What is This Thing Called Love?

A Guide to Psychoanalytic Psychotherapy with Couples

Sarah Fels Usher

• Publisher: Routledge
• Year: 2014
• Print ISBN: 9780415433846
• eBook ISBN: 9781317723882
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

What is This Thing Called Love? provides a clear how-to guide for carrying out psychotherapy with couples from a psychoanalytic perspective. The book draws on both early and contemporary psychoanalytic knowledge, explaining how each theory described is useful in formulating couple dynamics and in working with them. The result is an extremely practical approach, with detailed step-by-step instructions on technique, illuminated throughout by vivid case studies.

The book focuses on several key areas including:

• An initial discussion about theories of love.
• Progression of therapy from beginning to termination.
• Transference and countertransference and their unique manifestations in couples therapy.
• Comparisons between couples therapy and individual therapy.
• Step-by-step instruction on technique.

What is This Thing Called Love? is enlivened with humour and humanness. It is crucial reading for psychoanalytic therapists, psychologists, psychiatrists, couples therapists and students who want to learn about--or augment their skills in--this challenging modality.

Chapter 1

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The psychoanalytic perspective

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Couples, married and otherwise, usually come to a psychotherapist as a next-to-last resort, often after many years of unhappiness. They bring their most private selves, in some way urgently needing to expose problems; in another, embarrassed and shamed by what they often perceive as painful personal failure. Different from patients in individual therapy, they do not enter treatment for personal growth; these troubled people are about to uncover very raw and tender issues with each other, and with a third person (referee? judge? parent? friend?) observing, listening, and intervening. It is a tricky and complicated business for all concerned.

Therapists who work with couples are usually inundated with a myriad of dynamics, and so it seems only natural that different attempts to categorize and organize the work have evolved. Although, or maybe because, marital therapy has sometimes been described as a technique without a theory, it has been the object of a great variety of more or less theoretical approaches. Systems theory and cognitive-behavioural theory – including list-making and homework assignments – are popular methods of working with couples. Emotionally focused, brief strategic, structural strategic, solution-focused, narrative, relationship education, and transgenerational therapy are just a few of the chapter headings in the table of contents of the recently published Clinical Handbook of Couple Therapy (Gurman and Jacobson, 2002). Contract theory, where both the conscious and unconscious contracts that the couple have made with each other are examined and reworked (Sager, 1994), as well as the search for types or categories of couples that can be put into charts or spreadsheets (e.g. Sharpe, 2000), have also been attempts to cope with the complexity of both the emerging material and the ongoing interactions in the consulting room.

Psychoanalytic theory does not immediately appear to be a natural fit when applied to therapy with couples, since it was developed as a way of observing and interpreting intrapsychic, not interpersonal, data (except transference data, which originally were considered fantasied). Still, it is intricately bound up with the exploration of intimate relationships and, by extension, could be seen as leading to useful methods of treating these relationships. Having a psychoanalytic perspective on couples presenting for treatment gives the therapist the opportunity to bring the concept of the unconscious into the work and thus to get an understanding of the unconscious meaning of many of the dysharmonies of the relationship, as well as offering a framework in which to understand the transference and countertransference issues that arise in the treatment – usually not a focus of other types of couples therapies. When a therapist listens to a couple in a psychoanalytic way, they become more attuned to hidden or mixed motivations.

Is the relationship the patient? Or is it each individual? This question of how to formulate the problem reverberates on two levels: theoretically, should we refer to one-person, classical theory in attempting to understand each person who is a part of the relationship problem, or should we refer to object relations, two-person, theories, and focus on the interpersonal quality of their problems? We are not copping out by answering: both. “Emphasis on interaction alone minimizes the complex contribution of an individual's history and psychodynamics, while exclusive emphasis on individual psychology misses the way in which interpersonal interaction governs a couple's intimate life” (Cohen, 1999, p. 144).

Parallel to this, one of the main sources of tension in couples relationships is the need for individuals to grow and develop – to keep separate in relationships – and for individuals to connect, attach, and depend – to keep close to the other – in other words, the conflicting needs for autonomy and for intimacy. “The management of the inevitable feelings of love and hate towards the same person, which this conflict arouses, is central to understanding the psychodynamics of the marital relationship” (Cleavely, 1993, p. 56).

This chapter will cover the particular concepts from psychoanalytic theory that have, for this author, been most useful in treating couples.

Classical theory

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A classically oriented view of couples therapy would, of course, be based on the premise that all functioning is governed by conscious and unconscious phenomena; that an understanding of defences, conflicts, and symptoms is important for an understanding of the individual; and that a person's history explains why specific solutions have been adopted. A clinician applying classical theory to the treatment of intimate relationships would focus on intrapsychic drives and the unconscious reasons for partner choice, listening for evidence of the psychosexual development of each individual, their degree of success in resolving oedipal issues, their pattern of defensive operations, and any manifest compromise formations (symptoms). It is interesting to see how each spouse's conscious and unconscious conflict-ridden or conflict-free motives, that are bound in affect-laden fantasies or mental representations, are played out in the couple relationship, just as we notice how an individual's unconscious conflicts and fantasies are enacted in the therapeutic relationship in analysis or analytically-oriented psychotherapy.

A classical psychoanalytic therapist would make the couple aware that the past is contained in the present and that all thoughts, words, and actions are responses to what has come before. Cohen (1999) summarizes several other psychoanalytic concepts about which one can inform couples during the treatment: overdetermination – that behaviour, thoughts, and attitudes have more than one meaning and can be experienced in more than one way; the idea of primary and secondary gain – that a person might do something for one purpose, while serving another; the repetition compulsion – that we are often irrationally compelled to repeat behaviour that is unconsciously connected to our early experience, both in choosing a mate and within the relationship; and the idea of the observing ego – that it is helpful to step outside of ourselves to see what is going on.

Freud (1914) divided object choice into two types: anaclitic, or literally “leaning on” – the attachment type of object choice; and narcissistic, where the self chooses itself as an erotic object and the person loves what he once was, what he would like to be, or the person who represents a part of his own self. The reader might find the following passage from On narcissism somewhat amusing, although frighteningly relevant:

Women, especially if they grow up with good looks, develop a certain self-contentment which compensates them for the social restrictions that are imposed upon them in their choice of an object…. Nor does their need lie in the direction of loving, but of being loved. Such women have the greatest fascination for men…. For it seems very evident that another person's narcissism has a great attraction for those who have renounced part of their own narcissism and are in search of object-love. The charm of a child lies to a great extent in his narcissism … just as does the charm of certain animals which seem not to concern themselves about us, such as cats ….

(Freud, 1914, p. 89)

Narcissistic object choice is evident in the attraction of sameness in the other – which will be discussed throughout the book.

The concepts of transference and countertransference – the unconscious displacement of feelings and attitudes that were intended for someone from the past; resistance; projection; and defence – all of which were born in classical theory, are of the greatest importance in working psychoanalytically with couples. A partner often functions as a transference object, embodying projections and displacements from relationships with parents, and sometimes with siblings. To smoke out these partly unconscious dynamics, the therapist needs a good and thorough history of each individual in the couple, including early memories. History-taking will be discussed in detail in the next chapter.

As well, since classical theory focuses on oedipal time (approximately ages 3 to 6 years) – a period that can sometimes be remembered, albeit in bits – it can help us to understand the triangular relationship with the parents, the desire for and hatred of each parent, and unconscious fantasies about the parents' sexual relationship. During these sensitive years, before the blessed calm of latency, there is an overt re-emergence of sexuality and aggression, usually targeting the parents. As Lyons (1993) says, it is seen as common knowledge that men marry their mothers, even if it is less commonly known that women are sometimes, maybe more often than not, likely to choose mother too. The couples therapist, often a target through the medium of the transferences, can notice how the vestiges of this crucial and intensely conflicted time have hung around in the psyches of adult patients.

Being alerted to the intimate relationship as a place for the re-working of the oedipal conflict, the therapist can comment, if relevant, on the significance in the adult couple of the child's-eye views of parental relationships; of the oedipal issues of inclusion/exclusion; of considerations of gender identity and relationships with opposite-sex individuals; of issues concerning guilt and punishment for presumed bad, or perverted, behaviour; and on the important concept of the triangle, including both being the “third” as a child, and being the couple who excludes the “third.”

I find it helpful to assess and understand each partner individually, separate from, and then in conjunction with, the relationship they have created. My own first conceptualization has not to do with drives, but rather with individuals' unconscious motivations and defences, with anxieties and their aetiology. How oedipal issues have been resolved, or not, and how they have affected the choice of partner and the person's capacity for sustained intimacy are of the utmost relevance. Formulating the couple's dynamics will be described in Chapter 2.

In terms of informing technique, classical theory provides us with the tool of interpretation, which proves to be extremely useful in work with couples. Although interpretations usually are not as deep in this modality as they are in individual therapy, interpretative comments can still reflect connections with each individual's past and with unconscious motivation, very helpful in understanding behaviour in the contemporary relationship.

I want to comment here on the capacity to be the couple and exclude the “third,” referred to above – in this example, the parents – a perspective that does not get much attention in the literature. Every couple needs a shared private space, from which others are excluded, symbolized by the closed bedroom door. Often that is difficult to accomplish, as we can see from the following.

Carol and Bob, both physicians in their mid-thirties, seen as an ideal couple by their friends, were arguing constantly in private and had stopped having sex for almost one year. Historically, they had dated in medical school and married shortly after. They had two young sons who were cared for by a nanny. As their fights had become more and more bitter, Carol was threatening to leave. They had trouble scheduling their first therapy session because they were both so busy, and Carol could be called to an emergency with very little notice.

When asked about the problems they were having, Carol, a tall, engaging, attractive woman, responded quickly with noticeable pressure of speech. Everything in their lives was a rush. Work was extremely busy, as her hospital was involved in a merger. She was too exhausted for sex, and had to concentrate each evening on organizing for the next day. In addition, her parents, with whom she was very close, lived out of town, and felt they did not see her and the grandchildren enough, and certainly not as much as Bob's mother, who lived in town. She worried a lot about this, and kept trying to arrange trips to see them. She usually managed to travel back to her hometown about once a month for family occasions, and her mother sometimes surprised her with a weekend visit to Toronto. Carol also reported that she had a difficult relationship with Bob's mother who, she felt, was extremely critical of her. She stated that Bob never defended her with his mother.

Bob, a heavy-set, determined-looking man, sat sullenly throughout Carol's opening remarks, occasionally glancing around my office as if taking stock of the furniture. His story was briefer: Carol cared more about work and her mother than about him and the children. Her parents, who had a lot of money, and had “loaned” them a large sum when they bought their house, made him feel like he didn't earn enough. They offered them beautiful paid-for vacations, but the catch was that her parents went with them. Bob's mother, who had been alone since his father deserted the family when Bob was 8 years old, had always depended on him to look after her, as he was the oldest child. He proudly said that he had done a good job of this, tending to her financial and day-today needs.

This couple were in therapy for three years. I will extract here one piece of the work for purposes of demonstration. In terms of thinking about them individually, they seemed matched on difficulties in separating from their families of origin (Margaret Mahler's ideas about separation will be discussed in the next section of this chapter), manifested now as a feeling of responsibility for them: Bob felt he had to support his mother financially and when any minor problem arose, and Carol felt that she had to enliven her “lonely” parents with as much exposure as possible to their only grandchildren.

Each could see the folly of the other – i.e. how the other's family interfered with their marriage – and each could be remarkably articulate and insightful about the dynamics at play in the other. Neither could accept that their own concerns about parents were serving the function of keeping them tied to their family of origin, pushing away fears of abandoning or being abandoned by parents, calming fears of being grown-ups in the world, and avoiding intimacy with each other and even with their sons.

In our work together, we talked about their growing-up years. Carol's mother, who needed to know what was going on in her daughter's mind, would climb into her bed with her on weekend mornings and ask her what she was thinking about, how she was feeling, and later, even what was happening sexually with her boyfriends. Her mother was sometimes prone to depression and would take to her own bed for days at a time, absenting herself from the family. As we talked more about this, Carol began to connect these weekend morning talks not only with an expression of loving closeness, but also with the unconscious fantasy of paying this small price to keep her mother from getting depressed. She started to think that seeing her parents so often now may be serving that same function. Her mother's behaviour also had caused her to experience closeness to another as intrusive and self-serving, but something one has to endure to keep people happy. This was part of her intense ambivalence about being intimate with Bob, which she expressed as a fear of being swallowed up by him.

Bob's reaction to this disclosure in our third session was a spontaneous outburst of laughter – partly an expression of relief that this was what had been his wife's worry, and also a reawakening of the sense that Carol was, indeed, a kindred spirit, as he had known all along. “You too!” he said. Bob had been prematurely catapulted into a too-intense relationship with his mother in a different way. When his father left, this was an oedipal victory that was excruciatingly hard to bear. His mother, taking advantage of his natural intelligence and sense of responsibility, blatantly referred to him as her “little man,” and asked for his help in caring for his younger sisters, for his advice on which bills to pay, and for his knowledge in how to fix things around the house. She often told him stories about his father, painting him as a mean and violent man, the implication, of course, being that Bob would be different, and would protect her if needed. In our sessions, Bob was much more aware than Carol of his ambivalence toward his mother; he knew he was often quite hostile to her, resenting her demands on him. He said he kept her quiet now by “throwing money at her.” This worked for short periods of time. The rest of the time, he and Carol had to institute a telephone schedule with her, limiting the frequency of her calls. (In situations like this, my therapeutic intervention is often to advise getting “call display.”)

In this case, both sets of parents constituted the “third,” that had to be excluded for the couple to have their own, private space. The guilt and loss that Carol and Bob both felt in contemplating this was palpable. They paid for and took their first holiday with their children and no accompanying others about eight months before we ended treatment. They experienced it with pleasure and freedom. They were able to observe and enjoy their children, who played in the children's camp ar...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Preface
• Acknowledgements
• 1 The psychoanalytic perspective
• 2 Getting started: the first three sessions
• 3 Interlude: on love
• 4 The ongoing therapy: technique
• 5 Transference(s)
• 6 Countertransference
• 7 Dénouement: working through and termination
• Bibliography
• Index