Response to MacIntosh’s Systematic Review of Psychoanalytic Couple Therapy: A Brief Note from the Classical Perspective

ABSTRACT

Working with couples from a classical perspective can be thought of as an oxymoron, unlike working from object relations and relational viewpoints, often seen to be the more natural fits. This article offers a fresh look at those parts of the classical perspective that relate very clearly to working with two partners in a couple. Freud’s theories in Three Essays on the Theory of Sexuality (1905) and On Narcissism (1914a) provide theoretical background for the work. Concepts such as transference (between partners, between the partner[s] and the therapist) and countertransference are shown to be manifested in complex ways with couples. Being mindful of unresolved developmental issues—for example, Oedipal and separation-individuation issues—which may have played a part in partner choice and in the resulting problems, allows the therapist to offer deep interpretations of within- and between-partner conflicts. Interestingly, unresolved Oedipal issues, particularly, may form an important part of the countertransference.     

Countertransference as Projective Identification

SUMMARY

While all countertransference reactions call upon the therapist to examine his/her internal family and unresolved issues, many instances of countertransference can best be understood as originating from and replicating and clients' internalized object relations. In this way, countertransference can be likened to projective identification. By processing countertransference as a form of projective identification the couples therapist can more effectively comprehend and work with important relationship problems. This article outlines the process of analyzing and responding to these kinds of countertransference reactions.     

Countertransference as an Ally in Sexual Therapy

SUMMARY

This paper illustrates a constructive use of a persistent countertransference response of a therapist towards a client in sexual therapy. The recognition that the transference resistance from the client had multiple motivations assisted the therapist's constructive use of the countertransference to facilitate the treatment process of the couple.     

Client Perceptions of Couples Therapy: Helpful and Unhelpful Aspects

This article describes a qualitative study that investigated client perceptions of helpful and unhelpful aspects of couples therapy. A thematic analysis of interviews revealed among other themes, that couple participants associated helpful therapy experiences with (a) being given choices regarding ideas and ways of working that fit for them, (b) working with a therapist they trusted, and (c) developing new ideas about the couple relationship. Implications of this study for future research, practice, and training are described.     

The Journal of Couples Therapy Entelechy Institute CEU Quiz

SUMMARY

The majority of gay male couples are not monogamous. Relationship clinicians can help gay male couples to have a healthy sexually open relationship by working from a family systems perspective. This approach requires the therapist to have an understanding of family systems theory, the Enneagram (a personality topology), gay male sexual culture, as well as being clear of negative countertransference. Assessment of functionality of sexually open gay male relationships is described.     

Countertransference in group psychotherapy

This paper attempts to up-date our understanding of countertransference in the therapy group setting. After a brief review of some of the psychoanalytic and the group psychotherapy literature dealing with countertransference, the paper points out the vulnerability of the group therapist and presents examples of possible countertransferential situations, such as stereotyped roles, reactions to external aspects of patients, and therapists' insecurities. It concludes by suggesting ways in which group therapists can become more sensitive to their countertransferences.     

Enhancing the Creative Process in Couple Therapy

ABSTRACT

This paper reviews the literature as it relates to psychotherapy and creativity. The focus is on the creative process and the role of the therapist as “artist” in the practice of couple therapy. The theory on which the paper is based in problem-centered with influences from the writing of Satir, humanistic psychology and psychodynamic psychotherapy. The paper attempts to offer suggestions as to how therapists might enhance their innate creative ability when working with couples.     

THERAPIST DEFENSIVENESS AND MARITAL THERAPY PROCESS AND OUTCOME

Abstract

This study examined the effect of couple socioeconomic status (SES); pretherapy marital adjustment; and therapist, husband, and wife defensiveness during the third session of marital therapy on posttherapy marital adjustment. Participants were 22 therapists and 88 couples. Each therapist treated 4 couples, 2 from the middle SES level and 2 from the lower SES level. Path analyses revealed that for husbands higher marital satisfaction before therapy was associated with higher adjustment at the end of therapy, but defensive therapist behavior during therapy was associated with lower posttherapy adjustment. A similar pattern was found for wives, but this should be interpreted with caution owing to potential dependencies in the wives' posttherapy adjustment scores. Neither SES nor pretherapy adjustment predicted therapist defensive behavior in therapy, and SES did not predict marital therapy outcome variance. Results suggest that therapist defensive behavior may reflect a style or characteristic of some marital therapists.     

Asian American Intermarriage

SUMMARY

This paper describes the therapeutic process of an interracial couple: an Asian American woman and a White American man. The intent of this therapy was to broaden the conversational space and encourage the couple to explore the effects of cultural beliefs and practices on their relationship. The therapist introduced two approaches for evoking the couple's interest in sharing narratives about their individual and couple racial identity. One approach was to have the couple interview their partner's “internalized other.” The other approach used two research studies to stimulate conversation about outmarriage with Asian Americans. This case study offers an account of two different ways individual narratives and shared conversational space can be expanded.     

Personhood of the Therapist in Couples Therapy

SUMMARY

Integrity Therapy (Lander, 1986; Lander & Nahon, 1992a, 1995a; Mowrer, 1961b, 1964a) views the personhood of the therapist as the very essence of therapy. By meeting the deepest part of the therapist with the deepest self of individuals in therapy, a healing process unfolds which opens up the healing potential of both the individuals and the couple. This article offers couple therapists and other mental health professionals an Integrity Therapy perspective of the personhood of the therapist and its therapeutic potential for helping couples in distress to reclaim their personhood. Two aspects of the Integrity Therapy approach which play a critical role in enhancing therapists' use of their personhood in the therapeutic process are explored: (a) the use of therapist self-disclosure, and (b) therapists' awareness and therapeutic use of counter-transference issues.     

Therapeutic handling of marital infidelity

Abstract

In working with couples and families, the occasional clinical use of mental imagery techniques can frequently promote therapeutic breakthroughs. When sessions focused on a couple's (family's) current communication problems reach a point where progress seems slow and laborious, a therapist can encourage the couple (parents and perhaps even older children) to try one or more imagery sessions to understand their interactional patterns within the context of their own developmental periods. This article describes how imagery can lead couples to new and more constructive perspectives on the meaning of their interactions.     

Assessment and Intervention with Black-White Multiracial Couples

SUMMARY

Effective therapy with Black-White multiracial couples begins with therapist work on self attitudes and with sensitive assessment of the ways racism and race may or may not be connected to a couple's problems. We suggest ways to begin to explore self attitudes and suggest basic assessment questions for work with Black-White couples. In addition, we point out important clinical issues that may come up for Black-White couples in the areas of social support/social network, parenting, and grief.     

David and Judith

SUMMARY

This paper begins with a discussion of Dialogicai Psychotherapy-that “healing through meeting” which comes when the relation between therapist and patient is central-and explores inclusion, making present, confirmation, and the “normative limitation of mutuality.” Secondly, it discusses a Dialogicai Psychotherapy particularly important for couples therapy-Ivan Bos-zormenyi-Nagy's Contextual (intergenerational family) Therapy with its emphases on multidirected partiality, trustbuilding, rejunction, and the intergeneration merit ledger. The third part of the paper applies Dialogicai and Contextual therapy to the case of David and Judith, a couple who show clearly the importance of families of origin.     

Case Report: Object Relations Family Therapy as a Model for Genetic Counseling

Object relations family therapy (ORFT) is a psychoanalytically based approach for the treatment of couples and families which stresses the importance of past relationships. The therapist assumes a parentlike role and provides a holding environment in which clients can explore unconscious motivations. This paper will discuss the applicability of this method to genetic counseling. The case of a couple seen for recurrent trisomies will be presented and used as an example to discuss how ORFT might serve as a framework in a genetic counseling session.     

Basic Considerations in the Application of Therapy and Education to Parent Groups

This article presents a couples group therapy treatment approach that uses analytic object relations concepts such as transference/countertransference, projective identification, containment, and the holding environment. Object relations theory is seen as the most useful theory with which to view couple interaction because it is based on a two-person psychology and focuses on the impact of relational systems on the development of the person. This includes the idea that the person grows within the attachment to another person. Group therapy is seen as a more effective treatment approach because the group is a resilient holding environment that provides an avenue in which projective identifications can be understood and contained, power can be redefined, isolation of the couple can be decreased, and the couple's responses can become more versatile. The model described is illustrated with clinical vignettes from an open-ended couples group.     

Affect Regulation and Attachment Focused Treatment of a Husband with Obsessive-Compulsive Disorder and His Wife

Abstract

In this paper, the author presents an overview of Obsessive-Compulsive Disorder (OCD), an affect regulation and attachment framework for treatment of couples and families, and a case study illustrating how this framework can be used to work with a couple in which the husband has OCD symptoms.     

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.     

Core Energetic Couples Therapy

SUMMARY

Core energetics is a method of psychotherapy that seeks the integration of all aspects of humanity: the emotional, physical, mental, and spiritual. Based on a deep understanding of the ways in which energy and consciousness work together, the therapy, developed by John C. Pierrakos, MD, invites couples to experience their inner truth and to identify their universal life goals and core feelings. Core energetics emphasizes wholeness and unification without loss of individuation for the couple. This article describes core energetics as it is used in couples work; the theory, therapeutic stance, methods of diagnosis, and energetic techniques are discussed, as well as the focus on sexuality and Spirituality.     

Conjoint marital therapy to enhance anger management and reduce spouse abuse

Abstract

This paper describes a treatment program for couples who mishandle anger and/or are physically abusive. Based on a social learning conception of marital aggression, the treatment endorses the elimination of demonstrations of anger in abusive couples and elaborates upon ways to identify preliminary anger cues, to establish a ground rule that abusiveness is unacceptable, to develop alternative responses that interrupt conflict patterns, and to modify faulty relationship assumptions. Methods to improve couples' problem-solving skills and to enhance their overall enjoyment of the relationship are also proposed as important supplements to the training in anger management skills.     

A Farewell to Countertransference

The "discovery" of countertransference provided a much-needed corrective to the one-sided view of transference and a patient's pathology. Even if its usefulness in the development of psychoanalysis was indisputable, its days are numbered. When I present my clinical work at conferences, I am often asked questions about my countertransference. These questions contain numerous assumptions that are challenged in this paper. Treatment is discussed from a self psychological perspective to highlight the therapeutic value of enabling the patient to engage a selfobject transference. The concept of "projective identification" is also challenged. Systems theory, in which the therapeutic relationship is understood as a co-construction between therapist and patient, is proposed as a more effective model to deal with the issues formerly included under transference-countertransference.