Because we believe that assumptions of uncertainty reduction theory (Berger & Calabrese, 1975) have been translated into the context of close relationships without attention to the unique features of that domain, we begin by reframing questions about uncertainty to reflect issues relevant to intimate associations. In particular, we reconsider the focus of uncertainty, the function of uncertainty reduction, and the nature of information seeking. We then discuss how relationship intimacy, power dynamics, and information expectancies correspond with information‐seeking behavior within close relationships. In doing so, we highlight how the negotiation of relational uncertainty may function to sustain intimate associations.     

Gender role attitudes,relationship efficacy,and self-disclosure in intimate relationships

Drawing from the intimacy process model and data from 5,042 individuals who remained partnered across Waves 1 and 2 of the German Panel Analysis of Intimate Relationships and Family Dynamics (pairfam), this study examined the contributions of traditional gender role attitudes and relationship efficacy in predicting levels of self-disclosure within an intimate relationship. Independent samples t-tests demonstrated females scored higher than males on self-disclosure and relationship efficacy measures but lower on traditional gender role attitudes. An ordinary least squares regression analysis revealed relationship efficacy was a stronger predictor of self-disclosure compared to traditional gender role attitudes, which were not associated with self-disclosure. The findings suggest attitudes with an interpersonal motivational system may be especially important for setting the intimacy process into motion within an intimate union.     

Predictors of intimacy in couples' discussions of relationship injuries: an observational study.

The interpersonal process model of intimacy (H. T. Reis & P. Shaver, 1988) proposes that self-disclosure and empathic responding form the basis of intimate interactions. This study examined this model in 102 community couples who completed intimacy measures following videotaped discussions about relationship injuries occurring both within and outside the relationship. Observational assessments of self-disclosure and empathic responding, as well as their respective components, were related to self-reported ratings of post-interaction intimacy. Men's own disclosure and empathic responding predicted their feelings of intimacy, whereas women's intimacy was predicted by their partner's disclosure and empathic responding. Self-disclosure and empathic responding appear to be important behavioral determinants of intimate feelings, but the manner in which they influence intimacy differs according to gender.     

Révéler son humanité ? L’autorévélation du thérapeute à la lumière de la recherche empirique

Self-disclosure, which consists in revealing personal information about oneself to one's client, could be a beneficial therapeutic technique. There are yet many definitions of this concept. However, empirical research shows that self-disclosure may be favourably perceived by clients and that it could influence how they perceive their therapist. Moreover, it could positively influence treatment outcome. Self-disclosure about immediate feelings in the therapy and about the therapist–client relationship would be particularly effective in resolving problematic events by enabling feelings to be expressed and accepted and by providing clients with interpersonnal learning. Several authors finally advise using this technique infrequently, about moderately intimate but relevant themes in relation to the therapy, examining each client's specific needs, and always with the intention of helping them or improving the therapeutic relationship.     

Psychological Intimacy in the Lasting Relationships of Heterosexual and Same-Gender Couples

This research focused on the meaning of psychological intimacy to partners in heterosexual and same-gender relationships that have lasted for an average of 30 years. In-depth interviews were used to explore the meaning of intimacy to 216 partners in 108 relationships. The participants were whites, blacks, and Mexican-Americans, with Catholic, Jewish, and Protestant religious backgrounds; they were employed in both blue- and white collar occupations.Psychological intimacy was defined as the sense that one could be open and honest in talking with a partner about personal thoughts and feelings not usually expressed in other relationships. Factors that had a significant role in shaping the quality of psychological intimacy in the last 5 to 10 years of these relationships (recent years) were the absence of major conflict, a confrontive conflict management style between partners, a sense of fairness about the relationship, and the expression of physical affection between partners. Women in same-gender relationships, compared to their heterosexual and gay counterparts, were more likely to report that psychologically intimate communication characterized their relationships. The findings are important for understanding factors that contribute to psychological intimacy in long-term relationships and how the gender roles of partners may shape the quality of psychological intimacy in heterosexual and same-gender relationships.     

Growing at the Hyphen: Female Friendships and Social Context

Although the psychological literature has focused more on immigrant women's roles in their families, women's friendships are important sources of support and identity development. This article explores the development of friendship in the context of immigration, cultural adaptation, becoming a template for identity and intimacy. Specifically, the author describes a personal friendship and a psychotherapy case vignette, integrating feminist, multicultural, and relational psychoanalytic perspectives, to illustrate the influence of female friendship in coping with loss, acculturative stress, discrimination, and the formation of bicultural identity. These examples highlight the ways in which personal friendships of the therapist and the client contribute to the psychotherapeutic relationship, growth in intimacy and authenticity, and the negotiation of a hyphenated identity.     

Deliberate self-harm and sexual abuse in adolescence

Helping a young person to render repeated self-injury redundant as a solution to problems connected with having been sexually abused requires a containing context which both supports autonomic healing in the patient and provides an experiential model for the restoration of relationship with adults as a safe (non-abusive) activity. In this paper a case study is presented and some treatment issues for individual psychotherapeutic work are addressed. These include ensuring that the power balance between patient and therapist is acknowledged by emphasizing the patient's self-determination, recognizing patterns of re-enactment within sessions, and addressing here-and-now behaviour and its link with the original trauma. This paper also examines the changing function of self-injurious behaviour and how it can be perceived as addictive after the establishment of a proper alliance between patient and therapist. the circular logic involved in avoiding identification with the abuse-perpetrator by way of self-injury is explored. the therapeutic relationship as an alternative to this is discussed.     

Words and Drugs: Same Mechanisms of Action?

The therapeutic effects of words, rituals and, more in general, of the whole psychosocial context around the patient, have been investigated over the past few years by using the placebo response as a model. Today we are in a good position to study all these complex psychological factors by using a physiological and neuroscientific approach that uses modern neurobiological tools to probe different brain functions. Since a placebo is represented by the whole ritual of the therapeutic act, the main concept that has emerged today is that words and rituals may modulate the same biochemical pathways that are modulated by drugs. Most of our knowledge about these mechanisms comes from the field of pain, and represents a biomedical, psychological and philosophical enterprise that is changing the way we approach and interpret medicine, psychology and human biology. If on the one hand we know some of the mechanisms of drug action in the central nervous system, on the other we can now understand how the therapist’s words may affect different physiological functions. In fact, the placebo effect and the therapist–patient relationship can be approached by using the same biochemical, cellular and physiological tools of the materia medica. Although the responses to the therapist’s words cannot be reduced merely to the action of a single drug, this represents an epochal transition, in which the distinction between psychotherapy and pharmacotherapy is progressively getting thinner, and which helps us overcome the old dichotomy between psychology and biology.     

Client-therapist intimacy: responses of psychotherapy clients to a consumer-oriented brochure

Psychotherapy clients read two consumer-oriented brochures: a general brochure on psychology and a brochure on the topic of client-therapist intimacy. Half of the participants read the general brochure first and the brochure on client-therapist intimacy second, and half the participants did the reverse. Participants reported favorable reactions to the brochures, indicating they thought both should be made available to psychotherapy clients; that neither were too long, too sensitive, or too difficult to read; and that the brochures should be made available early during the therapeutic process. After reading the client-therapist intimacy brochure, participants also showed some changes in Likert-type scores measuring attitudes regarding intimate contact between clients and therapists. Although participants were more negative about issues of sexual misconduct after reading the client-therapist intimacy brochure, they did not indicate a decrease in trust of therapists, nor did they indicate a greater likelihood of filing a false complaint. We concluded that therapists' reservations about presenting clients with factual information regarding therapist sexual exploitation of clients are not empirically founded.