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Inside out, or outside in: meeting with couples
Hugh Jenkins
a
The complex difficulties often faced by couples require a range of modelsfor effective help. Relational intensity is heightened in therapy by the easewith which the therapist can be triangled into the couple’s relationshipand by the influence of the emotional triggers from their respectiveinternal worlds.This article draws on systemic and psychodynamic models and atransgenerational perspective for gendered stories. Different time frame-works link interpersonal and intrapersonal themes. In this sense, thetherapist works ‘inside out’ and ‘outside in’. A framework of behaviours,emotions, feelings, meanings and beliefs is proposed to help link theseperspectives. ‘Invisible contracts’ and the sense of there often being anunconscious ‘pact to disappoint’ are described.Clear models are not enough, for it is the intimate encounter betweenclient and therapist that is the bedrock of therapeutic change and growth.There is no short cut to this sense of intimacy in the unique encounter between therapist and each new couple. Brief examples from practicedescribe how the issues discussed may be addressed in couples work.
Introduction and background
[O]ne can get along for quite a time with an inadequate theory, but notwith inadequate therapeutic methods.(Jung, 1931 [Chodorow, 1997, p. 85])
Much of what we do in the moment as therapists is to respond, toinitiate, or to ‘be’ in certain ways. Later we take stock and askourselves how and what this was, and either attempt to link it to aframework, or to develop one that somehow fits with events. This isfrequently a process of attempting to conceptualize the relationship between our reciprocal roles, of making sense of ourselves in relationto others in their relationships to us. An exception to this is the
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The Association for Family Therapy 2006. Published by Blackwell Publishing, 9600 GarsingtonRoad, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA.
 Journal of Family Therapy
(2006)
28
: 113–1350163-4445 (print); 1467-6427 (online)
a
Institute of Psychiatry, London, and independent practice. Address for correspon-dence: 83 Hurstbourne Road, Forest Hill, London SE23 2AQ, UK. E-mail: ventris@dircon.co.uk.
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 2006 The Author. Journal compilation
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 2006 The Association for Family Therapy and Systemic Practice
 
original Milan Group (Palazzoli
et al.
, 1978, 1980), who set aboutdeveloping a way to describe relationships, a model of change andtherapeutic intervention methods that were internally coherent. Inthe light of these opening comments and the above quotation from Jung, the following brief case description highlights something of themixing of theory, method and use of self. It occurs in the ninth sessionwith a couple in their late fifties.The wife, Wyn, says that her husband, David, had told her that hewas not going to try any more. If they were to have a future,
she
had tochange. His history of depression during the second half of theirmarriage, his verbal and occasional physical outbursts had seemedintractable. When asked if that was ‘a fair view’, David agreed. Then,slowly, his expression changed, the colour of his face seemed to greyover, tears welled up in his eyes and flowed silently down his cheeks. Almost a minute passed in silence, during which I experienced apowerful urge, which I knew I would have to address in some way,emotionally, intellectually or cognitively. I knew that for me at least, itwould feel like a barrier about the unspoken if I did not trust myself and said or did nothing. In a quiet voice, I said, ‘If I were your father,I would come over and hug you now’, to this six-foot, 59-year-oldman. Then came the story of his father, a factory worker, who Davidfelt had never really held him physically, who had died when Davidwas 19 years old, and to whom he still spoke in his mind and wishedhe could tell of his career successes. Many authors attempt to describethat moment of encounter, when one steps out of the ‘safety’ of theoryand ‘being professional’. I have described this elsewhere, when onecannot fall back onthesecurity ofthe triedand tested,and from whichcan come a moment of liberation for both patient and therapist withan experience of relief as the unspoken, even the seemingly unspeak-able, is given voice (Jenkins, 2005, 2006).We will return later to this particular moment in therapy and towhat followed. However, it is important to state that while my internalresponse wasspontaneous, myarticulation was considered,using ‘trialidentification’ (Casement, 1985) which encourages an approach tem-pered by carefulness. Goldbeter-Merinfeld (1999) speaks similarly of the importance of responding to resonances (
 re´ sonances
) and of thedanger of invasion (
envahissement
) of the client and how we must payattention to the dynamic of the therapist–client relationship, echoingthe theoretical approaches of psychodynamic theorists. While it isimportant that we have clear theoretical frameworks to guide us inour work, it is essential that we be true to our intuition, grounded in
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experience. It is often that intuited ‘right brain’ response whichcreates the truly therapeutic healing moment (Damasio, 2000a,2000b; Pally, 2000; Schore, 2003a, 2003b), and conceptually it is themoment when left (language) and right (emotional abstraction) brainmeet to form articulated meaning. Stern (2004) refers to the momentof 
kairos
and the ‘now moment’ and the ‘moment of meeting’ (pp.165ff.). They are also moments of crisis, where the situation can never be quite the same again (Jenkins, 1989).Marital and couple relationships tend to be long term, have ashared history and a high level of personal investment – both in therelationship and in defining the emotional, psychological and sexualidentity of both individuals. The voluntary nature of Western-stylemarriages means that there is often considerable emotional pressure‘to make it work’. Where marriages are arranged and viewed muchmore as the bringing together of families, the pressure may be of not‘losing face’ and of not bringing shame on the family. Two people whochoose to live together may later find themselves caught in the mostpainful and destructive of relational dances. Fear of the consequencesof change being worse than the current pain may add to theconfusion, and the therapist who is drawn into this emotional forcefield risks being disempowered and becoming part of a new triangle(Bowen, 1978a; Dicks, 1967). Added to the emotional vortex in thepresent are the differing stories, beliefs, scripts and mental maps thateach brings from previous early life experiences. Some of thesethemes in couples work are examined from the perspective of vulnerability by Scheinkman and Fishbane (2004).Two therapeutic traditions, (psychodynamic and systemic), a trans-generational perspective for men’s and women’s gendered stories,and the interrelated perspectives of present, past and future timeprovide some of the structures for my practice. These are just that –structures – within which the therapist engages intimately with herclients. Different levels of description can help the therapist avoid becoming too focused on a single perspective (Goldner
et al.,
1990; Jenkins, 1985; Luepnitz, 1988), although understanding these theo-retical perspectives will not of itself ensure that there is a realtherapeutic encounter. Papp and Imber-Black (1996) elegantly re-concile some of the apparent contradictions of different therapeuticmodels by thinking in terms of themes, while safe practice comes fromself-questioning about the constantly evolving nature of the thera-peutic relationship (Sandler
et al
., 1992), influenced by gender, ages of the client, culture, ethnicity, (religious) beliefs, the nature of the
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