Contexts and Connections: An Intersubjective Systems Approach to Couples Therapy

CONTEXTS AND CONNECTIONS Also by David Shaddock From Impasse to Intimacy: How Understanding Unconscious Needs Can Tra...

Author: David Shaddock

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CONTEXTS AND CONNECTIONS

Also by David Shaddock From Impasse to Intimacy: How Understanding Unconscious Needs Can Transform Relationships

CONTEXTS AND CONNECTIONS An Intersubjective Systems Approach to Couples Therapy

BY D A V I D S H A D D O C K

BASIC

B BOOKS A Member of the Perseus Books Group

Copyright © 2000 David Shaddock Published by Basic Books, A Member of the Perseus Books Group All rights reserved. Printed in the United States of America. No part of this book may be l-eproduced in any manner whatsoever without written permission except in the case of brief quotations embodied in critical articles and reviews. For information, address Basic Books, 387 Park Avenue South, New York, NY 10016-8810.

Library of Congress Cataloging-in-Publication Data Shaddock, David. Contexts and connections: an intersubjecrive systems approach to couples therapy / David Shaddock p. cm. Includes bibliographical references and index. ISBN 0-465-09570-4 1. Marital psychotherapy. 2. Intersubjectivity. I. Title. RC488.5 .S483 2000 616.89'156--dc21 00-029267 FIRST EDITION

For Luba

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For every atom of me as good belongs to you. Walt Whitman


Contents

Acknowledgments Introduction

xi xiii

1

The Myth of Isolated Therapy

2

An Overview of Intersubjectivity Theory

17

3

Hopes, Needs and Disappointments: The Selfobject Dimension of Couples Experience

33

Overlapping Contexts: Childhood Trauma and the Repetitive Dimension of Couples Experience

49

"No Person" Psychology: A Dynamic Systems View of Relationships

69

4 5

6

1

The / in the Thou: The Empathic/Introspective Mode of Listening

93

7

Process and Cure in Couples Therapy

109

8

Combining Couples and Individual Therapy

127

9

Family Therapy

141

Breaking Cycles: Parental Therapy

159

Epilogue References Index

175 177 185

10

i\


Acknowledgments

I want to offer my most heartfelt appreciation to my editor, Cindy Hyden, whose high standards, clear thinking and passionate commitment to the subject matter have been simultaneously daunting and inspiring. I also want to express my gratitude to Robert Stolorow, Max Sucharov and Whitney Van Nouhuys, who were kind enough to read and comment on individual chapters. Many of the ideas of the book originated in my collaboration with Jeff Trop, M.D. and Luba Fischer, Ph.D., my sister, on two workshops presented in consecutive years at the Annual Conference on the Psychology of the Self. I owe my interest in self psychology and intersubjectivity theory and my commitment to "break the frame" in the service of our patients to Luba's influence. I would also like to acknowledge years of mentoring by Susan Sands, Ph.D. I want to thank the many people who have attended my workshops over the past year: their questions and comments have helped me hone the ideas in this book. This project would truly not have been possible without the help of my research assistant, Jill Miller, a graduate student at the Wright Institute in Berkeley. At times it feels that my entire professional life would be impossible without the help of my assistant, Marin Van Young. Marin also provided invaluable editorial assistance in the preparation of this manuscript. Finally I want to gratefully thank my family for their patience, support and forbearance. My wife, Toby, took on an inordinate share of family responsibilities at a time of personal stress, and despite the demands of her own career. My eight-year-old son, Jacob, came to me one day when I was pounding away at the computer and said, "Writing this book must be so hard on you, Dad." As I flushed with pride at his newfound empathy, he continued, "It must be so hard on you, not spending more time with me." How right he was. \i

xii

Acknowledgments

A version of Chapter 9 was published as a chapter in Conversations in Self Psychology, Progress in Self Psychology, Volume 13, Analytic Press, Arnold Goldberg, editor. A version of Chapter 10 was presented as part of the workshop "The Expanding Scope of Couples and Family Therapy," with Dr. Jeff Trop and Dr. Luba Fischer at the XlXth Annual Conference on the Psychology of the Self, Washington, D.C., October 1996. A version of Chapter 8 was delivered as part of the workshop "Reconceptualizing the Frame: Combining Couples and Individual Tlierapy," at the XXth Annual Conference on the Psychology of the Self, Chicago, November 1997.

Introduction

The central theme of this book is inclusion—in particular, the inclusion of the therapist's own subjectivity as a constituent part of the patient's ongoing psychological life and the inclusion of the patient's intimate relationships as part of the focus of psychotherapy. At a more general level, it is about the inclusion of ever-widening contexts—historical, relational and societal—in our understanding of personal experience. Twentieth-century science, in narrowing its gaze to isolated atoms and genes, brought us remarkable gifts. Classical psychoanalysis, by excluding "extraneous" details of a patient's life and focusing on mental products unmediated by conscious control—dreams, fantasies, transference—was able to illuminate the unknown world of the unconscious. But there was a liability: by excluding from our purview the lived contexts of atoms and genes-— and minds—we missed the actual effects of our cleverness and good intentions in the real world. As the poet William Carlos Williams (1963) wrote, "Divorce / is the sign of knowledge in our time" (p. 28). Such "divorce" begins in what Robert Stolorow and George Atwood (1992) call "the myth of the isolated mind" in which "the individual exists separate from the world of physical nature and also from engagement with others" (p. 7); it manifests in lives rent asunder by the continuing high rate of marital failures. It has been my passion, both personally and professionally, to try to alter this climate of divorce in all of its meanings and manifestations. As a therapist I have been drawn to work with couples and families, and to theories that value connection as the central organizing principle in our lives— specifically, to the phenomenological, experience-near theories of self psychology and intersubjectivity, which seek to overcome the gap between theoretical abstraction and empathic immersion in our patients' lives. xm

xiv

Introduction

As a poet, I have tried to find language that connects vividly to the world—rather than isolating us behind walls of rhetoric and abstraction. And as a wrriter for and about couples whose relationships have become stuck, chaotic or unfulfilling, I have attempted (From Impasse to Intimacy, 1998) to provide a context of understanding, informed by self psychology and family systems theory, for the nature and dynamics of the partners' unconscious needs and fears and for the way relationships work as a system to protect them from emotional pain. This book is an extension of that same passion. The two words of the title address the theme of inclusion. Contexts speaks in particular of the book's epistemological stance—against a view of personal experience grounded in determinism (by, say, early childhood) or an essentialist view of personality, and in favor of seeing our psyches at every moment as products of multiple and overlapping contexts: historical, relational, societal. It is impossible to understand personal experience divorced from these contexts, among them the context of a therapist's observing and trying to understand a patient. I argue for treatment contexts that include the significant relationships in a patient's life, in particular that between intimate partners. The word connection invokes the relational movement in psychoanalysis, evolving from Ferenczi and Sullivan to the British object relations theorists through Heinz Kohut and self psychology to the contemporary intersubjective thought of Robert Stolorow, George Atwood and their collaborators. All of these schools stress relationship as the central organizer of psychic life as well as the curative factor in psychotherapy. Several assumptions govern the intersubjective systems approach to couples therapy. • Individual experience is inherently embedded in an intersubjective relationship system. This is what Stolorow (1997) half-jokingly calls a "no person" psychology. The notions of a fixed self, a fixed representational world and intractable pathology give way to a view that human experience is at all times a product of the dynamic relationship between intrapsychic and interpersonal experience. • Intersubjectivity theory, which developed from the study of infantlcaregiver and patient I therapist dyads, can be usefully extended to the understanding of couples and families.

Introduction

xv

The most pivotal concepts are: the centrality of affect in human experience; the view of relationships as systems of mutual regulation; the centrality of empathic introspection as a listening stance in couples therapy; and the construct of the bipolar transference, according to which human experience in relationships continually oscillates between the hope for new, development-enhancing experiences and the fear that old traumatic, development-inhibiting experiences will be repeated. • If both partners are in the room, they both benefit from one partner's developmen t-enhancing experience. In effect, a rising (selfobject) tide lifts all boats. Providing empathy or selfobject experiences to one partner creates a context for openness and vulnerability that eventually redounds in the couple's favor. • Individual therapy can at times be alienating or even destructive to outside relationships. The idealizability of an individual therapist can provide an essential development-enhancing experience. However, a patient's spouse can pale by comparison to the idealized individual therapist. The individual therapist's empathy can, at times, be diverted to blame or anger toward the patient's partner. Conjoint treatment refocuses the patient on the developmental task at hand, such as engaging in an intimate relationship while tolerating inevitable disappointments. • Couples therapy is an underutilized treatment modality, most notably as the treatment of choice for individual problems and pathologies. In a useful comparison, Grotstein (1999) describes Kleinian therapies as informed by the metaphor of weaning and Kohutian therapies as informed by an emphasis on attachment or bonding. The couples treatment described here inherently supplies both: empathic exploration of each partner's experience creates an attachment to the therapist, and the selfobject experiences created in the room foster renewed attachment experiences for the couple. The presence of multiple subjectivities in the room intrinsically facilitates "weaning" from the therapist's exclusive support and empathy. The alternation of attachment experiences with experiences that foster accommodation to other points of view makes couples therapy a uniquely developmentenhancing modality. The first five chapters of this book offer a theoretical overview of the intersubjective systems approach:

xvi

Introduction

Chapter 1, "The Myth of Isolated Therapy," argues for widening the frame in psychoanalytic treatment to include the patient's lived relationships. Chapter 2 introduces key tenets of intersubjectivity theory, including its view of psychoanalysis, the structure of the subjective world, and development and pathogenesis. Chapter 3, building on Kohut's (1984) assertion of the persistence of selfobject needs throughout the lifespan, describes the selfobject yearnings and disappointments that underlie couples experience. Chapter 4 describes the other side of the coin: the transferences that come to dominate relationships when partners regard each other not as sources of longed-for selfobject experiences but as sources of pain and trauma that repeat pathogenic contexts from childhood. Chapter 5 applies nonlinear dynamic systems theory to intimate relationships, drawing on the work of developmentalists (Thelen and Smith, 1994) and infancy research (Beebe et al., 1988,1992, 1994,1996). The last five chapters apply intersubjective systems theory to clinical practice in a variety of treatment contexts. Chapter 6 describes the empathic/introspective listening stance, which remains at the core of the intersubjective systems approach. Chapter 7 provides a perspective on the way couples therapy proceeds, with particular attention to six general treatment areas: creating trust, fostering the capacity for introspection, making system interpretations, strengthening the holding environment, directly creating developmentenhancing experiences, and strengthening attachment. Chapter 8 describes a model in which individual and conjoint treatment is combined. Chapter 9 applies the intersubjective systems approach to conjoint family therapy. Chapter 10 describes an approach designed to interrupt the replication of pathogenic cycles through working with the caregiver in a variety of treatment contexts. I have chosen as the epigraph for this book a line by Walt Whitman, perhaps the ultimate poet of inclusion. The self that Whitman sang of was a self that "contain[s| multitudes" and yet was singularly his. The paradox that informed Whitman's poetry is the paradox that lies at the heart of the approach to couples therapy described in this book: that we are never more ourselves than when we transcend our preconceptions of self and let ourselves be transformed through contact with another.

CHAPTER 1


Richard and Beth were referred to me by their son's therapist. Richard sought treatment to "see if his marriage of 20 years could be saved" after the husband of a woman who worked for him had called Beth to reveal his discovery of his wife and Richard's affair. Beth arrived at the first session in an advanced state of intoxication. Slurring her words, she disclosed that she had been drinking steadily for several weeks and was an alcoholic. The alcohol heightened her already bitter affect. She denounced Richard sarcastically every time he tried to speak, with comments like, "Why don't you go tell that to cutie pie." Richard, for his part, did not seem to show any real remorse for the affair, several times looking at me with a complicit look that seemed to say, "Do you see what I was up against?" He also took pains to tell me early on how many branch offices his business owned. From time to time, however, 1 saw another expression on his face: that of a scared and helpless little boy. My nascent alarm about this case grew considerably stronger when, in the second week of treatment, Richard came by himself to announce that Beth was in the hospital with kidney faihire. In addition to being an alcoholic, she was also diabetic. Beth returned to treatment the next week, somewhat chagrined but no less bitter. It was tempting early in their treatment to protect myself from the vortex of their painful emotions by assigning them the diagnosis of a narcissistic/borderline couple (Slipp, 1988). This would have distanced me from the intersubjective field in the room, consisting of a woman in an acute state of 1

2


fragmentation, exacerbated by the alcohol she turned to for relief; a scared man looking for the only kind of emotional supply that had ever been available to him—admiration for his professional (and sexual) accomplishments; and an alarmed therapist struggling to contain his sense of competency in the face of overwhelming emotions and Beth's life-threatening condition. But such a retreat would have been a step away from the twin concepts that form the title to this book: that it is impossible to understand anything about people separate from their contexts, and that the underlying motivation for all people is the desire for a reliable emotional connection. Whatever the origins of Richard's so-called narcissism, it could not be understood outside of his experience in the relationship with Beth, nor indeed separately from the context of having talked to me on the phone and now being in my office. Nor could Beth's "borderline" condition be understood as anything other than a "phenomenon] arising in an intersubjective field—a field consisting of a precarious, vulnerable self in a failing, archaic selfobject bond" (Stolorow, Atwood, and Brandchaft, 1987, p. 130). While fighting the temptation to protect myself with diagnostic labels, I also considered calling collateral therapeutic troops: residential substance abuse treatment and medication for Beth, individual treatment for both of them. It turned out, however, that Beth had already tried residential treatment and twelve-step programs without success, and that she had been seeing a psychiatrist for years, both for therapy and medication. Richard also had been in long-term individual therapy. Indeed, each partner blamed the other's therapist for exacerbating the marital problems. They both used their individual treatment as a source of weapons to hurl at each other with comments such as "My shrinks been telling me to leave you for years." Against the press of these other options, I tried to bolster the central commitment of my work: to view a person's experience from within their subjective world, rather than from outside it (Atwood and Stolorow, 1984). Although the philosophical considerations that underlie this commitment (Atwood and Stolorow, 1984; Stolorow and Atwood, 1992; Orange, Atwood and Stolorow, 1997) have deeply moved me over the years that I have studied intersubjectivity, my consideration here was much more pragmatic. My clinical epistemology offered me a place to start working and offered the hope of establishing some kind of empathic bond in an intersubjective field characterized by real anxiety at the lack of any connection. As I began to explore their individual experiences of the relationship, another dimension emerged—they both were attached to the relationship, and


3

both held on to a glimmer of hope. Richard proposed a schedule of three times a week for sessions, and beginning in the third week of treatment this schedule was followed. Because of the extremity of her condition, I decided to start with Beth. From an objective point of view, Beth looked quite disturbed—some of her thoughts were incoherent, and her attributions of intentionality to some of Richard's behavior seemed paranoid. Richard told me he suspected her years of drinking had caused organic damage. But an investigation of Beth's experience from within her subjective point of view yielded a different picture: the central theme that emerged was her complete feeling of betrayal—not so much from Richard's infidelity itself, but from the denial and lies that surrounded it. During the year of the affair she had come to distrust her own thoughts and feelings in the face of Richard's denials: "I would confront him with inconsistencies and he would convince me that I was making it all up." Beth's sense of fragmented depersonalization began to make sense to me in this light. Richard's "gaslighting" (Beth's phrase, referring to the 1940s Ingrid Bergman-Charles Boyer movie Gaslight, in which a husband tries to convince his wife she is going insane) traumatically re-created the pathogenic developmental situation of a child whose "ability to sustain a belief in [her] own subjective reality was derailed because [her] perceptions contained information that was threatening to [her] caregivers" (Stolorow and Atwood, 1992, p. 95). In the context of this profound selfobject (Kohut, 1971,1977) failure, Beth's rage and attacks on Richard came to seem less an effort to punish or retaliate than a desperate attempt to shore u p the i-eality of her affective experience. Shouting and attacking provided her, however momentarily, with a feeling that her thoughts and feelings were valid. I continually interpreted my understanding of the devastating effects of Richard's invalidation of her self-experience with comments such as "You're telling me that your entire world has been shattered" or "It sounds like you came to distrust your own perceptions." Beth's face, contorted with emotion, would visibly soften, and her outbursts would gradually begin to subside. From time to time she still needed to consolidate by denouncing Richard, but denunciation began to alternate with a calmer exploration of her experience of the marriage and the affair. About three weeks into the treatment, Beth announced that she had stopped drinking. I believe that my provision of a self-delineating (Stolorow and Atwood, 1992) selfobject experience, in which an individual's thoughts

4


and feelings are confirmed and validated, was a crucial part of her making a commitment to sobriety. As Beth stabilized, Richard began to share his experiences of loneliness and frustration in their twenty-year marriage, but Beth was unable to listen to him without being provoked. She believed his only reason for describing these experiences was to justify the affair. Impasse: it was essential for Richard to begin to express his feelings, yet Beth's capacity for empathy at this point in the treatment was limited. Empathy for Richard threatened to return her to a depersonalized, boundary-less state in which Richard's reality supplanted her own. Although the lack of capacity for empathy often indicates developmental arrest, my commitment to view Beth within the context of her present relationship precluded this kind of diagnostic supposition. I interpreted my understanding of why she couldn't listen to Richard, along with my belief that it would be necessary and important for her to do so at some point later in the therapy. Richard said that he could postpone talking about his side of things. It is worth noting that Richard's capacity to forgo validation of his experience belied my initial impression of him as being highly narcissistic. Richard's narcissism was not a fixed property of an isolated mind (Stolorow and Atwood, 1992) but a self-organization that was highly context dependent. It emerged in a specific developmental context, and flourished in a relationship dominated more by enmity than empathy. The intersubjective field formed by my careful investigation of Beth's experience provided a different context, one in which Richard's need to be center stage was assuaged by the implied promise that his turn would come. When Richard's experience of the relationship emerged, it became clear that his narcissism—his sense of himself as a highly successful entrepreneur, athlete and womanizer—was a thin veneer. Underneath this shield lay a world of self-experience characterized by constant perceived threats to his autonomy and hopelessness that he would ever get his needs met. Early in treatment, a model scene from Richard's adolescence emerged, illuminating the origins of his self-experience. Richard had been playing basketball in the driveway when the mailman brought news of his admission to an elite Ivy League college. In order to preserve the experience from his intrusive mother, he just kept playing ball and didn't inform his parents for twentyfour hours. His mother was terribly hurt and his father bitterly denounced him for upsetting her. This dynamic completely overshadowed any ac-


5

knowledgment of his achievement. As therapy proceeded, this scene came to encapsulate his childhood history of domination by his mother's needs and his father's criticism. Richard's experience of his marriage was that Beth constantly attempted to control him to force him into meeting her needs and criticized him terribly when he did not succeed. He even felt that Beth's wish to have him buy her presents for birthdays, anniversaries and holidays was an example of this. He wondered why she couldn't appreciate what he provided for her every day. I speculated that there was a considerable amount of transference here, both maternal and paternal, and that his experience of Beth was being organized by his childhood experience of a mother who usurped his individualitv with her neediness and a father who criticized him. This material posed a theoretical challenge: whether to share with Richard the conviction that Beth's desire for presents on major occasions was normal or to explore the meanings that these occasions had for him from within his subjective world. The latter course allowed for the depleted, fearful self that lay under his achievements to surface. It became clear that admiration was the only selfobject experience that Richard could imagine; it was very hard for him to believe that anyone could resonate with his sad or depleted feelings. His resentment at gift giving hid a deeper resentment that the longedfor admiration came with the price of meeting others' needs. As this picture of Richard emerged, Beth commented, "I've always known this is true. I've always felt how much he needed to be admired for everything he did." 1 asked Beth why then she took Richard's actions as meaning he didn't love her, rather than seeing him as loving her as best he could, given his limitations. I was surprised at how readily Beth answered the question, and with the depth of understanding she expressed. "It's because I was never allowed to comment on the fact that our mother was incapable of loving anyone." Beth grew u p in a large Irish family. Her mother developed MS when Beth was six, but Beth was sure her mother's emotional remoteness predated her illness. Beth cited as an example of her mother's lack of caring the fact that she hadn't even phoned her brother when his wife died. Beth had a ready answer as to why she personalized Richard's lack of attention: "It's because I've always felt that it was my fault. That way I didn't have to violate our family's denial about our mother." These two childhood-derived imperatives—to blame herself for not being cared for and to protect the secret of a

6


caregiver's dysfunction—had ominous ramifications for her marriage. It is possible that behind Beth's vociferous condemnation of Richard was a shaky commitment not to protect him anymore. Without my taking a detailed history, both of the partners' family of origin materia] had emerged. And increasingly, the treatment became focused on illuminating how these experiences had organized the field of the relationship. We began to explore the overlapping contexts of their experience: how Beth's bitter denunciations reminded Richard of his father's criticism, how Beth's experience of being "gaslighted" ominously repeated the experience of having her experience of being unloved as a child constantly denied. As this occurred, a sense of collaboration slowly began to replace the bitterness and disappointment that had dominated the room. The approach to couples therapy that this case illustrates grows out of the historical shift from an objectivist to a systemic, contextual epistemology in analytically informed psychotherapy. The requirement that a therapist "know" what is right for a couple is the epistemological cousin of the belief that a therapist should have knowledge, by virtue of his theory, of the contents of a patient's mind. A couple's reality is a systemic creation, and reality in couples therapy is a creation of the three-person system. A key component of the new paradigm is that psychic reality is fluid and context-dependent. If we cannot understand a phenomenon such as Beth's rage separate from the developmental, relationship and treatment contexts that shape it, we must begin to rethink the boundary between individual and conjoint therapies. Does isolating a patient in individual treatment lead to a deeper or more profound cure? Does relationship therapy block access to the unconscious? How are we to understand patients without seeing them in their lived contexts? We are fortunate to be living in a moment in intellectual history when the theoretical tools that can unify our understanding of individual, couple, family and group therapy are available to us. Intersubjectivity theory provides a conceptual link between two domains that have heretofore been seen as separate: the intrapsychic and the interpersonal. Dynamic systems theory provides a way of understanding a wide range of personal experience, from mental structures to repetitive interpersonal enactments in a couple, not as isolated, linear phenomena but as emerging from a complex and fluid system.


7

THE PARADIGM SHIFT IN PSYCHOANALYSIS In their landmark opening chapter in Contexts of Being entitled "The Myth of the Isolated Mind," Stolorow and Atwood (1992) make it clear that intersubjectivity theory both grows out of and extends the revolt against the dualistic, Cartesian thinking that has dominated Western philosophy since the Renaissance. "The myth of the isolated mind/' they explain, "ascribes to man a mode of being in which the individual exists separately from the world of physical nature and also from engagement with others" (p. 7). The image of a mind "separated from all that actually sustains life" (p. 12) is a heroic myth that serves the psychological purpose of disavowing the vulnerability of the human condition. In particular this myth disavows the fact that our lives are inevitably imbedded in the vicissitudes of our bodies, our relationships and the ever-shifting organization of our subjectivity. The particular focus of intersubjectivity theory's critique of Cartesian thinking are the mechanistic, objectivist assumptions that have underlay psychoanalysis since Freud. At their root is the assumption that there is an "'objective reality' that can be known by the analyst and eventually by the patient" (Stolorow, Brandchaft and Atwood, 1987, p. 4). Intersubjectivity theory, in contrast, sees the observer as inextricably linked to the observed. Each patient/therapist dyad co-creates a specific intersubjective field (Atwood and Stolorow, 1984) out of which all meanings, transferences, interpretations and therapeutic outcomes emerge. The challenge to isolated mind thinking from within psychoanalysis parallels the challenge posed by the family therapy movement. Beginning in the 1960's with a critique of the portrayal of schizophrenia as an isolated mind phenomenon, rather than as a by-product of dysfunctional communication patterns in the family system (Bateson et al., 1956), the family therapy movement came to regard individual psychotherapy as an intrinsic part of the old paradigm that ignored the family contexts that maintained their pathology. Unfortunately, the family therapy movement, at least in its early manifestations, fell victim to its own hubris and epistemological blind spots. Early claims that family therapy alone could cure schizophrenia proved disappointing, especially in light of the widespread acknowledgment of the organic basis of it and other disorders. Furthermore, by failing to take into account the individual's subjectivity, it failed to recognize the way that manifestly new-other experiences could be assimilated into old-self/old-other

8


configurations (Shane, Shane and Gales, 1997). The result was that new patterns of behavior or communication did not invariably result in lasting individual transformations. Throughout the sixties and much of the seventies, the gulf between family therapy and psychoanalysis seemed uncrossable. By the 1980s, a number of theorists began to combine object relations theory and family therapy (Slipp, 1984, 1988; Scharf and Scharf, 1987). These theorists tended to privilege the view that fixed self and object representations, developed in childhood, controlled relationship and family systems. At about the same time, psychoanalytic theory was undergoing a profound shift Kohut (1984), who saw psychological life as influenced by the quality of relationships throughout the lifespan, challenged the view that psychological life is controlled by fixed structures that derive in childhood. Kohut's concept of the selfobject (1971,1977), in which the object's functions of soothing, regulating or encouraging are experienced as part of the self, inherently challenges the isolated mind view of the separation of self and other. Self psychology views the analyst as inextricably contributing to the patient's experience of self-cohesion, self-distress or fragmentation. The relational school of psychoanalysis (Hoffman, 1983; Mitchell, 1988; Aron, 1996; Renik, 1993) also came to view the therapist/patient dyad from a systems perspective. These theorists emphasize the here-and-now moments in which therapist and patient co-create meaning. As Orange, Atwood and Stolorow (1997) point out, however, these theorists tend to underemphasize the developmental contexts that shape those here-and-now experiences. Intersubjectivity theory, as originated by Robert Stolorow and George Atwood in the late 1970's and early 1980's, developed parallel with Kohut's self psychology, though the two theories have much in common. Intersubjectivity theory views the patient and therapist as a dyadic system in which the patient's tendency to assimilate his experience of the therapist into preexisting structures of experience and his accommodation of the therapist into a new sense of self and other oscillate between figure and ground. In a similar vein, Shane, Shane and Gales (1997) have categorized the patient's shifting experience of the analyst into three modes: old-self/old-other, newself/old-other and new-self/new-other. These conceptions of the therapist/patient dyad are readily applicable to couples. Intersubjectivity theory is a contextual theory that includes both the developmental context and the context of the patient and therapist together in


9

its attempt to understand and transform the patient's inner life. It is this book's contention, however, that an overemphasis on the patient/therapist system as the main subject of psychoanalytic inquiry has led intersubjectivity theory to ignore some of the most formative contexts of the patient's inner life: the context of present-day intimate and family relationships, as well as the wider contexts of social, political and economic conditions. Even as Stolorow, Atwood and their colleagues have deconstructed the myth of the isolated mind, they have not yet deconstructed the myth of isolated therapy. Similarly, while intersubjectivity theory has challenged the myth of the therapist's neutrality (Atwood and Stolorow, 1984; Stolorow, Brandchaft and Atwood, 1987; Stolorow and Atwood, 1992), it hasn't acknowledged as a myth the notion that therapy can be isolated from larger relationship systems, or that therapy is "contaminated" by the inclusion of these relationships in the treatment. There is a paucity of commentary in all of these authors' case presentations on the patient's present relationship contexts. In limiting their exploration of the intersubjective field to the two-person models of child/caregiver or patient/therapist, these authors have not yet followed through on the promise set out in their first book (Atwood and Stolorow, 1984) in which they state that the concept of the intersubjective field can be readily extended to shed light on a wide range of human interactions, including intimate love relationships, family patterns, group processes and even intergroup relations. The concept of intersubjectivity provides a broad basis for a psychoanalytic understanding of human social life, bridging the gap between the analysis of individual subjective worlds and the study of complex social systems (p. 119). Returning to the case of Richard and Beth, we see that without consideration of the relationship context, it is impossible to understand Beth's subjective world. Indeed, her alcoholism, reactivity and "paranoia" were all connected to this experience of her having been "gaslighted" by Richard. The epistemological stance I took toward Beth (that it is impossible to understand her experience without consideration of the developmental context of her mother's inability to validate her thoughts and feelings, the context of her relationship with Richard both before and after the affair, the context of her experience of Richard in the room and the context of our ever-shifting

10


transference/countertransference experience) was a crucial part of our therapeutic alliance. The empathic bond formed by my careful exploration of her experience in each of these contexts allowed her to have moments of increased self-cohesion, and to slowly begin to look nondefensively at her own role in the relationship.

RETHINKING THE BOUNDARY BETWEEN INDIVIDUAL AND CONJOINT THERAPY Both Richard and Beth had been in long-term, individual therapy. During the course of these therapies not only did their relationship deteriorate, but their individual pathologies—Ann's alcoholism and rage, Richard's manic defenses against a pervasive feeling of emptiness—grew worse. Richard and Beth's individual psychological organizations had become completely intertwined with a relationship system that assimilated those pathologies into fixed and relatively stable patterns of relating—at least until the revelation of the affair. Individual therapy had itself been assimilated to the relationship themes of blame and displacement. This is not a unique predicament. The family therapy movement has always contended that an hour or even five hours of individual treatment a week would not be enough to overcome the family system's pull toward maintaining old roles and behaviors. To use the terms of Shane, Shane and Gales (1997), the individual therapy's attempts to create and maintain a new-self/new-other configuration take place in a relationship context that frequently reinforces the old-self/old-other configurations. Richard's individual therapist appears to have confirmed his worst fears about Beth. Whatever the therapist actually said, what Richard reported hearing was essentially "You can do better than this." Even prior to the revelation of the affair, his sense of new-self/new r -other with his mistress began to give way to some familiar repetitive patterns, and this influenced his decision to break it off and seek couples treatment. Richard's experience of Beth as ruthlessly exploitative and unappreciative grew out of his childhood experience with his highly invasive and narcissistic mother. Moreover, the defensive structures that Richard developed as accommodation to this pathogenic surround—a belief that only grandiose feelings were worthy of mirroring and all other vulnerable feelings must be disavowed—contributed to the repetition of this childhood pattern in his relationship with Beth. Beth, starved for emotional contact in her own child-


11

hood, now found herself married to a man who habitually hid his own vulnerability and required constant mirroring of his achievements. A steady diet of this thin emotional gruel had led her to develop two responses—she either withdrew into her books or she became critical, self-destructive and demanding. In the relationship system, these responses only reinforced Richard's worst fears of being tied to an unavailable but nonetheless invasive and manipulative other.

PSYCHOTHERAPY AT THE BEGINNING OF THE TWENTY-FIRST CENTURY The current situation in psychotherapy resembles the parable of the blind man and the elephant. Each school is privileging the unique piece of psychological "anatomy" that they are touching: early self and object representations, the act of putting split-off or unacceptable parts of the self into another person, the influence of affect regulation by the primary caretaker, the evolution of constructed meaning in the therapy dyad, the influence of larger relationship and societal systems on the individual, the intersubjective field formed by the intersection of two differently organized subjective worlds. One of intersubjectivity theory's greatest accomplishments is its critique of the reification of these theoretical perspectives and their attendant metaphors into objective truths (Stolorow and Atwood, 1992) and accordingly of their transformation into enshrined techniques (Orange, Atwood and Stolorow, 1997). In spite of this recognition, the conception of psychoanalysis as a treatment modality consisting of one analyst and one analysand remains unchallenged. It is the central tenet of this book that intersubjectivity theory contains the theoretical power to transcend this limitation. Intersubjectively informed analytic psychotherapy is a treatment modality that can, and indeed should be, practiced in a wide variety of individual, group and conjoint configurations. Therapists should use maximum flexibility in designing treatment protocols that "will lead to an awareness, deepening investigation, and gradual illumination of existing structures of unconscious organizing principles and their continuing contribution to the repetitive course that life takes" (Brandchaft, 1993, p. 228). When this investigation takes place in conjoint treatment the effects can be immediate: the alternative to the world these unconscious organizing principles create is renewed intimacy with the person sitting on the couch next to you.

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Many issues in psychoanalysis have been discussed in terms of what Langs (1978) called the "frame." It is in the name of protecting the frame that psychoanalysis has proscribed such things as therapist self-disclosure or the therapist's contact with outside family members. As important as these considerations are, too often they have resulted in a priori assumptions as to what constitutes protection and what violation of the therapy situation. According to Orange, Atwood and Stolorow (1997), the frame should grow out of the process of therapy, rather than be something imposed on that process; ". .. we must take care to choose the frame for that particular painting, not buy the frame first and then attempt to create something or someone appropriate for it" (p. 24). Although there are specific intersubjective contexts where a relationship frame that excludes contact wTith outside partners is necessary to preserve a sense of integrity or safety, there is no reason to assume that this is a universal requirement. Indeed, in a case such as Richard and Beth, the frames around their respective individual therapies proved decidedly unsafe. The cases in the next chapters will likewise support the following argument: treatment that (1) takes the context of present-day relationship systems into account in any attempt to understand an individual's subjective world, (2) constructs a therapy frame that grows out of the process of the therapy, (3) includes whoever is relevant to the process of transformation, and (4) maintains a commitment to investigate the changing meanings that such a frame may evoke is preferable to one based on a rigid boundary between individual and conjoint therapies.

A UNIFIED THEORY OF PSYCHOANALYTIC THERAPIES In their chapter entitled "Beyond Technique," Orange, Atw r ood and Stolorow (1997) specifically challenge the idea that psychoanalysis can be conducted with a set of "rules of proper and correct procedure. . . . The primary purpose of the rules of any technique is to induce compliance, to reduce the influence of individual subjectivity on the task at hand" (p. 23). As an alternative to technique, the authors describe an attitude of "practice" in which the question "what is wise to do with this person, at this time, for this reason" is continuously asked (p. 27). The discussion that follows opens directly into the kind of treatment modalities proposed in this book:


13

Human beings are by nature relational. There is more to this assumption than meets the eye. It implies our psychological life cannot be the life of the isolated mind; it must originate, grow, and change within the intersubjective contexts in which we find ourselves. This premise requires us to ask not only what happened to this patient in what contexts of relatedness or experienced isolation to bring about the suffering he or she brings to treatment. As contextualists, we must also ask what resources for healing are available in this analyst-patient pair. We must ask how our own history, personality, and theoretical allegiances affect the understandings we reach with this patient (pp. 27-28, emphasis in original). We must also include the patient's intimate relationships and family ties in our consideration of resources, and we must further ask the crucial questions of how the patient's outside relationships affect the therapy and how the therapy is affecting the patient's outside relationships. The concept of the intersubjective field, along with the therapist's commitment to investigate that field through empathic immersion in the patient's subjective world and constant introspection, lies at the heart of intersubjectivity theory. Moreover, it offers a way to extend psychoanalytic treatment beyond the individual to the couple and family modalities and even to create new modalities that will address ever-widening contexts of human experience. In the last few years, intersubjectivity theorists have begun to embrace general systems theory as a way of understanding psychological phenomena (Sucharov, 1990; Orange, Atwood and Stolorow, 1997). According to Orange and her co-authors: Dynamic systems theory is centrally concerned with the process of developmental change—that is, the generation of "emergent order and complexity: how structure and patterns arise from the cooperation of many individual parts" (Thelan and Smith, 1994, p. xiii). Because it accounts for the "messy, fluid, context sensitive" (p. xvi) nature, we (Stolorow, 1997) have contended that this framework is exceptionally well suited to serve as a source of guiding metaphors for psychoanalysis. We now suggest that it also provides a broad philosophical and scientific net in which all the variants of contextualism in psychoanalysis can find a home (p. 75).

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Within this broad net, individual mental activity, the child /caregiver relationship, the patient /therapist relationship or adult intimate relationships are "subsystems or elements that constitute the whole" (p. 75). The capacity to think systemically does not come easily. Part of the difficulty is that viewing ourselves and others as operating within the bounds of a relationship system violates our cherished notions of autonomy and individuality. In order to overcome this dilemma, family therapy has often resorted to a reified view of the system as agentic, with its own needs for homeostasis, boundaries and so forth. The phenomenological approach of intersubjectivity offers a way out of the dilemma. The intersubjective field exists not as a reified mechanism but as a way of describing the subjective experience of being part of a relationship system, for instance experiencing the system as being greater than the sum of its parts and having orders and structures that organize and thematize the member's experience. The sense of ourselves as autonomous individuals becomes an important part of the intersubjective held, forming an ever changing figure-ground relationship with our sense of being caught up with or controlled by our engagement with others. This book argues for a treatment that is inclusive, context sensitive and fluid in terms of which subsystem deserves attention. As Orange, Atwood and Stolorow point out: "One- and two-person psychologies have tended to be reductive and incomplete because they proposed comprehensive explanatory theories grounded in one level only of a living system hierarchy " (p. 75). Intersubjectivity theory has the potential to engage any of the subsystems with the depth, rigor and power that have been the hallmark of psychoanalytic treatment. The emphasis here on intervention at the relationship level is a response to the fact that conjoint treatment is vastly underutilized as the treatment of choice not just for marital discord but for a wide variety of psychological phenomena. For therapists who came of age during the formative days of family therapy, the euphoria of rapid systemic change left an indelible impression. Although family therapy did not prove to be a panacea, the potential of new relationship systems to emerge, and the power of these new systems to affect seemingly intractable individual pathologies remains at the heart of the couples therapy enterprise. It is my hope that this book will be of use both practically and theoretically to my fellow therapists who are accustomed to working "where the rubber meets the road"—at the intersection of three or more differently organized subjective worlds. I am also hopeful that this


15

book will encourage psychoanalytically oriented individual therapists to take the plunge and use their profound knowledge of the unconscious origins of psychological life in treatment modalities that actively support their patients' relationships. As the example of Richard and Beth demonstrates, there is an untapped potential in intersubjectively oriented conjoint therapy as a treatment for both individual and marital problems.


CHAPTER 2


Intersubjectivity theory can best be understood as part of a wider paradigm shift taking place in Western thought. The old, expert-based positivist point of view, with a linear notion of cause and effect and an heroic myth of the individual struggling for individuation is giving way to a view that is relativistic, with a nonlinear systemic view of causation and a belief that the search for connection is the central task of human life (Stolorow and Atwood, 1992). As Stolorow et al. (1994) point out, the "new paradigm . . . brewing in psychoanalysis goes . . . by several names. Mitchell (1988) calls it relational model theorizing; infancy researchers (Beebe et al., 1992) call it a dyadic systems perspective; Hoffman (1991) calls it social constructivism; we .. . call it intei'subjectivity trwory" (p. ix). There are many sources of this new paradigm, including the scientific discoveries of quantum physics and nonlinear systems theory (Sucharov, 1990), the development in philosophy of hermeneutics, the study of how meaning and interpretations are created (Atwood and Stolorow, 1984; Orange, 1994), deconstruction and feminist challenges to patriarchal notions of absolute truth and hierarchical institutions. Intersubjectivity theory places the shift in the context of clinical practice, challenging the hierarchy in traditional psychoanalysis whereby a patient is considered resistant if he disagrees with the interpretations of an all-knowing therapist. 17

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The intersubjective therapist, by contrast, doesn't reveal the truth about the patient's unconscious mind. Therapist and patient engage in a collaborative effort to understand the patient's subjective experience. The therapist is at all times aware of his own contribution to that experience. Interpretations are not seen as being correct or incorrect; they can be evaluated only in terms of their contribution to the therapeutic process of illuminating the patient's inner world. The intersubjectively informed therapist is not free of beliefs and theories. Rather he sees his theories as his own subjective attempt to make sense of the clinical encounter. The intersubjectively informed therapist tries to hold his theories lightly: he observes the way they offer him security and coherence in the face of the often daunting work of therapy. The terms intersubjective and intersubjectivity at the most general level focus attention on the field formed by the interplay between the personal worlds of experience of two or more persons. Although the words are quite popular in psychology today, different theorists use the terms in different ways (Stolorow and Atwood, 1992). Infant researchers such as Stern (1985) use the term intersubjective relatedness to describe a developmental level in which the child can acknowledge the difference between his and the caregiver's subjective worlds. The term has also been used more narrowly by neo-Kleinians to focus on such unconscious communication between patient and analyst as projective identification. Benjamin's (1992) phrase "Where objects were, subjects must be" (p. 44) implies that intersubjective relationships are those in which the existence of the object's subjective world is recognized. Atwood and Stolorow (1984) use the term to describe any system consisting of two or more subjective worlds of experience. In the context of psychoanalysis, the term frames the domain of the investigation as "the interplay between the differently organized subjective worlds of the observer and the observed" (p. 41). Philosophically, intersubjectivity theory has its roots in phenomenology (Atwood and Stolorow, 1984; Orange, Atwood and Stolorow, 1994). It shares with self psychology a commitment to a so-called experience-near perspective, seeking to build its theoretical concepts out of a close investigation of the patient's experience, as opposed to experience-distant theories that generalize from abstract concepts back to particular experience. What follows addresses the intersubjective view of psychoanalysis, the intersubjective theory of the structure of the subjective world and the intersubjective theory of development and pathogenesis.


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PSYCHOANALYSIS Psychoanalysis is defined as a study of the intersubjective field created by two differently organized subjective worlds—that of the patient and that of the analyst—for the purpose of helping to articulate and render unto conscious control the patient's subjective world. The goal is to illuminate "the organizing principles and leitmotifs that prereflectively shape a patient's experiences and conduct" in order to enable the patient to "recognize his world as partially constituted by the structures of his own subjectivity" (Atwood and Stolorow, 1984, p. 42). Neutrality and Abstinence. Intersubjectivity theory rejects as an artificial construction the notion of analytic neutrality. To imagine that the therapist can put aside his own subjective organizing activity and, thus purified, focus only on the patient's subjective world is a fallacy. The technical prescription for abstinence is another issue that intersubjectivity deconstructs: "Abstinence is equated here with neutrality, on the assumption that the active frustration of the patient's wishes and needs constitutes a 'neutral' act that neither colors the transference relationship nor affects how these wishes and needs become manifest in the therapeutic relationship" (Stolorow, Brandchaft and Atwood, 1987, p. 42). Why should an environment that frustrates the patient's needs necessarily be more clinically useful than an environment that gratifies them? Indeed, intersubjectivity contends that abstinence and other aspects of traditional psychoanalytic practice are often the cause of iatrogenic reactions, which then are seen as confirming diagnostic data. For instance, Stolorow and Atwood (1992) cite the case of a young woman whose therapist, in the name of neutrality, "responded to her urgent need for mirroi'ing, affirming responses with silence or at best brief interpretations." The patient "began to experience [the therapist's] seeming aloofness and neutrality as a repetition of the traumatically depriving circumstances of her childhood and alternated in the treatment between sexualization of the transference and attempted seductions on one hand and expressions of deep rage on the other" (p. 107). The classic notion that abstinence will elicit the patient's repressed drives is here turned on its head. In accord with Kohut (1971, 1977), intersubjectivity believes that these drives are really reactions to selfobject failure and represent desperate attempts to preserve faltering self-organization

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and /or maintain the relationship tie. In place of these drives, intersubjectivity posits a number of motivational systems that emerge in therapy, primary among them being the emergence of developmental needs that were unmet in childhood. Whereas the goal of classical analysis was the renouncing of primitive drives in favor of more mature functioning, self psychology and intersubjectivity seek to overcome these developmental arrests through creating a corrective emotional environment (Kohut, 1984) in which thwarted developmental yearnings can be expressed, understood and integrated. Transference and Countertransference. The classical notion of transference as a projection of deep unconscious material onto the blank screen of the neutral analyst is radically revised by intersubjectivity theory to refer in the most general sense to the "universal psychological striving to organize experience and construct meanings" (Stolorow, Brandchaft and Atwood, 1987, p. 37). Transference, in analysis, occurs as the patient assimilates his or her experience of the analyst into preexisting themes and beliefs about relationships. Because all organizing activity is inevitably influenced by "the affect laden, archaically determined configurations of self and object that pervade [the patient's] psychological life" (p. 36), an analysis of the transference meanings that events in therapy have for the patient inevitably sheds light on these unconscious structures. Countertransference has traditionally been seen as an unwarranted intrusion of the analyst's own subjectivity into the analytic situation, or, by Kleinians, as a source of insight via the patient's projective identification into walled-off or disavowed aspects of the patient's unconscious. In contrast to these perspectives, intersubjectivity views countertransference merely as a particular aspect of the therapist's own ongoing subjective organizing activity: "Countertransference .. . refers to how the structures of the analyst's own subjectivity shape his experience of the analytic relationship and, in particular, of the patient's transference" (Atwood and Stolorow, 1984, p. 47). Indeed, the interplay of transference and countertransference constitute the intersubjective field that is the domain of analytic inquiry (Stolorow, Brandchaft and Atwood, 1987). Of particular importance in the analysis of transference and countertransference is the ebb and flow of moments of conjunction and disjunction. Conjunction occurs when the analyst's orga-

An Overview of Intcrsubjeclivity Theory

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nization of the patient's material corresponds with the patient's, disjunction occurs when the analyst "assimilates the material expressed by the patient into configurations that significantly alter its actual subjective meaning for the patient" (Atwood and Stolorow, 1984). Conjunctions can be a source of empathy and fellowship between the patient and the analyst, but they can also cause the analyst not to investigate important issues in the patient's inner life because he has countertransferentially assimilated them as normal. Disjunctions are inevitable and not necessarily retraumatizing in the absence of iatrogenic behavior on the part of the analyst. Blaming disjunction on patient resistance, for instance, directly discounts the patient's subjective reality, thereby re-creating traumatic intersubjective contexts. A therapist's repeated decentering on his own subjective experience of the patient in favor of investigating the meaning of the disjunction from within the patient's frame of reference creates a renewed experience of empathy. For example, in the conjoint treatment of a couple in which the wife had been sexually abused as a child and then told that the abuse never happened, the therapist repeatedly phrased interpretations to emphasize the subjective reality of each partner, with statements like, "You experience him as punishing you by withdrawing." These comments were inevitably followed by agitation or hopelessness on the part of the patient. The therapist's organization of her material into his own theoretical orientation—his commitment to multiple subjective realities as opposed to one objective truth— had led him to ignore their effect on the patient: a retraumatizing discounting of her sense of reality. When this disjunction was understood, the patient was able to recommit to the marital therapy. Just as unanalyzed disjunctions can be the source of retraumatization, so the careful analysis and working through of disjunctions can be assimilated as part of a new, healing therapeutic reality. Sustained Empathic Inquiry. Following Kohut, the intersubjectively informed therapist consistently tries to understand the patient's point of view from within his subjective frame of reference. He then uses his introspection to notice the way his own subjective experience contributes to his understanding of the patient's experience, both by analogy and through attention to the intersubjective field his subjective organizing activity co-creates. This listening stance is the subject of Chapter 6.

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Bipolar Transference. In a useful summary of modern relational psychoanalytic theories, Steven Stern (1994) categorizes the transferences they describe into the needed and the repeated. The former, in intersubjectivity theory, correspond to longed-for selfobject functions that are needed to undo developmental arrests and allow the patient to complete unfulfilled developmental tasks. In the latter dimension, the patient experiences the therapist as repeating the original developmental trauma. This is the source of resistance and conflict in the transference (Stolorow, Brandchaft and Atwood, 1987). Of course, rather than examining the "distortion" in the transference as in classical practice, the intersubjectively informed therapist searches to find the source of the repetitive meanings for the patient from within the specific intersubjective field of the relationship, as well as in the patient's developmental history. Chapter 4 will discuss bipolar transference, and especially the repetitive dimension of experience as it affects intimate relationships. Interpretation. Across the range of therapeutic responses, from those that emphasize new relationship experiences and affective attachment to those that emphasize bringing cognitive understanding to unconscious processes, to highly confrontational declarations such as Kohut's famous (1984) upbraiding of his client for being a "complete idiot," intersubjectivity distills a common thread for successful interpretation: each in some way is assimilated by the patient as a development-enhancing selfobject experience. As Stolorow (1994) states: The analyst, through sustained empathic inquiry, constructs an interpretation that enables the patient to feel deeply understood. The patient, from within the depths of his own subjective world, weaves that experience of being understood into the tapestry of unique, mobilized selfobject yearnings, enabling a thwarted developmental process to become reinstated. Psychoanalytic interpretations, I am contending, derive their mutative power from the intersubjective matrix in which they crystallize (p. 53). From this vantage point, a useful interpretation is one that makes a patient feel deeply understood, fosters a sense of connection and hope and contributes to the patient's higher functioning; an interpretation that contributes to the patient's sense of fragmentation or isolation is not useful, regardless of how "true" the therapist believes it to be.


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THE STRUCTURE OF THE SUBJECTIVE WORLD As opposed to reified notions of psychological apparatus such as Freud's model of the id, ego and superego, intersubjectivitv posits the notion of "structures of experience" defined as "the distinctive configurations of self and object that shape and organize a person's subjective world" (Atwood and Stolorow, 1984, p. 33) and are "disclosed in the thematic patterning of a person's subjective life" (p. 34). The Sense of Self. Building on the contributions of Heinz Kohut, intersubjectivity sees the sense of self as the prime organizer of the subjective world. In accord with intersubjectivitv theory's phenomenological approach, the self is not a reified mechanism. Rather the term self refers to a particular subjective organization of experience characterized by a sense of cohesion and continuity. In their early writings Atwood and Stolorow (1984) described the self as a psychological structure, but later conceptions (Stolorow, 1997; Orange, Atwood and Stolorow, 1997; Sucharov, 1999) move away from a structure to describe a self that is ever more fluid and context dependent. A positive sense of self is characterized by a sense of unity and cohesion, a sense of continuity over time, a sense of agency, and affect states of vitality and healthy self-esteem. Developmental derailments or psychopathology either impinge on these positive self-experiences or, in extreme cases, create a sense that the self is in jeopardy of being annihilated entirely. Motivation. Atwood and Stolorow (1984) assert that "the need to maintain the organization of experience is a central motive in the patterning of human action" (p. 35). As Kohut repeatedly emphasized, maintaining a cohesive sense of self is critical to this organizing activity. An empathic understanding of the primacy of the need for a sense of subjective order opens the door to the illumination of a number of complex pathologies—including psychotic actions, masochism, borderline states and trauma. Perhaps the single most useful aspect of both self psychology and intersubjectivity is their ability to shed light on the motivation that underlies pathology. Conveying this understanding to the patient offers a chance to restore a lost or damaged empathic tie and can of itself create an intersubjective context in which the pathology is no longer needed to maintain subjective organization. There are three primary motivations related to the need to maintain the organization of experience: (1) the fulfillment of developmental longings, (2)

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the maintenance of a cohesive sense of self, and (3) the maintenance of a needed relationship tie. Psychopathology arises in intersubjective contexts in which these motivations are pitted against each other. Organizing Principles. The term organizing principles refers to the "patterning and thematizing of events that uniquely characterize . . . personal reality" (Atwood and Stolorow, 1984, p. 36). In the absence of reflection, these organizing principles remain unconscious and we remain unaware of the role they play in constituting our view of the world. Organizing principles develop in particular child/caregiver contexts. For example, the perception that one's expansive or excited affects are dangerous to others and must be disavowed to preserve a relationship is an organizing principle formed in reaction to living with a depressed mother for whom such affects were intolerable. These principles remain context-dependent and become operative only in situations where they are relevant. In the foregoing example, they would come into play if a therapist failed to respond to the patient's expansive affect. Thus, "The organization of experience can therefore be seen as redetermined both by preexisting principles and by an ongoing context that favors one or another of them over the others" (p. 24). What is invariant about such organizing principles is not necessarily their capacity to dominate all psychic life, but their recurrence in coloring certain experiences. A growing awareness of their contributions to an individual's experience can lead to the capacity to decenter on the repetitive meanings and affects certain events evoke and to consciously open up to a new or different experience. This is of crucial importance in couples therapy. For instance, a partner whose developmental history led him to be organized around fear of abandonment can learn to move through the feelings that his partner's lateness evoke and reengage in a positive interaction rather than remain in a state of sullen reactivity. The Unconscious. Intersubjectivity posits three realms of the unconscious (Stolorow and Atwood, 1992). As with other psychoanalytic concepts, all three of these realms are reframed in relational terms. The prereflective unconscious refers to the organizing principles that structure experience, as discussed above. It is unconscious in two senses: (1) the child/caregiver interactions that formed it are often beyond the reach of memoiy, and (2) we are often unaware of the ongoing wTay it constitutes our


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sense of reality. However, "This form of the unconscious is not the product of defensive activity, even though great effort is required to overcome it" (Atwood and Stolorow, 1984, p. 36). Psychotherapy is to a large degree an exercise in that "great effort." The dynamic unconscious refers to certain affect states that had to be disavowed to maintain the tie to caregivers. Human development takes place within a child /caregiver system whose primary function is the regulation of affects. Derailments or malfunctions of this system can lead to the repression of certain affect states in the service of self-preservation or of preservation of the relationship tie. For example, a highly narcissistic mother viewed any of her daughter's discrepant affects as threats to her own self-cohesion. The patient consciously remembers being a docile and happy child, who "would sit at her mother's feet while she knitted." All feelings of anger or unhappiness were thoroughly repressed, but as an adult, she experiences crippling depressions when conflicts at work have called for her to defend herself against unwarranted control or false accusations. Instead of repression, she now tries to control her angry or hurt affects by replacing them with ruthless self-incrimination and suicidal ideation. In treatment, the dynamic unconscious will emerge as resistance when the patient fears that the therapist will respond to his expression of the repressed affects in a way that repeats the original trauma. The patient in the example above repressed any feelings of disappointment toward the therapist or any expression of unmet dependency needs. Even now, after seven years of treatment, when the therapist does something to constellate the repetitive pole of the transference, such as saying something the patient experiences as a criticism, expressions of need or disappointment disappear like a rabbit down its hole. The unvalidated unconscious consists of thoughts and feelings that were never brought into consciousness by the responsiveness of the caregiver. Consciousness is seen as developing through the ongoing dialogue—first nonverbal, later verbal—between child and caregiver. When the caregiver fails to facilitate the articulation of the child's experience, wide areas remain unconscious. As Stolorow and Atwood point out, analysis of the unvalidated unconscious is particularly important in the treatment of patients who have suffered severe developmental derailments in the articulation of perceptual and affective experience. These are patients, often prone to fragmented, disorganized or

26


psychosomatic states, for whom broad areas of early experience failed to evoke validating atrunement from caregivers and, consequently, whose perceptions remain ill-defined and precariously held, easily usurped by the judgments of others, and whose affects tend to be felt as diffuse bodily states rather than as symbolically elaborated feelings (1992, pp. 34-35). An example would be the couples therapy patient mentioned above whose childhood history of abuse and denial led to the situation where much of her history as well as her daily experience had a sense of dreamlike unreality. Concretization. Concretization is defined by Atwood and Stolorow as the "encapsulation of organizations of experience by concrete, sensorimotor symbols" (1984, p. 85). The "supraordinate" function of concretization is to "dramatize, reify and thereby maintain the organization of the subjective world" (Stolorow and Atwood, 1992, p. 44). Concretization is a fundamental process in the organization of psychological life. It provides substance and form to inchoate thoughts and feelings, and connects inner life to the world through action, symbols and images. It underlies such diverse psychological activities as behavioral enactments (in which motor activity predominates), dreams (in which perceptual imagery predominates) and psychosomatic symptoms (in which body experience predominates). Concretization is a universal hallmark of subjective experience, but it comes to dominate psychic organization when "early, validating responsiveness has been consistently absent or grossly unreliable" (Stolorow, Brandchaft and Atwood, 1987, p. 133). Given the centrality of affect as an organizer of psychic life, it is often particular affect states, such as sadness, excitement or shame, which come to be irrevocably associated with concrete imagery. For example, a powerful and overwhelming experience in childhood such as having a seductive or abusive parent can be concretized as an adult through sexual enactments that include danger. In cases where this kind of concretization dominates, psychic life is maintained through conversion symptoms, psychosexual enactments (Atwood and Stolorow, 1984), psychosomatic symptoms (Stolorow and Atwood, 1992) or in psychotic states (Stolorow, Brandchaft and Atwood, 1987) where concrete delusions serve to uphold fragmented subjective reality. In these cases a retreat from the vicissitudes of relationships to the literal, the compulsive or the absolute


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dominates psychic life. Concretization is discussed in terms of couples in Chapter 5, and in terms of families in Chapter 9.

DEVELOPMENT A N D PATHOGENESIS Modern infant research forms one of the foundational pillars of intersubjectivity theory. Building on Winnicott's (1965) now-famous dictum that "There is no such thing as an infant" (p. 39)—that the infant must be conceptuallyconsidered as an indivisible unit with the mother—and later theories that see the development and structuralization of the infant's subjective world as taking place within a "system of mutual influence" (Beebe and Lachman, 1988, 1992), Atwood and Stolorow (1984) see child development as well as pathogenesis "in terms of the specific intersubjective contexts that shape the developmental process and that facilitate or obstruct the child's negotiation of critical developmental tasks and successful passage through developmental phases" (p. 65). Theoretically, intersubjectivity does not so much posit its own developmental theories as recast existing ones—such as Mahler, Pine and Bergman's 1975 theory of separation and individuation— into an intersubjective context. Selfobject. Kohut's (1971, 1977, 1984) notion of a selfobject plays a central role in an intersubjective theory of development. It refers to the child's experience of being successfully attuned to and regulated within the child / caregiver system. Of course, given the reciprocity of that system, the term pertains as well to the ways that the child functions as a selfobject to the caregiver. The requirement that the child perform specific selfobject functions for the narcissistically vulnerable parent to the detriment of his own development is the source of much pathology. The centrality of selfobject experiences, both in infancy and throughout the lifespan, is a focus of Chapter 3. Affects. Affects play a central role in intersubjectivity. Indeed the concept of selfobject relationship itself is recast to emphasize providing "attuned responsiveness to affect states in all stages of the life cycle" (Stolorow, Brandchaft and Atwood, 1987, p. 66). Developmentally, affect plays a crucial part in the nonverbal communication between the child and the caregiver that forms the basis for attachment. It underlies empathic exchanges and is the primary mode for nonverbal communication throughout the lifespan

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(Demos, 1988). Stolorow, Brandchaft and Atwood (1987), summarizing a wide variety of researchers and theorists, posit "the central importance of affect integration in the evolution and consolidation of self-experience" (p. 67). From this perspective, development takes place in the intersubjective field created by the facilitating, attuned response of the caregiver to the ever varying affect states that mark each developmental milestone. Affect integration is quite complex, requiring a variety of selfobject functions from the caretaker (see Chapter 3). Conversely, pathology derives from the failure of the caregiver to provide such a response. The child's development from neonate to adolescent takes place in the context of specific child/caregiver intersubjective fields. In general, the most demanding developmental stages, and hence the most prone to derailment, are those such as rapprochement (Mahler, Pine and Bergman, 1975), the oedipal phase and adolescence, in which the child's affect states oscillate rapidly and unpredictably. For example, Mahler's toddler, oscillating among omnipotence, frustrated rage and sadness, requires "resonance with and sharing of the child's buoyant enthusiasm and pleasure in the emergence of his own particularity, but also attunement to and containment of his disappointments in his limitations and failings, coupled with a sustaining confidence in his growing abilities and ultimate success" (Stolorow, Brandchaft and Atwood, 1987, p. 49). A more detailed discussion of the intersubjective contexts of development throughout childhood is presented in Chapter 10. Pathogenesis. Intersubjectivity regards all pathology, from the tormenting inner conflict of neurosis to psychotic delusions, as arising from intersubjective contexts of developmental failure: "Pathogenesis . . . is understood in terms of severe disjunctions or asynchronies that occur between the structures of subjectivity of parent and child, whereby the child's primary developmental needs do not meet with the requisite responsiveness from selfobjects" (Atwood and Stolorow, 1984, p. 69). In the most general terms, these derailments occur on a spectrum from (1) a complete failure to provide the requisite selfobject needs at all, leading to a profound states of depersonalization or unreality a n d / o r lifelong fear of the destructiveness of the unregulated affects, to (2) the selective provision of selfobject functions to affect states that match the caregivers or to those that are required by the caregiver, leading to a lack of integration or defensive repression of unintegrated affect states, to (3) the requirement of highly narcissistic parents that the child constantly provide selfobject functions for them, leading to the devel-


29

opment of a "false self" (Winnicott, 1965) and defensively masking vast areas of experience that remain in the province of the unvalidated unconscious. For example, here is a discussion of the consequences of selfobject failure around the child's depressive affect states: When a parent cannot tolerate the child's depressive feelings—because they do not conform to her own affect states, self-organization requirements, or selfobject needs—then she will be unable to assist the child in the critical task of affect integration. When the child experiences such protracted derailments of affect attunement, he may, in order to safeguard the needed tie, blame his own depressive feelings for the selfobject failure, resulting in a pervasive, self-hating helplessness and hopelessness, or—if he responds by defensively dissociating the "offending" affects—in lifelong states of emptiness" (Stolorow, Brandchaft and Atwood, 1987, p. 76). Intersubjectivity theory has reconsidered in an intersubjective context the etiology of a wide range of psychopathologies. Among them are the following: • Conflict. States of chronic inner conflict, often characterized by a predominance of guilt, anxiety and shame, arise out of developmental situations in which the child's need for self-assertion and self development conflict with the parent's requirement that the child conform to the parent's own expectations and needs. In such situations the child's less formed psychic structure will be forced to adapt. When the child becomes an adult, the unintegrated affect states will be seen either as a threat to the self, leading to a fear of disintegration, or as a threat to others, leading to states of shame and guilt. • Psychosexual enactments. "Dramatically enacting these concrete symbolic forms to the accompaniment of orgasm" constitutes an attempt "to restore a failing sense of self" (Atwood and Stolorow, 1984, p. 94), as mentioned in the discussion of concretization. • Borderline states. Intersubjectivity's conception of the so-called borderline pathology differs from the traditional view in that it sees this diagnosis as steeped in isolated mind theory that does not take into account the context in which the borderline phenomena arise. For instance, symptoms such as splitting and excessive grandiosity are seen

30


not as defenses but as evidence of structural weakness caused by developmental derailments (Stolorow, Brandchaft and Atwood, 1987). In treatment, borderline symptoms are often iatrogenic reactions to the therapist's lack of empathic attunement. In the presence of needed selfobject functions of mirroring and holding, the borderline can begin to integrate discrepant affect states; in their absence fragmented self states prevail. • Trauma. Trauma is conceived of as an overwhelming affect state (Stolorow and Atwood, 1992). Such affect states require an ameliorative response from the parent that confirms the child's experience and helps him integrate the affect into a larger sense of self. When the parent is unable or unwilling (as in situations wThere abuse is denied) to provide that response, the child may defensively split off the traumatized affects, come to feel that he is unworthy of attention or even come to believe that he deserved the traumatic pain. Chapter 4 will treat the issue of trauma further. • Psychotic states/convictions of nonbeing. Psychotic symptoms are seen as extreme examples of "concrete symbols of psychological catastrophes and dilemmas that emerge in specific intersubjective fields" (Stolorow, Brandchaft and Atwood, 1987, p. 132), The intersubjective fields in which psychotic states emerge are saturated with profound and persistent invalidation and usurpation. Psychotic symptoms have a three-part etiology: a developmental history in which the individual, because of the profound absence or inconsistency of selfobject responses, lacks conviction as to the validity of his subjective experiences; a triggering event or events in which the individual longs for but does not receive a confirming response; and the emergence of an elaborate delusion that seeks to "symbolically concretize the experience whose subjective reality has begun to crumble" (p. 133). • One of the most painful subjective states is a sense of annihilation, complete loss of self, or of conviction of one's unreality or nonbeing (Orange, Atwood and Stolorow, 1997). Such self states emerge from intersubjective configurations where "relations to the human surround have broken down at the most basic level," including instances of "extreme usurpation of agency and subjectivity" (p. 55). In the case of a psychotic young woman who replies to everything the therapist says with the words "hit me," the therapist finally writes her a note


31

that says, "I don't want to cause you pain"; she replies with a note that says, "Physical pain is better than spiritual death" (Stolorow, Brandchaft and Atwood, 1987, pp. 157-158). While much of intersubjectivity theory has focused on illuminating the intersubjective field formed between patient and therapist, it can usefully be applied to the intersubjective field formed between intimate partners, as well as between couples and therapists.


CHAPTER 3

Hopes, Needs and Disappointments: The Selfobject Dimension of Couples Experience

According to Heinz Kohut, "A good marriage is one in which one partner or the other rises to the challenge of providing the selfobject function that the other's temporarily impaired sense of self needs at a particular moment" (1984, p. 220). The therapist's ability to understand the particular selfobject longings that underlie couples' experience is a key to evaluating both the Strengths and the impasses in a relationship. Often a question such as "What does she see in him?" can be answered by understanding the key selfobject function one partner performs for the other. Conversely, the question of why a seemingly positive relationship would break down over disappointment in one particular area can be answered by illuminating the selfobject longings or disappointments that a particular issue has come to symbolize. Gail and Richard were a couple in their fifties raising two teenage children from their respective previous marriages. Although they showed a great deal of tenderness for each other and went out of the way to praise each other for accepting and parenting each other's children, it was clear that their relationship had come to be dominated by a sense of profound disappointment on Gail's part and sullen defensiveness on Richard's. Gail complained that Richard was very closed to her, that he wouldn't tell her what 33

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was going on with him, and that this made her feel that she couldn't trust him at all. Richard, his face downcast, agreed that he was probably emotionally defective, but complained that he was tired of Gail railing at him and telling him to open u p when he often did not have the foggiest idea what he was feeling. Superficially this couple resembled the pursuit/avoidance couple (Shaddock, 1998) that one sees so frequently in the consulting room. But something didn't quite fit that picture. Gail and Richard were able to have heartfelt discussions on a number of subjects, including their values and their family, which were characterized by a tone of affective conjunction and philosophical agreement. This belied the picture of a pervasive pursuit/ avoidance couple in which one partner universally avoids contact and the other relentlessly pursues it. It appeared that this pattern was limited to particular relationship contexts. When asked to discuss the kinds of experiences that had led her to feel so lonely and let down in the relationship, Gail replied, "It's not about the dayto-day things—managing the household. He's right there for all of that. It's .. . it's when we plan any kind of a trip or an adventure. For instance, every once in awhile, his sister who works for the chamber of commerce gets us these coupons for a one-night stay at a nice hotel. But he forgets to make a reservation, or loses the coupon. Once when we did go we were stuck with a Friday instead of a Saturday, which gave us much less time." Gail was almost sobbing as she spoke, and on the other end of the couch, Richard was stiffening under her criticism. I wondered if, given the realities of life with two children, these trips away were the couple's only chance for sexual intimacy. Was Gail expressing disappointment about the breakdown of their sex life? As it turned out, they both reported that that their sex life was good; Gail experienced Richard as being romantic. But my next guess proved to be correct. The problem for Gail was essentially Richard's inability to provide a mirroring selfobject experience to her excited, expansive affect states. I specifically asked Gail if the issue concerned Richard's capacity to support her in having a life that transcended the mundane details, in having a life filled with possibility. Gail nodded through her tears, her rather tight, critical demeanor giving way to an expression of openness and deep sadness. As it turned out, Richard's behavior about weekend getaways was the result of his being in a terrible bind over custody of his daughter. His ex-wife, an unstable woman who was still bitter about the divorce, constantly criti-

The Selfobject Dimension of Couples Experience

35

cized Richard to their daughter and was always looking for ways to convince her that he didn't really care for her. On top of this present-day bind, the situation replicated Richard's childhood, in which, after his father left the family, Richard felt controlled and thwarted by his angry and depressed mother. Gail, being exquisitely sensitive to this particular kind of selfobject failure, could not put any of this in context; all she could experience was a crushing collapse of her expansive feelings. From a developmental perspective, a caregiver's attuned response to expansive affect states is vital—both in achieving a sense of intersubjective relatedness (Stern, 1985) over the child's full range of affectivity and in instilling in the child's developing self a sense of hope and possibility. For Kohut (1971,1977) an attuned response to the child's budding expansive affects facilitates the development and transformation of the child's grandiose self, which, when adequately invested with healthy narcissism, eventually becomes the seat of goals and ambitions. The developmental consequences of a caregiver's "selective attunement" (Stern, 1985) can, on the other hand, lead to the situation where "the positively exciting states of enthusiasm [will be] outside of shareable personal experience" (p. 209). For Gail, Richard's lack of responsiveness to her excited anticipation of vacation adventures repeated this kind of selective attunement; her reactive affects of depression, hopelessness and anger resulted from these relationship events reinforcing an underlying belief—derived from a developmental situation with her depressed mother—that this would be the case forever. It is not always the case that selfobject failures in marriage derive their power and meaning from the way they re-create childhood contexts of selfobject failure. Pervasive selfobject failure in a current relationship can create profound narcissistic vulnerability on the part of one of the partners, with the result that incidents that repeat or symbolize that failure can lead to the type of fragmentation usually associated with childhood trauma. The clinician must not privilege developmental contexts over relationship ones in assessing the origin of one partner's seemingly primitive self-state. When a specific event or issue has been "decoded" as Gail's was to reveal a particular set of selfobject longings and narcissistic vulnerabilities, it is important to make interpretations that normalize them, because their archaic nature can lead to a sense of shame when they are exposed. Indeed, some partners feel ashamed about revealing any dependency needs, much less those that directly affect their emotional well-being. Telling Gail that what

36


she was after from Richard belongs to one of the four or five basic food groups for emotional nurture helped to preempt her shame. Indeed it is usually important to educate couples about the universality and normalcy of selfobject needs. Heinz Kohut (1971) first used the term selfobject to describe a kind of transference that occurred in the treatment of a certain class of patients who saw him as an extension of themselves. He saw such transferences as revealing a needed and heretofore missing developmental experience, rather than as grandiosity and narcissism that expressed a primitive wish to omnipotently control the object. Kohut came to understand that by allowing this kind of selfobject transference to flourish, he could provide a corrective emotional experience—i.e., one that would allowr the patient's arrested development to proceed. He later (1977) broadened his understanding of the term to include any experiences that either create self-structure or, in the words of Paul Ornstein (1991), "maintain the strength, cohesion, vitality and harmony of a . . . self throughout life" (p. 24). Ornstein's use of the phrase "throughout life" echoes Kohut's conviction that the self always depended on others for selfobject experiences, be they archaic or mature. Indeed, it could be said that selfobject experiences occur on a broad, ever fluctuating, context-dependent continuum that runs from the archaic to the mature. In a famous phrase Kohut (1984) compared the notion that we outgrow selfobject needs to the notion that animals could outgrow their need for oxygen. Kohut's assertion of the normalcy of adult selfobject needs makes way for a radical re-visioning of our understanding of intimate relationships. It allows us to look at marriage as an intersubjective field characterized by two people's providing (or failing to provide) longed-for and necessary selfobject functions; by extension, it sanctions the concept that relationships are systems of mutual regulation. The very idea of the selfobject presupposes the centrality of affect in personal experience, and validates the importance of viewing marital relationships from inside each partner's experience of the other. Mutual Regulation. One of the key influences on the movement of contemporary psychoanalysis away from the isolated mind paradigm has been infant development research. Modern research sees the infant's development as inextricably bound u p with the caregiver—so much so that the infant/caregiver dyad can best be described as a system of mutual regula-


37

tion (Beebe and Lachman, 1988). The notion of a selfobject, whereby self experience is similarly connected to and modulated by others, can be conceptually extended to encompass this dyadic reciprocity. A selfobject experience, either in infancy, in treatment or in a relationship, is the experience of being deeply connected to another person who helps maintain emotional equilibrium and /or facilitates development. Centrality of Affect. Another finding of infant development research is the centrality of affect regulation in the development of a sense of self (Stern, 1985) as well as of self-with-other. In terms of couples therapy it is enormously valuable to track the flow of affect through the marital system and investigate the mutual regulatory activity—both provided and longed for. Successful affect regulation, in which one partner helps the other contain, integrate or diffuse difficult affects, creates a smooth relationship process in which the partners look to one another for selfobject experiences. Unsuccessful affect regulation, in which one partner dismisses or traumatically amplifies the other's affects, create patterns of escalation or withdrawal. However, it is not always obvious what constitutes affect regulation in a couple. Even provocative, conflictual responses can have a selfobject, affectregulating component for one or both partners. For example, Gail's disappointment at Richard's mirroring failures would generalize until she would accuse him of being closed and emotionally bland. But even this criticism has a regulatory function—it keeps him emotionally shut down. Though the message overtly conveys Gail's desire for more contact, what Richard hears is a message that reinforces his own sense of the danger of exposing painful or conflicted affects. Unconsciously, he may become attached to the regulatory function that Gail's criticism provides. This kind of "negative attachment" has a powerful hold on many couples. Importance of Staying Within Each Partner's Subjective Experience. The concept of the selfobject underscores the central commitments of both self psychology (Kohut, 1959) and intersubjectivity to "attempt to understand a person's communications and actions from the standpoint of his own subjective frame of reference" (Atwood and Stolorow, 1984, p. 4). For Ornstein, the term selfobject "refers to the quality of the experience the self has of the other . . . " (1991, p. 24). Stolorow, Brandchaft and Atwood concur: "the term selfobject refers to an object experienced subjectively as serving certain functions . . . " (1987, p. 16, emphasis in original).

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The implications for couples therapy here are important. Focusing on selfobject experiences leads the therapist to examine each partner's experience of the other from within his or her subjective frame, rather than from an objective point of view. Within that point of view, the therapist's understanding of the selfobject experience each partner has of the other begins to unfold. Does he or she feel validated, understood and soothed or discounted, usurped and abandoned? Does the relationship sponsor or disrupt the continuity of each partner's self experience? Is there a developmental component to the relationship, allowing for the expansion and unfolding of each partner's life? How does each partner respond to the other's intense or distressful affects? Gail and Richard provide a good example of how the answers to questions like these vary from context to context. In the area of parenting they both felt understood and sponsored. But in response to Gail's experience of Richard's mirroring failures, they entered a cycle that thwarted these positive selfobject experiences. Richard felt misunderstood and falsely accused of ruining vacations. He felt that Gail invalidated his commitment to put the weekends with his daughter ahead of time alone with Gail. And these respective distresses were not soothed or met with empathy, but were contradicted and minimized until both partners withdrew into sullen silences that could last for days and even weeks. Kohut's concept of the selfobject is so central to our understanding of relationship experience such as Richard and Gail's that we turn now to a more detailed examination of his theories, as well as to the contributions of his followers.

TYPES OF SELFOBJECT EXPERIENCES Heinz Kohut originally emphasized two primary types of selfobject functions, the mirroring and the idealizing. (He later added a third, the twinship or alterego.) Although others have since expanded or extended his formulations, Kohut's original constructs continue to offer a window into the nature of attachment, both between child and caregiver and between intimate partners. Broadly, mirroring refers to attunement and responsiveness, while idealizing refers to regulating activity such as soothing or containing. Kohut initially emphasized two critical experiences of mirroring and idealizing that arose in the clinical situation: the previously mentioned merging with an idealizable, powerful and calming other and the wish that the therapist


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admire and affirm the patient's grandiosity. He later expanded on these initial discoveries to cover a wide variety of clinical and developmental situations. Mirroring. The developmental consequences of the mirroring and integration of affect states involving pride, expansiveness, efficacy and pleasurable excitement (Stolorow, Brandchaft and Atwood, 1987) are profound. When adequate they provide a source for healthy ambition; when inadequate they lead to a life plagued by depletion and shame. As Morrison (1989) points out, shame arises out of continual selfobject failure, and becomes attached to the affect-states around which the failure occursand as Basch (1988) says, there is a physiological connection between mirroring failures of expansive affect states and the development of shame. So proper mirroring allows expansive affects to be integrated into self states characterized by healthy assertion and the capacity for enjoyment, while mirroring failures engender self states that are prone to shame and fragmentation. One of the most profound needs in marriage is the need to elicit some kind of mirroring response from one's partner. The concept of mirroring can be expanded to include a broad range of responses to affect states. These responses, whether they are optimal or not, at least provide a sense that someone is out there, listening. Faulty mirroring may not lead to developmental growth, but it at least maintains the tie in some form. Marital partners will frequently attempt to elicit some kind of response, attuned or not, to painful affect states. The most ominous marital problems come not from faulty attunement, which leads to conflict, but from no mirroring at all, which leads to terrible feelings of hopelessness and helplessness. Idealizing. Kohut's (1971) original conceptualization of the idealizing selfobject transference"you are perfect, but I am part of you" (p. 27) has been generalized to encompass a number of experiences of connectedness to someone wise, kind and powerful. If the central experience of being mirrored was being on center stage, feeling expansive and admired, the central experience of idealizing involved being a small part of a larger and greater whole. Just as they refined the mirroring selfobject, Stolorow, Brandchaft and Atwood (1987) have recast the idealizing in terms of an attuned response to certain affect states, saying, "The importance of early experiences of oneness with idealized sources of strength, security and calm . . . indicates the central role of soothing, comforting responses from caregivers in the in-

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tegration of affect states involving anxiety, vulnerability and distress" (p. 68). Thus mirroring and idealizing both describe a repertoire of regulatory behavior, between attunement and approval on the one hand and soothing on the other. Alterego. Kohut (1971) first characterized the twinship or alterego transference as a variety of the merger transference in which the patient saw in the analyst's grandiose self a "twinlike replica" (p. 251) of his own. Later (1984) he generalized the experience and proposed elevating it to coequal stature with mirroring and idealizing. Basch (1994) renamed this selfobject experience "kinship," and ascribed to it not equal but actually primary developmental importance. For Kohut, the presence of the alterego selfobject (whether actual or fantasized) provides a sense of belonging, as well as a sense that one's inner world is knowable. He offers three examples in his 1984 discussion: one of pathology in which a borderline patient compensates for her therapist's impending vacation by talking to her imaginary "genie in a bottle" who was a "little girl, a twin" (pp. 198-199); another of normal childhood whereby a girl kneads bread beside her grandmother or a little boy pretends to shave next to his father; and a third of the adult situation in which a friend places his hand on your shoulder during a time of distress. (Self-help groups such as Alcoholics Anonymous derive much of their power from providing the alterego experience: the alcoholic is freed of feeling the alienation of his addiction and instead is welcomed into a room of people who make a point of telling him that they are just like him. Kohut describes the absence of the alterego selfobject experience as, at its worst, a Kafkaesque feeling of not being human. The alterego experience is of primary importance in marriage. Couples depend on a sense of likeness in values, tastes and habits to establish a basic sense of security. Consider the example (Shaddock, 1998) of a religious couple in which the husband had a heart attack and developed an interest in Buddhism after undergoing stress-reduction counseling: the wife was traumatized by the change in him as a source of alterego experience for her; the husband was equally traumatized by her apparent lack of support for his life-saving transformation. Selfobjects as Metaphors. Two metaphors are implied in Kohut's triumvirate of selfobject experiences, one familial, the other spatial. Although Kohut by


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no means intended the selfobjects to be gender specific, it is worth noting that they in some respects reflect the traditional nuclear family in which the mother provides attuned responsiveness, the father is a source of admired strength and wisdom and the siblings supply a sense of belonging. They also relate to one another in terms of size: in mirroring, the self is very large, the center of the world; in idealizing it is a small part of a larger, greater other; alterego or twinship connotes equality or sameness. These metaphors offer clues to the selfobject dimensions of relationships. Marital partners look to each other for confirming alterego experiences as well as for mothering and fathering. And one can track the vicissitudes of narcissistic vulnerability in a couple by paying attention to the partners' relative "sizes": who is bigger than whom, are they the same size, and what do the answers to those questions mean for each of them. Contemporary demands for equality in relationships frequently mask the partners' desires to be little and be taken care of or to be great and be admired.

OTHER SELFOBJECT FUNCTIONS Stolorow and his colleagues (1987), emphasizing the key role of affect development and integration in self development, have identified four additional selfobject functions: Affect differentiation and self-articulation. The caregiver's accurate responses to the child's differing affect states contributes to the "progressive articulation of self experience" and to the establishment of "self-definition and selfboundary" (p. 70). Synthesis of affectively discrepant experiences. This occurs when the caregiver "is able to reliably accept, tolerate comprehend and eventually render intelligible the child's intense, contradictory affect states as issuing from a unitary, continuous self" (p. 71). Affect tolerance and the use of affects as self-signals. By providing a "holding environment" (Winnicott, 1965) for the child's intense affect states, the caregiver strengthens the capacity of the child to use them as self-signals, toward sustaining rather than fragmenting self-experience. As Ringstrom (1994) points out, this capacity is vitally important in marriage because it allows each partner to recognize the self as the source of powerful affects rather than attribute their cause to the other. The desomatization and cognitive articulation of affect. The authors emphasize the "caregiver's ability to identify correctly and verbalize the child's early

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affects" as contributing to the elevating of affect experiences from the somatic level to "cognitive affective schemata—psychological structures that, in turn, contribute significantly to the organization and consolidation of the self" (p. 72). Although many of these functions could be subsumed under the concept of mirroring, the particulars help keep the focus on the role an array of attuned responses plays in promoting self-development. Collectively, they may be defined as affect-regulation selfobject functions to distinguish them from the self-delineating selfobject function (Stolorow and Atwood, 1992) that confers a sense of boundedness and reality on self-experience. Developmentally, the self-delineating selfobject function "contributes to the articulation and validation of the child's unfolding world of personal experience" (p. 27). Clinically, it "serves to articulate and consolidate the patient's subjective reality, crystallizing the patient's experience, lifting it to higher levels of organization, and strengthening the patient's confidence in its validity" (p. 35). Many marital problems arise from competition for selfdelineating experiences as each partner seeks validation of his own subjective world. Another important selfobject experience is naming and repairing emotional injuries (Trop, 1997). In relationships, partners often also need validation of their hurt feelings. In the absence of that validation, emotional injuries can turn into intractable impasses. The same template—naming and repairing injuries—can be applied in the context of parenting: acknowledging the emotional pain they may have caused the child creates awareness that hurt feelings are valid and can be mended.

THE SELFOBJECT DIMENSIONS OF MARRIAGE As Dicks (1967) observed, marriage is the nearest adults get to re-experiencing the child/caretaker bond. Intimate relationships flood each partner with selfobject experiences of being heard, understood and protected. Sexual relations in particular create a virtual stew of feelings of having one's excited, expansive affects responded to in kind, and of being with someone who anticipates and meets your every need (Shaddock, 1998). "There is an unconscious wish for a re-experiencing of caregiving and hope for an experience that will repair what was lacking" (Solomon, 1989, p. 77). Like Proust's madeleine in Remembrance of Things Past, intimate relationships invoke a lost world of promise, pleasure and disappointment.


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The ability to regress in marriage, as in the clinical situation, is not necessarily a sign of pathology, nor is resistance to regression necessarily a sign of health. Adult relationships are inevitably a rich and ever changing admixture of the archaic and the mature—shifting from moment to moment, from context to context. Unless the archaic comes to completely dominate, there is nothing pathological here. Indeed, even where a given archaic selfobject need, for instance the need to be understood without having to explain oneself, does take center stage in a relationship, it can be seen as a window on an area of particular narcissistic vulnerability, which can be productively explored in the venue of conjoint treatment. The therapist's holding to rigid dichotomy between the archaic and the mature a m convey a sense of judgment and lead to defensive denial of the archaic longings; in the case where selfobject needs are attached to shame, such judgment can actually be retraumatizing. In Ringstrom's 1994 useful (if mythical) vision, relationship partners provide optimal mature selfobject experiences for each other. Specifically, they would without too many disruptions, reciprocally share in admiring one another's styles of expressiveness and expansiveness; take comfort in each other's soothing, have a sufficient mix of common qualities, interests, and beliefs; encourage one another's verbalization of feelings and experience; reckon with and tolerate inevitable disappointments; and utilize their own strong feelings as signals that indicate something to explore within themselves, instead of becoming fixated in blaming their spouse for their disappointment (p. 163). Incorporating the self-delineating selfobject function, such partners would also acknowledge and confirm their respective, differing subjective worlds.

SELF MAINTENANCE VS. SELF DEVELOPMENT As Omstein (1991) points out, Kohut described two sets of selfobject experiences—those that maintain or consolidate the structure of the self, and those that contribute to the establishment or unfolding of new structures. This distinction can be helpful toward making sense of the ever changing landscape of selfobject experience in relationships, especially toward understanding how certain such experiences, though seemingly growth-limiting, contribute

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to self stability. For example, consider the case where one spouse acts in an overly authoritative manner. Even as he is inhibiting his spouse's expansiveness, he might be contributing to her sense of self-coherence by providing an idealizable experience of connection to someone strong and authoritative. Marital crises are often precipitated by the emergence of developmental selfobject longings from the matrix of self-maintaining ones. This can be particularly baffling to a spouse who has dutifully provided the selfobject experiences that have maintained the stability of the relationship, only to find himself discounted. It can be equally disconcerting to the other spouse, who is finding herself flooded with longings and dissatisfactions that are difficult to understand or integrate into the old framework of the relationship. Interpretation of the emergence of these developmental needs as a healthy development in the relationship—for example with a comment like, "You have succeeded in making the relationship safe enough for those needs to emerge"—can be very helpful.

GAIL AND RICHARD, CONTINUED Although attention to the selfobject dimension is important at all points in couples treatment, it is especially vital at the outset. It creates a pathway into an intersubjective field that may be laden with old and new conflicts and symbolic issues. The therapist's coming to understand the selfobject yearnings that underlie relationship conflict makes for a powerful selfobject experience in its own right. Its provision can begin to lower defenses and instill hope that an intersubjective field characterized by disappointment can become one characterized by contact and understanding. A description of the third session with Gail and Richard will illustrate. Gail began the session saying that she had found the last meeting very useful. She explained that she had always found ways to avoid feeling the depth of her disappointment about the issue of weekends away by picking a fight with Richard. "I thought the feelings would be so strong that I couldn't survive them. But I allowed myself to feel them, and I feel much stronger as a result." I commented that it sounded like she was discovering the difference between reliving a childhood trauma and experiencing an adult disappointment. She then went into a long recollection of how her childhood household was completely dominated by her mother's depression.


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After a few minutes she interrupted herself to change the subject, and asked Richard why he had not arranged childcare for their agreed-upon one weekend together for the month. I observed that I didn't think this was a change of subject at all, but rather an expression of her determination not to live in a world where her yearnings for joy and expansiveness went unnoticed. I also noted that there was more demand and less blame in the way she was talking to Richard. Nonetheless, Richard replied with his usual kind of half-hearted defense. I said that he looked very sad. He proceeded to talk about his weekend custody of his daughter, explaining that his ex-wife had never recovered from their divorce tmd had nurtured a symbiosis whereby the daughter was completely wrapped up in her mother's needs. She would demand extra child-support money whenever Richard asked for a weekend off and tell her daughter that obviously Richard didn't care for her. Several times while he was reporting all this Gail jumped in to add details or offer suggestions. Richard seemed initially to resent her interruptions, but he would always patiently let her finish. I began to notice the same mixture of affects in response to my questions and comments. Whether Gail's comments were intrusive and critical or astute and helpful—as when she mentioned that he had an opportunity to show his daughter, in going away with Gail, that life goes on and that joy is possible—Richard's reaction was the same. The process of the discussion had a kind of rote, repetitive feel. Even when I attempted to up the ante by expressing my alarm that his daughter's future development could be thwarted by her relationship with her mother, Richard just looked at me sadly and helplessly. It began to seem to me as though Gail and I were subtly ganging u p on him—yet he wasn't resisting. I speculated that Richard was experiencing me the way he experienced Gail. Richard had never made space for his overwhelming feelings of loss, guilt and fear about his daughter, although he had been coping with his situation for seven years. In addition, he constantly feared retaliation from his ex-wife. For the first time, I began to understand the bind he was in. Adopting an empathic stance, I said, "It must be horrible, living with the constant threat of having the tie to your daughter cut." Richard looked up, interested. I was looking for a metaphor or a way to deeply convey my understanding, when I said, almost without thinking, "It re-

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minds me of times I've had patients threatening suicide. You feel so helpless, knowing at any time the person could do something that crazy." Without knowing wrhy, I had moved beyond mirroring his affect to providing an alterego experience that emphasized our commonality. Richard was quiet for a long time. For a moment I worried that Gail would feel that I had taken Richard's side in their controversy. But Gail was quiet, too, and her face looked much softer than it had at the beginning of the hour.

PROVIDING DEVELOPMENTAL SELFOBJECT EXPERIENCES The therapist enters a couple's intersubjective field with a determination to understand the selfobject functions of the existing relationship, while at the same time listening for the underlying developmental selfobject yearnings of both partners. Even patterns of blame and conflict can have hidden selfobject meanings. In addition to interpreting those yearnings and exploring their possible genetic components, the therapist actually attempts to fulfill unmet selfobject needs. Doing so in a conjoint context obviates the chief objections to Kohut's controversial mandate that therapy provide a corrective emotional experience. Rather than foster unrealistic expectations that the surround cannot meet, the therapist models empathic attunement for each of the partners precisely so that they can begin to provide similar understanding for each other. Further, the intensity of the transference and the supposed unresolvability of a "transference cure" are modulated by the transference of the partners to each other, whereby demands from the present-day surround constantly undercut the unfolding of archaic longings. Most importantly, in providing corrective experiences to each partner, the therapist helps to mitigate the conflict rooted in their wanting them from each other. After all, many developmental arrests do require therapeutic intervention, so by making reparative developmental selfobject experiences available, the therapist says to the couple, in effect, "those needs belong in here, with me." Partners are both relieved and enriched by witnessing the individual work the other is doing in the conjoint setting. Even if they can't consistently replicate these new-self/new-other (Shane, Shane and Gales, 1997) experiences for each other, they can enhance and support them as the intersubjective field created in treatment becomes a place where the new self can flourish in the presence of the other partner. The unfolding of these new-


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self/new-other experiences becomes a part of the couple's narrative, and part of their strengthened empathic bond. The mirroring failures that thwarted both Gail's and Richard's development were replayed in the relationship: Gail's longing for an attuned response to her expansiveness, and Richard's for someone to understand his grief and helplessness about the divorce and custody issues. These respective developmental arrests had contributed to the stalemate in the marriage. At impasse, relationships become a "zero-sum game" where one partner's selfobject needs are pitted against those of the other, and neither can grow. By both interpreting these longings and providing the longed-for mirroring, the therapy diminished the sense of scarcity and began the process of shifting the intersubjective field toward the possibility of both connection and compromise. The confusing interplay of deep selfobject experiences and real-life frustrations is what makes maintaining an intimate relationship such a challenging developmental step. Helping couples to achieve that step lies at the heart of the couples therapy enterprise, and is the source of its potential as a transformative treatment modality.


CHAPTER 4

Overlapping Contexts: Childhood Trauma and the Repetitive Dimension of Couples Experience

A commonly observed phenomenon in couples therapy is that one partner refuses to take yes for an answer. Even when one partner has changed a damaging behavior or begun to provide more emotional contact, the other remains wary and critical. The situation is analogous to resistance in psychotherapy. Intersubjectivity helps elucidate this situation by understanding transference as "organizing activity [in which] the patient assimilates the analytic [or marital] relationship into the thematic structures of his personal subjective world" (Stolorow, Brandchaft and Atwood, 1987, p. 36, emphasis in original). Resistance to selfobject experiences in marriage can be seen as one type of such organizing activity. Current experience is shaped by "the continual confluence of present events and previously formed psychological structures. Thus, what shapes the experience of the current situation . . . is derived from a multitude of sources in the person's history, as well as from properties of the current situation and the meanings into which they are assimilated" (p. 37). Stolorow and his colleagues (1987) have introduced the concept of the bipolar transference to characterize the mix of longings on the one hand and fears and conflicts on the other that underlie the analytic situation: £9

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At one pole of the transference is the patient's longing to experience the analyst as a source of requisite selfobject functions that were missing or insufficient in the formative years. In this dimension of the transference, the patient hopes and searches for a new selfobject experience that will enable him to resume and complete an arrested developmental process. At the other pole are the patient's expectations and fears of a transference repetition of the original experiences of selfobject failure. It is the second dimension of the transference that becomes the source of conflict and resistance (pp. 101-102). Anna Ornstein (1974) coined the term "dread of repeating" to describe this latter phenomenon. The two dimensions of experience form a continually fluctuating, contextdetermined figure/ground relationship (Mermelstein, 1998; Stolorow and Atwood, 1992). As Ringstrom (1994) points out, this conception is applicable to marriage, and especially to marital therapy, in which "two of the most powerful transference-prone relationships in a patient's life—the marital and the therapeutic—coexist" (p. 161). According to Stolorow and Atwood (1992): Retraumatization later in life occurs when there is a close replication of the original trauma, a confirmation of the organizing principles that resulted from the original trauma, or a loss or disruption of a sustaining bond that has provided an alternative mode of organizing experience, without which the old principles are brought back into the fore (p. 56). Adult relationships are rife with contexts that can provide any or all of these retraumatizing experiences. In this chapter we examine relationships in which one or both partners' experience is dominated by the repetitive pole of transference.

CASE VIGNETTE Darius and Janetta came to treatment following the revelation of Darius's year-long affair. Darius is an actor who travels constantly, while Janetta is the primary caregiver of their young son. Though they have a young child, they have been together for over twenty years. Initially, Darius was contrite and expressed a desire to recommit to Janetta. Janetta seemed to be coping with the situation as well. "I'm tak-

Childhood Trauma and the Repetitive Dimension of Couples Experience

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ing it as a wake-up call. We've been drifting apart for years." In the middle of the second session, however, Janetta broke down and expressed a strong desire to kill herself. Through her tears she kept repeating the phrase, "Every time, every time, I stick my neck out, it gets cut off." When she had calmed down a little, 1 asked her what she meant. "I knew things were going badly between us," she replied. "But I made a decision that I was going to try. I dropped everything and went and lived in London with him. I had a baby. And look what it got me." I mentioned that it sounded like she was saying that the affair had somehow happened because she had taken a risk. She replied that it had been that way her whole life-—every time she lets herself try or want something, she gets disappointed. Janetta's suicidality was coming not just from the affair, but from the way it appeared to validate a dreadful invariant organizing principle that allowing herself to feel affects of hope, effort or desire would inevitably lead to her being punished. Darius's affair was experienced as a repetition of the childhood context (a depressed mother and a brilliant but completely irresponsible father) in which this organizing belief was formed. Even when, as in this case, the present context is clearly traumatic, it is frequently the repetitive experience that is the greater source of pain. Couples therapy in these cases, in order to be effective, will have to address both dimensions of the patient's experience. In this chapter we will look first at how such pathogenic beliefs are formed, and then we will look at what happens when partners experience the present-day relationship as confirming or repeating them.

C H I L D H O O D DEVELOPMENT AND MARITAL CONFLICT Writing from an ego psychology viewpoint, Blanck and Blanck (1968) describe couples who are "burdened by the pressures of unresolved or partially resolved aspects of development" (p. 2). For these couples, "Blocked or incomplete developmental tasks which should have been completed earlier may impede further growth in marriage or may result in the attempt to find in marriage gratifications for which marriage is not designed" (pp. 2-3). The authors name five areas in which individual development must be completed: (1) sexuality, especially overcoming the incest taboo, (2) the establishment of fully reciprocal object relations, (3) completion of psychological

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separation from parents, (4) maintaining autonomy and identity while being close to another person, which means not repeating the childhood struggle for establishment of identity, and (5) establishing the ability to identify with your partner. Writing from an object relations point of view, Goldbart and Wallin (1994) similarly describe a series of developmental tasks that marriage entails. As useful as these discussions are in illuminating the developmental tasks of intimate relationships or, conversely, the problems that arise when those tasks are incomplete, these descriptions fail to take into account the intersubjective contexts that such developmental arrests occur in. Thus the picture of marriage is of two individuals, with different developmental histories and more or less fixed capacities for intimacy determined by these histories, separately trying to complete their individxial development. In contrast to that view, I believe that intractable conflicts and impasses in relationships occur when the intersubjective context of the relationship matches pathogenic childhood intersubjective contexts for one or both of the partners. The inevitably recurring intersubjective motifs in intimate relationships act as psychic "depth charges." The organizing principles that arose out of these pathogenic contexts become a kind of relationship "black hole," assimilating present events into old meanings, and locking the partners into the affect states and defensive behaviors that are associated with these organizing principles. It bears repeating here that couples treatment involves not only illuminating the unconscious nature of these organizing principles and their contribution to the daily life of both partners (Trop, 1994) but also altering the intersubjective field of the marriage so as to emphasize the differentiation of past and present. Both of these ends are greatly helped by the therapist's ability to understand the specific developmental contexts in which pathological organizations arise.

ABANDONMENT VERSUS INTRUSION In my previous book (1998) I described two childhood experiences—abandonment and intrusion—that are prone to be repeated in marriage. I used the term abandonment to refer to any kind of intersubjective experience between child and caregiver that the child experiences as a threat to the empathic tie or in which the parent fails to provide needed selfobject experiences. Intrusion applies to experiences that impede the child's emerg-


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ing self-delineation and autonomy, including the caregiver's narcissistic usurpation of the child to meet his or her own selfobject needs. These two experiences are often perceived by relationship partners as very distinct—pursuit/avoidance relationships in which one partner fears abandonment and the other fears intrusion are quite common. And they have traditionally been the source of controversy between psychoanalytic theories of developmental deficit (based on abandonment) and those of conflict (based on intrusion). However, I agree with Stolorow, Brandchaft and Atwood (1987) that, when viewed from the perspective of the intersubjective contexts from which they arise, the differences are more apparent than real. Both involve the caregiver's failure to provide attuned responses to the child's changing needs and affect states. Stolorow, Brandchaft and Atwood (1987), in agreement with Stern (1985), reframe Mahler's schema of development proceeding from symbiosis to autonomy in epigenetic phases to one in which self states characterized by affects of expansion and militant selfdelineation alternate with self states characterized by the need for merger or comforting. From this point of view it makes no sense to inevitably refer to abandonment as leading to pre-oedipal structural deficits or intrusion as leading to lifelong internal conflicts around issues of aggression vs. intimacy. Pathogenic impingements to self-delineation can occur at any point in development (including adult relationships) as can impingements to secure attachment. When pervasive, the selfobject failures that create experiences of abandonment or intrusion result in self organization that is prone to shame, fragmentation, depressive accommodation to the needs of others and rigid defensiveness—self states that are likely to reoccur in intimate relationships. It is vital that the therapist see these self states in terms not only of the developmental histories they reveal but also of the concomitant selfobject longings and /or failures that occur in the present relationship. Keeping this general discussion in mind, I will turn now to five developmental issues that have particular import for marriage: structural deficits, trauma, the fear not to repeat, shame and narcissistic rage.

STRUCTURAL DEFICITS A N D NARCISSISTIC VULNERABILITY Kohut's (1971, 1977) formulation of a separate, narcissistic line of development in which adequate selfobject experiences, along with optimal frustra-

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tions, form the basis for the adequately structured nuclear self remains central to our understanding of the repetitive dimension in relationships where one or both partners exhibit narcissistic vulnerability. Pervasive selfobject failure, especially in the needed regulation of an idealizable selfobject during the early stages of childhood, derails the formation of this sense of internal structure: In the realm of narcissism very early traumatic disturbances in the relationship to the archaic idealized self-object, and, especially, traumatic disappointments in it may broadly interfere with the development of the basic capacity of the psyche to maintain, on its own, the narcissistic equilibrium of the personality (or to reestablish it after it has been disturbed) (Kohut, 1971, p. 46). For these individuals, even the normal vicissitudes of a healthy relationship can be experienced as intolerable selfobject failures. Lacking the capacity to self-soothe, they are prone to defenses including acting out, addiction and narcissistic rage. Of course these behaviors have ominous effects on the ability of the other partner to provide the longed-for selfobject functions— narcissistically vulnerable people are prone to bite the hand that attempts to feed them. The metaphor of a lack of internal structure is apt: for these individuals the self can feel like a precariously built house in which the joists and studs are constantly threatening to collapse. Nonetheless, it is important to keep in mind that these structural deficits originated in specific developmental contexts and appear in the couples therapist's consulting room in specific intersubjective contexts. Keeping in mind Atwood and Stolorow's (1984) formulation of the term borderline as referring to a phenomenon "arising in a specific intersubjective field consisting of a precarious, vulnerable self and a failing, archaic selfobject" (p. 56), the therapist must look not only at a partner's narcissistic vulnerability but also at the disjunctions, past and present, that have led that partner to conclude that the trauma of early selfobject failure was repeating itself. Not the least of these contextual considerations is the entrance into the field of the couples therapist as a source of longed-for understanding a n d / o r a new threat, a topic we will discuss in detail in the next chapter. In the case of Richard and Beth from Chapter 1, for instance, Beth's drinking and chronic rage were certainly evidence of a precariously structured self. These symptoms, however, could only be understood in the context of


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the trauma of the affair, as well as Richard's history of demanding mirroring of his own accomplishments while at the same time denying her own longings for mirroring and soothing. Stolorow and his colleagues maintain that therapy often exacerbates borderline pathology by failing to recognize the repetitive meanings of treatment disjunctions between patient and therapist: . . . it is inevitable that the therapist will "fail" the patient and that in such circumstances borderline symptoms may appear. In our experience, it is only when the subjective validity and meaning for the patient of these disjunctions and selfobject failures go chronically unrecognized and unanalyzed (often because of they threaten the therapist's self-organization requirements), and the re-establishment of the therapeutic bond is thereby prevented, that borderline phenomena become encrusted into what has been described as "borderline personality organization" (1987, p. 131). If this is true for therapy, it is doubly true for adult relationships. The narcissistically vulnerable partner's attempt to communicate his or her traumatic self-state with anger, exaggeration or acting out is often dismissed by the other partner. In this way traumatic ruptures, such as one partner being late or appearing to flirt with someone at a party, go unrepaired, and the partner's childhood experience of anguish and trauma leading to ever greater states of fragmentation and aloneness is repeated. "Optimal Frustration" in Relationships. Kohut believed that it was the alternation of selfobject experiences and nontraumatic selfobject failures, which he termed optimal frustrations, that led to the internalization of structure. Although this notion has been challenged in regards to the clinical situation by Bacal (1985), who replaces it with the notion of optimal responsiveness, I believe it bears particular relevance to our consideration of the challenge of overcoming developmental arrests in adult relationships. The particular kind of selfobject attunement needed to repair structural deficits for narcissistically vulnerable partners is beyond the scope of most adult relationships. Optimal or not, adult relationships will be experienced by such partners as inherently frustrating. But if the relationship can withstand these inevitable ruptures with some degree of empathy intact, or if empathy can be restored at some later time, this cycle of disruption and re-

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pair can come to provide an alternative to the repetitive meanings that have come to organize the vulnerable partner's experience of the relationship. In the ideal circumstance, the vulnerable partner comes to see that no one will ever completely protect him from reexperiencing terrible feelings of abandonment, but that doesn't mean that he has to spend the rest of his life in chronic disappointment and reactive isolation. And the other partner can come to see that, although she can't be responsible for his emotional turmoil, she can develop empathy for its developmental origins, and use this empathy as a way of maintaining or restoring the tie. Of course this outcome is best achieved through the continued provision by the therapist, in the conjoint session, and if necessary (see Chapter 8) in concurrent individual treatment, of the longed-for attunement and careful repair of disjunctions.

TRAUMA Relationship conflicts over abandonment and intrusion often have their origins in one or both partners' fears that childhood traumas are being repeated. Understanding the intersubjective dimensions of trauma offers particular insight into the relationship contexts that create these repetitive experiences. As Stolorow and Atwood (1992) point out in their chapter "Trauma and Pathogenesis," "Pain is not pathology. It is the absence of adequate attunement and responsiveness to the child's painful emotional reactions that renders them unendurable and thus a source of traumatic stress and psychopathology" (p. 54). This remains true whether the trauma occurs as discrete traumatic events or more subtle, recurring wounding, such as a highly narcissistic parent's repeatedly requiring the child to abandon her own selfobject needs and mirror or admire him. Thus, trauma emerges in two phases, an emotional injury, followed by the absence of a secondary, attuned response. This formulation is particularly relevant to couples therapy. Existing cycles of blame and conflict often make it very difficult for one partner to acknowledge or attempt to repair the injury they have caused the other. One partner may fear that if she offers such a response the other partner will use the breach in her defenses to "drive a truck" of blame and accusation through. The absence of an attuned response to emotional pain in the relationship re-creates the traumatic developmental context, triggering regression to primitive defenses.

Childhood Trauma and the Repetitive Dimension of Couples Experience 57 It is the defensive structures and pathological (and usually unconscious) beliefs that result from the child's attempts to regulate the traumatic affects on his own that are the source of lifelong difficulty. An example from the vignette at the beginning of this chapter would be Janetta's belief that every time she risks exposing her needs she gets "shot down." As we shall see when we return to this case later in the chapter, these beliefs originate in her experience with her grandiose and wildly inconsistent father, and at their most unconscious level, involve the belief that her needs themselves are bad and therefore bring on the traumatic rejection. A number of the pathological self-organizations that result from childhood trauma are particularly important to adult relationships, including: 1. Dissociation. As Stolorow and Atwood (1992) point out, Lacking an affect-integrating, containing and modulating intersubjective context, the traumatized child must dissociate the painful affect from his ongoing experience, often resulting in psychosomatic states or in the split between mind and body . . . or withdrawal behind a protective shell or cocoon . . . safe from potential injuries that would result from attachment to others (pp. 54-55, emphasis added). The vulnerability of adult relationships often accentuates the need for these dissociative defenses, leading to the splitting off of one or both partners' needs or vulnerability. 2. Concretization. When the repetitive dimension of adult relationships overcomes dissociative defenses and evokes childhood trauma, partners will organize individual incidents as concretizations of their unbearable pain, and react as if the pain they experience resides solely in those particular incidents. Defenses such as blame or withdrawal can then be directed toward the particular incident. The intensity that such concretizations invoke is often baffling to the other partner, who then responds by minimizing or denying, thus ominously re-creating the pathogenic childhood context. 3. Projection. This can be understood as a particular form of concretization, in which the traumatized partner comes to identify his partner as the source of all disturbing affects, and mobilizes all of his defenses against that partner, rather than experiencing in himself the potentially destabilizing affects. 4. Defensive pessimism. As in the case of lanetta, merely embracing hope can be the source of profound disturbance. Lacking the presence of an

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attuned other, children learn to regulate traumatic affect by remaining in a chronic state of contraction. To such children, believing that the worst is inevitable protects them from traumatic deflation and chronic frustration. In adult relationships such partners will militantly resist either exposing their needs or trying to meet their partner's needs. 5. Chronic self-doubt, feelings of unreality. According to Stolorow and Atwood (1992): Even if able to remember the traumatogenic experiences, the child may remain plagued by tormenting doubts about their actuality, or even about tine reality of his experience in general . . . an inevitable consequence of the absence of validating attunement that are contending lies at the heart of psychic trauma (p. 55). 6. Profound alienation. Stolorow (1999) in a moving account of his experience after the traumatic death of his wife, points out that: The traumatized person cannot help but perceive aspects of existence that lie well outside the absolutized horizons of normal everydayness. It is in this sense that the worlds of traumatized persons are fundamentally incommensurable with those of others, the deep chasm in which an anguished sense of estrangement and solitude takes form (p. 467). One particularly poignant example of the way this alienation affects a relationship is a couple in which the husband is a committed atheist, while the wife, the victim of sexual abuse of the most sadistic kind in childhood, takes refuge in Catholicism. Try as he might, the husband cannot imagine, nor can the wife explain, the alienation that lies behind the balm she finds in church. In couples treatment a traumatized partner's lack of a sense of reality in the face of traumatic affect must be understood. Suggestions to such partners to be more assertive will be at best ineffective or at worst counterproductive and retraumatizing. Such partners may need extremely slow, step-by-step investigation of their experience of a particular relationship incident, with special attention paid to the moment-to-moment affects the experience created. The emergence of traumatic affects in couples therapy inherently recreates, with the therapist, the formative developmental context. It thus provides opportunity for either a new experience or for retraumatization.


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Interpretations that point out the "reality" of the situation, offer immediate solutions within the relationship or point out the other partner's side can be catastrophically retraumatizing. Again, the best response is to investigate the meaning of the event from within that partner's subjective frame, while simultaneously offering an attuned, empathic response.

THE FEAR NOT TO REPEAT: PATHOLOGICAL STRUCTURES OF ACCOMMODATION It is frequently the case, in both psychotherapy and marriage, that the repetitive pole comes to dominate the relationship. As I noted in my previous book (1998), the restructuring of childhood patterns that so often creates intractable impasses serves two purposes: (1) it controls the risk of reexperiencing selfobject disappointments and allows for the use of familiar defensive strategies, and (2) it preserves the hope, underneath the conflict and the complaints that so typify these relationships, that each partner's needs will be met. Indeed, in relationships where impasse and conflict are chronic, this disguised thread of hope constitutes the relationship tie. There is another class of patients, however, for whom the repetition of childhood patterns is not a defensive reaction to the fear of retraumatization, but is rather an aspect of the traumatic experience itself. For these patients, repetition of traumatic contexts is an imperative. For some individuals, the intrusion of a caregiver is so pervasive as to amount to a kind of psychological usurpation. As Bernard Brandchaft (1994) points out, such individuals suffer not only from a deficit of structure caused by the absence of attuned selfobject experiences, but by the presence of a pervasive requirement to comply with another person's expectations and to meet their needs. As Brandchaft describes it, for such persons, the process by which one way of organizing experience is usurped by another more forceful is an internal surd automatic replication of crucial developmental events of the child-caregiver experience. That point at which the shift in feeling state from enthusiasm to malaise occurs continues to mark exactly the great divide of developmental derailment. It reflects the fact that the child's attempts to use his own feelings as central organizers of experience and behavior were stifled by attitudes and actions of caregivers. The patient cannot exit what has become a closed and noxious system. He remains trapped in the structural remains of an archaic tie. The perspective and motivation that prevails is one in

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CONTEXTS AND C O N N E C T I O N S

which the individual is compelled to submit to a definition of himself determined by forces external to his control or volition, a definition determined by the needs, wishes and fears of caregivers or those who continue to represent them psychically (p. 63, emphasis added).

Brandchaft uses the term "structures of pathological accommodation" to describe these kinds of organizing principles. Relationships in which one person appears to actively, if unconsciously, seek out traumatogenic partners, or in which one partner displays tremendous loyalty to partners who ignore or even crush their basic needs can be understood through this lens. In the case of Janetta and Darius, it is remarkable how similar her description of her relationship with her "genius" father and her actor husband are. She had spent years supporting her husband and subsuming her career ambitions to his. The timing of the revelation of the affair after she had begun to assert more needs in the relationship paralleled her father's leaving the family after she, at age fourteen, had begun to rebel against his expectations. In both cases, the terrible unconscious meaning was the same: she was being punished for daring to give up being a relentless source of admiration and support for a man and for asserting her own needs. Such patients present a special issue in couples therapy. For them the figure/ground relationship between the selfobject and repetitive dimensions doesn't oscillate; the repetitive is always figure. Moreover, as Brandchaft points out, the submission to another is in the service of preserving a desperately needed archaic tie. For these patients, the existence of these unconscious organizing principles must be made conscious. As we will discuss below, doing this work conjointly can help prevent its being undermined by an equally precariously organized partner.

SHAME The propensity for one or both partners to experience profound feelings of shame is a barrier to intimacy. As Morrison (1989) states, "shame frequently causes one to hide, to avoid interpersonal contact as a protection against rejection, and to conceal the affective experience from one's own awareness" (p. 2). The potential for intimate relationships to create shame is clear when viewed through the lens of the intersubjective context in which it develops.


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As Orange, Atwood and Stolorow (1997) point out, shame develops in a context of selfobject failure: From early, recurring experiences of malattunement, the child acquires the unconscious conviction that unmet developmental yearnings and reactive feeling states are manifestations of a loathsome defect or an inherent inner badness. A defensive self-ideal is established, representing a self-image purified of the offending affect-states that were offensive to the early surround. Living up to this affectively purified ideal becomes a central requirement for maintaining harmonious ties to caregivers and for upholding self-esteem. Thereafter the emergence of prohibited affect is experienced as a failure to embody the required ideal, an exposure to the underlying essential defectiveness or badness, and is accompanied by feelings of isolation, shame, and self-loathing (p. 80). This scenario assumes the formation of the defensive ideal. For many people, shame is a predominant, rather than a reactive affect state. In either case, even the normal vicissitudes of selfobject experience in relationships expose such individuals to terrible shame. In our discussion of mirroring in the last chapter, we spoke of shame as arising from mirroring failures for affect states of competency, expansion and excitement. In truth, shame arises on both ends of the affective spectrum. Dependency needs for soothing for sad affects can become the source of shame also, resulting in individuals who habitually disavow any sad feelings or any need to be understood and comforted. Intimate relationships provide countless moments when one partner sees through the other's defensive ideal, or when needs are exposed. Indeed, it is impossible to conceive of intimacy without picturing two people revealing themselves and meeting each other's needs. Thus avoidance of intimacy becomes the hallmark of shame-based relationships. This avoidance manifests itself in a number of ways, including the following: 1. Disavowing dependency needs. In particular, the overlay of genderspecific shame leads men to frequently disavow their needs for comforting or nurturing while women are prone to disavow needs to be admired for their accomplishments or for separateness. 2. Defensive conflicts. Fighting endless and often hopeless battles around a particular need often masks feelings of worthlessness. Underneath the fight, one or both partners is communicating a belief that he doesn't really

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deserve what he is fighting for. This sometimes manifests itself in one partner sabotaging the process just when he is starting to be heard. 3. Delegating shame. Through an unconscious collusion one partner will carry the shame in the relationship, protecting the other one from feeling his own. This is frequently the case in so-called codependent relationships in which one partner's addictive behavior carries the bulk of the shame. 4. Developing rigid patterns of behavior. In order to protect against exposure, shame-based relationships frequently proscribe spontaneous behavior and limit affectivity to a narrow band. 5. Avoiding sexual intimacy. Because it is so connected with bodily experience and with expansive affects, sexual intimacy can be a source of shame. For shame-based people, "To desire sexually exposes the vulnerable self to mockery, laughter, unresponsiveness, and ultimately, rejection" (Morrison, 1989, p. 161). Shame can lead to the sequestering of sexual desire into fantasy or perversion. Or, through a kind of reaction formation, profound shame can develop into the sexualization of all experience. In couples treatment, it is very easy for shame scenarios to be introduced iatrogenically. Even the simplest direction can carry the meaning, "Do this, because what you are doing is wrong." In addition, interpreting underlying needs or affect states can bring about feelings of exposure, particularly in the presence of the other partner. While this is probably unavoidable, the attuned couples therapist will both observe and inquire about the meanings his activity has for each partner. Shame can also be quite contagious, as when one partner's shame-based avoidance of sex leads to the other's feeling of being completely undesirable. In a case I reported on previously (1998) the wife felt horribly ashamed of the fact that her feet and palms sweated during intercourse. The husband didn't mind the sweat, but his wife's extreme vulnerability re-created for him shame about his overly close oedipally tinged relationship with his mother, who required that he take the place of her insensitive husband. Of course, in reciprocal fashion, the husband's shame reinforced the wife's worst fears. The therapist's delinking of these two shame reactions helped restore sexual intimacy. The husband was able to say to his wife, in effect, "I don't particularly like your sweaty palms, but you still rum me on." And the wife was able to say, in effect, "I'd rather have sex with you than be protected by you."


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Just as adult relationships pose a great threat by repeating shameinducing contexts, they also provide great potential for the amelioration of shame. The acceptance of each partner's needs, vulnerabilities and affects can offer a new developmental opportunity. In treatment, the therapist conveys his own acceptance and slowly works to build understanding and acceptance between partners. Often the interpretation of shame as the cause of seemingly inexplicable defenses and behaviors can restore empathy for the couple. The work here is very slow and careful, with many backtrackings and careful repair of disjunctions.

NARCISSISTIC RAGE Kohut's (1985) distinction between mature aggression or self-assertion and narcissistic rage is very significant to our understanding of rage in the couples situation. No matter whether it is full of condemnatory vitriol or icy disdain, narcissistic rage is a desperate attempt to compensate for or at least survive a state of inner collapse. According to Kohut, "the most violent forms of narcissistic rage arise in those individuals for whom a sense of absolute control over the environment is indispensable because the maintenance of self-esteem-—indeed the maintenance of the self—depends on the unconditional availability of the approving-mirroring selfobject or the merger-permitting idealized one" (p. 149). Marohn (1993) uses the telling phrase "rage without content" to describe narcissistic rage. Paul Ornstein's (1993) comment, "We do not achieve a direct transformation of narcissistic rage into healthy self assertiveness" (p. 147) is a shot across the bow of the couples therapist working to help the chronically enraged partner communicate his needs and feelings more effectively. Ornstein continues, "Self assertiveness is a function of a healthy self whereas rage is a function of a vulnerable, structurally deficient self." As useful as this distinction may be in guiding the therapist's empathy and interpretations, it is important to see that in relationships rage occurs on a continuum between blind discharge and self-assertion, and cannot exist as purely one or the other. Rage in marriage occurs in a specific intersubjective field, and, for both partners, derives specific meanings from within that field. Even seemingly irrational or near psychotic rage, when directed at a spouse, carries the assertion, "I'm holding you responsible for my primitive affect states." And often the recipient of such rage buys into

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the request to some degree, creating a relatively stable, if highly dysfunctional relationship tie. For example, Darius reported that one night Janetta had come into his study and demanded fresh details of his infidelity. At some point she began shrieking and pounding him with her fists. As the rage subsided, she grew tender and performed oral sex on him. It is not hard to see both the rage and desperate orality as reactions to the vanquishing of her organizing belief that she could hold onto an archaic tie through relentless self-sacrifice. Clearly the aim of these behaviors was more self-restorative than selfassertive. Yet Darius, confused as he was at her contradictory behavior, felt that he understood that something of her terrible pain and something of her still existing love was being communicated. The clinical goal in rage-prone relationships is to achieve an indirect transformation of rage into self-assertion and communication. This is a tall order, requiring a great deal of patience and, often, adjunct individual therapy (see Chapter 8). In conjoint work, the therapist must actively move to interrupt the rageful communication and seek to provide a restorative empathic tie to the enraged partner (Livingston, 1998), alternately providing understanding to the recipient of the rage that he understands how traumatic it is to be treated that way. When some degree of self-restoration has taken place, the therapist can begin to interpret the selfobject longings that lie under the rage. Eventually the therapist can begin to interpret the self-fulfilling nature of the rage—that it triggers reactions in the other partner that are the exact opposite of the ones he longs for. In one case, a husband, the son of a manic-depressive mother, would fly into terrible rages at what he saw were examples of his wife's neglect, which obviously repeated the trauma of his mother's depression-induced abandonment. While the therapist interpreted over and over again his understanding of the way these incidents were a reexperiencing of childhood trauma, the wife was encouraged to feel as separate as she could be from the rage, with interpretations such as, "You did not cause this rage, and much as you love him, there is nothing you can do to fix it." Eventually the couple was able to develop a strategy where the wife could actually say to him, "Could you back off and consider what part of this is about your mother, and then come back and talk about what part might be about me?" Although this did not always work, it at least communicated her basic intent to both protect herself and maintain the tie.


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CASE VIGNETTE: CONCLUSION The repetitive dimension of Darius and Janetta's relationship grew clearer as the partners' developmental histories emerged. I do not usually take a specific developmental history. Although I will often nudge partners with questions such as "Does that seem in any way familiar to you?" I prefer to let associations to childhood emerge from discussions of present experience. One such case occurred when Janetta, replying to Darius's attempt to reassure her, said, "I hear your words, but they just don't register. I honestly don't know if you care whether I live or die." I asked if that was a feeling she remembered ever having before. After a short reflective silence, Janetta recalled a time from her adolescence. "My father was a genius. He had an IQ of 170. He was a doctor, but he was completely critical of Western medicine. He was also stoned all the time. But he didn't want me to rebel. He wanted me to be a reflection of his greatness. He sent me to this fancy private school in Manhattan. I hated it. I tried to fail, just to get his attention. He'd insist that I wear nice clothes, but I would purposely tear my pants on the subway, just to get to him. But he just grew meaner and more withdrawn. I even faked vomiting in the mornings. I wasn't bulimic, but I wanted him to think I was. All that happened was that he grew meaner and more withdrawn, and my mother grew more depressed. And then he left. After that, I just kind of gave up." Janetta's experience of her relationship with Darius could only be understood through the lens of the relentless organizing principles that grew out of her relationship with her father. When I mentioned that I was struck by how she used the word "genius" to describe both her father and Darius, she nodded grimly, saying, "I guess I'm still trying to get them to notice me." The key moment in Janetta's development was when she "just kind of gave up." Despite the histrionic quality, her adolescent acting out carried her yearnings for self-delineation. In forming a relationship in which she had "lived through Darius's career," she was re-creating a relationship tie in which she had to completely suppress her selfdelineation in order to maintain the relationship tie. But this repetitive scenario is only half the story here. In exploring the history of the repetitive pole of a couple's experience, one will often

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find a two-phase scenario: one phase in which the repetitive meanings get established and concretized in the relationship, and another in which the defenses the couple evolves to cope with the repetitive experiences break down, resulting in renewed trauma. For Janetta, given the relentless power of her organizing principles, the repetitive dimension of her relationship with Darius began almost immediately- Although she was a talented performer in her own right, she almost immediately suppressed her own art and supported his career. In the second phase, which began with the birth of their son, Janetta's traumatic experiences of abandonment began to break into her awareness. This moment coincided with the emergence of Darius's repetitive fears. Until the birth of their son, Darius experienced Janetta largely as a positive selfobject, providing longed-for mirroring to his career achievements. Darius's parents were also performers, and from early on they pushed Darius into the performing arts. As he put it, "My parents could nurture my talent, but they couldn't nurture me." Darius's parents, especially his father, were very controlling of his career, trying to dictate what parts he should accept, where he should live and, later, what sorts of teaching jobs he should accept. In some respects, Janetta's support for his career repeated his parents' selective mirroring, but with an important difference: Janetta's organizing principle that she suppress her own needs and desires led her to not interfere with Darius's career decisions. The first phase of the relationship, in the language of Shane, Shane and Gales (1997), was old-self (in the sense that he was still being mirrored for his achievements, not his needs or sadness) /new-other for Darius, and old-self/old-other for Janetta. As has been noted by many family therapists (Carter and McGoldiick, 1989), the birth of a child is a critical moment in the family life cycle, Janetta believed that Darius pulled away from her because the birth of his son was a threat to his career. As they discussed it in treatment, however, Darius explained that it was not a threat to his career, but a threat to his tie with Janetta that led him to withdraw. The relationship with Janetta had been crucial for Darius's development. As Janetta put it, "I could stand up for someone else, even if I couldn't stand u p for myself." Janetta had insisted, over Darius's parents objections, that they move awTay from the city where their families lived. Her


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in-laws have never forgiven her, but Darius expressed his gratitude for an important act of protection from an idealizable selfobject. The selfobject functions that Janetta fulfilled for Darius protected him from experiencing the devastating abandonment of his parents "nurturing his talent, but not him." Now as Janetta began to perform selfobject functions for their son, Darius experienced a terrible repetition of his childhood trauma. The path he took to cope with this repetitive trauma, immediately replacing Janetta with another admiring selfobject, is all too common for gifted and narcissistically vulnerable individuals like Darius. Janetta, like many new mothers, experienced childbirth as a time of both increased dependency and proud accomplishment. When Darius began pulling away, it initiated an even deeper experience of her childhood trauma of selfobject failure. Despite her history of relentless suppression of her own needs, she was being abandoned, just as her father had eventually left. In the face of this abandonment, Janetta renewed her attempts to repair the tie by suppressing her own needs to an even greater extent. She encouraged Darius to accept a role in London and willingly uprooted the family. The revelation of the affair represented the final vanquishing of her sustaining, if pathological, organizing principles, leaving her completely vulnerable to bouts of suicidal ideation and uncontrollable rage. Couples work for Darius and Janetta came to involve the uncovering of their pathological organizing principles, as well as discovering the selfobject needs that those principles obscured. For Janetta, who had actually begun a limited career as a children's performer after the birth of her son, the work focused on her ability to maintain self-delineation in the face of a belief that she would inevitably be punished for it. For Darius, the task was to begin to identify selfobject needs other than being admired for his career achievements. One breakthrough moment came when an attractive female press agent flirted with him at a backstage party: "I realized for the first time that 1 did not want that, I really didn't want it anymore. I would rather be home with my family." Janetta, to her credit, reacted warily, withholding her usual provision of admiring approval to Darius's accomplishments: "If that's true, I'll be glad, but I'm not convinced yet that it is true."


CHAPTER 5

No Person" Psychology: A Dynamic Systems View of Relationships

Couples therapy is exciting because of its unpredictability and the potential it creates for surprising growth and change. Dynamic systems theory, which is a "science of change" (Thelen and Smith, 1994, p. 49), provides an understanding of that potential. In this view, marriage is one more step in the ongoing process of human development, which, like all other developments, from learning to walk to achieving a stable sense of self to finding a mode of livelihood, can best be understood as phenomena emerging from complex interpersonal systems. Anyone who has worked with couples has most likely observed both the inexplicable persistence of patterns of relating that appear to frustrate, rather than meet, each partner's needs, and the sudden emergence of reactivity that threatens to plunge a heretofore stable-seeming relationship into chaos or breakup. Adoption of a systems perspective, which describes the flow between order and disorder, opens a new window on both phenomena. Dynamic, nonlinear systems theory, which describes how "structure and patterns arise from the cooperation of many individual parts" (Thelen and Smith, 1994, p. xiii), will be invaluable in our attempt to make sense of relationship process and understand both how stable patterns emerge and how change occurs. Esther Thelen and Linda Smith, developmental psycholo69

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gists from the University of Indiana, have applied dynamic systems theory to human cognitive and motoric development, which they see as phenomena emerging from an open system composed of, among others, neurological, mental and interpersonal parts. Unlike classical psychoanalytic development theories, which emphasized the determinism of early childhood epigenetic milestones, a dynamic systems view of human development does not proceed from a preprogramed plan, nor does it ever arrive at a particular endpoint: . . . in our view, development does not "know" where it is going from the start. There are no constraints on development like levees on a flooding river, keeping it from going where it ought not to go. There is no end-state other than the end of life itself. We propose instead that development is the outcome of the self-organizing process of continually active living systems (Thelen and Smith, p. 44).

From this perspective, marriage provides a context for the emergence of new forms of adult development, and couples therapy is the art and science of facilitating positive development within the relationship system. Since marriage is a reciprocal intersubjective system in which each partner's subjective organization both creates and is in turn created by the relationship, therapeutic interventions directed toward either partner or to the relationship itself will affect all parts of the system.

PSYCHOANALYTIC SYSTEMS VIEWS OF MARRIAGE Over the last twenty years, systems thinking has been incorporated into psychoanalytic theory of intimate relationships, variously describing the interplay of the partners' unconscious, subjective worlds as collusion (Willi, 1982; Slipp, 1988)1 or in terms of a system (Skynner, 1976; Scharf and Scharf, 1987).2

'E.g., Samuel Slipp on the narcissist /borderline couple: "There is a shared unconscious collusion between the couple, involving a dependency and anger at an abandoning bad parental introject. . . . Through projective identification, the narcissist puts anger into the borderline, who serves as an avenger to act out the split-off bad self of the narcissist" (p. 257). 2 Scharf and Scharf (1987) discussing a model analogous to the bipolar transference of intersubjectivity, on the oscillation between a "contextual holding" and a level where object rela-


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Solomon (1989) describes the formation of a "mutual self . .. based on complimentariness, an unconscious division of functions in which each partner supplies part of a set of qualities, the sum of which is a complete unit greater than the sum of its parts" (p. 27). She goes on to identify the establishment of a "mutual comfort zone or homeostasis" around such issues as closeness/distance and separation from the partners' respective families. Tn narcissistically vulnerable couples, this homeostasis is maintained through "a collusive pattern that seems to be causing considerable unhappiness but actually serves the purpose of maintaining a fragile equilibrium for both partners" (p. 30). Intersubjectivity theory has recently come to view both the individual's subjective world and the patient/therapist relationship in systems terms (Sucharov, 1994, 1999; Stolorow, 1997; Orange, Atwood and Stolorow, 1997; Shane, Shane and Gales, 1997). Beebe and Lachman (1988,1994) view infant attachment and development as intersubjective systems phenomena. Beebe and McRorie (1996) have applied their findings on infant development to adult love relationships. These developments are the starting point for the view of couples discussed in this chapter.

A "NO-PERSON" PSYCHOLOGY As self psychology and intersubjectivity evolve, such contemporary theorists as Sucharov (1994), Shane, Shane and Gales (1997) and Orange, Atwood and Stolorow (1997) are seeing dynamic systems theory as a powerful tool for integrating different levels of human functioning. According to Stolorow (1997), "Anew scientific paradigm has been evolving from the investigation of phenomena that have variously been called dynamic, nonlinear, selforganizing or chaotic systems." This new paradigm "is a source of powerful new metaphors for psychoanalysis. Phenomena such as conflict, transference, resistance and the unconscious itself are grasped from this perspective as dynamically emergent properties of self-organizing, nonlinear, dyadic, intersubjective systems" (p. 338).

tions dominate and "their split-off internal objects 'recruit' .. . conscious aspects of communication in order to establish unconscious communication at the same time." Further, "the mutual projections and introjections may assume a rigidity that comes from the relatively closed feedback loop of a two-person system" (p. 77).

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This paradigm has quite radical implications. It challenges the "false dichotomy . .. between intrapsychic and interpersonal theorizing" (p. 339). Indeed, it even challenges our basic notions of the barrier between self and other in favor of a "new understanding of experience that cuts across boundaries of internal /external and distributes experience in a relational field. Stability and identity will emerge not as properties of a reified self, but as experiential properties distributed in a complex relational web" (Sucharov, 1999, p. 1). From this viewpoint, Stolorow has quipped that his theory represents a "no person psychology, concerned as it is with how worlds of inner experience and intersubjective fields mutually constitute one another" (1997, p. 339). The implications here for our understanding of intimate relationships and couples therapy are equally profound. To return to the case of Beth and Richard from Chapter 1, Beth's "borderline personality" and Richard's "narcissism" do not exist as separate properties at all. Both are stable-seeming subjective organizations that emerge from the intersubjective system of their relationship, which is itself a creation born of the coming together of two individuals whose developmental histories have led to the emergence of subjective organizations characterized by a relentless need for admiration on the one hand and a precarious sense of self on the other. Impasse in relationships can be understood through the analogy to therapeutic impasse, characterized by "persistent pathology" and "intractable resistances and repetitive transferences" (Stolorow, 1997, p. 342). This impasse occurs in a patient/therapist system in which "the analyst's stance has become tightly coordinated with the patient's grim expectations and fears." This picture of two people tightly coordinated in their fears and pessimism can describe stuck marriages as well as stuck therapies. For example, Beth and Richai'd's marriage was a system comprised of the persistent pathology of Beth's underlying belief that she is completely unlovable and Richard's desperate attempts to ward off through the admiration of others his own crumbling self-esteem; intractable resistances such as those that have led Beth to reject whatever present Richard buys her because she "knows he's just doing it because he has to"; and repetitive transferences that even before the affair had led to a script of two people avoiding conflict and blame over their mutual disappointments by warily avoiding each other. How can therapy change such a stuck system? Again, both dynamic systems theory and the analogy to individual therapy provide answers. Change in dynamic systems is discontinuous and nonlinear. Following a perturba-


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tion of the existing organization, there is a period of fluctuation where "no stable pattern can be observed" before "the system evolves into a new . . . state" (Thelen and Smith, 1994, p. 63). In therapy, change requires "severe perturbations, shifts in the analyst's understanding and interpretive stance powerful enough to destabilize the invariant organizing process of the therapeutic system." Effective interpretations must disrupt the stable, repetitive patterns in the system, "freeing its components to reassemble in new ways" (Stolorow, 1997, p. 342). This leads to a period of destabilization that may be accompanied by painful and frightening affect states that must be contained if the change is to be tolerated and new orders emerge. Change entails a period of free fall. In marriage, perturbations powerful enough to cause change can come from a number of sources—the family life cycle, individual growth on the part of one or both of the partners, a traumatic experience—as well as the interventions of a therapist. The therapist is not in charge; she will not know what the end product of the change will look like. She seeks merely to derail the existing negative system by providing a jolt in the other (selfobject) direction. Whatever the source of change, couples therapy must provide a place to "hold" (Winnicott, 1965) the chaotic transition states and to allow a new, more differentiated (Bowen, 1978) order to emerge.

SELF AND MUTUAL REGULATION: A MODEL OF RELATIONSHIPS FROM INFANT RESEARCH If an intersubjective systems model of relationships is going to transcend the dichotomy between the intrapsychic and the interpersonal, it must account for each partner's representational world (Siegel, 1992)—the "affect-laden, archaically determined configurations of self and object that pervade psychological life" (Atwood and Stolorow, 1984, p. 36)—as well as for the dynamics of the relationship itself. The work of infant researcher and psychoanalyst Beatrice Beebe and her collaborators, which views the representations of self and other as emergent phenomena within an intersubjective caregiver/child developmental system (Beebe and Lachman, 1994), provides a conceptual bridge for this task. In accord with Stern (1985), Beebe and Lachman hold that the infant's mental models of attachment, self and other are formed by patterns of interaction between the infant and the caregiver, in particular the interplay between self and mutual regulation.

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Representations of self, other and self-with-other might be regarded as the "language" through which each partner understands relationships and through which she or he will later express that understanding. The "words" for "me," "you" and "me and you together" emerge from the lived experience of the infant: time consoling or stimulating (or failing to console or stimulate) himself alternating with time being consoled or stimulated (or failing to be consoled or stimulated) by the caregiver. Though this language is acquired quite young, and will probably remain one's primary tongue, it is open to modification through the assimilation of new vocabulary, in particular through dialogue with a partner wTho speaks a different, but, it is to be hoped, comprehensible dialect. According to Beebe and Lachmann (1994), three "principles of salience" underlie the grammar or structure of this language of attachment: (1) ike regularity and repetition of ongoing interactions between the infant and the caregiver; (2) the disruption of these expected patterns followed by the repair of those disruptions; and (3) moments of heightened affective intensity between the infant and caregiver. There are strong analogies here to adult attachments. Intimate relationships, forged by intense, affective moments, must develop a sense of regularity (we go for pizza on Friday nights; when I'm upset she understands me) as well as the courage and optimism to carry on and get back on track when the rhythm of expectations is traumatically disrupted. Conversely, examples abound of couples who have problems with attachment in one or more of these areas: their life is chaotically organized around intense emotions or entirely lacking in intensity; they have never found a modus vivendi or rhythm for living daily life together, or they have little or no ability to right themselves after emotional upset. In a paper entitled "A Model for Love for the 21st Century: Infant Research, Literature, Romantic Attachment and Psychoanalysis" (1996), Beatrice Beebe and Ed McCrorie look at adult relationships through the lens of childhood attachment patterns. In their model, childhood attachment is a developmental system in which "mutual and self regulation 1 are concurrent and complimentary processes" (p. 1). In a dynamic system of self and mu-

"Self-regulation is "management of inner state, the capacity to activate and dampen arousal, and to self soothe." Mutual regulation "refers to the bi-directional communication, but does not imply 'mutuality'"; the contributions of each partner are "not necessarily similar or equal."


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tual regulation, "both partners, whether mother and infant, adult lovers, or analyst and patient, jointly construct the rules of negotiating social relatedness, guiding the management of attention, turntaking, dialogue rhythms, and affect sharing. These 'rules' or predictable patterns of interpersonal contingencies are represented as mental models of relationships" (p. 4). Beebe and McCrorie posit a continuum of health in which "optimal social communication and development occur with flexibility to move between self and mutual regulation" (p. 2). Optimal communication is characterized by a balance of freedom and connection, which manifests as a sense of improvisation and playfulness in the nonverbal communication between mother and infant, like jazz riffs. Healthy relationships negotiate the flow between separateness and intimacy, whereas less healthy relationships are characterized by conflict between the two or by dominance of one over the other.1 In a "no person" model of adult relationships, the psychological structures that emerge from childhood attachment patterns contribute to, but do not determine, the organization of adult relationships, and are themselves subject to development and transformation through the relationship process. Beebe and McCrorie propose "a lifelong dialectic between intimate relatedness and the management of one's own states (including fantasies, projections, and transferences), each affecting the success of the other in achieving optimal levels of attention, affect, and arousal" (p. 9). Intimate relationships involve countless acts of self and mutual regulation. For instance, there's the prototypical scene (Shaddock, 1998) in which a husband, charmed by his wife's dancing to music while doing the dishes, approaches to give her a hug from behind. Intent on the task at hand, she rebuffs him. He withdraws and picks u p the paper. Noticing his withdrawal, she flips him a towel in time to the music and invites him to dry. Underneath this successful interaction are two worlds of personal history. His depressive withdrawal to the newspaper may reflect an archaic pattern of self-soothing in the face of an unavailable caregiver. Her towel flip may

*In her research with infants and mothers, Beebe measured the similarity or difference between the baby and mother's vocal rhythm. High levels of matching indicated "interactive vigilance," excessive monitoring of the partner, while low levels of matching indicate a preoccupation with self-regulation and insensitivity to the partner.

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reflect a history of her adapting her own self-regulatory "dance" to provide regulation to a depressed caregiver. Yet here these patterns are reshaped by lived experience and potentially transformed into a new mental representation of intimacy.

SYTEMS THEORY AND RELATIONSHIPS A brief summary of terms commonly used in dynamic systems theory will be useful here. Intimate relationships exemplify a type of open system that exists far from thermal equilibrium (e.g., "heat" or energy still move through them), as opposed to a closed system that, like a solution of salt in water, has reached the endpoint of its development. Open systems self-organize: "new, ordered structures may spontaneously appear that were not formerly apparent" (Thelen and Smith, 1994, p. 54). The organizations that surface "are totally different from the elements that constitute the system, and the patterns that emerge cannot be predicted solely from the characteristics of the individual elements." If relationships are more than the sum of their parts, then individual pathology is not predictive or deterministic. Stable and recurrent patterns in relationships are seen as attractor states. A metaphor for attractor states is a ball rolling into a concave hole: a shallow hole, from which it would take only a little added energy to get the ball rolling again, is a weak attractor; a deep hole by contrast is a strong attractor and would require greater perturbation to become unstable. Some attractor states are so stable as to seem inevitable, but that does not mean they are so; a multi-stable behavioral system may have "several quasi-stable options within the attractor basin" (Thelen and Smith, 1994, p. 60n). Human development is characterized "as the continual stabilization and destabilization, over time, of preferred attractor states" (p. 61). In relationships, a new pattern that is emerging in therapy may alternate over and over again with old patterns. The couple may feel frustrated or defeated, but the systemsoriented therapist will understand and interpret this oscillation as a normal occurrence. Even relationship patterns that appear hopelessly intractable are still best understood as strong attractor states. In one couple, years of the husband's anger and criticism had driven the wife into a sullen pattern of withholding all affection. The therapist was for a long time unable to say or do anything that would perturb this pattern. In one session, the history of a miscarriage


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(the couple was childless) was mentioned. The therapist wondered if some of the anger he saw masked grief at the loss. After some prodding, the husband agreed that this might be so. Though he talked rather perfunctorily about the details, it was clear that there was a lot of feeling behind his words. The emergence of this affect helped break down the walls of rigidity. What the wife eventually needed to talk about was not the miscarriage but her years of enduring the husband's anger. But their old script had begun to change. Dynamic systems are hierarchical. Individual components, such as each partner's subjective world, are considered separate systems, which in turn are part of the suprasystem of the relationship. The components of a suprasystem are soft-assembled— that is, a particular hierarchy can change, with another system becoming dominant, as when a certain repetitive theme comes to dominate a relationship. "There are no codes, prescriptions, schemata, or programs orchestrating the nature of the attractor or its trajectory" (Thelen and Smith, 1994, p. 60). It is sometimes the case that one partner's invariant organizing principles appear to have dominated the whole relationship, and indeed permeated the other partner's subjective world as well. In systems parlance, this parameter has "slaved" the system. It is still important to keep in mind that this organization is soft-assembled. A perturbation of the existing system, say in the form of a therapist's empathy for the dominating partner, can disassemble the existing hierarchy and allow the system to reorganize.

A DYNAMIC SYSTEMS MODEL OF RELATIONSHIPS What follows is a model for understanding relationships based on the dynamic interaction between two areas of experience: the dialectic between self and mutual regulation, and that between the selfobject and repetitive poles of each partner's subjective organization. These two are not separate domains but different lenses for looking at the relationship system. An intersubjective systems understanding of intimate relationships views each partner's subjective world as a subsystem of the relationship suprasystem. Each partner's subjective organization is in itself a dynamic, contextsensitive system of different variables, including systems of self and mutual regulation—which have formed relatively stable representations of self, other and self-with-other—and systems of selfobject longings and repetitive fears—which have formed not only a relatively stable self system open to

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engagement and modification through intimate relations but also a defensive system of invariant organizing principles that resists modification. The relationships that the therapist sees in his consulting room—be they rigidly vigilant and hyperreactive or disengaged, be they chaotic or controlled by repetitive, defensive enactments—can be understood as emergent states within the dynamic systems formed by these variables. Self arid Mutual Regulation. The lens of self and mutual regulation described by Beebe and her colleagues allows the therapist to rapidly assess the way a marriage system handles the boundary between individuality and connection: is there room for both? Does one partner feel crowded, stepped on, rushed? Does the other feel neglected, out of control, left dangling? How does each partner self-regulate? Does she or he count to ten, fantasize other lovers, drink alcohol, meditate? How long does it take them to be ready for mutuality? Does one partner's regulation of the other predominate? Does this regulation feel unequal or parental? If so, what is the affect of the providing partner—does she or he provide it grudgingly? And is the receiving partner grateful or chronically dissatisfied? Answers to these questions provide a snapshot of the relationship in the present as well as potential windows into childhood attachment issues. Relationship systems can be recognizably described by four common relationship scripts (Shaddock, 1998): pursuit and avoidance, angryconflictual, avoidant and pseudomutual. The pursuit/avoidance script is characterized by chronic conflict between one partner's often desperate need for mutual regulation and the other's need to self-regulate. In the angry script, mutual regulation is achieved through aggressive affect and subsequent reconciliation; self-regulation is mostly absent. Avoidant partners engage in parallel self-regulation, while pseudomutual couples create only a veneer of engagement in which affect is really neither exchanged nor regulated. Relationships that have reached impasse are usually characterized by fairly rigid patterns of self and mutual regulation. Rather than having the improvisatory character that Beebe and McCrorie associate with health, the interactions take on a repetitive or stereotyped style—whereby, for instance, one partner anxiously and vigilantly monitors the other, trying to evoke a response, and the other withdraws into the self-soothing of television or the Internet. Both partners in one recently treated couple regularly retreated to


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their respective computers after a fight and played video games, each trying to outscore the other. Many times these arrangements originate in one partner's retreating to an old representation of his self in relationship, such as "I'm invisible amidst all the family's chaos." Relationship systems often enshrine the very particular attunements or elaborate soothing schemes that individuals with precarious self states developed. Other couples systems are organized around one partner's urgent, ever escalating attempts to induce a regulatory response of some kind in the mate; still others become dominated by the self-regulating regimen of one partner, such as alcoholism or workaholicism. Remembering Beebe and Lachmann's three principles of salience, the couples therapist will try to alter the relationship system, creating new attachment modalities by • facilitating moments of emotional intensity through the encouragement and interpretation of each partner's affects; • working carefully to repair disjunctions both between himself and each partner and between the partners themselves in order to affirm the possibility of repair after disruption; and • restoring a sense of continuity through maintaining the regularity of sessions and sustaining a holding environment.

Selfobject vs. Repetitive Systems. The second lens, which parallels the bipolar transference described earlier, looks at relationships as soft-assembled systems of hope and dread (Mitchell, 1993), of self-selfobject engagement or defensive enactments. The therapist should pay particular attention in taking a couple's history to locating the moment(s) when the relationship system shifted from an attractor state organized by selfobject expectations to one dominated by one or both partners' fears of the repetition of childhood trauma. Even inquiry about when and how a couple's presenting problem started can reveal some disappointment, or even some innocuous-seeming event, that had the power to perturb the existing system and reorganize it along defensive lines. When such a reorganization takes place, a couple may reach all the way to the brink of breaking up without even understanding what has happened, as in the case of the young nursing student (Shaddock, 1998) who, on telling

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her husband excitedly about her first day at a hospital, experienced his nervous fidgeting as a crushing mirroring failure. She denounced him bitterly, then her criticism led him to withdraw, first emotionally then physically, in turn potentiating her already traumatic sense of abandonment. The result was a reorganization of the relationship system into an intractable pursuit and avoidance script. A systems understanding of these rather commonplace events allows us to understand how a relationship can change so dramatically, and how the resulting defensive pattern can become so entrenched. Couples who have undergone such a rapid systemic change feel baffled—they believe that they have chosen wrong, that new and terrible realities about their partner have been revealed or that they are doomed to disappointment and resignation. A systems interpretation such as "It seems that both of your fears took over and rearranged the relationship to protect you" can be very helpful. Indeed, in most relationships, mutual paranoia is the architect. In all four stuck-relationship scripts, both developmental longings and self-maintaining selfobject experiences play constituent parts in the dynamic equilibrium. It is hard to remember that conflict and chronic frustration are driven by hope and disillusion alike—that even the most relentless avoider is really yearning for a particular selfobject experience in which the capacity to be alone (Winnicott, 1965) is fostered by an emotionally present but nonintrusive mother, and that the most relentless pursuer is seeking an idealizable, soothing selfobject experience that will allow the return of a self state in which self-reflection and intimacy can coexist. The beauty of a systems model is that it allows the therapist empathic access to these hidden parts of the relationship, especially at times when the partners themselves have lost that access. The intersubjective field of a relationship in which repetitive meanings predominate is filled with enactments and identifications that concretize the repetitive themes. Statements that begin "you always" reveal the fixed nature of these concretizations in the partner's subjective world. And the resulting rigid relationship system further substantiates each partner's subjective view of the relationship. Remembering the reciprocal nature of our "no person" psychology, we see how each partner's subjective world becomes organized by the relationship system it helped to create. Herein lies one source of the often observed phenomenon of partners desperately clinging to an unhappy and unfulfilling relationship. If each partner's subjective world is substantially organized by the relationship system,


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the loss of that organization can be a frightening prospect. What's more, it is likely to be a familiar experience, in that each partner experienced a time of free fall when the relationship shifted from the selfobject to the repetitive. The prospect of reliving that chaos along with the loss of the concretized organization of each partners' subjective world act as powerful sources of resistance to change. The fact that systems, when perturbed, can reorganize at a quantum-like level allows the therapist to remain hopeful that the right intervention or interpretation could facilitate a positive change. A systems-informed vantage point will allow the therapist greater patience and empathy, while at the same time offering her hope that even a very stuck system can change as the level of empathy and positive selfobject experience come to predominate.

CASE EXAMPLE Let us return to the case from Chapter 1 of Richard and Beth, whose relationship system was chaotic following the revelation of Richard's affair. Out of this chaos, the relationship oscillated rapidly among several attractor states, which could be understood systemically in terms of the balance between self- and mutual regulation as well as in terms of the interplay between selfobject and repetitive experience. One was characterized by both disengagement and wary hypervigilance; bitter parallel self-regulation predominated (Beth reading, Richard pursuing his business), complicated by the hypervigilance that expressed both of their frustrated longings for mutual regulation. A second, angry/passive condition featured alcohol-fueled outbursts by Beth, which sometimes elicited contrition from Richard. At other times he simply ignored them. This pattern emerged when Beth experienced a traumatic abandonment of one sort or another, triggering her invariant organizing principle that she was completely unlovable; her rage and her drinking were desperate efforts to get some kind of selfobject soothing from the surround. At times she did elicit genuine concern from Richard; however, when her behavior kicked in repetitively themed material for him he saw Beth as manipulative and exploitative and withdrew. The third attractor state had a kind of honeymoon intensity: they actually vacationed together in Hawaii and had a wonderful time—only to reUirn to a period of uproar when the trip ended. The renewed-

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attraction scenario was very dangerous to Beth, who feared being retraumatized on letting her guard down; it was also an internally weak system, organized by selfobject themes and mutual regulation, but only until some repetition-tinged incident precipitated a recurrence of one of the other states. After some three months, Richard and Beth's thrice-weekly treatment schedule came to constitute a container for the relationship, and with it a regular rhythm (Beebe and Lachmann, 1994) that helped provide a semblance of secure attachment. Indeed it was safe to say that during this period the couple was more attached to treatment and to me than they were to each other. By about the fourth month, there were times when a lull in the storm of recriminations about Richard's affair allowed for exploration of some of the deeper issues in the marriage, including each partner's selfobject longings and the genetic origins of their repetitive fears. Vestiges of the pre-affair marital system—in which Richard held Beth responsible for providing mirroring and affirmation and Beth either guiltily complied or passively resisted—reappeared, along with hints of a more functional relationship system. Material from three of these later sessions follows, in which the possibility of positive reorganization both of the relationship and of Richard and Beth's subjective worlds surfaces. In the first session, the depth of Richard's oedipal wounding is revealed. In the second, Richard's relentless demand for mirroring is interpreted as an addictive defense. In the third a moment of genuine intersubjective conjunction is achieved around Richard's exclamation "parking tickets!"

Session A Beth: You know, Richard, you complain about my passivity, but when it comes to your family, you don't really initiate very much. David: What about that? The question of your passivity has come up a couple of times before. Richard: There are some tilings I seem to know how to do—run my business, make money. That's the one thing my father taught me. How to make money. Though he constantly reminded me, I could never do it as well as he did. I knew I'd disappoint him. (growing animated) And the outbursts! He'd yell at me for something as if it were the crime of the century. Jerry, my brother, got it worse than me. He won't even talk to

"No Person" Psychology: A Dynamic Systems View of Relationships 83 him now. I still call, since my mom died, I try to call once a week. But it's not like I have something to say. I want to tell him about how the business is doing, but he'll just find something to criticize. Next time I visit, I'm going to take him to look at the house where we used to go summers. He probably won't say anything. David: You're still trying to win his approval. Richard: I don't know why. One time he started to yell at Beth. He never accepted her. I stood up to him then, didn't I? I said, "Don't talk to my wife like that." David: How was that for you, Beth? Beth: I appreciated it. I really did. I think his dad always compared me to Richard's first wife. They liked her. Richard {after a long pause, to Beth): But you know, you never protected me. You never stood up for me. (growing more animated) You never protected me from him. David (to Beth, who is looking shocked): It sounds like there's a lot of anger at his mother mixed into that complaint. How does that affect you? Beth: I'm not June Cleaver. David: You mean the fifties wife who fixes everything? Beth: Yeah. David: Is there some part of you that thinks you should be, that your job is to make things perfect? Beth: Well, 1 think that's what Richard expects. David: But is there a part of you, maybe not a conscious part, that agrees? Beth: I guess so, yeah. David: I wonder if that's part of your depression. A kind of shutting down, because you can't or don't want to be Richard's mother? Beth nods thoughtfully, interested but noncommittal. David (to Richard): How are you doing? That was a lot, what you just got into. Richard (very quiet, and unusually thoughtful): I don't want to make her depressed, I really don't. David: The thing is, that stuff that just came out, we call it transference, it happens in all relationships. Relationships just bring back stuff from our rotten childhoods. These issues, your dad's criticism and your mom's not protecting you, have been a very powerful part of the rela-

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tionship, along with Beth's chronic guilt, which gets her depressed. Believe it or not, therapy can change that, just by talking about it, instead of living it.

Discussion The first of the sessions opens with Beth wanting to discuss the issue of Richard's passivity. Passivity, an accusation Richard has repeatedly thrown at Beth, is a coded complaint that she does not meet his selfobject needs for mirroring and affirmation. The fact that Beth could calmly confront Richard with his own passivity marks a change from her usual style of angry rage or hopeless withdrawal. After three months of treatment, Beth is beginning to feel solid enough to try new behaviors, and her advance proves to be a powerful perturbation of the existing system of mutual blame and withdrawal. Her comment opens up the oedipal wounding that underlies Richard's defensive grandiosity. Richard eloquently describes both the depleted self masked by his manic defenses and the hopelessness he feels about ever being good enough to win his father's approval. In a moment of near hallucination, Beth and his mother merge for Richard as he confronts an even deeper wound: the betrayal of his mother, who sided with the abusive father and did not protect him. The depth of this transference reveals how completely his experience of Beth is dominated by repetitive themes from his childhood. As Beth is revealed in Richard's subjective world as the longed-for but neglecting mother, Richard is revealed as the wounded son, with no one but himself to turn to for solace. It's as if the curtain of Richard's achievements and demands had—like the one that hid the Wizard of Oz—risen to reveal the desperate pulling of levers and throwing of voices that hid his lonely, depleted self. And these levers and voices, which had been so powerful in organizing the relationship system, lose much of their power in the light of day. The emergence of Richard's material affects both the relationship and Beth's subjective world. Beth comments that she's not June Cleaver. It is not so much that she is instantaneously freed of the requirement that she be all things to all people in order to be loved at all, but that, in a kind of symmetry to Richard's revelations, her own invariant organizing principles can now be consciously expressed.

"No Person" Psychology: A Dynamic Systems View of Relationships 85 A question arises here about the involvement of the therapist in what amounts to a replay of a model scene from Richard's childhood. In the shifting intersubjective field created by this moment of systemic reorganization, Beth is both the abusive father and the betraying mother, and I am pulled into a vertigo-inducing triangle. How can I respond to Beth's need not to be enslaved by Richard's archaic material without betraying Richard and traumatically reenacting the model scene of his mother's betrayal? In responding first to Beth's "June Cleaver" dilemma, I was taking the risk of leaving Richard unprotected. Although there is often competition for the attention and selfobject functions of the therapist in conjoint sessions, the revelation of one partner's deep material in the holding environment of the session creates a mutually shared sense of amplitude. It's as if a rising selfobject tide lifts all boats, freeing each partner's subjective world from the ruthless influence of repetitive fears and traumas.

Session B Richard began by asserting that he did not want the relationship to go back to its old ways: Richard: I've been reading a book on happiness. It may be a simple book, but it said to me, if you want to be happy, you have to actively create happiness. That's what I want. Beth: That scares me, that really scares me. If you say you want to be content, OK. But happiness, that scares me. It's for twenty-year-olds, and I'm afraid if that's what you want, you're going to go find another twenty-year-old. Richard: I don't want that, I said I didn't. I just want to be affirmed. That would make me happy. Like, my stock, the one I picked without the broker, has gone up and up. I want you to notice that, to know what it means to me. I've picked so many losers. But this one I picked myself, and it has done really well. Beth: I don't know what I can say that I haven't already said. I told you I was happy for you. I can't keep coming up with new ways to say it. You want some kind of cheerleader. Maybe I'm just too introverted.

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Richard: It's not what you say. I just want you to notice, to ask how it did yesterday, to know what it means to me. David (to Richard): There's a plaintive note in your voice. I can almost imagine a whole well of loneliness and desperation behind your words. Richard (crying lightly): I'm thinking about this next-door neighbor when I was a kid. He didn't have a son, only two daughters, so he kind of took me under his wing. He taught me to fish, we used to go fishing together, I was fourteen, maybe fifteen. He also taught me to play chess. I used to play chess by mail. I would write, "I'm fourteen years old and live in Delaware." My neighbor taught me well enough to get to level D. But 1 could never get to Level C. There was no one to show me more. Beth: You've really done a lot on your own. Richard (coming out of his reverie): That seemed pretty tepid. Beth: I was trying. I told you, I don't know what to say all the time. David: I'm going to interrupt, because think there's an opportunity here. We're talking about happiness, and it's an important question. The thing I notice, though, is that once we started talking about what would make you happy, Richard, you got in touch with a deep sadness. Beth: The thing is I've tried to make him happy. Though he doesn't appreciate it, I've tried. David: I'm sure you have, but it probably wouldn't help. There's a difference between real happiness and the absence of pain. You can get rid of pain a number of ways, as you guys well know—you can find a woman to admire you, you can pour yourself a drink. We all want to be admired, myself included. But I think this admiration thing has a bit of an addictive quality for Richard: being admired would take the pain away, but maybe there would never be enough admiration to really make you happy. (Beth nods, Richard looks confused.) Richard: So what do I do? David: In a sense you're doing it right now. The room feels different when your sadness is in it. Perhaps a chance to talk about it with Beth will make you feel close in a way that all of her admiration never did.

Discussion The marital system itself begins to change as its unconscious origins are illuminated, in particular the way Beth has been held responsible for


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fixing Richard's pain. In this session, Richard is trying to reestablish the old relationship pattern—trying to convince Beth that, in the name of happiness, she should mirror his grandiosity. Beth—though she initially is struggling against the pull of Richard's demands and rightly identifies the danger they pose for the marriage—ends up in trying to provide the longed-for mirroring. The affair has perturbed her subjective organization, leaving her vulnerable to states of internal chaos. In response to this chaos, the old invariant organizing principles that tell her she should indeed be June Cleaver or she will not be loved at all exert a powerful pull. Beth's attempt at providing the affirmation follows the reemergence of Richard's oedipal themes. Once again the question of how Beth is going to "mother" the oedipally wounded boy-Richard is in the air. This time, Beth, rather than resisting, tries to provide the affirmation. Here we see the old system being reassembled, piece by piece. Richard's reply of "That's pretty tepid," however accurate, is an attempt to reestablish the old relationship system of blame and defensiveness. At this point I choose to interrupt the reestablishment of the old relationship system. My interpretation of Richard's longing for a mirroring response to his grandiosity is based on a distinction between two very different types of mirroring (Morrison and Stolorow, 1997). One seeks to reinforce "an emerging, long-sequestered expansiveness" (Orange, Atwood and Stolorow, 1997) and the other to effectively sanction the kind of defensive grandiosity functioning as "an antidote to an underlying sense of defectiveness. . . . Mirroring experiences foster integration and developmental transformation in the first case"; but only "addiction to the analyst's [or spouse's] 'responsiveness'" in the second (pp. 65-66, emphasis added). It is this understanding that informs the interpretation linking Richard's longing-for mirroring-as-antidote to other forms of addictive behavior in the relationship—Richard's affair and Beth's drinking. There is also a considerable amount of confrontation in this interpretation, confrontation aimed at disorganizing this addiction-based system. Richard's sincere question—"So what do I do?"—is a response to this confrontation. In reply I emphasize another sort of selfobject experience—one that is attuned to the underlying sadness, rather than the defensive grandiosity.

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Session C Richard (after a mostly discursive discussion of howT Richard could show Beth that he cares): Your face looks strained. Do you have a headache? Beth: I'm all right, I took some Advil. David: Did you feel that Richard showed caring when he asked about your headache? Beth: I never know if he cares, or if he's going to be critical or disappointed. Sometimes I feel he's just checking me out, to see if I'm depressed or angry, to see if he's going to get anything from me. Richard (looking angry): That's just complete BS. David: This is the way things have gone for years, isn't it? Beth doesn't trust Richard's caring, Richard takes that as a personal injury and gets angry, and then Beth goes, "Look how angry he is; I'm right, he doesn't care." But underneath, there are these worlds of pain—Beth's feeling of being unlovable and Richard's experience that he's always had to sing for his emotional supper. (They discuss this interpretation for a while.) David (to Richard): Is there any reason that Beth doesn't experience you as caring? Richard: Well I've been told that I come across as judgmental. (Beth nods.) David: Can you give me an example? Richard: For instance, when I get home and see a yellow envelope on the table. I say, "What's this, a parking ticket?" Beth: And I think, he's going to bite my head off. Richard: No, that's not it. I'm just trying to share a feeling, those damn meter maids: Parking Tickets. (Beth looks interested, if puzzled.) I just don't want to use canned ways to show I care. That's just death to me. David: Well, from now on, all you have to say is "parking tickets."

Discussion The key here is the interpretation that describes the old relational system and its defensive functions, both for Richard and for Beth. This interpretation is also confrontational, saying, in effect, do you really want to go back to that? In including Beth in the interpretation of the system,


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I am specifically confronting the "Richard as bad guy" theme that has predominated since the affair. Richard responds in a way that is uncharacteristically vulnerable, as well as lively. In his ironic comment "parking tickets" there is a nondefensive invitation for Beth to participate in his subjective world. Marital therapy works at the systems level when confrontational interpretations that attempt to perturb the stable defensive system are followed by attempts to foster moments of intersubjective conjunction. These moments of conjunction, in which longed-for developmental experiences are evoked, can serve as seeds around which a newT relationship system can grow. In general, all of these sessions expose the long-prevailing organization of the marital system around both partners' developmental traumas and respective defenses, and they come at a moment when a more stable system appears to be emerging from the chaos that followed the affair. Clearly the possibilities inchided the re-creation of the old relationship (an outcome that Beth in particular saw as concretizing her worst fears), the creation of a healthier relationship or an end to the marriage. A moment like this in marital therapy demonstrates the fluidity of intersubjective relationship systems.

THE THERAPIST AS PART OF THE SYSTEM The intersubjective field formed in conjoint treatment is composed of three subjectivities. As Trop (1994) points out: "The area of investigation of the therapist is the interaction between the subjective worlds of the two partners, as well as the meanings that occur at the interface of the interacting subjectivities of the therapist and each member of the couple" (p. 149). The move from the two-person relationship system to the three-person treatment context is rife with familial meanings. The act of coming for help from an "expert" at least potentially reorganizes the hierarchy in the marital system. One common outcome of the reorganization is that the partners become, in a sense, siblings looking to the parent-therapist to intervene. Certainly the therapist's provision of a holding environment and idealizable interpretations, as well as his attuned mirroring of each partner's affect, reinforce this configuration. The leveling between the partners can become a source of alterego experiences—"we're in this together," "we both have problems." It can also be a source of intense rivalry as the "siblings" compete for attention and vindication. The all-wise parent role is a trap for the

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therapist—it may lead him to feel that he should be "in charge" of the nonlinear and unpredictable process taking place in his office. And of course the therapist is also at the mercy of his own selfobject needs that can be poignantly evoked by the couple's longings, sexuality, affection or anger. The triangular nature of the couples therapy situation invokes oedipal transferences and countertransferences. As Frank (1997) points out in a useful chapter entitled "Oedipal Countertransference in Marital Therapy," "Too often marital therapists fail to explore oedipal issues," such as "sexual identity, murderous aggression, incest, guilt, and obsession with triangular entanglements" (p. 88). These issues and their attendant affects can serve as powerful organizers of the treatment system. As Frank points out, a less obvious aspect is the countertransference situation in which the therapist is the child, gazing at the primal scene of his parents' intimacy: "it's as if the therapist is suddenly being born into a preexisting structure, within which communication codes and private cues abound" (p. 90). In this situation the therapist's own sense of helplessness may be defended against by grandiosity. At the very least, most marital therapies are organized to some degree by oedipally themed feelings, be they rivalry or identification with the samesex partner or seductiveness or repulsion toward the opposite-sex partner. In this regard it is worth looking at my own countertransference to tire manifest oedipal material that Beth and Richard presented. In the session in which Richard transferentially accused Beth of not protecting him from his father, my immediate response was to protect Beth, a response organized to some degree by the strong ties I had to both my mother and my aunt, who lived in our family. Was Richard's response, "I don't want to make her depressed," influenced by my countertransference (e.g. I'm protecting Beth and you should be also)? Perhaps. It was a developmental step for Richard to assert his need for protection from Beth, rather than repeat the oedipally themed acting out of the affair. Richard's wink at me when he first mentioned the affair, as well as his plea to be protected from his abusive father, carry a request that I be a different kind of father to him, a source of idealizable protection and mirroring of his developing manhood (Kohut, 1977). My reconnecting with Richard after talking to Beth about her "June Cleaver" organizing principles was a shift in my countertransference, undoubtedly influenced by remembering my own longing for such responses from my workaholic father. Systemically, this vignette shows three subjective worlds all to some extent


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knocked free from their usual organizations, all with the potential to reorganize along development enhancing lines. Siegel (1997) classifies countertransference in couples therapy into three orientations: the classical, in which the therapist's reactions are an obstacle to understanding the couple's dynamics; the totalist, which sees countertransference as a source of important information, primarily through projective identification, about the couple's unconscious dynamics; and the postmodern or constructivist, in which there is no objective view of the couple and the therapist's subjective reactions are an intrinsic part of the intersubjective field created by the treatment. The fact that the last is the view that informs this book doesn't preclude the possibility that the therapist's reactions to the couple might either obscure or contribute to his understanding. A view of countertransference in couples therapy as what Trop calls "the unconscious organizing principles that shape the therapist's experience in relationship to the couple and to each partner" (1997, p. 99) opens to multidimensional understanding the ways the therapist's subjective experience can help or hinder the treatment. Obviously, a profound intersubjective disjunction (Atwood and Stolorow, 1984) between the therapist and the couple is a potential problem. But a conjunction, in which "the patient's experience gives rise to expressions that are assimilated into closely similar central configurations in the psychological life of the analyst" (p. 47) can be equally problematic. In a case reported by Trop (1997), the way the husband's attitude toward work so closely matched his own unconsciously organized beliefs created an impediment to empathy with the wife, and led him to assimilate the husband's point of view as healthy and normal. Once he became aware of this conjunction, however, he was able to use the similarity of their organizing principles as a renewed source of therapeutic energy. One important aspect of the therapist's subjectivity is his own sense of the proper balance between self and mutual regulation. Is there a couplestherapist bias in favor of mutual regulation?'4 In and of itself the therapist's sense of self and mutual regulation, expressed through his own vocal matching, perturbs the existing pattern in ways that most often remain out of conscious awareness.

"At a recent self psychology conference, Lichtenberg (1999), in discussing infants who closely track their mother's affects, made the comment "We recruit a lot of therapists from that category."

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In general, the therapist's own unconscious organizing principles about relationships, shaped by his experience of his own parents' relationship, is a powerful influence on the treatment system. The therapist whose parents divorced or were on the brink of divorce may have strong beliefs about keeping couples together, while those who experienced their parents' relationship as stifling or abusive may be more inclined to sponsor separation. I define my goal as strengthening the marriage, a goal that in part might well be rooted in my own subjective experience. Nonetheless, the goal of the intersubjectively informed therapist is not to strive for neutrality but to be aware of the contribution his or her own unconscious organizing principles make to the intersubjective field of marital treatment. With this discussion of the systems level of intimate relationships, we have concluded our theoretical overview of relationship dynamics. The model we have described is a dynamic one, in which each partner's subjective world is constantly shifting between hope that the relationship will organize his or her inner life in a way that provides stability, coherence and new possibilities and fear that the relationship will bring pain, chaos and the foreclosing of possibilities. This is an open-ended process model in which relationship patterns, no matter how stuck or inevitable they appear, are nothing more than attractor states-—rest stops on the ongoing highway of human development. Succeeding chapters will focus on particular clinical issues and approaches to treatment, beginning with the empathic introspective listening stance in the next chapter.

CHAPTER 6

The I in the Thou: The Empathic/Introspective Mode of Listening

The first task in couples therapy is a thorough investigation of each partner's experience of the relationship. This is not only necessary for assessment; it is in itself a powerful therapeutic intervention. It slows the couple down, interrupting the ongoing enactments; it models for the couple the therapist's conviction that each partner's subjective experience is unique and valid, that there can be room in a relationship for differing realities. And most important, it provides each partner with vital mirroring and selfdelineating selfobject experiences that create a context where openness can begin to replace rigidity. Intersubjectivity theory and self psychology provide a listening stance that is invaluable to this task. The method of listening, called variously vicarious introspection (Kohut, 1959), empathic immersion (Kohut, 1971), sustained empathic inquiry (Stolorow, Brandchaft and Atwood, 1987) and empathic introspection (Stolorow and Atwood, 1992), involves the investigation of each partner's experience from "within, rather than outside of, the person's subjective frame of reference" (Stolorow, Brandchaft and Atwood, 1987, p. 15). This chapter will be concerned with the kind of empathy that Kohut (1982) defined as a "mode of observation attuned to the inner life of man" (p. 396). As Stolorow (1994) points out, Kohut used the term in a number of 93

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ways, including the sense of empathy as a "powerful emotional bond," whose "mere presence has a powerful therapeutic effect—both in the clinical setting and in human life in general" (p. 397). The mutative power of empathy is addressed in the next chapter. We will begin here by discussing the empathic/introspective listening stance.

THE EMPATHIC /INTROSPECTIVE METHOD Heinz Kohut (1984) gets at the essence of the empathic/introspective listening perspective when he reflects: If there is one lesson I have learned during my life as an analyst, it is the lesson that what my patients tell me is likely to be true—that many times when I believed that I was right and my patients were wrong, it turned out, though often only after a prolonged search, that my Tightness was superficial, whereas their lightness was profound (pp. 93-94). The self-psychologically and intersubjectively informed therapist privileges the patient's perspective and experience over the therapist's theories and beliefs, but he must also notice the inevitable way those theories and beliefs contribute to his own understanding. The profundity that Kohut found in his patients' statements "after a prolonged search" derived not from accepting the literal correctness of what they said, but rather from a deep exploration of all of the contexts, conscious and unconscious, present and historical, that gave rise to them, i.e., from empathic immersion.

INTROSPECTION Atwood and Stolorow trace the origin of their listening perspective back to the German philosopher Wilhelm Dilthey's belief that the methodology of the "human sciences" involved "the rediscovery of the I in the Thou" (1926, p. 191, quoted in Atwood and Stolorow, 1984, p. 3). Thus, "the investigator can, indeed must draw on his own experiences and self knowledge to guide interpretation of the lives of those he studies" (1984, p. 3). The act of listening to a patient requires that the therapist try to suspend his own beliefs, theories and experiences and imagine his way into the patient's experience, while at the same time noticing the way his beliefs, theories and personal experience are organizing his understanding of the patient's statements. It is as

The I in the Thou: The Empathicjlntrospective Mode of Listening

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though the patient plucks the strings and the notes are given shape through the "sounding board" of the therapist's introspection. For the couples therapist in particular, a thoroughly developed awareness of the role of his narcissistic vulnerability and the invariant organizing principles that govern his own relationship experience is crucial to apprehending the experience of each partner. In one example, a man long ambivalent about commitment proposed to his girlfriend that they move in together. When she hesitated, citing how much she liked her present apartment and how tight the rental market was, he grew cold and withdrawn, convinced that her affection was a sham and that he would have to prepare himself to live a life alone—the fate he had always anticipated. The therapist's first reaction was distress at the magnitude of the patient's apparent overreaction, mixed with temptation to view it through the lens of individual pathology, as evidence of narcissistic, schizoid or even borderline tendencies. The empathic/introspective stance, however, mandates an attempt to examine the reaction from inside the patient's perspective and then an effort to process it through the therapist's own experience. In terms of the former, the therapist realizes that it has taken the patient a lot of therapy and over a year of struggle even to risk making the overture to his girlfriend, and that, understood in the context of the patient's history of a highly narcissistic mother who would usurp his childhood excitement and take it as her own, showing any expansive affects at all is a huge gamble. On the introspection side, the therapist searching for an analogue in his own experience remembers times when he risked unselfconscious exuberance and was flooded with shame when he perceived that others disapproved. He further remembers the pervasive negative beliefs that shame can create. These analogies serve as empathic bridges to the patient. We will discuss this case in greater detail in Chapter 8.

BEGINNING THE INVESTIGATION Couples enter treatment in a variety of emotional states, with differing needs and goals; almost universally, however, there is a considerable amount of anxiety in the room during a first interview. It may stem from a crisis that has destabilized the marital system and affected the partners' sense of self. Even if the couple does not come in crisis, the very act of starting therapy causes one or both partners to examine issues in the relationship that they have consciously or unconsciously been avoiding. And each part-

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ner enters the room with the hope of being understood, protected and vindicated, while at the same time fearing that he or she will be misunderstood or exposed to criticism and shame. The therapist is not immune from the power of this anxiety. Many times it is experienced as a pull to arbitrate a conflict or to provide a quick fix. One way to understand this pull is to see it as a longing for an idealizable selfobject experience. The anxious couple longs for a soothing connection to the therapist's strength and wisdom. If the presenting problem involves a recent trauma or a traumatic de-idealization (Kohut, 1971, 1977) in which revelation of a secret, such as an affair, has led to the offending partner's no longer being experienced as idealizable source of soothing understanding or power, the longing may be intensified. From the empathic/introspective viewpoint, the pull to provide solutions for the couple is a source of insight into the selfobject dimension of their experience: what they want from you is probably what they are missing from each other. However, the therapist may be countertransferentially pulled to meet their needs for quick solutions—both from desire to help and as a defense against the destabilizing effect on his own self state of the couple's overpowering selfobject longings and anxiety. In the latter case, this can produce in the therapist a form of defensive grandiosity: he will begin acting as if he understood the couple and knows what they need to do to improve their marriage before he has really immersed himself in their experience. This particular kind of countertransference is best contained, or at least interpreted, with a comment such as "I can feel how much you need immediate help." It is better to respond to the pull for an idealizable selfobject with empathy, rather than provision. A commitment to begin empathic/introspective investigation of each partner's experience in the relationship as soon as possible helps to contain the unrealistic expectations of the couple as well as to frame the therapy process as a collaborative exploration. Further, the therapist's vulnerability in exposing the fact that he or she does not yet understand the couple or know what they should do encourages the partners to allow themselves to be vulnerable.

OBSTACLES TO EMPATHIC INTROSPECTION IN COUPLES THERAPY Given the complex field of differing subjectivities (including the therapist's own) in the room during a conjoint session, the prospect of entering

The I in the Thou: The Empathicflntrospecthv Mode of Listening deeply into one partner's experience presents all kinds of challenges, both theoretical and pragmatic, for the therapist. Indeed, the daunting prospect of working deeply with more than one person at a time leads many couples therapists to stick to communication or behavioral models. It is also one that convinces many therapists that couples work is not for them. The following discussion describes some of the commonly encountered obstacles, as well as ways to overcome them. • The therapist may fear that offering empathic understanding of one partner will appear to be condoning perceptions or reactions that seem to him to be unfair or distorted. An example is the vignette above, in which the husband reacts so powerfully to the wife's mere hesitation. The concerns here are both epistemological and practical. As to the former, Stolorow and his colleagues argue eloquently against a "God's eye" objectivist stance of the therapist. They maintain that at all times the therapist's own subjectivity contributes to the field being observed. The therapist's stance as an objective observer only obscures the central task of the therapy: to investigate each partner's subjective experience of the relationship and to enhance each partner's subjective experience of satisfaction and connection. At the same time, a more practical question arises to the problem of confronting a partner with the interpretation that his perceptions are incorrect. As we will see in the next chapter, the overall goal of couples therapy is to bring to both partners' awareness and conscious control the way their unconscious organizing activity contributes to their perceptions of and reactions to their partner, and thus to the outcome of the relationship. In this context, each partner's perceptions become something to be explored, rather than corrected. The therapist must educate each partner that his or her perceptions in a relationship are an admixture of present and past. A commitment by the therapist to explore each partner's subjectivity, without judgment, leads to a lowering of defenses. A commitment to "truth" about a relationship will likely have the exact opposite effect: it will contribute to the partners' defensive rigidity and leave the unconscious origins of their perceptions even less available for exploration. Most couples have already communicated to each other their belief that the other

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partner's view is completely wrong. If this had been enough to alter those views, they would not be seeking treatment. • He may have the related fear that a nonjudgmental exploration of one partner's experience will seem to condone that partner's reactivity or acting out. This issue cuts to the heart of a common misunderstanding or misuse of empathy: is it empathic to condone a patient's acting out? Critics of self psychology frequently argue that a stance of empathic/ introspection precludes confrontation. Kohut's extraordinary words to an analysand who had been ticketed for speeding yet again demonstrate otherwise: I said to him in seeming utter seriousness that I was going to give to him the deepest interpretation he had so far received in his analysis. I could see his utter surprise at this announcement; it was totally different than anything I had said to him before. Then, after a few seconds of silence, 1 said very firmly and with total seriousness: "You are a complete idiot." There was another second of so of silence and then the patient burst into a warm and friendly laughter and relaxed visibly on the couch. I then spoke to him for a couple of minutes, expressing my concern about certain aspects of his behavior, especially his potentially destructive and self-destructive outbursts of reckless driving, but also about other forms of tantrum-like behavior, including aggressive behavior at his place of work, when dealing with unresponsive salespeople, and the like. I ended by saying that we of course needed to understand what in his past, and, in particular, what in his childhood had made him so vulnerable in certain situations and led him to respond as he did, but that first things came first: if he killed or injured himself in an accident, we certainly could not analyze his motivations (1984, pp. 74-75). In couples therapy the dilemma of needing to save the acting-out patient from himself is compounded by several factors: the need to protect the other partner from the effects of the acting out; the fact that the line between acting out and expression is highly subjective, so there are likely to be three differing views in the room of where the line is; the problem that containing one partner's acting out can appear to be taking the other partner's side. The solution in each instance resides in maintaining, rather than abandoning, the empathic stance. Tantruming, blaming and other abusive behaviors are inherently selfdefeating. They are attempts to restore a sense of power and initiative to a vulnerable self (Kohut, 1985; Shaddock, 1998). Setting clear limits about what is permissible can be experienced by both partners as a safety-

The I in the Thou: The Empathicjlntrospective Mode of Listening providing idealizable selfobject experience. Saying to one partner "I will do everything I can to understand the source of your anger, but the way you are expressing it is only pushing me and your partner further away" can be experienced as a highly empathic intervention. Any parent recognizes the world of difference between being steadily empathic to a child and condoning his every behavior. The parent says, in effect, I know that you, being a child, are prone to behaviors that are not all right, and I'm going to intervene to control those behaviors. Children perceive limits as empathic; they feel secure in the presence of an idealizable selfobject who will contain them. Discipline that withdraws empathy, however, produces feelings of shame and rejection that are likely to exacerbate the problem. Acting out of all sorts—and narcissistic rage in particular—has its origin in the loss of an empathic connection. It is important to say to a couple, that, in the name of safety, you will act to contain hurtful behaviors, while at the same time you will do everything you can to understand the context that gives rise to those behaviors. • The therapist may also fear that the empathic exploration will lead to the patient's perceptions becoming more entrenched, to the detriment of the relationship. This issue also raises questions allied to the first two. At least initially, the partner on the receiving end of the empathy may feel vindicated. But couples therapy, as opposed to individual therapy, works systemically. The sense of vindication is tempered almost immediately as the therapist offers the same sort of understanding to the other partner. Primitive wishes to retaliate against selfobject disappointments by annihilating the offending partner will not flourish in an atmosphere where both partners can be "right." In couples where one partner is more narcissistically vulnerable (Solomon, 1989) or archaically organized, the therapist's empathy provides an important "holding" function (Winnicott, 1965; Siegel, 1992) by containing his reactivity. The other partner is often quite relieved to see the therapist providing this holding. It can free her from being vigilant or defensive, and, in turn, make room for positive, selfobject experiences to take place in other, less controversial areas. But the deeper question here is what leads to a patient's views of his partner to be "entrenched" and what leads to the ability to forgive old injuries and allow new positive experiences? Although the tenacity with which one partner holds to a belief in his own righrness or his

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partner's wrongness may look like blind confidence, it usually masks a shaky conviction as to the validity of his or her subjective experience. Again this is a systemic issue. The stubborn bitterness that can characterize so much couples process comes from two basic selfobject needs canceling each other. Each person wants a self-delineating selfobject experience that confirms his or her thoughts and feelings, and each person wants acknowledgment of his or her injuries. The therapist's providing one partner with these selfobject experiences perturbs the system, creating the possibility that it will reorganize along less competitive lines. • The therapist may be concerned that offering this empathy to one partner will be at the expense of the other. If the couple perceived that there was enough empathy to go around, they probably wouldn't be in treatment. The therapist must maintain a balance by moving back and forth between the partners, which can be difficult when both partners are volatile or if one partner is particularly needy or willing to engage at a deep level. It can be a mistake to be too scrupulous about parity, however. It is critically important to remember that empathy is an investigative tool. It is not the same as sympathy. The therapist's commitment to the propositions that all understanding will advance the collective cause and that all attention will balance out in the end sends a message that helps relax the relentless competition and counteract their tendency to "bean count." The other side of the coin is that working with one partner may convey the notion that he or she is the problem. This is especially true if an issue arises that takes many sessions to explore. It is important to inquire how each partner views the fact that one partner is receiving a lot of the focus. • The therapist may countertransferentially resist immersion in one partner's experience in defense of a walled-off or uncomfortable part of his oivn experience. An example would be the case of Jeff Trap's (1997) cited in the last chapter when he failed to question the husband's devotion to work because it so closely matched the therapist's own defensive organization. As Solomon (1997) points out, to immerse oneself in the inner life of a couple is to be flooded not only with lustful erotic feelings but also with feelings of both partners' maternal erotic transference, 1 "the urgent desire for actual bodily contact—a desire for !

One patient used the highly evocative phrase "skin hunger" to describe this transference.


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maternal enveloping along with a terror of being lost, engulfed, or smothered" (p. 139). If a therapist is uncomfortable with the highly charged issues the couple's erotic life evokes, he or she may be unable to acknowledge or convey a level of comfort, interest and acceptance with what is occurring in the relationship, or between one of the partners and the therapist.

CASE EXAMPLE A consultation done with a couple who are in ongoing treatment with another therapist will illustrate application of the empathic/ introspective method. I have here included some comments about my process to better illustrate the empathic/introspective listening stance. Terrence and Lynn are both 32 years old. Both are psychologists. They met working at a university counseling center. They have been married for two years and have two children, a three-and-a-half-year-old daughter from Lynn's previous marriage and a six-month-old boy. Terrence and Lynn see each other as "best friends," but both have come to feel that something is lacking in their relationship: Terrence complains that Lynn is too closed, especially to deeper psychological issues; Lynn, who claims that she doesn't know what he's after, says that he is too often critical or withdrawn. The most important event in Terrence's childhood was his parents' divorce, which occurred when he was five. His father, who had been the more physically affectionate of the parents, left the area, and Terrence tried desperately, and unsuccessfully, throughout his youth to get close to him. After the divorce his mother grew ever more rigid, becoming a devout and fundamentalist Catholic who would only relate to Terrence through dry Biblical homilies. She once sent him a letter listing ten Biblical reasons why he should treat her better. Lynn grew u p in an Anglo / Latino family. Her father was a highly successful physician, outgoing and charming—but also an alcoholic. As a young child, Lynn had idealized him, but as a young adult she confronted him about his drinking, bringing about a chilling in their relationship. Lynn describes her mother, who, like Terrence's, is a devout Catholic, as being highly controlling of her daughter, but not in control of her own emotions. When the couple first entered the consulting room, I was struck more by Terrence than by Lynn, who was attractive and warm, if slightly

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prim. Terrence was thin, almost gaunt, and wore a short beard. He had piercing blue eyes and projected both vigilance and withdrawal; I noticed my anxiety increase—would he be a kind of "black hole," absorbing all of my effort and energy and disappearing with it? I wondered if Lynn shared that anxiety. A series of initial questions identified the presenting problems as Terrence's dissatisfaction with Lynn's degree of openness and Lynn's perception of Terrence as critical and withdrawn. I consciously, and perhaps counter-phobically, chose to begin by exploring Terrence's experience, knowing that if I could not allay my anxiety about him I would not be able to listen well. David: Lynn complains that you are too withdrawn. How do you see it? Terrence: Well I've kind of given up. I've tried hard to get her to relate to me, but she just won't open up much anymore. Either that or she just takes out her frustration on me. David: I notice that you said "anymore." Did she used to relate to you? Terrence: Well, when we first met, she was willing to reassure me when I'd get insecure or something. You see, because of my background—my parents broke up when I was five, and my father rejected me—I have a terrible fear of being left. I'd get so jealous of Lynn's friends, especially if it was a guy, but women also, and I'd imagine all sorts of things. But Lynn was great; she would reassure me that it was all in my mind. David: That must have felt very good, that reassurance. Terrence: It did, it felt great; no one had ever offered me anything like that before. But lately, she has refused to give it; she just makes me feel like I'm bugging her, like I've burned her out or something. This short dialogue with Terrence had already brought up one of the chief difficulties in staying immersed in one partner's experience: it is very easy to get pulled into imagining the other partner's experience. After all, I was to some extent in Lynn's shoes, responding to Terrence's answers. I found myself wondering what must his obsessive jealousy be like for Lynn? And what must it be like to be required to offer reassurance any time Terrence needed it? These thoughts offered important


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insights into Lynn's experience, but they were an obstacle to empathy with Terrence. Terrence was describing his experience of that critical shift in all relationships from the selfobject to the repetitive mode, critical particularly in the case of a partner who, like Terrence, has a history of abandonment. David: I think what you are telling me about is a shift in your perception of Lynn from someone who seemed reassuring to someone who is angry and critical. How do you understand that shift? Terrence: It's not just the reassurance I miss. It's more that when we would get into discussions about my feeling threatened, Lynn would be open, we'd go deep, our talks would be deep. But now I can't seem to get her to go there. David: So it wasn't just her saying that she wasn't interested in someone else; it was the way those interchanges led Lynn to open up that was reassuring. Terrence: That's right. It's not that I still need that much reassurance. I've kind of gotten used to doing without that. I just wish that Lynn wouldn't be so superficial. Although Terrence archaically experiences Lynn's having other friends as a repetition of his father's abandonment, the context for his experience is his sense of Lynn's varying availability to intersubjective relatedness. The emergence later in the session of Terrence's mother's flat response to his emotional needs adds another context to my understanding of the repetitive meanings he assigns to his experience of Lynn's being closed or superficial. David: I think I'm beginning to catch on to what you're so frustrated about. You don't see any way to get the openness you long for, and so you alternate between criticizing and withdrawing from Lynn. Let's assume the withdrawal comes from some need to protect yourself, or some sense that connection is just hopeless. I wonder if the criticizing mightn't be, as it often is in other couples, a way to get some kind of response from Lynn, some element of the connection you're after? Terrence: Maybe so. I just want to have some meaningful communication.

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The empathy I had gained toward Terrence had already altered the three-person system. With Terrence seeming less of a threat, I was ready to shift my attention to Lynn, who seemed eager to talk. David: Tell me what's been going on for you in the relationship. Lynn: I just get so tired of his silences. They feel so punishing, (starting to cry) 1 feel him just looking at me. I start to feel so inadequate. I just don't know what he needs from me anymore. I must admit, lately I've kind of given up trying. I feel really bad about it but a part of me has kind of given up. David: I hear two things—that Terrence's withdrawals are really painful for you, and also that you feel guilty for having given up trying to take care of him. Lynn: I do feel guilty, but lately I've been really angry too. I now found myself caught in the middle between my two patients' competing needs—the prototypical situation discussed above as an obstacle to empathy. How could there be enough empathy to go around? On the one hand there was the extent of Terrence's need for Lynn's attention, how like a young child's that need was. And on the other, how hollow and battered Lynn felt, with two little children, one still a baby. I felt pulled into the despair of this impasse. Again the way out of this countertransference bind is to remember that empathy is a mode of investigation. In this case, the task was to find out more about Lynn's experience. David: I'm starting to understand how hopeless everything has come to feel for both of you. It just feels in the room that there is not enough to go around. But I want to get back to Lynn a bit more. I want to try and understand her feelings better. Especially the two feelings you told me about, your guilt and your anger. Is there a connection between the two? Lynn: Do you mean do I get angry because he makes me feel guilty? I never thought of it that way. Mostly I get angry because he's so withdrawn. I hate it when he's like that. David: Do you think he's punishing you for not meeting his needs? Lynn (thinking): Yeah maybe. I would really like to help him. I just don't know how to anymore.

The I in the Thou: The Empathicjlntrospective Mode of Listening 105 David: I wonder about this anger. I think you feel bad about having it. But I wonder if it's trying to tell you something. I have a feeling that the anger is a very important part of you. (Lynn looks very surprised.) David: Have you had to take care of people a lot in your life? Lynn: Yeah. David: Do you think that some of your anger is left over from childhood? (Lynn nods, interested.) David: One way to look at relationships is that they give you a second chance to get it right. I think your anger is trying to help you set a limit as to how much of someone else's feelings you have to feel, or how much of their stuff you have to take on. in this relationship, at first you were glad to reassure Terrence; you genuinely care for him, and, besides, the role was familiar. Eventually, though, his need for reassuring began to seem bottomless. Especially with two children to take care of. But since you didn't feel that you had a right to say no to him, you grew more and more angry and confused. And that's when Terrence got so critical and withdrawn. Lynn: That feels right. My expectations that the exploration of this couple's mutually exclusive needs—Terrence's for reassurance that Lynn would never abandon him and Lynn's to be bounded by and grounded in her own volition— would only escalate the conflict proved unfounded. I discovered that in fact Lynn and Terrence were both listening avidly, waiting to see what would happen next. Terrence (after a long silence): The thing is, I don't care so much about the reassurance anymore. I've been handling myself without it. What I can't stand is how we can't seem to get past superficial tilings. David: The most profound thing that's going on for Lynn right now is that she doesn't want to feel obligated to take care of you. And the reason she's what you call closed is because she feels too guilty to say that. (Terrence is quiet, very attentive. There is a long silence.) Lynn (crying softly): I do still love you.

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Discussion This case example vividly illustrates both the contextuality of each partner's organization of the relationship and the power of the empathic/introspective method to alter that context. A non-intersubjective assessment of this couple would have emphasized the primitive nature of Terrence's selfobject needs, as well as the possibility that Lynn, by projecting her own desperation onto Terrence, was defensively masking her own archaic longings. One consequence of this "isolated mind" view would be that the therapist would see only pathology in the room, rather than a complex three-person field of intersubjective relations that was in part organized by his own theory-based expectations. Of course, Terrence's history of abandonment by his father and emotional isolation from his mother plays a constitutive part in his experience of Lynn. But the present context—her recent withdrawal from intersubjective relatedness—is equally significant. And Lynn's withdrawal is itself a reaction to Terrence's defensive withdrawal. As so often happens, the predominance of primitive, repetitive themes in one partner (such as Terrence's fear of abandonment) leads to a similar response from the other (Lynn's shutting down). Thus archaic experience comes to be predictive. My entrance into this repetitive system offers the potential for altering it. By both experiencing the hopelessness of the system and committing to a nonjudgmental, empathic/introspective investigation of each partner's experience, I almost immediately changed the feeling in the room, including my own. The crucial point is that careful investigation of each partner's experience is a systemic intervention. Just as the predominance of one partner's repetitive organization of the relationship is multiplied systemically, so a profound selfobject experience, such as being deeply understood in conjoint treatment, can initiate a positive spiral. Mirroring Terrence's longing for contact and his fear of abandonment, and facilitating delineation of Lynn's anger and need for boundaries supplied longed-for and developmentally enhancing selfobject experiences for both of them. In the context of these selfobject experiences, Terrence's self organization shifted rapidly. From an almost ghostlike presence, he became an active participant. Still more significantly, he renounced his archaic

The I in the Thou: The Empathicflntrospecthv Mode of Listening 107 need for reassurance in favor of a more mature yearning for intersubjective relatedness. He was able to hear and accept Lynn's different subjective experience—her wish to not have to take care of him. At the same time, Lynn's self-organization shifted from a diffuse sense of anger and guilt to one that is more firmly grounded in her own feelings and desires. Once this more solidly bounded sense of self was achieved, she was able to move toward Terrence with more caring. The key to understanding these shifts is understanding that the same factors that potentiate one partner's repetitive experience can work the other way around. An intersubjective field characterized by empathy becomes a context for both partners to feel renewed hope and interest in the relationship.


CHAPTER 7


An intersubjective approach to couples treatment is by no means limited to any one modality, although empathic/introspective listening remains its core. The intersubjective approach emphasizes "practical reasoning" (Orange, Atwood and Stolorow, 1997) over any specific technique: "each analytic intersubjective field will develop its own process and change its own procedures as needed" (p. 24). An intersubjectively informed couples therapy will not proceed toward a specific set of goals, nor will it necessarily employ any specific techniques such as mirroring exercises, dialogues, directives or homework, though none of these is proscribed. The commitment is to investigate the meaning and effect of the therapist's activities, to identify which of those activities facilitate an enhanced sense of relationship satisfaction. It is particularly important to investigate therapists' actions that create a sense of blame or shame, because these often trigger a shift back toward defensive relationship configurations. Ironically, this can take place in communication models, where the partners are instructed to use "I" statements instead of blaming. Interrupting a statement to encourage a different sentence construction can feel to some patients as a discounting of what they are trying to say. Many otherwise useful approaches to couples therapy suffer from unexamined assumptions that fail to take into consideration the unique and differing responses the couple or either of the partners may have 109

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to the therapist's interpretations, suggestions or even innocuous comments. One important corollary to the freedom from specific technique in the intersubjective approach is that the therapist need not know what is right for a couple at any particular time. Indeed, relieved of the burden to know, the therapist is better able to listen and try and make sense of the aspirations and disappointments of the particular couple, with an eye for discovering how he can enter the existing system in a helpful way. Similarly, a contextualist view of couples therapy limits any notion of cure or success to what is created by the particular intersubjective triad at a particular moment in time. The therapist's assumptions about the couple's developmental level, invariant organizing activity or narcissistic vulnerability are an important part of the context in which a decision about the course of couples treatment is made. But these factors must remain one consideration among many. Although the therapist may hope for a fundamental or characterological change, couples may want a briefer, more focused treatment. Again, the systemic nature of couples treatment makes it impossible to predict at what point the system will shift and how stable the new organization will be. A disagreement between the partners or between the couple and the therapist as to when to terminate treatment may be an opportunity to express new health in the relationship in the form of increased ability to tolerate differing subjective views. Conversely, the context of societal, familial or personal expectations of what is "right" in a relationship may be part of the couple's problem.

FOCUS AREAS With these general thoughts in mind, let us turn to a more particular description of the process and goals of intersubjective couple therapy. We will discuss six general areas for the therapist to focus on—not a set of rigid procedures that take place in order, but themes that can be woven into the ongoing treatment: • creating trust, • fostering the capacity for introspection, • making system interpretations, • strengthening the holding environment, • directly creating development-enhancing experiences, • strengthening attachment.


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Creating Trust. The approach described in Chapter 6, whereby the therapist begins with a careful examination of each partner's subjective experience, goes a long way toward establishing trust. The message, conveyed both explicitly and implicitly, is that no one is to blame here, we are just trying to understand what has happened in this relationship. Beyond that, trust is created by careful exploration of each partner's experience of the therapist. Sometimes that can entail a review/recognition of where some failure on the part of the therapist threatened his bond with one or the other member of a couple. In such instances, the reparative process actually gives birth to trust of a greater magnitude than what was lost. For example, in a session near the beginning of treatment, the husband, Max, poignantly described the level of abandonment he'd felt growing up with an alcoholic mother. When he reported that, after a life-threatening motorcycle accident landed him in the hospital for a month, his parents barely phoned him. I observed, "In light of all this, it must be extraordinarily painful when your wife isn't there for you." His wife, Andrea, seized on the story, claiming that it explained his constant criticism of her for not being more present in the relationship. Max came into the next session very subdued. I sought to understand his affect in terms not only of what had happened in the relationship but also of the patient/therapist transference. After some discussion of the previous week's session, 1 understood that I had neglected to protect Max from Andrea's blame, and that Max experienced that oversight as a profound selfobject failure. I had completely missed the way Andrea's comment retraumatized him. The interchange in the preceding session repeated the childhood situation in which Max's father did not intervene to protect him from the effects of his mother's alcoholism. Once the issues were uncovered, Max expressed renewed hope in the therapy. Incidents like this one, recurring throughout the course of therapy, are the building blocks of trust. Fostering Self-Reflection. The capacity for self-reflection enables the patient to "recognize the patterns inherent in the mobilization of old, constricting organizing principles and their relational foundation" (Trop, 1994, p. 150). However, there is often resistance by one or both of the partners to this kind of self-reflection: they may fear that the material will be used against them, as in the case of Max and Andrea; the exploration may lead to walled-off areas of painful childhood experience; or the couple may feel that the therapist's job is simply to fix the relationship rather than examine their psyches.

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Educating the couple about the ubiquitous influence of transference and unconscious organizing principles can go a long way toward lowering the resistance. Relationships make us all crazy. The point of looking at your own part in creating or sustaining a relationship problem is to discover the one place you have some control. There are two areas in which increased self-awareness is enormously helpful to the course of therapy: awareness of the part that each partner's own organizing principles play in his or her experience of the relationship; and an awareness of the way these organizing principles and the actions they engender affect the outcome of the relationship. Many patients inherently resist interpretations that emphasize the unconscious factors that influence their perceptions. To these patients, such interpretations sound like accusations that they are paranoid or crazy. It is therefore incumbent on the therapist to focus not on the objectivity of a particular partner's observations (who said what, who did what) but on the meaning that they hold for the patient and on the affect they engender. I sometimes explain to couples that the mind makes these meanings by matching current events to previous patterns, and that one common source for the matching patterns is childhood experience. Kohut's (1984) conception of therapy occurring in two phases, understanding and explaining, is useful in fostering each partner's self-reflection. In the first phase, the therapist tries to understand the way each partner feels about the relationship and how these feelings are influenced by their histories. This is best accomplished through the empathic/introspective exploration discussed in Chapter 6. Once each partner develops an understanding that his or her experiences of the other partner are highly subjective, and are likely to be influenced by unconsciously held beliefs and expectations, the therapist can begin to explain that the attitudes and reactions that derive from those beliefs and expectations have a powerful effect on the other partner. Invariant organizing principles function like self-fulfilling prophecies, producing the very reactions the person most dreads. The hypervigiiant partner who fears abandonment drives a spouse away; the partner who passive-aggressively resists intrusion creates a partner who is so lonely that she is constantly after him. Partners' levels of readiness to address developmental issues often coincide or parallel each other (Dicks, 1967; Siegel, 1992; Solomon, 1989). When one partner begins to work on childhood-derived organizing principles and analogous issues arise for the other, the therapist should recognize a cue to


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intervene, to frame the situation as an opportunity for each partner to support the other in breaking a personal cycle. For example, one couple entered treatment after the wife's career necessitated a relocation. The husband was outwardly supportive and pleased for his wife, but as his own career suffered in the relocation, he grew withdrawn and bitter. In the course of treatment, the husband began to feel that his wife, a beautiful and highly competent woman, was indifferent to his sad, depleted affect states. Furthermore, the patient came to see a strong similarity between her lack of responsiveness and that of his prim, devoutly religious and rather depressed mother, who was outwardly very different. This correspondence led to the unfolding of a subjective world in which the patient's attempts to be nice and compliant in relationships masked a chronic state of despair and anger that anyone would ever meet his needs, and more profoundly, a pathological belief that he was worthless and would never amount to anything. The therapist interpreted the husband's reactive depression in the context of the relocation and the wife's preoccupation with her career as an opportunity for him to test the validity of those organizing principles: "As a child, you knew no other way to engage your mother except to be nice and compliant. The challenge in your marriage is to find an affirmative way to get your wife to be more tuned in to your needs and feelings, attuned to you." The husband was able to see that his core sense of his own worthlessness led him to withdraw when he was disappointed, defensively push his wife away and foreclose any possibility of attunement by hiding his true needs and feelings. As he explored these issues in therapy, his behavior and feelings began to make sense to his wife, who was able to move closer and offer him, by her quiet presence in the sessions, an attuned response to his emerging affect states. The Other-Centered Listening Stance. One wray the therapist can build self-reflection is to offer interpretations based on his own experience of the partners. Fosshage (1997) describes two basic listening stances in psychoanalysis—the subject-centered and the other-centered, in which the analyst "can experience the patient from the vantage point of the other person (in this case the analyst)." In couples therapy, there are two potential "other" perspectives to listen from, the therapist's and the other partner's. Each partner has most likely already made it abundantly clear what it is like to relate to the other. This is why it is so crucial for the therapist to provide a counterbalancing, subject-centered, empathic vantage point. The therapist

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who shares his own experience of relating to one of the partners prematurely will be perceived as taking sides. There comes a point in most couples treatments, however, when the therapist needs to help one of the partners reflect on the reactions, intended or not, he engenders from his partner. The therapist can either share his own subjective responses or interpose his understanding of why the partner responded as she did (e.g., "I'm beginning to understand why you feel misunderstood. I have the feeling that you are really expressing your concern and understanding, but he thinks you are trying to tell him what to think"). Of course the risk here is that the therapist can appear to be offering some objective truth and thereby undo all that he did to develop an atmosphere that values each partner's subjectivity, or to be taking one partner's side over the other's. It is often necessary to take this risk, however (albeit with a commitment to explore and repair any disjunction caused) because othercentered interpretations are often the only way to interrupt a patient's selfdefeating behavior. A husband's complaints about his wife's remoteness, for example, were highly inflammatory to the wife, who maintained that she was always present and wanting more intimacy. Even when the husband was able to say, "But you always seem so contained and competent, I wonder whether you need me at all," the wife replied that she did not experience herself that way at all, and felt that she always conveyed her needs to her husband. After the discussion continued in the same vein for a while, the therapist joined in and told the wife that he had sometimes wondered what she needed from him as well. The wife slumped completely, clearly feeling ganged up on. The therapist moved quickly to reassure her that he did understand her real need for help, but did not understand why she somehow was not communicating her need at a visceral level. What ensued was an exploration of how the patient's father, with whom she shared a love of books and music, had been her main support in childhood: she had learned to engage him by being bright and interested in the world; she "just assumed" he knew about her difficulties with her angry and critical mother, and was consciously offering her a place of refuge. Her unconscious assumption was that others also intrinsically understood (and were not particularly interested in) the devastated world beneath her brightness. Now her husband (and her therapist) also knew this shattered, lonely part of her experience, and were able to show her that revealing it could be a door to intimacy.


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Making System Interpretations. Addressing interpretations to the relationship itself rather than to one of the partners is an effective way to lower blame and engage the partners in collaboration. The focus shifts off each other and onto the relationship, which is seen as a living, feeling entity. Most couples have a sense that there is something distinct about "us" that is more than the sum of their individual selves. And most couples have a sense that they are often swept up by the relationship into behaving a certain way, whether they intend to or not. It is important to make system interpretations that connect to the affective life of the couple. Interpretations that make the system seem mechanical only serve to reinforce the sense of alienation between the partners' inner world of hopes and sadness and the frustrations of daily relationship life. Cybernetic thinking rooted in general systems theory and family therapy can, however accurate it may be descriptively, magnify a couple's feeling of deadness, both in the way the therapist thinks and in the way he conveys his view to the couple. For these reasons a metaphor of the "relationship self" is useful in imagining the system as a living, persona] entity. The collective, intersubjective entity that we are calling a relationship self can itself be better evoked by metaphor than in abstract language. The poet Denise Levertov ("The Ache of Marriage," 1964) describes partners who "look for communion/and are turned away" but who nonetheless keep searching for "some joy/not to be known outside it." The poet conceives of their disappointment and longing as a vessel in which they float "Two by two in the ark of/the ache of it." The therapist must foster a sense of his own intersubjective relatedness to the relationship self, and then convey it to each partner. Interpretations such as "I can feel the disappointment in this relationship" help express the therapist's involvement. One key to the therapist's ability to develop this kind of relatedness is for him to be aware of the way he holds his own relationship. In Levertov's idiom, the therapist who can feel both the sadness of being turned away from communion and the persistence of longing—despite all disappointment—for the joy that he knows can be found only in intimate relationships can connect to the inner life of his patients' relationship, however hidden it is behind silence, recrimination and deadening repetition. The therapist's sense of openness and connection to that inner life is very powerful for the couple. It is conveyed nonverbally as well as through interpretations that reflect the mix of affects in the relationship, as in a com-

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merit like "I can see the way this relationship struggles to keep something positive alive, despite all the anger." Interpretations that challenge the organization of the relationship self to allow more development-enhancing experiences can be powerful inducements to change. The case of Laura and Andy is illustrative. Laura, who had been in individual treatment for five years, requested some couples sessions when her relationship with Andy began to flounder. Andy had recently taken to becoming bitterly critical of something Laura did, accusing her of being dishonest or intentionally hurtful. Laura would begin by defending herself, but she would end by being desperate, calling Andy every hour and begging him to forgive her, not to leave. The power of Laura's reaction would, in turn, lead Andy to conclude that her need was overwhelming and that they should indeed break up. Andy's shifts from being loving and supportive one minute to being irrationally critical the next repeated Laura's childhood experience with a bipolar mother. Laura's desperate response to Andy's criticism was organized by a self-state overwhelmed by fears of abandonment and by an underlying belief that there was something fatally unlovable about her. Seeing the couple together might interrupt this enactment long enough to help Laura, through her individual treatment, develop a less archaically organized reaction to Andy's criticism. But, in order to be effective, it would be vital to develop a sense of empathic connection to the relationship itself, rather than just to Laura's retraumatizing experience of Andy. Given the ferocity of the couple's fights as well as the intensity of their reconciliations, it was difficult not to view the i-elationship in terms of a primitively organized, pathological system. But at the heart of the relationship was an ongoing struggle to contain the overpowering affects that both their closeness (sexual and intellectual) and their mutually triggered defensive reactions were engendering. The cycle of reconciliation, conflict and breakup was an attempt, however clumsy, on the part of the relationship to be at once elastic enough to expand and hold the full range of affects being produced and strong enough to contain them without breaking. Identifying their collective struggle to contain those intense affects was itself a powerful interpretation: it helped vitiate the belief that one or both of them were crazy or hopelessly defective. The therapy focused on searching for ways to achieve the containment without the repetitive drama. In order to prevent a sense of failure from developing, the couple was also told that they would need those enactments


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until they found something better. In contrast to a paradoxical family therapy technique of prescribing the symptom, which seeks to demonstrate a sense of control over a symptom by instructing a couple to purposely initiate it, the objective here was to convey empathy for the tug-of-war between hope and fear that was encapsulated in the enactment. The interpretations aimed at the relationship self were particularly important for Laura. Seeing the relationship as a living entity, struggling to meet both of their needs, enabled her to let go of the pernicious organizing principles that had led her to believe that the relationship was a sexual and emotional paradise that her underlying badness would inevitably destroy. Strengthening the Holding Environment. One specific type of systemic intervention involves strengthening the capacity of the relationship to withstand a number of kinds of stress. Various theorists (Scharf and Scharf, Solomon, Siegel) have applied Winnicott's (1965) notion of the holding environment to couples. Both Siegal and Solomon emphasize the therapist's empathic listening as the key component of the holding environment. In addition to strengthening each partner's individual capacity to contain reactivity and resist letting intense emotional experience trigger a repetitivethemed organization of the relationship, the therapist can work on the carrying capacity of the system as a whole. This enhancement can be presented as a collective task with a comment such as, "Even though you have a lot of anger that needs to be expressed, it should not be allowed to overpower the relationship, because then it will become unsafe and neither of you will get heard." The therapist can help the couple monitor together the carrying capacity in the relationship by creating rules such as prohibiting physical expressions of anger or ensuring a time-out whenever one person feels overwhelmed. If the couple gets close to exceeding the limit, they have not failed; rather, the marriage needs regulation. If they are unable to maintain safety, they need to take a time-out, seek outside help from friends and family a n d / o r increase the frequency of therapy sessions. The goal is to create collectively a relationship that can contain rather than amplify disturbing affects. Particularly in the beginning stages of treatment, the therapist's office can serve as a symbol of the holding environment. Couples can interrupt disturbing or escalating interactions with the hope that they will be able to be expressed and contained in the office. The therapist can say to the couple, "Try to work it out at home, but if you can't, leave off and bring it in here."

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Ultimately, the office becomes internalized as the capacity to contain differing subjectivities and painful affects in the same room, and by extension, in the same house and in the relationship itself. It is also true that couples who have been traumatized might be "gunshy" and need encouragement to push the limits to see if the holding environment can contain their disappointments. This is especially true when the sexual relationship has broken down. I sometimes suggest to a couple that they try and have "bad," perfunctory sex to see if the relationship can withstand the disappointing experience. Such couples often find that they have misread the relationship's capacity to tolerate intense affects. Surviving the disappointment emboldens them to try again. Directly Creating Development-Enhancing Experiences. Most of the approaches described in this book are nondirective. The goal of enhancing the capacity of each partner to tolerate inevitable selfobject failures while remaining open to intimacy and growth is achieved through creating an intersubjective field characterized by empathy, containment and a spirit of exploration. When one partner is silently witnessing the other's interaction with the therapist, the listening partner becomes part of the collective good will in the room and the therapist's mode of listening serves as a model for future interactions. There are times, however, when the therapist will intervene to directly facilitate a development-enhancing selfobject experience or to block a potential selfobject failure. As to the latter, it is vital that the therapist's office represents for each partner a place of sanctuary and hope. Accordingly, it is almost always appropriate for the therapist to interrupt escalating conflicts and redirect both partners' angry expressions to him. Similarly, the therapist will supplant one partner's incomplete or distorted response with his own understanding (e.g., "I can see how you would see it that way, but I noticed something else in what she was saying"). Another important intervention is to highlight both partners' emerging capacities to provide development-enhancing selfobject experiences. Comments such as, "Did you take in the way he was really listening this time?" or "She's trying to fulfill your request to be more positive there," both mirror the achievement of the provider and help interrupt the defensive resistance of the receiver. In terms of a more direct approach, I will describe three interventions that I have found useful: creating mirroring experiences, enlisting the partners to


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sponsor each other's growth and encouraging self-assertion. It is very important that any resistance to these interventions be met with tolerance and understanding, and that the therapist-—although at times quite forceful in initiating a certain type of interaction—not become too attached to a specific outcome. It is useful to remind yourself that no matter how "right" you think you are, yours is only one of three subjectivities in the room. Creating Mirroring Experiences. The therapist can intervene to directly create moments of mutual regulation and attunement in a session. Partners are directed to sit facing each other, to try and clear their minds of preconceptions and to take in what the other partner is verbally and nonverbally expressing: she's really afraid of you, he's saying how lonely he's been feeling. The therapist coaches each partner to come up with an accurate picture. The therapist slows the usual back-and-forth communication down and encourages each partner to listen. Exercises like this that foster reflective listening are a common stock of most couples therapists (cf. Hendrix, 1990; Wile, 1988). Most commonly they direct one partner to repeat in his own words what the other has just told him. This can provide a vital mirroring selfobject experience. However, rote repetition of content by one partner can create an experience of mirroring failure?—the listener gets all the words right but completely misses the affect behind them. When this happens, the therapist needs to interpret that affect explicitly and have the mirroring partner try again. The therapist should be careful to minimize and defuse blame or shame with a comment like, "All of us have trouble listening to others rather than just hearing what we have come to expect or defending ourselves." As a step beyond merely getting it right, partners can be encouraged to provide a self-delineating experience for each other by acknowledging, without judgment, the other's perceptions and feelings. Enlisting the Partners to Sponsor Each Other's Growth At a certain point in the treatment, the relationship will oscillate between development-enhancing and repetitive attractor states. The therapist can, in a sense, deputize each partner to be an advocate for the other's growth, and, in turn, an advocate for a developmentally themed relationship. One partner can encourage the expression of walled-off or disavowed affects, or the assertion of boundaries or limits. This can be doubly beneficial: one partner receives permission to try new modes of being; the "coaching" partner gets to be experienced as the longed-for parent who encourages, rather than thwarts, development. If one of the partners had a parent who only selectively or conditionally encour-

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aged her or his development, the "coaching" partner's provision of support for actions that appear to go against his interests can have a profound effect. Ultimately the two partners can be empowered to alter the system, both by regulating their own repetitively themed reactivity and by coaching their partner with comments like "You don't have to go there." Supplying this kind of encouragement can be a developmental step for the coaching partner as well. In one instance, a rather immature and narcissistic husband was able to advocate for his wife, who had been abused as a child, to be more assertive of her needs for safety around sex, urging her to ask for time-out when she became anxious. He was simultaneously differentiating himself from her abusive father and learning that he could be admired for being generative. Encouraging Self-Assertion. Along with advocating for the other, each partner needs encouragement to advocate for the kind of relationship he or she wants. In some instances, the therapist will stop a nonproductive process and invite a partner to try and change it, with a comment like, "Let's see if you can get her to understand what you're trying to say," or "Tell him what it feels like when he does that." The capacity for self-assertion is grounded in a conviction that one's thoughts, needs and feelings are valid. Therefore, the provision of a selfdelineating selfobject experience, at first by the therapist and then by the other partner, is a vital precursor. Another obstacle to self-assertion is the fear of retaliation. This fear can be a product both of unconscious organizing principles and of experience in the relationship. In either case, partners need a safe place to try to confront that fear. In the case of Beth and Richard, which we have been referring to throughout the book, Richard, for all of his demands for admiration, was really very unskilled at setting boundaries or protecting himself from Beth's angry denunciations. As you may recall, Richard was himself a victim of his father's verbal abuse. At first, Richard, in the name of repairing the injury of the affair, felt that he had to not respond to Beth's angry tirades. At one point in the therapy we worked directly on Richard's setting limits with Beth. He was encouraged to communicate both how her attacks made him feel and his need for her to stop treating him that way. Richard's ability to assert his needs was actually helpful to Beth; she experienced him as able to contain her anger, and she intuitively knew that if he was able to be more directly assertive he would be less likely to get his needs met by acting out.


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Strengthening Attachment. In some cases where attachment between partners is weak or inconsistent, it is possible for a therapist to make interventions directly designed to repair or strengthen the attachment. Recalling the work of Beebe and McCrorie (1996) described in Chapter 5, we note that attachment is a subjective experience that emerges from a dyadic system. Although, as the authors point out, there is a considerable amount of research supporting the profound influence that childhood attachment patterns have on the experience of adult love, this influence is not invariable, nor is it unidirectional. One partner's history of insecure or chaotic attachment (Ainsworth et al., 1978) can indeed be a factor in the emergence of a similar adult attachment that can negatively affect the other partner's ability to feel secure. But a partner with a childhood history of secure attachment can help create a new sense of refuge and freedom in a partner who has a history of less secure or chaotic attachment. Of particular importance to the couples therapist is the potential for creating attachment-enhancing experiences in the treatment context that can transform the partners' representations. Again we note that the influence between the interpersonal and intrapsychic is reciprocal. Remembering Beebe and Lachman's (1994) three principles of salience, the therapist can attempt to alter the experience of attachment of one or both partners by facilitating moments of heightened emotional intensity, helping to create a regular and expected pattern of relating, and seeing to it that emotional disruptions are repaired. As mentioned earlier, one disengaged couple was encouraged to try "bad sex." The idea was that emotional intensity of one sort or another would begin to alter the subjective sense of the relationship tie as weak or nonexistent. The narcissistically vulnerable husband reported that he was really into lovemaking until the wife made a joke, which spoiled everything. The therapist spent time exploring the different affects that had taken place in the sexual encounter: arousal, anxiety, humor, disappointment, anger; then explained that relationships were a stew made up of all of these intense feelings, not just safe or pleasurable ones. In another case, a couple who were only attached through intense feelings and who chaotically alternated between honeymoon intensity and breaking up were specifically advised to create routines. They agi*eed to go the grocery store together once a week to shop for their respective apartments and to develop a schedule for staying with each other on particular nights. These routines helped mediate against the reactive pull of their emotional upsets.

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While the repair of disruptions is the stock in trade of most couples therapy, couples for whom disjunctions or conflict threaten a weak sense of attachment may require further exploration, even beyond the usual working through. An infant whose sense of urgency and distress was not adequately regulated will likely develop an avoidant attachment, with an emphasis on self-regulation. As an adult he will be prone to retreat from conflict or intensity. The therapist may need to come back to a successful resolution of a conflict, no matter how trivial, again and again, to point out the couple's growing capacity to rebound from disappointment. The therapist holds out the potential for repair with her optimism and calm in the face of the couple's turmoil, and this gradually becomes assimilated into a new schema of attachment. Sexual intimacy, with its close resemblance to caregiver/child interactions, is rife with attachment meanings. In one couple, the husband reported that, though they loved each other dearly and had been married for ten years, he believed the relationship could end at any moment. Underneath this belief was a profound pessimism at the depth of their attachment—a pessimism rooted, it turned out, in the wife's reluctance to initiate sex. This experience echoed his understimulated experience with his depressed mother in infancy, an experience that had been assimilated into a profound sense of insecurity. In fact, the wife had long since given u p initiating sex because he was so often critical and angry. Because sex had become such a loaded issue for the couple, the therapist chose to work in the area of nonsexual physical intimacy. The wife was instructed to just place her hand on his head or back from time to time, and the husband was asked not to react, but to come in to treatment and report his various responses to her touching. Eventually, the couple was able to develop a rapport or nonverbal "grammar" of touches, which gave them a way of dealing with the problem of the husband's insecurity.

CURE IN COUPLES THERAPY If, as Thelen and Smith (1994) emphasize, development has no fixed endpoint, then our notion of what constitutes cure in couples therapy must remain open as well. Nonetheless, couples therapy needs to be informed by some sense of direction. This direction has usually been theory-driven. A brief survey of the psychoanalytic notions of health in relationships reveals that they grow more out of their implicit assumptions than out of pragmatic considerations. From


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an intersubjective perspective, these theories are ways for the therapist to organize his own experience of the relationship. They will also inevitably affect the three-person intersubjective field of the treatment. Kernberg (1974) emphasizes the need for drive neutralization and psychosexual development and identifies three hallmarks of mature love: the integration of aggression and bisexuality into the heterosexual relationship; the transformation of "pregenital strivings and conflicts" into mature object relations characterized by tenderness, concern and gratitude; and a sense of moral commitment to the partner created by healthy superego development. Object-relations-oriented therapists emphasize the lessening of projective identification: "The main therapeutic task is, as always, the reintegration of the feared, denied and split-off aspects of the relationship" (Scharf and Scharf, 1987, p. 153). Kohut (1971) emphasized transmuting internalizations, in which the selfobject provision of the caretakers is structuralized and internalized as part of the self. This internalized structure leads not to autonomy but merely to a reliance on more mature selfobjects throughout the lifespan. Although he never described these mature selfobjects in detail, he indicated (1984) that they would come from a wide variety of sources and include the use of symbols and identifications as well as interpersonal experiences. Following Kohut, Wolf (1988) describes marriage as a phase in which "Spouses are used by each other for a variety of selfobject functions" (p. 59). Wolf emphasizes two functions in particular, that one spouse allows the other to regress in the other's presence without fear of merger, and that spouses use intimate contact with the other's experience as a mode of expanding the boundaries of their selves. In true self psychological fashion, Wolf has here uncovered the positive developmental aspect of relationship configurations that might be otherwise be labeled as pathology: regression and living vicariously. In terms of couples therapy, Solomon (1989) emphasizes the achievement of narcissistic equilibrium, in which the relationship functions to stabilize each partner's narcissistic vulnerability. Livingston's (1995) goal is to get "the marital venture back on track so that it can once again function as a powerful source of developmentally needed experience and, thus, a mutually reparative process and the [vehicle for thej revitalization of two lives" (p. 430). Trop (1994) stresses increasing the couple's awareness of the contribution of each partner's invariant organizing principles to the dynamics and outcome of the relationship.

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Contextualists view individual development and marital development as reciprocal and mutually reinforcing. As evidenced in the preceding example of the husband who himself matured when he supported his wife's asserting her needs around her sexual anxiety, individual developments are potentially growth-enhancing for both members of a couple. In place of an end state of health for relationship development or a notion of cure in couples treatment, couples therapy can be evaluated and measured by the degree of progress the couple is making toward any of the following four goals. 1. The relationship will be characterized, at least some of the time, by a renewed sense of hope. Couples treatment mobilizes long-submerged selfobject needs, ft also exposes longstanding feelings of loss and hurt—both in the relationship and from each partner's family of origin. Hope, as opposed to actual fulfillment, is what allows couples to continue to engage, despite disappointments. Hope, according to Mitchell (1993), is "seeking a psychological space in which genuine desire may become possible, in which the self can find a 'new beginning'" (p. 206). The coping skills that partners need in relationships—a sense of personal agency, the capacity to tolerate painful affects, the ability to communicate—are all enhanced by an intersubjective field characterized by a sense of hope. In couples without hope, these skills, even if present, will atrophy. In order for hope to prevail in a relationship, the underlying beliefs that support hopelessness—that oneself or one's partner is defective, for example, or that one's needs are invalid—must lose their grip. An intersubjective field characterized by hope allows couples to occupy a middle ground between the need for perfectly attuned responsiveness and the defensive reactions engendered by its absence. 2. There will be an increased acknowledgment and acceptance of the partners' differing subjectivities, as well as a growing conviction that these differences need not threaten the relationship tie. Tolerance of difference is essential in a relationship. It is the source of novelty and aliveness. In order for partners to be curious instead of furious about differences, the capacity to stay rooted in one's own thoughts and feelings must be established. This is of course the sine qua non of a healthy sense of self. Developing this capacity, even as a transient phenomenon in couples treatment, can signify a new level of self-development. Pathological

Process and Cure in Couples Therapy 125 self-organization is based on the fear of repetition of trauma. The fear of difference is ultimately either a fear of annihilation—I will be overwhelmed and taken over by your differences—or a fear of abandonment—if you are different, we will not have any connection. Couples therapy provides the moment-by-moment possibility of the discounting of these pathological beliefs. 3. There will be an increased capacity to tolerate and process disturbing affects. The capacity to tolerate and integrate affects is central to intersubjectivity theory's view of mental health. The overall goal in couples therapy is to shift the quality of the relationship from a source of disturbance to a source of soothing. The silence, bickering or rage that characterizes unhappy relationships signals failures to contain disturbing affects. Understanding, tolerating and modulating—rather than perfectly integrating—them are appropriate objectives. The emphasis on affects— rather than representations as in object relations models—underlines the process aspect of relationships. The goal is not the "autonomy" offered by stable and realistic representations of self and other but the ability to process and recover from times when partners feel bad about themselves or see each other as hateful and destructive. 4. The relationship system will support each partner's development. If we view relationships as developmental systems, then we must pay close attention to the fate of each partner's emergent aspirations and achievements within the marriage. The concretized roles, rules and identities that characterize stuck relationships must become more flexible if these emergent developments are not to be stillborn. In one couple, a famous musician began canceling concerts to spend more time with his family and the wife, a talented woman in her own right, began to reclaim the career she gave u p to raise her children. This goal is akin to Bowen's (1978) concept of differentiation, but with a significant difference. Rather than seeing the goal for the relationship as tolerating increased differentiation, each partner's growth is inextricably linked to the relationship system. From a systems perspective, the achievement of this goal is not necessarily enhanced by the therapist's commitment to fairness and stability. A knowledge of systems theory will allow the therapist to view a period of chaos, perhaps precipitated by the individual growth of one of the partners, as a potentially positive harbinger of a more development-enhancing relationship system.

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At the heart of these four goals is intersubjectivity theory's challenge to the Cartesian dialectic between self and other. Remembering Beebe and McCrorie's (1996) metaphor, healthy relationships improvise like jazz music on the twin "riffs" of self and mutual regulation. Whether one partner is rising to new heights of individuation or the two are "playing" in close harmony, the goal of couples therapy is to help the couple find a relationship form that allows for both collaboration and improvisation.

CHAPTER 8


An intersubjective systems viewpoint, which views our subjective worlds not as distinct entities but as fluid constructs formed in a continual dynamic relationship between personal and interpersonal realms (see Chapter 5), necessitates a rethinking of the rigid boundaries between individual and conjoint therapy. In this chapter we will discuss treatment modalities in which the therapist intervenes at both the individual level and at the relationshipsystems level to facilitate development. Couples therapy and individual therapy can be combined from two directions. An individual client can seek support for his relationship by bringing the partner in for concurrent treatment, either to put what he is learning into immediate practice or to try to interrupt the way the relationship is undermining his progress. Another scenario is when one or both partners in couples therapy choose concurrent individual sessions to receive additional support for relationship issues or to address more intensively deep issues that surface in conjoint sessions. Although there is an unwritten rule against working in multiple forums with the same patient, I have found that many therapists, both those trained in family systems and those trained in psychoanalytic theories, will do so when they feel it is necessary, and a substantial number will do it routinely. Much of the objection comes from an outmoded notion of transference as a kind of pure culture of experience, uncontaminated by the outside world. 127

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From an intersubjective point of view, this notion of purity is a complete fiction that ignores the reality that all experience is embedded in a multitude of contexts. Consistent with intersubjectivity theory's rejection of rules or techniques, the therapist is free to begin by asking in what treatment context(s) can a particular patient be helped most effectively? Recalling the dictum of Orange, Atwood and Stolorow (1997), the answer is to fit the frame to the picture, not vice versa. An implicit intersubjective relationship obtains between a couples therapist and an individual therapist who are treating the same patient. As Burch and Jenkins (1999) point out, in an article entitled "The Interactive Potential Between Individual Therapy and Couple Therapy," "A sense of territory is evoked, and a subliminal awareness of other transference-countertransference fields is added to the original one" (p. 232). Referrals by one clinician for simultaneous couples treatment by a second are made with hope "for some extra benefit to their own work through this adjunctive work." Frequently there is an extra benefit derived from such referrals, but it is also the case that the "transference-countertransference fields" such referrals create work at cross-purposes. The frame of combining individual and conjoint treatments works well with many therapeutic "pictures." There are no a priori diagnostic guidelines. Indeed, many patients suffering from profound developmental deficits may require it, while otherwise healthier patients may find it intolerable. We will begin our discussion with an overview of the theoretical and clinical issues that arise in combining individual and conjoint treatment, and then present a case example.

THEORETICAL FOUNDATIONS In considering the combining of treatment modalities, we return to the critique of the myth of isolated therapy begun in Chapter 1: challenging the belief that a patient's experience in therapy can be separated from his ongoing experience of his present-day relationship surround also challenges the artificial fire wall between individual and conjoint treatment. The classification of subjective experience (Shane and Gales, 1997) into old-self/old-other, old-self/new-other and new-self/new-other configurations accounts well for the differing contexts of a patient's experience within the analytic situation. But surely her ability to wrest herself free of the province of her unconscious invariant organizing principles to attain the

Combining Couples and Individual Therapy 129 longed-for new-self/new-other experience is affected at every juncture by the context of her present-day-self/present-day-other relationships. It is the argument of this book that, contrary to the classical view that present-day relationships "contaminate" the analytic frame, therapy must address the task of building and strengthening the connection between the patient's subjective world and the relational matrix that sustains it. Several unique aspects of intersubjectivity theory offer permission to work in this way. The most important is that intersubjectivity, rather than reifying pathological structure, views pathology as part of a dynamic and ongoing developmental system. Since pathology is inextricable from the contexts that support it, where to intervene in the system—for example, which contexts to alter—is a pragmatic, rather than a dogmatic question. One might choose to work at the level of exploring childhood trauma, or on the here-and-now relationship with the therapist, or on the dynamics of the patient's marriage. Or, as described in this chapter, on several of those contexts simultaneously. Furthermore, rather than prescribing a rule-bound method of doing therapy, intersubjectivity merely requires investigating the meanings of therapeutic interventions for each patient. In a model that combines individual and conjoint sessions, the individual sessions provide a forum for investigating the meanings for the patient of breaking the frame and bringing his partner into treatment. Even when this experience leads to a disjunction with the individual therapist, as when a patient experiences the therapist as siding with his spouse in a conjoint session, the potential exists for acknowledgment and repair, experiences that can strengthen the patient/therapist tie. Working intersubjectively rapidly establishes a strong therapeutic alliance. The therapist's nonjudgmental exploration of the patient's subjective world, as well as a nonhierarchical attitude, can quickly create a sense of shared purpose. Finally, the commitment to the investigation of subjective experience, rather than to the illumination of an objective truth, by definition welcomes the existence of differing subjectivities in the same room or the same treatment, including those of two partners and their therapist.

CLINICAL CONSIDERATIONS A N D PROTOCOLS Working with patients in both conjoint and individual forums creates unique clinical issues, especially in regards to confidentiality and loyalty. Be-

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cause this is relatively uncharted territory, I will describe here my own approach, which has evolved primarily through trial and error. When I work with the same patient(s) both individually and conjointly, I make it clear that any information shared in a private session is privileged. This is as much a personal decision as anything: in the individual sessions it releases me from having to listen from the other partner's perspective and enables me to focus exclusively on empathic exploration of the patient's experience. I also make it clear to both partners that my basic stance is to advocate for the relationship. This is not a moral or judgmental position; it is an a priori, existential decision on my part intended only to provide me with a workable context. Keep in mind that, from my point of view, advocating for each partner's development is also advocating for the relationship. Therefore I do not scrupulously try to balance my attention. I will work with one partner of a couple individually for as long as it takes to help overcome a problem or achieve a developmental goal. Working separately with one or both partners and keeping the confidentiality of the individual sessions might seem to put the therapist in the triangulated position of either taking sides or keeping secrets. In my experience, that has not usually been the case. Maintaining and actualizing a commitment to multiple subjectivities rather than to some single objective truth allows me to tolerate the ambiguity of holding contradictions without feeling confused or torn apart. For example, a narcissistically vulnerable patient whose mother was psychotically depressed complained in individual sessions about neglect by his wife, citing as evidence her not serving him the right kind of vegetables. He was creating a terrible self-fulfilling prophecy, whereby his anger and criticism, originating in his childhood experience of his mother, would contribute to his wife's withdrawal and eventual depi-ession. His preoccupation with his wife's neglect made it impossible to focus, in individual treatment, on the genetic material, so I suggested that perhaps we could help him separate past experience from present problems by bringing his wife in for couples sessions. He agreed to give it a try. In the couples sessions, his wife begged me to help my patient overcome his terrible childhood. That was the only hope she could see for the marriage. I understood that her depression was caused by the fact that she felt responsible for fixing his childhood pain, an impossible task. I said that I didn't think it was her job to fix her husband at all, and recommending that she try not to engage him when she felt he was confusing her with his


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mother. She visibly brightened. When I asked my patient how what I had said affected him, he replied that he didn't want to make his wife depressed and was glad to see her smile again. Of course, I never would have worked this way if I did not have a strong therapeutic alliance with my patient. Nonetheless, I can imagine this scenario backfiring. The risk that my empathic failure could permanently derail the therapy had to be weighed against the risk of not intervening in the ongoing relationship, in the context of which my patient was generating an unhealthy new cycle while reinforcing his invariant organizing principle that his needs would never be met. I could have referred the couple to an outside therapist, but they had tried couples treatment and the therapist had insisted that my patient needed antidepressant medication. As it turned out, my patient assimilated my willingness to go into conjoint treatment as protecting him, even while I moved to protect his wife. Advocating for a relationship system that was not dominated by his repetitively themed organizing principles was indeed a kind of protection, and, in light of the fact that his own father had remained uninvolved in the traumatic emotional life of the family, created a powerful new therapeutic reality.

PITFALLS AND COUNTERINDICATIONS A decision about combining individual and conjoint modalities can only be made on a case-by-case basis. Conjointly exploring the individual issues of each partner in a couples case has the advantage of building empathy between the partners and enlisting their support for one another. A potential pitfall of suggesting individual treatment for either is that it sends the message that some material is out of bounds or too much for the relationship to handle. In fact, when one partner requests individual work, it is important to confirm that the other partner does not infer that he or she is the source of the problems in the relationship. There are times when bringing an individual patient's partner into conjoint treatment is counterindicated—primarily when doing so would threaten the original patient/therapist alliance. A case in which negative or wildly fluctuating transference predominates would be a poor candidate. But an overly idealized transference might be as problematic, in that the therapist's building an alliance to the spouse could precipitate a traumatic loss of the idealizable function of the therapist.

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A potential problem for bringing in the spouse of an individual patient arises when the spouse experiences the individual treatment as a threat to the marriage. Sometimes this can be dispelled and an alliance can be established all the way around. At other times, however, alliance is impossible. For example, a man contacted me for treatment when he realized that he had been acting to please people rather than following his own desires in every aspect of his life, his career, his marriage. He wanted to work on his marriage, but he wanted to see me individually for a few sessions first. Operating on my general assumption that each individual's growth is good for a marriage, I agreed. It turned out he desperately wanted his wife to validate his perceptions, functioning as a newfound selfobject, but she found his changes completely disruptive and wrote them off to midlife crisis. When she came in for a conjoint session at her husband's request, it was clear that she blamed his "awakening" for destroying the marriage, and with it the fabric of her world. It was equally clear that, on account of the individual sessions I had had with her husband, she saw me as part of the problem. Because my attempts to show empathy for her devastation were ineffective, I referred them to an outside couples therapist. The worst pitfall one can encounter in a modality combining individual and conjoint sessions is one partner's confidential revelation of an affair or other potentially devastating secret. In these cases I am still bound by commitment to keep confidentiality. There are times when this can work favorably, as when the individual sessions act as a kind of container for the troubling material, allowing it to be "metabolized" through interpretation and working through, in a safe forum. In one case, a woman patient was able to discuss her obsessive crush on a younger colleague in a way that helped her not act on her urges. However, if the affair or secret is posing a real threat to the relationship, I will do everything in my power to have it brought out in the conjoint sessions. There is a point where the need to confront one partner or to protect another supersedes the need to honor differing subjectivities. Recalling the discussion in Chapter 6 of the way confrontation can be empathic, 1 would stress again that allowing a duplicitous process to proceed in conjoint treatment is unempathic to both partners. In marital treatments where the tie between the partners is weak or the partners are disengaged, concurrent individual therapy might exacerbate the problem. The request for individual treatment could be a request for attention that was missing in the marriage. Providing an alternative source for


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that attention could derail the couple from confronting the problems in the marriage. Highly volatile marriages must be evaluated on a case-by-case basis. In some cases an angry or unstable partner will greatly profit from the support of individual treatment, and be better able to participate in the conjoint sessions. In couples where the volatility centers on issues of secrecy and betrayal, however, conjoint treatment is counterindicated. In the case of Beth and Richard that we have been discussing, Beth's suspicions of Richard's outside relationships, as well as Richard's style of protecting his boundaries by not revealing his thoughts and feelings, led me not to schedule collateral sessions, as much as both partners could have benefited from the additional support.

CASE EXAMPLE Alan and Ruth were a childless professional couple in their forties who had been married for seven years at the time they contacted me for couples therapy. From the outset it was clear that their relationship was in trouble. Both spoke of a sense of hopelessness: Alan seemed rather bitter, while Ruth seemed fragile and very sad. After several conjoint assessment sessions I proposed that they both see me individually on a weekly basis as well as in a weekly conjoint session. I made the suggestion of this modality based on my understanding of the profundity of the marital problems and of the fragility of both partners' self organizations. They agreed to this plan, and treatment has been going on for about two years. Alan, a business consultant, worked 70-80 hours a week. He was extremely withdrawn in the treatment room. He blamed his problems on his poor business skills—he described himself as a complete failure. However, there was an imperious quality to his tone as he described himself. His self-deprecation seemed designed more to keep others at bay than to invite a sympathetic response to his life struggles. Ruth, a social worker, would complain in a very young, almost whiny voice about the lack of contact in the marriage. She sought desperately to try to get Alan to let her help with his business or personal problems; he, contemptuous and suspicious, called that her "social worker act." Alan and Ruth met at a resort that they both had gone to alone. Alan had just come up for the day, but when he met Ruth, he decided to book

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a room. Alan later described this as an "almost unheard-of moment of risk and spontaneity." Later they discovered their shared interest in spirituality. The early part of their relationship was a revelation for both of them. Ruth had been married once before, but had divorced because of her husband's infidelity. Alan had long believed that he was destined for a lonely bachelorhood. At first they considered each other "soul mates." The early phase of their relationship was not all sweetness and light—they had many fights, but found a sense of relief in them, since neither grew up in a household where much affect was shown. But this initial closeness had given away to a relationship completely dominated by Ruth's pursuit of intimacy and Alan's avoidance of it. At the time they entered treatment sexual contact was all but nonexistent. Ruth pleaded with Alan to spend more time with her, but Alan, who had recently started his own business, claimed that he was just trying to survive. Alan would tell Ruth at times like this that he was completely worthless, "lower than pond scum," as he put it. In exploring the couple's history, it became clear that the pursuit/avoidance system had replaced a more selfobject-based organization in response to several emotionally difficult issues. Alan came to see that Ruth did not trust him about money issues, even though he was supposed to be an expert on finances. He took her distrust as evidence that she was preoccupied with her own needs for security and would never offer him mirroring admiration of his accomplishments. Ruth became more and more upset about Alan's work hours, as well as his angry, critical reactions to her attempts to help. These issues triggered repetitively themed transferences for both partners: Alan saw Ruth as his highly narcissistic and invasive mother, while Ruth saw Alan as her remote and critical father. Ruth was the middle of three children, with an older brother and a younger sister. Her brother, who was considered a genius, got more attention and more privileges than Ruth. He also used to verbally torment her. Ruth's mother had been an actress before marriage. She had given up her career when she married. Her father was a highly critical man. Ruth watched her lively mother grow moody and submissive as she got older. This was especially poignant for Ruth, because she was highly identified with her mother, especially as a prepubescent girl. Her mother had wanted Ruth to carry on her own, unlived life—she was given dancing and singing lessons, and auditioned for plays, even


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though she was not naturally talented. At puberty, when it became clear that Ruth was a rather ungainly, intellectual child, her mother began to give up on her and withdraw emotional closeness. Her father, on the other hand, began to take an active, if critical interest. He tried to "shape her" by sponsoring her intellect and telling her she was too emotional, even going as far as threatening to hit her if she started to cry. Both of her highly narcissistic parents treated her as extensions of themselves. Alan was an only child. His mother is a lively, if highly narcissistic woman, his father was an angry, withdrawn man. The one inviolable rule in the household was that Alan was to do nothing to upset his mother. His father would enforce this rule with angry threats. In one individual session, Alan summarized his childhood situation by saying, "It felt almost as if my father wrould hold me down while my mother would rape me." There are striking parallels in Alan and Ruth's families: both mothers are lively, if narcissistic, both fathers angry and threatening. One significant difference is that Ruth's father was highly critical of his wife, while Alan's father would brook no criticism of his. My understanding of Alan and Ruth's history, as well as my assessment of their relationship and the fragile organization of their respective subjective worlds, supported the initial decision to combine conjoint and individual sessions. Both Alan and Ruth clearly needed individual therapy, but their relationship tie was very weak, and probably would not survive the input of three different therapists. Combining individual and conjoint sessions allowed me to provide needed selfobject functions for both partners, while at the same time trying to facilitate moments when those functions could be met from within the relationship. The striking similarities in both partners' families of origin allowed for synergy between the individual and couples sessions. Each partner desperately yearned for mirroring of their individuality, rather than the selective mirroring they had received as children. The individual sessions, in which those mirroring failures were directly addressed, helped contain the disappointment resulting from selfobject failures in the conjoint sessions, allowing them more and more to become "testing grounds" for new responses, such as directly communicating feelings rather than acting out. Both partners became allied in supporting one another in overcoming the childhood patterns.

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About six weeks into treatment they had an incident that resulted in a separation. Alan's father was suffering from bladder cancer, and Alan had been trying to heal their distant relationship. He told Ruth that he wanted to bring his father to their annual religious retreat. Alan knew that Ruth did not like his father; taking him to the retreat, which represented the last vestige of their spiritual connection, was to her a complete betrayal of their original connection. She shouted, "You're not my soul mate anymore." That night he left and took his own apartment. Despite this separation, Alan and Ruth agreed to maintain the therapy in the same multiple forms, to see if they could save their marriage. Initially the prospects were not good. In this fight, Alan had resh-uctured his family of origin material with Ruth, such that he experienced it as a repetition of the triangle between his mother and his father, in which the mother's needs must come first. His developmental need for an identification with his father was once again being crushed. My early attempts to restore the ruptured empathic tie were unsuccessful—Alan had retreated into anger, withdrawal and defensive scorn, while Ruth, growing increasingly desperate, portrayed herself more and more as an innocent and misunderstood victim. This portrayal was highly inflammatory to Alan, who saw it as more evidence that Ruth would never understand him or take his needs seriously. In one couples session, Ruth was trying to get him to see how he frequently "went for her jugular" and attacked her whole being. Alan merely condemned her weakness: "I hate your neediness. It really disgusts me." Ruth kept repeating to him, rather desperately, that she just needed him to give her a break, to which Alan, in the throws of his repetitive maternal transference, replied, "So then I can't feel anything at all." At that moment, any expression of Ruth's feelings evoked the age-old requirement that he give up his own subjective world and merge with hers. When I tried to explain to him that Ruth wasn't after him to give up his feelings, but just to hear about hers, he replied in a cold, flat voice, "I can't have a self and feel empathy simultaneously." This attempt to help him accept the "reality" of what was happening in the room was an empathic failure on my part, and merely reinforced Alan's defensive hyperrationality and belief that he was an unfeeling machine. At this point Ruth had sagged down on the couch. When I asked her what was going on, she replied—with a statement revealing her invari-


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ant organizing principle of blaming herself for the selfobject failures of others—that she "felt completely unlovable," It would have been easy to look at the depth of Alan's narcissistic organization and feel hopeless, but I noticed that, in our individual sessions, when he felt understood and protected, he would have moments of greater empathy for Ruth. If it were possible to re-create that milieu in the conjoint sessions, perhaps Alan could demonstrate this empathy to Ruth, allowing them to reverse their demoralizing pattern and share a more positive experience. Paradoxically, one key to facilitating Alan's capacity to offer an empathic tie for Ruth was my supporting, in individual sessions, Alan's perception of Ruth's own narcissism. He sawT Ruth's suffocating helpfulness in the same light as his mother's intellectual liveliness: both were a kind of Trojan horse, designed to get him to lower his defenses and be invaded. Despite the extremity of his defenses, Alan did not really feel that his perceptions of either his mother or his wife were accurate. He felt that there must be something wrong with him for having such extreme reactions. When I was able to share with him that I too saw a considerable amount of self-interest in Ruth's "helpfulness," he was more able to move beyond his rigid defenses, both in regards to his marriage and to our individual exploration of his childhood experiences. A telling vignette that emerged in an individual session became a metaphor for our understanding of Alan's relationship with his mother, and the developmental importance of his wish to ally with his father. Alan had gone to visit his father, who was undergoing chemotherapy; after a visit with his doctor they were at home discussing treatment options and outcomes. His mother chose to stay uninvolved in this vital conversation. She continually interrupted them, however, with details and questions about an upcoming family celebration she was planning. Finally Alan, standing u p to his mother for what he described as the first time in his life, said, "Mom, Dad may be dying and you're talking about who to invite?" Alan was breaking the family rule of protecting his mother here, standing u p for his father's (and by extension, his own) survival. Alan's self-delineating selfobject experience, in which he began to accept as valid his feelings about both his mother and his wife, had a profound effect him. Contrary to the expectation that this validation would

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escalate his angry denunciations of Ruth, he became much more able to listen to her experience. Furthermore, his process in individual and conjoint sessions alike was no longer dominated by talk of how defective he was or by long bouts of silence. In one important moment, Ruth was able to tell him how angry she was at his silences and criticism. She was shaking with affect as she recounted her injuries. When she was through we both looked at Alan to see how he was reacting. "I'm right here," he replied, and we both knew that it was true. Ruth's work in therapy focused on the way she habitually replaced her own experience with concern for Alan's as a means of maintaining their tie. Once in an individual session Ruth was peppering me with questions about my view of Alan—Did I think he was capable of change? What's his diagnosis? I commented that she was again focusing almost exclusively on Alan, rather than talking about her own experience. I wondered if that was a way she could feel close to him, despite all the times he rebuffed her. She thought that was very possible. When I asked her where she might have learned to focus on someone else's issues rather than on her own feelings, she associated to a time in adolescence when she told her mother, a beautiful actress, about almost being molested by the chauffeur: her mother minimized her concerns and talked instead about her own unhappy childhood. These and other related insights into the nature of her tie to her mother proved pivotal for Ruth. She began to see Alan's withdrawal less as evidence of the fact that she was unlovable and more as simply intolerable behavior. And rather than defending against the abandonment by becoming obsessed with Alan's thoughts and feelings, she began to develop a strong outside support system to help her with the separation. The victim tone she had adopted in couples therapy was more and more frequently replaced by confident assertions of her own needs and feelings. The individual therapeutic gains helped unlock the reinforcing feedback loop of their relationship system. In the past, Alan's withdrawals would trigger Ruth's desperate attempts to make contact by being helpful, which only caused Alan, convinced of her duplicity, to withdraw further. When Ruth was able to express her anger or make demands instead of asking for sympathy, Alan would actually move closer. Eventually, they began to try dating again. Sometimes these dates brought fun and closeness, and at other times they ended in the old pattern.


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Most significantly, Ruth and Alan were developing a means for naming and repairing these disjunctions, which allowed them to move on and try again. It is hard for most couples to leave the idealization of the honeymoon phase and come to tolerate a relationship comprised of both selfobject failures and successes; for two people with self organizations as fragile as Alan's and Ruth's, it is especially difficult. Both partners made significant progress in disavowing long-held and heretofore largely intractable organizing principles, and also in creating relationship experiences that met their respective selfobject needs. The combination of individual and couples therapy helped them to contain their disappointments while they developed a third alternative to either endlessly replaying their relentless pursuit/avoidance script or breaking up.


CHAPTER 9

Family Therapy

At this point we widen our contextual focus to include parents and children, Our theoretical starting point is once again the shift in psychoanalytic thinking from an isolated-mind theory of drives and fantasy to one that views individual experience as embedded in relationships. Families are deve lopmental suprasystems, and each member's subjective world is a subsystem; accordingly, the intersubjective systems approach applies as naturally to family therapy modalities as to couples. Heinz Kohut (1977), seeking to understand the increase in the number of self disorders he observed, turned his attention to the changing nature of family process. "The environment [once] experienced as threateningly close is now experienced more and more as threateningly distant; where children were formerly over stimulated by the emotional (including the erotic) life of their parents, they are now often under stimulated" (p. 271). These speculations, which shift the focus of the study of intrapsychic life from universal psychological structures to those that arise in the context of a relational field, foreshadow the paradigm shift that Stolorow (1994) calls the "most important development in psychoanalysis over the past decade . . . the growing recognition that intrapsychic phenomena must be understood in the context of the larger interaction systems in which they take form" (p. 3). Families constitute an important example of a "larger interactional system." The concept of the intersubjective field usefully lends itself to an examination of family process. 141

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In the 1980s, several authors, including Lansky (1981), Scharf and Scharf (1987) and Slipp (1984), lamented the schism between psychoanalysis and family systems theory.1 The unfortunate result of this schism was that, until recently, family systems theorists focused exclusively on the environmental causes of behavior, construing intrapsychic life as a "black box" (Slipp, 1984). But since the initial formulation of family therapy, a significant body of literature has attempted to bridge this gulf (e.g., Stierlin, 1977; Lansky, 1981). Drawing largely from theories of group process derived from the British school of object relations, the Scharfs (1987) and Samuel Slipp (1984, 1988) created a theory of object relations-based family process. Cleghom (1987) and Rosenbaum and Dyckman (1995) have looked at self experience in family systems; Lansky (1981) and Solomon (1989) have extended self psychological concepts, especially the regulation of narcissism, to the study of couples. In a similar vein, Jacobs (1991) views pathological families as "narcissistic systems" in which the provision of selfobject functions is highly conditional and "individuals experience others as extensions of themselves" (p. 483). Solomon (1989) posits the existence of a "mutual self or joint personality that emerges from . . . marital interaction" (p. 27). In addressing the analogous dilemma of conceptualizing group process, Weinstein (1991) describes a group self in which the group is experienced as "an organism with its own boundaries, and its own self-cohesion-fragmentation spectrum" (p. 221). It is in this spirit that we speak below of a family self.

CONCEPTUAL DIFFICULTIES IN MOVING FROM COUPLES TO FAMILIES Intersubjectivity has successfully moved the scope of psychoanalytic inquiry beyond the one-body model of endogenously derived conflict into a consideration of the psychological system formed by two differently organized subjectivities. In the preceding chapters we have outlined a three-person model. An investigation of family process involves looking at systems with three or more members, each of whom is simultaneously organizing his or

'Slipp attributes it partly to the personal antipathy of Don Jackson, who formulated some of the key concepts in family systems theory, to psychoanalysis.

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her experience of relating to the others, and, in addition, responding to the family system as a whole. Statements like "my family never supported my career" acknowledge that individuals yearn for the family to meet their selfobject needs. Statements such as "my family needs me to be strong" acknowledge that individual family members concomitantly experience the family as requiring selfobject functions /rom them. According to Ungar and Levene (1994), the family is "a supraordinate selfobject" which provides experiences that "collectively . . . support and nurture the cohesion of each member's individual self structure" (p. 397). The reciprocal interactions of the different subjectivities in a family create a family self that is bigger than the sum of its parts. Each individual member organizes the family self differently in keeping with his or her own subjective experience of it. At the same time, the family self organizes family life, providing collective meanings to family experience. In understanding family process, the therapist is faced with the daunting task of examining each family member's subjectively experienced relationship to the others, each family member's transferences to the family self, the way the family self collectively organizes the family experience and the requirements it imposes on its members.

THE SELFOBJECT DIMENSION OF FAMILY EXPERIENCE Since the family is of course the original developmental context, selfobject experiences are first and foremost familial. The individual members look to the family to situate them as small parts of a larger, protective whole, and also to register and respond to their experiences. To be cut off from one's family is, traditionally, to be adrift; indeed, providing the alterego experiences of belonging and identity may be the most important of family functions.2 And there are others: Thematicatty Organizing Individual Experience. The family provides underlying meanings for affective experience. For example, in a unit organized around a theme of sacrifice, the governing ethos is that members must subordinate their own self-delineation to the greater needs of the family. Indi:

Interestingly, as noted Chapter 3, Kohut's original tripartite model of selfobject experiences parallels the roles assumed in the traditional family: idealizing needs are met by the strong father, the mirroring by the mother and the alterego by the siblings.

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vidua] decisions, such as a mother's putting her career on hold, become defined by the family as worthwhile, even noble accomplishments. This kind of organizing can have the merit of putting a positive spin on frustration and disappointment—or it can feel distorting and invasive and, as in the case of Gerald below, have negative consequences. What Minuchin and Fishman (1981) call family myths correspond to what Brandchaft and Stolorow identify as "invariant and relentless principles of organization that remain beyond the accommodative influence of reflective self-awareness or subsequent experience" (1990, p. 108). In cases where the myths perpetuate the family's problems, the primary therapeutic task is "reframing" them in order to "move the family toward a more differentiated and competent dealing with their dysfunctional reality" (p. 74 ). But in sharp contrast to the stance that Minuchin advises, in which the authoritarian therapist "challenges the family's accepted reality with an orientation toward growth" (1981, p. 67), such reframing is best achieved by a "stance of empathic inquiry," which "will lead to an awareness, deepening investigation, and gradual illumination of existing unconscious organizing principles and their continuing contribution to the repetitive course that life takes" (Brandchaft, 1994, p. 75). Regulating Affect. As in couples, affects are contained, modified or otherwise regulated within the family system. Homeostasis (Jackson and Weakland, 1968) is a central tenet of systems theory. Families have a set point for how much affect they can tolerate, and have developed fixed ways to return the family to equilibrium when that set point is exceeded. When powerful affects, especially shame and anger, threaten to destabilize the system, they are homeostatically modified. For example, a child may become increasinglysymptomatic in response to increased tension in the couple relationship. The more prone to fragmentation the family self is, the greater the burden on these homeostatic mechanisms. As Lansky (1981) points out, "A chaotic family homeostasis is maintained by collusive defenses, humiliation proneness, and terror of separations" (p. 9). Boundary Formation. Stolorow, Branchaft and Atwood (1987) have described the derailment of self differentiation that takes place when the boundary between the caregiver's needs and the child's emerging affect states is blurred. Such boundary issues are also important at the family sys-

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terns level. A strong but flexible boundary between parents and children allows the children valuable access (both cognitive and affectual) to the adult world, while at the same time protecting them from intrusion. Conversely, enmeshed families tend to share affect states, preventing the child from experiencing the "differentiating responsiveness to [his] affect states [which] constitutes a central selfobject function of the caregiving surround, in establishing the earliest rudiments of self definition and self boundary formation" (p. 70). Naming and Repairing Selfobject Injuries. We recall from Chapter 3 the critical importance of acknowledging a child's pain and repairing the injury (Trop, 1997). Families potentially offer a number of avenues to such repair: the other parent, grandparents, siblings, etc. Even if an offending parent is too narcissistkally vulnerable to acknowledge the child's feelings, another family member can confirm the validity of the child's experience, providing a vital self-delineating experience. These family selfobject experiences pertain to all family members, not just the children. Kohut's (1984) assertion of the persistence of selfobject needs throughout the life span illuminates the way the yearning for experiences that meet them colors all dimensions of family life. For the parents, providing children with such selfobject experiences is the central task, but doing so does not replace, and in some cases actually exacerbates, the parents' yearning for the family to meet their own needs. It is the therapist's attuned response to these yearnings in all the family members that can help the family lower its defenses. Thereupon, members can share a renewed sense of purpose, which in turn can be mobilized in the therapeutic task.

THE REPETITIVE POLE OF FAMILY EXPERIENCE Of course, families can also violate or disrupt self-experience: • Yearned-for mirroring can be conditional, requiring conformity to family norms at the price of individuality. • The sense of the unit as admirable and protective can be traumatically ruptured, as when the myth of the happy family is shattered by the revelation of an extramarital affair.

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• Intrafamily conflicts can lead to expulsion or voluntary cutoff from the family system, abruptly putting an end to the family's contribution of alterego experiences. • Families may impose distorted or reductive meanings on individual experience. For example, a family organized around the parents' fear of abandonment may exaggerate a child's problem in order to keep her dependent. • In chaotic families, the set point for affect tolerance may be so high that the members are chronically overstimulated. • Boundaries may be so diffuse or so frequently violated that selfdelineation within the family becomes almost impossible. • The family's defenses may be so pervasive as to preclude the acknowledgment or repair of an individual's injury. An alcoholic's family, for instance, might unite in defensive denial of the problem at the expense of a child who is a victim of the alcoholic's abuse. When adults form new families, negative or traumatic experiences in their families of origin color their expectations; if their fears become enshrined in the family organization, the family self then functions defensively, limiting the repertoires of all the members. Children's progression through the normal stages of development typically triggers defensive reactions, which impact in turn on the system: a two-year-old's intense self-delineating can flood the family system with feelings of frustration at being held back; a teenager's relentless criticism can challenge the organizing principles of the family; more complicatedly, the adolescent's budding sexuality confronts the family system not only with expansive feelings but also with disavowed parts of their own experience.

CONCRETIZATION When fears of traumatic repetition predominate, the family self is fragile and characterized by defensive organization. In such situations children often are called upon to concretize the family's subjective experience, to the detriment of their own development. As we recall from Chapter 2, concretization's "most general, supraordinate function is to dramatize, reify, and thereby maintain the organization of the subjective world" (Stolorow and Atwood, 1992, p. 44). Examples of the concretization of family experience include assignment of fixed identities (one child is the smart one, an-

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other is "cute" but ineffectual), and enactment (Atwood and Stolorow, 1984) of fixed or ritualized behavior patterns as illustrated by the following vignette. Mr. and Mrs. Z were unable to get their five-year-old son to sleep in his own bed. Bedtime had become a two-hour-plus ritual in which both father and mother participated, and which more often than not ended with the exhausted parents capitulating and letting the boy fall asleep in their bed. The father was a refugee from Eastern Europe while the mother grew up in an alcoholic family; their family self was organized around the belief that life is dangerous and requires constant vigilance. Their son's childhood illness, since outgrown, had led Mr. and Mrs. Z to concretize this belief through hypervigilance and a shared disposition to exaggerated precautions. Bedtime, with its shared ritual of endless stories and glasses of water, had become an opportunity for the parents to continue their overzealous enactment. Understanding the process of concretization allows the therapist to rapidly connect disparate parts of the family process to underlying organizing principles and the disavowed affects that support them. It is usually best at first not to confront or interpret the concretizations directly, which can be experienced as shaming or discounting the family's experience. Most often, allowing another route for the underlying fears and beliefs to come out—via the therapist's inquiry and understanding—reduces the need for concretizations, which wnll then resolve on their own.

CASE EXAMPLE The case of Gerald, a sixteen-year-old who was underachieving and had become unmanageable, indicates the way an adolescent's self organization is completely intertwined with the intersubjective field of the family, including multigenerational contexts. Gerald's haughty disdain and defensive grandiosity were so pervasive that he eventually could not even participate in treatment, which had to be conducted by proxy through the parents. The successful outcome of the treatment illustrates the way a shift in the psychological organization of the parents can lead to a reorganization of the entire family system, including the subjective world of the children. Understood in context, Gerald's symptoms turned out to be concretizations of the mother's unconscious belief that she was bad and would spoil everything she touched. His grandiosity was a desperate attempt to defend against this delegation.

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The C family was referred to me by the mother's analyst, who felt that the sixteen-year-old son's acting out was undermining his mother's analytic progress. The referring analyst stressed that the mother, though doing better recently, was still extremely fragile, having been hospitalized twice in the last six years for depression, once following a suicide attempt. The family consisted of Theresa, the mother, an attractive forty-fouryear-old woman of Latin American descent who worked as an executive in the advertising industry; Gerald, her sixteen-year-old son, who dressed entirely in black and communicated almost exclusively with sarcasm or cryptic phrases such as "We'll see about that"; and the boy's Anglo-American stepfather, Don, a forty-five-year-old scientist with a disaster relief organization. Don had been in the family since Gerald was two. (Gerald saw his father Ken about once a month.) Gerald had behaved well and received excellent grades in school until he was eleven, when things began to deteriorate. By the time he entered treatment, Gerald was flunking nearly all of his classes, and completely refusing Don's help with his homework. He spent a great deal of time in his room; his only friends were two older neighborhood boys with whom he shared a passion for kung fu-style gangster movies. I initially interviewed the C.s in different combinations: all of them together, the parents conjointly and Gerald alone. The family sessions revolved around the parents' desperate attempts to get Gerald to communicate. Gerald would thwart all such attempts, remaining silent, or starting absurd arguments, such as a discussion of what it means to talk. ("See, I'm talking to you. My mouth is moving. Talk talk talk.") Theresa would grow increasingly solicitous and desperate. In one session Don got very angry and confrontational (which was highly unlike him) and Gerald registered some hurt and anger, then pulled himself up. Soon after this, Gerald refused to participate in any more family sessions. This was more or less the way it went in my individual sessions with Gerald. In one of these sessions he reached into his pocket and tossed me a disposable cigarette lighter. "What's that thing I just threw you?" he asked. Then, following my puzzled silence, he answered his own question: "It's a cigarette lighter. Sometimes things are just what they seem, not what some psychologist tries to make them into." After some thought I replied, "I think you're telling me to leave you alone, not to

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probe inside you. 1 guess you can't stand that right now." Gerald nodded in agreement. Soon after, he began refusing to come, either to individual or family sessions. The parents offered to try and force him, but I told them that I felt that this would be counterproductive. I decided to see what 1 could find out about Gerald by interviewing the parents. I believed that Gerald's internal world would be greatly influenced by the parents, and that the intersubjective field of the couple would be reciprocally influenced by their experiences of parenting Gerald. Early on I noticed that Theresa would stiffen when I made a parenting suggestion. I decided as much as possible to refrain from suggestions, and instead tried to remain empathically attuned to the parents' experience and to let the underlying meanings of that experience emerge. This stance was not achieved without anxiety on my part, as I had to let go of my own need to provide immediate solutions for these likable and struggling parents and help for this obviously troubled boy. Many times Theresa presented in a highly fragmented state or became fragmented during the session. In the latter case it was usually in response to something I had said that made her feel criticized or slighted. In one instance she became anxious and withdrawn after a remark that I made concerning the discrepancy in income between Don and Ken, who was a factory worker. (I wondered if it wasn't confusing for Gerald to have a stepfather who could buy him things that his father couldn't.) Exploration of Theresa's reaction to my remark revealed that she felt that I was ignoring her contribution to the family income. This, in turn, revealed some significant parts of Theresa's family history. The oldest daughter of a large family, she was the only child who graduated high school, and had risen far higher economically than anyone else in her family. She felt that her family didn't appreciate her success, and was jealous of her. She also had considerable guilt about doing so much better than her parents. When I asked who in her family had appreciated her as a child, Theresa told me about her troubled relationship with her father, who had been very inappropriate sexually. As an adolescent she had been his favorite, and he used to enjoy showing her off. He even got her a job dancing as a go-go dancer in a cage in a night club he liked to frequent. When I asked what that was like for her, she replied that she remembered liking all the attention and then looked at me to see if I disap-

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proved. I felt that one disapproving look from me would have sent her into a fragmented state, flooded with shame. She also remembered several instances when her father had tried to fondle her breasts. She had begun to recover memories of these incidents about five years ago, about the time that Gerald had entered puberty. She had begun to wonder if she had repressed memories of incest, and has been pursuing this issue in her own analysis. Don's family history also emerged at this time. The oldest son of a working-class family, he had been relentlessly pressured to succeed. As he put it, "Fortunately I fell in love wTith science, so my dad's pressure wasn't so bad." I came to believe that this statement reflected both the fact that the family pressure hadn't completely derailed his selfdelineation, and the fact that he had repressed his own desire to live a life free of other's expectations. Don had been married once before, to a flight attendant who had become "crazily dependent on him." I wondered at the pattern of being a rescuer, and he acknowledged that there was something to it, that he was probably repeating his role in his own family. We both laughed when I remarked that in his job with the disaster relief organization he had made a career of it. Don repeatedly provided vital selfobject functions for Theresa, remaining very calm and empathic while she entered deeply fragmented states. Don was puzzled and a little bitter that Gerald had so violently withdrawn from the family. He initially continued to try to be friendly and helpful to Gerald, but his disappointment came through with outbursts of anger. Lately he reported that he felt withdrawn and distant from Gerald. This feeling was not i-eflected in the early family sessions, in which Don actively tried to get Gerald to communicate. About four months into treatment, Theresa came in saying that, though she didn't really understand why, she had something she needed to tell me. She then proceeded to reveal a secret that, until now, only she, Don and Ken knew: Gerald was conceived in a brief affair with a man she barely knew. She had not even revealed this to her analyst. (Later, on my urging, she was able to bring it up.) I was tempted to explore the way this secret functioned in the family system, but instead I focused on the meanings that this event had for her. At times she showed compassion for herself: "I married Ken to get away from my father, and I had the affair to get away from Ken." At other times she would be overcome with shame, and would repeat over

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and over that she was bad. She would lament that she had damaged Gerald terribly, or she would worry that she had not done enough to keep him from being sexually molested. An exploration of this belief revealed a pervasive fear that Gerald might be molested at any time, and that it was up to her to try to stop it. Clearly at such moments the boundary between her and her son was blurred. I began to see that at such times Gerald became a concretization of Theresa's belief in her inherent badness, and of the belief that her loving, expansive feelings were destructive: "I was so happy when Gerald was born, but look how it has turned out. I've really damaged him." Underlying this sense of badness were the powerful affects of shame that her father's misuse of her emerging sexuality had engendered. Theresa was very afraid how I would handle this secret: "If you tell me I've got to tell Gerald, I'll leave and never come back." I reassured her that I would leave that decision up to her. My attuned response to this material lowered the anxiety level in the family and created an important bond between the parents and myself. This bond was severely tested a few months later when Gerald left home during a fight with his parents over sitting down to dinner with the family. He was not seen or heard from for the next ten days. During this time I met with the family four times and was in daily phone contact. I shared with them their intense worry, and also their anger at Gerald for doing this to them. Gerald reappeared, but would not say a word about what had happened to him, or where he had been. At this point I became increasingly concerned about Gerald. The parents were considering placing him in a locked residential treatment school. I began to wonder if I would have the time to reach Gerald through his parents, given the escalation of his acting out and his parent's increasing anxiety. In order to get a better picture of Gerald's subjective world, I made a referral to a colleague for Gerald to be tested, and Theresa assured me that she would get Gerald to the appointments. The results of the testing were very illuminating. Though Gerald had been highly resistant, my colleague felt that he had been able to engage Gerald enough to get a valid profile. Gerald had a combined IQ of 122. He showed no learning disabilities that would have accounted for his poor school performance. Indeed, his math achievement scores showed that he had learned algebra, even while getting Ds and Fs in his math classes. His projective tests showed deep isolation, somewhat regressed

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object relations and narcissistic defenses. On the other hand, the psychologist felt that he had a fairly intact sense of self. The psychologist used the phrase that he believed Gerald could be "socialized by his peers" if the negative relationship between him and his parents could be interrupted. This testing became part of the context of the treatment. My colleague became part of the treatment system. The testing supported my belief that Gerald did not have some crippling pathology, nor, despite his gangster fantasies, was he actively sociopathic. The testing provided an idealizable selfobject experience for the treatment system: I was "held" by it and was able to continue to hold the parents' anxiety. This precipitated a subtle but powerful shift in the treatment system: from one that was equal and collaborative—in which an atmosphere of shared exploration predominated, and parenting suggestions were avoided—to one in which I gradually began to intervene to alter the pathogenic concretization.

Interventions The underlying assumption that guided my attempts to intervene in the family process was a belief that, if the all-encompassing enactment could be interrupted, Gerald's longing for selfobject experiences with his peers could be mobilized, and his developmental arrest reversed. To this end 1 made the following suggestions to the parents: 1. They should stop endlessly questioning, arguing, complaining and cajoling Gerald. I explained to the parents that this aspect of the family process was keeping Gerald stuck, and though he might try very hard to engage them in it, that they should try and resist as best as they could. 2. In place of these endless go-rounds, they should use a strategy I called "touch and go," in which they gave Gerald short bits of feedback about the effect of his behavior on them, such as "I really dislike your sarcastic answers," or "You really worried us last night when you came in late." If Gerald responded to these by trying to argue, they were urged to break the argument off as soon as possible. In addition to interrupting the enactment, I felt that this suggestion would interrupt the faulty mirroring (i.e., the hovering, the fascination) that

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supported Gerald's grandiosity and replace it with more accurate responses which might foster his self-delineation. 3. They should remove all academic pressure from Gerald, and tell him that from now on, his decisions were his own. All of their attempts to get Gerald to study—including grounding him for long periods of time—had failed, and in many ways had been counterproductive. Grounding him had only isolated him further from any developmentenhancing contact with his peers. Pressure to perform only heightened the anxiety that Gerald's oppositional imperviousness was trying to mask. 4. They should try to facilitate his moving out into the world. Gerald was about to turn seventeen and did not have a driver's license—a significant developmental delay for a young California boy. The parents told Gerald that they expected him to get a license and begin to provide his own transportation, and that if he would get a job for the summer, they would help him buy a car and pay for his insurance. I framed these interventions around the interpretation that, based on the psychological testing, I now felt that Gerald was basically all right, but that he needed to stop being so embroiled in the family and get on with his life. I interpreted Gerald's attempts to re-create the family imbroglio as an attempt to hold onto something safe in the face of the daunting task of moving into the world. The results were very encouraging. The parents were able to bring their confusion and struggles about these suggestions to the sessions, and to ask for my help, which let me know that they were not reacting defensively to them. During this time I urged them to try and rely on each other for clarification and support, which they were able to do. The parents reported that Gerald's behavior began to change. Although he still frequently tried to engage them in absurd arguments, he also began to be more open and pleasant. He began having dinner with the family again, and occasionally wore colors other than black. He took his family up on the offer to get a car. He got a summer job at a company that manufactured stereo speakers. He asked Don to teach him how to drive. He failed his driving test twice, yet persevered and passed it on the third time. Given the pervasiveness of his grandiose defenses, the fact that he was able to endure the failures and persevere was a most hopeful sign.

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Several months after I made my suggestions, Don was called out of town to run his agency's relief efforts at a major natural disaster. Theresa was quite labile at first, but with the help of nightly phone consultations with Don, she was able to maintain the implementation of the interventions on her own. During this time I met with the parents whenever Don was in town, about twice a month on the average. Theresa gained great self-confidence in her parenting ability, and this confidence enhanced other areas of her life. She applied for and received a promotion to a more creative part of her company. She decided to go back to finish her degree and was accepted at a prestigious women's college. Gerald developed a much wider social life, including many friends his own age. He began to date, and even brought his girlfriends home. In a telling detail, Theresa reported that one of Gerald's girlfriends had looked askance at him when he went into one of his sarcastic tirades, and that he had stopped himself and began to act more politely. It appears from this story that his desire for an approving selfobject response was stronger than his need to maintain his grandiose defenses within the family. Gerald's school performance improved somewhat, but still remained an area of concern for the family.

Discussion This case illustrates the way the family system was organized by the subjective worlds of the three members, and also way it was forced out of stability by the twin vectors of Gerald's entering puberty and Theresa's development in therapy, especially her remembering shameful experiences from her own adolescence. This shame, concretized around the secret circumstances of Gerald's conception, threatened the family self's cohesiveness, as well as the organization of each member's subjective world. Theresa became more emotionally labile and would often lapse into fragmented self states. Gerald severed his ties with the family and began to sustain himself with his grandiose fantasies. And, as Gerald began rebelling against the academic pressure that came with Don's parenting, Don came into contact with his own suppressed wishes to rebel and became dissatisfied with family life. The family self was flooded with potentially destabilizing affects, which defensively became organized in the family as the belief that there was something bad or even destructive at its core that they must work very hard to fix.

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Both Gerald's behavior—acting mysteriously, being rude, failing in school—and the parents' response—hovering solicitously, vigilantly monitoring his every action—were an enactment that concretized this belief. The enactment allowed the parents to try to control this badness, and to attempt to keep the family self from further fragmenting. This family self was created by a confluence of the subjective organizations of the individual family members. Gerald's mysterious and oppositional behavior, along with his kung fu gangster fantasies, were part of a defensive grandiosity (Orange, Atwood and Stolorow, 1997; Morrison and StolorowT, 1997) against the underlying belief, formed in the intersubjective field with his mother, that he was bad or unlovable. According to Morrison and Stolorow, this "conscious, noisy grandiosity" is not a derivative of unmediated archaic grandiosity, still longing for an approving mirroring response, as Kohut (1971) thought, but a defense against the overwhelming experience of having that archaic grandiosity traumatically crushed. The imperiousness ("I don't need you") keeps the longing for such mirroring repressed. We can speculate that Theresa nonverbally communicated to Gerald her shame at his being the product of an affair, perhaps by responding warily to his expansive moods or attempts at self-delineation. When he entered adolescence, Gerald's budding sexual interest and renewed attempts at self-delineation were crushed by the twin traumas of his mother's fragmented withdrawal (which would be followed by periods of overzealous parenting) and Don's rejection (which was also masked by periods of solicitous behavior). Identifying the defensive nature of Gerald's grandiosity allowed it to be understood not as a disguised communication of his selfobject needs, that is, a cry for attention or an attempt to mobilize his parents, but as a strategy that was keeping him isolated both from his own selfobject longings and from any chance of a development-enhancing selfobject experience. The maintenance of this defense required his refusal to live in the real world, since doing anything on the material plane (taking a test, expressing a feeling) threatened to defeat the defense and expose the underlying affects of shame and rejection. Don's self organization was similar to Gerald's, if less all-encompassing in its defenses. His attempts to remain constantly idealizable in the family were a kind of defensive grandiosity. They functioned to ward off his needs for an attuned response to his own states of sadness or de-

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pletion, as well as his longing for mirroring approval for his attempts at self-delineation—selfobject experiences denied him by his family's requirement that he be their hero and savior. Gerald's adolescent rebellion concretized Don's disavowed longings for self-delineation. As the treatment progressed, Don began to voice his own dissatisfactions with family life. When Gerald ran away, Don was able to say that he felt completely defeated and depleted: "This is just not the way I dreamed the family would turn out. I go back and forth between being worried sick about Gerald and being sick of the whole thing." When he would say things like this, Don would often look to Theresa to see if she disapproved. Theresa, to his surprise, would often express great relief, saying that his expressions of negativity helped her to accept her own negative feelings. This illustrates the way that Theresa's self-state was itself contexrually bound to Don's: when he became less defensively grandiose, she became more self-accepting. Theresa's self organization reflected Stolorow, Brandchaft and Atwood's (1987) conceptualization of the borderline as a "precarious, vulnerable self in a failing archaic selfobject bond," but it also showed impressive resilience in the presence of a restorative selfobject experience. Her relationship with Don reflected the twin aspects of her relationship with her father. As mentioned earlier, Don often provided her with an idealizable, calm selfobject experience that brought her back from severe states of fragmentation. But there were other times when these same qualities were provocative, because they reminded her of the way her idealizing tie was traumatically ruptured by her father's sexual misuse of her. At those times she would push Don away and lapse into states of profound agitation. When we look at Gerald's situation systemically, we see that he was in a double bind, for he was being called upon to simultaneously concretize Don's grandiosity by succeeding, and also to concretize Theresa's shame by acting as an extension of her badness. Many of the interventions were directed at freeing him from this bind. Gerald's dramatic improvement demonstrates the power of family therapy as a treatment modality for children and adolescents. It offers the potential to change the intersubjective field between the child and his caregivers, interrupting injurious patterns and replacing them with more development-enhancing ones. In this case the shift was facilitated by a change in the way the parents organized their experience of Ger-

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aid. Prior to treatment, both parents habitually replaced their spontaneous feeling response to Gerald's obnoxious behavior, that is, anger and disapproval, with one that was organized around their own sense of inadequacy. This organizing activity had the effect of reifying Gerald's "badness" and forcing him into his defensive grandiosity. In a therapeutic atmosphere of sustained empathic inquiry, Don and Theresa began to believe that they could be adequate parents and that Gerald, though he had many fears, could successfully move into the world. The family self became reorganized into one that allowed greater selfdelineation—Gerald's increased social life, Theresa's return to school, Don's career-enhancing relocation, while still providing connection. Interrupting the family enactment merely allowed Gerald respite from his need to maintain at all costs his grandiose defenses. This, in turn, allowed him to express some of the genuine expansiveness and self-delineation that are an intrinsic part of adolescence. The long-term effects of Gerald's missing these critical opportunities for self-development would have been very deleterious. There are several unique advantages that the intersubjective systems approach offered to this treatment. It is true that the same interventions could have been made by a therapist informed by other theories. An object-relarions-oriented therapist would have looked at the good/bad splits in the family system, seen Gerald's behavior as a product of projective identification and intervened to block the delegation of badness to Gerald. However, intersubjectivity, which does not reify intrapsychic structure, allows for the possibility of a much more fluid shift in the meanings and organizations of family experience, facilitated by the therapist's empathic attunement. Indeed my belief that Gerald's symptoms were a product of the family context and that his internal world could change rapidly if the parents' view of him changed was a constituent and invaluable part of the intersubjective field of the treatment. In addition, the intersubjective systems approach offers the following advantages: 1. Intersubjectivity doesn't pathologize or blame. The family therapy movement, which originated as a reaction to the tendency to blame the individual for his pathology, has too often blamed the family for the child's pathology (Lansky, 1981). This often leads an authoritarian family therapist, redirecting the families communication patterns, to

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inadvertently re-create the traumatic intersubjective experiences that created the family's defenses in the first place. 2. An atmosphere of sustained empathic inquiry allows the disavowed selfobject yearnings in the family to emerge. The repetitive dimension of Theresa's family experience led her to believe that revealing the secret of Gerald's conception would lead to discounting or further shaming. As a result of my staying empathically attuned to her experience, a myriad of selfobject dimensions emerged: the family became a place where the parents fostered a belief in each other's competency, family life became thematized by the possibility of change, etc. A crucial component of this atmosphere was my willingness to work with the family without the participation of the identified patient. By remaining attuned to the meaning of Gerald's refusal to participate, I refrained from conveying a sense of blame either to him or to the family. 3. Intersubjective treatment is characterized by a commitment to investigate the intersubjective field created by the therapist's entrance into the family system. As stressed throughout this book, intersubjective therapy does not include prescribed techniques, rules or procedures. The correct timing of my interventions was not the product of omniscience. I made numerous interventions prior to the ones that proved effective. However these precipitated disjunctions. By exploring the meanings that my earlier suggestions had for the family, I was able to repair the disjunction and, most importantly, develop the empathic bond that allowed my later interventions to be effective. As this case indicates, the dialogue between the family therapy movement and psychoanalysis that began in the 1950's-—involving such vital questions as, Who is the patient? How do we understand symptoms? What is the goal of therapy?—is far from over. An intersubjective systems approach enriches this dialogue by allowing family therapy to extend its reach into the darkest corners of the individual family member's subjective experience, such as Theresa's abuse-based shame or Gerald's terrible fear of his parents' rejection.

CHAPTER 10


Self psychology, intersubjectivity and infant research, with their emphasis on developmental systems, give us powerful tools for identifying the origin of pathology in the child/caregiver relationship. The intersubjective systems approach, by understanding the way the subjective worlds of the child and the parent are inextricably and reciprocally intertwined, offers the possibility of interrupting the process of pathogenesis itself. Interventions at the level of the individual parent can alter the organization of the parent/child dyad and affect the development of the child's subjective world. Parenting has become a daunting task for many in an age of random school violence and relentless pressure on children to succeed. Anna Omstein (1999) points to an alarming pattern in which parents are acutely afraid of disappointing their children. As a result, children are so lacking in the experience of an idealizable, affect-regulating selfobject that their emotional lives become ungovernable. Although family life is itself embedded in wider systems of culture and society, the therapist who treats families and children is faced with the immediate problem of addressing a child's derailed development. This chapter offers an approach to treating pathogenic familial patterns and interrupting the replications of pathology over generations. Trop (1995) reports a pathogenetic instance that will serve as a pivot for our discussion. 159

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Joan was a toddler who entered the elevator on the eighth floor with her mother. She looked at me shyly and started to smile, and looked away. She then immediately glanced up at the numbers above the doors in the elevator. They were lit up in different shades of colors, and she was transfixed and excited by the changing numbers as the elevator descended. Her face was alive and happy with excitement. At this point, her mother looked apprehensive and said to Joan, "Don't worry. The elevator ride will be over in a minute" (p. 35). Trop goes on to say, "Here we see an unconscious organizing principle in the making." The child learns that affects of vitality have to be disavowed in order to maintain the tie with her mother. Internalizing the conviction that states of expansiveness are dangerous, she unconsciously organizes her experience accordingly. How might a therapist intervene to interrupt such troubling pathogenic patterns, breaking a cycle before it generates adult pathology? In child/caregiver dyads, a little can go a long way. Therapeutic interventions that enhance, however transiently, the quality of parenting can alter the child/caregiver system in such a way that it begins to function as a source of developmentenhancing experiences for child and caregiver alike. The enhanced self-esteem that comes from more effective and satisfying parenting can be a powerful motivator for the parent's own development. At the systems level, the same leverage that can ominously magnify pathology can also magnify health. As Anna and Paul Ornstein (1985) point out in their pioneering work applying self psychology to the treatment of the parent self. "The conception and birth of a child 'reopen' adult self-development and constitute a potential for further consolidation of the adult self" (p. 195). Providing one's children selfobject experiences that were missing in one's own childhood can mark a profound shift from a life endlessly dominated by the invariant organizing principles such deficits engender to a life of hope and possibility. Two examples come to mind: a woman whose mother treated her as an extension of herself went out of her way to recognize and sponsor the individuality of her two children; and a man expected from age four on to be the "little man" in his family joyfully accepted his daughter's age-appropriate rebelliousness.

CLINICAL APPLICATIONS Because pathogenic patterns and attachment disorders are often visible in infancy (Beebe, 1999), preventive interventions (e.g., Fraiberg, 1980; Stern,


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1995), have most often focused on helping caregivers and infants during the first 18 months of life. A systems view, which sees development as an ongoing process, does not consider the earliest years as deterministic. As the case of Gerald demonstrated, pathogenetic patterns can be interrupted as late as adolescence. There are a number of different clinical situations where parental therapy is applicable, including (1) cases where the referral for a child's problem leads to conjoint or individual work with the caregiver, (2) cases of adult patients who describe, as part of their larger analytic themes, troubles with the parenting of their own children and (3) cases in which conjoint work with caregiver and child is integrated into an ongoing individual therapy. As with combining individual and couples therapy, the last of these clinical situations violates the rules that have governed strict analytic practice. Again, I maintain that intersubjectively informed therapists can work directly with outside relationships, including patients' children, while still maintaining the depth and power of a therapeutic alliance. The task of changing the caregiver's deep-seated organizing principles—such as Joan's mother's belief that expansive affects are dangerous—is daunting, especially when one sees the child's own unconscious organizing principle being formed and feels increased pressure to intervene. Many therapists get triangulated in such cases and consciously or unconsciously begin blaming the parent. This is an empathic failure by the therapist, who has lost contact with the most important part of the therapeutic alliance with parents: their motivation to be better parents. This alliance is built by empathic inquiry on the part of the therapist, who is seeking not to judge but to understand parents' subjective experience of parenting. The result can be a sense of shared purpose. Four elements that will facilitate and support this shared purpose merit attention: • empathic introspection as a method for understanding the meanings of a caregiver's experience of parenting; • a developmental perspective that focuses on the age-related issues impacting both the child and the caregiver; • awareness of the types of pathogenic child/caregiver systems; and • treatment considerations related to the different types.

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EMPATHIC INTROSPECTION There is a strong analogy between the empathic/ introspective clinical approach described in Chapter 6 and the skills of parenting. In the pre verbal stage the caregiver uses her own thoughts and feelings to enter into the infant's experience. That empathic introspection develops into a "schema of being with" (Stern, 1995) the infant. The caregiver's invariant organizing principles can impair the establishment of a schema that accurately responds to the child's needs. Ironically, these organizing principles, which arose in the face of repeated selfobject failure in the caregiver's childhood, now serve to perpetuate such selfobject failure. We can only speculate what kind of childhood experiences led Joan's mother to so aggressively downregulate her child's expansive affects. In treatment, the therapist creates an atmosphere of empathic introspection that "holds" the caregiver, and vicariously the parent/child dyad, in a developmentally necessary milieu. This kind of treatment works on several levels at once. The therapist's way of relating can serve as a model for the caregiver's parenting. Moreover, the therapist's commitment to correcting misunderstandings and malattunements within this treatment milieu can model the establishment of a system of mutual regulation between caregiver and child. The therapist's nonjudgmental investigation of the meanings caregivers impute to their parenting and their children's behavior can eventually make these meanings available to conscious control. To quote Daniel Stern, "if one can change how a mother subjectively experiences herself as a mother, that is, the representation of herself with her infant, . . . she will end up behaving differently in at least some of their interactions. The infant will have to alter his behavior to adjust to the new interactive reality" (1995, p. 15). The caregiver can assimilate the change in the child's behavior as a parenting success, further consolidating the change in his or her parental selfrepresentation.

DEVELOPMENTAL CONSIDERATIONS From the prenatal period (Brazelton and Cramer, 1990) into adulthood, the caregiver/child dyad forms a system of mutual regulation. The system must change over time to meet the needs of the developing child. The child's development poses challenges for the parent, whose own developmental


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needs are part of the dynamic child/caregiver system. Understanding those challenges and the reciprocal dynamics of mutual regulation can help locate the source of a specific fixation in the system, a pivotal step in formulating an intervention. When the caregiver and child are developmentally out of synch—a not uncommon problem—the caregiver may organize the child's affect around her own competing needs or re-emerging repetitive themes— and be misattuned to the child's. For instance, a caregiver who herself is fixated at the level of primary boundary formation may misread an oedipal child's aggression as a pushing away, rather than a lively request for engagement. Her need to defend herself from intrusive or threatening affects would lead her to misread as a serious threat her son's braggadocio ("If you don't give me that toy, I'm going to cut your head off"). It is particularly useful to look at the specific affects that characterize each developmental phase—the relentless self-delineation and angry frustration of the toddler, the sexualized affection and grandiose aggression of the oedipal child, the serious determination of the latency-age child, the emotional lability of the adolescent—in terms of the issues they raise for the caregiver/child system. Each calls for an attuned and containing response on the part of the caregivers. Of course the best source of this attunement is the caregiver's experience of having worked through the phase and consolidated the developmental tasks involved: "I was just like that at his age," or "I know I had to test the limits to find out what was right for me." Conversely, misattunement derives from the child's triggering the awakening of unworked-through developmental phases, as when a parent who never went through a rebellious phase lives vicariously through a teenager's acting out. Let us look in particular at the demands on the caregiver's self in the oedipal stage, when the child/caregiver system is flooded with powerful affects of sexuality, affection and aggression. According to Heinz Kohut (1977), "The parents will react to the sexual desires and to the competitive rivalry of the child by becoming sexually stimulated and counteraggressive, and, at the same time, they will react with joy and pride to the child's developmental achievement, to his vigor and assertiveness" (p. 230). Healthy regulation of the affects in question on the part of the caregivers mandates first allowing themselves to enthusiastically participate in them, and then modulating them, through "empathic contact with the developing self of the child" (p. 234) into pride and approval. Missteps can occur in both phases of this process. The caregivers' invariant organizing principles around affects of aggression or expansive sexual-

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ity may derail their ability to enthusiastically participate in them with their child. Or the parents' own overwhelming selfobject needs and narcissistic vulnerability may block their ability to make empathic contact with the child's newfound developmental achievements, leading to misuse of the child's sexuality or overreaction to his aggression. Kohut saw the parent's healthy response to the oedipal phase as an "expression of the fact that the parental selves are fully consolidated, that the parental selves have formed stable patterns of ambitions and ideals, and that the parental selves are experiencing the unrolling of the expression of these patterns along a finite life curve" (pp. 233-234). Looking at such a consolidation less as a fait accompli and more as a challenge in the ongoing process of the development of the caregiver's parent-self helps define the therapist's objective: providing development-enhancing selfobject experiences for the caregiver—that is, mirroring her successes as well as her frustrations and disappointments, offering her the alterego interpretation that all parents struggle, and providing advice and soothing from an idealizable expert. In particular, the therapist must be attuned to the caregiver's own oedipal affects, as for instance of pride and aggression, and provide a selfdelineating selfobject experience to help the caregiver experience these affects as part of herself, rather than residing in the child.

TYPES OF PATHOGENIC SYSTEMS A N D THEIR TREATMENT The overarching factor contributing to parental dysfunction is "failure or partial failure of parental empathy," including "those of particular pathonomic significance in which the child was being 'used' as a selfobject for the maintenance of the parent's self cohesion or self-esteem" (A. Ornstein, 1999, p. 247). This misuse of the child, along with gross neglect and abuse, informs most pathogenic child/caregiver systems. The parent's narcissistic vulnerability, be it expressed as rage, inappropriate dependency or preoccupation, is central to the child's developing woes. As the Ornsteins (1985) point out, however, the caregiver's narcissism both fuels the provision of development-enhancing experiences and is the source of potential pathology: [The] developmental process is made possible because of the narcissistic investment that parents have in their children. While it is this narcissistic investment


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in the child that assures adequate parental care, it is also the narcissistic nature of the parent-child tie that makes parenting a vulnerable adult function and accounts for its various forms of pathology (p. 201). All parents need the gratification, for instance, of seeing the child as a "chip off the old block," but pathogenic parents are so hungry for that gratification that the child cannot be seen as anything more than a chip. The treatment approaches discussed in this chapter utilize the transference experiences of the caregiver with the therapist to affect change in the child/caregiver system. These transferences can exist in a number of treatment modalities: within conjoint family treatment, as one part of therapy with a patient who is a parent, as part of a brief, focused individual treatment aimed at correcting a parenting problem, or, as in the case example below, in a treatment that combines conjoint and individual work. The primary task of treatment is the investigation, without judgment, of the meaning that the child's behavior, especially symptomatic behavior, has for the caregiver. The therapist must seek to understand those emerging meanings within the context of the caregiver's developmental issues and within the context of the developmental stage of the child /caregiver system. Only then can the therapist attempt to provide development-enhancing selfobject experiences for the caregiver, as well as for the child, if the treatment is conjoint. A classification of pathogenic child/caregiver systems is useful in guiding the provision of these selfobject experiences. For purposes of clarity I have classified four particular types of parental empathic failure and the pathogenic child/caregiver systems they engender. Misidentification, Delegation. In these systems, the caregiver misidentifies the child's affects, often viewing the child as an extension of him or herself. This of course is the case in the above-cited example of Joan and her mother on the elevator, in which the child's joy is misidentified because of the mother's projection of her fear. This type of system often arises from the caregiver's incomplete boundary formation. Often the parent identifies the child as a part of her self, that is, as an extension of her bad self or grandiose self (Brazelton and Cramer, 1990). A variant of this is when the caregiver identifies the child as another person, for example, a spouse or parent. In the most extreme cases, this progresses from "You are just like so and so," to "You are so and so." Often the delegation of identity is organized by the loss

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of a parent or grandparent—this process is described by Selma Fraiberg's (1980) famous phrase "ghosts in the nursery." In the case of the overidentifying or misidentifying caregiver, the careful provision of self-delineating experiences, which help the caregiver to identify her own affects, can facilitate boundary formation between caregiver and child. A parent like Joan's mother experiences affects as pervasive and universal (I'm feeling it so you must be too.) A careful exploration of the parent's experience, facilitated by the therapist's provision of mirroring and self-delineating selfobject functions, can help the parent to see that affects originate in her own subjective experience and are not always properties of the environment or of the child. The "splitting" that informs the delegation of badness or greatness to a child is a particular challenge to the parental therapist. To a Kleinian therapist, this splitting and the accompanying projective identification onto the child are evidence of the caregiver's primaiy developmental arrest. Again, the problem with this point of view is that it fails to take into account the specific intersubjective contexts in which this delegation takes place, including that of the larger family, that of the particular child and his or her endowment and personality and, most importantly, that of the treatment itself. In a treatment context in which blame or judgment is unconsciously communicated, the caregiver will have more shame or unmet dependency needs, and hence more need to project or delegate. An attuned response to the narcissistic vulnerabilities of parenting, on the other hand, will lessen that need. It is important to note again that empathy does not preclude confrontation—telling a parent that he or she is misrecognizing the child can be profoundly empathic. It must be done, however, in the service of the parent's development, not in the service of the objective "truth." The delegation of another's identity to the child, particularly that of a lost loved one, poses a similar challenge. Here again the parent's unworkedthrough grief (or other feelings) is assigned to the environment, rather than located in his or her self. The task here is to investigate carefully the meaning of having a child just like so and so, with the aim of facilitating a workingthrough of the parent's feelings toward that person. Requiring Selfobject Functions from the Child. All parents rely on their children to supply a sense of pride and connection, but this reliance turns pathogenic when the child is required to meet the parents' needs to the detriment of his or her own development, as in the case of caregivers who look to the


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child to constantly mirror them, or who rely on the child to be endlessly idealizable. These issues arise from the caregiver's narcissistic vulnerability, as well as from the selfobject failures of the present-day surround. In these cases, the therapist needs to investigate the context of the caregiver's unmet needs—including his or her own childhood and present-day relationships. Beyond that, he will move to perturb the caregiver/child system by providing selfobject experiences directly, through support, attuned responses to the caregiver's successes or struggles, and his or her function as an idealizable expert. Even though these selfobject experiences are unlikely to be immediately structuralized by the caregiver, they provide a respite for the system from the relentless needs of the caregiver. The system can then begin to function at a more differentiated level of organization. Neglect. Systems in which the caregiver is unresponsive or angrily rejecting of the child arise from a complex of problems, including the caregiver's lack of available energy due to depression or other self-disorders, or the child and the caregiver being constitutionally a poor fit. The factor in common is that all involve profound empathic failure. The caregiver either ignores or misreads both the child's needs and his reaction to the neglect. A particular form of neglect is the situation mentioned above in which the caregiver is so solicitous of the child's affection that he or she fails to provide a container for the child's affects. Anna Ornstein (1999) describes this particularly modern form of pathogenesis, in which "the parents' way of relating seems to be linked to their need to secure their child's love and to their anxiety that they will not be regarded by their children as 'good parents.'" Such children "experience their parents as weak, depriving them of a developmentally crucial experience of being merged with a strong and competent caregiver" (p. 247). These children are prone to fits of rage, both as an attempt to elicit a regulatory response from the caregiver and as a desperate attempt to cope with the fragmentary self-states the selfobject failures engender. Because of the number of possible causes of caregiver neglect or rejection, the third class of pathogenic systems requires a variety of different responses and interventions. For the poorly attuned dyad, an educational function may be needed, in which the therapist helps the caregiver identify and understand the child's various affects. Depressed parents will need direct treatment for the depression, as well as support for their parenting. These caregivers often need an alterego experience that will let them know

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that many parents struggle just as they do. This can go a long way toward alleviating the sense of guilt and alienation that such parents carry. Rage. Rage and abuse can arise in a variety of contexts, including those in which the child fails to live up to his delegated role or fails to meet the caregiver's selfobject needs. The child can also become triangulated into a parental conflict, serving as a scapegoat or surrogate target. In the cases where the child becomes the target of the caregiver's narcissistic rage, the child is ominously caught in a system where the rage serves to shore up the caregiver's shaky sense of self. In all cases the overall treatment goal is to interrupt the cycle of anger and restore empathy to the child. The therapist acts as the missing container in the system, listening carefully to the caregiver's anger and investigating its source. Angry parents are often simply overwhelmed. Treatment of these cases involves case-management issues of finding wider support systems or helping with problems such as marital conflict. The latter is particularly important if the child is being triangulated into the conflict. Narcissistically enraged parents are the most difficult to treat. The therapist must seek to understand the vulnerability and selfobject failures that underlie the rage. This may require the therapist to reply nonjudgmentally to the caregiver's distortions and projections. The goal is to stabilize the parent in order to enable him to begin to meet the child's needs. In conjoint work, the therapist attempts to interrupt the cycle by having the parent and child talk directly to the therapist. Often the caregiver and the child will each need his or her own individual therapist. As useful as this classification may be, in practice we are likely to see child/caregiver systems that present some combination of these patterns, as when rage or neglect are mixed with usurpation or overidentification.

CASE EXAMPLE The case of Nancy and her son Alex illustrates the importance of taking into account both the child and the mother's developmental issues in parental therapy. Nancy's lack of empathy for Alex could only be understood in the multigenerational context of her own mother's lack of empathy to her, as well as the context of Nancy's relationship with her ex-husband, an addict who abused her. The treatment focused not on


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correcting faulty parenting, but on creating a context for Nancy to experience parenting as part of her own development. Nancy is a single mother in her late thirties. Her son, Alex, is five. Alex's father, Tom, is a heroin addict, who went on a violent rampage when Nancy separated from him two years ago. Alex's contact with his father is presently limited to monthly supervised visits. The family originally contacted me at the suggestion of Alex's day-care teacher three years ago. The situation was untenable for family treatment. Alex's father was stoned and abusive in the sessions, at one point threatening to kidnap the boy. These sessions were soon broken off. About six months later, Nancy contacted me because she was planning to leave Tom. Since that time she has been in weekly individual treatment with me punctuated by occasional conjoint family sessions with Alex. Nancy works as an administrator for the local university. Nancy's own family background is patrician New England, but her father never lived u p to the expectations of his Ivy League background. Nancy describes him as very spineless and at her mother's beck and call. Her mother is a highly narcissistic woman, given to bouts of depression. Nancy remembers having been held responsible for "mom's moods," as she puts it, "forever." Her own mother's malattuned parenting is exemplified by an incident where young Nancy, aged two years, didn't want to walk across sand because she didn't like the feel of it between her toes, and her mother not only made her walk across sand, but teased her about it for years after. To Nancy this model scene came to symbolize the way her mother would never allow her to be a child, particularly if her childishness required extra effort for her mother, such as carrying her across the beach. Nancy's primary defense was to disavow her dependency needs and become as self-sufficient as possible. She withdrew into books, a habit that continues to this day. Indeed, through therapy she has come to understand that she unconsciously chose an addict for a partner because he wouldn't make emotional demands on her. Alex presents as a rather dreamy child, not quite put together, verbally quite precocious but emotionally immature. His teachers report that he is a likable child, but given to emotional outbursts. Almost from his birth, Nancy has found child rearing a dreary chore. She felt that she couldn't wait for the day when Alex would begin to take care of himself. Of course this needs to be understood in the context of her being

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the sole breadwinner for the family as well as being a de facto single mother before she actually became single. Nonetheless, the child/caregiver system was marked with a rather ominous repetition of Nancy's own childhood in which she was required to be a "little adult" and not trouble her mother. As therapy progressed and Alex grew older, Nancy reported much greater satisfaction in parenting. The following incident happened in a conjoint session with Alex and then was discussed in a subsequent individual session with the mother. Alex had asked if he could get ice cream after the session and Nancy had said no, he already had a treat in his lunch. After some unsuccessful cajoling, he said that he wanted to live with Paul and Ann, friends of the family, because they always let him have treats. The mother proceeded to reason with him about that choice, saying, well O.K., but have you considered this and this and this, concluding with the fact that Paul and Ann were planning to move to Texas, and that's very far away. Finally, Alex gave up and said that he didn't really want to go live with them. Nancy was very pleased with herself for outwitting him. Alex seemed withdrawn for the rest of session. In the subsequent individual session, Nancy wanted to know what I thought about the incident. I replied that I'd be glad to tell her, but I'd first like to hear about it from her. She described being pleased with herself for how she'd kept her cool and helped him to a reasonable conclusion. This was a very important moment. My own opinion was that Nancy was being unempathic to Alex and inappropriately counteraggressive. But I also realized that she was looking for a mirroring response from me for her developmental achievement in not reacting like her narcissistic mother would have—by getting upset and scolding her for saying such a thing. Although I saw a considerable amount of narcissism in her triumph of reason over Alex, I also understood that she was proud that she did not take his desire to live with another family as a personal wounding. From Nancy's point of view, there was a playful liveliness in her debate with Alex. Even if Alex did not respond to this playfulness and seemed depressed in the session, his best chance of ever getting such a response from his mother lay in my supporting her first, faltering attempts to provide it. I interpreted my understanding of how this playful debate with Alex was an important accomplishment for her and she seemed veiy relieved.


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My provision of this mirroring was akin to the famous gleam in the eye that Kohut saw in the "good enough" oedipal parent, a phase that this caregiver/child dyad was reciprocally engaged in. Just as the oedipal parent mirrors the developmental thrust of the child's pride and expansiveness, I was mirroring the developmental thrust of Nancy's developing parent self, rather than subjecting it to my standards of good parenting. We talked for a bit about her growing strength as a parent and how far she'd come. This moment of intersubjective relatedness is the crucial prerequisite to creating any shifts in the parent self. Following my interpretation, Nancy began to speculate about how her mother would have responded if Nancy had made a statement like Alex's: "She would either have mocked me or pouted." I replied that all her life she had been surrounded by confusion about how old she was supposed to be, and how old the people around her were. I mentioned that this makes it hard to sense how old she feels inside or how old Alex is. I detected her stiffen as she felt a hint of my judgment at her misrecognition of Alex's age. I tried to investigate her reaction to my comment, but she drew a blank. I realized that I was making the same mistake as her mother made with her, talking to the pseudo-adult parent self, rather than to the just developing self that was savoring her newly acquired parental skill. Seeking to find a way to repair this disjunction, I asked her if she had a sense of how she'd hoped I would respond to the incident with Alex. Again she drew a blank. I made a comment that all parents need guidance, appreciation, and a sense that other parents have the same problems, and perhaps something like this was what she was after. She brightened considerably and told me how something she read in a book helped her tremendously with bedtime. When I refocused our attention on her selfobject needs, rather than the moment of selfobject failure caused by my earlier interpretation, she remembered the idealizable book and displayed a much more consolidated and vital self. She then asked me to tell her more about what I thought of her interaction with Alex. I told her that, while I agreed it was an important accomplishment for her not to respond directly to Alex's provocation, I thought the best thing would have been just to reassure Alex that you knew how frustrated he was about not getting a treat, but that you were the parent and you were going to make the im-

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portant decisions like where and with whom he was to live. She smiled and said she liked that idea very much.

Discussion This brief vignette illustrates several aspects of the treatment of the parental self: • This type of pathogenic system is one in which the caregiver views the child as an extension of herself. Nancy misidentifies Alex as a "little adult" just as she was so misidentified by her own mother. Rather than moving to build empathy for Alex by interpreting to Nancy my understanding of his experience, I focused on her own experience and affects. My providing this self-delineating experience will eventually help her to respond to Alex as a separate person. • The case illustrates the need for the therapist to put aside countertransferential judgments and explore, through empathic immersion, the meaning that a particular behavior or interaction has for the caregiver. • The context of Alex's oedipal development created a context for Nancy that both exposed developmental arrests and opened new pathways for their resolution. Both child and mother were looking for a mirroring response to their newly acquired assertiveness, and both feared a withering, counteraggressive response, Alex from his mother, Nancy from me. Treatment that recognizes the reciprocal nature of development within the parent/child system will not only better understand the way they can become entrenched, but also understand the selfobject experiences the system needs to become unentrenched. • The case also demonstrates the way parenting provides a "second chance" to master developmental tasks and overcome trauma. Parenting for Nancy evolved from a chore to a proud accomplishment as she developed the capacity to love and to feel empathically attuned to another. She considered these achievements "steps away from Mom." Indeed, toward the end of her treatment, Nancy reflected that becoming a better parent was the most important gain she had made. In this case, the conjoint treatment with Alex, as well as the ongoing discussion of parenting in individual sessions, was an essential


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part of Nancy's individual treatment. Just as strengthening a patient's intimate relationships should be an important consideration in individual treatment, so should strengthening the relationship between patients and their children. Nancy responded to the selfobject failure of her childhood by developing a powerful schizoid-like defense system. Indeed, part of the hidden attraction of her relationship with Tom had been the way his addiction allowed her to maintain these schizoid defenses. During the course of treatment, parenting Alex became for Nancy the first real relationship she had ever had. The possibility that she could become a good mother came to mean to her that she did not have to live the rest of her life trapped in the isolation and shame of her schizoid world. My support of her parenting became a vital and tangible link between the laborious work of dismantling the schizoid defenses and her growing belief that an alternative was possible.


Epilogue

As this book is about the synergy between individual growth and the strengthening of relationship ties, it is fitting to end with a description of a moment in treatment that exemplifies both. And since we began with the case of Richard and Beth and have referred to it throughout the book, it is appropriate that the example come from their case. As Richard and Beth's treatment progressed, real progress alternated with times when Beth, retraumatized by something that reminded her of the affair, or by aspects of the relationship that were destructive to her, would lapse into bitter denunciations of Richard. For a long time Richard took these denunciations stoically, only increasing Beth's bitter conviction that he really didn't care at all and was just hiding his cards under the table. After one particularly bitterly tirade, Richard abandoned his lifelong defense of hiding his vulnerability and began to cry. "I just can't take your criticism anymore, Beth. You've just got to stop, or we're not going to make it." The effect on Beth was not immediate; in fact, she accused Richard of trying to make her look like the bad guy when it was he who had had the affair. But Richard's shift did perturb the system and eventually reverberate in Beth. A week or two after Richard broke down, Beth came into a session and announced, "I've been thinking that it's time for me to stop being so angryAll I'm doing is pushing Richard aw^ay, and I really don't want to be this isolated." Couples therapy is marked by these quiet moments that reveal a shift in each partner's subjective world. They offer hope that a relationship that for years has stifled each partner's growth in an endless cycle of anger and defensiveness can become a place for them to risk opening to new ways of being and to new dimensions of intimacy.

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Ornstein, A. (1994). Trauma, memory, and psychic continuity. In: A Decade of Progress, Progress in Self Psychology, Vol. 10. Goldberg, A. (Ed.). Hillsdale, NJ, Analytic Press. Ornstein, A. (1999). Changing patterns in parenting: comments on the origin and consequences of unmodified grandiosity. In: Pluralism in Self Psychology, Progress in Self Psychology, Vol. 15, pp. 245-258. Goldberg, A. (Ed.). Hillsdale, NJ, Analytic Press. Ornstein, A. and Ornstein, P. (1985). Parenting as a function of the adult self: A psychoanalytic developmental perspective. In: Parental Influences in Health and Disease. Anthony, J. and Pollack, G. (Eds.). Boston, Little, Brown. Ornstein, P. H. (1991). Why self psychology is not an object relations theory: clinical and theoretical considerations. In: The Evolution of Self Psychology,

References 181 Progress of Self Psychology, Vol. 7. Goldberg, A. (Ed.). Hillsdale, NJ, Analytic Press. Ornstein, P. H. (1993). Chronic rage from underground: reflections on its structure and treatment. In: The Widening Scope of Self Psychology, Progress in Self Psychology, Vol. 9. Goldberg, A. (Ed.). Hillsdale, NJ, Analytic Press. Renik, O. (1993). Analytic interaction: conceptualizing technique in light of the analyst's irreducible subjectivity. Psychoanalytic Quarterly, 62:553-571. Ringstrom, P. (1994). An intersubjective approach to conjoint therapy. In: A Decade of Progress, Progress in Self Psychology, Vol. 10, pp. 159-182. Goldberg, A. (Ed.). Hillsdale, NJ, Analytic Press. Rosenbaum, R. and Dyckman, J. (1995). Integrating self and system: an empty intersection? The Family Process, 34:21-43. Scharf, D. and Scharf, J. (1987). Object Relations Family Therapy. Northvale, NJ, Aronson. Shaddock, D. (1998). From Impasse to Intimacy: How Understanding Unconscious Needs Can Transform Relationships. Northvale, NJ, Aronson. Shane, M., Shane, E. and Gales, M. (1997). Intimate Attachments. New York, Guilford. Siegel, J. (1992). Repairing Intimacy. Northvale, NJ, Aronson. Siegel, J. (1997). Applying countertransference theory to couples therapy. In: Countertransference in Couples Therapy, pp. 3-22. Solomon, M. and Siegel, J. (Eds.). New York, W. W. Norton. Skynner, A. C. R. (1976). Systems of Family and Marital Psychotherapy. New York, Brunner/Mazel. Slipp, S. (1984). Object Relations: A Dynamic Bridge Between Individual and Family Treatment. Northvale, NJ, Aronson. Slipp, S. (1988). Object Relations Family Therapy. Northvale, NJ, Aronson. Solomon, M. (1989). Narcissism and Intimacy. New York, W. W. Norton. Solomon, M. (1997). On love and lust in therapeutic treatment. In: Countertransference in Couples Therapy, pp. 136-154. Solomon, M. and Siegel, J. (Eds.). New York: W. W. Norton. Solomon, M. and Siegel, J. (1997). Countertransference in Couples Therapy. New York, W. W. Norton. Stierlin, H. (1977). Psychoanalysis and Family Therapy. New York, Aronson. Stem, D. (1985). The Interpersonal World of the Infant. New York, Basic Books. Stern, D. (1995). The Motherhood Constellation. New York, Basic Books. Stern, S. (1994). Needed relationships and repeated relationships: an integrated relational perspective. Psychoanalytic Dialogue, 4:317-345.

182 References Stolorow, R. (1993). Thoughts on nature and therapeutic action of psychoanalytic interpretation. In: The Widening Scope of Self Psychology, Progress in Self Psychology, Vol. 9, pp. 31-44 Goldberg, A. (Ed.). Hillsdale, NJ, Analytic Press. Stolorow, R. (1994). The intersubjective context of intrapsychic experience. In: The Intersubjective Perspective. Stolorow, R., Atwood, G. and Brandchaft, B. (Eds.). Northvale, NJ, Aronson. Stolorow, R. (1997). Dynamic, dyadic, intersubjective, systems: An evolving paradigm for psychoanalysis. Psychoanalytic Psychology, 14(3):337-346. Stolorow, R. (1999). The phenomenology of trauma and the absolutisms of everyday life a personal journey. Psychoanalytic Psychology, 16(3):464-468. Stolorow, R. and Atwood, G. (1992). Contexts of Being. Hillsdale, NJ, Analytic Press. Stolorow, R., Atwood, G. and Brandchaft, B. (1994). Introduction to The Intersubjective Perspective. Northvale, NJ, Aronson. Stolorow, R., Brandchaft, B. and Atwood, G. (1987). Psychoanalytic Treatment: An Intersubjective Approach. Hillsdale, NJ, Analytic Press. Sucharov, M. (1990). Quantum physics and self psychology: toward a new epistemology. Presented at the Thirteenth Annual Meeting on the Psychology of the Self, New York, NY. Sucharov, M. (1994). Psychoanalysis, self psychology, and intersubjectivity. In: The Intersubjective Perspective, pp. 187-202. Stolorow, R., Atwood, G. and Brandchaft, B. (Eds.). Northvale, NJ, Aronson. Sucharov, M. (1999). Representation and the intrapsychic: Cartesian barriers to empathic content. Delivered at the 22nd Annual International Conference on the Psychology of the Self, Toronto, Canada, October 28-31, 1999. Thelen, E. and Smith, L. B. (1994). A Dynamic Systems Approach to the Development of Cognition and Action. London, MIT Press. Trop, J. (1994). Conjoint therapy: An intersubjective approach. In: A Decade of Progress. Goldberg, A. (Ed.). Hillsdale, NJ, Analytic Press. Trop, J. (1995). Self psychology and intersubjectivity. In: The Impact of New Ideas. Goldberg, A. (Ed.). Hillsdale, NJ, Analytic Press. Trop, J. (1997). Personal communication cited in Shaddock, D. (1997). An intersubjective approach to conjoint family therapy. In: Conversations in Self Psychology, Progress in Self Psychology, Vol. 13, pp. 289-306. Goldberg, A. (Ed.). Hillsdale, NJ, Analytic Press. Ungar, M. E. and Levene, J. E. (1994). Selfobject functions of the family: implications for the family. Clinical Social Work journal, 22(3):303-316. Weinstein, D. (1991). Exhibitionism in group psychotherapy. In: The Evolution of Self Psychology, pp. 219-234. Goldberg, A. (Ed.). Hillsdale, NJ, Analytic Press.

References 183 Wile, D. (1988). Couples Therapy. New York, Wiley. Willi, J. (1982). Couples in Collusion. New York: Jason Aronson. Williams, W. C. (1963). Paterson. New York, New Directions. Winnicott, D. (1965). The Maturational Process and the Facilitating Environment. New York, International Universities Press. Wolf, E. (1988). Treating the Self. New York: Guilford.


Index

Abandonment, feelings of, 24, 52-53, 103,106,125; and creating trust, 111; and cycles of reconciliation, conflict and breakup, 116; and family therapy, 146; and trauma, 56 Abstinence, 19-20 Abuse: and concretization, 26; and parental therapy, 168-169; and selfassertion, 120 Accommodation, pathological structures of, 59-60. See also Sexual Abuse Trauma Addiction, 62, 168-169 Adolescence, 4—5, 27-28; and family therapy, 149-158; and parental therapy, 163 Affect: in Atwood, 38; centrality of, 37; cognitive articulation of, 41-42; desomatization of, 41-42; and developmental theory, 27-28; differentiation, 41; and family therapy, 143-144, 146; integration, 28; and mirroring, 34; overview of, 27-28; and parental therapy, 159-160; and pathogenesis, 28; regulation, 37,144; and selective attunement, 35; tolerance, 41,146; use of, as a self-signal, 41 Aggression, 123 Alan and Ruth (case study), 133-139 Alcoholics Anonymous, 40 Alcoholism, 1-4, 9, 40; and childhood experience, 111; and family

therapy, 146; and systems theory, 81,87 Alex (case study), 168-173 Alienation, 58 Alterego, 38, 40, 46; and family therapy, 143, 146; and metaphors, 41; and parental therapy, 167-168; and systems theory, 89 Andrea (case study), 111 Andy (case study), 116-117 Anger, 25, 105, 136, 138; and family therapy, 144; and parental therapy, 163; and self-assertion, 120; and strengthening attachment, 121, 122. See also Rage Annihilation, sense of, 30-31, 125 Antidepressant medications, 131 Anxiety: and cure in couples therapy, 121, 124; and family therapy, 152; and the listening stance, 96; and strengthening attachment, 121 Attachment: and developmental theory, 27-28; and parental therapy, 160-161; patterns, 74-75; strengthening, 110,121-122 Attractor states, 76, 81 Attunement, selective, 35 Atwood, George, 7-9,12-14; abandonment in, 53; affect in, 28; and intersubjective theory, 18,19; borderline in, 54; boundary formation in, 144—145; child development in, 27; the concept offrame in, 128; concretization in, 26; dissociation in, 57; dynamic 185

186 Indexsystems theory in, 71; idealizing in, 39; intrusion in, 53; listening perspective in, 94; motivation in, 23; retraumatization in, 50; the self in, 23; self-doubt in, 58; selfobject in, 37; shame in, 61; trauma in, 56; the unconscious in, 25-26 Authoritarian therapist, 144 Autonomy, 52, 53 Bacal, H., 55 Basch, M , 39, 40 Bedtime rituals, 147 Beebe, Beatrice, 71, 73-75, 78-79,121, 126 Belonging, sense of, 40 Benjamin, J., 18 Bergman, A., 27, 28 Beth (case study), 1-6, 9-11, 54-55, 72, 81-91,120-121,133, 175 Bipolar transference, 22, 49-50, 79 Bisexuality, 123 Blame: of disjunction, on patient resistance, 21; and family therapy, 157; and individual therapy, 10; and mirroring experiences, 119; and parental therapy, 166; and systems theory, 87; and trauma, 56; using "I" statements instead of, 109 Blanck, G., 51 Blanck, R., 51 Borderline states, 1-4, 29-30, 72; and the alterego selfobject, 40; and the listening stance, 95; and structural deficits, 54 Boundaries, 144-146, 163, 166 Bowen, M., 125 Brandchaft, Bernard, 28, 59-70; boundary formation in, 144-145; family myths in, 144; idealizing in, 39; selfobject in, 37 Buddhism, 40 Burch, B., 128 Cartesianism, 7, 126 Catholicism, 58, 101 Child/caregiver relationship: and developmental theory, 27-28, 36-37; and family therapy, 144-145;

and the interplay between self and mutual regulation, 73-76; and organizing principles, 24; and parental therapy, 160-167; and selective attunement, 35; and sexuality, 122; similarity of marriage to, 42,122; and types of selfobject experiences, 38-41; and the unconscious, 24-25. See also Infancy Child custody, 34-35, 45, 47 Classical orientation, 91 Codependent relationships, 62 Concretization, 26-27, 57,146-147 Confidentiality, 129-130 Conjunction, moments of, 20-21, 34, 91 Connection, sense of, fostering, 22 Constmctivist orientation, 91 Context, 2, 4, 8-9; dependence of psychic reality upon, 6; and the listening stance, 106; and the notion of cure, 110, 124; and a unified theory of psychoanalytictherapies, 14—15 Contexts of Being (Stolorow), 7 Conversion symptoms, 26 Coping skills, 124 Counterindications, 131-133 Counter-transference, 20-21, 90; and the listening stance, 100-101; and individual therapy, combination of, with couples therapy, 128. See also Transference Cure, notion of, 109-126 Cybernetic thinking, 115-117 Darius (case study), 50-51, 60, 64-67 Deconstruction, 17 Defenses: and family therapy, 146,155; and shame, 61-62; and trauma, 56, 57-58 Defensive pessimism, 57-58 Delegation, 165-166 Dependency: and shame, 61; and the unconscious, 25 Depression, 44,122, 130; and fostering self-reflection, 113; and parental therapy, 167-168

Index Desomatization, of affect, 41-42 Development: -enhancing experiences, creating, 22, 47,110, 118-119,155; supporting each partner's, 125; theory, 27-31, 35-37, 51-52 Diabetes, 1 Dicks, H.V., 42 Difference, tolerance of, 124-125 Differentiation, 41,125,144-145 Diithey, Wilhelm, 94 Disappointment, 33-34, 72, 121 Disjunction, moments of, 20-21 Dissociation, 57 Divorce: and child custody, 34-35, 45, 47; in the therapist's personal history, 92 Dualism, 7 Dyckman, J., 142 Dynamic systems theory, 6,13-14,17; and case examples, 81-89; and family therapy, 144; overview of, 69-92; and parental therapy, 161; and relationships, 76-77; and the therapist as part of the system, 89; views of marriage in, 70-71 Dynamic unconscious, 25. See also Unconscious Ego, 23 Ego psychology, 51 Empathic immersion, 172 Empathic inquiry, sustained, 21, 22, 93, 94, 144, 157, 158. See also Empathy Empathic/introspective method, 93-107, 161, 162. See also Empathy Empathy, 4, 10; and conjunctions, 21; as an investigative tool, 100; and optimal frustration in relationships, 55-56; and parental therapy, 161-162,168,172; and providing developmental selfobject experiences, 46—47. See also Empathic inquiry, sustained; Empathic/introspective method; Listening stance Epistemology, 2, 6; and intersubjective theory, 7, 9; and the listening stance, 97

187

Family life cycle, 73 Family myths, 144 Family self, 142, 144 Family therapy: case example, 147-158; and concretization, 146-147; and empathic inquiry, 144, 157, 158; interventions, 152-154; overview of, 141-149; and psychoanalysis, gulf between, 8; and the repetitive pole of famity experience, 145-146 Fear: and self-assertion, 120; of repeating, 50,125; of retaliation, 120 Feedback, 138,152 Feminism, 17 Fishman, H., 144 Focus areas, 110-122 Fragmentation, state of, 2, 8, 22; and concretization, 26; and family therapy, 144,156; and selfobject failure, 35 Fraiberg, Selma, 166 Frame, analytic, 12,128,129; and family therapy, 144; and the importance of staying within subjective experience, 38 Frank, J., 90 Freud, Sigmund, 7, 23 Frustration, optimal, 55-56 Gail (case study), 33-38, 44-46 Gales, M , 8, 10, 66, 71 Gaslight (film), 3 "Gaslighting," 3, 6 Gerald (case study), 144, 147-158,161 Gift giving, 6 "God's eye" objectivist stance, 97 Grandiosity, 84, 87; and family therapy, 147,153-155,157; and the listening stance, 96; and parental therapy, 165 Group self, 142 Growth, sponsoring each other's, 119-120 Guilt, 45,105 Hermeneutics, 17

188

Index

Hoffman, I., 17 Holding environment, 79, 99; and parental therapy, 162; strengthening the, 110, 117-118 Homeostasis, 71, 144 "Homework," 109 Hope, 3, 22, 35, 124 Humor, 121 Iatrogenic behaivior, 21 Id, 23 Idealizing: and family therapy, 155; overview of, 38, 39-40; and systems theory, 80 Identification, projective, 123 Identity: and concretization, 146-147; delegation of, 165-166; maintenance of, 52 Incest, 51,150. See also Sexual abuse Individual therapy, 64,116; case example, 133-139; combining, with couples therapy, 127-130; and conjoint therapy, rethinking the boundary between, 11-12; and counterindications, 131-133 Individuality: and developmental theories, 27; and family therapy, 145 Infancy: and centrality of affect, 37; and the interplay between self and mutual regulation, 36-37, 73-76; and selfobject experiences, 27; Winnicott on, 27. See also Child/caregiver relationship Infidelity, 1, 3-4, 9-10, 50-51; and family therapy, 145; and rage, 64 Integration, affect, 28 Internalizations, 123 Intersubjective, use of the term, 18 Intersubjective relatedness, use of the term, 18 Intersubjective theory: and abstinence, 19-20; and Cartesianism, 7,126; conceptual links provided by, 6; and critiques of reification, 11; and development theory, 27-31; and family therapy, 157-158; and the frame, concept of, 12, 38,128, 129, 144; and individual therapy,

127-128; and the listening stance, 93; and neutrality, 19-20; overview of, 8-10, 17-32; and pathogenesis, 27-31; and the structure of the subjective world, 23-27; and successful interpretation, 22; and sustained empathic inquiry, 21, 22; and systems theory, 71; and a unified theory of psychoanalytic therapies, 12-15 Interventions, 106, 152-154 Introspection, 94-95, 110 Intrusion, 52-53, 56 Isolation, 22 "1" statements, 109 Jacobs, E., 142 Janetta (case study), 50-51, 57, 60, 64-67 Jenkins, C , 128 Kafka, Franz, 40 Kernberg, G., 123 Kernberg, O., 123 Kohut, Heinz, 22, 33, 35, 46; alterego in, 40; empathy in, 93, 94; and family therapy, 141, 145; and intersubjective theory, 19-20, 21, 23; narcissistic rage in, 63; oedipal stage in, 163-164; optimal frustration in, 55; phases of therapy in, 112; selfobject in, 8, 27, 36, 3 8 ^ 1 , 4 3 , 53-54, 145; transmuting internalizations in, 123 Lachman, F., 71, 73-74, 79,121 Langs, R., 12 Lansky, M., 142, 144 Lateness, habit of, 24 Laura (case study), 116-117 Levertov, Denise, 115 Levine, J. E., 143 Life cycle, family, 73 Listening, reflective, 112, 119. See also Listening stance Listening stance, 21, 109; case example, 101-107; and fostering selfreflection, 112; and longing, 96,

Index 106-107; obstacles to, 96-97; othercentered, 113-117; overview of, 93-107 Livingston, M., 123 Longings, 33, 77,115; and biopolar transference, 49-50; and Levertov's description of marriage, 115; and the listening stance, 96, 106-107; and rage, 64; and self-maintenance, 44 Love, hallmarks of mature, 123 Loyalty, 129-130 Lynn (case study), 101-107 McRorie, Ed, 71, 74-75, 78, 121, 126 Mahler, M., 27, 28, 53 Manic-depression, 64 Marohn, R. C , 63 Max (case study), 111 Medications, 131 Memory, and the unconscious, 24 Metaphor, 45, 54; selfobjects as, 40-41; and systems theory, 71 Midlife crisis, 132 Minuchin, S., 144 Mirroring, 11, 34, 37-40, 47; basic description of, 38, 39, 40; in case studies, 66; exercises, 109; experiences, creating, 47, 118-119; and family therapy, 145, 152, 155-156; and individualtherapy, combination of, with couples therapy, 135; and the listening stance, 106; and metaphors, 41; and mutual regulation, 37; and parental therapy, 164, 166, 167, 171; and shame, 61; andstructural deficits, 55; and systems theory, 80, 87; and trauma, 56 Miscarriage, 76-77 Misidentification, 165-166 Mitchell, S„ 17, 124 Morality, 123,130 Morrison, A., 39, 60,155 Motivation, 23-24 Mutual regulation, 36-37, 73-76, 77, 78-79, 91 Myths, family, 144

189

Nancy (case study), 168-173 Narcissism, 1-2, 4, 10; and the achievement of equilibrium, 123; and attachment, 121; and family therapy, 142,145, 152; healthy, 35; and individual therapy, 130, 137; and the listening stance, 95, 99; and metaphors, 41; and parental therapy, 164-168; and pathogenesis, 28; and rage, 63-64; and structural deficits, 53-56; and systems theory, 72; and the unconscious, 25 Neglect, 167-168 Neutrality, analytic, notion of, 19-22 Neutralization, 123 "No person" psychology, 69-92 Nonbeing, convictions of, 30-31 Nuclear family, 41 Object relations theory, 8, 51-52,123, 125

Objectivist stance, 97 Oedipal phase, 63, 87, 90 Open systems, 76. See also systems theory Orange, D., 8,12-14; concept of frame in, 128; dynamic systems theory in, 71; shame in, 61 Organizing principles, 24, 49-50; in case studies, 65-66, 67; and cure in couples therapy, 123; and parental therapy, 161; and self-assertion, encouraging, 120; and selfreflection, 112; and systems theory, 78, 92 Ornstein, Anna, 159-160, 164-165; dread of repeating in, 50; pathogensis in, 167 Ornstein, Paul, 36-47, 43, 63, 160, 164-165 Parables, 11 Paradigm shifts, 6, 7-10,17, 36, 71-72 Parent self, 160 Parental therapy: case example, 168-173; developmental considerations for, 161, 162-164;

190

Index

and empathy, 161-162,168, 172; interventions, 160-161; and mirroring, 164,166, 167,171; and pathogenic systems, 159-161, 164-168, 172; and requiring selfobejct functions from the child, 166-167 Passivity, 84 Pathogenesis, 27-31,159-161,164-168, 172. See also Pathology Pathology, 43, 123, 129; and accommodation, 59-60; and the child/caregiver relationship, 28; and family therapy, 152, 157; motivation that underlies, 23-24; and trauma, 56. See also Pathogenesis Pessimism, defensive, 57-58 Phenomenology, 14, 18, 23 Physics, 17 Pine, R, 27, 28 Positivism, 17 Possibility, 34-35 Postmodern orientation, 91 Pre-oedipal phase, 53 Principles, organizing, 24, 49-50; in case studies, 65-66, 67; and cure in couples therapy, 123; and parental therapy, 161; and self-assertion, encouraging, 120; and selfreflection, 112; and systems theory, 78,92 Process, notion of, 109-126 Projection, 57,123 Protocols, 129-131 Proust, Marcel, 42 Psychoanalysis: and intersubjective theory, 19-22; overview of, 19-22; paradigm shifts in, 6, 7-10,17, 36, 71-72 Psychological testing, 153 Psychotic states, 26, 30-31 Pursuit /avoidance relationships, 34, 53; and individual therapy combination of, with couples therapy, 139; and systems theory, 78

Quantum physics, 17 Rage, 63-64, 99,167, 168. See also Anger Reasoning, practical, 109 Regression, 43, 56,123 Regulation: affect, 37, 144; mutual, 36-37, 73-76, 77, 78-79, 91; self-, 73-76, 77, 78-79, 91, 122 Reification, 11 Religion, 40, 58,101 Remembrance of Things Past (Proust), 42 Renaissance, 7 Repetition, fear of, 50,125 Repression: of anger, 25; and pathogenesis, 28 Resistance, 49 Retaliation, fear of, 120 Retraumatization: and alienation, 58-59; and disjunction, 21; and the dynamic unconscious, 25; fear of, 59-60; and pathological accommodation, 59-60; and rage, 64; Stolorow and Atwood on, 50. See also Trauma Richard (case study), 1-6, 9-11, 33-38, 44-46, 54-55, 72, 81-91, 120-121, 133, 175 Rigidity, 77 Ringstrom, P., 41, 43, 50 Rosenbaum, R., 142 Ruth (case study), 133-139 Sacrifice, theme of, 143-144 Salience, three principles of, 74, 79, 122 Scharf, D., 142 Scharf, J., 142 Schizophrenia, 7 Selective attunement, 35 Self: assertiveness, 63,120-122; cohesive sense of, 24; false, 29; family, 142, 144; group, 142; and the listening stance, 93, 98; loss of, 30-31; and mutual regulation, interplay of, 36-37,73-76; and other, 8, 126; parent, 160; sense of, overview of, 23. See also Selfobject Self-articulation, 41

Index Self-assertion, 63,120-122 Self-cohesion, 8,10, 25 Self-development, 43-44 Self-disclosure, 12 Self-doubt, 58 Self-esteem, 23, 72, 164 Self-maintenance, 43-44, 80 Selfobject, 3-5; and abandonment, 53; and abstinence, 19-20; and admiration, 5; basic description of, 8, 36; and bipolar transference, 22; and the child/caregiver relationship, 37; dimensions of family experience, 143-145; dimensions of marriage, 42-43; experience, developmentenhancing, 22, 47, 110, 118-119, 155; experiences, types of, 38-41; failures, 3-4,19-20, 29, 35, 41-42, 53; functions from the child, requiring, 166-167; functions, understanding, 33-35; and the importance of staying within subjective experience, 37-38; injuries, naming/repairing, 145; in Kohut, 8, 27, 36, 38-41, 43, 53-54, 145; and the listening stance, 100; mature experiences of, 43; and metaphor, 40-41; and mirroring, 38, 39; and the nature of a good marriage, 33; needs, universality/normalcy of, 36; overview of, 27; and parental therapy, 171,173; and pathogenesis, 28-31; repetitive systems versus, 79-81; and shame, 61; and structural deficits, 53-56; and transference, 36. See also Self; Self psychology Self psychology, 8, 18; and abstinence, 20; and the importance of staying within subjective experience, 37-38; and the listening stance, 93, 98; and motivation, 23; and parental therapy, 160; and systems theory, 71 Self-reflection, 111-113

191

Self-regulation, 73-76, 77, 78-79, 91,122 Separation, 27, 52 Sexual abuse, 21, 26; and alienation, 58; and concretization, 26; and family therapy, 149-151,156-158. See also Abuse; Incest Sexuality, 34, 51; and the child/caregiver relationship, 42; and cure in couples therapy, 124; and family therapy, 149-151, 155, 156-158; and individual therapy, combination of, with couples therapy, 134; and parental therapy, 163, 164; and shame, 62; and strengthening attachment, 121, 122; and systems theory, 90. See also Sexual abuse Shame, 39, 119; as a barrier to intimacy, 60-63; delegating, 62; and family therapy, 144,150, 155; and the listening stance, 96, 99 Shane, E., 8, 10, 66, 71 Shane, M , 8,10, 66, 71 Siegel, J., 91, 117 Sleep, 147 Slipp, Samuel, 142 Smith, Linda, 69-70, 122 Soft-assembled systems, 77, 79 Solomon, M., 71,100; empathy in, 117; mutual selves in, 142; narcissistic equilibrium in, 123 Splitting, 166 Stern, Daniel, 18, 22, 73-74, 162 Stern, Steven, 22 Stolorow, Robert, 7-9, 12-14, 53-55, 71-72, 128; abandonment and intrusion in, 53; affect in, 28; bipolar transference in, 49-50; boundary formation in, 144-145; child development in, 27; concretization in, 26; dissociation in, 57; family myths in, 144; grandiosity in, 155; idealizing in, 39; on interpretation, 22; and intersubjective theory, 18, 19; listening perspective in, 94; motivation in, 23; the objectivist

192

Index

stance of the therapist in, 97; paradigm shifts in, 17,141; the self in, 23; self-doubt in, 58; selfobject in, 37; shame in, 61; trauma in, 50, 56; the unconscious in, 25-26 Stress-reduction counseling, 40 Strong attractors, 76 Subjective experience, the importance of staying within, 37-38 Subjectivity, 7, 37-38 Substance abuse, 1-2, See also Alcoholism Sucharov, M., 71 Suicide, 46 Superego, 23, 123 "Supraordinate" function, of concretization, 26 Suprasystems, 77, 141 Systemic intervention, 106 Systems interpretations, making, 110, 115-117 Systems theory, 6, 13-14, 17; and case examples, 81-89; and family therapy, 144; overview of, 69-92; and parental therapy, 161; and relationships, 76-77; and the therapist as part of the system, 89; views of marriage in, 70-71 Terrence (case study), 101-107 Testing, psychological, 153 Thelen, Esther, 69-70,122 Therapeutic alliance, 129, 131-132, 161 Totalist orientation, 91 "Touch and go" strategy, 152 Transference, 5, 7, 36; alterego, 40; bipolar, 22, 49-50, 79; counter-, 20-21, 90, 100-101, 128; and creating trust, 111; cure, 46; and idealizing, 39; and individual therapy, combination of, with couples therapy, 127-128, 136; and neutrality, 19; as organizing

activity, 49; overview of, 20-21; and parental therapy, 165; and providing developmental selfobject experiences, 46; and systems theory, 72, 90 Trauma, 49-67,129, 168-172; and family therapy, 145, 155, 156; and fragmentation, 35; and the listening stance, 96; and neutrality, 19; overview of, 30. Sec also Abuse; Retraumatization Trop, Jeff, 89, 91,100,123,159-160 Trust, creating, 110,111-113 Truth: absolute, notion of, 17; and the listening stance, 97; about the patient's unconscious mind, 18 Twelve-step programs, 2, 40. See also Alcoholism Unconscious, 15,128; access to, blockage of, 6; dynamic, 25; and the listening stance, 95; and organizing principles, 24; prereflective, 24-25; and shame, 62; and successful interpretation, 22; and systems theory, 70, 91; three realms of, 24-26; truth about, 18; unvalidated, 25-26 Ungar, M. E., 143 Unified theory, of psychoanalytic therapies, 12-15 University of Indiana, 70 Unreality, feelings of, 58 Validation, 42 Weak attractors, 76 Weekend getaways, 34-35, 44-45 Weinstein, D., 142 Winnicott, D. W., 27, 117 Wolf, E., 123 Zero-sum games, 47

Contexts and Connections: An Intersubjective Systems Approach to Couples Therapy

Schema Therapy with Couples

Handbook of Couples Therapy

Handbook of Couples Therapy

Clinical Manual of Couples and Family Therapy

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