Attachment and PEP

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Record: 1
Title: Couple Narratives and Adult Attachment - Using Conversation Analysis in Assessment
Authors: Gross, Carola
Source: British Journal of Psychotherapy, 2014; v. 30 (4), p499, 18p
Document Type: Article
Language: English
Abstract: Observation of unstructured interactional dialogue in a clinical setting using the method of
conversation analysis found that couples at assessment interact in ways that show close
association with features determined from their adult attachment classification. Two
couples were selected from a cohort of research participants seeking couple
psychotherapy, both with high scores on the Conflict Tactics Scale (Straus, 1979), but with
different attachment status as independently assessed in individual adult attachment
interviews. Each couple was videotaped, without interviewer, in 15 minute discussions of
their problems. Their conversational strategies identified using Conversation Analysis
showed close agreement with those associated with each participant's adult attachment
status as independently derived using the Adult Attachment Interview. This study provides
a first step in building an evidence base for a joint couple attachment interview, as
proposed by Fisher and Crandell (2001).
Accession Number: BJP.030.0499A
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Couple Narratives and Adult Attachment - Using Conversation Analysis in Assessment

Carola Gross, author, 1953-2013 completed her MSc in Clinical Psychology at the Free University, Berlin, in 1982 and worked
initially as a scientific researcher at the Max Planck Institute and as a child therapist in Berlin until 1987. After further studies in
New York and London she graduated with an MA in Dance Movement Therapy from Hahnemann University/Laban Centre
London in 1992. Between 1988 and 2003 she worked in adult psychiatry as a clinical psychologist at St Clements Hospital in
East London whilst also training as a psychoanalytic psychotherapist at the Lincoln Centre for Psychotherapy, London. From
2003, as Consultant Lead Adult Psychotherapist at the Department of Psychotherapy, St Bernard's Hospital, West London, she
contributed to the development of borderline personality disorder services and postgraduate training. She served on the
Registration Committee of the British Psychoanalytic Council from 2006 to 2012. The research reported here formed part of her
Clinical Doctorate studies at the University of Essex/Tavistock Centre which she completed in 2011. The dissertation has been
prepared for publication by Laurence Higgens, her husband, with the assistance of Dr Georgia Lepper and Dr Avi Shmueli, both
of whom supervised the original research.; [Laurence_higgens@hotmail.com]
Observation of unstructured interactional dialogue in a clinical setting using the method of conversation analysis found that
couples at assessment interact in ways that show close association with features determined from their adult attachment
classification. Two couples were selected from a cohort of research participants seeking couple psychotherapy, both with high
scores on the Conflict Tactics Scale (Straus, 1979), but with different attachment status as independently assessed in individual
adult attachment interviews. Each couple was videotaped, without interviewer, in 15 minute discussions of their problems. Their
conversational strategies identified using Conversation Analysis showed close agreement with those associated with each
participant's adult attachment status as independently derived using the Adult Attachment Interview. This study provides a first
step in building an evidence base for a joint couple attachment interview, as proposed by Fisher and Crandell (2001).
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Introduction
Over the last two decades there has been an upsurge in attempts to provide an evidence base for psychoanalytic approaches to
both individual and couple psychotherapy(Fonagy, 2002). Whilst there is a considerable body of case study research on the
process of couple psychotherapy, there has been very little empirical research on the process of assessment in couple
psychotherapy (Lanman, 2003; Lanman & Grier, 2003). Attachment theory and associated empirical research studies remain one
of the most productive lines of development. One of the products of this work has been the adult attachment interview (AAI)
(George et al., 1996) that provides a validated instrument for baseline assessment of individuals entering therapy and for
monitoring progress in therapy. The AAI is an individual assessment instrument designed to elicit accounts of significant past
relationships. George et al.(1996) manualized the evaluation of these accounts by drawing on discourse analysis to produce a
description of current interpersonal functioning captured within the framework of attachment theory.
The AAI has also been usedto assess individuals before they enter couple therapy, but in a one to one assessment setting (Cohn
et al., 1992; Crowell & Treboux, 1995; Dickstein et al., 2001). The couple assessment situation differsinbeing triadic, with the
couple interaction being directly observable by the assessor. Currently, there are no validated assessment instruments based on
the AAI for use in the couple assessment situation. An approach to developing such an instrument has been outlined by Fisher
and Crandell (2001). They developed a Couple Attachment Joint Interview based on an adaptation of the AAI, and predicted
specific couple attachment configurations. Their proposal is based on the assumption that analysis of the couple interaction can
produce descriptions of the couple's interpersonal functioning using attachment theory classification. This study makes an initial
contribution towards validating this approach.
Fisher and Crandell (2001) envisaged devising methodologies based within attachment theory similar to the Strange Situation
Test (SST) (Ainsworth et al., 1978) and the AAI, combining interactive behavioural measures and narrative analysis. However,
the research methodology employed in this study is an approach developed outside attachment theory, namely conversation
analysis (CA) (Sacks, 1992a, 1992b). CA provides a method for analytically describing structural and procedural strategies
people use in their conversational interaction. In this study CA is applied to couple dialogues in an assessment setting to
determine whether it may be possible to derive the couple's individual attachment status from analysis of their interaction.
Attachment Status and Couple Functioning

The AAI as a validated instrument for accessing individuals' mental representations of early attachment bonds has encouraged
therapists and researchers to examine different domains of attachment in couple relationships (Cohn et al., 1992; Crowell &
Treboux, 1995; Fisher & Crandell, 2001; Hazan & Shaver, 1994; Kobak & Hazan, 1991; Mikulincer & Shaver, 2007). Studies in
adult attachment have been conducted within the research culture of developmental psychology, which link the AAI and its
foundation in early relationship experiences to an understanding of current relationships (Hesse, 2008; Roisman et al., 2007). In
Britain, this work has been taken up by Clulow and colleagues at the Tavistock Centre for Couple Relationships, integrating
psychoanalytic understanding of couple functioning and attachment theory (Clulow, 2001; Scharff & Scharff, 2005).
AAI-Based Studies in Couple Psychotherapy

Levy and Kelly (2009) reviewed the literature on the use of the AAI in clinical outcome research with different populations and
concluded that: ‘The AAI is an extremely rich and clinically relevant measure that generates narratives very similar to the
narratives commonly told in psychotherapy’ (p. 145). The literature on the use of the AAI in couple psychotherapy assessment
has been considerable, considering that it is a much smaller area of clinical practice and research. Hesse (2008) reviewed a
range of studies on the effects of attachment status on couple relations. He found that couples where both partners displayed
secure attachment characteristics were more able to use each other for support, to regulate affect, to reflect on themselves and
their partners, and generally engage in more constructive interactions; insecurely attached partners in the ‘dismissing’
subcategory displayed more hostility, controlling and distancing behaviour; those in the ‘preoccupied’ subcategory displayed
more anxiety and intrusiveness; and those with ‘unresolved insecure’ attachment status showed high degrees of negativity.
A number of clinical researchers have devised interviews, modelled on the AAI, but with a change of focus to examine adult
attachment in the couple relationship. Their underlying assumptions draw on Bowlby's developmental view that early attachment
relationships are prototypes of later partner relationships, as they shape the internal working models and mental representations
of self and other. Unlike the AAI, they assess mental representations of self and the adult partner by exploring different
attachment behaviours in their relationship. However, like the AAI, these interviews are conducted with individual partners, i.e. not
in joint interview settings (Cohn et al., 1992; Crowell & Treboux, 1995; Dickstein et al., 2001).
It is significant that all AAI-based studies and interview versions in relation to couple functioning were conducted in individual
interview settings. They relate to the couple dimension in the content of the interview, but not in the interview structure, i.e. they
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do not interview the couple together with the aim of utilizing the encounter for the purpose of examining the multi-faceted aspects
of attachment status as they manifest in the couple relationship.
By contrast, Fisher and Crandell (2001) took the joint interview approach when they spearheaded a new line of development for
the assessment of adult attachment - the Couple Attachment Joint Interview (CAJI). They built on the emerging results of studies
which demonstrate that one important quality in adult couple relationships is that both partners function as attachment figures for
the other at different times. They conceptualized this as ‘complexattachment’ because of the potential reciprocity of the roles both
partners take in relation to dependency needs and providing comfort and emotional security. However, the CAJI has yet to be
validated.
The semi-structured design of the CAJI is based on both the Strange Situation Test (SST) and AAI, and incorporates behavioural
observation and evaluation of the narrative. It is not directed at the individual partners, but at the couple as a unit. Attachment-
related questions, such as their ways of coping with illness, loss or separation, are aimed at exploring or examining their couple
relationship. Fisher and Crandell (2001) outlined the predicted patterns of couple attachment on the basis of their clinical couple
assessments, showing ‘couple “templates” of complexattachment’ (p. 21) that respectively comprise two overlapping attachment
configurations of behavioural and mental representations.
Fisher and Crandell's Couple Attachment Joint Interview (2001) seems to be unique and differs from other approaches of
assessing attachment status in relation to couple functioning, in that they aim to create a couple attachment score based on the
joint interview.
The Research Question

The importance of keeping the AAI as the ‘gold-standard’ for developing new approaches to attachment-based measurements
has been asserted by Crowell and Treboux (1995). An adaptation of the AAI to apply to couples beingjointly assessed is needed,
as assessments to date have relied on measures of individual partners' attachment status. Fisher and Crandell's (2001) outline of
a joint couple attachment interview aimed to fill this gap. They considered that, in addition to a semi-structured interview that
addressed attachment-related issues in the couple's relationship, an observational instrument that captured interactional
behaviour would be required. The study reported here applies CA as this instrument and sets out to support Fisher and Crandell's
proposed joint assessment by examining the extent to which the conversational strategies of the partners in interaction can be
used to identify their attachment status as determined by the AAI.
Methodology
This study comprises case studies of two couples selected to be matched on one variable (manifest conflict) and different on
another variable (attachment status). The method of conversation analysis (CA) is used to identify features of the couple
interactions which are then compared with conversational features used in the AAI to determine attachment status. The
hypothesis is that the conversational features identified by CA in the joint interviews will show close association with those
features associated with the individual's adult attachment status as determined previously from individual AAI interviews.
CA is based on the assumptions that:
Lepper & Riding, 2006Sacks, 1992a
Methodologically, CA's empirical strategy is to collect samples of naturally occurring data that are audio- or videotaped. The
recordings are transcribed in detail, including non-verbal data, e.g. silences, sighs. The transcripts aim to capture what was said
or done, the content of the conversation, as well as how it was said or done. The coding system used is made available to the
reader and the transcripts remain backed up by the recordings which allow access to the core data to enable independent
validation. Written transcripts are usually the main scripts the researcher works with, as their format allows micro-analysis of the
turn by turn interaction.
Transcription is followed by data analysis: finding patterns and characteristics in the respective talk-in-interaction. Sacks
emphasized that the initial analysis should not be limited by prior theoretical assumptions or motivations, but rather be guided by
‘unmotivated examination of some piece of data’ (Sacks, 1984, in Ten Have, 1999, p. 103). Schegloff elaborated on Sacks's
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principle of ‘unmotivated examination’ and described it as noticing of initially possibly ‘unremarkable features of talk or of other
conduct […] pursued by asking what - if anything - such a practice of talking has as its outcome’ (Schegloff, 1996, in Ten Have,
1999, p. 103). The value of this approach, which could be likened to the psychoanalytic stance of ‘free-floating attention’ when
listening to patients' narratives, is in tuning into naturally occurring talk among people, without imposing a priori assumptions.
Recently, a number of conversation analysts have applied CA in psychotherapy research, and psychotherapists have
incorporated CA in reflecting on their therapeutic work (Forrester & Reason, 2006; Lepper & Riding 2006; Peräkylä et al., 2008;
Streeck, 2004). This increase in interest has not been systematic, and Peräkylä et al.(2008) discuss likely reasons for this
situation.
This study drew on Ten Have (1999) who proposed a general strategy for data analysis comprising data exploration followed by
analytic elaboration, supported by data sessions, in which researchers jointly discuss and share their understanding of the
material.
Data Collection and Measures

The three sets of data for this study comprised (a) video recordings of assessment meetings of couples who jointly sought
psychotherapeutic help for their relationship problems and consented to taking part in a larger research project; (b) individual AAI
scores for participants (George et al., 1996); and (c) Conflict Tactics Scale (CTS) measures (Straus, 1979; Straus et al., 1996).
Independently and prior to this study all subjects were assessed by a trained AAI interviewer to determine their attachment
classification. These classifications were made available to the researcher at the beginning of the study.
Two couples were selected by the researcher for this study, chosen from a larger sample of 14 heterosexual couples forming part
of another larger research study. Ethical approval for the use of this data was sought and granted by the host institute's Ethics
Committee. Both couples selected presented with high conflict scores (CTS). The rationale for choosing participants with self-
reported high levels of conflict in their relationship was the assumption that they would display a greater dynamic range in their
interaction. One couple scored with a secure attachment status as assessed in individual AAIs; the other couple presented with
mixed attachment status. The AAI classifications were as follows: Mrs A dismissing; Mr A secure-autonomous; Mrs B secure-
autonomous; Mr B secure-autonomous.
The important factor here was that the couples had different combinations of AAIs to enable the research question to be
addressed.
Ideally, the couples selection would have been made by a person not involved in the data analysis so that the researcher was
blind to their attachment status. This was not possible partly because the researcher was working solo (this work formed part of a
doctoral research project) and partly because the research design evolved after the researcher had made an initial viewing of the
video data of all 14 participants and had been given the attachment data.
As noted above, in order to ensure validity of the data analysis, it is common practice for CA practitioners to present and discuss
their material in data sessions with peers. In this case this was done with a more experienced CA practitioner who was not aware
of the attachment status of the participants.
The setting was an outpatient psychotherapy department. Each couple was seated in an interview room with a video camera. An
interviewer gave each couple the task to talk together for 15 minutes about one of the main difficulties that had brought them to
this consultation, and to try to make some headway with it. They were told that they were not expected to come to a solution of
these difficulties. The interviewer asked them to start their discussion once he gave them a signal by knocking at the door from
the outside. The interviewer signalled the end of this assessment mode by again knocking at the door from the outside, before
entering the room. The couples were assured that the interviewer would be available to be contacted in the vicinity of the
interview room at any time.
Data Analysis
The videotapes were transferred to CD-ROM for ease of repeated viewing. The selected couple dialogues were repeatedly
viewed and transcribed in accordance with CA conventions. In this study three lenses, under which the data were analysed and
compared, were chosen after initial repeated viewings and analytic exploration of the material. The first focus was on openings or
beginnings, looking at how the couples started their conversation and negotiated the topic. The second approach examined how
the couples used questions and answers in their conversations, and their implicit strategies. The third perspective was that of
stories, looking at how the couples told their stories, and asking the question: what are the likely functions of these narratives in
their conversations. For each of the four participants in the study, characteristic features of their conversational strategies were
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distilled from each of these three CA perspectives and tabulated. Language feature sets from the AAI were then searched to find
matching or similar descriptors and these were tabulated alongside the CA descriptions for each participant.
Findings
Analysis of openings for couple A showed Mrs A as rejecting and dismissive, abruptly cutting off conversation. One such example
follows:
Transcript Line
15 Mr A: ok. Do you (.) want to start
off then (.) from your
notes?
16 Mrs A: no ((drinks water)) (2.0)
17 MrA: Hm?
18 Mrs A: No (0.5) that's for the
counselling session.
19 Mr A: Alright
20 Mrs A: it's (.) uhm (6.0)
(Table 3 provides a key to CA transcription conventions.) In the Q&A analysis Mrs A's predominant strategy was to avoid
engagement and change the subject.
Line
173 Mr A: …Now, as soon as you
come to bed you
174 want the television off, you
want me to stop reading,
[don't you?]
175 Mrs A: [We don't] go to bed very
early when we are both
going to bed at the same
time. (.)
176 Mr A: Hmmm (.) hhhhhh
In the stories sequences, Mrs A again consistently blocks, blames, withholds, and remains unwilling to cooperate or elucidate her
story. These features are associated with dismissing attachment. However, the picture is not entirely clear cut. In the opening
section, after a great deal of support from her partner, she was able to display a little cooperation. Later, after her partner creates
a safer place by deflecting criticism away from her to a third party, she was able to show some cooperation.
Line
98 Mr A: … when we went down to
99 the airport with Lucy (.) you
were arguing with her
nonstop
100 Mrs A: yes
101 Mr A: I was sitting in the back (.)
minding my own business (.)
in the end you're screaming
at
102 her (.) and I lost my rag
103 Mrs A: Yeah -
104 Mr A: because I thought she was
unreasonable and banged
the back of her seat and
now(.)
105 uh she won't speak to me
106 Mrs A: Well she won't speak to me
either now
These might seem like momentary indicators of secure autonomous attachment, but are compromised in the overall context of a
controlling and antagonistic stance. In the stories section, her strategies to blame and portray the other as negative functioned to
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control the talk of her partner. Table 1 summarizes the CA derived descriptors for Mrs A and demonstrates how these show close
association with AAI descriptors linked to the dismissing attachment category. This is in agreement with the previously
independently determined AAI classification for Mrs A.
In the opening sequence Mr A initiates turn taking and is active in attempting to engage his partner in discussing the topic. In the
Q&A sequences he repeatedly seeks agreement and cooperation. He shows flexibility by trying different strategies to achieve his
partner's agreement. In the stories sequences he provides contextualizing
Table 1: Predicted attachment status based on CA findings in openings section of narratives in partners of couple A
CA findings - Openings Matching descriptors

Couple A from the AAI manual
and associated adult
attachment status
Mrs A - Conversational
strategies Predominant
strategies
She rejects or dismisses focus persistently away
offers of partner to engage from [current]
in topic discussion. attachment relationship;
terse responses
She rejects repeated offer refusal to respond;
of topic with increasing unwillingness to
directness, strategically cooperate; avoids or
misunderstands the diverts from topic
request.
She abruptly cuts off unfinished sentences;
conversation; she creates unwillingness to
a void in the conversation. cooperate; distancing
(long pauses)
⇒
indicators of
dismissing attachment
Changes during the
conversation
After partner takes the seemingly cooperative,
lead following a vacuum but compromised by an
she had created in their overall antagonistic
talk, she cooperates. stance
After initial reluctance to
take a turn, she eventually
takes more turns
The reason for couple B's high conflict score starts to become apparent in the following sequence which also reveals the
imbalance in length of turns (structural asymmetry) in their interaction, and the way they handle disagreement.
Line
66 Mr B: ((clicks with the tongue))
yeahhh (0.5) I think (0.2)
mhh (0.2)
<the reasons> why
67 thou:sss (0.5) are big
problems has to do with
the amount of emotional
(.) tension (0.4)
68 tied up in the particular
problem in the first place
69 [and there]
70 Mrs B: [Yes sure]
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71 Mr B: are certain things
72 Mrs B: → [well I'm not sure]
73 Mr B: [in which we are quite
tense]
74 Mrs B: → well I'm not sure we last
night, I mean,
75 Mr B: hhm
76 Mrs B: → there were no, no - we
should - there was no
emotional problem tied up
in anything we
77 had to discuss. It's just that

there was a background of
pain and frustration as far as
I'm
78 concerned because of this
problem with the dentist, and
with the traffic, with my eyes,
I
79 mean everything
80 Mr B: Yeah
81 Mrs B: together. Eh - and, eh, and
you obviously got very
fraught about this MOT thing,
which I
82 → understand, but we didn't
have to discuss anything
hugely problematic.
83 I mean, that is the stupid
thing about it. I mean, there is
-
84 Mr B: No, the practicalities were
fairly straightforward. Uhm, I
mean the MOT thing, uhm,
85 had a - an emotional content
for me, because it was quite
obviously a major cock-up
86 eh- from my point of view.
And I get less and less happy
about dealing or discussing
87 such things because of the
emotional (1.0) issues that
surround mistakes or
problems
88 Uhm [which is part -]
89 Mrs B: [But that is something which]
you had
90 →forgotten to do, which is not
a big problem.
91 Mr B: No. But the tension comes
into it because of concern
about the fact that I have
92 forgotten to do it.
93 Mrs B: → Well - onne mm- no. It's
something you've forgo[tten
to do, which]
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94 Mr. B: [That's from my side, anyway]
Mr B starts off with an explanation in quite general terms on ‘emotional tensions’ linked to their problems. He is repeatedly
interrupted by his wife disagreeing with him, with increasing forcefulness on six occasions within the space of 21 lines of the
conversation. Faced with this barrage of negation, Mr B initially holds his ground, and repeatedly attempts to explain his position.
After the sixth negation (line 93), he seems to draw a line under the disagreement, which enables them to move on from this
impasse, by qualifying his view as being his experience, and acknowledging that she is not prepared to accept his explanation,
when he says: ‘That's from my side, anyway’. In this interchange Mr B demonstrates stamina in holding on to his explanation. He
also takes charge of the next turn, which he allocates to her with an indirect question, shifting the focus onto her experience.
Despite this level of conflict couple B are more able to engage in dialogue about their troubles than couple A. In the opening
section Mrs B uses humour to support the couple's togetherness and to soften the impact of disagreements. Turn-taking seems
effortless. As the dialogue proceeds Mrs B is able to handle disagreements by acknowledging differences in individual
perceptions.
Line
107 Mrs B: … but I can
108 see that for you it's a major
reason for tension, because
you don't like to sort of
109 forget things. And I, I get
tense when I have the
feeling that - because I have
too
110 Mr B: hhm
111 Mrs B: much to do, I am losing
control of the practicalities in
my life, so I get quite
115 worked up, when I can't find
the papers for my mobile
phone, for example
((continues))
205 …I know that
206 our perceptions of these
circumstances are totally
different, … ((continues))
As the dialogue proceeds Mrs B is able to move to a greater degree of ownership of her own experiences.
Line
248 Mrs B: I'm particularly sensitive to
that, because my mother
does exactly the same …
249 …, but that's, you know,
that's my problem,
((continues))
The Q&A perspective does not provide additional information. The stories perspective shows Mrs B is able to co-construct
stories, and provides further examples of her capacity to acknowledge her own state of mind as different from her partner's. The
stories sequences support the findings from the openings section that she is able to function as cooperative, coherent, flexible,
balanced, with capacity for meta-cognitive functioning. The CA analysis identifies features that show close association with the
AAI features of secure autonomous attachment. This is in agreement with the previously independently derived adult attachment
status for Mrs B.
In the opening sequence Mr B takes turns with clear verbal and paralingual indicators. He is cooperative in allowing his partner
extended turns, is able to handle disagreements, and joins his wife in laughter. Mr B also made little use of Q&A strategies, but
when he did so, they functioned to support progress in the dialogue.
Line
5 Mr B: uhh dear .hhh uh, things
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we've let ourselves in for
(2.0)
6 shall I kick off?
7 Mrs B: yes, yes, yes
8 Mr B: uh (.) hhh ((through the
nose)) I think the obvious
starting point is …
((continues))
In the stories section he was able to provide contrasting accounts, as well as engaging in co-constructing stories. He was able to
acknowledge his own state of mind as different from that of his partner's. Although he appeared to withdraw into a listening and
supporting role in the face of his wife's more forceful presentation, his subtle intervention enabled his wife to move from a
confrontational to a more cooperative stance. Mr B's style in terms of AAI descriptors was cooperative, clear and orderly,
relevant, and showed capacity for meta-cognitive monitoring. The CA analysis features show close association with AAI features
of secure autonomous attachment, again in agreement with the independently determined AAI results.
Tables 1 and 2 juxtapose the conversational strategies used in openings by the female partners in the each couple, referred to as
Mrs A and Mrs B, with the
Table 2: Predicted attachment status based on CA findings in openings section of narratives in partners of couple B
CA findings - Openings Matching descriptors

Couple B from the AAI manual
and associated adult
attachment status
Mrs B - Conversational
strategies
She uses humour and cooperative; sensitive to
laughter, supporting the mental state of other;
couple's togetherness; sense of humour
softening the impact of
disagreements; and
conveying taking things
lightly.
Taking turns seems cooperative; coherent
effortless, with clear verbal
and para-lingual
indicators.
Swift agreement to cooperative; flexible
partner's request for responses
extended turn; takes
extended turns.
She handles balanced account of
disagreements by experiences; coherent;
distinguishing individual at ease with
perceptions whilst imperfections in self and
acknowledging the impact other; cooperative;
on self and other and meta-cognitive
keeping a couple focus. monitoring
⇒indicators of secure
autonomous attachment
She rejects and overrides refusal to respond;
partner's views, using attempt to persuade
humour to avoid conflict. rather than converse;
diverts from topic
⇒indicators of
dismissing Attachment
Table 3: CA transcription conventions
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(.) small pause
(2.0) timed pause / silence
[words] overlapping talk
.hh hh in-breath (with dot in front)
and out-breath
word underlining indicates
emphasis by speaker
<word> slower speech
((description)) transcriber adds
descriptive comments,
e.g. non-verbal
communication
Space limitations mean that only a small sample of the CA can be presented here, however full transcripts and data analysis are
available in the author's unpublished dissertation (Gross, 2011).
Discussion
This study piloted a new approach to the assessment of couples using the method of conversation analysis. It demonstrated that
analysis of the structural and process features of couples' dialogues using CA produced detailed descriptions of the interactional
style and conversational strategies of the participants which showed close association with those descriptors used in the AAI
corresponding to the participant's adult attachment status.
The CA findings in this study provide support for a new joint interview approach to couples assessment as proposed by Fisher
and Crandell (2001). They suggested that this approach incorporate observational measures, in order to capture the complexity
of the interaction. This study has demonstrated that one such observational measure could be CA. In addition, the couple
attachment configurations predicted by Fisher and Crandell (2001, pp. 21-24) are confirmed by the CA descriptions of the
couples in this study. Their predictions of secure couple attachment (flexibility between taking on dependent and depended-on
positions; appreciation of the partner's thoughts and feelings in both roles; ability to express needs and receive help; and
awareness of impact of experiences on self and partner) are supported by the results from the CA approach with couple B in this
study, who were both individually classified as securely attached. The CA couple B profile of conversational strategies
demonstrated that they had capacity to reflect on their own and the other's state of mind, and some ability to take on flexible
roles, despite revealing a conflict in relation to the reciprocity of these roles.
Fisher and Crandell's (2001) predictions are also supported by the findings from couple A in this study, who displayed a
secure/insecure attachment combination. They predicted that this combination of partners would show an asymmetry in their
relationship, in that the secure partner would potentially provide an emotionally reparative experience for the dismissing partner,
but could also be pulled into an entrenched or inflexible position. The CA of couple A revealed a clear asymmetry in their
conversational strategies: Mr A worked hardto draw his partner into a more cooperative dialogue and tried different strategies to
overcome her blocking and diverting manoeuvres.
This study presents the first systematic application of CA to couple dialogues at assessment and demonstrates that CA can
support and enrich the measure of individual adult attachment status as determined by the AAI. It demonstrates the value of CA
as a relevant research instrument and assessment tool in couple assessment.
Empirical Measurements in Couple Psychotherapy

Whilst many different types of empirical measures have been devised to evaluate assessment findings in individual
psychoanalytic psychotherapy, there have been relatively few in psychoanalytic couple psychotherapy(Gross, 2011). Interestingly,
Dicks (1967) in his landmark study on couple psychotherapy, dating back to 1947, already welcomed the inclusion of empirical
measures, and in particular sought a dyadic interaction test. However, it is only in the last two decades that this theme has been
taken up by a small number of clinician-researchers within the context of evidence-based practice requirements (Clulow, 2001;
Clulow et al., 2002; Fonagy, 2001, 2002), as pursuing empirical research into the effectiveness of therapies in the NHS became a
matter of therapeutic survival. This has sparked more interest in integrating empirical measures in assessment and outcome, and
revived the debate as to what extent such measures intrude into or assist therapy processes.
More recently, Wood (2010) challenged the reluctance within the psychoanalytic community to engage with integrating research
into clinical practice, and likened research (and not the supervisor) to be the ‘true third’ in the Oedipal triangle of therapist-
patient/couple, that brings ‘a different perception or viewpoint on the particular issue … [and] a different set of assumptions and
concepts with which to understand it’ (p. 256). Apart from empirical measures being seen as helping to provide the best therapy
possible, Wood also regards these as necessary in order to ‘have a place at the table of policy-makers and funders’ (2010, p.
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259). It can be argued (Gross, 2011, p. 22) that, of the various types of empirical measures used in psychotherapy assessment,
narrative-analytic measurements demonstrate the greatest affinity with the naturalistic setting of psychoanalytic therapy. They
allow the unimpeded exchange of words between patient/couple and therapist and the fluidity of conscious and unconscious
mental processes to unfold.
In psychoanalytic research, it has been noted by a number of researchers (Fonagy, 2003; Hobson, 1993; Leuzinger-Bohleber et
al., 2003) that considering non-analytic research instruments that complement psychoanalytic studies not only contributes to
validate their findings, but helps cross-fertilizing the various disciplines that engage in furthering the understanding of the
complexities of human relationships. The empirical approach of CA provides an opportunity for psychoanalytic research and
clinical practice to draw on their methods of following details of talk and interaction to find more evidence for subtle designs in
interactive processes (Peräkylä et al., 2008; Streeck, 2004, 2008).
Implications for Clinical Practice

In a wider context, the CA findings in this study offer much more than a confirmation of the attachment status of the individuals
and the couples involved. Assessment in psychoanalytic couple psychotherapy is concerned with a number of clinical tasks,
including identifying the strengths and conflicts facing the couple, and developing a formulation. The CA approach with its
emphasis on the process of interaction has the potential to contribute to other clinical aspects at assessment stage. For example,
the study showed that Mrs A's conversational strategies of blocking cooperation and locating the relationship problems in her
partner created an impasse. This impasse was lifted when her partner externalized the conflict outside their relationship. These
manoeuvres as revealed by CA's analytic descriptions illustrate aspects of specific attachment-related problems. From a
psychoanalytic perspective, this example can be understood in terms of processes of projective identification and the role of the
‘third’ for triangulating conflict (Morgan, 1995; Ogden, 1979; Ruszczynski, 1993; Ruszczynski & Fisher, 1995). In this respect, the
CA descriptions can provide evidence for clinical concepts, and contribute to an understanding of the developmental and
therapeutic tasks the couple partners present at assessment.
Implications for Teaching and Training

The richness of the descriptions of interactional phenomena from the CA perspective, as demonstrated in the study, shows their
potency for teaching and training purposes. The CA material gives a perspective from a non-psychoanalytic point of view on
structural and process features in the couple conversational interactions, enabling them to be studied in detail. This micro-
analysis may be used to reflect on possible therapeutic interventions. In addition, studying fine-grained moment-by-moment
interactional processes would contribute to fine-tuning the perception of the subtleties of talk when training in the ‘talking cure’.
This was something Rey (1994) seemed to have in mind when he suggested incorporating psycholinguistics as part of the
psychoanalytic training curriculum.
Limitations of the Study

The main limitation of this study was that only two couples' interactions were analysed. Its findings therefore have to be
considered provisional, and in need of much more study to validate them. The CA approach is very labour intensive and time-
consuming if larger sections of material are to be analysed. This clearly poses certain limitations to the practicality of CA,
probably more so in the clinical domain than in research and teaching and training. This can be mitigated by analysis of selected
sections of the transcript. In this study portions of the transcripts were selected using the ‘filters’ of openings, question and
answer sequences, and stories. The findings from each of these selections were consistent. This suggests that the interactional
profiles in a particular context are consistent across task and time in the dialogue and can be captured using a sampling
approach rather than requiring analysis of the entire dialogue. The rapid development of computer analysis tools (Lepper &
Riding, 2006; Mergenthaler 1996) suggests that in future automation of some, but not all, of the CA process may be possible.
Recommendations
This study has established that conversation analysis of couple interaction can provide information both about individual
attachment status as identified by the AAI, and couple attachment status as postulated by Fisher and Crandell (2001). These
results are preliminary but promising and call for further work to establish the extent of their applicability. Immediate next steps
would be to repeat the study, using couples with the whole range of different attachment status combinations to see if CA
provides sufficient resolution to discriminate all adult attachment classifications. These studies could also look for more detailed
correlations between the CA descriptions and subcategories of the AAI results. It would be advisable that the researcher was
‘blind’ to the specific attachment profile of the couples.
One of the selection criteria for subjects in this study was that they had high conflict tactics scores, as measured by the Conflict
Tactics Scale (CTS) (Straus, 1979). It is possible that the CA approach would be less discriminatory with subjects with low to
medium conflict scores. Further research might explore the impact of this variable.
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Possibly the most interesting extension of this work would be to compare the conversational strategies in the dyadic situation with
those identified in the triadic situation with the therapist present in the room. It is possible that the attachment behaviours of the
couple are more clearly revealed in a dyadic situation than in the triadic couple therapy constellation. The promising results from
this study suggest that applying CA to the triadic situation could be used to verify Fisher and Crandell's (2001) prediction of
complexattachment categories.
CA has the potential to contribute to an understanding of the triadic couple assessment process in other ways, for example, by
providing fine-grained descriptions of the way the presence of the therapist changes the quality of the couple interaction, and the
extent to which the couple are able to make use of the therapist to become more reflective about themselves and their partner.
The results would illuminate the ‘trial’ therapeutic process, and allow comparison of the two assessment modes, with and without
the presence of the ‘third’.
Further research might select same sex couples and couples from different ethnic backgrounds to extend the independent
variables, without applying the ‘“variables and effects” model of language’ (Speer, 2005, p. 46), but being mindful of the impact of
the macro-social context on these (not so independent) variables.
Conclusion
The findings of this study provide support for the hypothesis that application of conversation analysis to couples' conversational
interactions can reveal the attachment status of the individual partners as determined by the Adult Attachment Interview. They
also provide support for a new joint interview approach to couples assessment as proposed by Fisher and Crandell (2001). Since
the study only included two couples, the results are preliminary and must be regarded with caution. Further studies using the CA
methodology would be justified.
References
1
Ainsworth , M.D.S. , Blehar , M.C. , Waters , E. & Wall , S. (1978) Patterns of Attachment: A Psychological Study of the Strange
Situation. Hillsdale NJ: Erlbaum .
2
Clulow , C. (ed.) (2001) Adult Attachment and Couple Psychotherapy: The ‘Secure Base’ in Practice and Research. London:
Routledge .
3
Clulow , C. , Shmueli , A. , Vincent , C. & Evans , C. (2002) Is empirical research compatible with clinical practice? British
Journal of Psychotherapy 19 ( 1 ): 33-44. (BJP.019.0033A)
4 Cohn , D. , Silver , D. , Cowan , P. , Cowan , C. & Pearson , J. (1992) Working models of childhood attachment and couples
relationships. Journal of Family Issues 13 : 432-49.
5
Crowell , J.A. & Treboux , D. (1995) A review of adult attachment measures: Implications for theory and research. Social
Development 4 : 294-327.
6
Dicks , H.V. (1967) Marital Tension: Clinical Studies Towards a Psychological Theory of Interaction. London: Karnac .
7
Dickstein , S. , Seifer , R. , St Andre , M. & Schiller , M. (2001) Marital attachment interview: Adult attachment assessment of
marriage. Journal of Social and Personal Relationships 18 ( 5 ): 651-72.
8
Fisher , J. & Crandell , L. (2001) Patterns of relating in the couple. In: Clulow , C. (Ed.), Adult Attachment and Couple
Psychotherapy, pp. 15-27. London: Brunner Routledge .
9
Fonagy , P. (2001) Attachment Theory and Psychoanalysis. New York, NY: Other Press .
10
Fonagy , P. (ed.) (2002) An Open Door Review of Outcome Studies in Psychoanalysis. 2nd revised edition. London:
International Psychoanalytic Association .
11 Fonagy , P. (2003) Psychoanalysis today. World Psychiatry 2 ( 2 ): 73-80.
12
Forrester , M. & Reason , D. (2006) Conversation analysis and psychoanalytic psychotherapy research: questions, issues,
problems and challenges. Psychoanalytic Psychotherapy 20 ( 1 ): 40-64. (PPTX.020.0040A)
13
George , C. , Kaplan , N. & Main , M. (1996) Adult Attachment Interview Protocol. 3rd edition. Unpublished manuscript.
Berkeley, CA: University of California Press .
2/6/2018 EBSCOhost
14
Gross , C. (2011) Couple narratives and adult attachment—using conversation analysis in assessment. Unpublished doctoral
dissertation. Department of Health and Human Sciences, University of Essex.
15
Hazan , C. & Shaver , P. (1994) Attachment as an organizational framework for research on close relationships. Psychological
Inquiry: An International Journal of Peer Commentary and Review 5 ( 1 ): 1-22.
16
Hesse , E. (2008) The adult attachment interview: Protocol, method of analysis, and empirical studies. In: Cassidy , J. and
Shaver , P. (Eds), Handbook of Attachment. Theory: Research, and Clinical Applications, pp. 552-98. 2nd edition. London:
Guilford .
17
Hobson , R.P. (1993) The intersubjective domain: Approaches from developmental psychopathology. Journal of American
Psychoanalytic Association 41S : 167-92. (APA.041S.0167A)
18
Kobak , R. & Hazan , C. (1991) Attachment in marriage: Effects of security and accuracy of working models. Journal of
Personality and Social Psychology 60 : 861-9.
19
Lanman , M. (2003) Assessment for couple psychoanalytic psychotherapy. British Journal of Psychotherapy 19 ( 3 ): 309-23.
(BJP.019.0309A)
20
Lanman , M. & Grier , F. (2003) Evaluating change in couple functioning: A psychoanalytic perspective. Sexual and
Relationship Therapy 18 ( 1 ): 13-24.
21
Lepper , G. & Riding , N. (2006) Researching the Psychotherapy Process. A Practical Guide to Transcript-based Methods.
Basingstoke: Palgrave Macmillan .
22
Leuzinger-Bohleber , M. , Stuhl , U. , Rüger , B. & Beutel , M. (2003) How to study the ‘quality of psychoanalytic treatments’
and their long-term effects on patients' well-being: A representative, multi-perspective follow-up study. International Journal of
Psychoanalysis 84 ( 2 ): 263-90. (IJP.084.0263A)
23
Levy , K. & Kelly , K. (2009) Using interviews to assess adult attachment. In: Obegi , J. and Berant , E. (Eds), Attachment
Theory and Research in Clinical Work with Adults, pp. 121-52. London: Guilford .
24 Mergenthaler , E. (1996) Emotion-abstraction patterns in verbatim protocols: A new way of describing psychotherapeutic
processes. Journal of Consulting and Clinical Psychology 64 : 1306-15.
25
Mikulincer , M. & Shaver , P.R. (2007) Attachment in Adulthood. London: Guilford .
26
Morgan , M. (1995) The projective gridlock: A form of projective identification in couple relationships. In: Rusczynski , S. and
Fisher , J. (Eds), Intrusiveness and Intimacy in the Couple, pp. 33-48. London: Karnac .
27
Ogden , T. (1979) On projective identification. International Journal of Psychoanalysis 60 : 357-73. (IJP.060.0357A)
28
Peräkylä , A. , Antaki , C. , Vehviläinen , S. & Leudar , I. (eds) (2008) Conversation Analysis of Psychotherapy. Cambridge:
Cambridge University Press .
29
Rey , H. (1994) Universals of Psychoanalysis in the Treatment of Psychotic and Borderline States. London: Free Association
Books .
30
Roisman , G.I. , Holland , A. , Fortuna , K. , Fraley , R.C. , Clausell , E. & Clarke , A. (2007) The adult attachment interview
and self-reports on attachment style: An empirical rapprochement. Journal of Personality and Social Psychology 92 ( 4 ): 678-97.
31
Ruszczynski , S. (ed.) (1993) Psychotherapy with Couples: Theory and Practice at the Tavistock Institute of Marital Studies.
London: Karnac .
32
Ruszczynski , S. & Fisher , J. (eds) (1995) Intrusiveness and Intimacy in the Couple. London: Karnac .
33
Sacks , H. (1984) Notes on methodology. In: Atkinson , J.M. and Heritage , J. (Eds), Structures of Social Action: Studies in
Conversation Analysis, pp. 2-17. Cambridge: Cambridge University Press .
34
Sacks , H. (1992a) Lectures on Conversation, vol. 1 . Oxford: Blackwell .
2/6/2018 EBSCOhost
35
Sacks , H. (1992b) Lectures on Conversation, vol. 2 . Oxford: Blackwell .
36
Scharff , D.E. & Scharff , J.S. (2005) Psychodynamic couple therapy. In: Gabbard , G. , Beck , J.S. and Holmes , J. (Eds),
Oxford Textbook of Psychotherapy, pp. 67-75. Oxford: Oxford University Press .
37
Schegloff , E.A. (1996) Confirming allusions: Towards an empirical account of action. American Journal of Sociology 104 :
161-216.
38
Speer , S.A. (2005) Gender Talk. Feminism, Discourse and Conversation Analysis. London: Routledge .
39
Straus , M. (1979) Measuring intrafamily conflict and violence: The conflict tactics (CT) scales. Journal of Marriage and the
Family 41 : 75-88.
40
Straus , M. , Hamby , S. , Boney-McCoy , S. & Sugarman , D. (1996) The revised conflict tactics scales (CTS2). Journal of
Family Issues 17 ( 3 ): 283-316.
41
Streeck , U. (2004) Auf den ersten Blick. Psychotherapeutische Beziehungen unter dem Mikroskop. Stuttgart: Klett-Cotta .
42
Streeck , U. (2008) A psychotherapist's view of conversation analysis. In: Peräkylä , A. , Antaki , C. , Vehviläinen , S. and
Leudar , I. (Eds), Conversation Analysis and Psychotherapy, pp. 173-87. Cambridge: Cambridge University Press .
43 Ten Have , P. (1999) Doing Conversation Analysis: A Practical Guide. London: Sage .
44
Wood , H. (2010) Integrating research with NHS clinical practice: Unwelcome intrusion or constructive triangulation?
Psychoanalytic Psychotherapy 24 ( 3 ): 252-61. (PPTX.024.0252A)
CAROLA GROSS 1953-2013 completed her MSc in Clinical Psychology at the Free University, Berlin, in 1982 and worked
initially as a scientific researcher at the Max Planck Institute and as a child therapist in Berlin until 1987. After further studies in
New York and London she graduated with an MA in Dance Movement Therapy from Hahnemann University/Laban Centre
London in 1992. Between 1988 and 2003 she worked in adult psychiatry as a clinical psychologist at St Clements Hospital in
East London whilst also training as a psychoanalytic psychotherapist at the Lincoln Centre for Psychotherapy, London. From
2003, as Consultant Lead Adult Psychotherapist at the Department of Psychotherapy, St Bernard's Hospital, West London, she
contributed to the development of borderline personality disorder services and postgraduate training. She served on the
Registration Committee of the British Psychoanalytic Council from 2006 to 2012. The research reported here formed part of her
Clinical Doctorate studies at the University of Essex/Tavistock Centre which she completed in 2011. The dissertation has been
prepared for publication by Laurence Higgens, her husband, with the assistance of Dr Georgia Lepper and Dr Avi Shmueli, both
of whom supervised the original research. Address for correspondence: [Laurence_higgens@hotmail.com]
This publication is protected by US and international copyright lawsand its content may not be copied without the copyright
holder's express written permission except for the print or download capabilities of the retrieval software used for access. This
content is intended solely for the use of the individual user.
British Journal of Psychotherapy, 2014; v.30 (4), p499 (18pp.)
BJP.030.0499A
Record: 2
Title: The Entangled Nature of Attachment and Sexuality in the Couple Relationship
Authors: Caruso, Norma
Source: Couple and Family Psychoanalysis, 2011; v. 1 (1), p117, 19p
Language: English
Abstract: This paper demonstrates the dynamic interplay of attachment styles and sexual
functioning by presenting a couple with anxious—avoidant and anxious—
ambivalentattachment patterns that are evident in their sexual difficulties. It uses the
language of attachment and object relations theory to discuss their sexual and marital
dysfunction and illustrates the integration of behavioural and psychoanalytic techniques to
provide treatment. Particularly, it makes use of Fairbairn's (1943) concept of the ‘return of
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the repressed’ to help each partner reclaim lost, unconscious parts of themselves and, in
turn, improve their sexual functioning. It also makes extensive use of transference and
countertransference as therapeutic tools. The treatment outcome supports the attachment
tenet that a secure base serves as the foundation for exploration (Ainsworth, 1972), in this
case, of the body (Holmes, 2007).
Accession Number: CFP.001.0117A
(Permalink): direct=true&db=pph&AN=CFP.001.0117A&site=ehost-live&scope=site
direct=true&db=pph&AN=CFP.001.0117A&site=ehost-live&scope=site">The Entangled
Nature of Attachment and Sexuality in the Couple Relationship</A>
The Entangled Nature of Attachment and Sexuality in the Couple Relationship

Norma Caruso, author, Clinical psychologist, treats couples and individuals in private practice in Richmond, Virginia. She is
Assistant Clinical Professor in the Department of Psychiatry at the Medical College of Virginia, and faculty member of the
International Psychotherapy Institute, a British object relations training programme, where she trained. She has presented her
work at professional seminars and in the Journal of Applied Psychoanalytic Studies, and New Paradigms for Treating
Relationships. She is certified as a sex therapist by the American Association of Sexuality Educators, Counselors and Therapists.
Her interest in attachment began in graduate school, where she studied with Dr Beatrice Beebe, who advised her on her
dissertation: ‘Early mother—infant gaze behavior as a predictor of attachment at one year’.
This paper demonstrates the dynamic interplay of attachment styles and sexual functioning by presenting a couple with anxious
—avoidant and anxious—ambivalentattachment patterns that are evident in their sexual difficulties. It uses the language of
attachment and object relations theory to discuss their sexual and marital dysfunction and illustrates the integration of
behavioural and psychoanalytic techniques to provide treatment. Particularly, it makes use of Fairbairn's (1943) concept of the
‘return of the repressed’ to help each partner reclaim lost, unconscious parts of themselves and, in turn, improve their sexual
functioning. It also makes extensive use of transference and countertransference as therapeutic tools. The treatment outcome
supports the attachment tenet that a secure base serves as the foundation for exploration (Ainsworth, 1972), in this case, of the
body (Holmes, 2007).
Introduction
The writings of Diamond, Blatt, and Lichtenberg (2007) reflect the renewed efforts of attachment and psychoanalytic theorists to
investigate the relationship of attachment and sexuality. In their book, Attachment and Sexuality(2007), a compilation of
theoretical, empirical, and clinical papers, they present findings congruent with Bowlby's (1969, 1973, 1980, 1988) idea that these
systems are reciprocal. The authors also suggest a shift away from an earlier debate that centred on the question of which
system is primary. Instead, they argue that the more critical clinical issue is ‘how [attachment and sexuality] are integrated or fail
to be integrated at the level of the representational world’ (Diamond, Blatt, & Lichtenberg, 2007, p. 8). Additionally, Diamond,
Blatt, and Lichtenberg note that Bowlby's (1958) focus on the reproductive aspects of sexuality, instead of the subjective
presence or absence of pleasure, separated him from psychoanalytic thinkers.
Recently, attachment theorists have broadened the attachment perspective to include pleasure as a component of sexuality
(Holmes, 2007; Clulow & Boerma, 2009), and to study the interplay of attachment and sexuality through the lens of internal
representation(Holmes, 2007). Such efforts enhance the appeal of attachment theory to psychoanalytic thinking and practice.
This paper is specifically concerned with psychoanalytic couple therapy, and it utilises attachment, and object relations theory
and practice, to explore the entangled nature of attachment and sexuality in a couple with sexual dysfunction, and to provide
treatment. It considers these difficulties a reflection of the couple's internal object relations that evolved from each partner's
attachment and psychosexual history. Particularly, it makes use of Fairbairn's (1943) concept of the ‘return of the repressed’
(Dicks, 1967; Scharff & Scharff, 1987) to help each partner reclaim lost parts of themselves and, in turn, improve their sexual
functioning. The treatment combines behavioural sex therapy techniques (Kaplan, 1974; Scharff, 1982; Scharff & Scharff, 1991)
with psychoanalytic techniques, such as transference and countertransference, to address the marital and sexual issues. The
exploration of each partner's transference to each other and to the therapist offers the therapist insight into the couple's
experiences with primaryattachment figures. Countertransference enables the therapist to understand the couple's difficulties
from inside their shared experience.
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Attachment and sexuality are fundamental aspects of couple relationships, and yet, few studies (Clulow, 2009) explore the
dynamic interplay of these two systems in the couple relationship and its implications for treatment from a psychoanalytic
perspective. This paper aims to help fill this gap.
Case Illustration
Presenting Problem
Joanie and Bobbie, a couple in their mid-twenties, sought treatment because of Bobbie's premature ejaculation and disinterest in
sex. They dated for several years before marrying after college. Bobbie was drawn to Joanie's outgoing, ‘super sweet’, vibrant
personality that countered his shy, reserved manner; Joanie liked Bobbie's calm, level-headed approach that soothed her. While
dating, they enjoyed an active, fulfilling sex life; Bobbie's sexual difficulties began after marrying, triggered by Joanie's comment
that she was not satisfied sexually. Joanie perceives Bobbie as sexually and emotionally withholding, and they engage in a
vicious circle in which Joanie pursues Bobbie, and he withdraws. Thinking Bobbie is vindictive, Joanie feels abandoned and
rejected, and criticises him. Bobbie denies any conscious intention to withhold sex; he thinks Joanie's criticisms are justified, and
feels like a failure for not gratifying her.
Background Information
Joanie is the youngest of three children. When she was three years old, her father sustained a minor brain injury following a work
accident. Three years later, her parents divorced and, along with her mother and siblings, she went to live with her maternal
grandparents in a close-knit family. Joanie had contact with her father several times a year, but she sensed his discomfort with
her and questioned if he loved her. She cut off all contact with him in her mid-teens. Joanie was overindulged by her mother,
whom she idealizes for her strength and independence, and with whom she maintains a close relationship by living next door and
having daily telephone contact. Joanie was popular in school, dated frequently, and was sexually active in high school with a
number of partners, a cause for gossip among her peers. Joanie views herself as a sexual person with a strong desire for sexual
intimacy. Nevertheless, she is anorgasmic, not only with Bobbie, but with all previous partners. Joanie's negative attitude about
masturbation interferes with her ability to enjoy it.
Bobbie describes his mother as controlling, anxious, and an obsessive housekeeper. While he complied with her demands for
order and cleanliness, his older sister rebelled and, during her teenage years, became involved with drugs. Bobbie's father, with
whom he identifies, dealt with his overbearing wife by being remote and distant. Bobbie's parents showed little affection to each
other and never discussed feelings or sexuality with him. Joanie was his first long-term relationship, and he had few prior dating
or sexual experiences.
Joanie's curly hair, large blue eyes, big smile, and bubbly personality create a doll-like appearance. Her frequent requests that I
tell her how to fix her problem leave me feeling idealised, but, as with Bobbie, like a failure.
Bobbie's affect is constricted, and he lacks access to his internal life. He responds to my efforts to have him identify feelings or
thoughts by shrugging his shoulders and saying, ‘I don't know.’ Bobbie is uncomfortable with enquiries about his sexual life, and
his vague responses create the impression that, like Joanie, I am injuring him, and he wants to retreat from me.
Attachment Perspective
Both attachment and object relations theory view early attachment bonds as the foundation for adult sexual relationships
(Diamond, Blatt, & Lichtenberg, 2007). While Winnicott (1971) identifies a childplaying alone in the presence of his/her mother,
unencumbered by intrusions, as a basis for adult sexual pleasure, Holmes (2007) identifies mutuality in pleasurable interactions
between children and care-givers as another influence on adult sexuality. Holmes considers these experiences an opportunity to
perceive the subjective state of another and meld into it, and, thereby, serve as a foundation for pleasurable adult sexual
encounters, which entail two erotic imaginations ‘“thinking with the body” in tandem’ (Holmes, 2007, p. 145).
Mikulincer and Shaver (2007) recently reviewed research that examined the relationship between adult attachment patterns and
sexual functioning, and conclude that individuals with insecure attachment styles use sex primarily to meet attachment, rather
than sexual, needs. Specifically, for individuals with anxious attachment, sex can satisfy unfulfilled emotional needs and lessen
fears of separation and abandonment, while for those with avoidant attachment the need for emotional and sexual distance is
paramount and may be achieved by infrequent, absent, mechanical, or casual encounters. From this perspective, Joanie's and
Bobbie's sexual difficulties reflect a lack of trust resulting from problematic attachment relationships. Joanie worries that Bobbie
will reject and abandon her, like her father, and anxiously clings to him in search of security, not sex; her anxious seeking
interferes with experiencing bodily pleasure. Fearful of experiencing the control he felt with his mother, Bobbie is unable to merge
into Joanie sexually. His avoidance is aimed at promoting security and prevents a fulfilling sexual life.
Object Relations Perspective

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Dicks (1967) linked Fairbairn's model of endopsychic structure(1944) and his description of the return of repressed bad
object(1943) with Klein's (1946) concept of projective identification to create a framework to explain marital and sexual
functioning in couples. By forming a ‘joint personality’ (Dicks, 1967, p. 69), each spouse locates split-off and repressed aspects of
the self in their partner through projective identification and either treasures or attacks those aspects, depending on how those
parts of the self were treated. The ‘joint personality’ also allows each member of the marital dyad to re-experience aspects of
their primaryobject relations in their partner through projective identification. In the sexual relationship, the genitals can serve as
the body screen for the projection of split-off conflicts with attachment figures and intimate partners through the mechanism of
conversion (Fairbairn, 1954; Scharff, 1982). In other words, the genitals become the medium for expressing unresolved
intrapsychic conflicts, thereby compromising the expression of libidinal energy. Through projective identification, Bobbie's penis
becomes the physical locus for Joanie's conflict with her rejecting father; and Joanie's vagina embodies Bobbie's relationship with
his anxiously arousing, but engulfing, mother.
Treatment
Treatment Model: From an Attachment and Object Relations Framework
When mothers and infants relate, they experience each other on both a physical and psychological level. Sex within marriage
echoes this relationship in that partners also connect on both levels. While a fulfilling sexual life recalls early nurturing, frustrated
sexual relations intensify repressed longing for, and unappeased anger at, unavailable or rejecting attachment figures (Caruso,
2003; Scharff & Scharff, 1991). Psychoanalytic methods can treat the psychological, as well as the physical component of sexual
difficulties. This paper presents a treatment model that integrates these techniques with behavioural sex therapy techniques
(Kaplan, 1974; Scharff, 1982; Scharff & Scharff, 1991). This combined approach provides a concrete way to take into account
both dimensions of sexual problems. It also offers an added way to elucidate each partner's attachment style and internal object
world.
Behavioural sex therapy involves a series of graded home exercises that the couple performs twice weekly. They begin with non-
threatening, non-genital pleasuring of each other and end with intercourse. The assignments recall the types of behaviours that
Bowlby (1969) identified as attachment behaviours, and Ainsworth and her colleagues (Ainsworth, Blehar, Waters, & Wall, 1978)
captured in the Strange Situation Test. In prescribing them, the therapist, in effect, calls upon the couple to engage in proximity-
seeking behaviour that requires them to initiate contact with each other and then to participate in a shared activity that involves
the exploration of each other's body. With the completion of each exercise, the couple is free to resume separate activities, but is
also expected to reunite for a second episode each week.
The exercises expose each partner to the physical and emotional presence of the other and to the self experienced in relation to
another. As such, they have the potential to trigger experiences of the self in relation to internalized attachment relationships that,
over time, became mentally represented and contributed to the formation of particular attachment styles. As the couple narrates
their experience in the session, they reveal their internalized images and attachment orientations, which the therapist uses to
understand their execution of the exercises and their overall sexual functioning. Although the couple's narrative style, used to
relate their experiences, may provide useful information about each partner's attachment patterns (Main & Goldwyn, 1995;
Holmes, 2002), I gave limited consideration to it in this paper.
Specific object relations issues are associated with each behavioural exercise (Scharff & Scharff, 1991). The beginning exercises
tend to evoke early mother—child experiences around trust and safety. As the sequence of exercises progresses, the focus
expands to include greater intimacy and co-operation as features of relatedness. Once the exercises address specific sexual
disorders, object relations issues related to each entity become the focal point. For example, with premature ejaculation,
underlying fears of engulfment and concerns about the harmfulness of the penis, which result in confusion about anxiety and
arousal, are likely to emerge. Object relations issues around self-reliance, fears of the bad object, and confusion about excited
and aggressive components of self and other can surface with an individual's difficulty in experiencing bodily pleasure through
masturbation or orgasm.
The conflicts that form the basis of a couple's sexual difficulties emerge as the couple reports their experiences of the exercise in
the session, and the therapist uses psychoanalytic techniques, such as asking for associations, dreams, emotions, fantasies, and
anxieties, to understand them. The use of psychoanalytic techniques to explore the behavioural components of the couple's
sexual activity promotes the emergence of unconsciousmaterial. The psychic pressure that is triggered by the intimate nature of
the exercises and the couple's success or failure to complete them also contributes to this emergence. The therapist analyses
resistances and relies on transference and countertransference to help the couple work through their conflicts. As this takes
place and the couple masters each exercise, the therapist assigns a new task. When the couple encounters difficulty, the
therapist instructs them to repeat the exercise.
Couple Therapy
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Following an extended evaluation, I began weekly couple's sex therapy. A segment from a session in which the couple report on
the first exercise follows:
Joanie said, ‘We had planned to do the exercises a second time, but our dog bit me. I was so upset because I had taken that
dog in and nursed it.’
Bobbie said, ‘Joanie thinks the dog attacked her, but it was just an accident.’ Joanie said, ‘I just wasn't in the mood after that;
besides, I was edgy all week.’
I asked, ‘What was that about?’
Joanie said, ‘It had to do with the exercises being assigned. I desire Bobbie and he should desire me without an assignment.’
She also indicated that when Bobbie massaged her the first time, he only used one hand. When I asked what his behaviour
meant to her, she said, ‘I'm not worth two hands.’
Bobbie said, ‘I don't know why I used one hand, but it had nothing to do with how much I value or desire her. I had been
looking forward to the exercise, but she was so tense; I couldn't relax.’
This segment illustrates features of Joanie's and Bobbie's attachment style.
Joanie's exquisite sensitivity to rejection is consistent with her ambivalent style and Bobbie's use of one hand, which gives him
some distance from Joanie, captures his avoidant attachment style. It also demonstrates how these styles of relating jointly
contribute to the couple's sexual difficulties. Additionally, this narrative captures aspects of the couple's internal objects or mental
representations of self and other, as well as their shared state of not knowing, which contemporary attachment theorists consider
a failure to mentalise (Fonagy, 2001). Joanie is injured by Bobbie, whom she believes has no desire for her, an accusation he
refutes. While she portrays herself as being filled with desire for him, she fails to recognize her anger at him and understand that
beneath Bobbie's distant attachment style is anxiety. He is like the dog she has nursed who then bites her. Bobbie believes that
Joanie has misread him in the same way she misinterprets the dog's motivation. However, Bobbie is unable to assign meaning to
his actions, and in using the word ‘accident’ to describe the dog bite, he reveals how he discounts internal motivators of
behaviour.
Underlying the couple's different attachment styles and their compromised ability to think is a shared anxiety, which pervaded the
beginning phase of treatment. In response, I repeatedly named the couple's anxiety and interpreted how it interfered with their
sexual connection. My interventions are intended to be like the sensitive care-giver who is attuned to the infant's mental state and
reflects it back, in the words of attachment theory. Using object relationslanguage, I am like the mother who provides safety and
security through holding(Winnicott, 1956) and containment (Bion, 1962, 1967, 1970). The goal is that, over time, Joanie and
Bobbie, like the infant who internalises the mother's attuned care-giving, will improve their ability to identify and tolerate their own
and each other's mental states, and in turn, be able to discuss their sexual difficulties and develop more satisfying intimate
relations.
Despite my efforts, however, the couple's anxiety remained high. This was evident in their inconsistent completion of the
exercises, Joanie's escalating anxiety about work and the viability of the marriage, and her frequent undoing of her words, which
left me frustrated and confused. I imagined my state of mind captured her inner turmoil. From an attachment perspective, as
Joanie felt increasingly threatened, she lost ‘narrative competence’ (Holmes, 2007, p. 151, 2002) and her speech became devoid
of meaning and fluidity. Dynamically, Joanie's faltering speech was an obsessional defence used to manage intolerable feelings
triggered by the work. After six months, Joanie's distress motivated her to seek individual treatment.
Individual treatment offered Joanie an opportunity for increased containment, as well as a forum in which she could become
increasingly self-reliant and less dependent on Bobbie emotionally and sexually. I decided to provide individual treatment to
Joanie in order to address her sexual difficulties and their contribution to the couple's shared problem. I believed that offering
both the individual and couple treatment would also enhance my understanding of how Joanie enacted her dynamics in both
contexts and provide an added opportunity for me to interpret the organising nature of the transference as it manifested with me
in the individual treatment and with Bobbie in the couple work. At the same time, I recognised that this decision would have an
impact on each partner individually and the couple as a whole.
Bobbie supported Joanie's individual treatment. In addition to viewing his endorsement as a reflection of genuine concern, I
understood it as an indication of his hope that I would absorb Joanie's anxiety and offer him relief. He had conveyed his ongoing
frustration in dealing with Joanie in one session when he said, ‘I don't know what to do with [her anger]. I try to calm her, but it
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doesn't work … Nothing I do helps.’ Joanie's individual treatment afforded Bobbie greater emotional distance from her and, in
turn, lowered his anxiety, which is consistent with his avoidant attachment style. Dynamically, it offered him the opportunity to
decrease his fear of being engulfed by his anxious wife, an unconsciousfantasy rooted in his experience with his mother. Bobbie
resisted individual treatment for himself in lieu of confronting his attachmentanxiety and unconscious fantasies within the
transference. At this point in the treatment, these factors prevented him from recognising his longing for me as a maternal object
or his envy of what I offered Joanie.
Joanie's individual treatment with me reinforced her unconsciousfantasy that I would supply her with the emotional sustenance
that Bobbie failed to provide and she was unable to derive from herself. From an attachment perspective, my increased contact
with her represented the possibility of obtaining the security she craved and, thereby, of lowering her anxiety. Consistent with her
anxious—ambivalentattachment pattern, however, Joanie had difficulty sustaining contact with me. Three months into her
individual treatment, after indicating how helpful the work had been, she expressed a desire to end her sessions.
Despite blaming Bobbie for their sexual difficulties, Joanie had taken the lead in identifying a problem within the marriage and
seeking treatment. Her behaviour typified the more active role she played within the couple. The couple replicated this pattern,
with Joanie's pursuit of individual treatment and Bobbie's resistance to it. Furthermore, it intensified her belief that she did ‘all the
work’, along with her feelings of anger and resentment, and his feeling of inadequacy. I used this situation to uncover how this
dynamic reflected their internal object world and affected their relationship. Their shared experience of having dominant mothers
and unavailable fathers, either physically or emotionally, had not provided them with an internal model of a couple who could
successfully negotiate their relationship. Their bickering, which pervaded all aspects of their relationship, signalled this failure and
captured their struggle to be a couple. When they reported their arguments or enacted them in the sessions,
countertransferentially, I felt like a mother called upon to settle her children's disputes. At these times, I also became increasingly
aware of the value of individual treatment for each partner to promote their maturation, a prerequisite for developing a viable
partnership.
Joanie's Individual Therapy

Although ambivalent, Joanie remained in individual treatment. The following two segments illustrate how these sessions allowed
more in-depth exploration of the intrapsychic dynamics triggered by the behavioural exercises.
Joanie said, ‘Something is starting to happen to me. I used to feel comfortable with my body. I could walk around naked in front
of Bobbie. Now, I'm so embarrassed and need to cover myself. Last night when we did the exercises I felt pain (vaginal) for the
first time. I told Bobbie, this is about me.’
I said, ‘I'm struck by your need to cover up. I think you feel exposed, emotionally, as well as physically. You've kept this part of
yourself hidden.’ Joanie looked stunned by my comment and said, ‘I'm so confused and scared.’
The exercises were exerting a psychic pressure on Joanie and stripping away her defences. She could no longer view herself as
a sexually vibrant woman whose desires were thwarted by her unavailable husband. Instead, Joanie had new knowledge: that is,
she had a problem, and with this awareness came a ‘disruption of [her] existing psychic world’ (Britton, 2003, p. 38), symbolized
by her physical and emotional pain. In ‘The Oedipus situation and the depressive position’, Britton (2003) uses the parable of
Adam and Eve to discuss the consequences of this psychic shift, characteristic of the depressive position, that is, ‘having eaten
of the fruit of the tree of knowledge we can no longer live in Eden’ (p. 38). Like Eve, Joanie, was now painfully aware of her
nakedness. Countertransferentially, I felt my efforts to touch upon her internal life injured her in the same way that she felt injured
physically by Bobbie.
Another individual session several months later follows.
Joanie said, ‘I didn't do the exercises because my stomach was upset.’
I asked, ‘Did you vomit?’ and she said, ‘Yes.’
I said, ‘I think you internalise things in a way that feels toxic, and then rid yourself of the horrible contents.’ I then noted that
Joanie had behaved similarly when she changed her residence after being frightened by a mentally-ill neighbour with whom she
had an altercation. behaved similarly when she changed her residence after being frightened by a mentally-ill neighbour with
whom she had an altercation.
Joanie spontaneously associated to my reference saying, ‘I regret the way my relationship with my father ended. It became
difficult to have contact with him. When I was little, being with him was good. But when I turned sixteen, I pulled back because he
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was so uncomfortable around me. It was hard to watch.’ Crying, she said, ‘I never understood how he couldn't love me.’
I said, ‘You long for your father.’
Joanie said, ‘I thought by cutting off contact with him I would leave all this behind. I realise this is not the case.’
I said, ‘Being intimate with Bobbie triggers the longing, pain, and vulnerability that you felt with your father and you want to rid
yourself of these feelings in the same way you wanted to rid yourself of them with your father.’
I had imagined Joanie vomited based on my countertransference. Within the transference, her difficulty in being entered
psychically by my interpretations prevented her from facing painful affects, and, in turn, I felt expelled and unable to penetrate
her. Through my countertransference, I gained an inside appreciation of this dynamic that plays out with Bobbie and captures the
psychosomatic component of Joanie's sexual dysfunction: in essence, physical penetration represents mental penetration.
Couple Therapy
The following segment illustrates the couple's collusive efforts that result in failed intimacy.
Joanie (in an angry tone) said, ‘We didn't do the exercises because Bobbie felt too full after eating pizza.’
I said, ‘I think an unspoken fight has been going on, and it began in last week's session.’ (Bobbie smiles). I said, ‘Your smile
tells me you know what I mean.’ Joanie said, ‘But I have no idea.’
Bobbie said to Joanie, ‘Last week when you asked “What happens when partners have different sexual needs?”, I felt
criticised.’
I said, ‘But you didn't say anything. You took your anger with you, ate pizza, and then lost interest in sex.’ He said, ‘But I was
hungry.’
I said, ‘You're hungry for a wife who you feel doesn't criticise you.’
Although the couple became increasingly aware of their dynamics, they clung to dysfunctional styles of interacting and
inconsistently completed the exercises. According to Fairbairn (1952), such resistance is linked to an unconscious reluctance to
relinquish ties to bad internal objects because these connections comprise the essence of identity and the workings of internal
life. This idea is captured in a question Joanie asked in one session, ‘Who would we be if we didn't operate this way?’
In Attachment Theory and Psychoanalysis, Fonagy (2001) discusses both Eagle's belief, that the need for security is inadequate
to explain the maintenance of ties to primary objects, and his suggestion of integrating this idea with Fairbairn's (1952)
formulation of the role of unconscious, intrapsychic factors(Eagle, 1999). Fonagy also cites Eagle's proposal to use different
objectives in working with avoidant and anxious attachment styles. Specifically, those with avoidant attachment styles need to
acquire greater access to affects, such as sadness, loss, and anger, experienced in reaction to frustrating early attachment
figures; whereas those with enmeshed-preoccupied styles need to surrender the fantasy of reclaiming lost relationships. Joanie
had the added advantage of working towards her goal in her individual therapy, a benefit that Bobbie remained unwilling to
pursue.
Joanie's Individual Therapy

Joanie gained insight into the way her mother's indulgence shielded her from her psychic distress associated with her father,
while it fostered idealisation and dependency. This dynamic is evident in the following segment, in which Joanie describes her
mother dealing with an agitated neighbour on her behalf.
Joanie said, ‘I was awed by how my mother dealt with this man. She was gentle and calm. I could never have done that. It's
really great to have my mother next door.’
I said, ‘Your mother's presence gives you security, but it interferes with building the confidence to deal with situations on your
own. Without her, you feel anxious. You rely on Bobbie in the same way.’
Joanie said, ‘Wow, how do you make these links?’
I said, ‘Sounds like you think you couldn't make that link without me.’ After a brief burst of laughter, she looked sad.
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Connecting Joanie's lack of self-reliance with her discomfort with masturbation was part of the treatment. Joanie admitted that
she never considered being ‘the kind of woman who would masturbate’. When I asked about her beliefs regarding such women,
she said, ‘Someone who knows what they want, someone who is confident.’ In the same way that Joanie could not rely on her
own internal resources to deal with her neighbour, she fails to derive pleasure from her own body; instead, she relies on Bobbie.
Joanie equates a state of mind with masturbation, a connection similarly made by Winnicott (1958). He writes,
To be able to be alone in these circumstances (masturbation) implies a maturity of erotic development, a genital potency or the
corresponding female acceptance; it implies fusion of the aggressive and erotic impulses and ideas, and it implies a tolerance of
ambivalence … (p. 417)
In short, to be or act alone will require Joanie to recognise her mother's failings and experience some aggression towards her,
disrupting the illusion of an idyllic, harmonious union and creating space for greater autonomy.
During Joanie's treatment, her mother's acknowledgement that she had ‘spoiled’ her mobilised Joanie's anger. Within the
transference, Joanie also recognised her anger towards me, and as she came to see her mother and maternal figures more
realistically, she became more confident and self-reliant. Additionally, as she thought about her painful relationship with her father,
she began to let him back into her life.
The following segment illustrates Joanie's struggle.
She said, ‘For the first time in my life I realise that my father didn't mean to hurt me; he's brain damaged. I wish he hadn't hurt
me, but I'll be OK. Before, all I could think was, “How could he not love me?” Now, as long as I know he didn't mean to hurt me, I
can forgive him. I came across a picture of me and my father dancing at my wedding. He had asked me to send him a copy, but I
never did. I wanted to hurt him as much as he hurt me. I didn't even ask him to walk me down the aisle. Now I want to send him
the picture and have a relationship with him.’
Joanie also resumed painting, a skill she acquired from her father and had given up when she ended her relationship with him. In
one of her paintings, she depicted the orgasm she had yet to experience. Subsequently, Joanie dreamed she had an orgasm
through masturbation; at first an unidentified man is present, followed by her being alone; she woke with a feeling of satisfaction.
Soon after, Joanie experienced her first orgasm while masturbating.
Joanie's realisation that her father did not wilfully hurt her represents a shift in her perception of his mental state that is
accompanied by a sense of well-being and a desire for connection with him. This change indicates an improved capacity to
mentalise and is linked to greater attachment security. Joanie no longer views her father as a persecutor. She recognises that he
hurts her, but appreciates the good he offers, evident in her return to painting, a skill she acquired from him. In other words, she
views her father as a whole object, an indication of depressive position functioning.
In discussing her dream, Joanie associates the unidentified man to her father. He is present in her dream after she revised her
perception of him and before she has an orgasm on her own. This chronology mirrors her need for a more benign mental
representation of him before she could derive pleasure autonomously and supports the attachment tenet that a secure base
serves as a foundation for exploration (Ainsworth, 1972), in this case, of the body (Holmes, 2007).
Couple Therapy
Joanie continued in individual treatment for another five months and stopped her anxious pursuit of Bobbie. Meanwhile, he
became depressed, lost total interest in completing the exercises, and began sleeping on the couch. The following segment
captures this shift.
Bobbie said, ‘I used to be there for Joanie to tell her that everything would be OK. Now I feel like her. I'm not sure where our
relationship is going.’
I said, ‘Joanie has carried the anxiety and sadness about your relationship, and you have been her cheerleader. With her
feeling more self-reliant, you feel less pumped up and your own anxieties and uncertainties are emerging.’
Joanie said, 'I know this feels terrible, but once you talk about it, you'll feel better. After several minutes of silence, Bobbie said,
‘This makes no sense to me.’
Joanie's emotional and sexual growth signals her desire to become a parental couple, symbolised in the reassurance she offers
Bobbie. This shift shatters the couple's unconscious marital contract that relied on her maintaining her dependency, and, in the
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face of this disruption, Bobbie becomes increasingly symptomatic. He is able to acknowledge his feelings, but unable to think
about their meaning, and responded to my efforts to understand his behaviour by saying, ‘I don't know.’
Countertransferentially, I felt I had failed Bobbie. Because of his mental and emotional unavailability, along with Joanie's high
level of emotionality and my response to it, he held a less prominent place in my mind. I imagined this void replicated Bobbie's
absence from his parents' minds as they attended to their drug-abusing daughter, while Bobbie, the good, compliant son,
remained in the background. Bobbie agreed with my interpretations that linked his past and present experiences, but affectively
they seemed to make no sense to him and left him feeling lost. For eight months, the couple work was at an impasse. Joanie's
previous harshness was replaced by empathy, but eventually she admitted not wanting the marriage and moved into an
apartment. Her decision reflected her progress, but countertransferentially, I felt angry at her, a feeling that Bobbie was unable to
bear, and that I had absorbed through projective identification. Bobbie felt he could not ask Joanie to remain in the marriage and
described himself as ‘pathetic, different, and alone’. He also said, ‘I hate that I don't know,’ and asked to meet with me
individually.
Bobbie's request reflects his unconscious longing for the maternal object, a desire he had previously negated by refusing
individual treatment and dismissing the impact of my alliance with Joanie on him. Because of my concern that Bobbie would
experience a referral to a new therapist as further evidence of my unavailability and intensify an injury for which he would have no
words, I decided to see him individually. Joanie endorsed my decision, a reflection of her genuine concern and her guilt for
leaving Bobbie.
Bobbie's Individual Therapy

In meeting with Bobbie individually, I felt pulled to supply words and feelings and worked to have him locate them within himself.
The following segment from a session four months into treatment illustrates my efforts.
Bobbie said, ‘Whatever happens will be OK … I'm not sure I miss her or if I'm just lonely.’ He then proceeded to tell me that he
met Joanie's friend, who told him that Joanie had struggled over the holidays.
I said, ‘I think you're telling me that whatever happens, you'll have no feelings; Joanie possesses the feelings. You keep your
feelings hidden from yourself.’ Bobbie began to cry and said, ‘I miss her.’
Bobbie's sadness was palpable, and in conveying it, he took back the heaviness that I had been carrying. Gradually, he
acknowledged his anger towards Joanie for failing to appreciate him, as well as his envy of her treatment gains. When he denied
his anger at me for facilitating those gains, I interpreted his late payments as a symbolic expression of it. Rather than feel short-
changed, he short-changed me, and countertransferentially left me wanting and angry. I said I believed a similar dynamic
operated in his premature ejaculation, and that although his behaviour served to minimise feeling overpowered by women, it also
left him feeling ‘pathetic, different, and alone’. Bobbie also discussed his anxieties about his sexuality and the impact of not
growing up with a strong male presence. He viewed his premature ejaculation as a failure to please Joanie. Because Bobbie had
learned to calm his mother by pleasing her with his compliant behaviour, he felt particularly distressed by this perceived
shortcoming. He also expressed anger, particularly at his mother, who was exerting pressure on him to reunite with Joanie;
Bobbie told her that this matter was between him and Joanie.
Bobbie discussed his relationship difficulties with his parents, friends, and co-workers, and was surprised by the connection he
felt with them. He took particular delight in his first long talk with his father. Because Bobbie now lacked a sexual partner, it is not
clear if treatment impacted on his ejaculatory control within the context of a sexual relationship; however, his sexual desire
returned. In one session he said, ‘Joanie thinks I'm not sexual, but I am. I've started thinking about other women and no longer
feel attracted to Joanie. We are very different. Joanie said the words, “We can't do this any more,” but I checked out a long time
ago. I was doing the exercises for her.’
I said, ‘You had no words for what you felt and could only speak through your behaviour.’ He agreed.
Bobbie's mindfulness developed within the context of his relationship with me. According to attachment theory, his development
mirrors that of the infant who acquires the capacity to reflect on experiences of self and other within the matrix of the mother—
infant dyad. Additionally, his greater capacity to mentalise, in turn, improves his ability to construct a coherent narrative, and
reflects greater attachment security. Bobbie's increased self-awareness and ability to bear his experiences enable him to
communicate through words, rather than evacuate the contents of his mind (Klein, 1946) and rely on projective identification to
convey split-off aspects of himself and his experiences (Bion, 1962).
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The object relations concepts of projective and introjective identification(Scharff, 1992), mechanisms that capture
unconsciousfantasy and communication, can explain Bobbie's loss of attraction to Joanie, as well as Joanie's separation from
Bobbie. Bobbie has reclaimed his emotional and sexual vitality and, as a result, he is no longer drawn to Joanie to supply these
previously split-off parts of himself, and now that Joanie can rely on her own internal resources and does not avoid her painful
affects, she does not need to depend desperately on Bobbie for emotional and sexual gratification. Without this intrapsychic pull,
they decide not to live together with their interpersonal differences.
Discussion
Both attachment and object relations theory have long maintained that early attachment bonds form the foundation for adult
sexuality. Recently, proponents of these theories have renewed their interest in exploring the link between these two systems
(Diamond, Blatt, & Lichtenberg, 2007; Clulow, 2009). Using clinical material, this paper illustrates this connection by focusing on
the dynamic interplay between a couple's divergent attachment styles and their sexual functioning. It views the couple's sexual
difficulties as a reflection of their internal object relations that evolved from their attachment and psychosexual histories.
From an attachment perspective, the couple's anxious—ambivalent and anxious—avoidant styles manifested in one partner's
anxious pursuit and the other's disinterest in sex. Propelled by their unconscious goals of attaining attachment security and
maintaining allegiance to early attachment figures, the couple was unable to share a fulfilling sexual life together. In addition to
using the language of attachment theory, this paper also utilises object relations theory to explain unconscious, intrapsychic
factors that formed their partnership and compromised their sexual functioning. It considers the couple's sexual problems as
rooted in unresolved conflicts with internalised primary objects, with the genitals serving as a vehicle for its expression. In
negotiating their sexual relationship, each member of the dyad re-experienced in the other aspects of their spilt-off and repressed
conflicts through projective identification. Their inability to tolerate these dreaded aspects within themselves and within their
spouse challenged the resiliency of the couple's relationship.
Once in treatment, the couple's anxiety and difficulty mentalising, which hindered their marital and sexual functioning, came to life
in the transference. Their perceptions of self and other, considered as reflections of their experiences with primaryattachment
figures, also manifested in the transference. Analysing countertransference reactions helped me find meaning in the couple's
unconscious communications that took place through projective identification, and my interventions based on this understanding
advanced the treatment.
In addition to using psychoanalytic techniques, such as transference and countertransference, to address the multiple
dimensions of the couple's sexual difficulties, the treatment relied on behavioural sex therapy techniques. This integrated model
offers a concrete way to consider the physical and psychological components of sexual difficulties and to enrich the
understanding of each partner's attachment style and internal object world. However, the model also has the potential to confuse
patients, because of the conflicting goals and types of interventions associated with each approach. Whereas psychoanalytic
therapy promotes insight and relies on non-directive interventions, behavioural therapy uses directive strategies to achieve
symptomatic relief. To best ensure that patients experience this combined model as cohesive, the therapist needs the technical
skills to implement the different types of interventions and to oscillate between them. Additionally, flexibility in the therapist is
essential. In the words of Holmes (2007, p. 151), ‘the therapist, like a securely attached child, needs to have a fluid attentional
inner gaze enabling him or her to adopt whichever model is most appropriate any given moment’.
I provided couple treatment in conjunction with individual psychotherapy for each spouse at various points throughout the course
of treatment. By offering both modalities, rather than making a referral, in part, I may have been responding to
unconsciouscommunication from one partner about separation fears and from the other about maternal longing. Because each
partner's dynamics were enacted similarly in both contexts, this combined approach provided an added opportunity to interpret
the organising nature of the transference. However, it also increased the complexity of transference and countertransference
issues and heightened my risk of developing a stronger alliance with one partner, thereby making it more difficult to maintain an
even-handed approach. I discussed these pros and cons with the couple and considered their input in making a treatment
decision. To minimise adverse effects, it is advisable to seek input from a consultant, as I did with this couple. It is also advisable
to avoid this approach in couples who rely on splitting as a major defence or have a high level of conflict. Additionally, the
therapist's capacity to hold the couple in his/her mind when working with one member of the dyad, and each individual when
working with the pair, contributes to the cohesiveness of the work. This attunement, in turn, enables the therapist to explore the
impact of the individual work on the couple relationship and vice versa.
As therapy progressed, each partner showed greater tolerance for affects, progressed toward depressive position functioning,
and improved his/her capacity to mentalise and construct a coherent narrative, all of which reflect greater attachment security.
The couple's perception of primary objects as more benign preceded their improvement in sexual functioning. This chronology
supports the attachment tenet that a secure base serves as a foundation for exploration, in this case, of the body.
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This paper analyses a couple with sexual dysfunction from both attachment and object relations perspectives. The application of
both theories illustrates the commonalities and differences in these frameworks. Additionally, it offers clinicians a broader lens
through which to view case material. It is my hope that this approach will promote greater exploration and deeper understanding
of couples' experiences.
References
1 Ainsworth , M. D. S. (1972). Attachment and dependency: a comparison. In: J. L. Gewitz (Ed.), Attachment and Dependency
(pp. 97-137). Washington, DC: Winston .
2
Ainsworth , M. D. S. , Blehar , M. C. , Waters , E. , & Wall , S. (1978). Patterns of Attachment: A Psychological Study of the
Strange Situation. Hillsdale, NJ: Lawrence Erlbaum .
3
Bion , W. R. (1962). Learning from Experience. London: Heinemann . (ZBK.003.0001A)
4
Bion , W. R. (1967). Second Thoughts. London: Heinemann .
5 Bion , W. R. (1970). Attention and Interpretation. London: Tavistock . (ZBK.002.0001A)
6
Bowlby , J. (1958). The nature of the child's tie to his mother. International Journal of Psychoanalysis, 37 : 350-373.
(IJP.039.0350A)
7 Bowlby , J. (1969). Attachment and Loss. Vol. 1 Attachment. New York: Basic Books . (IPL.079.0001A)
8
Bowlby , J. (1973). Attachment and Loss. Vol. 2 Separation. New York: Basic Books . (IPL.095.0001A)
9 Bowlby , J. (1980). Attachment and Loss. Vol. 3 Loss, Sadness and Depression. New York: Basic Books . (IPL.109.0001A)
10
Bowlby , J. (1988). A Secure Base: Parent—Child Attachment and Healthy Human Development. New York: Basic Books .
11 Britton , R. (2003). The Oedipus situation and the depressive position. In: R. Anderson (Ed.), Clinical Lectures on Klein and
Bion (pp. 34-45). Hove: Brunner-Routledge . (NLP.014.0034A)
12
Caruso , N. (2003). Object relations theory and technique applied to sex and marital therapy. Journal of Applied
Psychoanalytic Studies, 5 ( 3 ): 297-308. (APS.005.0297A)
13
Clulow , C. (Ed.) (2009). Sex, Attachment and Couple Psychotherapy: Psychoanalytic Perspectives. London: Karnac .
(APS.005.0269A)
14
Clulow , C. , & Boerma , M. (2009). Dynamics and disorders of sexual desire. In: C. Clulow (Ed.), Sex, Attachment and Couple
Psychotherapy: Psychoanalytic Perspectives (pp. 75-101). London: Karnac .
15
Diamond , D. , Blatt , S. J. , & Lichtenberg , J. D. (Eds.) (2007). Attachment and Sexuality. New York: Analytic Press .
16 Dicks , H. V. (1967). Marital Tensions. London: Karnac .
17 Eagle , M. (1999). Attachment research and theory and psychoanalysis, presented at the Psychoanalytic Association of New
York, November 1999.
18
Fairbairn , W. R. D. (1943). The repression and the return of bad objects (with special references to the ‘War Neurosis’). In:
Psychoanalytic Studies of the Personality (pp. 59-81). London: Routledge & Kegan Paul , 1952 .
19
Fairbairn , W. R. D. (1944). Endopsychic structure considered in terms of object-relationships. In: Psychoanalytic Studies of
the Personality (pp. 82-135). London: Routledge & Kegan Paul , 1952 . (IJP.025.0070A)
20 Fairbairn , W. R. D. (1952). Psychoanalytic Studies of the Personality. London: Routledge & Kegan Paul . (ZBK.007.0001A)
21
Fairbairn , W. R. D. (1954). Observations on the nature of hysterical states. British Journal of Medical Psychology, 27 : 105-
125.
22 Fonagy , P. (2001). Attachment Theory and Psychoanalysis. New York: Other Press .
2/6/2018 EBSCOhost
23
Holmes , J. (2002). The Search for the Secure Base: Attachment Theory and Psychotherapy. East Sussex: Brunner-
Routledge . (PI.037.0309A)
24 Holmes , J. (2007). Sense and sensuality: hedonic intersubjectivity and the erotic imagination. In: D. Diamond , S. J. Blatt , &
J. D. Lichtenberg (Eds.), Attachment and Sexuality (pp. 137-159). New York: The Analytic Press .
25 Kaplan , H. S. (1974). The New Sex Therapy. New York: Brunner/Mazel .
26 Klein , M. (1946). Notes on some schizoid mechanisms. International Journal of Psychoanalysis, 27 : 99-100. (IJP.027.0099A)
27
Main , M. , & Goldwyn , S. (1995). Interview based adult attachment classification: related to infant-mother and infant-father
attachment. Developmental Psychology, 19 : 227-239.
28
Mikulincer , M. , & Shaver , P. R. (2007). A behavioral systems perspective on the psychodynamics of attachment and
sexuality. In: D. Diamond , S. J. Blatt , & J. D. Lichtenberg (Eds.), Attachment and Sexuality (pp. 51-78). New York: Analytic Press
.
29 Scharff , D. E. (1982). The Sexual Relationship: An Object Relations View of Sex and the Family. Northvale, NJ: Jason
Aronson .
30 Scharff , D. E. , & Scharff , J. S. (1987). Object Relations Family Therapy. Northvale, NJ: Jason Aronson .
31 Scharff , D. E. , & Scharff , J. S. (1991). Object Relations Couple Therapy. Northvale, NJ: Jason Aronson .
32
Scharff , J. (1992). Projective and introjective identification, love and the internal couple. In: Projective and Introjective
Identification and the Use of the Therapist's Self (pp. 133-157). Northvale, NJ: Jason Aronson .
33
Winnicott , D. W. (1956). Primary maternal preoccupation. In: Through Paediatrics to Psycho-Analysis (pp. 301-305). London:
Hogarth Press , 1958 .
34 Winnicott , D. W. (1958). The capacity to be alone. International Journal of Psychoanalysis, 39 : 416-420. (IJP.039.0416A)
35 Winnicott , D. W. (1971). Playing and Reality. London: Tavistock . (ZBK.017.0001A)
Couple and Family Psychoanalysis, 2011; v.1 (1), p117 (19pp.)
CFP.001.0117A
Record: 3
Title: Sex, Couples, and Attachment: The Role of Hedonic Intersubjectivity
Authors: Holmes, Jeremy
Source: Attachment: New Directions in Psychotherapy and Relational Psychoanalysis, 2007; v. 1
(1), p18, 12p
Language: English
Abstract: The paper starts from a discussion of the psychoanalytic idea of infantile sexuality, seen
from the perspective of attachment theory (AT). AT sees human sexuality and security-
seeking as separate behavioural systems. However, there is a pleasurable aspect to the
infant's relationship to the secure base, which the author characterizes as ‘hedonic
intersubjectivity’. He critiques traditional psychoanalysis for its failure to demarcate clearly
between problematic and non-problematic sexuality, and suggests that securely attached
couples elicit one another's ‘erotic imaginations’ in ways that cement their relationship. He
shows that different attachment styles may pattern sexuality in different ways. For
ambivalent individuals, sex can be a hook to establish attachment; avoidant people may
have difficulty in either bringing emotions into play in sex, or keeping violence at bay. In
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mild cases of disorganized attachment sex may be used as a way of activating dissociated
feelings, often via the other's sexuality. In severe borderline states, with disorganized
attachment, sexual pleasure is almost always compromised, and degradation and
exploitation provide the means of supplying a degree of security. The paper ends by
contrasting psychoanalytic and attachment readings of a poem about conjugal sexuality.
Accession Number: AJRPP.001.0018A
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direct=true&db=pph&AN=AJRPP.001.0018A&site=ehost-live&scope=site">Sex, Couples,
and Attachment: The Role of Hedonic Intersubjectivity</A>
Sex, Couples, and Attachment: The Role of Hedonic Intersubjectivity

Jeremy Holmes, MD, FRCPsych, author, Visiting Professor of Psychological Therapies at the University of Exeter, and the author
of several books, including The Search for the Secure Base: Attachment and Psychotherapy (Routledge, 2001) and Oxford
Textbook of Psychotherapy (co-edited with G. Gabbard & J. Beck, Oxford University Press, 2005). Correspondence: E-mail:
j.a.holmes@btinternet.com.
The paper starts from a discussion of the psychoanalytic idea of infantile sexuality, seen from the perspective of attachment
theory (AT). AT sees human sexuality and security-seeking as separate behavioural systems. However, there is a pleasurable
aspect to the infant's relationship to the secure base, which the author characterizes as ‘hedonic intersubjectivity’. He critiques
traditional psychoanalysis for its failure to demarcate clearly between problematic and non-problematic sexuality, and suggests
that securely attached couples elicit one another's ‘erotic imaginations’ in ways that cement their relationship. He shows that
different attachment styles may pattern sexuality in different ways. For ambivalent individuals, sex can be a hook to establish
attachment; avoidant people may have difficulty in either bringing emotions into play in sex, or keeping violence at bay. In mild
cases of disorganized attachment sex may be used as a way of activating dissociated feelings, often via the other's sexuality. In
severe borderline states, with disorganized attachment, sexual pleasure is almost always compromised, and degradation and
exploitation provide the means of supplying a degree of security. The paper ends by contrasting psychoanalytic and attachment
readings of a poem about conjugal sexuality.
Introduction
Contemporary psychoanalysis has, it seems, gone off sex. In a recent broadside against psychoanalytic pluralism, André Green
(Green, 2005, p. 630) bemoans the current emphasis on the ‘role of attachment which supposedly replaces infantile sexuality; the
conceptions of memory based on neuroscientific findings rather than repression, and so on’. Meanwhile, Fonagy and Target
(2005) chart the waning number of publications on sexuality in psychoanalytic journals, and Budd (2001) notes the curious
reversal whereby sex, for Freud the latent theme concealed in every psychiatric symptom and dream, is now viewed merely as
the manifest content of a psychotherapy patient's difficulties, concealing ‘deeper’ issues such as maternal deprivation and other
attachment-related themes.
In one sense Green's concern is justified. Infantile sexuality and the Oedipus complex are central planks of psychoanalytic theory
- take them away and what remains? It is also true that attachment theory was devised by Bowlby in part to provide an account of
parent-child relationships in which security, rather than sex, was the central theme (Holmes, 1993).
In this paper, I suggest that attachment theory does indeed offer a radical challenge to the theory of infantile sexuality. Despite
this, given that secure attachment arises out of mutually pleasurable care-giver-child interactions, I argue that that the two
approaches can in part be reconciled. As a bridging concept I propose the notion of hedonic intersubjectivity. By this I mean a
playful, self-affirming, interactive sensuality - which can, however, only tendentiously be described as sexual. This, in turn, links
with the erotic imagination, a concept with Winnicottian overtones, which, I argue, has its origins in the ‘transitional’ phenomena
of hedonic intersubjectivity. Finally, I apply some of these ideas to different patterns of insecure attachment seen in the consulting
room. (Note that, although the article is written from a heterosexual perspective, I hope that its contentions are equally applicable
to same-sex relationships.)
Theorizing Sex
One of the difficulties in discussing sex is that the word itself encompasses such a variety of meanings and connotations: a
manifestation of love and communication between two participants; a reproductive act; a solitary or pseudo-relational
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masturbatory act; an instrumental act; exploitative (as in prostitution for example); a sado-masochistic pastime; sex as an
observable fact (à la Masters and Johnson) versus the experience of sex as an unobservable but reportable ph(f)antasy (as per
Kinsey, erotic literature, and the analytic couch); and sex as a moral category (‘good’/‘bad’, satisfying/disappointing,
healthy/perverted, erotic/pornographic).
Sex is inescapably both psychophysical and relational. Theorizing sex needs to take account of this, yet it is hard to theorize in a
way that does justice to both mind and body. Despite Freud's often quoted statement that ‘ultimately the ego is a body ego’
(Freud, 1923b), and occasional references to children's and babies' erections and vaginal sensations, psychoanalytic discussion
of infantile sexuality is primarily at a mental level. Until recently, mental experience necessarily relied on self-report - mainly on
clinical experience in psychotherapeutic work, with extrapolations and speculations about the mental life of infants. Now,
however, modern neuroscience enables experience to be directly studied, in ways that can usefully advance the discussion
(Bartels & Zeki, 2004).
Freud's theory of infantile sexuality had two main building blocks: (a) the contention that adult patients' neurotic problems could
ultimately be traced back to sexual repression, and (b) a developmental perspective that saw early childhood experiences as the
key to adult mental life. If adult neurosis is essentially a manifestation of repressed sexuality, and neuroses can only be
understood in terms of the developmental continuity from infancy and early childhood into adulthood, ergo, sexuality must be as
salient for infants and children as it is for adults. The psychoanalytic theory of infantile sexuality is essentially a theoretical rather
than an observational proposition.
Equally, classical psychoanalytic theory sees attachment relationships as a manifestation of the sexual instinct and its
vicissitudes. Infantile sexuality - initially the oral pleasure derived by the infant from sucking at the breast - is the glue that binds
children to their parents, and continues, through the developmental pathway from polymorphous perversity to genital sexuality, to
be the fundamental force that both holds human society together, and, with the inherent ambivalence of the oedipal situation (‘the
mother whom I love is possessed by another’), promises the ever-present possibility of disruption.
Freud saw the psychological vulnerability of humans as arising from the contrast between physical immaturity and ‘adult’
psychological impulses (love, hate, the desire to possess) together with their physical manifestations (excitation of the various
body parts). To oversimplify, the little boy cannot ‘possess’ his mother because he is not big enough to do so, nor strong enough
to defeat his father in a battle for her possession. Love and hate, attachment and separation, can ultimately be traced to infantile
sexual desire and its inescapable emotions of envy and castration-anxiety.
Attachment theory, by contrast, as an ethological account of security provision and protection from threat, sees the need for
security as the prime motivational force holding families and societies together: together we withstand predation, divided from our
secure base, we fail. The attachment and sexual behavioural systems are distinct and separate, each with their own releasers,
timing, and, to use Freud's terminology, aims and object.
Attachment theory starts from the need for parents and other care-givers to provide security for their helpless infants in the face
of a hostile and potentially predatory environment. Like Freud, Bowlby homed in on the helplessness of the human infant as a
crucial developmental factor. As with psychoanalysis, attachment theory as formulated originally by Bowlby might agree that the
ultimate biological purpose of life is self-reproduction. But, rather than installing the sexual impulse as omnipresent throughout
the life-cycle, Bowlby argued that attachment theory encompasses sexuality through the fact that infants need to survive to
sexual maturity in order to be able to reproduce. Physiologically, sex hormones and the immune system have little in common,
but unless the immune system is intact there will be no one for the sex hormones to drive towards mating. In modern terms, the
same applies to the ‘psychological immune system’ provided by attachment relationships (Holmes, 2001). Without attachment,
physical survival is impossible. But equally important is the fact that successful child care requires complex interpersonal skills,
based on the sensitivity and mentalizing (Holmes, 2005) that are integral to secure attachment.
While Bowlby was insistent that attachment and sexuality should be seen as distinct systems, he also acknowledged the close
links between them (Bowlby, 1971). The difficulty in disentangling sex and attachment is that although they demonstrably involve
separable behaviours, emotions, and constructs, it is clear, too, that they are intimately and bi-directionally related. In Western
urbanized cultures, as courtship proceeds sexual attraction can usher in attachment feelings. As the pair-bonding dance
progresses each member of the potential couple may be mutually exploring whether sexual attraction and secure attachment can
be mapped on to one and the same individual. Once established, a close co-habiting attachment relationship between adults
provides the usual context for quotidian sexuality. For established couples, sex and attachment can be mutually reinforcing. The
‘bonding’ hormone, oxytocin, is released during sex, but also in non-sexual activity such as hugging.
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Sex, even between one couple, takes many and varied forms. From an attachment perspective one might speculate that for each
of the defined patterns of attachment there could be a corresponding pattern of sexuality (Hazan & Shaver, 1994; Feeney, 1999).
Perhaps securely attached couples make love freely, spontaneously, safely, excitingly, harmonically, tenderly, and empathically;
insecurely enmeshed couples clingingly, desperately, reassurance-seekingly, endlessly; avoidantly attached couples' sex might
be distant, mechanical, emotionless, violent, inconsiderate, and infrequent; disorganized couples might make love controllingly,
inconsistently, dissociatedly, self-destructively. At the extreme ends of human behaviour, although most sex takes place in the
context of an attachment relationship, attachment is clearly neither necessary nor sufficient for sex: rape represents sex devoid of
attachment, and vice versa in unconsummated marriage.
Sexual and Attachment Arousal - A Source of Confusion

Moving from sexual behaviour to the phenomenology of sexual experience itself, confusion may arise between sexual and
attachment arousal. In order to become sexually aroused, each member of the couple, especially the more vulnerable and
necessarily biologically more choosy female partner, needs to feel safe. People almost never make love in public. In a hostile
savannah, a couple having sex would have been vulnerable to predation, and in a modern environment they are subject to
envious and judicial censure.
One of the fundamental tenets of attachment theory is the incompatibility of exploration and attachment seeking. Exploration is
inhibited in the face of threat as a secure base is sought. Applying this principle to sex, since every act of sex is an exploration of
one's own and the other's body and mind, if attachment needs are unassuaged, sexual arousal will be compromised. What
complicates the picture, however, is that sexual behaviour and attachment behaviours may look, from the ‘outside’ as very
similar, even though they feel very different from the ‘inside’. If one partner feels unsafe, she or he may seek out the other's
proximity in a way that may be misread as ‘wanting sex’. A classic source of misunderstanding and resentment in couples is the
scenario that when ‘she’ seeks out a reassuring attachment-driven hug, ‘he’ takes this as a go-ahead for sex.
Nevertheless, secure attachment is perhaps the precondition for the paradoxical combination of extreme excitement and absolute
relaxation and trust needed for ‘good sex’. This theoretical and experiential, but thus far not experimental, view is supported by
neuro-imaging studies which show that orgasm in females - but not simulated orgasm - involves de-activation of hippocampal
regions of the brain associated with anxiety(Bartels & Zeki, 2004). Comparable neuro-imaging data for males have been thus far
less informative.
Attachment versus Infantile Sexuality

Are these attachment-derived ideas compatible with the psychoanalytic notion of infantile sexuality? From an attachment
perspective it makes little sense to use the word sexuality to characterize the physical proximity of care-giver and infant; (a)
because its purpose is primarily security-providing rather than reproductive, and (b) because, with the possible exception of
Bonobo monkeys, the genital aspects of security seeker-secure base provider contact are non-existent or minimal. Freud gets
round the latter objection via the concept of ‘polymorphous perversity’, but from a philosophy-of-science perspective (Lakatos,
1970) this can be seen as an arbitrary addition of an unfounded supernumerary concept to buttress a fundamentally questionable
theory.
That said, pleasurable, touch-mediated interaction between care-giver and infant is clearly central to good care-giving. While the
experience for mother and infant of lusty breast-feeding may be in some ways only analogous to (rather than a homologous
antecedent of) enjoyable love-making, pleasure is inescapably the appropriate word to apply to kissing, cuddling, tickling, holding,
mutual gazing, stroking, playing, patting, and all that goes on to cement a secure attachment bond between parents and their
infants and small children. What makes a secure base secure is, in large measure, its physicality: the warmth, holding, feeding,
reassuring heart-beat, soothing words, gentle touch that proximity to the parent gives to the infant - and that is something desired
by both child and parent.
The mutuality, responsiveness, and empathic attunement of such interactions provide the foundations of secure attachment. The
experience of bodily pleasure, in a playful, respectful, interpersonal/intersubjective environment makes for secure attachment,
and conversely, secure attachment makes such playfulness pleasurable. Bodily stimulation that lacks interpersonal sensitivity
quickly becomes unpleasant - an everyday example would be when tickling gets ‘out of hand’. Similarly, there is something
essential missing from an unembodied verbal or visual relationship with a held-at-a-distance infant.
Thus, while the classical psychoanalytical concept of infantile sexuality is questionable, the residuum of infantile sexuality in what
Widlocher (2002) calls ‘hedonic capacity’ remains crucial. This re-emphasizes the significance - paradoxical only from a now-
outmoded Cartesian perspective - of bodily experience as a component of mental life. In addition, all relationships, usually
thought of in rather abstract terms, can be seen as (and indeed are) psychophysical phenomena, mediated by an interactive
bodily ‘dance’ - whether this be patterns of eye contact, posture, gesture, voice timbre, or touch. Thus, there is an invariable
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physical component in the metaphors used to describe relationships: we feel close or distant, in tune, in or out of touch, on the
same wavelength, unable keep our hands off each other, sparring all the time, etc.
Fonagy and Target (2005) attempt to rescue the idea of infantile sexuality by considering the contribution made by the parent in
this infant-care-giver dance. While the infant may be sexually naïve, the parent necessarily brings sexual resonances to the
relationship. These include the sexual feelings described by some, but by no means all, women while breast feeding, and fathers'
occasional erections while handling and dandling their infants. There is, thus, a mysterious disjunction between the parent's and
the infant's experience of mutual bodily interaction. They argue that the infant senses this mystery and that the inherently
disturbing aspect of adult sexuality has its origins here. In addition, they argue that incest taboo requires that, unlike other
affective experiences, even, or perhaps especially, in normal development, a child's sexual feelings be ‘unmirrored’ by the parent.
This, too, makes sexuality a mystery, only to be solved in adolescence via the search for a partner with whom mutual mirroring
can begin to be established.
From the perspective of this article, attachment-organized interactions provide a ‘platform’ out of which phantasies associated
with infantile sexuality arise, since in order to find and sustain a relationship with such a partner a measure of security is required.
Thus, the apparently abstract sub-categories of attachment can be seen as mental representations of physical relationships -
characterized by fluidity, clingingness, distancing, or bizarreness of posture, and so on. Longitudinal studies show that the quality
of parent-child interaction in infancy and childhood predicts the quality of young people's ‘romantic relationships’ (Grossman,
Grossman, & Waters, 2005). It follows, therefore, that the quality of adult sexual relationships is built on the foundations of
childhood capacity for playfulness and mutually pleasurable physical interactions.
From Drive Theory to Intersubjectivity

The history of psychoanalytic theorizing can be seen as progressive trajectory from an intrapsychic emphasis, through the
interpersonal to the intersubjective (Atwood & Stolorow, 1984). Attachment theory is interpersonal in that its central focus is the
child-care-giver relationship, but not strictly intersubjective in that the experience of the subject is not fully brought into focus,
perhaps because Bowlby felt constrained to confine himself to what could be observed and objectively researched. Since sex is
reportable but not observable - pace Masters and Johnson - this may go some way to explaining its relative neglect by
attachment theorists.
Classical psychoanalytic drive theory focuses on the individual and her inner world. Object relations incorporates the object and
the self's relationship with it, but still as played out within the psyche, rather than between psyches. Winnicott's ideas form a
bridge from Kleinian object relations towards an interpersonal perspective, and between attachment theory and mainstream
psychoanalysis. His seminal paper, ‘The capacity to be alone’ (Winnicott, 1971), centres on the image of a securely attached
child happily playing ‘alone in the presence of the mother’. The mother's background presence as a secure base allows the child
to be (with) him or herself. Winnicott explicitly includes sex as an adult analogue of this situation, but remains intrasubjectivist
rather than intersubjectivist in the sense that, while he conceptualizes each participant in sex as needing, post-coitally, to be able
to ‘be alone in the presence of the other’, he does not address the mutuality of sex itself.
Yet ‘good sex’ is hard to conceptualize other than from an intersubjectivist perspective, albeit one that can usefully incorporate
Winnicottian notions. When sex ‘works’ (the repeated parentheses are an acknowledgement of the normative implications of what
is being conveyed) each partner incorporates (literally, as well as psychically) the other's body into his and her inner world and
makes it his and her own. The pretend/equivalence mode distinction (Fonagy, Gergely, Jurist, & Target, 2002) - the separation
between phantasy and reality - is temporarily obliterated. The barrier between self and other is in abeyance. Each partner is,
momentarily, simultaneously both alone and united with the other.
Sex here becomes a form of everyday creativity. In Winnicott's model of the origins of creativity, a mother anticipates her child's
needs so that the infant has the temporary illusion of having ‘created’ the breast, which appears, as though by magic, just at the
moment that he or she begins to imagine it. Similarly, in satisfying sex, each partner ‘knows’ before the subject her or himself is
aware, just what feels good - and not so good.
Note that the view of the developmental origins of sexuality suggested here is in a sense a mirror image of the Kleinian
perspective espoused by Britton (2005). The attachment model suggests a sequence running: (a) secure, playful, psychophysical
mutually mentalizing interaction with care-giver; (b) leading to general imaginative competence; (c) leading in turn to the capacity
for an erotically imaginative sexual relationship. By contrast, Britton sees the existence of ‘good primal scenephantasy’ - i.e., an
inner imago of satisfying parental sex - as a precondition for the imaginative function itself, including, presumably, sexual
imagination. Kleinian psychoanalytic theory requires everything, in the end, to come back to sex and the primitive Oedipus
complex. From an attachment perspective, good sex follows from, and is a manifestation of, imaginative freedom; for Britton,
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imaginative freedom is only possible in the context of a ‘good’ primal scene - i.e., a phantasy of parental intercourse neither
obliterated by splitting nor damaged by envy.
The Erotic Imagination

Hedonic intersubjectivity now can be linked to Denman's notion (2004) of ‘the erotic imagination’. Like all imaginative activity,
erotic imagination can be seen as a form of ‘free association’, expressed not in words but in the ‘dance’-image-emotion-
sensation-proprioceptive amalgam that comprises sexual experience. But how do we distinguish the essentially unsatisfying
nature of masturbatory sex (whether practised alone or with a partner) from ‘good sex’? Both involve the imagination, albeit, in
pornography, in a debased and potentially harmful form. Devoid of the mutual excitement inherent in ‘good sex’, the need for
stimulus in masturbatory sex often becomes more and more extreme, and ultimately grotesque. The protective barrier between
phantasy and reality remains unpenetrated, the post-orgasmic outcome ultimately a vacuous tristesse.
What makes ‘good sex’ different is that it involves two erotic imaginations, feeding, playing, sparking, gyrating off one another.
Good sex is ‘thinking with the body’ - in tandem. When a couple's sex life works well, each partner can freely follow his or her
sensual/sexual feelings with the help of the other's body, which becomes a medium, each to each, like the sculptor's clay, the
poet's words, the musician's instrument. Good therapy has a similar quality - what Malan (1979) calls ‘leapfrogging’, where the
patient's association sparks off a thought in the therapist, whose interpretive response enables the patient to leap one place
further and so on. Note, too, that just as in sex the partners adopt different and often mutually exchangeable roles - containing-
contained, exploratory-subsuming, urgent-tender, so too in therapy the different roles of patient and therapist facilitate the
associative process. The therapeutic implication of this suggests that learning to associate freely in therapy might enhance
sexual capacity, just as we imagine the foundations of enjoyable sexuality to lie in the hedonic intersubjectivity of parent and child
in infancy.
That, in turn, takes us back to a consideration of possible barriers to the full expression of the erotic imagination. As suggested,
from an attachment perspective the crucial impediment is the lack of a sense of security, since, in the absence of a secure base,
exploration and imagination, including the sexual imagination, are necessarily inhibited. It is impossible fully to trust the object if
there is an ever-present fear of losing it, and good sex is predicated on trust. In insecure attachment the avoidant child never fully
locks into the mother because he runs the risk of being pushed away; ambivalent infants cling to mothers whose inconsistency
activates the fear of losing her attention. In these organized forms of insecurity the object at least exists, albeit as one with whom
ambivalence is never fully overcome. In disorganized insecurity the object as a separate entity, with a life of its own, cannot be
fully formed in the mind (Fonagy, Gergely, Jurist, & Target, 2002), making mutuality even more problematic. Here, survival
strategies such as controlling behaviour, dissociation, exploitation, or malevolent aggression come to occupy the interpersonal
field. In each case hedonic intersubjectivity is compromised.
The notion of hedonic intersubjectivity is offered as a bridge between psychoanalysis and attachment theory. Infantile sexuality
lives on in the concept of hedonic capacity; intersubjectivity and the ability to mentalize involve the capacity to see the other from
the inside that is the precondition of good care-giving, and also characterizes successful adult romantic relationships. Barriers to
hedonic intersubjectivity will inhibit or distort sexual life in ways that need both psychoanalytic and attachment theory for a full
understanding.
Clinical Implications
Contemporary psychoanalytic psychotherapy - in contrast to behaviourally influenced sex therapy, or possibly to ‘classical
psychoanalysis’ - does not focus on sex as such, but rather sex as part of the totality of a person's relation to others: parents,
partners, friends, children, and therapist. Those relationships may be more or less sexual, but unless the patient is specifically
sexually dysfunctional, sex will be discussed mainly as a manifestation of relationships in general. Some patients talk a great deal
about sex, others hardly at all.
In ambivalentattachment, attachment needs often masquerade as sexuality, and then the therapeutic strategy is to help the
patient differentiate one from the other. In avoidant attachment the problem can lie either with repression or exaggeration of
aggression in relation to intimacy, both of which can compromise sexual relationships; the patient needs to be helped to healthy
assertiveness, which in turn may have consequences for sexuality.
In disorganized attachment, imaginative activity, including the erotic imagination, is not clearly bounded off from reality, leading to
either degraded or grossly inhibited sexuality. The self-destructive behaviours of people suffering from borderline personality
disorder, including risky, debased, unpleasurable, perverse, or shame-inducing sexual activity, can be understood in a number of
different ways:
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1. it may be a way of engaging the Other, albeit by resorting to dominance-submission rather than mutuality;
2. because there is a routine that is better than a sense of total chaos;
3. the bringing together of sex and aggression means that the sufferer feels something at least - even if it is pain, and so
escapes from feeling-less dissociation;
4. being a victim ensures a role, and some sort of protection, at the expense of pleasure or self-respect;
5. the shame of vulnerable neediness is re-enacted through degraded sex in a repetitive way, that gives the subject an illusion
of mastery;
Helping the patient to ‘mentalize’ (Holmes, 2006), and thus to differentiate action from thought, can be brought to bear on
sexuality in helpful ways with these patients.
Coda and Conclusion

One of the key differences between attachment theory and psychoanalysis is that the former makes a clear distinction between
normal, sub-optimal, and potentially pathogenic developmental lines. In psychoanalysis, by contrast, the boundaries between
normal and abnormal are much less clear-cut. In the Freudian world-view ‘we’ are all, to a greater or lesser extent, neurotic, and
this applies especially to sexual life, since we all have to negotiate the incest taboo and therefore the inherent ambivalence of the
oedipal situation.
In the spirit of normalization of non-problematic sexuality, I end with the happily married, albeit at times depressive, Georgian
poet Edward Thomas's poem about his experience of his sexual relationship with his wife.
After you speak
After you speak

And what you meant
Is plain,
My eyes
Meet yours that mean,
With your cheeks and hair,
Something more wise,
More dark,
And far different.
Even so the lark
Loves dust
And nestles in it
The minute
Before he must
Soar in lone flight
So far,
Like a black star
He seems -
A mote
Of singing dust
Afloat
Above,
That dreams
And sheds no light.
I know your lust
Is love.
The poem can be read as follows. The poet's wife, in a simple and sexual way, invites him to bed. But he sees/feels beyond
sexual desire something wider and wiser - a feeling not just of lust, but love. His poetic/erotic imagination shifts to the lark,
nestling in a corporeal way in the dust - a lust rhyme, symbol of bodily/interpersonally hedonic need - before soaring from below
to above. Their sexual love is the sublimation of dust, a composite of song and dream and darkness.
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Psychoanalytically the poem might be read as saying that our highest feelings - love, the capacity for poetry and song, the
sublime - cannot be divorced from the baseness of lust and dust - Freud accused Jung of trying to obliterate the importance of
the ‘bottom story’ in the house of the psyche. Fonagy and Target might suggest that, despite the comfortable domesticity of sex in
a good(enough) long-term relationship, there are questions nestling in the kernel of the poem - does she really love him; is hers a
lust which could be satisfied by any man? The unanswerableness of this leaves the poet in the dark (Thomas suffered from
serious depressions) - no light can be shed on the question: when it comes to sex, he is no better off than the pre-borderline
infant who is generally, rather than simply sexually, deprived of mirroring by the Other (Fonagy & Target, 2005).
An attachment reading of the poem starts from the security of a good long-term relationship. The fact that the poet knows his
wife, nestles with her, enables his poetic and sexual imagination to be released. His feet are on the ground; dust is the secure
base from which he soars to explore his feelings. Their sexuality is as much ‘above’ as it is ‘below’. Instead of an impasse that
confuses attachment and sexuality, sex and love are two sides of a coin, held, like a kite, by its earth-bound flyer. They are linked
each to each in a fluid, three-dimensional, flexible, interchangeable way, releasing the sexual and poetic creativity that comes
with secure attachment, and that can, with the help of good developmental experiences, or, when necessary, psychotherapy,
sometimes be achieved.
Perhaps both interpretations are ‘right’, one emphasizing the mysteriousness of sex, the other the comforts of sexuality in a good
long-term relationship. Psychoanalysis and the attachment-informed therapy theorize this dichotomy in contrasting ways. For
psychoanalysis, conjugal sex is the hard-won result of a successfully resolved oedipal situation in which the potential disruptions
of infantile sexuality are contained but not neutralized by tolerance of envy, possessiveness, aggression, and exclusivity. For
attachment theory, the security of a long-term relationship is the bedrock out of which passionate sex can arise, the pathologies
of sex being manifestations of disrupted attachments. Every therapist must choose which language fits best with their own
experience and predilections. Psychological theorizing remains, as Jung claimed, a covert form of autobiography - a stricture
from which this article is by no means exempt.
Acknowledgement
Some of the material in this paper appears in Diamond, D., Blatt, S., & Litchenberg, J. (Eds.) (2007), Attachment and Sexuality,
New York: Academic Press.
References
1 Atwood , G. , & Stolorow , R. (1984). Structures of Subjectivity. Hillsdale, NJ: Analytic Press .
2
Bartels , A. , & Zeki , S. (2004). The neural correlates of maternal and romantic love. Neuroimage, 21 : 1155-1166.
3 Bowlby , J. (1971). Attachment. London: Penguin .
4
Britton , R. (2005). Anna O: the first case. In: R. Perelberg (Ed.), Freud: a Modern Reader. London: Whurr .
5 Budd , S. (2001). No sex please we're British: sexuality in English and French psychoanalysis. In: C. Harding (Ed.), Sexuality:
Psychoanalytic Perspectives (pp. 14-28). Hove: Brunner-Routledge .
6
Denman , C. (2004). Sexuality: A Biopsychosocial Approach. London: Palgrave .
7 Feeney , J. (1999). Adult romantic attachment and couple relationships. In: J. Cassidy & P. Shaver (Eds.), Handbook of
Attachment (pp. 355-377). New York: Guilford .
8
Fonagy , P. , & Target , M. (2005). Getting sex back into psychoanalysis. Paper presented at Day Conference, May 2005,
University College London.
9
Fonagy , P. , Gergely , G. , Jurist , E. L. , & Target , M. (2002). Affect Regulation, Mentalization, and the Development of the
Self. New York: Other Press .
10 Freud , S. (1923b). The Ego and the Id. S.E., 19 . London: Hogarth . (SE.019.0000A)
11
Green , A. (2005). The illusion of common ground and mythical pluralism. International Journal of Psychoanalysis, 86 : 627-
633. (IJP.086.0627A)
12
Grossman , K. , Grossman , K. & Waters , E. (2005). Attachment from Infancy to Adulthood: The Major Longitudinal Studies.
New York: Guilford .
2/6/2018 EBSCOhost
13
Hazan , C. , & Shaver , P. (1994). Attachment as an organisational framework for research on close relationships.
Psychological Inquiry, 5 , 1-22.
14 Holmes , J. (1993). John Bowlby and Attachment Theory. London: Routledge .
15
Holmes , J. (2001). The Search for the Secure Base: Attachment Theory and Psychotherapy. Hove: Brunner-Routledge .
(PI.037.0309A)
16 Holmes , J. (2005). Notes on mentalising - old hat, or new wine? British Journal of Psychotherapy, 22 : 179-198.
(BJP.022.0179A)
17 Lakatos , I. (1970). Criticism and the Growth of Knowledge. London: Butterworth .
18 Malan , D. (1979). Individual Psychotherapy and the Science of Psychodynamics. London: Butterworth .
19
Thomas , E. (1971). Collected Poems. London: Faber .
20 Widlocher , D. (2002). Infantile Sexuality and Attachment. New York: Other Press .
21
Winnicott , D. (1971). The capacity to be alone. In: Maturational Processes and the Facilitating Environment (pp. 29-36).
London: Hogarth , 1982 .
Attachment: New Directions in Psychotherapy and Relational Psychoanalysis, 2007; v.1 (1), p18 (12pp.)
AJRPP.001.0018A
Record: 4
Title: Integrating Attachment Theory and Neuroscience in Couple Therapy
Authors: Goldstein, Sondra; Thau, Susan
Source: International Journal of Applied Psychoanalytic Studies, 2004; v. 1 (3), p214, 10p
ISSN: 15569187
Language: English
Abstract: The authors integrate findings from neurophysiology, affect regulation and attachment
research, and apply them to treating couples. They observe that adult styles of relating to
primaryattachment figures parallel the attachment styles identified in infant-caregiver
relationships. They work with couples on maintaining a state of attunement, providing a
secure base, recognizing non-verbal signals of unconscious associations, and processing
the emotionally charged interactions that frequently occur in the relationship. They give a
clinical example that shows how an understanding of attachment styles and internal
working models of relationships provides a perspective in couple therapy for dealing with
the underlying needs and longings of intimate relationships.
Accession Number: IJAPS.001.0214A
(Permalink): direct=true&db=pph&AN=IJAPS.001.0214A&site=ehost-live&scope=site
direct=true&db=pph&AN=IJAPS.001.0214A&site=ehost-live&scope=site">Integrating
Attachment Theory and Neuroscience in Couple Therapy</A>
Integrating Attachment Theory and Neuroscience in Couple Therapy
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Sondra Goldstein, PHD, author, Clinical Associate Professor, Department of Psychology, University of California at Los Angeles,
and is a clinical psychologist in private practice, Encino, California.; 16055 Ventura Blvd. #923 Encino, CA 91436, USA
sgold@ucla.edu
Susan Thau, PHD, author, Clinical psychologist in private practice in Santa Monica, California, and a training and supervising
analyst at the Institute of Contemporary Psychoanalysis, Los Angeles, California.; 2730 Wilshire Blvd. #544 Santa Monica, CA
90403, USA susanthau@adelphia.net
The authors integrate findings from neurophysiology, affect regulation and attachment research, and apply them to treating
couples. They observe that adult styles of relating to primaryattachment figures parallel the attachment styles identified in infant-
caregiver relationships. They work with couples on maintaining a state of attunement, providing a secure base, recognizing non-
verbal signals of unconscious associations, and processing the emotionally charged interactions that frequently occur in the
relationship. They give a clinical example that shows how an understanding of attachment styles and internal working models of
relationships provides a perspective in couple therapy for dealing with the underlying needs and longings of intimate
relationships.
Introduction
Bowlby wrote that the human attachment patterns noted in infant-caregiver interaction continue to play a vital role in human
development “from the cradle to the grave” (Bowlby, 1979: 129). Following the seminal work of Bowlby and other infant
researchers, there has been growing recognition that the quality of childhood attachments is intimately linked with patterns of
interpersonal relatedness throughout life (Clulow, 2001). Attachment theory provides a theoretical framework for understanding
adult couple relationships, and a valuable perspective for assessing and treating couples. An attachment perspective shifts the
focus of concern of couple therapy from the security of the individual to the security of the couple relationship. Central to a
couple's sense of security is the ability to regulate affect within the relationship. Schore's (2001) findings from neuroscience
provide evidence that attachment patterns influence interactive affect regulation in dyads.
We find parallels between the defining features of infant-caregiver attachmentbehavior and adult couple attachments. Bowlby
(1969, 1973) proposed that attachment bonds are characterized by: (1) proximity-seeking; (2) safe-haven behavior; (3)
separation distress; and (4) secure-base behavior. All of these features of infant-caregiver bonds may be observed in couple
relationships (Weiss, 1991). The partners derive comfort and security from one another. Each partner wants to be with the other,
particularly in times of stress. When one partner in a relationship threatens to be physically or emotionally unavailable, the other
partner may protest. However, in adult romantic bonds the asymmetry of early bonds is replaced by symmetry, mutuality and
sexual intimacy (Hazan and Zeifman, 1994).
Adult styles of relating to primaryattachment figures parallel the attachment styles identified in infant-caregiver relationships.
Hazan and Shaver (1987) presented groundbreaking research, which showed that the three major childhoodattachment styles
(secure, insecure-avoidant and insecure-ambivalent) are also found in adult romantic relationships. Hazan and Shaver (1994)
taught that attachment styles of couples can be viewed in terms of the answer to the question “Can I count on this person to be
there for me if I need them?” If the answer is “Yes” in a positive and secure way, the partners feel confident that they may rely on
each other, have open communication, and experience a flexible, cooperative relationship. If the answer is “Maybe”, partners
tend to have an insecure-ambivalent style, with vigilance about loss, and alternating clinging and angry demands for
reassurance. If the answer is “No”, the partner's past history of abuse, neglect or rejection may have left no hope for a secure
relationship. In the resulting insecure-avoidant attachment style, the partner avoids closeness or dependency, denies the need for
attachment and views others with mistrust.
Hazan and Shaver's findings are consistent with Bowlby's (1982) hypothesis that children develop internal working models about
relationships. These relatively stable working models are implicit, non-conscious guides for later adult attachment relationships.
Bowlby (1982) hypothesized that these childhoodattachment patterns could change later in life as a result of new emotional
experience, and new mental representations of attachment relationships. Thus, internal working models may be altered and
updated, allowing the child to earn a secure attachment style as development goes on (Hesse, 1999). These ideas provide a
rationale for therapeutic efficacy.
Additional understanding of attachment relationships is found in neuroscience. Attachment drives depend on the right brain
regulation of biological synchronicity between organisms (Schore, 2001). Infant right brain to adult right brain psychobiological
transactions, mediated by mutual gaze, promote the attachment bond between infant and caregiver. Early emotional regulation,
established through infant-caregiver synchrony, leads to the organization and integration of neural networks and eventual self-
regulatory capacity in the child. Attachment experiences directly influence the wiring of the orbitofrontal cortex to the limbic
system. The orbitofrontal cortex mediates emotional responses and coordinates the activation and balance of the sympathetic
and parasympathetic branches of the autonomic nervous system (Price et al., 1996). A balance between sympathetic and
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parasympathetic arousal is found in secure attachments, whereas an imbalance is found in insecure attachment patterns
(Schore, 1994). In insecure-avoidant infants, the autonomic balance is parasympathetically dominated, and geared to respond
maximally to low levels of socio-emotional stimulation (Izard, 1991). In insecure-ambivalent infants, the autonomic balance is
biased toward the sympathetic excitatory system over the parasympathetic inhibitory system, creating a vulnerability to under-
regulation disturbances (Schore, 2003).
The prefrontal system generates internal working models, which guide interpersonal behavior and affect regulation. These
attachmentschemas become implicit, non-conscious procedural memory networks, which are evoked in interpersonal
experiences, particularly attachment relationships. Attachmentschemas guide the selection of significant others and influence the
emotions experienced within relationships. When a couple's attachment schema is challenged, or the attachment bond is
breached, a couple may seek treatment (Cozolino, 2002). An understanding of attachment styles and internal working models of
relationships provides a perspective in couple therapy for understanding the underlying needs and longings that are readily
evoked in intimate relationships. The overarching work of therapy is to “replace silent, unworkable intuitions with functional ones”
(Lewis et al., 2002: 179).
Couple therapy has traditionally been associated with building communication skills as a means of increasing intimacy between
partners. But frequently this approach does not create lasting improvement. Couples may relapse into familiar patterns of conflict
that become increasingly destructive. The integration of attachment theory with neuroscience and its application in couple
therapy places the emphasis on dyadic affect regulation. By understanding how each partner's nervous system is affected by
“emotional reverberations” triggered in dyadic interactions (Lewis et al., 2002: 131), couples can work to create greater emotional
attunement and the hope for a secure base within the relationship.
The newly emerging field of developmental neuropsychobiology provides a road map of how emotional patterns develop and a
window into the interpersonal patterns of intimate relationships (Schore, 1994, 2001, 2003). This perspective emphasizes the
complex interactive experience that includes both the individual's internal process as well as the co-constructed reciprocal
interactions between the two partners. It also focuses on the therapist's role in this interactive sequence as a consideration. In
attachment-based couple therapy, the therapist is committed to creating a secure enough environment in which partners can
explore each individual's attachmentschemas, enacted in their ongoing intimate relationship (Clulow, 2001). Partners' relational
needs are best addressed within a psychotherapeutic relationship, which honors the belief that the offer of secure attachment is
essential to the curative possibilities of psychotherapy(Amini et al., 1996). Each partner is encouraged to become aware of
personal and dyadic non-verbal communication patterns and to reach beyond them to discover the unconscious implicit
memories that drive them (Schore, 2003). The therapeutic emphasis is on creating a safe base, which permits joint investigation
by couple and therapist. Within the secure base of therapy, each partner may feel more balanced, thereby contributing to an
enriched and attuned relationship which enhances neural plasticity and learning (Schore, 2003).
Scharff and Scharff (1991) describe the therapeutic base in different terms. They see it as “a transitional space in which the
couple can portray and reflect upon its current way of functioning, learn about and modify its projective identificatory system, and
invent new ways of being” (1991: 108). They emphasize that the therapist creates this environment in order to manage and
metabolize the couple's anxiety through holding and containment.
There has been a proliferation of research involving the relational patterns between mothers and infants (Beebe and Lachmann,
2003). This has shown that a baby initially needs the interactive presence of an attuned mother in establishing the ability to
regulate affect. This finding is validated in couple dynamics too. In couple treatment, the partners are dependent on the therapist
to provide the affect regulation that has been eroded by unrepaired continuing conflict. As the partners are helped to understand
their unresolved yearnings, they can begin the process of establishing interdependency in which each takes turns as the benign
caretaker, especially in stressful life conditions (Solomon, 1994). There is hope that by deepening each partner's understanding
of the other, by learning to read each other's verbal and non-verbal cues, and by gaining a deeper appreciation of their own level
of arousal, the partners will become more adept at interactive affect regulation, thereby strengthening the security of their
attachment bond.
In attachment-based couple therapy, the partners learn about the language of emotion. They are taught to appreciate both verbal
and non-verbal communication, including the multitude of signals that are bodily and viscerally based. In any dyad the individual
is affected by his own behavior and by his partner's behavior, and each partner is influenced on a moment-to-moment basis by
the other (Beebe and Lachmann, 2003). By becoming sensitive, partners learn to pay close attention to their own visceral
changes and to be curious about what these bodily signals may mean in identifying non-conscious emotions.
Nonverbal aspects of communication reflect right hemisphere emotional and implicit processes. Quality of eye contact, tone and
volume of voice, nature of body movements, facial expressions, and posture are examples of nonverbal aspects of
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communication which provide avenues of insight into underlying non-conscious emotion. For example, when the couple therapist
asks a man to notice his eyes rolling upwards as his wife speaks, the man may become aware of the contempt and disdain
nonverbally communicated to his wife. When the therapist calls attention to the husband's stroking his face, the man may recover
memories of soothing himself after being slapped by his mother, a sensitivity reactivated when he feels criticized by his wife.
The following vignette from sessions with Anne and Ed illustrates how the therapist's focus on nonverbal aspects of couple
communication allows access to non-conscious emotion in dyadic transactions:
Anne: (Beginning the session) I can't believe how far apart I've felt from Ed this week. It all started when he discovered the
$75.00 late fee from Visa. He thought that I paid the bill, and I thought that he had done it. So, we ended up with a late fee. For
the rest of the week, he's been so distant and quiet.
Ed: (His face hardened, jaw and teeth clenched, but speaking in a measured tone) I hate to waste money and the late fee is
$75.00 wasted. She's so careless with money. Just like her family that always lived beyond their means. No one in her family
ever paid a bill on time. She's going to get us into the same financial mess.
Anne: (Slumped into the sofa, crying)
Ed: (Continuing to clench his teeth, his face hardened and tense)
Therapist: (Thinking that Ed's tone of voice does not match his facial expression of anger, noting that he is speaking so calmly,
yet his face looks furious, wondering how to help him have a connection with his emotion, and deciding that his facial expression
seems to be the key) Ed, can you pay attention to your face, and touch your lower face? What do you feel in your face?
Ed: (Looking surprised, and touching his face hesitantly) My jaw is clenched, and my teeth are grinding together. The muscles in
my face are tense and they almost hurt. I am so embarrassed. I did not know that I was so angry, and I'm embarrassed that you
see it in my face.
Anne: And this is what happened at home. Ed had that look on his face all week, but didn't talk to me about how he really felt and
how mad he was about the late fee.
Ed: I guess I didn't want to admit to Anne or myself how mad I've been about this. It's really hard for me to be angry out in the
open.
Therapist: For you, Ed, anger is not an emotion that you allow yourself, and you feel embarrassed that others may see it on your
face. But Anne always senses when you are angry, and pulls away.
This sequence in treatment of Anne and Ed became a reference point in our talking about feelings which are expressed between
them nonverbally — for instance, in gestures, facial expressions and visual cues. The concept of being attuned to each other's
nonverbal communications has been extremely helpful to this couple in creating attunement, recognizing misattunement, and
developing the ability to repair breaches in their attachment relationship. Good enough attunement is defined in current research
as 30% of mutual time spent in a good psychic place (Gianino and Tronick, 1988). This concept of ‘good enough attunement’ is
helpful to couples. While learning to value balance and harmony, the couple also learns to process the pain of their periods of
misat-tunement, enduring these lapses by remembering that conflict is a normal part of any couple relationship as a reflection of
the differences between the two separate partners (Gottman, 1991). Couples can feel hope about resolving their conflicts by
thinking of them as opportunities for engaging in the process of mutual repair and so achieving greater closeness. Often neither
partner has experienced his negative emotions as tolerable or understandable. Thus, when there is an attachment breach, a
cycle of shame is triggered, with one partner feeling that he or she is being held responsible for being unreasonable and
demanding. Couples are taught how the intense state of interactive dysregulation is maintained by both partners, and how this
dysregulated state can undermine their attachment bond if it is not interrupted by more reparative approaches. When conflictual
feelings are seen as a normal part of a couple's interaction, then each partner can be more interested in what is being activated
to create his or her personal contribution to their interactive stalemate. Each partner is encouraged to learn how to self regulate
and so become more sensitive to the partner's affect regulation. This builds mutual awareness and empathy within the dyad, and
interrupts the ongoing negative cycle.
In this approach to treatment, there is a continuing emphasis on how each partner is processing the emotionally charged
interactions that frequently occur in the relationship. By deepening the understanding of one's own internal conscious and non-
conscious systems, each partner has a greater capacity to explain his emotional state and needs. The couple learns about the
unique subcortical emotional system that they have constructed. They are shown that the automatic rapid and non-conscious
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appraisal of danger and frightening stimuli can be slowed down when conscious thought and language are used to interrupt this
rapid fear cycle (Cozolino, 2002). By emphasizing the neuropsychobiological basis of automatic, rapid fear and shame
responses, the therapist is able to normalize conflictual states. This type of shaming sequence begins when a young child is
socialized, and can become a chronic pattern in adult relationships. Schore (1994, 2001, 2003) describes shame-based
responses moving in a sequence from negative affect to reestablish the state of positive affect, a state of equilibrium and
calmness. Healing of the couple's attachment needs is brought to the foreground when these frightening moments are made
conscious, then given form, substance and language, allowing joint examination of the interactive process (Johnson, 2002). The
healing process of repair begins with making a commitment to engage in the examination of fearful moments and goes on to
include the co-creation of a shared narrative of the couple's history and manner of emotional processing (Siegel, 1999).
We propose that couple therapy based on the integration of attachment theory and neuroscience provides a secure base for the
couple, allows the possibility of updating old internal attachmentschemas, and creates new neuronal connections with altered
ways of thinking about experience (Siegel, 1999). From a neuropsychobiological perspective, the dysfunctional right brain to right
brain transactions between the two partners are replaced with more balanced and considered transactions (Schore, 1994, 2001,
2003). Partners no longer engage in unconsciously traumatizing each other. Being capable of navigating these lapses in
connection actually creates resilience and hope at the foundation of the partnership. All of this is fundamental to the creation of a
secure base in which each partner can experience his emotional needs, with a sense of wellbeing, and the state of feeling loved.
Conjoint therapy with Sue and John offers an opportunity to examine these principles from attachment theory and neuroscience
in a treatment sequence. Sue and John sought couple therapy because they were having frequent crises regarding their
professions as university professors. The following vignette is from a session in which Sue became extremely upset about her
overwhelming responsibilities, both at home and at the university.
Sue: (Her voice escalating, becoming increasingly shrill) You just can't imagine how burdened I feel. All I do is work, work, work.
John has his tenure track appointment, so he can just work on his research and the book he is writing without having to do
anything else. (Yelling at John who sits passively in his chair staring straight ahead) I'm the one who is expected to pick up and
take care of whatever is necessary in our family. It just isn't fair. I have no life. (Looking at him for some sign that he had taken in
what she had been yelling about, for some sign of recognition and concern, but finding none, becoming even angrier and more
rageful) You are so mean and uncaring, I can't take it any more.
Upon hearing these words, John's eyes were filled with disgust and he scowled, and then quickly turned away. He seemed
impervious to her cries. Sue saw this and bit her lip, fighting back her rage which soon turned to tears.
Therapist: (thinking) I saw this coldness and felt the tension in the room as each partner retreated into a closed down space. I
wondered what John was feeling that made him react to Sue in this way. Was it just that he was feeling blamed, and if this was
so, why didn't he say something to her? Both seemed so angry. I felt powerless to be able to calm their vibrating nerves down. I
wanted out of there too. Wasn't this what both of them felt?
The partners were exhibiting their individual insecure-avoidant attachment styles which were dismissive and rejecting. Their
outward behavior suggested that neither believed that the other wanted to be there. In this evocative moment, neither was able to
bridge the gulf because both carried the internal view of themselves as someone who is unlovable. This insecurity left each
partner vulnerable to being easily disrupted. The continuing occurrence of attachment breaches without the ability to repair
created pessimism and despair in the couple.
Therapist:(thinking) I had to do something to interrupt this escalating situation and that was a challenge when I too was feeling
threatened. I told myself that I could manage my fears as long as I kept away from absorbing theirs. I was there to provide a
holding environment for them, and I had to begin relating to them. I began by speaking quietly to each one separately about the
rapid shaming that had just occurred. I was extremely careful about the tone and tempo of my voice, knowing that it could
negatively impact one or both of them.
Therapist: This was really an intense time, and we all had our own reaction to how quickly feelings were triggered. (Looking at
John) You were so overwhelmed by Sue's anger that it looked like you wanted to get away from her. Each of you feels as if you're
being made into the bad one while your partner gets to walk away untouched. Each of you feels the hurt and pain of being
unwanted so it is hard for you to want to look at your contribution to this moment. You both want me to bear witness to how poorly
you have been treated, so that maybe I'll get you, John, to think about how much you have hurt Sue by ignoring and how much
you, Sue, have hurt John by complaining.
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Sue: I am feeling upset, and then I look at your blank face, John, and it makes me feel absolutely so alone that all I can do is feel
rage and fury. I want to get as far away from you as fast as I can. You just don't seem to care at all.
John: (Attentive, quiet, listening, watching Sue, his face no longer like a mask) I guess that when you begin to talk like that, it
makes me so upset that I don't want to have to hear you.
Therapist: Sounds like Sue's tone and expression make you tense and nervous.
John: I guess I never like to think of myself as a nervous person, but you're right, I feel weird and kind of shaky. Like, I really
don't know what to say or do.
Therapist: (thinking) I could see that this was causing a reaction in John because it was too close to his experience with his
parents who had frequent rages over the fact that his father was usually out of work and unable to support the family. I waited for
him to begin to make the connection as we dealt with his feelings of helplessness.
John: I guess that I am more upset with the way you tell me things than what you are actually saying. You do have to do a great
deal, and we have to work out a way to manage all these responsibilities better together. But I can't think when you start raging at
me.
Sue: I am amazed, John. You are actually talking to me. That's what I have been wanting and thought was so impossible. Maybe
this therapy thing really can help us to learn to listen to each other after all. I thought it never would happen.
Therapist: Well, now we have a beginning. (Trying not to overtalk this point, but wanting to lay the groundwork to explore their
co-constructed unconscious patterns of the dismissive attachment I am seeing) We have to begin to unravel why you revert to
the particular patterns of relating that have become so automatic and habituated in your relationship.
This brief moment is an example of the rapid cycle of fear and anger that becomes a regularly enacted pattern when each
partner's insecurity is being repetitively triggered by both verbal and nonverbal cues. Additional couple therapy with Sue and John
allowed them to become increasingly aware of emotional triggers in words and gestures which escalated conflict, and eroded
their sense of a secure attachment bond. As this example illustrates, the therapist has to manage his or her own feelings which
are being triggered by the continuing enactment of the two partners.
Summary
The goal of couple therapy based on an integration of attachment theory and neuroscience is to explore and identify the
interaction patterns of affect regulation that are the basis of either enhancing or diminishing the emotional connection between
the partners. This type of couple therapy is not just about verbal communication patterns and the words used to convey emotion.
Nonverbal and non-consciouscommunication allows us to observe how partners are affecting one another's psychophysiological
reactions on a moment-to-moment basis. These patterns of interaction are maintained by the non-consciousattachmentschemas
that organize each partner's sense of himself or herself in the relationship. There is an ongoing struggle for the couple to answer
the question “Can I count on this person to be there for me?” (Hazan and Shaver, 1994). In effect, the answer to this question
provides an important perspective for the couple in understanding attachmentschemas. This profoundly complex work is about
helping each partner understand his or her part in interrupting the attachment connection, in both overt and non-conscious ways.
Each member of the dyad must endeavor to make sense of personal attachment needs, understand that perfect attunement is
not the goal, and aim for the repair of inevitable moments of disruption. We propose that this resiliency is the essence of a truly
loving and enduring relationship.
References
1 Amini F , Lewis T , Lannon R (1996) Affect, attachment, memory: Contributions towards psychobiologic integration. Psychiatry
59 : 213-239.
2
Beebe B and Lachmann F (2003) Infant Research and Adult Treatment: Co-constructing Interactions. Hillsdale, NJ: Analytic
Press .
3 Bowlby J (1969) Attachment and Loss, Vol. 1: Attachment. New York: Basic Books . (IPL.079.0001A)
4
Bowlby J (1973) Attachment and Loss, Vol. 2: Separation, Anxiety and Anger. New York: Basic Books . (IPL.095.0001A)
5 Bowlby J (1979) The Making and Breaking of Affectional Bonds. London: Tavistock .
2/6/2018 EBSCOhost
6
Bowlby J (1982). Attachment and loss: Retrospect and prospect. American Journal of Orthopsychiatry 52 : 664-678.
7
Clulow C (2001) Attachment Theory and the Therapeutic Frame in Adult Attachment and Couple Psychotherapy: The Secure
Base in Practice and Research. Philadelphia: Brunner Routledge . (CFP.005.0103A)
8
Cozolino L (2002) The Neuroscience of Psychotherapy: Building and Rebuilding the Human Brain. New York: W.W. Norton .
9
Gianino A and Tronick EZ (1988) The mutual regulation model: The infant's self and interactive regulation. In T Field , P
McCabe and N Schniederman (eds) Stress and Coping. Hillsdale, NJ: Lawrence Erlbaum , pp. 47-68.
10 Gottman J (1991) Predicting the longitudinal course of marriage. Journal of Marital and Family Therapy 17 ( 1 ): 3-7.
11
Hazan C and Shaver PR (1987) Romantic love conceptualized as an attachment process. Journal of Personality and Social
Psychology 52 : 511-524.
12 Hazan C and Shaver PR (1994) Attachment as an organizational framework for research on close relationships. Psychological
Inquiry 5 : 1-22.
13
Hazan C and Zeifman D (1994) Sex and the psychological tether. In K Bartholomew and D Perlman (eds) Advances in
Personal Relationships: Vol. 5, Attachment Processes in Adulthood. London: Jessica Kingsley , pp. 151-177.
14
Hesse E (1999) The Adult Attachment Interview. In J Cassidy and P Shaver (eds) Handbook of Attachment. New York:
Guilford Press , pp. 395-433.
15
Izard CE (1991) The Psychology of Emotion. New York: Plenum .
16 Johnson SM (2002) Emotionally Focused Couple Therapy with Trauma Survivors: Strengthening Attachment Bonds. New
York: Guilford Press .
17
Lewis T , Amini F and Lannon R (2002) A General Theory of Love. New York: Vintage Press .
18
Price JL , Carmichael ST and Drevets WC (1996) Networks related to the orbital and medial prefrontal cortex: A substrate for
emotional behavior? Progress in Brain Research 107 : 523-536.
19 Scharff DE and Scharff JS (1991) Object Relations Couple Therapy. Northvale, NJ: Jason Aronson , p. 108.
20 Schore AN (1994) Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development. Mahwah, NJ:
Erlbaum .
21
Schore AN (2001) The effects of a secure attachment relationship on right brain development, affect regulation and infant
mental health. Infant Mental Health Journal 22 : 7-66.
22
Schore AN (2003) Affect Regulation and the Repair of the Self. New York: W.W. Norton .
23 Siegel DJ (1999) The Developing Mind: Towards A Neurobiology of Interpersonal Experience. New York: Guilford Press .
24 Solomon MF (1994) Lean on Me: The Power of Positive Dependency in Intimate Relationships. New York: Simon & Schuster .
25
Weiss RS (1991) The attachment bond in childhood and adulthood. In CM Parkes , J Stevenson-Hinde and P Marris (eds)
Attachment Across the Life Cycle. London: Tavistock-Routledge , pp. 66-76.
International Journal of Applied Psychoanalytic Studies, 2004; v.1 (3), p214 (10pp.)
IJAPS.001.0214A
Record: 5
Title: An Attachment Perspective on Reunions in Couple Psychoanalytic Psychotherapy
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Authors: Clulow, Christopher

Source: Journal of Applied Psychoanalytic Studies, 2003; v. 5 (3), p269, 13p
Language: English
Abstract: Psychoanalysis has been slow to acknowledge attachment theory as one of its own. Yet
traditions of observational and representational research associated with it have much to
offer in shedding light on intrapsychic as well as interpersonal phenomena. This paper
explores these traditions and their potential clinical utility for couple psychoanalytic
psychotherapy. In particular, attention is drawn to behaviour and representations
associated with the experience of reunion in therapy sessions.
Accession Number: APS.005.0269A
(Permalink): direct=true&db=pph&AN=APS.005.0269A&site=ehost-live&scope=site
direct=true&db=pph&AN=APS.005.0269A&site=ehost-live&scope=site">An Attachment
Perspective on Reunions in Couple Psychoanalytic Psychotherapy</A>
An Attachment Perspective on Reunions in Couple Psychoanalytic Psychotherapy

Christopher Clulow, PHD, author; The Tavistock Marital Studies Institute Tavistock Centre, 120 Belsize Lane, London NW3 5BA,
England; e-mail: cclulow@tmsi.org.uk.
Psychoanalysis has been slow to acknowledge attachment theory as one of its own. Yet traditions of observational and
representational research associated with it have much to offer in shedding light on intrapsychic as well as interpersonal
phenomena. This paper explores these traditions and their potential clinical utility for couple psychoanalytic psychotherapy. In
particular, attention is drawn to behaviour and representations associated with the experience of reunion in therapy sessions.
Attachment Theory and Psychoanalysis

Historically, attachment theory and psychoanalysis have been uneasy bedfellows. The reasons for this are many and complex,
and it is relatively recently that progress has been made in integrating this “black sheep” of the psychoanalytic community back
into the fold (Fonagy, 2001). Because scepticism remains about the claim to membership of a theory that has been influenced by
nonpsychoanalytic approaches (evolution, ethology, control systems and cognition) it sometimes needs to be restated that
attachment theoryis a branch of psychoanalysis. In understanding human development and behaviour it takes account of
unconsciousprocesses, defence mechanisms, the formation of an internal world of object relations and the relationship of
reciprocal influence that exists between this and the social environment of the individual. Today, attachment theory research is
providing an empirical basis for many of the clinical assertions made by practitioners of psychoanalysis.
At the heart of attachment theory lie two interrelated propositions that apply to the adult couple, as well as to the nursing couple:
the felt security of an individual is a product of social relatedness; the development of social relatedness is a product of the felt
security of individuals. Herein lies the paradox of partnership: intimate involvement with others is a precondition for developing a
capacity to be alone; the capacity to be alone is a precondition for developing intimate involvement with others. Herein also lie the
different starting points of attachment and object relations theories (individuation as a product of intimate relating) and Freudian
dimensions of ego psychology (primarynarcissism giving way to intimacy) in charting human development.
Intimacy has been defined as “making one's innermost self known, sharing one's core, one's truth, one's heart, with another, and
accepting, tolerating the core, the truth, of another” (Cassidy, 2001, p. 122). Since the development of intimacy is at the very
heart of the psychoanalytic enterprise, and the capacity to be intimate is related to secure attachment, psychoanalysis has
reason to be informed about attachment theory. However, a further problem in effecting a rapprochement has been that for
psychoanalysis the site of learning about the vicissitudes of intimacy has been clinical practice, whereas for attachment theory it
has predominantly been empirical research.
Insofar as attachment theory has become associated with a tradition of observational research, doubt has been raised about its
claim to share the same field of concern as psychoanalysis. There is a vigorous debate in psychoanalytic circles about the
relevance and utility of observation for therapeutic practice. On one side of the debate there is the argument that
unconsciousprocesses and the transference cannot be “seen,” in any observable sense, but only experienced within the clinical
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setting. Meaning results from the processing of experience, and therefore what is of importance follows rather than accompanies
events. Everything of clinical interest is then contained in the “après coup.” From this perspective, observational research falls
outside the psychoanalytic paradigm and constitutes a potential threat to “the spirit of psychoanalysis, the specific mental state
that inhabits the psychoanalyst during his or her work and thinking” (Green, 2000, p.26). An alternative view is that from the
earliest stages of infancy there is a capacity for intersubjectivity that can be captured in the present “moment of meeting,” and
that this present fleeting moment contains aspects of an experienced past and anticipated future that may be communicated
through enactments and patterned behaviour. The difference then is between a “psychology of presence,” infant observation
focusing upon an interaction, and a “psychology of absence,” exploring what is in the infant's mind when the object is absent
(Stern, 2000).
Stern's distinction between the “observed infant” and the “clinical infant” is helpful to this debate (Stern, 1985). He writes that the
“observed infant” is a direct construct of what can be directly observed in the present—movements, facial expressions, language,
patterns of behaviour and so on. The “clinical infant” is a construct of the therapist and adult patient as they recreate infancy from
memories, enactments in the transference and theoretically guided interpretations. The “clinical infant”:
is created to make sense of the whole early period of a patient's life story, a story that emerges in the course of its telling to
someone else. This is what many therapists mean when they say that psychoanalytic therapeutics is a special form of story-
making, a narrative. The story is discovered, as well as altered, by both teller and listener in the course of the telling. Historical
truth is established by what gets told, not by what actually happened … real-life-as-experienced becomes a product of the
narrative, rather than the other way around. The past is, in one sense, a fiction (p.15).
Stern argues forcefully that both kinds of infant are needed in pursuing the quest for truth, the “clinical infant” breathing subjective
life into the “observed infant,” and the “observed infant” pointing towards general theories upon which the inferred subjective life
of the “clinical infant” can be built.
Observing Patterns of Behavior

The concept of maternal mirroring provides an insight into the process by which secure attachment and the “truth” about the
infant's self becomes known through observation (Winnicott, 1974). When an infant looks at her mother what she sees is herself
reflected in her mother's expression. The mother's capacity to focus on her infant, to attend to her and be sensitive to her
gestures in the responses she makes provides the infant with a picture of who she, the infant, is. Winnicott's insight has been
developed through observations that show how attuned mothers help their infants identify their feelings by mirroring behaviour
that has two characteristics: “marking” and “contingency” (Gergely & Watson, 1996). “Marking” allows for the infant's experience
to be distinguished from that of the mother and may be communicated by the mother's facial expressions being exaggerated—
playfully allowing her to convey that she has recognised and is responding to the infant's signal. “Marking” is therefore a bulwark
against the excessive use of projective identification. “Contingency” is related to the “truthfulness” of the response, the response
being contingent upon the emotional communication of the infant. When the mother reads the situation accurately, “contingency”
gives “marking” coherence. Both form the basis of the beginnings of a sense of an inner world, a “place” in which experience can
be projected, represented, thought about and creatively assimilated. “Untruth” is introduced into the relationship when the mother
can afford to respond to only part of the infant's signals and ignores other communications that might disturb her own
psychological equilibrium and state of mind. Parents can be unconsciously “untruthful” with their infants when they deny their
reality, attack it or attempt to convert it into something else. The title of the paper “On knowing what you are not supposed to
know and feeling what you are not supposed to feel”(Bowlby, 1988) speaks precisely to this condition, one which is manifested
most dramatically in relation to events of loss and trauma.
Implicit in this account is the developmental significance of a process in which successions of encounters with the mother provide
confirming or disconfirming responses to the infant's experience and nascent sense of self. These encounters might be thought of
as reunion episodes, when the infant is not only reunited with the physical presence of the mother but also with an experience of
self.
The significance of reunion behaviour was emphasised by the results of an attachment-based research process designed to
capture and classify the “truthfulness” or “security” of attachment in the infant-parent dyad. Mary Ainsworth, a close colleague of
John Bowlby, developed her naturalistic observations of infant-mother relationships in Uganda into similar home observations
and a laboratory-based procedure for infants and their mothers in Baltimore known as the Strange Situation Test (Ainsworth,
Blehar, Waters, & Wall, 1978). This procedure allowed observers to study the responses of infants to being separated from and
reunited with their primary caregiver (usually mother). The procedure exposed infants aged between twelve and eighteen months
to a stressful sequence of events designed to activate attachment behaviour. In a playroom setting the parent twice left and twice
returned to her child. A stranger twice entered the room. The infant was once left alone with the stranger and once left entirely
alone. The whole procedure, lasting about twenty minutes, was recorded on film.
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While Ainsworth and her colleagues had assumed this test would demonstrate the universality of attachment behaviour—
expecting infants to cry and protest about being separated from their parents, and to run to and be comforted by them upon their
return—this was true of only thirteen of the twenty-three infants originally studied. Six showed little or no distress at being left
alone or with a stranger, and then ignored or avoided their parents when they returned to the room. The remaining four
responded with a mixture of anxiety and anger, clinging ambivalently to the caregiver on her return but unable to engage in
exploratory play even when she was present. From these responses a classification of attachment behaviour was created. The
first, and largest, group of infants were classified as securely attached. The remaining two groups were deemed to be insecurely
attached, the first being classified as avoidant and the second as anxious/ambivalent. Attention later turned to
disorganised/disorientated patterns of behaviour in which the infant appeared both drawn to and fearful of the mother, but this will
not be elaborated upon here.
It is important to remember that while only the infant's behaviour was being rated, that behaviour was specific to a particular
relationship. The infant could behave differently in different contexts. In that sense, what was being observed was a relationship.
When insecure behaviour was organised (in contrast to the disorganised/disoriented category that was created later) it was
understood as a strategy developed by the infant for maintaining proximity with the caregiver in less than optimal conditions. As a
result of countless interactions it was assumed that the infant was responding to cues from the caregiver, “reading” how best to
avoid outright rejection, or how to be close to her without being intruded upon. This was in contrast to securely attached infants,
whose behaviour was highly correlated with maternal sensitivity to the infant's signals as evidenced at home over the preceding
year.
What is of greatest significance from the Strange Situation Test is that the episodes in which the infant was reunited with the
mother provided the strongest evidence for the classification of attachment security. In other words, the infant's inferred state of
mind with regard to attachment was most visible at the point of reunion with mother.
Representing Experience
The tradition of attachment research has not confined itself to observation. The shift from analysing the detailed behaviour of
infants and mothers to examining the pictorial communications of older children and the representation of early family
relationships by adults is documented in a seminal paper on attachment research (Main, Kaplan, & Cassidy, 1985). From an
attachment perspective, narratives constitute important emotional communications and mechanisms for transmitting—and,
importantly, from a psychotherapeutic perspective, transmuting—patterns of attachment across the generations (Holmes, 2001).
Restricted stories are too bounded and rigid to allow the truth out or others in; unbounded stories can have the same effect by
confusing the listener and encouraging an enmeshment that allows no coherent theme to emerge.
For adults, a sophisticated system has been devised to classify individual attachment security from the way subjects represent
their early family experiences in the semi-structured task posed by the Adult Attachment Interview (George, Kaplan, & Main,
1985). Secure subjects have a narrative style that fulfils four indices of coherence: quality (being “truthful” and having evidence
for what you say), quantity (being succinct and yet complete), relation (being relevant and collaborative in presenting what is
said) and manner (being clear and orderly). Ratings of security also take account of spontaneity in the telling of stories and the
openness of the teller to reviewing and revising the story as it is being told (the distinction between narrative and story being that
between form and content).
Through an analysis of discourse it is possible to discern how language and syntax are used to regulate attachment-related
anxieties, much as the observed infant uses behaviour to the same end. Insecure patterns take two main organised forms:
Dismissing narratives attempt to limit the influence of attachment experiences in the way they represent past family relationships.
Idealization, lack of recall, abstraction and, sometimes, denigration serve to keep attachment systems deactivated.
Contradictions between semantic and episodic accounts fail to provide internal consistency in the narrative which, combined with
its brevity, operates to keep the interviewer at bay. Preoccupied narratives are confused, passive, vague, sometimes
unconvincingly analytical or angrily conflicted. The teller often gets lost in his or her story, fails to find an autonomous perspective
in relation to events being recounted, and unconsciously invites the interviewer to become similarly enmeshed in the experience.
The task of the Adult Attachment Interview (AAI) is comparable to that of the Strange Situation Test (SST). It is designed to
expose subjects to a stressful situation in order to activate and make evident their orientation towards attachment. There is a
reunion dimension in both procedures, the AAI inviting its subjects to reencounter themselves and their internalised object
relationships, rather than actually reencountering an attachment figure as happens in the SST. However, both procedures are
concerned with accessing patterns of attachment in the domain of child-parent relationships. Can the adult couple be construed
as an attachment relationship, and if so, what might be taken from the traditions of observation and representation that might be
useful for therapeutic practice?
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Attachment and the Adult Couple
It was 1987 before adult romantic relationships were formally conceptualised in attachment terms (Hazan & Shaver, 1987).
Subsequently, there has been a growing interest in researching couples from an attachment perspective, especially within the
discipline of social psychology (Feeney, 1999). Significant differences between attachment in the parent-infant and adult couple
dyads have been described in terms of the latter being reciprocal and being sexually motivated to seek physical proximity—the
sexual relationship creating conditions in which attachment can develop (Hazan & Zeifman, 1999).
The reciprocal nature of couple attachment has attracted interest from couple psychotherapists and researchers. A distinction
has been drawn between simple (unidirectional) and complex (bidirectional) attachment in the couple (Fisher & Crandell, 2001).
The hallmark of secure attachment for these authors is the capacity of each partner to move between the positions of depending
upon and being depended on by each other in a flexible and appropriate manner, what they term complexattachment. In insecure
partnerships the direction of attachment may become uni-directional and rigidified, with partners competing with each other for
care, denying their need to be cared for, or settling into a quasi-parental pattern where one partner is designated as the carer and
the other as being in need of care.
Reciprocity in giving and seeking care is also implicit in the criterion of attachment security for researchers investigating the
behaviour of adults in couple relationships, although it is not used as a measure of security (Crowell & Treboux, 2001). Building
on Ainsworth's observational methods for capturing patterns of infant behaviour, these researchers have developed a measure of
attachment security that examines the quality of secure base use (the “child” role) and secure base support (the “parental” role)
displayed by partners in their partnership. In optimal secure base use a partner signals his or her needs clearly and consistently
until there is a response. The response received is comforting and enables emotional equilibrium to be established in the
partnership. Equally, in providing secure base support the other partner recognises the distress signals, correctly interprets the
need and provides a response that is timely and appropriate.
Observational and representational measures for capturing attachment security in the domain of the adult couple are still in the
early stages of development, but available results indicate that the domains of early family relationships and the adult couple do
not map identically on to each other. In other words, there are indications that support the clinical contention that relationships in
later life can influence patterns of attachment established during childhood. This is generally encouraging, but more specifically,
the methods used to capture patterns of attachment may have real clinical utility.
Attending to Reunions in Psychotherapy with Couples

Whatever their modality, therapists in the psychoanalytic tradition have long been aware of their significance as attachment
figures in their patients' inner and outer worlds. Working with the experience of separation in the therapeutic relationship, whether
owing to breaks in the therapy or its ending, is recognised as having tremendous therapeutic potential. This stems from an
awareness of how frequently patients manage separations by falling back on characteristic defensive strategies. The loss of, or
anxious regard for time boundaries at the end of sessions, the fear or dismissed significance of impending holiday breaks, and
the idealization of, or attack on therapy at its close can be understood and worked with as manifestations of, and defences
against, separation anxiety.
The fear of separation, and separateness, lies at the heart of many couple problems. Attempts to control behaviour, to plan ways
forward and to structure relationships—whether in the context of the couple or the therapy—can represent attempts to avoid
anxiety associated with needing and depending upon others. The failure of one partner to turn up for a session may generate
anger in the other that conceals the distress of being left behind. The act of leaving, or not turning up, may be to protect against
the fear of being left. The absence of one therapist (in situations where there are two), or sessions missed through therapist
absence, can similarly raise anxiety, eliciting angry, dismissing or fearful responses to the prospect of loss.
The rhythm of weekly sessions, with their regular separations, also brings a cycle of reunions. In this respect therapy sessions
can be regarded as having some of the properties of Ainsworth's Strange Situation Test (Clulow, 2001; Holmes, 2001). The
reunion dimension of the therapeutic process is likely to activate fears about intimacy which, in turn, are linked with internal
assumptions and anxiety about the prospect of future loss. The task of therapy means that partners will re-encounter each other
—and themselves—in ways that are different from the usual routines of every day life. Their inner world assumptions about the
nature of relationships are tested against those of their partner in an actual relationship. Any dissonance between the two is likely
to be stressful, and the couple will work towards arriving at a modus operandi in their partnership that “fits” (as distinct from
“meets”) the needs of each partner. Together they are likely to fashion and share defensive systems to protect them from threats
to their individual and collective representational worlds. It is these dimensions of experience that constitute the focus of attention
for couple psychoanalytic psychotherapy (Ruszczynski, 1993; Scharff & Savege Scharff, 1991).
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Because reunion behaviour tests conscious expectations and the unconscious premises of the representational worlds of each
partner against the reality of an actual social experience (in the contexts of the partnership and in the therapy) there is much
potential for learning to occur. The articulation of a shared internal world allows for partners to re-encounter themselves as well
as each other, and so provides opportunities for moving from narcissistic object relating towards real intimacy in the partnership
and the therapy. In this process the therapist might be regarded as the stranger in the Strange Situation Test. He may constitute a
threat by appearing to come between the couple, raising the possibility of separation or divorce by engaging them in discussions
about areas that threaten their sense of security. He may also diminish that anxiety by making the process safer—creating for the
couple a “secure base” or psychological “container” that facilitates change.
The therapist is also a potential attachment figure, akin to the caregiver in the SST, although in couple psychotherapy he is likely
to be of less significance than the partner in the room. Nevertheless, in working with the transference it is to be expected that
some of the patterns operating between the couple will apply also in relation to the therapist. Here there is scope for a more
subtle and intricate series of separations and reunions to be attended to. The therapist's gaze of attention, when turned towards
one partner, may break a sense of connection with the other, replicating an oedipal dilemma that he may need to notice and
respond to in order for the couple as a whole to stay engaged with the process. The therapist will also need to be alive to how
each partner turns away from or intrudes upon the other (and him/herself) at moments of potential emotional engagement, when
he faces being reunited with aspects of his experience that cause discomfort or anxiety. He will also need to take into account
how counter-transferential pressures and their own attachment orientation may result in patterns of relating that avoid real
engagement with the dynamic issue that is waiting for recognition and a response.
Case Illustration
In the illustration that follows an attempt is made to show how observing behaviour and attending to representations contained in
a couple's narrative in the opening stages of a therapeutic consultation has potential for providing access to material that is
relevant for making a clinical diagnosis and indicating a possible focus for therapeutic work. The couple were seen in the context
of a pilot research project exploring the feasibility of testing associations between attachment status and conflict management
strategies among those approaching the Tavistock Marital Studies Institute, London, for help with their partnership.
Alan and Anne are a couple in their mid-fifties whose children have left home. Prior to the consultation they had completed a
fifteen minute research task in which they were videotaped trying to make headway on their own with the problem that had
brought them for therapy. With their consent, the video camera was left running for the consultation. The consultation begins with
the therapist saying how long the session will last and asking how he might help. Alan begins:
The main thing is the last two months. They had left a restaurant where they had been having a meal with their daughter, and
she had annoyed him. His daughter was driving them home from the restaurant, but as they made to leave a car had pulled out in
front of them. He got out of the car to face the driver, fearing he might be in a rage and wanting to protect his wife and daughter.
Anne became hysterical. He lost his temper and hit her twice on the arm. The second occasion was when they were on holiday.
The holiday was his treat for her. They had run out of money at the hotel, he went to get more, and was locked out of their room
by her on his return. He had to ask the concierge to let him in. They then had a “totally irrational” fight about where he had been.
To prove his position he had even produced the timed receipt from the cash machine. He had withdrawn into another room with a
book, she had pursued him not satisfied with his answer. He had pushed her (“hit me on the head,” she says), then she had
smashed a lamp and left. He didn't know where she had gone, checked the airport, telephoned his daughter at home, and it was
the next day before she returned having slept elsewhere in the hotel. She was “totally irrational—that's my story.”
The therapist, anxious about the violence, asks if he is worried about his behaviour. He says yes, but excuses himself by
saying that he thought he was doing the right thing in each case. He was trying to protect them in the car, he hadn't run away.
The therapist asks how he had felt at the time. “Totally angry,” Alan replies, and especially because he had been given no
explanation by Anne. Had they tried talking about this, enquired the therapist? They had, he said, but he still had no answer.
Anne comes in at this point saying she had stopped talking because he might become violent, and he had threatened to leave
her rather than have that happen again. She refers back to a time some ten to fifteen years previously when she had threatened
to take out an injunction against him because of his violence. The children had seen it and been damaged by it. This was news to
Alan, and Anne says the children hadn't told him about it because they were scared of him. He says he can't believe this, and
comments on all he's done for them, adding that she has been violent too, even cutting up his clothes. He then protests that the
session is getting too adversarial and he feels as if he is in a court of law—like “trying to put my case.” His fear is that if he comes
out on top from the session then she'll think it is a waste of time, so the only option open to him is being the bad guy.
The therapist picks up the “court of law” experience, commenting on how difficult it must be to talk and listen together in that
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frame of mind. He asks what they want to come out of the session. Anne responds by saying she thought he had been having an
affair when he had been violent before, explaining his behaviour by inferring that he had felt guilty then as now. She fears the
violence means the same thing is happening again. She feels they have lost their good relationship with the children, and that
they need to talk about the past, perhaps with their grown-up children present. The therapist picks up on her fear of Alan having
an affair. She agrees, saying they were not as close as they used to be.
Commentary
In this illustration there is evidence of a patterned interaction in the marriage that might be described as a shared defence. The
observed dynamic is of a frustrated, angry man being arraigned and controlled by his wife for behaving violently. Alan's gestures,
expressed in exaggerated body movements—arms gesticulating wildly and repeatedly slapping the top of his legs as they fall in
his lap—convey just how agitated he has become. This is in marked contrast to Anne's stillness as she studies her notes and
pursues her arguments. Observing his counter-transference, the therapist was aware of feeling anxious about a potentially violent
threat, coerced into taking sides and left in a position there was little space to think laterally about what the couple might be most
anxious about in seeking help.
As we have seen, it is important not only to observe behaviour and subjective responses to it but also to understand how couples
represent their experience, and to consider what they are trying to communicate through the stories they tell. Here, the truth of a
story may not correspond with the truth of the narrative. What is important for the therapist is listening to how the story is told and
accessing what it is being used to convey. In this latter respect it has been argued that the stories couples tell in therapy sessions
can be regarded as couple “dreams”—sometimes “nightmares”: pictorialized communications of emotional experience(Fisher,
1999).
Alan and Anne's opening stories suggest roles that each partner takes up in response to an experience of threat. In the first, Alan
perceives himself to be both the potential victim and perpetrator of an attack on his family, threatened and frustrated by his exit
being blocked by a stranger (the threat of coming to therapy?). In the second, he conveys his response to the experience of
being shut out and abandoned. Anne's exclusion of him suggests that this may have been an enacted communication about how
she was feeling, having been left on her own at the hotel without explanation. There is a victim-victimiser interaction between
them, but the roles are ambiguous and move between them, concealing key emotional communications around the experience of
leaving and being left.
Their story and narrative style depict a man who wishes to be in the position of protector and provider for his family and in the
marriage, but whose actual experience in relationships falls short of this ideal. He avoids expressing his feelings directly, except
through his behaviour and in relation to his uncomprehending frustration with his wife. He is prepared to be the “villain of the
piece” if that will protect both the marriage and his need for emotional distance. Anne finds it difficult to speak to her own feelings
and needs, instead triggering them in Alan. Her ambivalent bids for attention (pursuing, provoking and protecting herself from
him) suggest her underlying anxiety about her entitlement to be loved and wanted for herself, and a belief that she will only be
able to keep Alan if she controls him. Their story can be taken as indicative of a shared phantasy that being loved carries
conditions, and that intimacy is potentially dangerous in the violent engagement it can provoke. So they keep their distance, but
in different ways. This is both a protective strategy and one that can itself trigger a crisis. What they seek is some validation of
themselves by each other, but this turns into an appeal for judgement from a third party (therapist, camera, children) that they
believe can only be satisfied at the expense of one of them.
Conclusion
It is reasonable to assume that couples seeking professional help will find talking about their problems stressful. Attachment
theory proposes that such threats will activate both attachment behaviour and strategies of relating that individuals assume (often
unconsciously) will protect them against the threat of intimacy when that has become associated with the prospect of loss.
Strategies relied upon to manage such conflicts are likely to be evident in the “reunion” behaviour at the start of therapy, the start
of sessions and the moments of potential encounter within sessions.
By drawing from traditions of attachment research it may be possible for therapists to become more attuned to detecting the
nature of the anxiety that underlies a couple's defensive strategies, especially by processing what is said and done in the opening
stages of a therapy session. This is likely to involve observing the behaviour of couples and the therapist's emotional responses
to them, as well as attending to the stories partners recount as representations of the shared unconscious phantasies that bind
them together as a couple, and decoding the emotional communications that they contain.
Whether observing or listening, therapists need to take account of the context they create for couples as partners re-encounter
themselves and each other in the session. That context, including the therapist's own attachment status, will influence the
gestures made and the responses they receive in the fine grain process of the session. What they create together then becomes
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open to being experienced and thought about. Given that an optimal level of anxiety is necessary for therapeutic change, creating
“secure base” conditions in which exploration is neither under-stimulated nor inhibited by anxiety becomes an important objective
of the work. Attending to behaviour and narratives associated with the reunions that are part of the fabric of every therapeutic
relationship may then have real practical utility in helping therapists think about and work with insecure patterns of attachment in
the couple.
Acknowledgments
The author wishes to acknowledge the assistance of the Lord Chancellor's Department for providing a grant for undertaking part
of the work described in this paper.
Footnotes
1
Correspondence should be directed to Christopher Clulow, Ph.D., Director, The Tavistock Marital Studies Institute, Tavistock
Centre, 120 Belsize Lane, London NW3 5BA, England; e-mail: cclulow@tmsi.org.uk.
References
1
Ainsworth , M. D. S. , Blehar , M. , Waters , E. , & Wall , S. (1978). Patterns of Attachment: A Psychological Study of the
2
Bowlby , J. (1988). On knowing what you are not supposed to know and feeling what you are not supposed to feel, A Secure
Base. Clinical Applications of Attachment Theory. London: Routledge .
3
Cassidy , J. (2001). Truth, lies, and intimacy: An attachment perspective. Attachment and Human Development, 3 ( 2 ), 121-
155.
4
Clulow , C. (2001). Attachment theory and the therapeutic frame. In C. Clulow (Ed.), Adult Attachment and Couple
Psychotherapy. London & Philadelphia: Brunner-Routledge .
5
Crowell , J. , & Treboux , D. (2001). Attachment Security in Adult Partnerships. In C. Clulow (Ed.), Adult Attachment and
Couple Psychotherapy. The ‘Secure Base’ in Practice and Research. London: Brunner-Routledge .
6
Feeney , J. (1999). Adult romantic attachment and couple relationships. In J. Cassidy & P. Shaver (Eds.), Handbook of
Attachment. Theory, Research and Clinical Applications. New York: Guilford .
7 Fisher , J. (1999). The Uninvited Guest. Emerging from Narcissism towards Marriage. London: Karnac .
8
Fisher , J. , & Crandell , L. (2001). Patterns of Relating in the Couple. In C. Clulow (Ed.), Adult Attachment and Couple
Psychotherapy. The ‘Secure Base’ in Practice and Research. London: Brunner-Routledge .
9
Fonagy , P. (2001). Attachment Theory and Psychoanalysis. New York: Other Press .
10
George , C. , Kaplan , N. , & Main , M. (1985). The Adult Attachment Interview. Unpublished manuscript, University of
California, Berkeley.
11
Gergely , G. , & Watson , J. (1996). The social bio-feedback theory of parental affect-mirroring. International Journal of
Psycho-Analysis, 77 , 181-212. (IJP.077.1181A)
12
Green , A. (2000). What kind of research for psychoanalysis? In J. Sandler , A. Sandler , & R. Davies (Eds.), Clinical and
Observational Research: Roots of a Controversy. London: Karnac .
13
Hazan , C. , & Shaver , P. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social
Psychology, 52 ( 3 ), 511-524.
14
Hazan , C. , & Zeifman , D. (1999). Pair Bonds as Attachment: Evaluating the Evidence. In J. Cassidy & P. Shaver (Eds.),
Handbook of Attachment. Theory, Research and Clinical Applications. New York and London: Guilford .
15
Holmes , J. (2001). The Search for the Secure Base. Attachment Theory and Psychotherapy. London: Brunner-Routledge .
(PI.037.0309A)
16
Main , M. , Kaplan , N. , & Cassidy , J. (1985). Security in Infancy, Childhood and Adulthood: A Move to the Level of
Representation. In I. Bretherton & E. Waters (Eds.), Growing Points of Attachment Theory and Research. Monograph of the
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Society for Research and Child Development. Serial No 209, Vol 50 , Nos 1-2.
17
Ruszczynski , S. (Ed.). (1993). Psychotherapy with Couples: Theory and Practice at the Tavistock Institute of Marital Studies.
London: Karnac .
18
Scharff , D. , & Savege Scharff , J. (1991). Object Relations Couple Therapy. New Jersey and London: Jason Aronson .
19
Stern , D. (1985). The Interpersonal World of the Infant. A View from Psychoanalysis and Developmental Psychology. New
York: Basic Books . (ZBK.016.0001A)
20
Stern , D. (2000). Empirical infant research. In J. Sandler , A. Sandler , & R. Davies (Eds.), Clinical and Observational
Psychoanalytic Research: Roots of a Controversy. London: Karnac .
21
Winnicott , D. (1974). Playing and Reality. Harmondsworth: Penguin . (ZBK.017.0001A)
Journal of Applied Psychoanalytic Studies, 2003; v.5 (3), p269 (13pp.)
APS.005.0269A
Record: 6
Title: Attachment, Family Therapy, and Relational Psychoanalysis: Introduction to Virginia
Goldner’s “Romantic Bonds, Binds, and Ruptures: Couples on the Brink”
Authors: Seligman, Stephen
Source: Psychoanalytic Dialogues, 2014; v. 24 (4), p399, 3p
ISSN: 10481885
Language: English
Abstract: Virginia Goldner’s paper reflects her exceptional role as a leader in both the family therapy
and relational psychoanalytic worlds. Integrating those domains with theory and
attachment and affect regulation, she presents a vivid and elegant theoretical perspective
with an acutely empathic and self-reflective account of a torturous case. Commentaries by
Leslie Greenberg and Paul Wachtel follow, along with a reply from Goldner.
Accession Number: PD.024.0399A
(Permalink): direct=true&db=pph&AN=PD.024.0399A&site=ehost-live&scope=site
direct=true&db=pph&AN=PD.024.0399A&site=ehost-live&scope=site">Attachment, Family
Therapy, and Relational Psychoanalysis: Introduction to Virginia Goldner’s “Romantic
Bonds, Binds, and Ruptures: Couples on the Brink”</A>
Attachment, Family Therapy, and Relational Psychoanalysis: Introduction to Virginia Goldner’s

“Romantic Bonds, Binds, and Ruptures: Couples on the Brink”
Stephen Seligman, DMH, author, Stephen Seligman, D.M.H., is Clinical Professor of Psychiatry, Infant–Parent Program,
University of California, San Francisco; Training and Supervising Analyst, San Francisco Center for Psychoanalysis &
Psychoanalytic Institute of Northern California; Joint Editor-in-Chief, Psychoanalytic Dialogues: International Journal of Relational
Perspectives.Correspondence should be addressed to Stephen Seligman, 3667 Sacramento Street, San Francisco. 94118, CA.
Email: stephen.seligman@ucsf.edu
Virginia Goldner’s paper reflects her exceptional role as a leader in both the family therapy and relational psychoanalytic worlds.
Integrating those domains with theory and attachment and affect regulation, she presents a vivid and elegant theoretical
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perspective with an acutely empathic and self-reflective account of a torturous case. Commentaries by Leslie Greenberg and
Paul Wachtel follow, along with a reply from Goldner.
Virginia Goldner is best known among contemporary analysts as one of the leaders of the Second Wave feminist turn in
psychoanalytic gender studies that emerged in the 1980s and beyond. While other critical writers had commented on the
prejudices and limitations of the Freudian theorizing about women and girls, the Relational gender theorists allied with academics
and eventually, queer theorists to take a more radical look, turning the established orthodoxies on their heads. Goldner (1991)
was part of the group of four authors (along with Benjamin, 1991; Dimen, 1991; and Harris, 1991) of a seminal set of articles in
Psychoanalytic Dialogues’s third issue, which continues to set the parameters for the emergent discourse. One of the leading
spokeswomen for this emerging perspective, Goldner was the founding editor of Studies in Gender and Sexuality and has
continued her dynamic work in a variety of forums.
It may be less well known that Goldner has been a core contributor in the family therapy world. This distinction is of particular
note: While a number of analysts have worked to apply their analytic expertise to related fields, Goldner’s contributions to the
family therapy tradition have been primary and original, rather than subsidiary to analysis. This quality has been apparent in her
ongoing work in both arenas, both in its breadth and its distinctive, vital voice. She has also taken a serious interest in
developmental research, which is apparent in this article.
In keeping with this, this essay is a flexible and effortlessly elegant synthesis of family systems clinical theory, attachment theory
and research, and Relational analysis. Goldner presents a vivid, complex conceptualization of an exceptionally difficult couples
case with exceptional range and evocative force, encompassing the current Relational insights about the intertwining of
transference and countertransference, along with a working knowledge of the attachment categories, mentalization and affect
regulation and dysregulation. All of this is linked to a sophisticated understanding of the role, nonconscious and nonverbal
communication and the transformative effect of interaction.
This paper thus marks a convergence of the two independent strands in her distinguished career, both in its conceptualization
and its scope. It begins with a sophisticated, evocative reflection on the turmoil that working with high-conflict couples can
provoke in their therapists. She then moves on to show how the same attachment dynamics that organize infants and parents in
their search for emotional security take hold between the partners in intimate dyads: “… if you have been living and sleeping with
your partner for two years (it should be no surprise that we only attach to those we touch), you are now bonded, wound around
each other, nervous system to nervous system, and your psychic state is now joint property” (p. 404).
From here, Goldner moves toward an exploration of the emerging conceptualizations of disorganized attachment and affect
dysregulation, which leads to an inventive discussion of what she calls “small ‘t’ trauma.” This rather subtle usage enables her to
apply these new models, developed as they have been to severely traumatized children, to the more ordinary, but perhaps even
more frequently occurring moments amidst couples in the throes of emotionally heated impasses where fear and arousal reach
unmanageable levels. Gracefully and pragmatically applying the mentalization research that has shown how projection eclipses
judgment, attention, and thinking about others’ experiences when strong, negative feelings can’t be otherwise managed, Goldner
notes that “each partner is like that alarmed child, seeking … confirmation for what they are seeing, clear as day. … Since
psychic reality is only granted the status of externality if it is consensually validated, the issue is no longer a matter of who is right,
but of whether … someone is crazy” (p. 409).
With this in focus, Goldner is now able to illuminate an element of the couples therapist’s experience, those (more or less)
transient moments (which are indeed often not so transient) in which the therapist herself is tormented and increasingly
emotionally disorganized and finally worn out. In the vividly and precisely presented case of “Bill and Jane,” she describes how
she became increasingly helpless, agitated as the couple fought endlessly, fearfully, bitterly, and without any recognition of the
destruction that they were wreaking on one another and, indeed, on themselves. Finally reaching the limits of her ability to work
with these patients, she lets them know that she has but “another minute of this in me” (p. 415). She goes on to report that
something in the case shifted when she became able to recognize and disclose these emotional limitations, ones that were so
compelling and most of all, inevitable, in this case.
Finally, then, Goldner applies several dimensions of the Relational analytic innovation to couples therapy. The family therapist is
no more “omnipotent” or deserving of idealization than the analyst entangled with an individual patient. She sees the complex
and emotionally intense web of object relations emerging in couples therapy—dyads, triads, past and present, internal and
external; she is exquisitely (if inevitably) aware of these are projected, internalized, aggregated, diffused, dispersed, and so on
(and so on). As the family therapist is likely to be emotionally and interactionally implicated in these relationship networks, she
can hardly expect to be consistently in control of herself: Thus, the relational insistence on the therapist’s explicit attention to her
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own experience, including her willingness to disclose it, will be useful in clinical work with couples and families. Indeed, couples
therapy may subject us to even more direct experience of the “small ‘t’ traumas” than individual treatments do, since these
situations place the therapist in direct contact with interactions that are considerably more out-of-control, since there are at least
two parties who will perform their difficulties regulating their feelings and indeed, their identities. Paradoxically, this may be
especially likely when the therapist can enable a background of safety (Sandler, 1960), since the patients will feel freer to “be
themselves.” Infant–parent therapists are well aware of this kind of impact, as they watch parents reenact their traumatic
experiences with their own parents with their own babies (Seligman, 2013).
Goldner’s paper is followed by commentaries by Leslie Greenberg and Paul Wachtel. Both are distinguished academic clinical
psychologists, ideally qualified for this task. Greenberg is one of the leading developers of innovative psychotherapeutic
applications of affect theory and research. Wachtel has pushed the boundaries of psychotherapyintegration while remaining
rooted in psychodynamics. Goldner’s reply further sharpens and clarifies the many issues and perspectives raised in the
exceptionally lively interchange which her essay stimulates.
REFERENCES
1
Benjamin , J. (1991). Father and daughter: Identification with difference—A contribution to gender heterodoxy. Psychoanalytic
Dialogues, 1 , 277 - 299–. (PD.001.0277A)
2
Dimen , M. (1991). Deconstructing difference: Gender, splitting, and transitional space. Psychoanalytic Dialogues, 1 , 335 -
352–. (PD.001.0335A)
3
Goldner , V. (1991). Toward a critical relational theory of gender. Psychoanalytic Dialogues, 1 , 249 - 272–. (PD.001.0249A)
4
Harris , A. (1991). Gender as contradiction. Psychoanalytic Dialogues, 1 , 197 - 224–. (PD.001.0197A)
5
Sandler , J. (1960). The background of safety. International Journal of Psycho-Analysis, 41 , 352 - 356–. (IJP.041.0352A)
6
Seligman , S. (2013). Attachment, intersubjectivity and mentalization within the experience of the child, the parent, and the
provider. In K. Brandt , B. D. Perry , S. Seligman , & E. Tronick (Eds.), Infant and early childhood mental health: Core concepts
and clinical practice ( 309 - 322–). Washington, DC: American Psychiatric Publishing .
Psychoanalytic Dialogues, 2014; v.24 (4), p399 (3pp.)
PD.024.0399A
Record: 7
Title: How was it for You? Attachment, Mirroring and the Psychotherapeutic Process with
Couples Presenting Sexual Problems
Authors: Clulow, Christopher
Source: Fort Da, 2012; v. 18B (2), p9, 20p
ISSN: 1943958X
Language: English
Accession Number: FD.018B.0009A
(Permalink): direct=true&db=pph&AN=FD.018B.0009A&site=ehost-live&scope=site
direct=true&db=pph&AN=FD.018B.0009A&site=ehost-live&scope=site">How was it for
You? Attachment, Mirroring and the Psychotherapeutic Process with Couples Presenting
Sexual Problems</A>
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How was it for You? Attachment, Mirroring and the Psychotherapeutic Process with Couples
Presenting Sexual Problems
Christopher Clulow, PHD, author, Senior Fellow of the Tavistock Centre for Couple Relationships, London, where he works as a
visiting lecturer and researcher. He has published extensively on partnerships, parenthood, and couple psychotherapy, most
recently from an attachment perspective. He is a founding member of the British Society of Couple Psychotherapists and
Counselors and registered with the British Psychoanalytic Council.; 62 Clarence Road, St Albans, Herts., AL1 4NG, UK
Christopher.clulow@btinternet.com 07955 223796
This article has been withdrawn by the publisher. It is no longer available electronically.
Fort Da, 2012; v.18B (2), p9 (20pp.)
FD.018B.0009A
Record: 8
Title: An Attachment Systems Perspective Treatment of a Bicultural Couple
Authors: Howard, Sally, A.
Source: Progress in Self Psychology, 2004; v. 20, p151, 15p
ISSN: 08935483
Language: English
Accession Number: PSP.020.0151A
(Permalink): direct=true&db=pph&AN=PSP.020.0151A&site=ehost-live&scope=site
direct=true&db=pph&AN=PSP.020.0151A&site=ehost-live&scope=site">An Attachment
Systems Perspective Treatment of a Bicultural Couple</A>
An Attachment Systems Perspective Treatment of a Bicultural Couple

Sally A. Howard, PHD, Psy.D, author, is Vice President, Faculty, and Training and Supervising Analyst, Institute of Contemporary
Psychoanalysis, Los Angeles.
From its inception, self psychology has asserted the belief that development is possible throughout life. The nexus of
development, according to Kohut, is certain relational experiences. Kohut's focus on development within the analytic relationship
provided a rich and ample context for further theoretical cultivation, evidenced by the eight broad paradigms now considered a
part of contemporary self psychology. In addition to traditional self psychology(Kohut, 1977), these paradigms include
intersubjectivity and contextualism(Stolorow, Atwood, and Orange, 2002), self and motivational systems(Lichtenberg, Lachmann,
and Fosshage, 1992), specificity theory(Bacal, 1985), attachment/infant research (Beebe and Lachmann, 2002), developmental
systems self psychology(Shane, Shane, and Gales, 1997), nonlinear dynamic systems theory or complexity theory (Trop, Burke-
Trop, and Trop, 1999; Coburn, 2002), and relational self psychology(Fosshage, 2003). In this paper, I discuss the treatment of a
bicultural couple—Tyler, a Caucasian woman, and Ben, a Japanese man, from an attachment systems perspective. This
theoretical base incorporates nonlinear dynamic systems theory, attachment/infant research, and some additional currents
outside self psychology which I believe enrich our dialogue.
Tyler first captured my attention as she sat on the edge of a parenting group I was teaching for those brave parents anticipating
entry into the land of adolescent children. She stood out in this manicured crowd as a self-revealing, somewhat anxious, unruly
and flamboyant flower child. She was concerned about the effects of commercialism, TV, Barbie, and nonorganic products on her
children. I liked her and admired her courage to be herself, although I found her difficult to follow at times and a challenge to
contain within the group. As the parenting class progressed through its eight-week course, her differences from the group
became more pronounced, and she became even more of an outsider, with some members ignoring or withdrawing from her.
She appeared highly anxious, and her comments became overly expansive, less connected to group discussion, and more
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idiosyncratic. As I approached my car after the last parent meeting, Tyler approached me and asked me if I would see her and
her husband for marital counseling. She appeared acutely distressed and frightened, stating, “We are having so much trouble. I'm
not sure what's going to happen.” I agreed to meet with them for an initial consultation.
My first meeting with Tyler and Ben introduced me to a very divergent and interesting couple. He appeared as highly contained
as she was expansive, as carefully stated as she was fluid and spontaneous. When I asked them to tell me what concerns
brought them to treatment, Tyler waited briefly for Ben to speak and then began speaking herself. She complained that Ben
worked too much and that the house they had purchased was too big, too materialistic, too expensive, and the cause of Ben's
excessive work schedule. She described Ben as irritable and withdrawn. She said she felt very alone and that Ben barely spoke
to her and rarely expressed any feelings. As a full-time mother, she felt isolated with the children. Tyler said that, when Ben did
talk, he was critical of her for not keeping a cleaner house or for not getting a job. She stopped every so often, looking at Ben to
confirm or deny her statements. He did neither, but looked painfully embarrassed. Tyler then began to speculate about what Ben
might be feeling and why he behaved the way he did. Maybe he had lost interest in her; maybe he was angry with her. Maybe he
wished he had never left Japan or that Tyler would be more like Ben's mother. She was worried he wanted a divorce. The more
Tyler talked, the quieter and more withdrawn Ben appeared. He folded his arms across his chest, drew his shoulders forward,
crossed his legs, and stared painfully ahead. She in turn, became more emotional, more animated, tilting her body towards him to
gain access to his field of vision, gesturing in a larger more rapid way. I thought, at that moment of the “chase and dodge”
interactions filmed by Beebe and Lachmann (in Shore, 1994), as Tyler looked to me like the anxious mother, desperate to gain
access to her child and Ben looked just as desperate to escape. I wondered about Ben and Tyler's history of attachment and
about the cultural meanings and patterning of their emotional exchange. They appeared acutely distressed and uncomfortable to
me, and I felt it was important to intervene.
At this point, I asked Tyler if she could pause for a moment, stating that I could see how desperate she felt to make contact with
Ben and how shut out I thought she felt. I then addressed Ben, saying “I wonder what this has been like for you and how you feel
about what Tyler is saying?” He responded that Tyler's descriptions were not the way things were, that he had to work to support
the family. “She's not reasonable,” he said. “I don't know what she wants. We have bills that have to be paid.” Tyler began to
object. I stated to Tyler, “I know that there is a lot you want and need to say and it's very important to hear all of it, but I know also
that you want very much to have Ben tell you more about what he feels and thinks, and I think he is trying to do that right now.”
Ben looked relieved, Tyler dubious. I continued, “I'd like to understand both of you more and help you feel better together. You
both seem to feel quite bad and I would like to help. May I share with you my initial thoughts about what's happening between the
two of you?” They assented. “Tyler, I think that you feel very left out, shut out of Ben's life and it makes you feel very frightened
and upset. I know it is very important to you to feel that you can connect to Ben and that he is connecting to you.” Tyler nodded
with tears. “Ben, I am aware that you did express yourself today, and I don't know how easy that was for you. When you say Tyler
doesn't make sense to you, I believe that is true, that it really is difficult for you to understand what she is about. I have a sense
that there is more that you think and feel that you might like to share if we can make it feel safe for you to do so.”
Ben said quietly, “I think that is right.”
In my presentation of this case, I want to show how attachment and systems theory have informed the way I work and how I
understand some of the changes that occurred in the course of treatment. A primaryprinciple from an attachment perspective is
the importance of establishing a sense of safety or a secure base for each partner of the couple in therapy. This idea, originally
developed by Bowlby (1988), conveys that a sense of safety provided through reliable, contingent responsiveness is not only
prerequisite to, but the primary engine of, optimal development and therapeutic change. Attachment theory and the idea of
secure attachment have been further articulated by many theorists. Fonagy (2002), for example, describes attachment as the
context that allows for development of interpersonal understanding. Attachment determines the depth to which the social
environment may be processed and understood. In his opinion, secure attachments and productive therapeutic intervention are
characterized by mentalization, or the ability of the therapist to recognize the mind of the patient and vice versa. In this opening
session, my verbal intervention was an initial attempt to recognize the subjective experience or mind of each person, letting each
person know that this is a place where being heard and understood is possible and protected. Boszormenyi-Nagy and Ulrich
(1981), describe this stance as “multidirected partiality” (p. 52). The goal of such action is to articulate attention, interest, and
respect for each person's experience. The therapist's ability to do so is the cornerstone of building trust between patient and
therapist. Heavily influenced by Martin Buber, Nagy spoke of this experience as one of dialogue or I-Thou, the foundation of
which is deep recognition of and respect for the other. Initiated by the therapist's recognition of each person's experience, a
developmental process begins that one hopes will result in collaborative dialogue for the couple: getting to know another mind
and taking it into account in constructing and regulating interaction.
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A second aspect to my intervention in the first session is in the enactive realm. I responded to regulate Ben and Tyler's affect as
well as my own. As I observed what I experienced to be a painful, probably repetitive pattern of Tyler's escalating attempts to
reach an increasingly withdrawn and escaping Ben, I felt an urge to respond. Byng-Hall (1995) emphasizes the importance of the
therapist's willingness to intervene or act in crisis as foundational to a sense of security. The willingness to respond to a crisis or
to the patient's perception of danger is essential from an attachment perspective. With couples this may mean fairly active and
direct attempts to reduce distress and intervene to alter patterns of mutually alienating interactions. This creates a safe
environment that is prerequisite for new, more adaptive regulation of interpersonal experiences.
Beebe and Lachmann (2002) emphasize that therapist and patient simultaneously, although asymmetrically, create an affectively
well-regulated system. Thus the therapist's own regulatory needs, strengths, and weaknesses play a part in the system that
develops. The regulatory system that emerges contains verbal and conscious components as well as procedural and
dynamicunconscious components. For example, the desire I had to alter the escalating negative affect between Ben and Tyler
reflected my own complex procedural history, culture, and socialization, as well as my training. I am an American female, a
mother, I was a child who acted as mediator in a blended family of origin, I am married to a man who immigrated as an adult to
the United States, and I am an analyst trained in infant and attachment research. All of these past and current experiences
(record of finitude, as Gadamer, 1976, would put it) inform my affective responses. The hope, of course, when one acts in the
analytic relationship, is that the action will be based in self-reflective capacities or “mentalized affectivity” (Fonagy, 2002)—an
ability to understand the subjective meanings of one's own affect states and therefore to direct one's actions towards therapeutic
ends. Yet as Lyons-Ruth (1998) has written, much of the relational procedures and processes that affect change occur out of
awareness. The verbal intervention I have described was accompanied by particular tones of voice, vocal rhythms, facial
expressions, and body movements—all ways I have of being with, emergent in this context, most of which I cannot tell you now,
and could not have fully articulated then. The result, however, was in the moment to provide some measure of relief, affect
stabilization, and scaffolding for further developments.
One last note about my own experience as I began treatment with Ben and Tyler: I was aware of the excitement and mild anxiety
that I have come to associate with doing analytic work, particularly analytic work with couples and families. I relate this
excitement and anxiety to the nonlinear nature of therapeutic experience. The triadic system of the therapist and couple is
necessarily more complex than that found in individual work, and I am often surprised by what happens. Although I identify
certain global processes or patterns that I find useful in understanding treatment, growth, and development, unpredictability is
always present on the local level of a particular treatment triad. (Thelan and Smith, 1994). An understanding of nonlinear systems
theory has increased my tolerance for the unpredictability of therapeutic work and supported an increased sense of openness to
novelty, divergence, and context dependence.
Within the first two months of treatment, I knew the following historical information about Ben and Tyler: They had met in a major
east coast city where Tyler was working and Ben was attending graduate school. Ben was raised outside Tokyo, the only child of
a middle-class Japanese family. Tyler was the third of four girls in a well-to-do Caucasian family from upstate New York. Both had
experienced significant parental loss in childhood, Ben through his father's death when he was 11 and Tyler through her father's
career, which took him away from the family frequently, and through the father's eventual departure from the family after an affair.
Ben's mother had been depressed, and Ben recalled that he often heard her crying in her bedroom. Tyler described her mother
as frequently stressed, during which times she would “yell.” Her mother was very busy with so many children, and Tyler thought
that the most unruly child got the attention. Everyone argued a lot, and they were loud.
Tyler and Ben were married after two years of courtship. Tyler described Ben as different from previous men she had dated in
that he was stable, faithful, and committed. She admired his intellect, as he did hers. She also commented that she enjoyed their
sexual relationship. Ben stated in his more minimalist emotional style that he wanted to marry Tyler and that he thought she
would be a good mother and wife. He agreed with Tyler that their intimate relationship had been enjoyable. It was not until later in
treatment that Ben expanded his emotional expression to include words like sadness, love, or excitement.
Shortly after they married, Ben and Tyler had moved to Japan where they lived for four years. During their second year there,
they had the first of two children. Tyler stated that this time had been very difficult for her. She felt isolated and very much like an
outsider. She stated she often felt judged for not “being Japanese enough.” She complained that Ben had not been
understanding or supportive of her experience. Things worsened for her with the birth of their baby, and she felt “locked in a box”
in the small apartment in which they lived. When she became pregnant with their second child, they moved to the United States.
Although Tyler wanted to move to the east coast to be close to her family, they chose the west coast due to a career opportunity
for Ben. When I asked them how they had made the decision about where to live in the United States, neither person could offer
a very detailed or coherent narrative about it. They did state that where they lived and where they spent their vacations continued
to be a painful source of conflict.
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On the west coast, Ben and Tyler purchased a home in an exclusive area. Tyler saw the house as too burdensome: she felt
alienated both from her neighbors and from her past. I suspected that Ben, too, must have feelings about living away from his
family and country of origin, but they were not accessible at this time in treatment.
I wondered about Ben's (from my point of view) restricted emotional expression. I formulated that this style reflected a pattern of
interaction emergent from a number of contexts, including the domain of interaction we think of as attachment and the domain of
culture and language. Here I was faced with a dilemma: how much of Ben's demeanor was an expression of cultural codes and
norms with which I had limited experience, and how much did it reflect his personal attachmenthistory? This is a dilemma we all
face when we meet a person from a different culture. I thought it was possible that Ben's emotional expression might be
patterned by traditional Japanese cultural norms such as an emphasis on harmony, masking negative facial expressions, and
displaying less facial affect overall. In this cultural context, a universe of feelings may exist between individuals, feelings that are
acknowledged, though not spoken or expressed in the explicit way so typical of American culture. How well did traditional
Japanese norms describe Ben? It remained to be seen. On the other side of the dilemma, understanding Ben only through a
cultural lens would miss him as an individual and leave out consideration of such important developmental contexts as
attachment experiences. Along these lines, I wondered about Ben's attachmenthistory and the impact of the loss of his father. Did
the loss of his father impede him from risking a deep attachment to his wife? Did Ben's relational and affect repertoire reflect an
avoidant attachment and consequent lack of connection to certain feelings and self states? Lastly, I was aware of the interesting
parallel in my position to that of Tyler: we were both western females who valued verbal and emotional expression, and we were
both trying to understand what Ben was about.
I found it easier to formulate a picture of Tyler. Perhaps this was because I already had experiences of her, but certainly also
because of her cultural familiarity to me. I hypothesized that she was an anxiously attached person with concerns about betrayal
by important men. She appeared to me to be prone to affect dysregulation and to becoming increasingly upset in the face of
Ben's self-containment. She appeared very anxious that she would be abandoned and read most of Ben's behavior as indicative
of impending rejection. I added a note of caution to myself, that the ease with which I felt I could understand Tyler did not make
my formulations necessarily more accurate or helpful. I felt very aware of my own cultural and contextual embeddedness.
Finally, looking at Ben and Tyler as a couples system, I postulated that they were engaged in a pattern of insecure attachment,
with Tyler displaying an anxious attachment pattern interacting with Ben's avoidant or minimally expressive affective style. Both
appeared limited in their ability to self-reflect or to reflect on the mind of the other. Without this capacity to recognize the other
person's initiatives or communications, little dyadic regulation or collaborative dialogue was possible. The implicit procedures
each brought to the table for negotiating affectively charged exchanges were mutually dysregulating. I held open the possibility
that they were further challenged by cultural differences and the attendant differences in procedural learning and meaning
systems pertaining to affect display.
During the first several months of treatment, Ben and Tyler often displayed the chase and dodge pattern observed in the first
session. Even though I would sometimes begin the session by asking Ben about his experience, shortly thereafter, Tyler would
begin talking, followed by Ben's increased withdrawal and Tyler's increased anxiety, an interaction sequence which culminated in
both people feeling affectively dysregulated. I continued intervening to disrupt this cycle by offering my observations of the pattern
and by articulating each person's experience. With Ben, my work often involved trying to make a connection between what I
thought to be his self states and his awareness of them. For Tyler, it often involved affectmirroring to reassure and calm her
rather than to intensify her affective experience. For example, Tyler was quite distressed by Ben's working in the evening. She
was lonely at the end of a day spent in the company of her children and wanted to be with Ben. He often worked until eleven
o'clock, after Tyler had gone to bed. I said that I thought Tyler must feel very lonely and agitated when the day ended with a lack
of connection to Ben and that I knew the sense of urgency this caused in her. I then stated to Ben that I thought he must feel
puzzled and perhaps unappreciated because he was working so hard to take care of the family, yet Tyler did not experience his
care for her in this way. Tyler appeared calmer and Ben more alert. This was one of the moments in which I felt we were making
progress.
There were other moments in which I did not feel we were making progress. There were sessions in which I felt as stuck as I
think they did, unable to facilitate much sense of connectedness. At times, I found myself guessing what I thought Ben might be
thinking or feeling, in a fashion that was reminiscent of Tyler, with little sense of what Ben felt or thought about what I said. When
Ben did respond to my formulations and ventured some thoughts of his own, Tyler felt threatened and upset that he would not do
the same with her. At times I felt agitated by Tyler's escalating affect and I struggled to find ways of listening to her, as I thought
Ben did. I wondered also if she feared she might lose my attention, as I thought she must have felt with her mother. I found it
difficult to help Tyler feel safe. This kind of emergent, at times turbulent, self-finding process felt like traveling with a map that
lacked the detail necessary to navigate the turns. It reminded me of Lyons-Ruth's (1998) description of “complexempathy”:
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Empathy is not a simple apprehension of one person's state by another but a complex outcome of a number of [skilled]
communicative procedures for querying and decoding another's subjective reality. Another's mind is a terrain that can never be
fully known. The difficulty of knowing another's mind guarantees that communication will be fraught with error and require many
procedures of disambiguating messages, detecting and correcting misunderstandings, and repairing serious communicative
failures [p. 584].
Yet with continued effort and commitment on all of our parts, things began to change. The repeated experience of affectmirroring
and affect regulation led to each person anticipating a positive and emotionally safe experience with me that allowed us to
explore the immediate interactive patterns and the way each experienced the other in them. For example, I eventually was able
to ask Ben and Tyler if they were aware that, often when Tyler began to talk, Ben became quiet. They were able to see that, too. I
then asked Tyler if she was aware of becoming louder and more upset as Ben grew quiet. She was. She was also able to
describe how his quietness made her think he wanted nothing to do with her. I asked Ben if he was aware that this is how Tyler
experienced him. He said no. In turn, I asked Ben if he was aware of how he felt when Tyler became more upset. He stated that it
made him uncomfortable and that it was hard to understand her. As he said this, he brought his shoulders toward his ears. I
asked him if her voice felt too loud to him, and he said yes. Tyler did not take this information well at first. She became defensive,
feeling criticized by Ben. I responded by pursuing repair, both between Ben and Tyler and between Tyler and me. I emphasized
that I thought it was quite a difficult task I was asking of them. I emphasized that I saw each person's mode of affect expression
as different but of equal value; that neither was wrong or bad. I said that, in order to improve things, it was important for each
person to understand the meaning and experience of that style for the other. Lyons-Ruth might describe this process as the
active bridging of dialogue to new levels of awareness. I also offered that I was concerned that she felt criticized and hoped to
improve things so that she would feel criticized much less often.
With this reassurance, Ben and Tyler expanded their exploration of how they experienced each other in moment-to-moment
interactions. They discussed facial expressions or the lack thereof; the tone of voice that caused each to feel criticized; and how
to tell the other they were not finished with expressing a thought or feeling. Later, they began trying to identify what kinds of
experiences made each feel safe and understood. For example, Tyler expressed a desire for more eye contact when she spoke;
Ben asked her not to stare at him when it was his turn. I was aware of the cultural dimensions in some of the differences they
discussed and felt at times that I was assisting in a translation of some kind. I thought about the cultural linguist, Michael
Tomasello (1999), and his theory of languagedevelopment. From this perspective our work could be thought of as creating a new
culture by entering into joint attentional states, taking each person's perspective and describing it linguistically. Over time, each
person became more articulate about his or her individual experience and also began to understand more about the intentions
and communications of the other.
Ben and Tyler also developed new procedures for negotiating affectively charged interactions. They made fewer critical and
guiltinducing remarks in stressful situations. As Ben became more able to talk about his own experience, Tyler made fewer
“guesses” about his inner state, and he felt less cornered by her. Each appeared better able to understand the mind of the other
and to take it into account in constructing and regulating interactions.
As the couple's sense of safety with me and each other increased, they began sharing more deeply, including narratives of
childhood experiences. This began rather abruptly following a discussion of greeting routines. Tyler was expressing her distress
at Ben's lack of acknowledgment of her in the morning and when he returned at the end of the day. She expected a hello, a kiss,
a “how are you?” This seemed not only reasonable but universally understood to her. Ben claimed he acknowledged her and was
puzzled and annoyed at her complaint. At this juncture, I asked each of them to tell me about greeting routines in their respective
families of origin. Keep in mind that I had tried several times prior to this point to initiate a more indepth discussion of family
history, but to no avail. Ben began by stating that he usually got himself out of bed in the morning, particularly after his father had
died. His mother often did not arise until he had left for school and that he often heard her crying in her room. Greetings upon
arriving home were brief, with a hello or nod of the head. He had some memory of things being different before his father died,
although he seldom saw his father in the morning and not until late in the evening after he came home from work. He stated that
he assumed his father loved him and his mother by the way that he took care of them and worked so hard. He knew his mother
loved him even though she never spoke those words. Ben thought he was a very responsible and independent child. He
remembered feeling very sad when his father died, but he did not recall ever talking about that with anyone until now. As he was
speaking, Ben began to look sad, as did Tyler. I shared my observation that they both looked sad. I asked Ben if he had felt alone
when his father died, and he stated that he had. I expressed my sadness that Ben had experienced this painful loss and that I
was glad he could share his feelings with Tyler and me. I added that I thought he had had to be alone with too many feelings and
experiences in his life. Tyler also expressed her sadness that Ben was sad and that he had been by himself so much as a child.
She added that she was always up early and would be happy to do something, such as make him breakfast
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I was aware again of feeling the complexity of our work in understanding individuals in a multicontext way. Ben was clearly
experiencing pain associated with the death of his father. Had he also experienced his father as distant before he died? He also
seemed to be describing a norm of paternal love demonstrated through hard work and material provision that he understood as
an expression of his father's love. When he told us that he had never spoken of his sadness to anyone, was he describing a
culturally influenced way of processing emotion that was more internal and less public than is emphasized in American culture,
but nonetheless consensually understood and acknowledged as real? I entertained the idea that the consensual recognition of
emotional experience that is not explicitly expressed might nonetheless facilitate connection to internal feeling states. Given all of
these factors, I still thought Ben was indicating a family history in which there were less than optimal self-with-other regulating
experiences, and that this experience with me and with Tyler represented a powerful new experience of affect regulation within
the context of a relationship. It was also a moment for Ben of knowing himself in the context of being known by another.
The session when Ben talked about his father's death was a watershed event for Tyler and Ben's relationship. Tyler began to
develop greater empathy for Ben and to take less personally many of the things that she had previously experienced as rejecting.
It also appeared to usher in an increased vulnerability and willingness to share on Tyler's part. When we returned to the issue of
greetings during another session, Tyler recalled that, although there had usually been some kind of greeting in her family after
separations, it was difficult to get much attention because of the number of children in the house. She added that it was worse
when her father was away, as he often was. I asked her to tell me more about her father. She described her father as irritable and
preoccupied. He was rarely affectionate, and she felt it was very difficult to please him. She described having written numerous
letters to him when he went on business trips, letters that she initially asked her mother to send. He never responded to or
mentioned the letters. She kept writing them but eventually, instead of sending them, stored them in a box in her room, hoping
that someday she could give them to him and he would read every one. Three years after her parent's divorce, her father ceased
contact with her and her siblings. I said how sad it made me feel to hear her story and to hear about the painful longings she had
had to be close to her father. I then asked her if she felt some of those same longings with Ben. She agreed tearfully that she did.
I asked Ben if he was aware of Tyler's sadness and of how much she longed to feel close to him. Ben responded that he was
aware of her wanting to be close to him and that he wanted to be close to her too. For the first time in treatment, Ben took Tyler's
hand.
Ben and Tyler continued to expand their capacity for open and collaborative dialogue. For example, each began to create a
narrative about his or her own family and was able to relate it to current experiences between them. Tyler realized not only how
difficult it was to get her parents' attention as a child, but also that it left her feeling uncertain that anybody would really want to
attend to her. She understood that this made it hard for her to believe that Ben loved her. With this awareness, she began to
accept and feel his love and to view his ways of expressing love as real. In turn, Ben felt more successful with her and with his
own increased affective capacities and understanding of Tyler; he expressed his love in ways she could more easily recognize.
Ben began to formulate an awareness that, as a child he had always kept very busy and had relied on himself and his hard work
to feel good. He realized that keeping so busy then and now had been a way to self-regulate in the absence of needed comfort
from, and connection to, his parents. He began to express his needs to Tyler, including wanting increased time with her and
wanting her to listen to some of the stressful things that happened at work. She responded readily to him. Each person was
getting to know the mind of the other and was able to take it into account in constructing and regulating interactions. I noticed that
certain nonverbal and procedural components of the relationship had changed, too. A rhythm developed between them
conversationally, with a greater ease in taking turns and expressing points of view. Tyler's tempo of speech slowed down, Ben's
became faster and more fluent. They began to smile. Their bodies appeared more relaxed together, they touched more, they
made more eye contact.
After 18 months of hard work and sustained commitment, Tyler and Ben had established a significantly increased sense of
intimacy and safety together. Not only had they grown as individuals, but the relationship itself was becoming one that was
developmentally enhancing. From an attachment systems perspective, these changes reflected the establishment of an attuned
and well-regulated system, or in Bowlby's terms, the establishment of a secure base. The therapeutic stance of multidirected
partiality is a key component in creating a sense of safety and optimizing development. Of particular importance is the recognition
and articulation of, as well as respect for, each person's intersubjective experience. For Ben and Tyler, this included exploration of
cultural differences in both the declarative and procedural realms. What followed in the remaining months of treatment were
some truly dramatic and surprising changes, including expanded individual capacities and enhanced relationships with their
children. The nature of these changes reflect emergent and nonlinear properties of living systems, systems which sometimes
develop in leaps and bounds that are unpredictable and noncontinuous with past development.
References
1
Bacal , H. (1985), Optimal responsiveness and the therapeutic process. In: Progress in Self Psychology, Vol. 1 , ed. A.
Goldberg. Hillsdale, NJ: The Analytic Press , pp. 202-227. (PSP.001.0202A)
2/6/2018 EBSCOhost
2 Beebe , B. & Lachmann , F. M. (2002), Infant Research and Adult Treatment. Hillsdale, NJ: The Analytic Press .
3 Boszormenyi-Nagy , I. & Ulrich , D. N. (1981), Contextual family therapy. In: Handbook of Family Therapy, ed. A. S. Gurman &
D. P. Kniskern. New York: Brunner/Mazel .
4
Bowlby , J. (1988), A Secure Base: Clinical Applications of Attachment Theory. London: Routledge .
5
Byng-Hall , J. (1995), Rewriting Family Scripts: Improvisation and Systems Change. New York: Guilford Press .
(JCPTX.012A.0003A)
6 Coburn , W. (2002), A world of systems: The role of systemic patterns of experience in the therapeutic process. Psychoanal.
Inq., 22 :655-677. (PI.022.0655A)
7
Fonagy , P. , Gergely , G. , Jurist , E. L. & Target , M. (2002), Affect Regulation, Mentalization, and the Development of the Self.
New York: Other Press . (PI.022.0307A)
8
Fosshage , J. L. (2003), Contextualizing self psychology and relational psychoanalysis. Contemp. Psychoanal., 39 :411-448.
(CPS.039.0411A)
9 Gadamer , H. G. (1976), Philosophical Hermeneutics. Los Angeles: University of California Press .
10 Kohut , H. (1977), The Restoration of the Self. Madison, CT: International Universities Press .
11
Lichtenberg , J. , Lachmann , F. & Fosshage , J. (1992), Self and Motivational Systems: Toward a Theory of Psychoanalytic
Technique. Hillsdale, NJ: The Analytic Press .
12
Lyons-Ruth , K. (1998), Implicit relational knowing: Its role in development and psychoanalytic treatment. Infant Mental Health
J., 19 :282-291.
13 Shane , M. , Shane , E. & Gales , M. (1997), Intimate Attachments: Toward a New Self Psychology. New York: Guilford Press .
14
Shore , A. (1994), Affect Regulation and the Orgin of the Self: The Neurobiology of Emotional Development. Mahwah, NJ:
Lawrence Erlbaum Associates .
15
Stolorow , R. D. , Atwood , G. E. & Orange , D. (2002), Worlds of Experience: Interweaving Philosophy and Clinical
Dimensions in Psychoanalysis. New York: Basic Books .
16
Thelan , E. & Smith , L. B. (1994), A Dynamic Systems Approach to the Development of Cognition and Action. Cambridge,
MA: MIT Press .
17 Tomesello , M. (1999), The Cultural Origins of Human Cognition. Cambridge, MA: Harvard University Press .
18
Trop , G. , Burke-Trop , M. & Trop , J. (1999), Contextualism and dynamic systems in psychoanalysis: Rethinking
intersubjectivity theory. Constructivism Human Sci, 4 :202-223. (PSP.018.0129A)
Progress in Self Psychology, 2004; v.20, p151 (15pp.)
PSP.020.0151A
Record: 9
Title: Attachment, Recognition, and Secondary Trauma: Reply to Commentaries
Authors: Goldner, Virginia
ISSN: 10481885
Document Type: Commentary
Language: English
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Abstract: This response first addresses the interimplication of attachment and recognition in couples
work and reargues that disorganized attachment is the central dynamic underlying the
emotional torment of failing relationships. In the second section, the author expands upon
the secondarytrauma that haunts the therapist who is trying to hold and contain the
destructiveness that couples “on the brink” can enact.
direct=true&db=pph&AN=PD.024.0433A&site=ehost-live&scope=site">Attachment,
Recognition, and Secondary Trauma: Reply to Commentaries</A>
Attachment, Recognition, and Secondary Trauma: Reply to Commentaries

Virginia Goldner, PHD, author, Virginia Goldner, Ph.D., is Adjunct Clinical Professor of Psychology, NYU Post-doctoral Program in
Psychotherapy and Psychoanalysis; Faculty, Stephen Mitchell Center for Relational Studies; and Senior Faculty Emeritus at the
Ackerman Institute for the Family. She is the Founding Editor of the journal Studies in Gender and Sexuality, an Associate Editor
of Psychoanalytic Dialogues, and a Founding Board member of the International Association of Relational Psychoanalysis and
Psychotherapy. Dr. Goldner is the co-Editor, with Muriel Dimen, of Gender in Psychoanalytic Space, and with Mary Gail Frawley
O’Dea of Predatory Priests: Sexual Abuse in the Catholic Church. The author of more than 50 publications, she is completing a
book on gender and relationality.Correspondence should be addressed to Virginia Goldner, Ph.D., 102 East 22nd Street, New
York, NY 10010. E-mail: vgoldner@aol.com
This response first addresses the interimplication of attachment and recognition in couples work and reargues that disorganized
attachment is the central dynamic underlying the emotional torment of failing relationships. In the second section, the author
expands upon the secondarytrauma that haunts the therapist who is trying to hold and contain the destructiveness that couples
“on the brink” can enact.
I am grateful for the opportunity to think about my essay through the responses of two readers whose work has represented a
standard of excellence in the field of psychotherapy for a very long time. Paul L. Wachtel is known to all of us as a theoretical and
clinical integrator, whose intellectual breadth and freedom of mind brought together insular traditions which had typically
considered common ground to be heresy. He anticipated the relational turn in his insistence on a third way, and he still charts his
own course rather than lining up behind anyone’s flag.
Leslie Greenberg, a clinician-researcher, is also a major integrative thinker, who may best be known for his collaboration with Sue
Johnson with whom he developed Emotionally Focused Therapy, one of the most well-regarded, popular, and empirically
validated approaches to couples treatment. After their initial joint publication (Greenberg & Johnson, 1988), each went on to work
separately to expand different aspects of the model, with Johnson focusing on adult attachment in couples, and Greenberg on
the processing of emotion in individuals. Greenberg subsequently returned to the couples arena, where he developed a related,
but distinctive, integrative model, Emotion Focused Couples Therapy (Greenberg & Goldman, 2008).
Both of my interlocutors have done serious time in the trenches I describe, and I appreciate the way they identify and resonate
with my attempts to capture the affective extremes of couples work. They clearly know the experience of watching ordinarily put-
together people, datebook and water bottle still in hand, suddenly tumble into an emotion-drenched enactment that knows no
bounds. “Hurling thunderbolts,” Wachtel writes, “from the safety of [his] quiet study” (p. 420).
Wachtel wants to remind us that the tensions between most couples are not at the same voltage as the couples “on the brink” I
have been describing. But while I agree that, thankfully, Bill and Jane are in a class by themselves (no mainstreaming here), it is
the affective extremes that particularly interest me. This is because, as I argue in the paper, all of us can be driven to call up our
inner borderline under the right (bad) conditions. Every winner in life has been a loser in love, and everyone has a “Pathetic Me”
who knows the experience of romantic loss all too well.
Perhaps because none of us are immunized against love-sickness, we all want to keep our distance from these self-states and
experiences. Consider, for instance, the unremarkable circumstance of sitting with romantically devastated patients who will leave
our office to wander in the void, while we cleave to the remains of our safe and ordinary day, knowing that they envy us that day,
so near, yet now so far away.
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My project has been to ask what causes these debacles. What is it that can make fair-minded, sturdy people throw all their rules
of engagement out the window, turning the safety of a therapy hour into the chaos of a combat zone? While many troubled
processes are implicated in this collapse, and are discussed in this essay, my primary emphasis has been on attachment and
recognition. This is why it was odd to find that Greenberg viewed me as overstating the centrality of attachment, while giving
short shrift to other dimensions of romantic love. It is a strange experience to be agreeing with someone who seems to disagree
with you, which is why I am going to take up Greenberg’s discussion first. This will allow me not only to clarify my intentions but
also to reprise the important moves in my argument.
Let me begin by making it clear that I was never attempting a complete account of “love” in the abstract. That would necessitate a
book-length project on the order of the exhaustive volume Greenberg himself has written, which he attempts to summarize in his
discussion of my paper. Moreover, writing for a journal with hard-won page constraints means that lots of cherished material
winds up on the cutting room floor. Many of the elisions and omissions that caught Greenberg’s attention were reluctant
concessions to that reality, which has now become more forgiving, thanks to the opportunity afforded me by this reply.
Greenberg is right about the fact that I make big claims for attachment as foundational. But while he seems to feel that I am
asking too much of a worthy but shopworn construct, I believe he is asking too little. While he acknowledges attachment’s
“usefulness and established scientific validity,” Greenberg seems to be dumbing it down. In reducing attachment to a placid and
passive notion of closeness and comfort, he is choosing, for whatever reason, not to take the measure of all the scientific work to
which he alludes, work that built the case for attachment’s complexity and profundity.
There is only so much one can accomplish in a discussion of someone else’s work, and I know that Greenberg has addressed
attachment more fully in other contexts. But he has made it quite clear that he wants attachment to mean less, not more, going
forward. He states his position quite explicitly in his book, writing that
attachment has come to be seen as “the master motive” by many theoreticians and practitioners, and has been over-applied to
explain almost all of human functioning, not only security seeking and comfort, but also warmth, emotion regulation, agency,
exploration, self-esteem, and even love itself. (Greenberg & Goldman, 2008, p. 80)
But I am left quite puzzled by his skepticism, since these conclusions, which Greenberg feels are too far-reaching, were the
outcome of years of collective, painstaking scholarship. I understand that Greenberg was also limited by time and page
constraints in his discussion, but I am sorry he did not directly critique the work on which I relied to make my version of that case
(Beebe, Zeifman and Hazan, Johnson, Schore, Fonagy, Hesse and Main, Lyons-Ruth, Slade, etc.). I would have been eager to
learn if and why it no longer captivates him. While it is clear from his book (which I found to be an exemplary work of clinical,
theoretical, and empirical scholarship) that he wants to complicate our theories of romantic motivation, I am still unclear about
why he wants to restrictattachment’s reach while doing so.
But it does appear that our different ways of reading the attachment literature have led us in quite different directions. While his
former collaborator Sue Johnson seems (in her books, training tapes, and workshops) to have moved toward a more totalizing
“attachment-o-centric” reading of human relations, Greenberg wants to return to a strict interpretation of attachment, narrowly
defined. (His position is shared by Helen Fisher, the anthropologist and author of many books on romantic love, who critiqued
Johnson’s overemphasis on the attachment dimension of romantic love in a New York Times book review earlier this year; Fisher,
2014).
Given that I am looking to deconstruct and reassemble the category of attachment to see what more work we might ask it to do, it
is no wonder that Greenberg would have balked at my grandiloquent conclusion that “attachment is romantic, and that romantic
love is an attachment process.” But I believe that my strategy has, in fact, yielded significant theoretical results, as, for example,
my idea that romantic deadlock is an exemplification of the torment of disorganized attachment.
Moreover, after 10 years, I have become rather used to arguing the case for romantic attachment. In 2004, I took issue with
Stephen Mitchell (1998, 2002), who anticipated Greenberg’s position by writing that “attachment is not a useful model of mutual
adult love” (Mitchell, 1998, p. 564). At that time, I made the opposite case, arguing that childhoodattachment not only provided a
template for adult romantic love, but I quoted the editors of the Handbook of Attachment that “just as Bowlby surmised, romantic
bonds are the prototypical adult instantiation of attachment … in every sense of that term” (Zeifman & Hazan, 1999, p. 336).
This has always seemed obvious to me, an experience-near truth, while the arguments against it have seemed hidebound and
defeatist, as if Freud’s rule were Law: “Where they love, they cannot desire, where they desire, they cannot love.” The erotic
complications of attachment are indeed threatening, which is why cultures regulate love relations (both the “who” and the “how” of
our practices of love). Whether flowing from child to parent, parent to child, or partner to partner, we are bent on patrolling the
boundary between passion/romance and attachment/dependency, the action and legacy of the incest taboo, still making its mark.
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Freud and Fairbairn’s work laid the groundwork for our understanding of how children, who depend on their parents (attachment),
also fall in love with them (eros), a spell that is cast on their parents as well. We may want, and defensively need, to segregate
attachment and erotic love by keeping Winnicott’s “environmentmother in the kitchen and the objectmother in the dungeon”
(Goldner, 2006, p. 634), but this runs counter to psychic reality, as well as to the letter and the spirit of Winnicott’s profound
insight. (“The coming together of affection and instinct requires the reliable presence of the environment [attachment] mother”;
Winnicott, 1963/1979, p. 75).
In adult romantic love, where each partner occupies both positions, eros and attachment are literally wound around one another
(as when the comfort of spooning turns into the excitement of sex and back again). As I argued at that time, in an erotic
encounter between long-term partners,
safety and adventure oscillate as each partner provides a secure base for their lover’s sexual exploration, freeing the
otherness of one’s own desire to encounter the strangeness of the lover’s sexuality. … Under these conditions, the familiar and
the novel, the body you know and need, and the one you discover and destroy, interpenetrate in a paradox of erotic simultaneity.
(Goldner, 2004, p. 389; see also Goldner, 2006)
But, as I argued in this paper (p. 408), we make the place of attachment in sexuality uninteresting and obvious because it is
associated with the taken-for-granted circumstance of domesticity and thus with the maternal. Our culture of individualism, with
its phobic dread of dependency, has severed romance from attachment, aligning eros with agentic masculinity (‘libido’), while
attachment is consigned to childhood, weakness and femininity. Since attachment’s motivational affect is a state of fearful need,
(Slade, 2014), it culturally codes as childish, which itself reads as feminine, the whole package becomes shameful (Goldner,
2004, 2006, 2012; see also Atlas, 2012; Atlas-Koch & Benjamin, 2010).
But while regulatory cultural processes serve to desexualize attachment, the intense affects released during a reunion, or through
the repair of a rupture, reveal how much we want to overturn this binary, to bridge this split.
Instead of the housebound mother who has to be there, or the exciting father who happens to be there, the (m)other we joyfully
fall in love with over and over again wants to be there. Each time the parent/partner returns, each time the couple repairs a
rupture [I argue that it’s not just the “fear of abandonment” that activates attachment, but the fear of losing love itself], we bring
the freedom, strangeness, and excitement of the outside back into the safety of home, which is now imbued with its own
shimmering poignancy, just because we have gone away. (Goldner, 2004, p. 392)
As I hope I have established, my approach is significantly different from the one Greenberg has developed. He is arguing for a
particular kind of precision, asking us to “discriminate which [motivational] system [sexuality/attraction, attachment,
identity/validation] is operating when” (p. 429). While I appreciate the intellectual rigor that resulted in setting that standard,
echoed by Fisher (2014), I find it too constraining, because I consider motivational systems to be layered and multiple, more a
matter of the psychoanalytic both/and than the empiricist either/or. While Greenberg believes I am conflating distinctions that
need to be maintained, I would argue that I am complicating categories that would benefit from being perturbed. To my mind
eros/romance, recognition/validation and attachment ought not to be taken as absolutely separate phenomena, even if they
activate different parts of the brain (Fisher, 2014). This is because, dynamically speaking, they are acting upon each other in the
action of psychic life. I see them as psychically braided, interimplicated, and as I hope I have shown, ultimately synergistic. Isn’t
falling in love with the one you love as good as it gets?
This brings me to Wachtel, who is troubled by the way in which the notion of separate psychic spheres can default to a concrete
shorthand of separate biological brains (emotional/rational, right brain/left brain). More specifically, he questions my deferential
reference to Allan Schore’s notion of romantic love as a “right brain” phenomena.
I certainly take his point that pop neuroscience oversimplifies the elegant complexity of the brain’s functioning, and the way in
which the two sides of a normal brain are “closely interconnected and working together,” even if it can be shown that one
hemisphere is dominant. But it is important to underscore that Allan Schore is a scholar as well as a popularizer, and he has
marshaled a lot of evidence to show how, in infancy, specific parts of the right brain process the emotionalized bids for contact
between mother and baby that result in an “interpersonal resonance” and “affective synchrony” between them (Schore, 2000).
Unfortunately, as Wachtel observes, a careful consideration of the implications of these findings is nowhere to be found on much
of the conference circuit, where “right brain communication” reigns supreme, “as if the entire left half of the brain is on vacation in
Tahiti” (p. 425).
This lapse is unfortunate because, as we know, when intersubjectivity develops, it complicates. The move is from “motherdoes
baby” (feeds/comforts, contains, etc.) to mother “knows baby,” while baby learns to engage mother’s mind so as to fulfill his
needs and desires. As I discussed in the paper, the mother’s capacity to mentalize her child as an independent center of
orientation (her “mind-mindedness”), along with the baby’s growing ability to do the same, turn out to be critical to the
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development of secure attachment. This is a highly significant finding because it shows how safety and security (attachment)
derive from the transformational experience of “being known” (recognition). Here again, we see how attachment cannot stand
alone as a driving force. It is, rather, part of a tapestry of motivations that must also include recognition.
This was the conceptual framework in which I situated my treatment of Bill and Jane, a couple defeated by disorganized
attachment, and by their power struggles around recognition and negation, reality and truth, blame and badness. As I indicated,
in their win/lose economy, if one person was understood, the other would be put at risk, and thus one partner’s gain was the other
one’s loss. The couple was driven to extremes of destructiveness by their fear that the other would get to inhabit the victim
position (making them the perpetrator). As a result, they were caught in the vice grip of reactive, mutual invalidation, which I
considered to be their presenting problem.
Oddly, although Greenberg quotes me as formulating the case in this way, which is the way he also saw it, he discussed my
interview as if I disagreed with him. He seemed to think I saw the case as an illustration of attachment troubles, but my point,
once again, is that attachment and recognition are interimplicated. Bill and Jane’s habits of mutual negation were made all the
more agonizing by the fact that they simultaneously needed each other’s comfort and care. They were in a power struggle around
recognition, to be sure, but they were also palpably aching for the soothing and containment that only the other could provide.
This is, once again, the torment of disorganized attachment. The only one who could make it better was making it worse
because, in Wachtel’s terrific phrase, each was being asked to “feed the hand that bit them.”
Working with this reckless, war-weary couple was grueling, frightening, and sometimes even traumatizing (the “secondarytrauma”
of witnessing the ongoing enactment of relational destructiveness). Wachtel got it just right when he described the couple as
presenting with an “unreflective immersion in an endless conflict unmediated by transitional space” (p. 420). Their borderline
template left me alone in a desert of mutual negation, where as Wachtel grasps, I was attempting to be “heard by the deaf, seen
by the blind, and comforting the unable-to-be-comforted” (p. 422).
Even after all these years, I can still feel the dread I experienced each time I brought this couple into my office, knowing that no
interview was complete without a take-no-prisoners enactment. It was exhausting and dangerous work, and I felt deeply
recognized by Wachtel’s close reading of this challenging interview. I am not going to reprise his incisive distillation of the nested
series of interpretive statements I made. He has grasped my intentions and systematically explicated how I went about
accomplishing them.
I do, however, want to comment on how oddly comforted I felt by his sturdy and thoughtful companionship, even after all these
years. I can now take the full measure of how awful it was being alone with these characters, and how much I needed the
buffering of a co-therapist, either behind the one-way mirror, or better yet, in the chair across from me. It is a relief to revisit this
case, knowing Wachtel now occupies that position.
He distills something important when he positions my clinical work as being held in the tension between
interpretation/observation and participation. In dynamic work, where the analytic partners are exclusively co-creating their
experience, the deconstruction of the analyst’s participation is obviously essential and must be ongoing. But in couples work,
where the therapist is primarily in the observer position, his or her self-experience is typically backgrounded, even though as
Wachtel reminds us, no one is ever really outside the inside.
Moreover with this couple, my attempts at interpretation/observation were often fruitless because their suspiciousness (“who is
she going to blame?”) and instant reactivity (“better not be me!”) blocked the therapeutic action of most of what I tried to say. In
this particular session, there was simply no way to keep them from destroying each other, other than to show them that I was at
risk of being destroyed myself.
As I have already discussed, I see Bill and Jane as both a “couple on the brink” and the couple next door. In other words, “they”
could be “us.” I appreciate Wachtel’s concern that by making Bill and Jane’s highly disturbed relations emblematic of marital
disharmony, we run the risk of pathologizing the ordinary human misery of being unhappily married. That might be a risk, but I am
also suggesting that the gap between this couple and the rest of us is not necessarily all that great.
Every insecurely attached couple can become ominously disorganized, if, when they are triggered, their experience of
emergency is not fully and adequately addressed. When attachment bids activate relational trauma, each partner needs the other
to be their own special caregiver, stepping in with protection, soothing, and recognition/validation (“I understand how you feel”
and “I do see what’s going on around here [from your point of view]”). But since each partner is the other one’s injured party, this
experience of healing cannot take place (“You soothe me first!”/ “No, you admit you hurt me first!” and so on).
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That said, Bill and Jane did present with a far more intractable power struggle, just because it was so totally compelling. The
healing action of being sensitively understood by me never seemed to matter all that much to them. As Wachtel observes,
nothing short of absolute and complete validation (which would require blaming and disqualifiying the other partner’s truth) was
acceptable. Their flat refusal to do much of any personal work would not yield to any of my strategies, including the attempts I
made to sympathetically frame their resistance in terms of their respective trauma histories. (Since Bill and Jane were punished
as children for seeing and speaking the truth, when they were triggered, each was thrown back to that state of “all-or-nothing,”
where to accept anything less than “all” would feel like “nothing,” which would then leave them open to an escalation of blame.)
Moreover, the couple had reason to distrust therapists. Their histories were littered with therapeutic failures for which they were
blamed (“the impossible patient/the untreatable couple”), and there were many early experiences in which they were in the hands
of incompetent or duplicitous clinicians (one of whom was Jane’s father).
Now that I have the pleasure of Wachtel’s company, I can imagine talking this through with him in the presence of the couple. I
would have gone much further and taken more creative risks with my ideas about the risks of change if I’d had a co-therapist who
was sharing the clinical responsibilities of holding and interpreting with me. But these are the costs of working alone—as we must
do in private practice.
Absent that other mind, most of my attempts to create emotional parity between Bill and Jane around their mutual vulnerability
(“You are two ‘like subjects’ sharing the same painful experience”) came to nothing. Too much of the time I failed to remember
that these “like subjects” were also competitive “like siblings” who could not share anything I sought to provide. If one person was
in pain, that made them a victim, which made the other one a perpetrator, who would then be treated as a pariah. Theirs was a
relation of “either/or” complementarity. A posture of “Both/And?” A trap for suckers.
Things opened up when I constituted them as “Two Gladiators (fighting to the Death)” because that frame positioned them as
actors driven to fight each other, rather than victims looking for a perpetrator. (No victim = no one to blame.) The Gladiator
reframe also had the effect of shifting our threesome out of a sputtering state of negative complemenarity: “resistant
patients/ineffective therapist.” By characterizing Bill and Jane as refusing my care (because they were too adrenalized to need it),
I was no longer a “failed therapist” (trying to give the couple something they did not want). And, by extension, the couple was also
freed from the “negative attribution” (cf. Wachtel) of being constituted as self-defeating, failed patients refusing to be helped.
In Wachtel’s discussion of that turning point, and of my disclosure to the couple that I was fading fast, he contributes, once again,
the idea of “transitional space,” which complements my notion of a therapeutic paradox. Both constructs capture, in different
ways, how, in the fraught circumstance of this treatment, I could be representing myself as being at grave risk while also being
bold enough to admit to it, and competent enough to hold the situation while I did. Both frameworks illuminate the path out of our
stalemated therapeutic power struggle (“You must change”/“We can’t/won’t change”). Now instead of my being the inadequate
regulator of the willfully dysregulated, I introduced the shock of the real—we were all in need of special care.
In reminding the couple that this was not an episode of House of Cards but a matter of “flesh and blood,” where any one of us
could bleed out, Wachtel hones in the way I was helping them feel the wounds they had inflicted. As he points out, I was calling
for their adults-in-residence to make an appearance, which, as he indicates, is an attribution that, in and of itself, can serve as a
self-fulfilling prophesy. I was not just saying they should become adults, or even that they could become adults, but that they
were adults, and it was time they starting acting that way. “The movers have arrived!” I called out. “Good bye paranoid/schizoid,
Hello depressive position!”
I want to end these remarks by returning to a point I made at the end of my paper that neither of my discussants addressed. Like
many couples, Bill and Jane were probably at their worst in my company because couples therapy is often the court of last resort,
the place where partners believe “the truth” will be unearthed, and where the therapist becomes its final arbiter. Again, I want to
emphasize that the issue is not merely a battle over who is right and who is good, but whether or not someone is crazy. (Can’t
you see what I see?)
This tormenting question is at the heart of why couples work can push affects to their limit, and thinking to the breaking point. If
your partner denies what you see clear as day, are they lying or are you crazy? Here we are in the realm of mystification, which
as I have written, has been associated with both the genesis of schizophrenia (Laing, 1965), and with the development of
borderline personality disorder (Liotti, 1999).
To the extent that there is a question of technique here, my advice, as I indicated in the paper, is to give each partner a very big
dose of recognition before moving to the other one. It is better to risk the observing partner’s feeling momentarily sidelined than to
sprinkle each of them with a little Holy Water and hope for the best. Each one is craving recognition and understanding at the
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deepest levels. They need the best psychoanalytic attention we can provide. Only after we really find out what’s at stake
internally can we help them tolerate the otherness of their partner’s externality. Over time, couples can increase their capacity to
wait, even to hear things they disagree with, without melting down.
At this point, I believe I have said more than enough about Bill and Jane, and about my ideas regarding psychoanalytically
grounded couples treatment. (For those readers interested in learning more about this topic, take a look at these two books by
relational authors: Gerson, 2010; Ringstrom, 2014). I want to thank Leslie Greenberg and Paul Wachtel for their intense readings
of this paper. I hope my response adequately addresses their contributions to this evolving conversation.
REFERENCES
1
Atlas , G. (2012). Sex and the kitchen: Thoughts on culture and forbidden desire. Psychoanalytic Perspectives, 9 , 220 - 232–.
(PPERSP.009.0220A)
2 Atlas-Koch , G. , & Benjamin , J. (2010). The too muchness of excitement and the death of desire. San Francisco, CA:
International Association for Relational Psychoanalysis and Psychotherapy .
3
Fisher , H. (2014, February 9 ). Love in the time of neuroscience: Sue Johnson’s Emotionally Focused Therapy. New York
Times Book Review, p. 9.
4
Gerson , M. J. (2010). The embedded self: An integrative psychodynamic and systemic perspective on couples and family
therapy ( 2nd ed.). New York, NY: Taylor and Francis .
5
Goldner , V. (2004). Attachment and eros: Opposed or synergistic? Psychoanalytic Dialogues, 14 , 381 - 396–. (PD.014.0381A)
6 Goldner , V. (2006). Lets do it again: Further reflections on eros and attachment. Psychoanalytic Dialogues, 16 , 619 - 637–.
(PD.016.0619A)
7
Goldner , V. (2012). Gender deconstructed, complicated and queered. Paper delivered, Toronto Institute of Contemporary
Psychoanalysis, Toronto, Canada, May 5, 2012 .
8
Greenberg , L. S. , & Goldman , R. (2008). Emotion-focused couples therapy. Washington, DC: American Psychological
Association .
9 Greenberg , L. S. , & Johnson , S. M. (1988). Emotionally focused therapy for couples. New York, NY: Guilford .
10
Laing , R. D. , (1965 /1976). Mystification, confusion and conflict. In C. Sluski , & D. Ransom (Eds.), Beyond the double bind
(pp. 129–219). New York, NY: Grune & Stratton .
11
Liotti , G. (1999). Disorganization of attachment as a model for understanding dissociative psychopathology. In J. Solomon &
C. George (Eds.), Attachment disorganization (pp. 291 - 317–). New York, NY: Guilford .
12
Mitchell , S. A. (1998). Reply to commentary. Psychoanalytic Dialogues, 8 , 561 - 572–. (PD.008.0561A)
13 Mitchell , S. (2002). Can love last: The fate of romance over time. New York, NY: Norton .
14
Ringstrom , P. (2014). A relational psychoanalytic approach to couples therapy. New York, NY: Routledge .
15
Schore , A. (2000). Attachment and the regulation of the right brain. Attachment and Human Development, 1 , 23 - 47–.
16
Slade , A. (2014). Imagining fear: Attachment, threat, and psychic experience. Psychoanalytic Dialogues, 24 , 253 - 266–.
(PD.024.0253A)
17
Winnicott , D. W. (1979). The development of the capacity for concern. In Motivational processes and the facilitating
environment (pp. 73 - 83–). New York, NY: International Universities Press. (Original work published 1963 )
18
Zeifman , D. , & Hazan , C. (1999). Pair bonds as attachments: Evaluating the evidence. In J. Cassidy & P. Shaver (Eds.),
Handbook of attachment (pp. 336 - 355–). New York, NY: Guilford .
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PD.024.0433A
Record: 10
Title: The Relationship between Attachment Patterns and Parenting Style
Authors: Ktistaki, Maria; Papadaki-Michailidi, Eleni; Karademas, Evangelos
(2), p172, 20p
Language: English
Abstract: The present study examined the attachment bond mothers have with their partners and
the parenting style they use in relation to their children. It was found that mothers with high
attachment security more frequently use a positive authoritative parenting style, while
mothers with high attachmentanxiety and mothers with high attachment avoidance tend to
use negative parenting styles. More specifically, mothers with an anxious attachment
pattern were found to behave either in an authoritarian or in a permissive way towards
their children. Both the authoritarian and the permissive parenting styles were found to
have a significant impact on the mothers' ability to create an effective emotional bond with
their child. On the other hand, mothers with an avoidant attachment pattern were found to
behave in a more authoritarian way. A high level of security in attachment relationships (or
low levels of attachment avoidance and low levels of attachmentanxiety), was strongly
linked with the authoritative parenting style. Generally the results of the present study
show that whenever attachment security prevails within a romantic relationship, there is a
strong possibility that an effective parenting style is also used in relation to the couples'
children.
direct=true&db=pph&AN=AJRPP.008.0172A&site=ehost-live&scope=site">The
Relationship between Attachment Patterns and Parenting Style</A>
The Relationship between Attachment Patterns and Parenting Style

Maria Ktistaki, BA, author, Psychology at the Aristotle University of Thessaloniki Greece (2002) and an Msc course in
Psychological Assessment in Organisation (2003) at Goldsmith's College, University of London. She is currently a PhD student in
the Department of Primary Education, at the University of Crete. She is doing research on maternal attachment, parenting style,
and different aspects of children's development. She has attended a six year course training in family-systemic therapy and is a
qualified administrator of the Child Attachment Interview (Anna Freud Centre). She has been working with families in private
practice since 2006. She has also worked in several public services for children with special needs, learning disabilities,
maltreated children and their families. She has run several psychoeducational programmes for parents and she is currently the
coordinator of a lifelong training programme, run by the Ministry of Education around Chania prefecture. She lives in Chania with
her husband and her five-year-old daughter. Email: ktistaki@hotmail.com
Eleni Papadaki-Michailidi, author, Professor of Developmental Psychology at the University of Crete. She is a chartered
psychologist of the British Psychological Society and an Honorary Research Fellow of the School of Psychology, University of
Birmingham where she did her PhD studying children's drawings. Additionally she has been trained in psychotherapy,
psychoanalytic studies, and parent-infant psychotherapy. Mrs Papadaki-Michailidi's research interests include children's
drawings, child abuse, interpersonal relationships, non-verbal communication, and psychotherapeutic interventions. She is the
author of three books, The Silent Language of Love, The Bond of Love, and From Parents to Lovers, and is the editor of
Questions and Prospects on Learning and Language Teaching. She is also the author of several publications in journals and
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chapters in other books. E-mail: papadaki.mihaelidi@gmail.com
Evangelos Karademas, author, Faculty member at the Department of Psychology, University of Crete (currently an associate
professor of clinical health psychology). He is currently teaching health psychology at a pre-graduate level at the University of
Crete as well as at post-graduate programs at the Universities of Crete and Athens. He is also the chair of the University of Crete
Counselling Center for Students. He has authored one book, as well as more than eighty-five scientific articles and chapters in
international and local journals and editions. He has also edited four handbooks and one conference papers book (three in
English and two in Greek). His research interests include the role of stress and related factors in health and illness, self-
regulation and health, adaptation to chronic illness, and quality of life issues.
The present study examined the attachment bond mothers have with their partners and the parenting style they use in relation to
their children. It was found that mothers with high attachment security more frequently use a positive authoritative parenting style,
while mothers with high attachmentanxiety and mothers with high attachment avoidance tend to use negative parenting styles.
More specifically, mothers with an anxious attachment pattern were found to behave either in an authoritarian or in a permissive
way towards their children. Both the authoritarian and the permissive parenting styles were found to have a significant impact on
the mothers' ability to create an effective emotional bond with their child. On the other hand, mothers with an avoidant attachment
pattern were found to behave in a more authoritarian way. A high level of security in attachment relationships (or low levels of
attachment avoidance and low levels of attachmentanxiety), was strongly linked with the authoritative parenting style. Generally
the results of the present study show that whenever attachment security prevails within a romantic relationship, there is a strong
possibility that an effective parenting style is also used in relation to the couples' children.
Adult Attachment
Attachment relationships during adulthood are long term, affectional bonds between people who seek intimacy, security, and
protection from one another (Bowlby, 1979). The expectations, the needs, and the social behaviours within adult attachment
bonds are strongly affected by the primaryattachment relationship both partners have had with their own primary caregiver
(Fraley & Shaver, 2000; Raval et al., 2001; Van IJzendoorn, 1995). Children's conscious and unconscious memories of their early
attempts to attain attachment security constitute their working models of attachment(Main, Caplan, & Cassidy, 1985). During
adulthood, these working models result in autobiographical and episodic memories, beliefs, and attitudes, concerning how we
regulate emotions and behave within romantic relationships (Collins & Read, 1994). Experiences from the primary caregiving
relationship also set the stage for subsequent caregiving behaviours that specify the working model of ones' parenting style
(Rholes et al., 1997).
According to Brennan, Clark, and Shaver (1998) the construct of attachment in adult romantic relationships is organised around
two underlying dimensions; attachment avoidance and attachmentanxiety. Attachment avoidance refers to intense feelings of
discomfort a person feels, when his/her partner seeks emotional closeness or interdependence. The person with an avoidant
strategy feels more comfortable with emotional distance and extreme self-reliance. On the other hand, attachmentanxiety is
related to an obsessive need for closeness and protection, accompanied by an excessive worry about the availability of the
partner. Bartholomew and Horowitz (Bartholomew, 1990; Bartholomew & Horowitz, 1991) proposed a four category model
according to which, adults can be classified as having different attachment patterns: secure, dismissing, preoccupied, and fearful
attachment. These four attachment patterns are located in two dimensions, defined by attachmentanxiety and attachment
avoidance, as depicted in Figure 1.
ajrpp.008.0172a.fig001.jpg
Figure 1: Model of adult attachment (Bartholomew, 1990).
Based on this particular model, secure individuals experience low levels of attachmentanxiety and avoidance while they possess
a positive view about themselves and about other people. Adults with a dismissing pattern of attachment, experience high levels
of avoidance and low levels of anxiety in their relationships, while they have a positive view about themselves and a negative
view about other people. Individuals with a preoccupied pattern experience high levels of attachmentanxiety and low levels of
avoidance, while they hold a negative view about themselves and a positive view about other people. Finally, adults with a fearful
pattern experience high levels of both attachmentanxiety and avoidance, while they hold a negative view about themselves and
about other people. Researchers, who adopt this particular model, either classify individuals as having one of these four patterns
of attachment or they use a continuous rating in order to measure the degree to which individuals fit in each one of the two
dimensions namely avoidance and anxiety (Bartholomew & Horowitz, 1991; Shaver et al., 1996).
Within a therapeutic setting all individuals with an insecure attachment pattern may reveal serious emotional and relational
difficulties. Adults with a dismissing state of mind show very limited self-awareness while not allowing themselves to feel, think,
and verbalise about painful matters. As Freud (1914g) pointed out, dismissing individuals tend to forget all unpleasant memories
of their past, but at the same time they tend to communicate their own past experiences in their present relationships. Wallin
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(2007) in his book Attachment in Psychotherapy suggests that when working with patients who have a dismissing state of mind,
the therapist needs to be empathically attuned, restrained in the way they express their emotions, and avoid direct confrontation.
Direct confrontation if not timed carefully, may frighten the patient into retreat. This specific therapeutic attitude can help patients
to gradually become more open about their emotional experiences and more capable in integrating their own dissociative
feelings.
Regarding those with a preoccupied pattern, Wallin (2007) suggests that the basic aim of the therapist should be to work with the
“other-directed” quality of the patient's emotional expression. They should be helped to express themselves and their feelings
rather than overreact emotionally, the only way they have found to effectively elicit care from others. So the therapist should be
available to the patient both when emotions are heightened as well when the person is calm and relaxed. Finally, in relation to a
patient who is unresolved, Wallin (2007) recommends that the therapist should encourage the patient to recall and process their
traumatic experiences, feelings, and bodily sensations related to the trauma, it is to be hoped within the secure-enough context of
the psychotherapeutic relationship. In this way patients will be able to step back from their painful experiences, understand them
better and gain a sense of control over their feelings and behaviours. This particular approach is aimed to amplify patients'
feelings of emotional security.
Attachment and Parenting

Regarding the relationship between adult attachment patterns and parenting, Nathanson and Mahonar (2012) point out that a
persons' desire to have children as well as having positive expectations about their own relationship with any prospective children
is strongly linked to a secure attachment pattern. It is their view that individuals with insecure attachment patterns have a lower
desire to become parents and have less adequate and less adaptive parenting styles. Mikulincer and Shaver (2007), suggest that
the experience of attachment security allows people to attend less to their own personal needs and shift their attention to
caregiving in a more effective way. Considering motherhood in particular, women with a secure state of mind in relation to their
early attachment relationships hold positive representations about themselves as caregivers, while they hold positive
representations about their own children and about their mutual relationship (George & Solomon, 1999; Slade & Cohen, 1996).
Secure mothers have been the lucky recipients of attuned and sensitive care by their own attachment figures in the past, which
acts as a positive role model that shapes their own caregiving ability (Collins & Feeney, 2000).
On the other hand, adults with high attachmentanxiety have an intense need to satisfy their own unmet needs for emotional
closeness, inclusion, and acceptance and this particular longing may lead to insensitive and intrusive caregiving—that can be
seen as a repetition of their own early experience (Collins et al., 2006). The personal distress and hypervigilance that anxiously
attached mothers and fathers experience (Mikulincer & Shaver, 2007), seems to diminish their ability to encourage their children's
development of social skills, autonomy, and independence (Mayseless & Scher, 2000). Role reversal often appears in the cases
of anxiously attached parents (Boszormenyi-Nagy & Spark, 1973; Jurkovic, 1998). In such instances, parents expect their
children to satisfy their unmet emotional needs, instead of seeking support from their partner. This type of relationship often
results in boundary dissolution within the parent-child relationship, characterised by intrusiveness, overprotectiveness, and
enmeshment (Jacobvitz et al., 1991; Kerig, 2003). A situation like this sadly compromises the healthy development of the
child(Lyons-Ruth, Bronfman & Atwood, 1999).
Similarly, the limited capacity of adults with an avoidant attachment pattern to provide emotional support to their partners extends
to an analogous difficulty of offering supportive care to their own children (Rholes, Simpson, & Friedman, 2006). Their past
experience of repeated experiences of rejection leads them to deactivate their attachment seeking behaviour, especially when
they themselves experience distress (Crittenden & Ainsworth, 1989). Bowlby (1979) stated that people with this particular
attachment pattern do not allow themselves to rely on anyone else, in order to avoid the pain of beingrejected, as well as to get
away from the pressure of becoming someone else's caregiver. Mothers in this group show low levels of positive affect towards
their children (Adam, Gunnar, & Tanaka, 2004). They also perceive parenting as a less satisfying and meaningful experience and
they often feel emotionally detached from their own children (Rholes, Simpson, & Friedman, 2006). Sadly, this is a reflection of
their own experience of being parented.
Parenting Style
Millings and colleagues (2013) mention that parents' caregiving responsiveness in relation to parenting behaviours can be
conceptualised around the construct of “parenting style”. Baumrind (1968) defined parenting style as the values and the beliefs
that parents hold about their parental role and the nature of their children. Parenting style also refers to the attitudes parents have
towards their children, the socialisation processes they use, and the prevailing emotional climate within the parent-child
relationship (Baumrind, 1991). Baumrind (1966) hypothesised that the parenting style used actually determines how open
children are to their parents' attempts to socialise them, and she considered that the socialisation process is a dynamically
oriented aspect of children's development. Baumrind basically distinguished three different types of parenting: the authoritative,
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the authoritarian, and the permissive. Authoritative parents direct children's activities in a supportive and rational way. They
encourage verbal give and take, they reason with the child, and they recognise and respect the child's individual interests.
Authoritative parents also encourage children's autonomy, self-confidence, and responsibility, while at the same time they value
discipline and conformity. They are highly responsive to children's emotional needs, they set realistically high standards for the
development of the child, and generally they represent the optimum kind of child rearing.
On the other hand, authoritarian parents call for absolute acceptance of their attempts to shape and control their children while
they set unrealistically high goals for the child's development. They impose inflexible standards and they favour punitive or
forceful ways to restrain the self-will of the child. The third kind of parenting style is the permissive parent, who is characterised
by a non-punitive, all acceptant, and affirmative manner towards the child's impulses, desires, and actions. Permissive parents
allow their children to regulate their own activities, they do not encourage them to obey externally defined rules, and they do not
set limits in order to facilitate their adaptation to social norms. Maccoby & Martin (1983) distinguished two different subtypes of
permissive parenting; the indulgent and the neglectful type of parent. Indulgent parents may be somehow responsive towards
their children but this responsiveness does not match the particular needs of the child. The indifferent parent usually neglects
their parental responsibilities and they do not seem to care about their children at all. The four parenting styles are depicted in
Figure 2.
Clinical experience suggests that authoritative parents appear to handle the difficulties they face, while parenting their children, in
a more effective way. Authoritarian parents on the other hand often face serious communication problems with their children,
while the emotional climate of the relationships they create is very tense. Conflicts between authoritarian parents and their
children are frequent, especially during adolescence. Adolescents complain that their parents “squeeze them” and they often
rebel. Parents with a permissive parenting style often face delinquency problems with their children. The indulgent subtype of the
permissive parent experiences extreme levels of insecurity, while the relationship they create with the child is enmeshed. They
are also observed to have a pattern of interfering in the everyday life of the child, without asking the child's permission.
Boundaries in these families are very vague and obscure. Parents classified
Figure 2: The four parenting styles (Baumrind, 1991; Maccoby & Martin, 1983).
Gender Issues in Attachment Patterns and Parenting

The first studies conducted on the gender differences in the attachment patterns of romantic relationships found no significant
difference between women and men (Hazan & Shaver, 1987). In other words, both genders were found to be equally likely to be
secure or insecure within their romantic relationship. However, more recent research data (using continuous measures of the
adult attachment patterns) found men to be significantly more dismissing than women (Brennan, Clark, & Shaver, 1998; Scharfe
& Barthlomew, 1994). Schmitt and colleagues (Schmitt, 2008; Schmitt et al., 2003) found that men rated themselves as more
avoidant and less anxious than women. Later, Del Giudice (2009a, b) claimed that significant gender differences in romantic
attachment patterns exist, specifically in the frequencies of the insecure styles (anxious and avoidant), with more men being of an
avoidant type and more women being of an anxious type. Additionally, Del Giudice found that insecure attachment patterns are
correlated with a propensity to get involved in sexual relationships very easily and quickly. These strategies include either a very
limited emotional commitment (which is exhibited by avoidant adults) or an excessive closeness and over investment with the
partner (which is exhibited mainly by anxiously attached adults).
Del Guidice (2011) also conducted a meta-analysis study on the gender differences that exist in the avoidance and anxiety
dimensions of adult romantic relationships. More specifically he pooled data from almost 100 studies employing two-dimensional
questionnaires concerning romantic attachments. It was found that men exhibited higher attachment avoidance and lower
attachmentanxiety than women. Del Guidice's findings are in line with a common stereotype of the western culture, that indicates
that men tend to be more emotionally distant and more dismissive than women (Bem, 1993). Brody and Hall (1993) also claimed
that men are less likely to express emotions associated with affiliation and relationships. In general, romantic relationships are
largely characterised by women's complaints about men's lack of closeness (Bush, 1989) and men's discomfort towards women's
desire for emotional closeness (Feeney, 1994).
Regarding gender differences in parenting styles Turner (2011), described some of the main differences between mothers' and
fathers' parenting styles in an overview paper published by the organisation “Parents as Teachers”. He stated that fathers'
parenting style tends to be less predictable and more physically active, while mothers tend to follow more established patterns of
physical contact with the child. Fathers promote the child's intellectual and social development through physical play, whereas
mothers use more talking, teaching, and caregiving. Fathers' play is also more challenging for the child. Mothers on the other
hand tend to play more at the child's level: they let the child direct the play and proceed in their own way. Another basic
difference, referred to by Turner, is that fathers tend to offer less immediate support to their children in times of discomfort, with
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the overt aim of enhancing their child' problem-solving skills, whereas mothers tend to intervene more quickly in order to reduce
the frustration of the child. Additionally, fathers engage more often in activation-exploration themes while playing with their
children and they generally focus on what their children need to learn in order to become competent in their everyday life. On the
other hand, mothers tend to play with their child in a more conventional way, by employing traditional games or songs while they
tend to discipline children by focusing on the impact their behaviour has on their relationships with others.
Despite these differences between mothers' and fathers' parenting methods, both parents have been found to be equally capable
in acting as primary caregivers. Erlandsson, Christensson and Fagerberg (2008) studied fathers' taking care of their infants as
primary caregivers, during the first hours following birth. These fathers claimed that they experienced immediate father-child
togetherness when they undertook the full responsibility of their child. The same fathers felt that they knew their children better
than the mother of the child, and claimed that their infant became familiarised with their body smell very easily. Erlandsson and
colleagues (2007) also found that fathers, when acting as primary caregivers, are perfectly capable of providing calming skin-to-
skin contact with their babies in situations where the mother-infant dyad was interrupted. In general, studies show that fathers are
just as capable as mothers in child-rearing (Sunderland, 2000). Despite this fact, mothers still remain the main person
responsible for the vast majority of children (Craig, 2006; Fox, 2001, Ranson, 2001; Wall & Arnnold, 2007). According to Wall and
Arnold (2007), mothers are the primary caregivers of children, while fathers tend to act as “part-time” or “secondary parents”, as if
their own relationship with the child is of less importance than the mother's.
The Present Study

As mentioned above, there is a growing interest in the potential relationship between the quality of the romantic attachment of the
couple and their parenting styles (Cox & Paley, 1997; Howard, 2010; Selcuk, Zayas, & Hazan, 2010). Millings and colleagues
(2013) have found that high levels of attachment avoidance and high anxiety levels in both mothers and fathers are negatively
correlated with the authoritative parenting style, while they are positively correlated with the authoritarian or the permissive
parenting styles. However, this evidence is neither enough nor generalisable in different cultures. The present study initially tried
to investigate the attachmentanxiety level and the avoidance level that Greek mothers and fathers feel within their romantic
relationship, and relate the particular feelings of the couple to the parenting style they use in relation to their own children.
However, during data collection it became obvious that the overwhelming majority of fathers we had recruited into our study were
extremely reluctant and unwilling to provide any information, especially on topics concerning their own romantic relationship.
On the other hand, the mothers we had recruited seemed to have no problem participating in the same study. As a result it was
decided to investigate only the mothers' attitude towards their romantic relationship and the parenting style they were using.
Specifically, then, the remit of the present study examined whether the level of attachmentanxiety, and the level of attachment
avoidance mothers experience, was related to the particular parenting style they then used with their child. Possible associations
between a mother's attachment pattern and parenting style, it was hypothesised, might reveal the need for relational
psychotherapy in an effort to support mothers and therefore, it is hoped, improve or enhance their parenting skills.
Sample and Procedure

A cross sectional research design was used. The data of the present study were collected by visiting children's schools. All
parents and teachers were informed about the purpose of the study. Confidentiality rules were explained to both parents and
teachers in order to ease any worries. Additionally, in order to motivate people to participate in the present research, two free
counselling sessions were offered after data collection. At the same time, the counselling sessions offered, it was hoped, would
ease some possibly strong emotions triggered by the questionnaires. However, only eleven mothers attended the free
counselling sessions. None of them showed any signs of emotional upset, on the contrary they all commented that completing
the questionnaires was an interesting procedure for them.
In total, 137 mothers agreed to participate in the study. The average age of mothers was 40.93 (SD = 4.78) and their children
were eleven to twelve years old. 74.5% of mothers and 96.3% of fathers were working outside their home environment. As far as
the educational level of mothers is concerned, 40.9% of them were university graduates, 43.1% of them were primary and/or
secondary school graduates, and 16% of mothers were technical school graduates. Regarding the educational background of
their partners, 32.9% of them were university graduates, 60.6% were primary and/or secondary school graduates, and 6.6% of
them were technical school graduates.
Fathers' difficulties with our request to provide information regarding their attachment relationship could be related to men's
tendency to be emotionally less expressive than women when discussing personal or intimate topics (Brody & Hall, 1993; Kring &
Gordon, 1998). Figures 3-6 in the Appendix picture the employment status and the educational background of mothers and their
partners. The mothers completed the following questionnaires.
The Experiences in Close Relationships Scale (ECR)

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All mothers completed the experiences in close relationships scale (ECR) (Brennan, Clark, & Shaver, 1998, adjusted for the
Greek population by Kafetsios, 2002). The ECR is a thirty-six item scale, assessing how the respondent feels when involved in
close relationships. Half of the items of the ECR scale (eighteen), measure the avoidance dimension and the rest (a further
eighteen items) measure the anxiety dimension of an adult attachment relationship. Mothers answered in a seven point Likert
scale, ranging from “strongly disagree” to “strongly agree”, indicating how much they disagree or agree with the statement of
each item. So the higher scores indicate greater relationship insecurity.
The Parenting Style and Dimensions Questionnaire (PSDQ)

Additionally, all mothers completed the parenting style and dimensions questionnaire (PSDQ) (Robinson et al., 2001, adjusted for
the Greek population by Antonopoulou & Tsitsas, 2011). Both original and short versions of the PSDQ evaluate the three different
parental typologies proposed by Baumrind. The Greek version of the PSDQ contains twenty-nine items that identify and evaluate
an additional type of parent: the extremely strict parent, a category that came up during the standardisation procedure applied to
the Greek population being researched. The extremely strict type of parent sets up very strict and rigid rules for the child, like the
authoritarian parent, but does not use any corporal punishment or physical control. Mothers answered in a four point Likert scale
ranging from “never” to “always”, indicating how often they show certain behaviours towards their children. Each mother receives
a different score for the utilisation of each separate parenting style.
Results and Discussion

The results of the present study revealed that mothers with high attachment security significantly apply a positive authoritative
parenting style more frequently, while both mothers with a high attachmentanxiety and mothers with a high attachment avoidance
tend to apply negative parenting styles. More specifically, anxious mothers were found to behave either in an authoritarian or in a
permissive way towards their children. Both authoritarian and permissive parenting styles have a significant impact on the
mothers' ability to create a successful emotional bond with their child. On the other hand, mothers with an avoidant strategy in
their romantic relationship were found to behave in a more authoritarian way. A high level of security in romantic attachment
relationships (or else low level of attachment avoidance and low level of attachmentanxiety) was strongly linked with the
authoritative parenting style, so it can be concluded that whenever attachment security prevails within a romantic relationship,
effective parenting is also evident.
Put simply, most mothers who feel secure within their own romantic relationship, tend to be loving and affectionate towards their
children, while they define clear boundaries within their family relationships. Ward and Carlson (1995), confirmed that mothers
with a secure attachment pattern are sensitive in their parenting attitudes and behaviours. Their early experiences from their own
attachment relationships allow them to reduce their own personal needs and to shift their attention to providing adequate
caregiving (Mikulincer & Shaver, 2007). These mothers have been raised with sensitivity, availability, and consistency and as
result they have formed a positive role model of parenting that they use in relation to their own children (Collins & Feeney, 2000).
Additionally caregivers with a secure state of mind in relation to attachment support their children's challenges, encourage their
children to acquire new skills, reveal a genuine interest in their children's goals and plans, avoid interfering with their children's
exploratory activities, and admire their children's successes (Feeney, 2004; Feeney & Collins, 2004).
On the other hand, the present study revealed that mothers who feel insecure and anxious within their own romantic relationship
(in other words mothers who do not feel safe and relaxed with their partners), when relating with their children, do not provide
enough love and affection while they over emphasise discipline without any reasoning or explaining (a sign of inadequate
communication). In addition, mothers with an anxious and insecure pattern are unable to guide their children while also failing to
set clear rules and boundaries within their families. Similarly, the vast majority of mothers with high attachment avoidance (in
other words the mothers who keep a great emotional distance from their partners), do not behave in a loving and affectionate
way towards their children, while they over emphasise discipline at the expense of effective family communication.
In general, the results of the present study supported the main hypotheses, linking mothers' high attachment security with a
positive, authoritative parenting style and mothers' high attachmentanxiety or avoidance with negative parenting styles. These
results are in accordance with the findings of a study conducted by Millings and colleagues (2013), who examined the
relationship that exists between the quality of the attachment romantic bond and the parenting style in a sample of British
mothers and fathers. They found that high levels of attachmentanxiety and attachment avoidance in romantic partnerships are
linked with either an authoritarian or with a permissive parenting style, whereas low levels of anxiety and avoidance are related to
a more authoritative parenting style. The relationship between mothers' attachmentanxiety and authoritarian and/or permissive
parenting style can be explained by evidence provided by Collins and colleagues (2006), who assert that the unfulfilled emotional
needs of the anxiously attached individuals are often closely related to their various insensitive and/or intrusive caregiving
behaviours. Both the authoritarian and the permissive parenting styles are characterised by lack of sensitivity and/or by lack of
interest in the child's emotional needs.
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Mayless and Scher's (2000) study also found that when mothers experience intense attachmentanxiety, they exhibit a diminished
ability to encourage their children's social skills, autonomy, and independence, while the exact opposite is true for mothers
experiencing low levels of attachmentanxiety. As far as attachment avoidance is concerned, the results of the present study, as
well as the results of previous studies carried out on different populations, linked mothers' high levels of attachment avoidance
with the authoritarian parenting style. According to Bowlby (1979) adults with a dismissing attachment pattern have a diminished
ability to act as a “secure base”, so they cannot be effective caregivers to other people, including their own children. Crowell and
Feldman (1988) have found that caregivers who have an avoidant attachment pattern feel emotionally detached from their own
children and consequently cannot support their children adequately. They are also found to be less helpful towards their children
while they often have a distant, controlling, and task-focused style, even at times when their children need assistance in a
problem solving situation. It seems that whenever caregivers with an avoidant attachment pattern are called upon to act as “a
secure base”, their attachment system is activated in an unpleasant way and their capacity to be emotionally responsive is
blocked.
Finally, the present study revealed the strong reluctance of this sample of Greek fathers to participate. More research is
necessary to reveal the exact reasons behind the fathers' decisions to not provide information about both their attachment
relationship and about the parenting style they use in relation to their children. Possibly the unwillingness of fathers to answer
and return the questionnaires provided by the study, is related to the traditional roles of parenthood within Greek families and
within Greek society in general, revealed in Kataki's (2012) work. Specifically, Kataki found that the majority of Greek mothers act
as the primary caregivers in families, whereas at the same time the majority of Greek fathers remain the main family
breadwinners. This trend was found to be significantly stronger and more common in rural areas and in small cities. Moreover,
Maridaki-Kassotaki (2000) found that many Greek fathers experience a strong psychological distress whenever they face child-
rearing responsibilities. This finding could also be one of the reasons behind the refusal of the vast majority of fathers to
participate in the present study.
To summarise, even though the researchers consider fathers' feelings about and attitudes towards their intimate relationship, as
well their parenting style, as being of equal importance to those of mothers, the present study only managed to explore the
parenting style that mothers use and its relationship to their own romantic attachment. Obviously, more work needs to be done on
men's abilities to discuss their emotional issues as well as on their own everyday involvement in caregiving, since these factors
are of extreme importance for all healthy, intimate relationships and for strong family bonds. The legacy of patriarchy is still very
entrenched.
Bearing in mind the importance of openly discussing intimate and emotional issues, as well as analysing the importance of both
paternal and maternal roles in childdevelopment, it is proposed that various psycho-educational programmes that encourage
these abilities should be available in Greece and wherever needed. More specifically, these programmes should encourage
fathers to get in touch with their emotional lives and sensitise them to the social stereotypes that sometimes impede the father-
child relationship. At the same time, mothers should be encouraged to trust the caregiving abilities of men, where these are
demonstrably present. Stewart-Brown and McMillan (2010) established a database of evidence-based programmes that support
parenting and promote mental health. They identified three different types of intervention: perinatal programmes, programmes for
parents of infants and toddlers, and parenting programmes for the prevention of behavioural problems in children.
The perinatal programmes include a combination of practical and emotional support given to parents, anticipatory guidance and
promotion of caregiving behaviours such as skin to skin care, kangaroo care, and infant massage. Parenting programmes during
infancy and during children's early years, include either “short, sensitivity focused interventions” or “multicomponent, long-term
home visiting programmes”. Short, sensitivity focused interventions include approximately six sessions that focus on enhancing
parental observation skills and positive interchanges and enjoyment in the parent-infant relationship. The long-term home visiting
programmes also focus on the positive side of the parent-infant relationship, but they start around the antenatal period and they
emphasise the fact that the relationship that the practitioner forms with the mother is of great importance. The long-term
programmes offer at least weekly visits. The third type of parenting programme, which focuses on the prevention of children's
behavioural problems, include either manualised parenting programmes, such as group based behaviour management, group
based relational programmes, or media based programmes, with or without a session with a therapist. The main principle of
these programmes is that parents can and should be helped to establish healthy relationships with their own children.
The results of the present study generally confirmed the strong relationship that exists between mothers' quality of romantic
relationship and the quality of the parenting style they adopt. Additionally, qualitative measurements on the same topics could be
of considerable importance in future research. Keeping in mind that insecurity and emotional distance in couples affects
parenting in an extremely negative way, it is our recommendation that family and couple therapy centres should be readily
available for young couples in order to break the vicious circle of anxiety and/or avoidance that unfolds across the generations.
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The need for family and couple therapy centres is particularly urgent in contemporary Greek society, where many families suffer
from various economic and social stressors during this very difficult historical period. We feel that emotional insecurity and
emotional distancing in couples and families should be approached by re-examining the painful, unmet emotional needs of the
parents within a therapeutic setting. Main (1995) emphasised that therapy, in the form of providing a new, attuned attachment
relationship experience within a supportive environment, is necessary because knowledge alone often fails in resolving family
problems since people have an unconscious need to preserve unchanged their own state of mind regarding the attachment
experiences they once acquired from their own parents.
Appendix 1. Demographic Data

The following Figures 3-6 depict the demographic data of the research sample.
Figure 3: Mother's employment status.
Figure 4: Mothers' educational level.
Figure 5: Fathers' educational atatus.
Figure 6: Fathers' educational level.
Appendix 2. Statistical Analysis

Tables 1-4 depict the statistical analysis of the research.
Table 1: Descriptive statistics and intercorrelations between the variables
Mean SD 1 2 3 4 5 6
*p < 0.05; **p < 0.01; SD: standard deviation.
1. Mothers' 3.68 1.13 −
anxiety
2. Mothers' 2.57 0.87 0.23** −
avoidance
3. 4.29 0.48 −0.21* −0.29** −
Authoritative
parenting
style
4. 1.83 0.56 0.30** 0.24** −0.44** −
Authoritarian
parenting
style
5. Strict 3.87 0.63 0.15 −0.07 0.09 0.31**
parenting
style
6. Permissive 2.81 0.70 0.31** 0.06 −0.27** 0.38** −0.31**
parenting
style
Table 1 depicts the mean scores, standard deviations, and a correlation analysis of the main variables under investigation. As
seen, mothers' anxiety is significantly related to authoritarian (rs = 0.30, ps < 0.01) and permissive (rs = 0.31, ps < 0.01)
parenting styles. A statistically significant, negative correlation was found between mothers' attachmentanxiety and authoritative
parenting style (rs = −0.21, ps < 0.05). Respectively, mothers' attachment avoidance was found to have a significant, positive
correlation with authoritarian parenting style (rs = 0.24, ps < 0.01) and a negative correlation with authoritative parenting style (rs
= −0.29, ps < 0.01).
Furthermore, three multiple regression analyses were run in order to check whether mothers' attachmentanxiety and attachment
avoidance predict each one of the three parenting styles under investigation. Attachment avoidance and attachmentanxiety were
both treated as independent variables and each one of the parenting styles was treated as the dependent variable in each one of
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the three models. Both dimensions of attachmentanxiety and attachment avoidance were found to predict in a statistically
significant way the levels of the authoritative parenting exerted by mothers, F(2, 12) = 8.51, p < 0.001. Among several factors,
attachmentanxiety and attachment avoidance were found to explain 10% of the variation observed in authoritative parenting.
Considering the contribution of each separate variable to the model, it was found that attachmentanxiety (b = −0.167, t = −1.988,
p = 0.049) and attachment avoidance (b = −0.252, t = −3.004, p = 0.003) have a statistically significant impact on authoritative
parenting.
Regression coefficients and standard errors are presented in Table 2.
Table 2: Summary of multiple regression analysis for authoritative parenting
B SE B β
*p < 0.05; **p < 0.01; B = unstandardised regression coefficient; SE B =
standard error of the coefficient; β = standardised coefficient.
Attachment anxiety−0.070 0.035 −0.167*
Attachment −0.124 0.041 −0.252**
avoidance
Similarly, attachmentanxiety and attachment avoidance were found to predict in a statistically significant way mothers'
authoritarian parenting F(2, 12) = 8.916, p < 0.001. Both dimensions of attachment insecurity were found to account for 10% of
the variation in authoritarian parenting and considering these two variables separately, attachmentanxiety (b = 0.251, t = 2.993, p
= 0.003) and attachment avoidance (b = 0.179, t = 2.137, p = 0.034) were found to have a statistically significant impact on
authoritarian parenting. Regarding the permissive type of parenting style, its levels can also be predicted, in a statistically
significant way, by both dimensions of attachmentF(2, 12) = 7.105, p > 0.005, which explain 8% of the variation observed in
permissive parenting style. Regarding the separate impact of each independent variable to the model, only attachmentanxiety
had a statistically significant impact (b = 0.312, t = 3.683, p = 0.000) on permissive parenting style. It is important to note that
wherever the term “impact” is mentioned a cause-effect relationship between the variables under investigation is not implied but a
rather strong link between them.
Regression coefficients and standard errors for authoritarian and permissive parenting are depicted in Tables 3 and 4.
Table 3: Summary of multiple regression analysis for the authoritarian parenting
B SE B β
Attachment anxiety0.122 0.041 0.252**
Attachment 0.102 0.048 0.179*
avoidance
Table 4: Summary of multiple regression analysis for permissive parenting
B SE B β
Attachment anxiety0.192 0.052 −0.312**
Attachment −0.0009 0.061 −0.012
avoidance
References
1
Adam , E. K. , Gunnar , M. R. , & Tanaka , A. (2004). Adult attachment, parent emotion, and observed parenting behavior:
mediator and moderator models. Child Development, 75 : 110-122.
2
Antonopoulou , K. , & Tsitsas , G. (2011). The investigation of Greek mother's parenting styles: adaptation and standardization
of the parenting styles & dimensions questionnaire (PSDQ). Science of Education, 2 : 51-60.
3
Bartholomew , K. (1990). Avoidance of intimacy: an attachment perspective. Journal of Social and Personal Relationships, 7 :
147-178.
4
Bartholomew , K. , & Horowitz , L. (1991). Attachment styles among young adults: a test of a four category model. Journal of
Personality and Social Psychology, 61 : 226-244.
2/6/2018 EBSCOhost
5
Baumrind , D. (1966). Effects of authoritative parental control on child behavior. Child Development, 4 : 887-907.
6 Baumrind , D. (1968). Authoritarian v. authoritative parental control. Adolescence, 3 : 255-272.
7
Baumrind , D. (1991). Parenting styles and adolescent development. In: J. Brooks-Gunn , R. Lerner , & A. C. Petersen (Eds.),
The Encyclopedia of Adolescence (pp. 746-758). New York: Garland .
8
Bem , S. L. (1993). The Lenses of Gender. New Haven, CT: Yale University Press .
9
Boszormenyi-Nagy , I. , & Spark , G. M. (1973). Invisible Loyalties: Reciprocity in Intergenerational Family Therapy.
Hagerstown, MD: Harper & Row .
10 Bowlby , J. (1979). The Making and Breaking of Affectional Bonds. London: Tavistock .
11
Brennan , K. A. , Clark , C. L. , & Shaver , P. R. (1998). Self-report measurement of adult attachment: an integrative overview.
In: J. A. Simpson & W. S. Rholes (Eds.), Attachment Theory and Close Relationships (pp. 46-76). New York: Guilford Press .
12
Brody , L. R. , & Hall , J. (1993). Gender and emotion. In: M. Lewis , & J. Haviland (Eds.), Handbook of Emotions (pp. 447-
460). New York: Guilford Press .
13
Bush , D. M. (1989). Conflict between the sexes: strategic interfering and the evocation of anger and upset. Journal of
14
Collins , N. L. , & Feeney , B. C. (2000). A safe haven: an attachment theory perspective on support seeking and caregiving in
intimate relationships. Journal of Personality and Social Psychology, 78 : 1053-1073.
15
Collins , N. L. , & Read , S. J. (1994). Representations of attachment: the structure and function of working models. In: K.
Bartholomew & D. Perlman (Eds.), Advances in Personal Relationships Vol. 5: Attachment Process in Adulthood (pp. 53-90).
London: Jessica Kingsley .
16 Collins , N. L. , Guichard , A. C. , Ford , M. B. , & Feeney , B. C. (2006). Responding to need in intimate relationships:
normative processes and individual differences. In: M. Mikulincer & G. S. Goodman (Eds.), Dynamics of Romantic Love:
Attachment, Caregiving and Sex (pp. 149-189). New York: Guilford Press .
17
Cox , M. J. , & Paley , B. (1997). Families as systems. Annual Review of Psychology, 48 : 243-267.
18
Craig , L. (2006). Does father means fathers share? A comparison of how mothers and fathers in intact families spend time
with their children. Gender & Society, 20 : 259-281.
19 Crittenden , P. M. , & Ainsworth , M. (1989). Child maltreatment and attachment theory. In: D. Cicchetti & V. Carlson (Eds.),
Clinical Maltreatment: Theory and Research on the Causes and Consequences of Child Abuse and Neglect (pp. 432-463).
Cambridge: Cambridge University Press .
20
Crowell , J. A. , & Feldman , S. S. (1988). Mothers' internal models of relationships and children's behavioral and
developmental status: a study of mother-child interaction. Child Development, 59 : 1273-1285.
21
Del Guidice , M. (2009a). Sex, attachment and the development of reproductive strategies. Behavioral and Brain Sciences, 32
: 1-67.
22 Del Guidice , M. (2009b). Human reproductive strategies: an emerging synthesis? Behavioral and Brain Sciences, 32 : 45-67.
23
Del Guidice , M. (2011). Sex differences in romantic attachment: a meta-analysis. Personality and Social Psychology Bulletin,
37 : 193-214.
24
Erlandsson , K. , Christensson , K. & Fagerberg , I. (2008). Fathers' lived experiences of getting to know their baby while
acting as primary caregivers immediately following birth. Journal of Perinatal Education, 17 : 28-36.
25
Erlandsson , K. , Dsilna , A. , Fagerberg , I. , & Christensson , K. (2007). Skin-to-skin care with the father after cesarean birth
and its effect on new born crying and prefeeding behavior. Birth, 34 : 105-114.
2/6/2018 EBSCOhost
26
Feeney , B. C. (2004). A secure base: responsive support of goal strivings and exploration in adult intimate relationships.
Journal of Personality and Social Psychology, 87 : 631-648.
27
Feeney , B. C. , & Collins , N. L. (2004). Interpersonal safe heaven and secure base caregiving processes in adulthood. In: W.
S. Rholes & J. A. Simpson (Eds.), Adult Attachment: Theory Research and Clinical Implications (pp. 300-338). New York: Guilford
Press .
28
Feeney , J. A. (1994). Attachment style, communication patterns, and satisfaction across the cycle of marriage. Personal
Relationships, 1 : 333-348.
29
Fox , B. (2001). The formative years: how parenthood creates gender. Canadian Review of Sociology and Anthropology, 28 :
373-390.
30
Fraley , R. C. , & Shaver , P. R. (2000). Adult romantic attachment: theoretical developments, emerging controversies, and
unanswered questions. Review of General Psychology, 4 : 132-154.
31 Freud , S. (1914g). Remembering, repeating and working-through. S.E., 12 : 145-156. London: Hogarth . (SE.012.0145A)
32
George , C. , & Solomon , J. (1999). Attachment and caregiving: the caregiving behavioral system. In: J. Cassidy & P. R.
Shaver (Eds.), Handbook of Attachment: Theory, Research and Clinical Application (pp. 649-670). New York: Guilford .
33
Hazan , C. & Shaver , P. (1987). Romantic love conceptualized as an attachment process. Interpersonal Relations and Group
Processes, 52 : 511-524.
34
Howard , K. S. (2010). Paternal attachment, parenting beliefs and children's attachment. Early Child Development and Care,
180 : 157-171.
35 Jacobvitz , D. B. , Morgan , E. , Kretchmar , M. D. , & Morgan , Y. (1991). The transmission of mother-child boundary
disturbances across three generations. Development and Psychopathology, 3 : 513-527.
36
Jurkovic , G. J. (1998). Destructive parentification in families: causes and consequences. In: L. L'Abate (Ed.), Family
Psychopathology (pp. 237-255). New York: Guilford .
37
Kafetsios , K. (2002). Experiences in close relationships scale (standardization in Greek population). In: A. Stalikas , S. Triliva ,
& P. Roussi (Eds.). Psychometric Tests in Greece (pp. 357-358). Athens: Greek Letters .
38 Kataki , Ch. (2012). The Three Identities of the Greek Family. Athens: Pedio .
39
Kerig , P. K. (2003). Boundary dissolution. In: J. Ponzetti , R. Hamon , Y. Kellar-Guenther , P. K. Kerig , L. Scales , & J. White
(Eds.), International Encyclopedia of Marital and Family Relationships (pp. 164-170). New York: Macmillan .
40
Kring , A. M. , & Gordon , A. H. (1998). Sex differences in emotion: expression, experience, and physiology. Journal of
41
Lyons-Ruth , K. , Bronfman , E. , & Atwood , G. (1999). A relational diathesis model of hostile-helpless states of mind. In: J.
Solomon & C. George (Eds.), Attachment Disorganization (pp. 330-370). New York: Guilford .
42
Maccoby , E. E. , & Martin , J. A. (1983). Socialization in the context of the family: parent-child interaction. In: P. H. Mussen , &
E. M. Hetherington . Handbook of Child Psychology: Vol. 4. Socialization, Personality and Social Development (pp. 1-101). New
York: Wiley .
43
Main , M. (1995). Attachment: overview with implications for clinical work. In: S. Goldberg , R. Muir , & J. Kerr (Eds.),
Attachment Theory: Social, Developmental and Clinical Perspectives (pp. 407-474). Hillsdale, NJ: Analytic Press .
44 Main , M. , Kaplan , N. & Cassidy , J. (1985). Security in infancy, childhood and adulthood: the relationship between
attachment patterns and parenting style - a move to the level of representation. In: I. Bretherton & E. Waters (Eds.), Growing
Points of Attachment Theory and Research. Monographs of the Society for Research in Child Development , 50 ( 1-2 , Serial No.
209): 66-104.
2/6/2018 EBSCOhost
45
Maridaki-Kassotaki , K. (2000). Understanding fatherhood in Greece: fathers' involvement in child care. Psicologia: Teoria e
Pesquisa, 16 : 213-219.
46
Mayseless , O. , & Scher , A. (2000). Mother's attachment concerns regarding spouse and infant's temperament as
modulators of maternal separation anxiety. Journal of Child Psychology and Psychiatry, 41 : 917-925.
47
Mikulincer , M. & Shaver , P. (2007). Attachment in Adulthood: Structure, Dynamics, and Change. New York: Guilford .
48
Millings , A. , Walsh , J. , Hepper , E. , & O'Brien , M. (2013). Good partner, good parent: responsiveness mediates the link
between romantic attachment and parenting style. Personality and Social Psychology Bulletin, 39 : 170-180.
49
Nathanson , A. , & Mahonar , U. (2012). Attachment, working models of parenting, and expectations for using television in
childrearing. Family Relations, 61 : 441-454.
50 Ranson , G. (2001). Men at work: change or no change in the era of the “new father”. Men and Masculinities, 4 : 3-26.
51
Raval , V. , Goldberg , S. , Atkinson , L. , Benoit , D. , Myhal , N. , Poulton , L. & Zwiers , M. (2001). Maternal attachment,
maternal responsiveness and infant attachment. Infant Behavior & Development, 24 : 281-304.
52
Rholes , W. S. , Simpson , J. A. , & Friedman , M. (2006). Avoidant attachment and the experience of parenting. Personality
and Social Psychology Bulletin, 32 : 275-285.
53
Rholes , W. S. , Simpson , J. A. , Blakely , B. S. , Lanigan , L. , & Allen , E. A. (1997). Adult attachment styles, the desire to
have children and working models of parenthood. Journal of Personality, 65 : 357-385.
54
Robinson , C. C. , Mandleco , B. , Olsen , S. F. , & Hart , C. H. (2001). Parenting styles and dimensions questionnaire (PSDQ).
In: B. F. Permulter , J. Touliatos & G. W. Holden (Eds.), Handbook of Family Measurement Techniques: Vol. 3. Instruments and
Index (pp. 319-321). Thousand Oaks, CA: Sage .
55
Scharfe , E. & Barthlomew , K. (1994). Reliability and stability of adult attachment patterns. Personal Relationships, 1 : 23-43.
56 Schmitt , D.P. (2008). Evolutionary perspectives on romantic attachment and culture: how ecological stressors influence
dismissing orientations across genders and geographies. Cross Cultural Research, 42 : 220-247.
57
Schmitt , D. P. , Alcalay , L. , Allensworth , M. , & Zupaneye , A. (2003). Are men universally more dismissing than women?
Gender differences in romantic attachment across 62 cultural regions. Personal Relationships, 10 : 307-331.
58
Selcuk , E. , Zayas , V. , & Hazan , C. (2010). Beyond satisfaction: the role of attachment in marital functioning. Journal of
Family Theory & Review, 2 : 258-279.
59 Shaver , P. R. , Papalia , D. , Clark , C. L. , Koski , L. R. , Tidwell , M. , & Nalbone , D. (1996). Androgyny and attachment
security: two related models of optimal personality. Personality and Social Psychology Bulletin, 22 : 582-597.
60
Slade , A. , & Cohen , L. J. (1996). Process of parenting and the remembrance of things past. Infant Mental Health Journal, 17
: 217-238.
61
Stewart-Brown , S. , & McMillan , A. S. (2010). Home and Community Based Parenting Support Programmes and
Interventions: Report of Work Package 2 of the DataPrev Project. Coventry: Warwick Medical School . Available at:
http://wrap.warwick.ac.uk/3239/
62 Sunderland , J. (2000). Baby entertainer, bumbling assistant and line manager: discourses of fatherhood in parent craft texts.
Discourse and Society, 11 : 249-274.
63
Turner , R. D. (2011). How fathers' style of parenting benefits their children development. Parents as Teachers. Available at:
www.parentsasteachers.org/images/stories/documents/Fatherhood_Resources/HowFathersStyle_ofParentingBenefits.pdf
64
Van Ijzendoorn , M. H. (1995). Adult attachment representations, parental responsiveness, and infant attachment: a meta-
analysis on the predictive validity of the adult attachment interview. Psychological Bulletin, 117 : 387-403.
2/6/2018 EBSCOhost
65
Wall , G. , & Arnold , S. (2007). How involved is involved parenting? An exploration of the contemporary culture of fatherhood.
Gender & Society, 21 : 508-527.
66
Wallin , D. (2007). Attachment in Psychotherapy. New York: Guilford .
67
Ward , M. J. , & Carlson , E. A. (1995). Associations among adult attachment representations, maternal sensitivity, and infant-
mother attachment in a sample of adolescent mothers. Child Development, 66 : 69-79.
AJRPP.008.0172A
Record: 11
Title: The “Original Couple”: Enabling Mothers and Infants to Think about What Destroys as Well
as Engenders Love, When There Has Been Intimate Partner Violence
Authors: Jones, Sarah; Bunston, Wendy
Language: English
Abstract: This paper addresses the importance for therapists, working with infants, of holding in
mind all aspects of the parental couple's relationship history, both positive and negative.
This also includes the therapists' possible ambivalence about a violent father. Using object
relations and attachment theory frameworks we articulate our approach to the “original
couple” when working in the area of family violence and infant mental health. We propose
that if therapists can develop this capacity, it assists both mothers, and ultimately their
infants, in tolerating thinking about their violent experiences. Work with infants and their
mothers in an infant/motherpsychotherapy group for those affected by family violence is
described, illustrated by a clinical vignette.
direct=true&db=pph&AN=CFP.002.0215A&site=ehost-live&scope=site">The “Original
Couple”: Enabling Mothers and Infants to Think about What Destroys as Well as
Engenders Love, When There Has Been Intimate Partner Violence</A>
The “Original Couple”: Enabling Mothers and Infants to Think about What Destroys as Well as
Engenders Love, When There Has Been Intimate Partner Violence
Sarah Jones, author, Psychotherapist/mental health social worker in Private Practice in Melbourne, as an individual, couple, and
infant-parent psychotherapist. She worked at the Royal Children's Hospital for fifteen years and remains a consultant to a number
of specialist departments including the Peek a Boo Club™: a therapeutic intervention for infants and mothers exposed to intimate
partner violence with the RCH/Addressing Family Violence Program. Previously she worked at the Royal Free Hospital, London,
and trained at the Tavistock Clinic. She has a special interest in palliative care, perinatal, and infant mental health, working
clinically and as consultant and trainer.
Wendy Bunston, author, Senior clinical social worker with a Masters in Family Therapy and further post graduate qualifications in
Organisational Dynamics and Infant Mental Health. She is manager of the multi-award winning Addressing Family Violence
Programs in the Integrated Mental Health Program of Melbourne's Royal Children's Hospital. She has published work in the area
of child protection, childhood trauma, child/adolescent sex offending, family violence, and group work. Wendy has developed
specialist group work programmes for children and parents affected by family violence, “PARKAS”, the “Peek-A-Boo Club™” for
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infants and mothers, and more recently “Dads on Board™” for men who have successfully completed a men's behaviour change
programme, and their infants. Her latest publication is Refuge for Babies in Crisis written with Robyn Sketchley.
This paper addresses the importance for therapists, working with infants, of holding in mind all aspects of the parental couple's
relationship history, both positive and negative. This also includes the therapists' possible ambivalence about a violent father.
Using object relations and attachment theory frameworks we articulate our approach to the “original couple” when working in the
area of family violence and infant mental health. We propose that if therapists can develop this capacity, it assists both mothers,
and ultimately their infants, in tolerating thinking about their violent experiences. Work with infants and their mothers in an
infant/motherpsychotherapy group for those affected by family violence is described, illustrated by a clinical vignette.
Introduction
When infants and their mothers have been affected by violence within the intimate partner relationship, how can therapists
working with them usefully hold in mind the relationship of the “original couple”?
The term the “original couple” offers a construct with which to think about both the biological and the symbolic context of the
relationship into which the infant was conceived. Whilst acknowledging the biological factor, it also allows consideration of the
emotional, inter- and intrapsychic world of the infant, and enhances our capacities to think about the introjected parent-couple, as
much more than a biological entity. This in turn fosters further thinking about the infant (and his or her experience) as more than a
“product” of the coupling, and as a subject, in and of her own right. (In accordance with this, hereafter we refer to the infant as
“she” and/or “her” rather than as the more impersonal he/she.)
Using object relations theory and attachment theory to frame our thinking about the “original couple”, we hope to offer an
understanding of our work that may prove useful to other therapists involved in the area of infant mental health, family violence,
and work with couples. We will consider the interpersonal processes of intimate partner violence and the importance for
therapists when working with infants to hold in mind both positive and negative aspects of the parental couple's relationship
history. This also includes the therapists' possible denigration of, or ambivalence about, a father who is violent. The infants'
fathers are not usually participants in our therapeutic work. Reasons for this are multifarious; the couple's separation results in a
father abandoning contact/being in jail; court orders preventing contact; mothers/children residing in refuges, etc. Practitioners
working in family violence services with women and children usually need their work to be undertaken separately from that with
fathers and men. This is due to the risks to safety posed by the men's past histories of extreme violence. While the rationale for
this prioritises safety in reducing further violence, it may result in practitioners not being sufficiently supported to engage with the
ideas this paper attempts to address.
The clinical example1 we have chosen to illustrate our thinking and approach as set out above, is drawn from our clinical
experience of working, training and writing with colleagues of the RCH Infant Mental Health Program a time-limited specialist
infant/mother therapeutic group work intervention at the Peek-A-Boo Club™ (Bunston, 2006, 2008a), an initiative of Melbourne's
Royal Children's Hospital Integrated Mental Health Program.2 The clients of the groups are infants from birth to thirty-six months,
where the infant/s and mother have been exposed to family violence. The Peek-A-Boo Club™ aims to create a space that is
“infant led” (Bunston, 2008b) through privileging the experience of the infant.
Clinical experience leads us to believe that either parent may be violent. While it is the mother-infant pair who are referred to the
programme, which is elucidated later below, our therapeutic focus attempts always to hold the triad of mother, father, and infant,
in mind. This paper addresses one dimension of that focus, the capacity of therapists working directly with both infant and
mother, to be able to tolerate, reflect on, and process the intimate adult sexual relationships that have been, or continue to be,
violent, occasionally even murderously so. (While we recognise the importance of the exceptional complexities for children
conceived as a result of rape or incest, (Paul, 2007), they are beyond the scope of this paper). Tangible legal and social
responses are needed to keep mothers and infants safe from male violence. However, “we obfuscate the complexity of self and
thereby of our relationships if we over identify with polarities that reduce rather than enlarge our understanding of the dynamics
that play out in landscapes dominated by violence. This is turn limits our ability to effectively respond” (Bunston, 2008a, p. 155).
When therapists can develop this capacity, it assists the mother and infant's potential to think about, and make conscious, that
which is often considered intolerable or is unconsciously split off. From this a different kind of thinking may enable some healing
or resolution through tolerating the enormity and complexity of their violent experience. We see this capacity as part of the overall
therapeutic endeavour which aims to attend to both the traumatic disruptions to the infant-motherattachment, resulting from
exposure to severe familial violence, the “ghosts” in the mothers' past (Fraiberg, Adelson, & Shapiro, 1975), and to the very
present “ghost” of the absent partner/father.
The potential for dehumanising, dismissing, or denying of the other as a subject may occur when either parent resorts to
destructive and violent splitting; such splitting has important and developmental impact on the infant and the family. Lieberman,
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Padrón, Van Horn, and Harris (2005), in their paper “Angels in the nursery” suggest the importance of holding in mind that which
is good:
We propose that the parallel identification of “beneficial cues” can hasten recovery from trauma by placing the traumatic cues
within the larger perspective of nurturing and growth-promoting experiences. (p. 507)
An Attachment Approach to Understanding Violence in Couples

Bowlby (1988) wrote, “violence … can be understood as the distorted and exaggerated version of behaviour that is potentially
functional” (p. 81). In an effort to maintain or regain contact with another, anger, but not violence, can function as a form of
protest. In healthy relationships it is normally responded to, by another, in an effort to hear and understand the protest with the
aim of maintaining, restoring, or repairing the seeming breach/rupture in the attachment relationship at that moment. In intimate
partner violence, when the frustration or perceived insensitivity of the other overwhelms the individual, anger may turn to
aggression. As their best bid to keep their partner “available”, when they become overwhelmed by their internal well of despair
and sense of powerlessness, the angry partner may resort to attempts to control the other, through abuse, intimidation, or
coercion.
Early implicit memories of relational ruptures can activate primitive, inchoate emotional states. The subsequent aggression can
be understood as a regressive and maladaptive effort to regain some sense of control. With limited creative or healthy ways to
ensure proximity of loved ones, or to stave off the terror of being abandoned, one or both individuals may feel a desperate need
to maintain contact with a partner whom they are fearful of losing. In the presence of such powerful feelings their approaches
may become coercive and emotionally destructive. Overwhelmed by primitive responses the distressed person cannot “think”,
and instead “reacts” in response to the perceived threat. At such times, by grabbing at what they want, or pushing away what
they hope to avoid, the other, as an individual demonstrating her own independence and separateness of mind, cannot be seen.
Garcia-Moreno, Jansen, Ellsberg, Hesie, and Watts (2006) reporting in The Lancet on 24,000 women from fifteen different
countries, found that men whose usual relational style is controlling are also more likely to be violent to their partners. The pursuit
of control can be understood as an inflexible effort to manage anxiety that threatens to overwhelm.
Bowlby (1988) reminds us that the strength of an attachment is unrelated to the quality of that attachment. Bartholomew,
Henderson, and Dutton (2001) confirmed this notion through attachment informed research with couples. They write,
we became impressed by how particular forms of insecurity appeared to put individuals at risk of becoming involved in, and
having difficulty leaving, problematic and even abusive relationships. (p. 43)
The authors found that:
In some unhappy partnerships, individuals can face the hurts of separation, in the knowledge they will survive them. However, the
authors found the most insecure individuals/couples are more likely to endure and maintain a relationship, even where abuse is a
common dynamic.
Goldner, Penn, Sheinberg, and Walker (1990) explored love and violence in the couple relationship through the lens of a
“genderparadox”. They proposed that men, and particularly those from rigidly prescriptive gendered backgrounds, learnt to be
masculine by denying their feelings, primarily so as not to be like their mothers. Women, on the other hand, may need to refute
their subjectivity and independence by becoming an “object” that a man would desire. Men and women often unconsciously form
attachments with one another in order to find that which they feel is missing within themselves. In their work with volatile couples
who remain together, Goldner, Penn, Sheinberg, and Walker (1990) found that the “original” attraction for these couples “was [in]
looking for a magical rescue from the loyalty binds and gender injunctions they experienced in their original families” (p. 360).
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Evidence from couple and family violence research shows that men and women alike can be victims and can be violent.
Acknowledging reciprocal couple violence or women's violence is still controversial in the family violence arena and not often
openly debated (Dutton, Saunders, Starzomski, & Bartholomew, 1994; Wangmann, 2011). Many practitioners have difficulty in
being able to perceive women as using violence. It is recognised, however, that men perpetrate more severe physical violence
and that women invariably are at greater risk of injury or death in violent heterosexual couple relationships (Salter, 2012; Strauss,
Hamby, Boney-McCoy, & Sugarman, 1996).
When considering research findings about the enduring qualities of some abusive relationships, our clinical experience leads us
to appreciate how little experience of healthy reciprocal relationships the men and women in abusive relationships have usually
had. The capacity to build or create such a relationship requires, either an experience of a “good enough” emotional relationship,
or, a well-developed ability to reflect upon and imagine what such a relationship might look and feel like. In the absence of these,
a person's internal world will, in many ways, be limited, leading to difficulties in regulating emotions, mentalising, reflecting upon,
or finding words to deal with the pain of disruptions in their relationships.
We propose that violent behaviours reflect an individual's own impoverished attachment relationships which are incorporated into
an intra-psychic internal world in such a way that emotional distress is expressed as aggression, angry outbursts, or demands to
be obeyed in efforts to control the other. These aggressive behaviours operate in response to their own urgent emotional needs.
This understanding about early privations within the “original couple” is important. It extends the clinicians' perspectives to
encompass the minds of the mothers in our groups and their respective introjected parent couples. (While exploration of the
mothers' sense of their own original families is vital to our work, it is not a focus in this paper.)
Fonagy (2003), expanding on Bion's pioneering work regarding infant containment (1962) and the capacity for thinking(1967),
draws an association between the experience of feeling emotional containment and the ability to mentalise. Fonagy (2001)
argues that clarity of self and other depends, from infancy, on being held in the mind of a care-giver who has a sense of self and
other. He proposes it is the lack of emotional containment and being cared for by a parent/care-giver without the capacity to
mentalise, or think about the infant's feelings and experiences, that leads to a disorganised state of mind, and further, fails in the
normal developmental task of regulating “natural aggression”. Fonagy (2003) considers “aggression in infants” to be a normal
phenomenon. An individual, with poor attachment experiences operating from a state of psychic disorganisation, has no
possibility for finding a way to think through the turmoil of aggressive feelings and so fails to master them. An adult, who needed
to eschew his emotional life as a child, will have a limited capacity to deal with and manage the boundary between self and other
leading to dangerous expressions of an unthinking kind.
The emerging evidence of a strong link between the disorganised state of mind and violent behaviour is compelling. In a lecture
entitled “The male perpetrator: the role of trauma and failures of mentalization in aggression against women”, Fonagy (1999)
outlines his views regarding the transmission of trauma:
The child's understanding of minds critically depends upon a developmental opportunity to find himself represented in the
caregiver's mind as a mentalizing individual (an intentional being motivated by mental states, beliefs, and desires). Their parents'
mentalizing capacity is … a good predictor. Thus a theory of mind is, first of all the other's theory of mind, then a theory of self
and finally a theory of the other. Mentalization, the capacity to understand and interpret human behaviour in terms of putative
mental states underpinning it arises through the experience of having been understood in the context of an attachment
relationship. This, in our view, is a critical aspect of the transgenerational transmission of abuse. (p. 3)
Understanding Violence and Trauma

The phenomenon of interpersonal violence in all its different manifestations is hard to gauge, define, and adequately measure.
Recognition that violence within relationships can be due to the intra-psychic/interpersonal emotional disturbance within the
couple is essential for therapeutic endeavours. Yet we wish to also acknowledge that social impoverishment (poor education,
race discrimination, drug and alcohol abuse, and poor housing all contributing to unemployment and poverty) can lead to extreme
stress and failure in the emotional holding a couple is required to bear. Salter (2012) reminds us of the lack of adequate “housing,
employment, health and other difficulties that are prevalent in the lives of serious domestic violence offenders and victims” (p.
18). We hope that in a contemporary psychoanalytic paper, these vicissitudes that increase the distress on couples can be
acknowledged, reflecting the thrust of our paper; the importance of holding in mind all aspects of the relationship history.
When there are children, the complex choices of leaving a violent partner (male or female) are multiplied. Severing school and
community connections and embarking on a life of reduced income and single parenthood often result from these separations,
particularly for women. Weighing up the consequences of leaving, the attendant shame and threat of chronic poverty, compared
with staying in an abusive relationship, contribute to the turmoil of the decision making. Research indicates that women will leave
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a violent partner between four to six times over a period of eight years before doing so permanently (Gondolf, 1988; Horton, &
Johnson, 1993; Okun, 1986; Walker, 1979).
The trauma of intimate partner violence may damage or even destroy an individual's capacity to remember the nuance and
complexity of the relationship. It is important to think about how therapists can become drawn into colluding with avoiding what
has been lost or destroyed, thereby eschewing the often painful and complicated memories of early love and attachment that
have been eclipsed by the violent events. Collusion by therapists may mean that opportunities to enable the mother-infant dyad
to integrate some of the “good and bad” aspects of that infant's parent's relationship are also lost. Without some integration of
their different parts, the infant's future capacity to tolerate ambivalence in herself as well as others may be compromised.
The mother's capacity to hold and contain her infant will be enhanced by her greater understanding of the complexity of the
history of her relationship with the infant's father. Our case vignette below demonstrates an infant's responses to her mother's
emotional turmoil. Infants, who remain alone and uncontained in these situations, may be at risk of developing a defensive
identification with the aggressor/perpetrator or identification with the powerless victim. Such “either/or” identification was first
described by Anna Freud (1936/1966). Sigmund Freud (1923b) made the assertion that trauma that has not been resolved will
repeat. Fraiberg, Adelson, and Shapiro (1975) and Fraiberg (1980) built on Freud's idea when they brought this notion to the
heart of infant parent work in the seminal paper, “Ghosts in the nursery”. Fraiberg, Adelson, and Shapiro (1975) describe work
with infants and parents and propose that the “ghosts in the nursery”, metaphorically, represent the repetition of the past conflicts
and traumas in the present.
Some women cannot recognise the extreme implications of the violence for themselves or for their children. Their denial can
become converted into an impulse frequently to forgive or idealise their partners which risks minimising the abuse. This may
partly explain why many women repeatedly return following a partner's pleas for forgiveness and a commitment to change. This
“idealisation” maybe an unconsciousdefence against the pain of being alone, the guilt of being the one who abandons the family,
and/or feeling worthy of the assaults. This thinking can be both erroneous and dangerous for the infant. The consequence for the
therapist in this situation might also be to overemphasise all that is bad in the father for fear of encouraging the woman to return
to their partner, enacting a countertransference response to the mother's idealisation. We are concerned here with the
development of the therapist's capacity to hold in mind both sides of the “idealisation/denigration” split that arise in this work. It
behoves therapists to take the preliminary step of tolerating and working through their own anxious defences.
By making space for reflection about the violence in what may previously have been an intimate relationship that contained some
loving elements, mothers and their children are helped to create a more contingent authentic narrative surrounding the couple
relationship. Such contingency fosters positive emotional development in healing the splits that resulted from trauma. With
therapeutic support the mother may be able to provide a less fragmented narrative to her infant. When a child is given a more
authentic account, over time, she has a better chance of understanding herself and the often conflicted nature of her feelings
about herself and about those she loves. We acknowledge, however, that it is not necessarily love that draws some women to a
violent partner; love may never have been truly experienced or expressed within the relationship.
Consequences for Infants Witnessing Violence

Underlying our work is the indisputable finding that exposure to intimate relational violence can adversely affect the infant's
developing mind (Schechter & Willheim, 2009), particularly in relation to the development of self, of object relations together with
the understanding of others, and capacity for empathy. Development in infancy is critical, and more rapid than at any other
period, laying down the template upon which the rest of relational life will be built. Intervening early is therefore urgent work
(Thomson Salo, & Paul, 2007).
Perry, Pollard, Blakley, Baker, and Vigilante (1995), writing about childhoodtrauma, were among the first to integrate
neurobiological principles to the understanding of the emotional states children use to “adapt” to violence. If a child remains in a
persistent fearful state, she will be easily triggered into anxiety or feeling terrorised. Such emotional states can become persistent
traits as the child is highly sensitised to hyper-arousal and may use dissociation in order to survive psychically being in the
presence of an attachment figure who may be both loving and also abusive. Lieberman and Van Horn (2005) report that children
exposed to violence suffer sleep disturbance, bouts of intense fear and uncontrolled crying, regression in developmental
achievements, aggression, and non-compliance. Jordan (2007) alerts us to the consequences for infants who witness domestic
violence, which may include feeding/sleeping difficulties, non-organic failure to thrive, traumatic re-enactment in play, hyper-
arousal, and other symptoms.
Baradon (2010) raises the intense complexities for infants when there is only a traumatising father in their mother's mind. She
writes,
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The mother may show an unremitting need for her infant to identify with her psychic position, so that there is not possibility for the
developing child to create a separate notion of father. (p. 134)
The concept of maternal projections is fundamental in all relationships. A significant component of the mother's projection onto
the child may contain the unwanted parts of herself. This may be her disowned part of self, which unconsciously re-enacts a love
which is felt to be destructive.
Therapeutic Work with Infants

In her paper “Relating to the infant as subject in the context of family violence” Thomson Salo (2007) proposes that, “thinking
about the infant as subject is about thinking of the infant as a person. This means the infant is talked to rather than only being
talked about” (p. 182).
For the infants in our groups it is incumbent on the therapist holding our knowledge of them, what terror they may have
witnessed, instigated by those who have both loved and harmed them. Yet the therapist must also find ways to work directly with
them in the therapeutic space. Slade (1994) outlines that clinicians' work is towards helping young children, primarily through
play, to create their own notions, separate from those held by their care-givers.
When therapists create a play space in which all things can be thought and talked about, in which the infants and mothers feel
held by the therapists, and where all participants and their experience are honoured, there is an opportunity to take something
enormous and terrifying from the outside world and make it into something smaller and perhaps a little less frightening within their
internal world (Singer, 2002; Streeck-Fischer, & van der Kolk, 2000). As the renowned paediatrician and psychoanalyst Donald
Winnicott (1971) suggested, “children play more easily when the other person is able and free to be playful” (p. 60) and that
“playing is itself a therapy” (p. 67). We take very seriously the idea of “playing as a thing in itself” (p. 54). Slade (1994) describes
that,
by putting experiences into play rather than into words the child is creating a structure. And by playing with the child we
become part of the child's discovery of what he or she means to say and means to feel. (p. 91)
Our Therapeutic Context

The Peek-A-Boo Club™ aims to create opportunities for infants and toddlers attending the group to experience a sense of
mastery over their environments, as well as a safe space in which we endeavour to give meaning to experiences that do not
make sense. We know infants and young children may “manage” horrendous violence by dissociation, sublimation, and/or re-
enactment. Every infant in a Peek-A-Boo Club™ group brings her own conflicts and distress about traumatic memories.
The therapeutic frame for the sessions is not dissimilar to adult or childpsychotherapy in that time, place, and group therapists
remain constant. We are mindful of what the group comes to mean or represents for the infants and talk about this with their
mothers, who, of course, will also have her own relationships with the other babies and mothers in the group and with the group
therapists. Playful rituals have been developed which include songs for greetings and separation, and a lullaby song for farewells,
as befits a group for infants. The use of music offers the infants a means to help them organise their experience and over time,
enables them to anticipate predictable reunions and separations. Alongside this therapists both observe and engage in the play
of each infant-mother dyad. However, play for these infants can be frightening and confusing. In all our work, we are acutely
interested in how these traumatic events are expressed, what aspects are emphasised, what are omitted, and what level of affect
is conveyed. Infants can sense that there are secrets that are not to be spoken about, as if something is so terrible that even their
parents, who should protect them, dare not speak about them.
Case Example
Amelia was the only child of Julie and John, who married readily when they became aware of Julie's pregnancy with Amelia.
John, who was in his early thirties and ten years older than Julie, had lost contact with his first wife and his first child, a son. Late
in the pregnancy, John became concerned that Julie would leave him. As he became increasingly anxious, he started controlling
Julie's access to money and eventually he also became violent.
After an assault on Julie, where six-month-old Amelia was present, Julie left the home, taking Amelia. She returned to John a few
times although the violence continued. Neighbours called the police and eventually Julie sought legal help. John was subjected to
an intervention order preventing him from seeing his wife and child. John had agreed to get some psychological help for his
“anger problem”, and made known his wish to return to live with Julie and Amelia. At two years and ten months old, the very
active Amelia arrived in a Peek-A-Boo Club™ group. In the first meeting of the group, as we got to know one another, the
mothers settled as the toddlers explored the room and the toys that were scattered around the floor. Amelia enthralled the other
three toddlers in the group, often leading them in vigorous games of “chasey”.
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We felt Amelia appeared a little too assertive for a first group session. She began a game that consisted of her running furiously
around the room yelling out, “SHUT UP! SHUT UP!” Then she whispered “Shhh, Shhh”, then half-hid under a cushion, holding
her finger to her mouth to indicate to all to be quiet. She would then peek over the top of the cushion pointing to the window as
though to indicate someone was coming and that we needed to keep out of sight. She did this repeatedly, and all in the room
went quiet. The therapists wondered aloud what was being enacted by Amelia in this play. Eventually her mother whispered,
“She does this game at home, all the time”. This seemed to open up the thinking space in which as a group we could wonder
together what Amelia might be showing and telling us.
In an attempt to put the play into words, one of the therapeutic staff gently asked, “Amelia, why do we need to be quiet?” Amelia
again “shushed” us, then rushed off. We asked Julie what she thought might be happening for Amelia. She explained that she felt
it was something to do with her father, although they had never hidden from him. Julie explained that sometimes Amelia's father
would drive by them in the street or drive past the house, although he did not approach them directly. She told us the next time he
breached the intervention order he could go to jail. Julie said she felt puzzled by Amelia's game. When Amelia asked about her
father, Julie would simply tell Amelia that Daddy was “on holiday” and that they could not see him at the moment.
The therapists suggested the play may be an expression of Amelia's fear and confusion related to her traumatic experiences.
They also wondered if it reflected Amelia's wish to see her Daddy, as he was clearly in her mind. We wondered how often Amelia
might have heard “Shhh, Shhh” or “Shut Up”. We also wondered how Amelia made sense of her father “being on holiday” with
him driving by them in the street.
The question, in our minds, and taken up in supervision, was how can we help Amelia and Julie, and naturally the other mothers,
think about their infants in their particular family and what each had experienced. Amelia was told Daddy was on holiday, yet her
mother talked about jail in Amelia's presence in the group. Amelia seemed to us to have enacted something of her anxieties and
longing for her Daddy, yet also possible fears of what might happen if he did come home. We explored the confusion in her play,
and related it to our thinking about Amelia's memories and/or fantasies of Daddy, and maybe fears that Mummy was not strong
enough to protect her. Her mother was helped to notice how watchful Amelia was towards her, and consider both the need for
and the impact of this vigilance. We used the play to allow thinking about Amelia's unspoken worries about her father as a fearful
presence, alongside feelings about him not being at home.
In one session, we worked more closely with this mother-infant pair (in the presence of all the group mother-infant dyads) to help
Julie create a more honest account about the violence and the current parental separation. Julie eventually asked how she might
talk to her daughter more truthfully. We have found this a common question once the therapeutic work is underway. She was able
eventually to explain to Amelia that Daddy got very, very angry and hurt and frightened them both, and that that was not OK. She
also told her Daddy was getting some help to be less angry because he wanted to see her as well. In our work with Amelia and
Julie, we noticed that, as these conversations evolved, so too did Amelia's “game”. We observed that Amelia transformed the
“Shhh Shhh” into a more inclusive “chasey” game that could be enjoyed with others, taking turns excitedly to chase and be
chased.
Over the next few sessions, Amelia continued to play the same game while other children and the facilitators “joined” her in the
game. Slowly the game took on a different dimension and her disquiet seemed to turn to something more playful and less
traumatic. By the conclusion of the group Amelia's coercive-fearful play diminished and other more spontaneous and negotiated
play took its place.
The Infant (Amelia)

Amelia's capacity to enact something of her aggression and the fear she had witnessed was thought to be both a sign of her
distress and a strength. It demonstrated her emotional capacity to bring symbolic meaning to her play. This is “playing as a thing
in itself” (Winnicott, 1971). It is also play where she becomes the aggressor—one who can command others with her own, “Shut
up, shut up”. Fear is aroused in others as she requires all present to submit. The mothers responded with silence. Amelia was not
left alone with her traumatic play, as one therapist actively joined with Amelia while the remainder of the group spoke about its
meaning.
We considered that this may have evoked similar traumatic memories for other children and their mothers, and thus we wondered
about this play and its meaning for the group as a whole. Observing and actively engaging Amelia, her mother and all members
of the group in reflecting on the meaning of the play, helped to contain it and brought about a reduction in Amelia's anxiety. This
talking is delicately balanced between adults talking and direct work with the children. We attempt to attend to both the child and
the dyadic work in our two hour sessions.
The Mother (Julie)

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We should also consider what Julie, the mother, might have been projecting into Amelia. The mother deceived, but also confused
Amelia about her father's whereabouts and the violence. This may be the mother's best attempt to “save” the relationship and
protect Amelia from the brutal reality. Yet Amelia's coercive play shows us otherwise. In avoiding an honest reply to her
daughter's entreaties about her father, her mother created a quandary for her daughter. By denying Amelia the truth, she risked
losing opportunities for helping Amelia to process both her fears and losses. Amelia both wanted her Daddy and feared his return
(the unknown intruder). Was this Julie's wish projected into Amelia? Where is her anger and shame at being violated, when she
returned to John after the violence? We suggest the violence and its meaning, and the attendant terror was split off in the
mother's mind. The deceit about his whereabouts offered little protection for infant or mother, as is evidenced by the traumatic
repetition in Amelia's play. There is always a tension for the therapists between working with the mothers' difficulties while
attending to our infant patients. This reflects the mother's dilemma; whose needs do they attend to first, their own or those of their
infants?
The Therapists
The group process aimed to contained Julie and her own trauma sufficiently for Julie to both see and listen to her daughter's fear
of her father (the intruder) and a fear of being abandoned to deal with it alone. The therapists attempt to hold and support the
group to think more together about their past. This often means that we explore how the other mothers first met their children's
fathers, what their hopes and dreams had been then, and what they had done with these early memories of less traumatic times.
We create a focus on how and what the mothers thought and felt about their experiences of their own families, their loving
memories and sadness about their own parents, as well as about their (ex)partners.
A vital aspect of our therapeutic work is support for the therapists to ensure they are available to infant, mother, and the group as
a system. This includes weekly supervision with a psychotherapist, and additional training, aimed at optimising the containment
of all the members of the group. This is a challenge, as the very nature of the material participants are encouraged to think and
talk about evokes and resonates with the most fearful, vulnerable, and violent aspects of themselves. We acknowledge the power
of countertransference responses for the clinicians, how this is worked with in supervision is beyond the scope of this paper.
Many of the therapists involved in this work are supported by their own psychotherapy.
Supervision attends to the impulse to “not think” about violence and the ensuing violation of infant's minds. Traumatised people
can underestimate the risk to themselves or to their children; therapists need to be vigilant they do not unwittingly collude by
ignoring, or neglecting, danger signs. Their own therapeutic model must equip them with the skills needed to be alert to those
signs and to take appropriate action with child protection services and/or the police, if necessary.
The “Original Couple”

The notion of the “original couple” enables therapists to think about the infant's experience more richly. It includes the infant's own
internalised self derived from her own early object relations. Every infant will have their own experience, memories, feelings, and
fantasises about their father and their mother and also her introjections regarding the violence witnessed and/or experienced
themselves. If her father has left or abandoned them, or been removed from living in the home, there may be conflicted feelings
of perhaps dissociation, numbness, or relief, mixed with guilt, sadness, and loss at being separated from her father. It is our role
as therapists to help infants and mothers to try to separate what belongs to each of them and to recognise their experiences as
being different. Clinicians need to be able to think about the intense feelings left in the abused mother/father, with the possibility
that such feelings may also be projected onto the child. We also need to consider a child's play as being both an enactment with
the group of the traumatic experience and as possessing unconscious elements. Our clinical vignette clearly demonstrates the
therapeutic power of being able to process together highly evocative experiences. We believe it is important to raise with the
mothers in the group, early memories and experiences of love, even though that love has often been destroyed. We aim to reach
the shame inherent in the mother's unconsciouscompulsion to seek a love object that both attracts and ultimately repels her,
someone who is excitingly familiar and yet ultimately dangerous and possibly even deadly. Some mothers may have heightened
degrees of ambivalence about the pregnancy and/or infant, as the new life raises anxieties about being excluded and about their
capacities to love another. It may be that both partners perceive the baby as an object who will come between them; neither
parent may have wanted a baby. There is always a risk that the baby may be destroyed if they do stay together. There is
unfortunately not space to expand on the partners' sometimes sadomasochistic dynamic, where they both feel unlovable but
cannot tolerate such feelings.
Discussion
Themes of trauma, violence, loss, and distress are ever present in work with infants who have experienced violence within their
parent's relationship. In the group we create a space to allow the meaning of these relationships and the events that brought the
women/infants to us to emerge. This attends also to a need for “counterbalance”. Some experiences, some of which may have
been shared with the father, may have been loving and beneficial. It is incumbent therefore on infant-parent clinicians to think
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about love, when violence has felt to be so destructive. Lieberman, Padrón, Van Horn, and Harris (2005), as quoted above,
suggest that therapists need to seek out, that which was once beneficial and may still promote growth, in relation to the infant's
father.
Thus thinking about what destroys, as well as what engenders, love occurs in the presence of the infants. As all the infants
assessed and accepted into this therapeutic programme have been exposed to significant, if not lifelong violence, might not
speaking about it in their presence add to their trauma? What the infants have taught us is that they bring their experiences and
fantasies into the therapeutic space, via their play. We believe these children live, see, feel, and introject these experiences,
whether the mothers are talking about the violence or not. We also believe the baby cannot wait for the mother's recovery. This is
urgent work with rapidly developing minds. The group experience enables each mother's capacities to hold her infant in mind,
supporting her to create a congruent and meaningful account in a way that is particular to her and her child. Being heard and held
by the group, mothers often also see their infant anew, recognising her as a sentient human being with a mind and a memory.
Conclusion
The enactment of destructive phantasies in intimate adult relationships, often itself arising from the experience of early
childhoodtrauma, poses serious threats of injury and death. Our therapeutic endeavour is essentially family-based, yet the actual
separation of the parental couple in our work is imperative when family members face death should the couple remain together.
We are not absolving mothers from perpetrating violence, as this presents its own complex dilemmas in the mother-infant
relationship and must be thought about. However this paper attests to the profound psychic presence of the absent violent father;
absent from the therapy room as his behaviour is deemed be too “unsafe” to be included, and absent from the relationship
because the mother has fled or been abandoned.
Despite his physical absence, the father is usually highly present in the mind of the mother even as she denies his existence to
herself and her infant. It is valuable for infants' mental health to keep open a space in our own thinking about the “original couple”.
In infant work involving intimate partner violence there may be a pull towards thinking exclusively about repairing the infant's
relationship with her mother and to expelling any thinking about the parental couple. However, we risk losing something of great
significance when we restrict our work to the infant's relationship with her mother. The infant has a mother and a father, the
sexual couple who created her; that coupling underpins her history. Therapeutic services that offer interventions for “violent men”
for good reasons often operate separately from interventions for “survivors of violence” (mostly women). However, in this paper,
we are proposing that therapists working with infants have a unique opportunity to be able to bring together the “original couple”
in their own thinking, in order to enhance “integration” over “disintegration” for vulnerable infants and their parents.
Acknowledgements
The authors would like to acknowledge the generous assistance of Dr Julie Stone, Infant Psychiatrist, and Mr Peter Fullerton,
Jungian Psychotherapist.
Notes
The names and some details have been changed to ensure confidentiality. Informed consent to present material from our groups
for teaching purposes is obtained from all participants before any material is shared with others.
The work of the Peek a Boo Club™ was generously supported by the Sidney Myer Fund and The Grosvenor Foundation through
the Victorian Women's Trust.
References
1
Baradon , T. (2010). And what about fathers? In: T. Baradon (Ed.), Relational Trauma in Infancy (pp. 130-136). East Sussex:
Routledge .
2
Bartholomew , K. , Henderson , A. , & Dutton , D. (2001). Insecure attachment and abusive relationships. In: C. Clulow (Ed.),
Adult Attachment & Couple Psychotherapy (pp. 43-61). East Sussex: Brunner-Routledge .
3 Bion , W. R. (1962). Learning from Experience. London: Heinemann [reprinted: London: Karnac , 1984 ]. (ZBK.003.0001A)
4
Bion , W. R. (1967). Second Thoughts: Selected Papers on Psycho-Analysis. London: Heinemann [reprinted: London: Karnac ,
1984 ].
5
Bowlby , J. (1988). A Secure Base: Clinical Applications of Attachment Theory. London: Routledge .
6
Bunston , W. (2006). The Peek a Boo Club: group work for infants and mothers affected by family violence. Domestic Violence
Incest Resource Centre Quarterly, Autumn ( 1 ): 3-8.
2/6/2018 EBSCOhost
7 Bunston , W. (2008a). Who's left holding the baby? Infant-led systems work with in intimate partner violence. In: J. Hamel (Ed.),
Intimate Partner and Family Abuse: A Casebook of Gender Inclusive Therapy (pp. 155-173). New York: Springer .
8
Bunston , W. (2008b). Baby lead the way: mental health group work for infants, children and mothers affected by family
violence. Journal of Family Studies, 14 : 334-341.
9
Dutton , D. G. , Saunders , K. , Starzomski , A. J. , & Bartholomew , K. (1994). Intimacy-anger and insecure attachment as
precursors of abuse in intimate relationships. Journal of Applied Social Psychology, 24 : 1367-1386.
10 Fraiberg , S. (Ed.) (1980). Clinical Studies in Infant Mental Health. New York: Basic Books .
11
Fraiberg , S. , Adelson , E. , & Shapiro , V. (1975). Ghosts in the nursery: a psychoanalytic approach to the problems of
impaired infant-mother relationships. Journal of the American Academy of Child Psychiatry, 14 : 387-421.
12
Fonagy , P. (1999). The male perpetrator: the role of trauma and failures of mentalization in aggression against women—an
attachment theory perspective. Paper given at the 6th John Bowlby Memorial Lecture. London: The Centre for Attachment-based
Psychoanalytic Psychotherapy .
13 Fonagy , P. (2001). Attachment Theory and Psychoanalysis. New York: Other Press .
14 Fonagy , P. (2003). Towards a developmental understanding of violence. The British Journal of Psychiatry, 183 : 190-192.
15
Freud , A. (1936/1966). The identification with the aggressor. In: The Ego and the Mechanisms of Defense, The Writings of
Anna Freud 2 (pp. 109-112). New York: International Universities Press .
16
Freud , S. (1923b). The Ego and the Id. S.E., 19 : 12-66. London: Hogarth . (SE.019.0001A)
17
Garcia-Moreno , C. , Jansen , H. , Ellsberg , M. , Hesie , L. , & Watts , C. (2006). Prevalence of intimate partner violence:
findings from the WHO multi-country study on women's health and domestic violence. The Lancet, 368 : 1260-1269.
18
Goldner , V. , Penn , P. , Sheinberg , M. , & Walker , G. (1990). Love and violence: gender paradoxes in volatile attachments.
Family Process, 29 : 343-364.
19
Gondolf , E. W. (1988). The effect of batterer counseling on shelter outcome. Journal of Interpersonal Violence, 3 : 275-289.
20
Horton , A. L. , & Johnson , B. L. (1993). Profile and strategies of women who have ended abuse. Families in Society, 74 :
481-492.
21
Jordan , B. (2007). Infancy and domestic violence: an annotation. In: F. Thompson Salo , & C. Paul (Eds.), The Baby as
Subject (pp. 178-179). Melbourne: Stonnington .
22
Lieberman , A. F. , & Van Horn , P. (2005). Don't Hit My Mommy!: A Manual for Child-Parent Psychotherapy With Young
Witnesses of Family Violence. Washington, DC: Zero to Three .
23
Lieberman , A. F. , Padrón , E. , Van Horn , P. , & Harris , W. W. (2005). Angels in the nursery: the intergenerational
transmission of benevolent influences. Infant Journal Mental Health, 26 : 504-520. (AJRPP.008.0120A)
24 Okun , L. E. (1986). Woman Abuse: Facts Replacing Myths. Albany: State University of New York Press .
25 Paul , C. (2007). Infants born of rape. In: F. Thompson Salo , & C. Paul (Eds.), The Baby as Subject (pp. 199-201). Melbourne:
Stonnington .
26
Perry , B. , Pollard , R. , Blakley , T. , Baker , W. , & Vigilante , D. (1995). Childhood trauma, the neuro-biology of adapation
and the “use dependent” development of the brain, how “states” become “traits”. Infant Mental Health Journal, 16 : 271-291.
27
Salter , M. (2012). Managing recidivism amongst high risk violent men. Australian Domestic and Family Violence
Clearinghouse Issues Paper No. 23. Sydney: University of New South Wales .
28 Schechter , D. S. , & Willheim , E. (2009). The effects of violent experiences on infants and young children. In: C. H. Zeanah ,
Jnr. (Ed.), Handbook of Infant Mental Health (pp. 174-214). New York: Guilford .
2/6/2018 EBSCOhost
29
Singer , J. L. (2002). Cognitive and affective implications of imaginative play in childhood. In: M. Lewis (Ed.), Child and
Adolescent Psychiatry: A Comprehensive Textbook (pp. 81-107). Philadelphia: Lippincott, Williams, & Williams .
30
Slade , A. (1994). Making meaning and making believe: their role in the clinical process. In: A. Slade & D. P. Wolf (Eds.),
Children at Play: Clinical and Developmental Approaches to Meaning and Representation (pp. 81-107). New York: Oxford
University Press .
31
Strauss , M. A. , Hamby , S. L. , Boney-McCoy , S. , & Sugarman , D. B. (1996). The revised Conflict Tactics Scales (CTS2):
development and preliminary psychometric data. Journal of Family Issues, 17 : 283-316.
32
Streeck-Fischer , A. , & Van der Kolk , B. A. (2000). Down will come baby, cradle and all: diagnostic and therapeutic
implications of chronic trauma on child development. Australian and New Zealand Journal of Psychiatry, 34 : 903-918.
33
Thomson Salo , F. (2007). Relating to the infant as subject in the context of family violence. In: F. Thompson Salo & C. Paul
(Eds.), The Baby as Subject (pp. 182-198). Melbourne: Stonnington .
34 Thomson Salo , F. , & Paul , C. (2007). Some principles of infant-parent psychotherapy. In: F. Thompson Salo , & C. Paul
(Eds.), The Baby as Subject (pp. 182-198). Melbourne: Stonnington .
35
Walker , L. (1979). The Battered Woman. New York: Harper & Row .
36
Wangmann , J. (2011). Different types of intimate partner violence—an exploration of the literature. Australian Domestic and
Family Violence Clearing House Issues Paper No. 22. Sydney: University of New South Wales .
37 Winnicott , D. W. (1971). Playing and Reality. New York: Routledge . (ZBK.017.0001A)
CFP.002.0215A
Record: 12
Title: Rome Couple and Family Attachment Lab
Authors: Zavattini, Giulio, Cesare
Document Type: Report
Language: English
direct=true&db=pph&AN=CFP.003.0270A&site=ehost-live&scope=site">Rome Couple and
Family Attachment Lab</A>
Rome Couple and Family Attachment Lab

Giulio Cesare Zavattini, author, Full Professor of “Clinical Psychology of the Couple”. He is member of the doctorate programme
in Dynamic and Clinical Psychology, at the Faculty of Medicine and Psychology, La Sapienza, University of Rome. He is a
member of Società Italiana di Psicoanalisi, the International Psychoanalytical Association, and the International Association of
Couple and Family Psychoanalysis. He is a member of the International Advisory Board of Couple and Family Psychoanalysis
and a full member of BSPCP. He has a private practice with individuals and couples, and is engaged in research about adoption,
families with eating disorders, and adult attachment.
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A new website www.cfalab.com now provides information about the research on couples and family relationships conducted by
the Couple and Family Attachment Lab (CFALab) based in Rome. Directed by Prof. Giulio Cesare Zavattini, CFALab is a
research team which studies couple and family relationships and their effects on human behaviour. The laboratory comprises
professors of psychology, psychoanalysts, psychotherapists, and researchers.
Research is conducted in various fields, such as assessment of infants and adults, and on couples relationships and
psychotherapy. The Centre also focuses on issues such as violence, adoption, and eating disorders. The assessment process is
primarily informed by psychoanalysis and attachment theory, and is underpinned by several training courses. Measures and
assessment tools used include: adult attachment interview, current relationship interview, conflict in the interparental system
coding scale, reflective functioning sale, childattachment interview, Manchester childattachment story task, strange situation
procedure, and family drawing.
The work of the Lab has been reported in journal articles and books, and presented in posters and symposia at national and
international conferences. A full list of publications can be found on our website.
CFP.003.0270A
Record: 13
Title: The Sense of Entitlement in Romantic Relationships—Scale Construction, Factor
Structure, Construct Validity, and Its Associations with Attachment Orientations
Authors: Tolmacz, Rami; Mikulincer, Mario
Source: Psychoanalytic Psychology, 2011; v. 28 (1), p75, 20p
ISSN: 07369735
Language: English
Abstract: Based on clinical evidence and theoretical writings that pointed to the importance and
uniqueness of the sense of entitlement in couple relationships, two studies were designed
to develop and validate the Sense of Relational Entitlement (SRE) scale. A factor analysis
performed on the scale's items yielded five factors that identified three basic entitlement-
related attitudes toward a romantic partner. Findings indicated that both exaggerated and
restricted forms of relational entitlement seem to be maladaptive and put people at risk for
emotional problems. Findings also indicated that excessive and restricted forms of
relational entitlement were significantly associated with attachment insecurities. In
addition, the SRE scale was found to tap a unique psychological construct that moderately
overlapped with constructs of narcissism and global entitlement. The discussion focuses
on the developmental and psychodynamic sources of the sense of relational entitlement.
Accession Number: PPSY.028.0075A
(Permalink): direct=true&db=pph&AN=PPSY.028.0075A&site=ehost-live&scope=site
direct=true&db=pph&AN=PPSY.028.0075A&site=ehost-live&scope=site">The Sense of
Entitlement in Romantic Relationships—Scale Construction, Factor Structure, Construct
Validity, and Its Associations with Attachment Orientations</A>
The Sense of Entitlement in Romantic Relationships—Scale Construction, Factor Structure,

Construct Validity, and Its Associations with Attachment Orientations
Rami Tolmacz, author; Department of Psychology, Bar-Ilan University Ramat-Gan, Israel 52900. E-mail: tolmacr@mail.biu.ac.il
Mario Mikulincer, author; Interdisciplinary Center (IDC) Herzliya
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Based on clinical evidence and theoretical writings that pointed to the importance and uniqueness of the sense of entitlement in
couple relationships, two studies were designed to develop and validate the Sense of Relational Entitlement (SRE) scale. A
factor analysis performed on the scale's items yielded five factors that identified three basic entitlement-related attitudes toward a
romantic partner. Findings indicated that both exaggerated and restricted forms of relational entitlement seem to be maladaptive
and put people at risk for emotional problems. Findings also indicated that excessive and restricted forms of relational entitlement
were significantly associated with attachment insecurities. In addition, the SRE scale was found to tap a unique psychological
construct that moderately overlapped with constructs of narcissism and global entitlement. The discussion focuses on the
developmental and psychodynamic sources of the sense of relational entitlement.
A person's sense of entitlement—the subjective perception of what one deserves in a specific situation—is considered one core
facet of the construct of narcissism(Emmons, 1984) and is receiving growing attention in psychological discourse and research.
While there are many areas in which one's sense of entitlement might be activated, there is growing evidence of its unique role
and paramount importance in determining the quality of couple relationships as well as cases of relationship dissolution, abuse,
and violence. However, no reliable and valid tool has been developed to assess the sense of entitlement in close relationships
(“relational entitlement”). In order to fill this gap, we have constructed and tested a self-report scale specifically aimed to measure
relational entitlement.
A Psychoanalytic Perspective on Entitlement

Freud (1916/1963) began the theoretical and clinical discussion on the subject of entitlement when he referred to a group of
patients as “the exceptions.” Freud stipulated that these patients felt they deserved special treatment or reparation following
wrongs done to them in the past. Jacobson (1959) developed Freud's theory about “exceptions,” and added that entitlement may
also be characterized those who were “blessed” with unusual beauty or unique talents and therefore felt exempt from the rules
that apply to everyone else. According to Horney (1950), feelings of entitlement surface during therapy in patients who expect
special treatment and have what she named “neurotic claims”—claims that are a result and expression of a situation whereby “a
wish or need, in itself quite understandable, turns into a claim” (p. 42). The individual characterized by these claims expects
special attention and treatment from others and feels entitled that all his needs will be satisfied or duly respected, without his
having to voice them at all. Horney (1950) also described these people as reacting with bouts of anger and rage to the frustration
of their sense of entitlement in situations they experience as unjust or unfair.
An important development in understanding the sense of entitlement occurred when several psychoanalytic writers (e.g., Levin,
1970; Kriegman, 1983; Moses & Moses, 1990) linked such a sense with self-esteem and differentiated three attitudes toward
personal entitlement: normal, adaptive entitlement; excessive or exaggerated entitlement; and restricted entitlement or
nonentitlement. Normal, adaptive sense of entitlement characterizes people who are able to make realistic evaluations of what
they are entitled to expect from others. Individuals who have a sense of limited or nonentitlement are characterized by a limited
sense of autonomy and assertiveness, and behave in a particularly modest, bashful, cautious, and introverted manner, as if
doubting their right to express their needs and receive attention from others. Such a sense of limited entitlement seems to reflect
a person's impaired sense of self-esteem and to result from a history of frustrating interactions with others (e.g., Levin, 1970;
Kriegman, 1983; Moses & Moses, 1990). For example, Levin (1970) believes that a low sense of entitlement develops at an early
age from maternal messages that communicate a degree of dissatisfaction with her infant. A child who receives such a message
may develop feelings of shame and guilt and then attempt to regain others' esteem and approval by acting in a manner that
pleases others (Miller, 1979).
People characterized by an excessive or exaggerated sense of entitlement feel free to do anything they want and believe they
deserve to have their needs and wishes satisfied regardless of others' feelings, needs, and rights (e.g., Levin, 1970). Solomon
and Leven (1975) hypothesized that it might also develop through identification with parents who had an exaggerated sense of
entitlement. However, most writers believed that excessive entitlement can be a defense against psychic pain and frustration
experienced during interactions with insensitive others (e.g., Horney, 1950; Shabad, 1993; Moses & Moses, 1990). For example,
Billow (1999b) linked an exaggerated sense of entitlement to feelings of helplessness and powerless, and Mayer (1991) found
that autobiographic narratives of patients who exhibited exaggerated entitlement attitudes included episodes of deprivation and
abuse as well as parents who seemed insensitive to their child's emotional needs. Moses and Moses (1990) also suggested that
excessive entitlement can result from trauma. Although traumatic events, such as sexual abuse or death of a parent, may lead to
feelings of guilt and shame and then result in a sense of nonentitlement, they also lead to feelings of being wronged which, in
turn, can bring to a strong sense of entitlement.
Measuring the Sense of Entitlement

In the personality and social psychology literature, an exaggerated sense of entitlement is considered to be a specific aspect of
narcissism(Emmons, 1984). Therefore, Raskin and Hall (1979) included a few items assessing entitlement in the Narcissistic
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Personality Inventory (NPI). However, Campbell, Bonacci, Shelton, Exline, and Bushman (2004) pointed to a number of
limitations concerning the use of the NPI entitlement subscale as the single index of the sense of entitlement: lack of face validity,
relative shortage of items, and low reliability. Moreover, the set of entitlement items failed to load on a single, differentiated factor
in most factor analytic studies of the NPI (Emmons, 1984). In fact, Emmons clearly showed that the entitlement and
exploitiveness items of the NPI formed a single, undifferentiated factor.
The growing research interest in the sense of entitlement led Nadkarni and Malone (1989) to develop the Entitlement Attitude
Scale. This scale consists of 27 items organized around four factors: (a) self-effacing attitude, (b) narcissistic expectations, (c)
self-promotion, and (d) self-assurance. Recently, Campbell et al. (2004) developed the Psychological Entitlement Scale, which
includes nine items reflecting the understanding that “psychological entitlement is intrapsychically pervasive or global; it does not
necessarily refer to entitlement that result from specific situations. … Rather, psychological entitlement is a sense of entitlement
that is experienced across situations” (p. 32).
While these scales tap a global sense of entitlement, several writers noted that a person's sense of entitlement might differ in
different life areas. For example, Kriegman (1983) claimed that “occupationally the individual may manifest normal entitlement
attitudes but in social or personal aspects of his life may have exaggerated or nonentitlement attitudes” (p. 273). Similarly, Moses
and Moses (1990) suggested that even if exaggerated entitlement is dominant in an individual, such a sense may surface only in
specific situations and relationships. Thus, though an individual's sense of entitlement can shape his or her interactions and
views in a wide variety of situations and relationships, the quality and intensity of a particular entitlement attitude depends on the
specific situation or relationship that the individual is involved and the subjective meaning he or she attributes to it (Moses &
Moses, 1990).
In our view, this is especially relevant in the case of romantic relationships, because the clinical literature notes that entitlement
issues tend to be of crucial importance in couple relationships (e.g., Blechner, 1987; Billow, 1999a, 1999b). On this basis, we
believe that a separate measure assessing sense of entitlement in couple relationships might be valuable. We define sense of
entitlement in couple relationships as the extent to which an individual expects his or her relational wishes, needs, and fantasies
should be fulfilled by a romantic partner. It also refers to a person's affective and cognitive responses to a romantic partner's
failure to meet these wishes, needs, and fantasies.
Sense of Entitlement and Couple Relationships

There is hardly any doubt that the sense of entitlement in couple relationships is largely influenced by prevailing norms in a
certain culture. In her book, The Bookseller from Kabul (pp. 278-279), Norwegian author Aasne Seierstad quotes the following
dialogue between two young Afghans:
“What is your answer?” he asks.

“You know I cannot answer you,” she says.
“But what do you want?”
“You know I cannot have a desire.”
“But do you like me?”
“You know I'm not allowed to answer that.”
“Will you say yes when I propose?”
“You know it is not me who answers.”
“Will you meet me again?”
“I can't”
“Why aren't you being a bit nicer? Don't you like me?”
“My family will decide whether I like you or not.”
In Western societies, gender, for example, plays a central role in shaping the sense of relational entitlement. In this context,
Chodorow (1989) argued that differences between men and women in identitydevelopment result in different attitudes toward
relational entitlement. Eichenbaum and Orbach (1984) claimed that internalization of a cultural norm by which women should
fulfill others' needs and expectations leads to depreciation of women's wishes, needs, and sense of self-worth, thereby
undermining their sense of relational entitlement. Indeed, Sanchez and Gager (2000) found that violation of one's sense of
entitlement played a more important role in deciding whether or not to divorce among men than among women.
Beyond the effect of cultural norms, psychoanalytic writers suggest that romantic relationships are the main arena where adults
expect to meet and negotiate their needs, wishes, and fantasies. For example, Person (1989) believed that romantic love helps
us to preserve the kind of hope and longing that aims to break the barriers that separate self from others and restore the lost
sense of oneness that an infant experiences with primary caregivers (see also Mikulincer & Shaver, 2007). Thus, according to
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Person (1989), romantic love is the main arena where we seek to undo early losses and to gratify unfulfilled or frustrated
childhood wishes and fantasies. Bergmann (1987) also believed that romantic relationships allow people to negotiate basic
psychological needs and wishes, such as refinding parental love, so that the new love object will be as similar as possible to early
parental images. There is often the expectation that a romantic partner will heal one's earlier relational wounds. Similarly,
Mikulincer and Shaver (2007) stressed the importance of early experiences in shaping the quality of adult romantic relationships,
and wrote about the formation of an attachment bond within couple relationships that reproduces attachment patterns with one's
parents. This bond is aimed to provide the individual with a sense of safety, security, and permanence and to deny the recognition
that people are essentially alone and will eventually die. As such, this bond places great demands and expectations on a
romantic partner and thus may cause relational tensions and conflicts.
Research in couple relationships stressed the link between relational entitlement and violence in romantic relationships. For
example, Wilson and Daly (1998, 2001) found that men who feel more entitled to their women's body were found to be more
violent. Entitlement was also found to be one of the explanations used by men to excuse their violence toward women (Wood,
2004). Similarly, Hannawa, Spitzberg, Wiering, and Teranishi (2006) linked entitlement to a sense of propriety, and viewed these
feelings as predictors of violent behavior toward a female partner. Hill and Fischer (2001) found that a general sense of
entitlement to a woman, and specifically a sense of entitlement to sexual intercourse, underlies rape-related attitudes and
behavior.
We witnessed a dramatic illustration of excessive male sense of relational entitlement during a court discussion in an Israeli
tribunal during 2005. In this discussion, a high-profile lawyer drafted a contract for his wife, demanding that “the couple shall have
sexual intercourse every evening and every morning, unless ‘Diane’1 is having her period. The sexual relations will be unlimited
and Diane will never express disagreement to having sexual intercourse and/or to fondling of some sort or another. Sexual
intercourse - in any sense, including turning a table (i.e., anal sex) … Diane will never claim David performed any ‘indecent act’
on her, and certainly not ‘by force’ … Diane shall sleep fully naked every night, save during her period days when she shall wear
panties only … shall take contraceptive pills regularly. Should Diane conceive for any reason whatsoever, she shall terminate the
pregnancy (abortion) immediately and without delay … Diane will never cut off phone calls with David and the mobile phone
David will give her shall always be charged and available.”
The Current Study

The current study describes the development of a self-report scale aimed at examining individual differences in a person's sense
of entitlement within romantic relationships, based upon the previous clinical and research findings of the three basic entitlement-
related attitudes: (a) attitudes of normal entitlement, (b) attitudes of excessive or exaggerated entitlement, and (c) attitudes of
restricted entitlement or nonentitlement. We examined the factor structure of this scale and its associations with other personality
and mental health constructs as well as marital satisfaction. We hypothesized that forms of inflated or restricted entitlement would
be associated with more emotional problems and less marital and life satisfaction. In addition, we examined the extent to which
the new self-report instrument assesses a unique psychological phenomenon (relational entitlement) or it is a mere reflection of
broader constructs of global entitlement(Campbell et al., 2004) or narcissism(Emmons, 1984).
We also examined the associations between relational entitlement and attachment style. In their pioneer study of adult
attachment, Hazan and Shaver (1987) found that young adults who endorsed different attachment styles (secure, avoidant,
anxious) in a self-report questionnaire experienced romantic relationships differently. These initial findings were replicated and
extended in subsequent studies (e.g., Mikulincer & Erev, 1991; Mikulincer & Nachshon, 1991; Tolmacz, Goldzweig, & Guttman,
2004). Attachment theory explains these attachment-related differences in relational experiences in terms of internal working
models—beliefs and expectations about the self and others (Mikulincer & Shaver, 2003, 2007). We believe that these working
models are also linked to a person's sense of entitlement. A person's bids for proximity and support—basic attachment behaviors
—implicitly imply “take care of me - I am entitled,” and the ways others respond to this appeal indicate to a person how entitled he
or she is. Therefore, when a person's attachment needs are not optimally met, attachment insecurities (anxiety, avoidance) can
be formed together with doubts concerning his or her sense of entitlement. For this reason, we hypothesized that attachment
insecurities would be associated with exaggerated and restricted forms of relational entitlement. In the current study, we want to
examine such a hypothesized association.
Study 1
The main goal of Study 1 was to develop a self-report scale to assess a person's sense of entitlement within romantic
relationships and to examine whether its factor structure is organized around attitudes of normal entitlement, attitudes of
excessive or exaggerated entitlement, and attitudes of restricted entitlement or nonentitlement. In Study 1, we also examined the
associations of this new scale with personality traits, mental health, and marital satisfaction.
Method
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Participants
There were 687 participants (254 men and 433 women ranging in age from 18 to 67, M = 29.47, SD = 10.28 (Median = 27). The
mean years of education of the participants was 12.43, SD = 2.86 (Median = 12). Most of the participants (65%) had a college
education. All the participants were currently involved in a romantic relationship (76%) or had been involved in such a relationship
in their past (22%). Fifty-six percent of the participants were single, 37% were married, and 7% were divorced. All the participants
volunteered to participate in the study without any monetary reward. However, they were promised feedback about themselves
on the well-established scales included in the packet.
Materials and Procedure
The questionnaires were administered to a large sample using a Hebrew-language Internet site (www.midgam.com) designed to
collect data for psychology studies. Participants register on the site, provide sociodemographic information, and receive an
individual code that allows investigators to avoid repetitive participation. The site calls for participants to respond to various self-
report scales in order to receive feedback about themselves and gain greater self-awareness. Participants are assumed to
respond frankly in order to receive reliable feedback on the well-established scales included in the packet.
Participants were told that the study concerned social attitudes, thoughts, and feelings and were asked to complete a battery of
self-report scales assessing the sense of relational entitlement, the Big Five higher-order personality traits, self-esteem,
attachment orientations, negative emotionality (stress, anxiety, depression), subjective well-being, life satisfaction, social anxiety,
loneliness, and marital satisfaction. These questionnaires were given in a random order across participants in order to avoid
systematic priming effects of one questionnaire on another. All the scales were not labeled in order to reduce potential problems
related to demand characteristics.
In order to assess variations in sense of relational entitlement, participants completed the Sense of Relational Entitlement (SRE)
scale—a 33-item scale assessing entitlement-related thoughts, feelings, and behaviors in romantic relationships that was
specially constructed for the current study. Participants were asked to read each item and to rate the extent to which each of
them was descriptive of their attitudes, feelings, beliefs, and reactions in romantic relationships. Ratings were done on a 7-point
scale, ranging from 1 (not at all) to 7 (very much). Items were derived from our theoretical conceptualization of the sense of
entitlement in romantic relationships and they were intended to capture the three theoretical patterns of entitlement we described
in the general introduction. Originally, we constructed 45 items tapping relational entitlement. However, based on a pilot study
with a sample of 250 Israeli adults (156 women and 94 men), ranging in age from 18 to 42 (Median = 24) only 33 items fitted the
inclusion criteria of factor analyses (factor loadings after Varimax rotation that were higher than .40 on one factor and lower than
.40 on the remaining four factors).
The well-known Big Five high-order personality traits—Openness to Experience, Conscientiousness, Agreeableness,
Extraversion, and Neuroticism (Costa & McCrae, 1992)—were assessed with a Hebrew version of the International Personality
Item Pool (IPIP; Goldberg, 1999). The IPIP is a 50-item measure with 10 items for each high-order trait. Although lower-level
facet measures were also developed for other IPIP scales, we did not examine them in this study because our focus was on the
five-factor level. Each item was assessed using a 5-point scale ranging from 1 (very inaccurate) to 5 (very accurate). Each factor
is scored such that higher numbers indicate greater quantities of the trait. The scores on these scales have relatively high
reliability and also have convergent validity with other measures of personality(Goldberg, 1999). In the current study, Cronbach
Alpha coefficients were acceptable: Extroversion, .87; Agreeableness, .82; Conscientiousness, .85; Neuroticism, .85; and
Openness to Experience, .79.
Self-esteem was assessed with a Hebrew version of Rosenberg's (1979) 10-item Self-Esteem Scale. Ratings were made on a 4-
point scale ranging from 1 (strongly disagree) to 4 (strongly agree). In our sample, Cronbach's alpha for the 10 items was high
(.87). We therefore averaged the items with higher scores indicating more positive self-esteem.
Attachment orientations were assessed with a Hebrew version of the Experiences in Close Relationships scale (ECR; Brennan,
Clark, and Shaver, 1998; Mikulincer & Florian, 2000). The ECR is a 36-item measure assessing the two major dimensions of
adult attachment style, attachmentanxiety (e.g., “I worry a lot about my relationships”) and attachment avoidant (e.g., “I don't feel
comfortable opening up to other people”). Participants rated the extent to which each item was descriptive of their feelings in
close relationships on a 7-point scale ranging from 1 (not at all) to 7 (very much). In the current sample, Cronbach's alphas were
high for the 18 anxiety items (.89) and the 18 avoidance items (.91). So, following the standard scoring procedure for the scale
(Brennan et al., 1998), two scores were computed by averaging items on each subscale.
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Negative emotionality was assessed with a Hebrew version of the 42-item Depression, Anxiety, and Stress Scales (DASS;
Lovibond & Lovibond, 1995). This scale is composed of 14 items assessing depression (e.g., dysphoria, hopelessness,
devaluation of life), 14 items assessing anxiety (e.g., autonomic arousal, situational anxiety, subjective experience of anxious
affect), and 14 items assessing stress (difficulty relaxing, nervous arousal, being easily upset/agitated, irritable/overreactive,
impatient). Participants were asked to rate the extent to which they have experienced each state over the past week in a 4-point
scale, ranging from 1 (not at all) to 4 (very frequently). Scores for depression, anxiety and stress were calculated by summing the
scores for the relevant items. In the current study, Cronbach Alphas were acceptable for the three scales and ranged from .79 to
.86.
Mood was assessed with a Hebrew version of the Positive and Negative Affect Schedule (PANAS) (Watson, Clark, & Tellegen,
1988). This is a 20-item measure describing different moods, and participants rated the extent to which each item accurately
described them on a 5-point scale, ranging from 1 (not at all) to 5 (very much). Ten items describe negative moods (worry,
troubled, angry) and 10 items describe positive moods (excited, proud, interested). In the current sample, Cronbach Alphas were
.88 for positive mood and .91 for negative mood. On this basis, responses to each subscale were averaged to form two global
indexes.
To assess life satisfaction, we used a Hebrew version of the 5-item Satisfaction with Life Scale (Diener, Emmons, Larsen, and
Griffin, 1985), which was developed to measure the cognitive component of global life satisfaction (Diener et al., 1985, pp. 71-
75). The scale consists of five items and uses a 5-point scale, ranging from 1 (not at all) to 5 (very much). In our sample,
Cronbach's alpha for the 5 items was high (.86). We therefore averaged the items, with higher scores indicating more life
satisfaction.
Social anxiety was assessed with a Hebrew version of the 30-item Social Interaction Self-Statement Test (Glass, Merlluzi, Bireve,
& Larsen, 1982), which taps the extent to which people view their social environment as threatening and a source of tension.
Each item presents a specific thought about social interactions and participants were instructed to rate how frequently they may
have experienced this thought before, during, and after social interactions. Answers were rated on a scale from 1 (hardly ever) to
5 (very often). In the current study, Cronbach's alpha for the 30 items was high (.92). We therefore averaged the items, with
higher scores indicating higher levels of social anxiety.
To measure loneliness, we used a Hebrew version of the 20-item R-UCLA scale (Russell, Peplau, and Cutrona, 1980), a
measure of loneliness and satisfaction with one's social connections. Participants rated the extent to which an item is self-
descriptive on a 4-point scale from 1 (not at all) to 4 (very much). In the current study, Cronbach's alpha for the 20 items was high
(.89). We therefore averaged the items, with higher scores indicating higher levels of loneliness.
Participants who were married at the time of the study also completed the Dyadic Adjustment Scale (DAS) (Spanier, 1976). The
DAS is a 32-item scale assessing quality of marital relationship. Participants were asked to indicate the extent of agreement or
disagreement in 15 areas (e.g., family finances, household tasks). They were asked to indicate how often they engaged in
behavior in seven areas (e.g., confiding in mate, quarreling with mate), how often they did things together, how recently they had
been too tired for sex, how happy the relationship was, and how they felt about the future of the relationship. Participants rated
the extent to which item was descriptive of their marital relationship on a 5-point scale from 1 (not at all) to 5 (very much). In the
current study, Cronbach's alpha for the 32 items was high (.87). We therefore averaged the items, with higher scores indicating
more satisfactory marital relations.

Factor Structure of the SRE Scale
In order to examine the factor structure of the sense of relational entitlement scale, we conducted a principal component factor
analysis with Varimax rotation. Although we constructed the SRE scale around three theoretical forms of entitlement, we first
conducted an exploratory rather than confirmatory factor analysis in order to assess whether there is more item variation than
can be explained by a three-factor solution. This analysis yielded five major factors (eigenvalue >1) that accounted for 55.6% of
the total variance (see Table 1 for items' wording and factor loading).
Factor 1 (31.7% of explained variance) included 10 items (loading > .40) assessing a person's tendencies to focus on negative
aspects of a romantic partner, to end a romantic relationship and search for other alternatives when a romantic partner does not
fit expectations, to devaluate a romantic partner and to mistrust and criticize him or her (e.g., “I'm often preoccupied with the
question if my partner is good enough for me”). We labeled this factor “vigilance on negative aspects of partner and relationship.”
Factor 2 (8.9%) included 9 items (loading > .40) assessing the strength of negative cognitive and
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Table 1 Factor Analysis of SRE Items (Study 1)
Factor loading
Note. Numbers within parentheses refer to the ordering of the items in the scale. Percentages within
parentheses refer to the amount of variance explained by A factor.
Vigilance of
negative aspects
of partner and
relationship
(31.7%)
I am possessed .79
with my partner's
faults (11)
I'm often .77
preoccupied with
the question if my
partner is good
enough for me (10)
Sometimes I .76
feel my partner is
not good enough
for me (13)
When my .75
partner frustrates
me, I contemplate
ending the
relationship (27)
When my .74
partner frustrates
me, I start thinking
about new
relationships (6)
I'm less tolerant .62
in my relationship
with my partner
than in daily life
(15)
Sometimes I get .60
very critical of my
partner (14)
When my partner .53
hurts me, I'm
immediately filled
with a sense of
distrust (12)
In my .51
relationship, I'm
sometimes filled
with rage that I
hardly ever
experience in daily
life (33)
I often feel I .50
deserve to get
more than I do in
my relationship
(31)
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Sensitivity to
relational
transgressions and
frustrations (8.9%)
When I'm not .70
getting what I
deserve from my
partner, I become
very tense (21)
When my .63
partner frustrates
me, I can't let it go
(24)
When I'm .62
frustrated with my
relationship, I
suffer a deep pain
(29)
When I'm .62
frustrated with my
relationship, I get
filled with rage (16)
When I'm .60
frustrated with my
relationship, I feel I
don't deserve it
(17)
When I feel .59
angry with my
partner, it's difficult
for me to calm
down (8)
It is very .59
important to me
that my partner
takes responsibility
when s/he hurts
me (20)
When my .57
partner fails to live
up to my
expectations, I feel
it isn't fair (9)
I'm very .52
sensitive to
expressions of
indifference from
my partner (4)
Assertive
entitlement (6.3%)
I won't make do .64
with less than what
I deserve in a
couple relationship
(7)
I insist on .63
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getting what I
deserve in my
relationship (30)
I am unable to .62
make
compromises in
choosing a partner
(19)
I think my .59
partner is lucky to
be with me (28)
I deserve to get .58
in my relationship
things I was
deprived in prior
relationships (25)
I deserve a .50
partner who is very
sensitive (18)
Expectations for
partner's attention
and understanding
(4.8%)
I have high .79
expectations of my
partner (2)
I can't give up .68
my expectations
from my partner in
a relationship (3)
I expect my .57
partner to
understand me
without having to
explain myself (1)
I expect my .56
partner to be very
attentive to me (5)
Restricted
Entitlement (4.2%)
I'm often .81
preoccupied with
the question if I
deserve my
partner (23)
Sometimes I .72
feel I am not good
enough for my
partner (32)
I feel my partner .66
deserves to get
more than s/he
does in our
relationship item
(26)
Sometimes I .52
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feel the couple
relationship is my
last chance of
getting the special
attention I deserve
(22)
Cronbach Alpha .89 .84 .83 .78 .76
Coefficients
Cronbach Alphas for the five extracted factors ranged from .76 to .89. Cronbach Alpha for all the 33 SRE items was also high
(.86). On this basis, we computed five scores for each participant by averaging items that loaded high on a factor as well as a
total SRE score by averaging the 33 items.
These five factors seem to tap the three forms of entitlement noted by Levin (1970), Kriegman (1983), and Moses and Moses
(1990). Three factors seem to tap different aspects of inflated forms of entitlement: (a) vigilance on negative aspects of partner
and relationship, (b) sensitivity to relational transgressions and frustrations, and (c) expectations for partners' attention and
understanding. High scores on these factors indicate that a person expects that a partner would take care of his or her needs and
wishes and is highly sensitive and responsive to a partner's transgressions of such expectations. This way of relating implies an
inflated sense of entitlement, by which people pose excessive and unrealistic demands to a partner and express intense rage
every time a partner does not behave according to these demands. The restricted entitlement factor seems to tap a restricted
form of entitlement or no-entitlement, whereas the assertive entitlement factor seems to tap an uncompromising attitude about
getting what one feels one deserves.
In order to examine whether the three theoretical forms of entitlement underlie the five extracted factors and whether the SRE
items tap a single construct of relational entitlement, we made several analytical steps. First, the Cronbach Alpha coefficient for
the 33 items was .93, implying high internal consistency of the entire pool of items. Second, we computed Pearson correlations
between the five factors. As can be seen in Table 2, the intercorrelations between the three factors representing an inflated sense
of entitlement (vigilance on negative aspects of partner and relationship, sensitivity to relational transgressions, and expectations
for partners' attention) were significant and ranged from .41 to .49. Moreover, although these three factors showed a positive
association with assertive entitlement or restricted entitlement, the strength of the correlations was notably weak (ranging from
.16 to .23). The correlation between assertive entitlement and restricted entitlement was also significant but weak in strength
(.19).
Third, we conducted a second-order factor analysis of the five SRE factors. This analysis yielded three major factors (eigenvalue
>1) that accounted for 72.8% of the total variance and represented the three theoretical forms of entitlement. The first factor
(49.4% of explained variance) included (loadings > .40) the three factors representing an inflated
Table 2 Pearson Correlations Between the Five SRE Factors
Factors 1 2 3 4
*p < .001.
1. Vigilance on
negative aspects of
partner and
relationship
2. Sensitivity to .49*
relational
transgressions and
frustrations
3. Assertive .21* .18*
entitlement
4. Expectations for .44* .41* .16*
partner's attention
and understanding
5. Restricted .19* .22* .19* .23*
entitlement
These findings have two main implications. First, the finding that the 33 SRE items showed high internal consistency implies that
all these items tap a global construct of relational entitlement. Second, the pattern of interfactor correlations and the second-order
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factor analysis revealed that the five SRE factors can be organized around three forms of entitlement—inflated, assertive, and
restricted. However, due to the moderate correlations between the three factors composing the inflated entitlement construct
(ranging from .41 to .49), we decided to conduct further statistical analyses on each of these three factors separately. This
decision was further supported by a CFA testing the fit of a three-factor model to the 33 SRE items. The findings clearly showed
that the three-factor solution fit poorly (CFI = .74, NNFI = .71, RMSEA = .079), indicating that there is more item variation than
can be explained by a three-factor structure. Importantly, findings from statistical analyses conducted on a composite score of
vigilance on negative aspects of partner and relationship, sensitivity to relational transgressions, and expectations for partners'
attention were quite identical to the findings reported here.
Sociodemographic Differences
One-way ANOVAs were performed examining gender differences in the five SRE scores. These analyses indicated that gender
differences were significant in three of the five SRE factors as well as in the total SRE score (see Fs in Table 3). As can be seen
in Table 3, women scored higher than men in vigilance on negative aspects of partner and relationship,
Table 3 Means, SDs, and F-Ratios of SRE Factors According to Gender
Men Women
*p < .001.
Vigilance on 3.40 1.40 3.75 1.43 7.61
negative aspects
of partner and
relationship
Sensitivity to 4.21 1.35 4.93 1.18 43.09*
relational
transgressions and
frustrations
Assertive 4.40 1.22 4.93 1.08 28.77*
entitlement
Expectations for 5.31 1.09 5.42 0.97 1.56
partner's attention
and understanding
Restricted 3.54 1.36 3.23 1.51 6.09
entitlement
Total SRE score 4.05 1.04 4.42 0.95 18.38*
Marital status was not significantly associated with any of the five SRE factors. However, age was significantly associated with
sensitivity to relational transgressions and frustrations, r(685) = -.11, p < .01, expectations for partners' attention and
understanding, r(685) = -.13, p < .01, and restricted entitlement, r(685) = -.17, p < .01, with older adults exhibiting less inflated or
restricted forms of relational entitlement than younger adults. This finding may imply that these forms of entitlement are more
relevant for younger adults. Alternatively, it is possible that as couple partners get older, they come to accept each other's faults
and become more realistic about what they can and cannot expect. In addition, this finding may reflect the fact that the majority of
participants in the current sample were young adults or that the SRE scale's items are less relevant to older adults' relational
experiences. Further research should examine more in-depth the observed association between age and sense of relational
entitlement.
Psychological Correlates of the Sense of Relational Entitlement
Table 4 presents Pearson correlations between the five SRE scores and the Big Five high-order personality traits. The total SRE
score as well as four SRE factors—vigilance on negative aspects of partner and relationship, sensitivity to relational
transgressions and frustrations, expectations for partners' attention and understanding, and restricted entitlement—were
associated with higher neuroticism and lower levels of conscientiousness and agreeableness. In addition, restricted entitlement
showed an inverse association with extraversion. Assertive entitlement was only significantly associated with higher
conscientiousness (see Table 4).
Table 4 Pearson Correlations Between SRE Factors and Other Scales (Study 1)
Measure Vigilance Sensitivity Assertive Expectation Restricted Total

entitlement entitlement SRE
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score
*p < .001.
Big-Five Personality
traits
Neuroticism .44* .43* -.02 .22* .33* .35*
Extraversion -.09 -.03 .12 -.02 -.30* -.03
Openness -.07 -.08 -.04 -.01 .02 -.05
Conscientiousness -.24* -.27* .28* -.23* -.24* -.24*
Agreeableness -.41* -.46* -.06 -.31* -.24* -.35*
Self-esteem -.26* -.27* .20* -.02 -.46* -.28*
Attachment anxiety .32* .36* .02 .26* .55* .39*
Attachment .19* .03 -.03 -.02 .26* .19*
avoidance
Negative mood .37* .38* .04 .17* .43* .41*
Positive mood -.38* -.28* -.03 -.21* -.31* -.36*
Stress .44* .44* .06 .32* .34* .42*
Depression .42* .39* .03 .25* .42* .42*
Anxiety .41* .31* .09 .26* .39* .40*
Loneliness .28* .27* .04 .26* .45* .36*
Social anxiety .37* .47* .06 .28* .63* .44*
Life satisfaction -.33* -.20* -.03 -.05 -.30* -.31*
Marital adjustment -.59* -.35* -.02 -.08 -.21* -.43*
As can be seen in Table 4, the total SRE score as well as three SRE factors—vigilance on negative aspects of partner and
relationship, sensitivity to relational transgressions and frustrations, and restricted entitlement—were significantly associated with
lower levels of self-esteem. Assertive entitlement was significantly associated with higher self-esteem. Attachment orientations
were also significantly associated with the SRE scores. The total SRE score was significantly associated with more attachment
insecurities, either anxious or avoidant. Vigilance on negative aspects of partner and relationship and restricted entitlement were
also associated with higher scores on both anxious and avoidant attachment. Sensitivity to relational transgressions and
frustrations and expectations for partners' attention and understanding were associated with more anxious attachment, but not
avoidant attachment. Assertive entitlement was not significantly associated with either attachmentanxiety or avoidance.
The total SRE score as well as four SRE factors—(a) vigilance on negative aspects of partner and relationship, (b) sensitivity to
relational transgressions and frustrations, (c) expectations for partners' attention and understanding, and (d) restricted entitlement
—were significantly associated with more negative mood and less positive mood in the PANAS and higher levels of stress,
depression, anxiety, loneliness, and social anxiety. The total SRE scores as well as three SRE factors—(a) vigilance on negative
aspects of partner and relationship, (b) sensitivity to relational transgressions and frustrations, and (c) restricted entitlement—
were also significantly associated with lower levels of life satisfaction. No significant associations were found between assertive
entitlement and these psychological constructs.
Marital Adjustment and the Sense of Relational Entitlement
As can be seen in Table 4, the total SRE score and three SRE factors—vigilance on negative aspects of partner and relationship,
sensitivity to relational transgressions and frustrations, and restricted entitlement—were significantly associated with lower levels
of marital adjustment (DAS score). Since previous studies have shown that neuroticism and attachment orientations are strong
personality predictors of marital satisfaction and stability (Karney & Bradbury, 1997; Mikulincer & Shaver, 2007), we wanted to
examine to incremental validity of the SRE scores for predicting marital adjustment. For this purpose, we conducted a multiple
regression analysis in which we entered neuroticism, attachmentanxiety, attachment avoidance, and the five SRE scores as
predictors of the DAS score. In this way, we examined the unique contribution of SRE scores to marital adjustment after
statistically controlling for neuroticism and attachment orientations. Findings revealed that, even after neuroticism and attachment
orientations were controlled for, two of the SRE scores—(a) vigilance on negative aspects of partner and (b) relationship and
restricted entitlement—still made a unique contribution to marital adjustment, βs of -.43 and -.25, ps < .001.
Conclusions
The findings reveal a significant association between problematic aspects of the sense of relational entitlement (whether an
inflated or restricted sense of relational entitlement) and several of signs of maladaptive psychological functioning, such as
neuroticism, low self-esteem, insecure attachment orientations, negative mood, feelings of stress, depression, loneliness, social
anxiety, and lack of life satisfaction. Findings also reveal associations between assertive sense of relational entitlement (what we
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viewed as a more adaptive component of this sense) and more adaptive psychological functioning—relatively high scores on
conscientiousness, self-esteem and secure attachment. However, it did not correlate with less depression or anxiety or with
better quality of marriage. In addition, the associations between the different aspects of the sense of relational entitlement and
attachment insecurities suggest that the individual variations in this sense have to do with the quality of emotional bonds with
attachment figures, beginning in infancy, and the extent to which these figures are a source of safe haven and secure base.
Study 2
Study 2 further examined the convergent, discriminant, and construct validity of the SRE scale by assessing associations
between the SRE scores and scales tapping narcissism, global sense of entitlement, and attachment orientations. In this study,
participants completed the SRE scale together with the Narcissistic Personality Inventory (Raskin & Terry, 1988), the
Psychological Entitlement Scale (PES, Campbell, Bonacci, Shelton, Exline, & Bushman, 2004), and the ECR scale (Brennan et
al., 1998) tapping attachmentanxiety and avoidance.
Method
Participants
The sample included 182 Israeli undergraduates (73 men and 109 women, ranging in age from 18 to 32, Median = 24) who
volunteered to participate in the study without any monetary reward. The mean education years of the participants was 13.98, SD
= 2.04 (Median = 14). All the participants were currently involved in a romantic relationship (62%) or were involved in such a
relationship in their past (38%). Seventy-one percent of the participants were single and the remaining participants were married.
Materials and Procedure
Participants completed the battery of self-report scales in small groups of 5-15 participants. The order of the questionnaires was
randomized across participants.
Participants completed the 33-item SRE scale described in Study 1. In Study 2, Cronbach Alphas for the five SRE factors ranged
from .74 to .91. Cronbach Alpha for the 33 SRE items was .88. On this basis, we computed a total SRE score by averaging the
33 items and five factor scores by averaging items that belonged to each factor. Participants also completed the ECR scale
described in Study 1. In Study 2, Cronbach Alphas were .85 for attachmentanxiety and .88 for attachment avoidance.
Narcissism was assessed with a Hebrew version of the 40-item Narcissistic Personality Inventory (NPI, Raskin & Terry, 1988).
The NPI consists of 40 forced choice items, which were constructed to assess the DSM—III(APA, 1980) description of narcissistic
personality disorder in nonclinical adult samples (Raskin & Hall, 1979). Each item consists of two statements, with participants
asked to choose the statement in the dyad that best describe themselves. Raskin and Terry (1988) found that the NPI consists of
seven different factors: (a) authority, (b) self-sufficiency, (c) superiority, (d) exhibitionism, (e) exploitativeness, (f) vanity, and (g)
entitlement. In the current study, Cronbach Alphas were acceptable for the seven factors and ranged from .72 to .86. On this
basis, we computed seven scores for each participant by averaging answers to items that belong to each factor. We also
computed a total narcissism score by averaging the 40 NPI items (Cronbach's alpha = .92), with higher scores reflecting higher
narcissism.
The global sense of entitlement was assessed with a Hebrew version of the 7-items Psychological Entitlement Scale (PES,
Campbell et al., 2004). Participants were instructed to rate the extent to which each item reflects their own beliefs, using a 7-point
scale, ranging from 1 (strong disagreement) to 7 (strong agreement). Sample items are “Great things should come from me”,
“Things should go my way”, and “I feel entitled to more of everything.” In the current sample, Cronbach Alpha was .92 for the 9
items. On this basis, we computed a total PES score by averaging the nine items.

As can be seen in Table 5, the total SRE score as well as four SRE factors—vigilance on negative aspects of partner and
relationship, sensitivity to relational transgressions and frustrations, expectations for partners' attention and understanding, and
assertive entitlement—showed positive but small correlations with the total PES score and the NPI entitlement score. However,
all these SRE scores were not significantly associated with the total NPI score and other NPI subscales. Assertive entitlement
was significantly associated with higher scores in the total NPI score and the exhibitionism, superiority, self-sufficiency, and vanity
NPI factors. Restricted entitlement was not significantly associated with the NPI and PES scores.
The associations between the SRE scores and attachment orientations replicated Study 1's findings. The total SRE score as well
as two SRE factors—vigilance on negative aspects of partner and relationship and restricted entitlement—were associated with
higher scores on both anxious and avoidant attachment. Sensitivity to relational transgressions and frustrations and expectations
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for partners' attention and understanding were only associated with more anxious attachment. Assertive entitlement was not
significantly associated with either attachmentanxiety or avoidance.
Overall, the findings suggest that the SRE and NPI scales tap related but not overlapping constructs, while extending Campbell
et al.'s (2004) findings that a sense of
Table 5 Pearson Correlations Between SRE Factors and Other Scales (Study 2)
Measure Vigilance Sensitivity Assertive Expectation Restricted Total

entitlement entitlement SRE
score
*p < .001.
NPI
Total score .04 .03 .27* .05 .13 .06
Authority .05 .14 .09 .05 .12 .10
Exhibitionism .07 .01 .24* .16 .05 .09
Superiority .11 .07 .22* .03 .09 .12
Entitlement .23* .20* .21* .24* .01 .23*
Exploitativeness .01 .05 .06 .03 .02 .04
Self-sufficiency .10 .13 .23* .01 .14 .13
Vanity .05 .06 .25* .08 .09 .10
PES score .24* .34* .31* .29* -.11 .28*
ECR
Anxiety .47* .51* .09 .23* .49* .48*
Avoidance .26* .09 -.10 -.09 .20* .24*
General Discussion
Based on clinical evidence and a number of theoretical perspectives that pointed to the importance and uniqueness of the sense
of entitlement in couple relations, the current studies were designed to develop the SRE scale as a valid measure of this
construct. With this goal in mind, we constructed 33 items based on clinical sources, psychoanalytic theories, and social
exchange theory. A factor analysis performed on these items yielded five factors that touch on the whole spectrum of entitlement-
related attitudes toward a romantic partner. Whereas factors dealing with vigilance on negative aspects of partner and
relationship, sensitivity to relational transgressions and frustrations, and expectations for partners' attention and understanding
expresses exaggerated (or inflated) sense of relational entitlement, the assertive entitlement factor seems to express what we
can regard as healthy sense of entitlement, and the restricted entitlement factor expresses limited sense of entitlement. These
three kinds of a sense of entitlement match previous theoretical writings. For example, Levin (1970) described three quantitative
entitlement categories: (a) normal entitlement, (b) excessive entitlement, and (c) restricted entitlement. Similarly, Kriegman (1983)
referred to three types of entitlement: (a) normal, (b) exaggerated, and (c) nonentitlement, and Moses and Moses (1990) view the
sense of entitlement as existing in three different modes: (a) an adequate sense of entitlement, (b) an excessive sense of
entitlement, and (c) a sense of entitlement which is not usually within a person's awareness.
Findings also indicate that both exaggerated and restricted forms of relational entitlement seem to be maladaptive and put people
at risk for emotional problems. For example, both inflated and restricted senses of entitlement are associated with poor self-
esteem, signs of emotional reactivity and instability, as manifested in neuroticism, negative mood, distress, depression,
loneliness, social anxiety, and lack of life satisfaction. It is possible that excessive and restrictive types of entitlement may have
grim interpersonal consequences and thus may by themselves contribute to the development of these emotional problems.
However, since our studies are cross-sectional, we can alternatively propose that poor self-esteem and emotional problems can
lead people to either restrict their sense of entitlement or exaggerate their demands and expectations from a romantic partner
that should heal their wounds. Further prospective research should examine the direction of causality of the link between
exaggerated and restricted forms of relational entitlement, on the one hand, and emotional problems, on the other.
The SRE factor of assertive entitlement seems to represent a more adequate sense of entitlement, thereby not putting people at
risk for emotional and interpersonal problems. Fitting this reasoning, the findings indicated that this factor was not significantly
associated with measures of emotional problems and relational distress. However, with the exception of a positive correlation
with self-esteem, this factor was not positively related to other measures of psychological functioning and adjustment, such as
positive mood, life satisfaction, and marital adjustment. It is possible that although assertive entitlement does not entail a risk
factor for emotional problems, it does not contribute to improved functioning and adjustment. Alternatively, we might have failed
to assess the specific facets of functioning and adjustment that assertive entitlement can contribute, such as assertiveness,
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social power, or control. Further studies should further examine the psychological correlates and outcomes of a sense of
assertive entitlement in close relationships.
One of the core questions of the current study dealt with the extent to which the sense of entitlement in couple relationships taps
a unique psychological phenomenon or it is a mere reflection of a more global psychological construct, such as narcissism or
global sense of entitlement. The findings suggest that although the sense of entitlement in couple relationships (as measured by
the SRE factors) was significantly associated with narcissism (as measured by the NPI) and global entitlement (as measured by
the PSE), the correlations were only moderate. That is, fitting Kriegman's (1983) and Moses and Moses' (1990) ideas, the SRE
scale seems to tap some unique psychological construct that moderately overlaps with constructs of narcissism and global
entitlement. Moreover, the findings support our assumption that many entitlement issues are uniquely expressed in romantic
relationships, since these dyadic relationships are characterized by high levels of intimacy, passion, and commitment (Sternberg,
1986), which naturally generate entitlement-related wishes, needs, and expectations of the sort we would not expect in other life
contexts. However, the current study should be viewed as an initial investigation of the associations between relational
entitlement and narcissism. Further research should provide more systematic evidence on the incremental validity of relational
entitlement beyond and above the contribution of narcissism to relational cognitions, behaviors, and quality.
Our findings also indicated that attachment insecurities were significantly associated with excessive and restricted forms of
relational entitlement. In the case of excessive sense of entitlement, vigilance on negative aspects of the partner and relationship,
sensitivity to relational transgressions, and expectation for partner's attention were associated with anxious attachment, which
reflect a hyperactivation of attachment wishes, needs, and fears (Mikulincer & Shaver, 2007). Thus, inflated entitlement demands
may reflect the same frustration and dissatisfaction with relationship partners that lead to anxious attachment. As such, the partial
and unsystematic recognition of one's entitlement by others may be one particular aspect of close relationships that is
internalized into negative working models of the self and contribute to both anxious attachment and exaggerated entitlement in
romantic relationships.
The fact that restricted sense of entitlement was associated with attachment insecurities (either anxious or avoidant) was not
surprising. Individuals who have a sense of restricted entitlement behave in a particularly modest, bashful, cautious, and
introverted manner—as if doubting their right to express their needs and receive attention that others take for granted. According
to Kriegman (1983), this as an expression of worthlessness, incompatibility, and defectiveness that may emanate from others'
disapproval, criticism, and rejection. The lack of recognition of one's entitlement by relationship partners may be internalized into
negative working models of the self and contribute to both attachment insecurities and restricted entitlement-related demands
and concerns in romantic relationships.
Of interest, our findings revealed that one aspect of excessive entitlement—vigilance on negative aspects of the partner and
relationship—was also associated, though moderately, with avoidant attachment. It is possible that avoidant people's negative
models of others (e.g., Bartholomew & Horowitz, 1991) are directly manifested in active monitoring and search for negative traits
and behaviors of their romantic partner. Alternatively, this kind of vigilance may serve as a post hoc “justification” for adopting an
avoidant orientation: finding again and again serious flaws in the partner or relationship can justify relational avoidance.
The current findings suggest that Bowlby's (1979) distinction between sensitive caregiving and compulsive caregiving is highly
relevant to the development of the sense of entitlement in romantic relationship. According to Bowlby (1979), although these two
forms of caregiving reflect an approach attitude toward the needs of a suffering other, they seem to be activated by two different
motives. While sensitive caregiving may be associated with a motive to care for the other without negating or ignoring oneself,
compulsive caregiving may be a strategy to maintain proximity while suppressing one's attachment needs and feelings. In
Bowlby's view, “the typical childhood experience of such people is to have a mother who, due to depression or some other
disability, was unable to care for the child but, instead, welcomed being cared for and perhaps also demanded help” (p. 207).
From this description, compulsive caregiving seems to be a result of insecure attachment during childhood and an expression of
an anxious parental attitude during adulthood. We assume that this anxious parental attitude may be related to offspring's
difficulties in developing a healthy and balanced sense of entitlement in romantic relationships. However, one should take into
account that current findings indicate that relational entitlement was associated with attachment insecurities in adulthood but not
with actual experiences of parental caregiving in childhood. Further developmental, longitudinal research should be conducted
examining actual experiences of parental caregiving in childhood and relational entitlement in adulthood.
Before ending this discussion, it is important to make clear that the studies reported here represent only an initial examination of
the validity of the SRE scale. First of all, the current studies were conducted with Israeli young adults. Further studies should
attempt to examine the replicability and generalizability of the findings to other age, cultural, ethnic, and religious groups. Future
research should also examine the associations of the SRE scale with projective tests and partner's evaluation of participants'
sense of entitlement. Future research can also examine the contribution of the sense of relational entitlement to dyadic
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interactions in real-life settings and daily romantic partner's relational appraisals and behaviors. Research can also examine the
associations between the sense of relational entitlement of both members of a couple and the stability of their sense of relational
entitlement over time and along different phases of their shared life (e.g., during pregnancy, prolonged illness).
Footnotes
1
Names of persons have been changed to protect confidentiality.
References
1
American Psychiatric Association (1980). Diagnostic & statistical manual of mental disorders (3rd. ed.). Washington DC: Author
.
2
Bartholomew , K. , & Horowitz , L. M. (1991). Attachment styles among young adults: A test of our category model. Journal of
Personality and Social Psychology, 61 , 226-244.
3
Bergmann , M. S. (1987). The anatomy of loving. New York, NY: Ballantine Books .
4
Billow , R. M. (1999a). An intersubjective approach to entitlement. Psychoanalytic Quarterly, LXVIII , 441-461.
(PAQ.068.0441A)
5
Billow , R. M. (1999b). Power and entitlement: Or, mine versus yours. Contemporary Psychoanalysis, 35 , 473-489.
(CPS.035.0473A)
6 Blechner , M. J. (1987). Entitlement and narcissism: Paradise sought. Contemporary Psychoanalysis, 23 , 244-255.
(CPS.023.0244A)
7
Bowlby , J. (1979). The making and breaking of affectional bonds. London, U.K.: Tavistock Publications .
8
Brennan , K. A. , Clark , C. L. , & Shaver , P. R. (1998). Self report measurements of adult attachment: An integrative overview.
In J. A. Simpson & W. S. Rholes (Eds.), Attachment theory in close relationships (pp. 46-76). New York, NY: Guilford Press .
9 Campbell , W. K. , Bonacci , A. M. , Shelton , J. , Exline , J. J. , & Bushman , B. J. (2004). Psychological entitlement:

Interpersonal consequences and validation of a self report measure. Journal of Personality Assessment, 83 , 29-45.
10
Chodorow , N. J. (1989). Feminism and psychoanalytic theory. New Haven, CT: Yale University Press .
11
Costa , P. T. , Jr., & McCrae , R. R. (1992). Normal personality assessment in clinical practice: The NEO personality inventory.
Psychological Assessment, 4 , 5-13.
12
Diener , E. , Emmons , R. A. , Larsen , R. J. , & Griffin , S. (1985). The satisfaction with life scale. Journal of Personality
Assessment, 49 , 71-75.
13
Eichenbaum , L. , & Orbach , S. (1984). Understanding women: A feminist psychoanalytic approach. New York, NY: Basic
Books .
14
Emmons , R. A. (1984). Factor analysis and construct validity of the narcissistic empirical evidence. Journal of Personality and
Social Psychology, 60 , 53-78.
15
Freud , S. (1963). Some character types met with in psychoanalytic work. In J. Strachey (Ed. and Trans.), The standard
edition of the complete psychological works of Sigmund Freud (Vol. 14 , pp. 311-333). London, U.K.: Hogarth Press . (Original
work published 1916 )
16
Glass , C. R. , Merluzzi , T. V. , Biever , J. L. , & Larsen , K. H. (1982). Cognitive assessment of social anxiety: Development
and validation of a self-statement questionnaire. Cognitive Therapy and Research, 6 , 37-55.
17
Goldberg , L. R. (1999). A broad-bandwith, public-domain, personality inventory measuring the lower-level facets of several
Five-Factor models. In I. Mervielde , I. J. Deary , F. de Fruyt , & F. Ostendorf (Eds.), Personality Psychology in Europe (Vol. 7 ,
pp. 7-28). Tilburg, Netherlands: Tilburg University Press .
18 Hannawa , F. A. , Spitzberg , B. H. , Wiering , L. , & Teranishi , C. (2006). “If I can't have you, no one can”: Development of a
relational entitlement and proprietariness scale (REPS). Violence & Victims, 21 , 539-560.
2/6/2018 EBSCOhost
19
Hazan , C. , & Shaver , P. R. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and
Social Psychology, 52 , 511-524.
20
Hill , M. S. , & Fischer , A. R. (2001). Does entitlement mediate the link between masculinity and rape-related variables?
Journal of Counselling Psychology, Vol, 48 , 39-50.
21
Horney , K. (1950). Neurosis and human growth: The struggle toward self-realization. New York, NY: Harper .
22
Jacobson , E. (1959). The “exceptions”: An elaboration of Freud's character study. The Psychoanalytic Study of the Child, 14 ,
135-154. (PSC.014.0135A)
23
Karney , B. R. , & Bradbury , T. N. (1997). Neuroticism, marital interaction, and the trajectory of marital satisfaction. Journal of
Personality and Social Psychology, 72 , 1075-1092.
24
Kriegman , G. (1983). Entitlement attitudes: Psychosocial and therapeutic implications. Journal of the American Academy of
Psychoanalysis, 11 , 265-281. (JAA.011.0265A)
25
Levin , S. (1970). On the psychoanalysis of attitudes of entitlement. Bulletin of the Philadelphia Association for
Psychoanalysis, 20 , 1-10.
26
Lovibond , P. F. , & Lovibond , S. H. (1995). The structure of negative emotional states: comparison of the depression anxiety
stress scales (DASS) with the beck depression and anxiety inventories. Behaviour Research & Therapy, 33 , 335-343.
27
Mayer , W. (1991). A case of restricted entitlement. Clinical Social Work Journal, 19 , 223-235.
28
Mikulincer , M. , & Erev , I. (1991). Attachment styles and the structure of romantic love. British Journal of Social Psychology,
30 , 273-291.
29
Mikulincer , M. , & Florian , V. (2000). Exploring individual differences in reactions to mortality salience: Does attachment style
regulate terror management mechanisms? Journal of Personality and Social Psychology, 79 , 260-273.
30
Mikulincer , M. , & Nachshon , O. (1991). Attachment styles and patterns of self disclosure. Journal of Personality and Social
Psychology, 61 , 321-331.
31
Mikulincer , M. , & Shaver , P. R. (2003). The attachment behavioral system in adulthood: Activation, psychodynamics and
interpersonal processes. In M. P. Zanna (Ed.), Advances in Experimental Psychology (Vol. 35 , pp. 53-152). New York, NY:
Academic Press .
32
Mikulincer , M. , & Shaver , P. R. (2007). Attachment in adulthood: Structure, dynamics and change. New York, NY: Guilford
Press .
33
Miller , A. (1979). The drama of the gifted child. New York, NY: Basic Books . (IJP.060.0047A)
34
Moses , R. , & Moses-Hrushovski , R. (1990). Reflections on the sense of entitlement. The Psychoanalytic Study of the Child,
45 , 61-78. (PSC.045.0061A)
35
Nadkarni , L. , & Malone , J. A. (1989, March). The development of a self report inventory to measure personal entitlement.
Paper presented at the meeting of the Eastern Psychological Association, Boston, MA.
36
Person , E. S. (1989). Dreams of love and fateful encounters: The power of romantic passion. London, U.K.: Penguin .
(APA.039S.0383A)
37
Raskin , R. , & Hall , C. S. (1979). A narcissistic personality inventory. Psychological Reports, 45 , 590.
38 Raskin , R. , & Terry , H. (1988). A principal-components analysis of the narcissistic personality inventory and further evidence
of its construct validity. Journal of Personality and Social Psychology, 54 , 890-902.
39
Rosenberg , M. (1979). Conceiving the self. New York: Basic Books .
40
Russell , D. , Peplau , L. A. , & Cutrona , C. E. (1980). The revised UCLA loneliness scale: concurrent and discriminative
validity evidence. Journal of Personality and Social Psychology, 39 , 472-480.
2/6/2018 EBSCOhost
41
Sanchez , L. , & Gager , C. T. (2000). Hard living, perceived entitlement to a great marriage, and marital dissolution. Journal of
Marriage and the Family, 62 , 708-722.
42
Spanier , G. B. (1976). Measuring dyadic adjustment. New scales for assessing the quality of marriage and similar dyads.
Journal of Marriage and the Family, 38 , 15-28.
43
Shabad , P. (1993). Resentment, indignation, entitlement: The transformation of unconscious wish into need. Psychoanalytic
Dialogues, 3 , 481-494. (PD.003.0481A)
44
Solomon , I. , & Leven , S. (1975). Entitlement. Psychotherapy: Theory, Research, and Practice, 12 , 280-285.
45
Sternberg , R. J. (1986). A triangular theory of love. Psychological Review, 93 , 119-135. (PPSY.003.0001A)
46
Tolmacz , R. , Goldzweig , G. , & Guttman , R. (2004). Attachment styles and the ideal image of a mate. European
Psychologist, 9 , 87-95.
47
Watson , D. , Clark , L. A. , & Tellegen , A. (1988). Development and validation of brief measures of positive and negative
affect: The PANAS scales. Journal of Personality and Social Psychology, 54 , 63-70.
48
Wilson , M. , & Daly , M. (1998). Lethal and nonlethal violence against wives and the evolutionary psychology of male sexual
proprietariness. In R. E. Dobash & R. P. Dobash (Eds.), Rethinking Violence Against Women (pp. 199-230). Thousand Oaks, CA:
Sage .
49
Wilson , M. , & Daly , M. (2001). The evolutionary psychology of couple conflict in registered versus de facto marital unions. In
A. Booth , A. C. Crouter , & M. Clements (Eds.), Couples in Conflict (pp. 3-26). Mahwa, NJ: Erlbaum .
50
Wood , J. T. (2004). Monsters and victims: Male felons' accounts of intimate partner violence. Journal of Social and Personal
Relationships, 21 , 555-576.
Psychoanalytic Psychology, 2011; v.28 (1), p75 (20pp.)
PPSY.028.0075A
Record: 14
Title: Separated Attachments and Sexual Aliveness: How Changing Attachment Patterns Can
Enhance Intimacy
Authors: Orbach, Susie
(1), p8, 10p
Language: English
Abstract: This paper explores a common dilemma with couples: the disappearance of an active
sexual relationship. Orbach shows how difficulties with merged or avoidant attachments
that create implosion can be transformed in the couple relationship to enable a sufficiently
separated attachment that allows for sustainable intimacy. The couple is encouraged to
use the relationship as a joint psychological space, a third. This joint space takes on the
psychic task of providing a secure enough platform to enable them to then individually
attain a felt sense of separateness. In this way the tension between their commitment and
their distinctiveness is managed and provides a base from which they can re-engage and
sustain intimacy.
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direct=true&db=pph&AN=AJRPP.001.0008A&site=ehost-live&scope=site">Separated
Attachments and Sexual Aliveness: How Changing Attachment Patterns Can Enhance
Intimacy</A>
Separated Attachments and Sexual Aliveness: How Changing Attachment Patterns Can Enhance
Intimacy1
Susie Orbach, author, Co-founder of The Women's Therapy Centre and The Women's Therapy Centre Institute in New York. She
is visiting Professor at the London School of Economics, and an associate member of the Society of Couple Psychoanalytic
Psychotherapists. She is the author of many papers and books on couple relationships. Correspondence: 2 Lancaster Drive,
London NW3 4HA. E-mail: susieorbach@blueyonder.co.uk.
This paper explores a common dilemma with couples: the disappearance of an active sexual relationship. Orbach shows how
difficulties with merged or avoidant attachments that create implosion can be transformed in the couple relationship to enable a
sufficiently separated attachment that allows for sustainable intimacy. The couple is encouraged to use the relationship as a joint
psychological space, a third. This joint space takes on the psychic task of providing a secure enough platform to enable them to
then individually attain a felt sense of separateness. In this way the tension between their commitment and their distinctiveness is
managed and provides a base from which they can re-engage and sustain intimacy.
We meet couples in difficulty. These were not always couples in difficulty but couples who were once sexually vibrant, engaged,
enthusiastic partners who were eager to be closer and closer and to find themselves through their attachment to one another.
The exquisite tuning that allowed the individuals in a couple to sense each other's strengths is matched by an equally exquisite
sensitivity to the other's attachment patterns. In getting to know one another, each person finds out about past loved ones, the
nature of those previous relationships and what went wrong and what went right. Quite unselfconsciously, they are each
acquiring the emotional information that will in part enable them to solidify their choice of life partner. They listen carefully to hear
what was problematic about the previous partner as they build knowledge about attachment patterns, defences, how
disappointment or betrayal are dealt with, as well as, of course, discovering the nature of the attachment bonds in each of the
individual familial relationships.
Love is much about finding psychological fits: fits that work and enhance each individual and fits - particularly the fits we
encounter as couple psychotherapists - that enact and confirm some of the most unwanted sense of selves that make
relationships sites of disappointment. People seek loving partnerships, but the click of connection can reside in the unconscious
patterns of relating experienced in one's first attachments, now echoed in the couple relationship. To put this starkly, for those
couples we encounter whose relationship has turned violent, we often discover an equation of love and attachment linked with an
ambience of violence in the early parent-child relationship. Violence, we come to understand, for those individuals can feel as
though it belongs, is almost an essential feature of the attachment. The relationship may even be experienced as lacking intensity
without it. Similarly, children who grow up in apparently sexless marriages can feel there is something ‘right’ at the feeling level of
that emotional tableau. They do not, in the marrow of who they experience themselves to be, easily imagine themselves in a
sustaining sexual relationship. They may be in one, but this can challenge the internal image of relationship that permeates their
sense of self, and it takes a long time for new experience to become as emotionally compelling as the states of being that have
been absorbed from early life.
For me, attachment is a descriptive category, a pictorial and only schematically a diagnostic one. What I mean by this is that in
my mind, I have a geometrical picture of the distance or lack of distance between couples and a three-dimensional
dynamicpicture of their attachment patterns. This kind of geometric attachmentpicture enters into my thinking in doing couple
work when I am trying to understand the space between the individuals in the couple, their capacity to share, their individual and
joint ability to desire, the disposition of the dependency needs between the two people, and the intensity, or absence, of the
search for recognition from the other and the attachment features of the relationship the couple jointly creates.
There are three different attachmentschemas at work: that of each individual and that of the entity, the couple relationship (the
marriage, the partnership) they have made. This last feature, which can be psychically idealized, disdained, or made use of in a
helpful way, is something I take up later in the paper. For the present, I use less the conventional attachment categories of
secure, avoidant, dismissive, preoccupied, or disorganized than the words that emerge for me when working with couples which
are more couple specific but, nevertheless, in broad terms fit into the main attachment categories.
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Formulating attachment out of our work at The Women's Therapy Centre in London, Luise Eichenbaum and I came up with two
overarching clinical categories. They are the reference points that guide the poles which illuminate couple relationships for me:
poles that go from merged attachments, which I would put running along one surface of a trapezoid (Figure 1), and which can
include a range from sticky at one end to avoidant/dismissive attachments at the other. At the base of the trapezoid is the optimal
outcome we call separated attachments,
Figure 1. Attachments trapezoid
A separated attachment would be equivalent to the couple having a secure base between them. The couple relationship creates
a third category, the relationship, which itself may function as an external and yet at the same time a lived attachment by which
they are both underpinned.
These poles from merged attachment to separated attachment hold equally for the same sex couples and the heterosexual
couples I have worked with. With heterosexual couples, the differing biological sex of the individuals may confer, although I am
not necessarily sure that it does, a brief temporary advantage in that in the very short term each can use the other's sexual
difference to institute a degree of differentiation. When merger occurs, the differentiation is then of a ‘false’ or defensive nature -
such as avoidant, rejecting or dismissive - which is not especially protective.
Within the category of separated attachments, there is recognition of the space required by differing individual couples.
Importantly, there is no absolute sense of what a separated attachment is for each individual and for the couple. There is only a
sense of what a separated attachment would look like for this particular couple. What would make it possible for them to create
and maintain sufficient distinction from one another in order to be close: in order for there to be an actual other - as opposed to a
predominantly fantasized internal other (an object relation) - that is being relating to? The challenge in couple therapy for me, and
I am sure for all of us, is enabling a couple to create a platform of good enough closeness together from which each can feel
secure enough to express their distinct identities while appreciating and sustaining an experience of the difference as well as the
sameness of the other.
Let's look at Jonathan and Kusum. Jonathan is Catholic upper middle class, educated at Ampleforth, Cambridge, and Harvard.
He is from a large family, and many aspects of him would lead me to believe that he is securely attached. He is quite laid back,
has the confidence of class, is an artist who, compared to his siblings who work in the City, makes little money. Kusum is first
generation Iranian-Indian English. Her middle class parents moved to the UK when she was five. They have several small
businesses. She is a successful agent for Indian artists. She is intense and dramatic. She and Jonathan have two teenage
daughters and a twelve-year-old son. I would describe her as insecurely attached.
Although Jonathan made the initial phone call for therapy, when they entered the room Kusum delivered Jonathan to me to be
dealt with. She was extremely unhappy. She'd had enough of Jonathan. I was designated as the one to fix him or she was going
to leave. What needed fixing? He didn't make enough money for her. He didn't pay enough attention to her. And he could not
meet her sexually.
I found Jonathan personable and open. In the countertransference I noticed that a part of me was increasingly unsympathetic to
Kusum. He seemed to be a punch-bag for her, and it took me a while to comprehend the ways of his neglect of her, the
projections of one on to the other, and to even put on the table how or whether Kusum might be disappointing him. The
asymmetry in the complaints was not unfamiliar from couples work, nor was the rage and blame that permeated the initial
sessions. Kusum complained about how weighed down she was, or how much work she had, and how very sad she was. The
expectation that got in the way of their relating, or forced their relating in this unproductive and hurtful pattern, was that Jonathan
should fix, make up for, sort out, or compensate her for her burdens. In the first instance Jonathan seemed to accede to this, as
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though indeed it was his responsibility to make it better. He tried, but couldn't quite get it right for her. Kusum then would feel a
kind of contempt for his ‘insufficient’ efforts, which would diminish both of them and increase their unhappiness.
Jonathan felt sad to be upsetting Kusum and sad that she was so unhappy. His kindness and caring could further inflame Kusum,
who carried many of the domestic uncertainties about the finances for the couple. For her part she envied his ability to be so laid
back and to be unworried. In the countertransference I felt protectiveness towards Jonathan; I saw it as my identification with his
retreating in response to her asking too much.
Formulating my countertransference as a response to her ‘asking too much’ intrigued me. It had the tinge of that sexist mantra of
a woman being and wanting too much. But a genderconscious psychoanalytic approach allows one to engage the sense that was
aroused in me of Kusum's ‘asking too much’ with curiosity. Why might I be feeling that? What was that feeling for? Might it
illuminate Kusum's own conflicts about her needs and desires?
Asking myself these questions decontaminated me from the negative reaction I was unwittingly experiencing. Could my
countertransference indicate its opposite: Kusum not being able to ask in a way that could be heard? Could the ‘asking too much’
arise out of an insecure childhoodattachment that had left Kusum feeling uneasy about her needs? Was it that she wasn't asking
too much but that she felt unworthy to want, and that my countertransference response reflected her confusion regarding her
needs and her desires? Hence the difficult delivery.
Kusum was showing the impact of an insecure attachment, her shrillness and insistence masking feelings of confused
unentitlement (Orbach & Eichenbaum, 1982, 1983). The relationship and Jonathan became for her both a site of hope and a site
of disappointment. Into it went the intensity of her longings and the ghastliness of her dissatisfactions. Her distress operated like
a massive current overworking the circuit breakers in the relational fuse box.
The understanding of her confused unentitlement enabled me to go some way forward and to be able to rebalance the therapy
relationship to feel compassion for Kusum's struggle to legitimate her desires. She felt so unsure of her desires. She herself was
unable to use what came back to her. It wasn't even that she made them so intense that she courted dismissal or rejection.
Jonathan appeared willing to meet them. It was more that her desires, once out and even being addressed, would boomerang
around the room. Jonathan could actually really hit the spot for her but she could not assimilate his caring.
Identifying Kusum's difficulties with receiving as a consequence of her being insecurely attached, made sense of her compulsion
to attack Jonathan. The attack was a form of adhesive involvement. Her emotional battering was an act of desperation, an
attempt to be noticed and valued because she could not value herself. At the core of her self experience was a struggle about
how much she could matter to herself and thus feel on sure enough ground to trust what emanated from her and to receive what
was given back.
She had ‘chosen’ this man because he seemed so at ease, so securely placed in British society, so able to take for granted his
place in the world and his very being. She wanted their alliance to give this to her. When she was unable to access his solidity
and legitimacy for her own self, her despair led her to bluster and rage all over him and the therapy room.
In the course of the therapy, Jonathan was able to expand his emotional repertoire. This happened in two main ways that had an
enormous significance for her and, of course, for him. In the first instance, he was able to express his own ambition. This was
new for him. Yes, he was laid back, but he himself longed to join his peers who had become established and who were now
named artists and sculptors. He was no less interested in making it and being financially secure than was Kusum. But his
background did not push ambition in the arts or money as necessary. The secure nature of both his familial attachments and his
attachment emerging from his class and school positioning mitigated the anxiety one might expect. It did not mean, however, that
he had no ambition. Appearing not to have ambition put all the striving in Kusum's court, which she experienced as depleting and
isolating, particularly as she had gender-related conflicts about her own desires and ambition.
Where his anxiety did emerge, and what interfered with their intimacy from his side, was his guilt about not making things better
for Kusum. They had taken up a guilt/recrimination dynamic between them, with Jonathan paralysed by not knowing what kind of
response to give to Kusum's declarations of fatigue and burden. His position of guilt stemmed from an identification with his
parental story, in which his father had ‘disappointed his mother’ by not reaching the highest echelons of the diplomatic corps.
This, combined with a sense of not knowing what might ‘help’ Kusum, led him to fiddle with his pen and go into silent withdrawal.
Reacting to Jonathan's withdrawal, Kusum escalated into rage and blame. She felt driven mad by what was, for her, his
abandonment. Frantic at the gulf between them, she would experience an intense desire for sex and closeness. Kusum would
approach him. Jonathan would then feel hopeless and misunderstood, and would retreat.
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Although Jonathan was, for the most part, securely attached, he could move into a merged position (and at these times become
avoidant). Then he would feel as hopeless as Kusum and be as unable as she was to access anything helpful to her. From there
he slid into aspects of a merged attachment in which she no longer became separate but became, as it were, a twin part of him,
expressing for him those dissatisfactions, albeit in another domain, that were his own personal and professional dissatisfactions.
When he felt helpless with regard to her difficulties around receiving, he withdrew into ruminating about his own longings. And
here one of the common phenomena that occurs between couples emerged: he was accessing her rages for his own purposes -
to reflect on his own unmet (and somewhat oedipally conflicted) ambitions. The energy in her rages galvanized him in an area he
hadn't been easily able to feel directly on his own behalf. He ‘borrowed’ the energy of her affect to propel his personal struggle
around work. When we could talk about this phenomenon in the therapy, they could see the shared function of her rages and
they endeavoured to find other ways to support each other in pursuing their separate and joint desires.
Managing to see her rages as something useful for both of them could not have happened, of course, unless Jonathan was able
to make a more adequate response to Kusum's emotional distress. He had to access the part of himself that was secure enough
to ask her to tell him more about how her burdens were for her. He didn't need to be instrumental in fixing them or even to
understand them. He needed to be curious about them, as he might have been at the beginning of the relationship when they
were getting to know one another. When he retreated into himself, it was a dismissal. What was actually required was that he be
present with her.
This is where the therapy comes in. It provides a relationship of support that enables Jonathan to ask Kusum about her distress
and then to listen to it and empathize with it. This put both of them into a position where they felt adequate and interested in one
another. Jonathan was then able to bring his need for her support with his professional struggles to her. She could help him with
that. Their psychic positioning was redrawn. Kusum, seen and recognized, felt immediately calmed. Jonathan felt he was getting
to know Kusum all over again and he was able to experience how powerful it was for both of them for her to talk and be heard.
He also felt sexually drawn to her in an invigorated way, but he was reticent about it.
Over the past several years their sexual life had all but disappeared. Children and overwork were their explanations to
themselves. In the beginning, the erotic was a crucial aspect by which they created a bond, the connected twoness in which their
attachment needs, their desires for recognition, and their individual sense of being valued, loved, and secure occurred. This
phase of their relationship created a merged attachment, as it does for most couples. Being able to take the love that emerges
out of the merger, providing as it does a new positive embrace where an early attachment may have been problematic, provides
for valuable and long sought psychic repair. The difficulty Kusum and Jonathan encountered was how to climb out of that state of
psychic merger, which at the beginning was experienced as so blissful and wondrous and completing, into a relationship in which
they could use their attachment as a basis for supporting their individual senses of self (Eichenbaum & Orbach, 1983; Orbach
1999). How could they be both connected and separate?
Paradoxically, in our initial ‘falling in love’, being separate and connected is not a problem. It is simply how it is. One feels alive in
the connection together while one's distinctness is emphasized. But as time and life intervene and intimacies deepen in ways
other than sexual, the erotic aspect of a relationship transforms. The slippage, too, between a merged attachment and one that is
on the way to being separately attached, can be very difficult. It can produce over-connection or distance rather than the space
offered by a separated attachment. This has an impact on the sexual relationship.
And so it was for Jonathan and Kusum. They slipped between being over-connected and being distant. For various reasons to do
with Kusum's own development, Kusum felt that Jonathan needed to take the lead sexually. If Jonathan did not initiate sex she
felt it as abandonment, as though he needed to be over present with his desire in order to make her desire possible. Her wish for
him to initiate was another expression of her unentitlements stemming from her insecure attachments. She wanted to feel desired
by Jonathan, so that she could feel desire herself.2 She could not access her own sexual vitality except out of the place of rage.3
Kusum's wish for Jonathan to be the desiring other clashed with the legacy of his Catholic background, out of which he felt a
reluctance to ‘impose’ himself. His desire was present, but he had his own version of not bringing it forth for fear of being
inappropriate. He had sexual hesitancy from his upbringing and the celibate monks at Ampleforth, and this combined with the
confusing cultural messages that Kusum had absorbed about femininity and the erotic.
Attachment theory offers a tangible pictorial view of individuals and their capacity to ‘attach’ and relate to one another. I use the
geometry of the couple as a diagnostic, and observe how attachment categories and the attachment that pertains to the couple
changes during the course of therapy. In the beginning of a couple therapy we are inclined to assess the individual attachment
profile of the individuals in the couple. We ask ourselves: where do the two people stand in relationship to one another in the
articulation of their needs and desires? Who complains? Who is able to receive? Who retreats? Who is dismissive? Who shows
their insecurity? Where are the points of mutuality, and so on? The way a couple sit together, the emotional valences and
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ambience and utterances in the therapy room, combined with what is ascertained in the countertransference, is the first
diagnostic.
During the course of the couple therapy there are shifts in the way we look at the attachment profile. We no longer assess the
couple as only two individuals with their unique attachmenthistory. It is the attachment which is co-created by the couple that is
now of interest. The co-created attachment can provide either a secure or an insecure base for their relationship. The relationship
itself becomes a third kind of attachment, taking on the capacity to become a platform as well as a container from which the
individuals relate.
Interestingly, even if individual attachment patterns veer towards insecure, anxious, clingy, or sticky, the relationship itself can
provide a robustness that mitigates some of that insecurity and can provide a dynamic secure base from which each individual
now lives. By coming to couple therapy they consciously grant a respect and status to the couple relationship. This shifts matters
psychically. The couple relationship as a relationship they have created becomes a potential good relationship: a third (Benjamin
2004; Aron, 2006) from which they can view their interactions and which feeds back into each of them and the relationship itself.
For some, the granting of status to the relationship and making it a potentially good relationship can produce dramatic changes.
The individual moves towards seeing the couple relationship as generative and creative. For Kusum and Jonathan it meant
seeing Kusum's concerns as concerns they as a couple could address. It meant seeing Jonathan's conflict's about his ambition
as something the couple relationship could handle.
In reformulating individual difficulties in this way, it does not take away from individual responsibility. Strikingly, it becomes
imperative that the individual must take a particular kind of responsibility: one that allows them to act knowing that they are
supported by the relationship they have jointly created rather than making an isolated and isolating demand on the other in the
couple. This dual position of respecting self and risking what is felt to be wanted directly, rather than in carping, put-downs or
withdrawals, combines with seeing the couple relationship as sufficiently resilient to be a benign germinating platform. This opens
up a more democratic view of a relationship, containing psychic parity and joint responsibility.
The issues then that pertained to sexuality and who initiated and how it could express their intimacy, becomes a relationship
issue rather than a contest between two people. What strengths could each bring to bear on this? What vulnerabilities existed for
each of them? What untangling needed to happen that they could do if they accepted that the relationship was there for them as
a couple as they puzzled out what was occurring with their sexuality? And did that understanding enable them to move from a
relationship of insecurity to one of promise and sexual aliveness?
Using the lens of attachment, we could see that the lack of sex had another function. It was a regulator, a needed protection in
the struggle not to be merged. To have sex in an unproblematic and vibrant way, as they had in the beginning years of their
relationship, might have brought them too close, as though there were no space between them. Kusum's complaints and
Jonathan's reluctances acted as spacers, creating enough distance, albeit in a negative way, for them to get on. Of course, the
price was high, and left them each rather stranded, but getting too close sexually in the state that they were in might have
disturbed the equilibrium they had established.
In order to reinstitute a sexual relationship that was alive for both of them, the fundamental dissonances in their attachment
patterns needed to be recognized. The nature of the complaints about Kusum wanting Jonathan to initiate were less significant,
in fact, than addressing the need to equilibrate the flux between merger, with its insecure and avoidant attachments, and their
attempt to create a secure enough separated attachment where respect and excitement were both present (Orbach, 1999;
Clulow, 2000; Mitchell, 2001). By asking the relationship to carry this sense of a secure base, there was more possibility for the
risks, excitements, and pleasures associated with intimacy to breathe rather than collapse.
We might think that in couple work we need to adjust the attachment patterns of each individual. (Would that we could.) We might
despair if we see both parties as insecurely attached. However, the couple relationship can be leveraged in a creative way to
provide a proxy separated attachment for both individuals to use as they work through the difficulties that arise between them.
The couple relationship is the key feature that needs to be used to enable conflicts, disappointments, and desires to be engaged.
Sexual intimacy is dependent not so much on each individual sorting themselves out per se as it is on creating a platform of
security from which the couple can nourish itself.
Notes
Based on a talk given at the Summer Conference of the Tavistock Centre for Couple Relationships: ‘Couple Therapy and
Attachment Theory’, 26 May 2006.
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Of course, this is something feminism has been addressing for many years: how might a woman feel desirable from the inside
and not because she is desired from the outside?
Why this was in relation to the construction of a feminine psyche is a much longer discussion.
References
1
Aron , L. (2006). Analytic impulses and the third: clinical implications of intersubjectivity theory. International Journal of
Psychoanalysis, 87 : 349-368. (IJP.087.0349A)
2
Benjamin , J. (2004). Beyond doer and done to: an intersubjective view of thirdness. Psychoanalytic Quarterly, 73 : 5-46.
(PAQ.073.0005A)
3
Clulow , C. (2000). Adult Attachment and Couple Psychotherapy: The ‘Secure Base’ in Practice and Research. London:
Routledge . (CFP.005.0103A)
4
Eichenbaum , L. , & Orbach , S. (1982). Outside In Inside Out: A Feminist Psychoanalytic Approach to Women's Psychology.
London: Penguin .
5 Eichenbaum , L. , & Orbach , S. (1983). What Do Women Want? London: Michael Joseph .
6
Mitchell , S. (2001). Can Love Last? New York: W. W. Norton .
7
Orbach , S. (1999). The Impossibility of Sex. London: Allen Lane .
AJRPP.001.0008A
Record: 15
Title: Random Thoughts on Couple Therapy in a Postmodern Society
Authors: Segalla, Rosemary
Source: Psychoanalytic Inquiry, 2004; v. 24 (3), p453, 15p
ISSN: 07351690
Language: English
Abstract: The postmodern period in psychoanalysis has had a considerable impact and influence on
the psychotherapeutic process in both psychoanalysis and psychotherapy. The paradigm
shift, reflected in the work of the intersubjectivists, rationalists, and social constructivists,
has shifted emphasis from a one-person psychology to a two-person psychology.
Implications for treatment are numerous. The change in emphasis affects not only how
individual treatment is conducted but also couple therapy and group therapy. In
considering the impact of these recent changes, the author notes the wide range of
influences that inform her couple and group therapy. Although the current paradigm shift
offers much, it seems to be an extension of earlier influences from self psychology,
motivational systems, and attachment theory and of findings from neuropsychology. The
author concludes that her couple work has also been intuitively informed by the implicit
experience of the intersubjective field of group therapy.
Accession Number: PI.024.0453A
(Permalink): direct=true&db=pph&AN=PI.024.0453A&site=ehost-live&scope=site
direct=true&db=pph&AN=PI.024.0453A&site=ehost-live&scope=site">Random Thoughts
on Couple Therapy in a Postmodern Society</A>
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Random Thoughts on Couple Therapy in a Postmodern Society

Rosemary Segalla, PHD, author, is Cofounder, Director Emeritus, and Faculty, Institute of Contemporary Psychotherapy and
Psychoanalysis; Faculty, Group Training Program, Washington School of Psychiatry.; 4501 Connecticut Avenue NW, Suite 109
Washington, DC 20008 rosemary544@earthlink.net
The postmodern period in psychoanalysis has had a considerable impact and influence on the psychotherapeutic process in both
psychoanalysis and psychotherapy. The paradigm shift, reflected in the work of the intersubjectivists, rationalists, and social
constructivists, has shifted emphasis from a one-person psychology to a two-person psychology. Implications for treatment are
numerous. The change in emphasis affects not only how individual treatment is conducted but also couple therapy and group
therapy. In considering the impact of these recent changes, the author notes the wide range of influences that inform her couple
and group therapy. Although the current paradigm shift offers much, it seems to be an extension of earlier influences from self
psychology, motivational systems, and attachment theory and of findings from neuropsychology. The author concludes that her
couple work has also been intuitively informed by the implicit experience of the intersubjective field of group therapy.
The recent foment within psychoanalysis has emerged from the work of many theorists who have grappled with the restrictions of
classical drive theory and moved on to a creative and dynamic period of theory building. The unfolding of this postmodern period
has been gradual, resulting in a revitalization of psychoanalysis. The influence of infant and attachment research has had a
significant role in the development of the various forms of intersubjectivity which is at the root of the new theories. The
implications for psychoanalysis are many, particularly in how the analytic work is undertaken. Gone are the restraints of Freud's
neutrality and abstinence, and in their place we see a level of analyst engagement that was unthinkable not too long ago.
These developments have had an impact on therapeutic work and have raised questions about how these theoretical shifts are
incorporated not only in the work with the individual patient but also in the work with couples and groups. How do we understand
the intersubjective space of couple or group work? Is the mutual influence system similar for couple or group therapy and
individual treatment? How do we honor the couple while maintaining a connection to each individual? How do we comprehend
the impact of our personal history and that of our patients' histories? Do any techniques anchor us as we work in the
intersubjective space of therapist-patient(s) despite the fact that current theorists seem to eschew such a possibility?
These are a few of the questions that emerged as I considered writing on couple therapy. I would like to share my musing and
random thoughts on the subject and examine in my own work the impact of these emerging ideas. Although my emphasis is on
couple therapy here, I am aware that my group therapy work forms the background of my work with couples. My underlying
speculation is that doing group therapy has provided me with a unique opportunity to consider an intersubjective perspective. I
have implicitly been an intersubjectivist because of the inevitability of engagement at this level in groups, and it has also been a
primary influence on my couple work. In this paper, I elaborate these ideas and discuss an illustrative clinical example.
There can be no doubt that recent cultural shifts have had a dramatic impact on the ways in which psychoanalysis and
psychotherapy are conducted. The emphasis on intersubjective and relational perspectives, which view the dyad as “interactive
systems within which self and mutual regulation must be integrated” (Lachmann and Beebe, 1996, p. 2), has had a significant
impact on how we understand the treatment process and how we implement the work. Recognition and acceptance of the “myth
of the isolated mind” (Stolorow and Atwood, 1992) have brought an appreciation of the impossibility of analysis without an
ongoing awareness of this mutual influence and regulation system.
How treatment is conducted has many implications. For example, how do we understand the contribution of the therapist/analyst
to the process, and how do we use this information? If there is a move to self-disclosure, for example, how can we determine if
this aids the process? How do we reformulate transference and countertransference? And, what does it mean to use
confrontation (Ehrenberg, 1992; Maroda, 1994; Renick, 1996) with a patient? How do we understand our own motivation in doing
so?
These questions are being addressed in a rich and varied way by relationalists, social constructivists, and intersubjectivists—with
the result being an atmosphere of innovation, complex understanding, and a large variety of individual approaches. Two types of
treatment, couple therapy and group therapy, have much to gain from and much to offer to this postmodern theorizing. Those
who do this work find much of what is being explored familiar in a clinical sense. Although much of the theory building has
emerged from dyadic treatment, it captures what we intuitively have known from working in these two arenas. The group therapist
has been immersed in the intersubjective/ relational because it is impossible to work with a group without being aware of the
impact of members and therapists alike. This is also the case for couple treatment. The complicated work of acknowledging and
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including the impact of the therapist on the process is a challenge that is being addressed in many ways (Aron, 1996; Hoffman,
1996; Mitchell, 1997). It is often difficult to address in dyadic work and daunting when attempting to explicate the therapeutic
action in couple or group treatment. Yet much of my work with these modalities emerged from the theoretical influences of writers
focusing on individual treatment: Kohut's (1984) emphasis on empathy and selfobjects; Stolorow, Brandchaft, and Atwood's
(1987)intersubjectivity; and Lichtenberg's (1989; Lichtenberg, Lachmann, and Fosshage, 1992) motivational systems. For
example, the importance of empathy and selfobject experiences within the couple is part of my observational stance. I explore a
couple's capacity to be empathetic, to provide selfobject experiences to each other (Kohut, 1984). I wonder about the
intersubjective field and how each member of the dyad is shaping that, and I speculate on my impact on the couple and on each
individual as well as their impact on me—understanding the power of the unconscious in each of us. I keep in mind Lichtenberg's
motivational systems—sensing the couple's capacity to operate from an attachment motivational system, their sensual/sexual
experiences with each other, their capacity to be exploratory and assertive, and the presence of aversive motivations. I know that,
when I have a strong sense of the couple's capacity for attachment, there is a better platform from which to explore their
difficulties, or, when there is a chronic and persistent aversive motivation, I know that often there is an absence of the goodwill or
desire necessary to do the difficult work of the therapy.
More recent ideas from neuropsychology and attachment theory also contribute to my work. Both of these fields provide ample
evidence to support the postmodern intersubjective position of mutual responsiveness and cocreation. As the authors of a book
exploring scientific discoveries of the brain poetically stated, “patients are often hungry for explanations, because they are used
to thinking that neocortical contraptions like explications will help them. But insight is the popcorn of therapy. Where patient and
therapist go together, the irreducible totality of their mutual journey, is the movie” (Lewis, Amini, and Lannon, 2000, p. 179). Lewis
et al. suggested our inevitable impact on each other, the inevitability of intersubjectivity: “All of us, when we engage in
relatedness, fall under the gravitational influence of another's emotional world, at the same time that we are bending his
emotional mind with ours” (p. 12).
From attachment theory, we have further evidence of the profound importance and impact of mother-infant and patient-therapist
bonds. The work of Bowlby (1969) and the explication and exposure of his work by Ainsworth (1982), Main (1991), and others
inform us about attachment and the power of therapy to heal damaged bonds. Looking at my patients as having an
attachmenthistory—secure, avoidant, ambivalent, or disorganized—also informs how I work and what will inevitably get
reenacted in some form in the treatment.
Couple all these theoretical influences with the therapist's own personal history and “coupledness” and with the current social and
political climate, and the picture becomes increasingly complex. Add to this a personal bias that couple therapy and group
therapy are significant and often necessary parts of clinical practice, and you have a glimpse of what is brought to the treatment
process. Add a rich history from each patient, and you have a sense of the complexity of what emerges in the treatment.
In my own practice and in the practices of several colleagues, the demand for couple therapy has increased considerably. This
increase seems to reflect a cultural shift in which efforts are being made to save marriages rather than simply to divorce. Often,
the couple is referred by the primary therapist of one spouse who sees the necessity of adding couple therapy to the individual
treatment to facilitate further progress. Until fairly recently, there has not been a strong emphasis within psychoanalysis on
including other treatment modalities. Perhaps Sutherland serves as one inspiration for using every available means to aid the
therapy. As Holmes (1996) wrote,
Sutherland starts from a basic faith in the supportive and healing power of social groups: “Man as a person is sustained by his
social relatedness” [Holmes, p. 343]. Like Bowlby, he thought systemically as well as psychoanalytically … he visualized a
system as having central “organizing principles,” as needing a well organized hierarchy … his systematic view enabled him to
see that these failures can be counteracted by a healthily functioning family and social group system [Holmes, p. 107].
The individual treatment of one or both partners creates a holdingenvironment that provides stable, dependable selfobject
experiences. The patient learns to consider and think about the self and the self in relation to the other, which can support the
couple's endeavor. This capacity to think about one's own motivations, history, and current experiences aids in moving the work
forward. Working with a naïve couple is a much more difficult process. Without the selfobject experiences of individual treatment,
the often stormy work with the dyad cannot sustain the couple between sessions. If there is a “good enough” therapeutic bond,
however, the individual may be willing to take a referral to begin individual treatment in conjunction with the couple work. Here I
suggest that the selfobject bonds are a necessary and basic aspect of good couple therapy. How this is created is one of my
thoughts that I explore further.
In summary, I bring to my work with couples a varied history that oscillates in a foreground-background way as I conduct the
therapy. I discuss how I work, and I clarify some of these influences. This rather self-conscious approach seems useful in that it
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explores these influences, perhaps shaping them further, rather than attempting to force clinical details to fit a preconceived
model of treatment.
Group Therapy: A Model for Couple Therapy

Well before I began doing couple therapy, I had extensive experience both in writing about and conducting groups. Briefly, many
of the early influences on my work came from my understanding and appreciation of Kohut's work. My emphasis in group was on
the empathic stance as a model of communication and on selfobject experiences. My colleagues and I formulated group as a
venue for offering multiple selfobject experiences (Harwood, 1986; Segalla et al., 1988; Segalla, 1995). We questioned the limited
number of selfobject functions formulated by Kohut as well as his position that a particular selfobjectdeficit would come to be
dominant in the analysis, and we suggested that we all have multiple selfobject needs, that there are many other selfobject
functions beyond mirroring, idealizing, and twinship(Kohut, 1984), and that many of them become activated in group. This was
also put forth by Stolorow et al. (1987) and Wolf (1988). Group therapy expands the opportunity for selfobject experiences of all
types. I further theorized that, besides having selfobject needs, we inherently have groupobject needs (Segalla, 1996) that are
best met in a group setting. This concept, not unlike Lichtenberg's attachment and affiliation motivation, helps to explain the
tremendous power of group experiences and the strong bonds and commitments people form to groups of all kinds.
As I indicated, the primary influence on my group work, and later on my couple work, emerged from my appreciation of Kohut's
theory. I found his theoretical model for psychoanalysis equally useful for other treatment modalities. More recently, postmodern
perspectives have shaped many aspects of my thinking and have influenced my engagements. Orange, Atwood, and Stolorow's
(1997) work on the inevitability of intersubjectivity, as well as work by Mitchell (1988), Aron (1992), and Odgen (1997), seemed to
mirror what I already saw occurring in my group and couple work. Cocreation as a concept was particularly useful in these
modalities. What has been a particularly interesting challenge for me is how we come to understand intersubjectivity and
cocreation in the more complicated environment of couple or group treatment. How do we address mutual influence or
recognition, and how do we comprehend it? As Schermer (2000), writing from a group therapy perspective, pointed out,
clinical knowledge is garnered through the coming together of subjectivities. Two important challenges to intersubjective
theorists will be to articulate therapeutic strategies and techniques within their theoretical frame and to say when and how
statements of either patient or therapist can be evaluated in terms of their utility and accuracy [p. 16].
Group members can appreciate in a deeper way the mutual reactions and responses in their encounters—learning firsthand
about intersubjectivity. In couple work, this is a more difficult stance to maintain because often by the time the work commences
there is a strong pull to place blame on one member of the dyad.
Group therapy, inherently a system, requires awareness of both the individual and the group as a whole. The small group of
couple therapy is not unlike this. In both modalities, it is necessary to stay aware of each individual as well as the whole. What is
well understood by those who work in these modalities is that the individual identities of each member and the therapist are but
part of a larger picture. That is, the “group as a whole appears to be a separate entity that takes on a life of its own” (Ettin, 2000,
p. 157). In couple therapy, this translates into tending to the couple, to each partner, and to the whole, which is composed of the
three of us.
A further parallel between the two modalities is the members' commitment to the “group.” Members refer to the group, and they
feel loyalty and affection for the group that goes beyond their attachment to particular members. This also occurs in couple
therapy, though to a less pronounced degree.
Perhaps the importance of this observation is that it reflects how this sense of cohesion emerging between the couple and me
helps me in my own struggle to understand what is actually being accomplished and what holds the couple in the work. Often this
occurs despite my own feelings of despair about the couple's ability to change.
How couple or group therapy is actually conducted is an interesting question. The group therapy field has several main
perspectives on how treatment is conducted. Working from a systems perspective, the therapist focuses on the action of the
whole group—making observations and interpretations only about the group as a whole. This would be parallel to a couple
therapist emphasizing the dyadic action of the couple. Perhaps now, with intersubjective and relational perspectives, emphasis
would be on the action of the threesome.
Another group approach is that of focusing on and working with a group member in the presence of other members. This group
analytic model would parallel working with each partner in a couple while the other partner observes.
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A third model from group therapy sees the group as systems within systems. In this approach, the therapist alternates between
tending to an individual/dyad/subgroup/whole group and tending to his or her own contribution to action in any system or
intersubjective matrix. The translation to couple treatment is obvious—a fluid model of engagement with each individual, with the
couple, and with the threesome. Although there seems to be an impossible level of complexity in such a model, in fact it
resembles most closely lived experience—child-caregiver, family, and other social structures such as school, religious, and
community institutions—all of which shape the nature of the couple work.
Deciding to ignore existing models arose out of my own commitment to a more analytic stance as has unfolded in the work of
Kohut, Lichtenberg, the relationalists, and the intersubjectivists.
Postmodern Couple Therapy: Old Wine in New Bottles?

Just as each individual treatment is a unique encounter between patient and therapist, couple therapy is a unique encounter
among three people. There are a variety of approaches to this work, as is the case with group, informed in a general way by the
therapist's theoretical perspective. The reality of what happens within a particular therapy is almost beyond description in terms of
general therapeutic principles. The therapist must be prepared for any encounter, for any surprise. An intersubjective, relational
perspective is helpful in trying to understand the work. It honors the unique engagement with each member of the dyad and with
the couple. Recognition of the cocreation of every encounter helps in understanding the subtle and often hidden dance of the
relationship. Focusing in this way helps in the struggle to understand what is being accomplished, what is changing, and why it is
changing. Although this is not unique to couple therapy, it can be particularly problematic in that it requires the agreement of two
people for the work to commence. Agreement is often reluctant, but nevertheless it must be reached for the work to proceed. At
times, one member sabotages this agreement, despite acknowledgment of difficulties.
The therapist has the task of creating and maintaining a bond with both partners in their coupledness. Sometimes this bond is
precarious and easily disrupted, particularly if one person is more committed to the treatment process. Despite this apparent
disequilibrium, that the treatment is about the couple remains a constant. This is parallel to group therapy, in which the state of
the group alternates in a foreground-background way with whatever action is engaging the members at a particular moment. In
each case, the therapist must hold the couple or group in mind. If not, couple therapy can seem like two-person therapy in which
one partner or the other is the real patient. This pull to create an identified patient, one potential danger in couple work, can be
rather easy to overlook because, by the time treatment begins, each partner has become polarized. Perhaps one looks extremely
reasonable, rational, and clear, and the other seems fragmented. When this scenario is repeatedly played out, there is an almost
irresistible urge to identify one partner as the patient—the sicker one, the bitch, the narcissist. How this is negotiated is one of the
most delicate aspects of the work. The therapist may feel compelled to remove herself from experiencing the dyad, to ignore
theoretical anchors and her own personal dynamics, to allow herself to abandon her therapeutic stance and to sink, perhaps
gratefully, into the role of an individual therapist—the guilty pleasure of doing the more obvious, often easier, job.
How and why this happens are just two of the questions we must ask when we see a couple's treatment become an individual
therapy with an onlooker. Here the intersubjective stance is most important, but this exploration is particularly difficult when the
therapist is trying to understand the complex engagement of the couple as well as her own part in the action. Explicating this
action with language that clarifies without blaming or identifying the problem person requires accepting the intersubjective stance
—learning to talk about a particular engagement from within the treatment.
My experience is that the closer I remain to my own inner experience, and the more clearly I articulate it as such, the more likely I
am to be accurate in my reflection of some process that is occurring. Therefore, I am suggesting that therapeutic action occurs as
a result of my remaining immersed in the intersubjective field and my speaking from this place without offering ironclad
interpretations of the truth. Of course, this requires that we hold in mind the many influences on the work that came from our own
personal histories, social forces, generational pulls, and so forth. Many of these are unconscious but may be called to
consciousness in our work with the couple. Each couple calls on different aspects of our own psychology in a manner more
magnified than that in an individual treatment. In the next section, I present a case example to try to show the therapeutic action
of the therapist and the intersubjective field created among the therapist and the two partners. Odgen (1997) spoke of the
“analytic third” created by the coming together of analyst and patient. In couple work, the analytic third has special significance
when it is created between therapist and each patient and between therapist and couple. For the couple, the third may reflect the
bond that is newly forming between the partners as they allow themselves to become immersed in the work of finding new ways
to connect.
Case Example
Such a bond formed when Ted and Joyce, a couple I had been seeing for a year, came to session with Joyce stating that our
previous meeting had not been helpful. She said that I had seemed to be off on a tangent that wasn't useful to either of them. I
was not surprised by her statement, as I too was ready to comment on the previous session, in which I had felt unable to forge a
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connection with the couple. I made this observation to both of them. Joyce asked what had been happening. I responded that I
wasn't sure, but what I was sure of was that there were times when their dialogue felt very confusing to me and left me feeling
that I simply wasn't “getting them.” I suggested that maybe this feeling of confusion was a clue to something they also
experienced. Ted responded that he also often felt confused, but his confusion felt more like he didn't get Joyce, so my
experience felt like his. Joyce responded that she had a similar experience with Ted—that his articulation of a problem rarely
stayed clear or focused, and so she felt he wasn't “playing fair.”
Recognizing the similarity of our experiences became a very important development. We were talking about levels of confusion
that had both Ted and Joyce reeling, unable to comprehend the other's position or feeling. I indicated that I felt we were talking
about a process that had essentially disabled the couple's efforts at both empathy and communication. We were not talking about
a simple misunderstanding but instead about a long-term disjunction that had left everyone (all three of us) confused. The dyad's
and the triad's inability to forge a common language that would allow dialogue to occur was a longstanding problem. Ted, an
engineer, was more concrete in his language and in providing examples of difficulties but was unable to stay with and explore his
point. Joyce, a writer, was more abstract in her language and framed her difficulty with Ted in terms describing a process but
omitting the content Ted needed. I was somewhere between the two of them—able to appreciate Ted's concreteness and factual
reporting and yet drawn to Joyce's more unique expressiveness. Her commentary spoke in a larger way to communication
difficulty as a symptom of deeper psyche withdrawal and disengagement from an empathic position. This encounter helped us
begin to move the therapy in a new direction.
Both Ted and Joyce are very interested not only in their misses but also in my experiences and moments of confusion and
misapprehension. We have begun to use these moments as indicators of a larger confusion in the work. Bringing my confusion
into the work more readily, I feel confident that my fogginess contains important clues for us. At times, however, I am unable to
articulate my experience, and I retreat into a listening mode and wait for some clue that will allow me to aid in the process. Often,
from this position, which feels like a reverie(Odgen, 1997), I may make a statement such as, “Ted, I keep wondering about your
mother.… I'm not sure what I'm thinking, but I keep seeing you with her trying to figure out what she wants.” In this case, Ted,
looking blank and then annoyed, replied, “This is not about history—it's about what is happening now.” I said, “I don't dispute that,
but I am curious as to why I can't stop thinking of you with your mother.” Joyce interjected, “It is about history too, Ted, and not
just about this minute.” Ted, looking thoughtful, stated, “Well, this discussion or struggle we were just having is like me and my
mother. I was always trying to figure out how I could give her what she wanted without giving up what I wanted.” I asked, “So, this
conversation with Joyce was feeling similar?” He replied, “Yes, I guess so. She is so sure of what she is saying. I feel that it
makes perfect sense and is completely reasonable, but I just don't want to agree. Then I end up agreeing and feel like I gave in
because I couldn't offer a better alternative.” Joyce countered, “I don't need you to agree. I just need to know you understand my
point, my feeling. I don't expect perfect agreement. I just want us to know and understand our differences and accept them. You
get enraged at me because you think I am trying to force you to think or feel my way. I can't stand that!” Ted, looking defensive,
stated, “You can say that here, but when I disagree at home you aren't so agreeable and accepting. Just last night, you were
furious with me because I didn't agree with your idea about the birthday party!” Joyce replied, “I was angry not because you didn't
agree—just because I felt we were into an old pattern. I could sense that you didn't agree, but you weren't acknowledging your
disagreement, and I know that that is when you sabotage something. So I forced the issue.” Ted hesitated and then said, “You
are right. I wasn't being completely honest. I was trying to figure out a way to satisfy you without going along with the party idea.”
Then I joined in, “So it does seem that my reverie about you and your mother was about something important that was going on.”
Ted said, “Yes, but I wasn't thinking about that either now or last night!” I replied, “Yes, I know, but it has helped clarify something
for me and perhaps for both of you.” Ted acknowledged my statement, and we were able to discuss the more subtle emotional
dynamics that often impeded Ted and Joyce in their efforts to connect.
My comments were not offered as interpretations or statements of facts but rather as observations about my own experience with
the dyad. Teicholz (1999), speaking to the growing recognition of the analyst's influence on the patient, stated:
An unofficial consensus seems to have developed among the moderate postmoderns that it is better to make this influence the
focus of explicit psychoanalytic inquiry than to allow it to continue its influence hidden and unrecognized. This consensus leads
them to recommend an overt exploration of the patient's experience of the analyst's subjectivity and countertransference(Aron,
1996) and to include in the analyst's repertoire of interventions a readiness for deliberate self disclosure (Renick, 1996; Aron,
1996) [p. 189].
What aided me and gave me a certain freedom in my work with this couple was my sense of their desire to remain coupled. This
was often a difficult dilemma, as both partners also struggled to maintain their own individual subjectivities. The postmoderns see
“that desire is at the heart of individual subjectivity(Benjamin, 1988), but, in sharp contrast to Kristeva (who rejected individual
subjectivity), they honor desire as that which keeps individual subjectivity alive” (Teicholz, 1999). This is a very important aspect
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of couple work—the struggle to maintain one's own sense of self as well as one's sense of coupledness. Holmes (1996) stated,
“Attachment is the basis for intimacy, but runs the risk of engulfment; detachment is needed for autonomy, but can also lead to
schizoid avoidance” (p. 68). Ted, Joyce, and my work with them reflect our essentially relational stance. We all constantly attempt
to read and understand one another, more or less successfully, as we bring to each encounter our own psychological histories.
This becomes most significant when we wish to couple successfully in a marriage, partnership, or therapeutic relationship.
Summary and Conclusion

I have attempted to explore the many theoretical and intellectual as well as emotional forces that shape my work with couples.
This exercise allowed me to comprehend in a fuller way the complexity of what I as a therapist bring to the therapeutic endeavor.
Rather than operating from one position that defines my focus as I work, I find that the influences are numerous. All these
aspects of self, my own and the patients', become activated in the intersubjective field. Although I cannot fully comprehend how
this happens, I carry a certain trust in the process—guided by my general goodwill toward the patient.
In the case of Ted, Joyce, and me, we all shared this goodwill, and we all felt its effects. The ability of Ted and Joyce to use me
as a selfobject, their capacity to provide those experiences to each other, served as a containingenvironment in which to do the
work. The prominence of their need for attachment held them when more aversive motivations were activated. The couple was
able to “self-right” (Lichtenberg et al., 1992) and continue to work despite the aversive experiences. Their candor with me arose
from an intersubjective matrix in which I consistently modeled for them a freedom of expression when sharing my ideas. As I
thought about this case, what became very clear to me was my own commitment to a relational or intersubjective view in which
cocreation, mutual influence, and mutual recognitionstructure my work.
References
1
Ainsworth , M. (1982), Attachment: Retrospect and prospect. In: The Place of Attachment in Human Behavior, ed. C. M. Parkes
& J. Stevenson-Hinde. London: Routledge .
2
Aron , L. (1992), Interpretation as expression of the analyst's subjectivity. Psychoanal. Dial., 2 : 475-507. (PD.002.0475A)
3
Aron , L. (1996), A Meeting of Minds: Mutuality in Psychoanalysis. Hillsdale, NJ: The Analytic Press . (PD.007.0885A)
4
Benjamin , J. (1988), The Bonds of Love. New York: Pantheon Books . (SGS.014.0001A)
5
Bowlby , J. (1969), Attachment. London: Penguin . (IPL.079.0001A)
6
Ehrenberg , D. (1992), The Intimate Edge of Experience. New York: Norton . (PD.004.0303A)
7
Ettin , M. (2000), Modern dyadic relations and group psychotherapies: A convergence. Internat. J. Group Psychother., 50 : 156-
160.
8
Harwood , A. (1986), The need for optimal, available selfobject caretakers: Moving toward extended selfobject experiences.
Group Anal., 19 : 291-302.
9
Hoffman , A. (1996), The intimate and ironic authority of the psychoanalyst's presence. Psychoanal. Q., 65 : 102-136.
(PAQ.065.0102A)
10
Holmes , J. (1996), Attachment, Intimacy, Autonomy. London: Aronson .
11
Kohut , H. (1984), How Does Analysis Cure? ed. A. Goldberg & P. Stepansky. Chicago: University of Chicago Press .
(ZBK.034.0001A)
12
Lachmann , F. & Beebe , B. (1996), Three principles of salience in the organization of the patient-analyst interaction.
Psychoanal. Psychol., 13 : 1-22. (PPSY.013.0001A)
13
Lewis , T. , Amini , F. & Lannon , R. (2000), A Generation Theory of Love. NewYork: Vintage Books .
14
Lichtenberg , J. D. (1989), Psychoanalysis and Motivation. Hillsdale, NJ: The Analytic Press .
15
Lichtenberg , J. D. Lachmann , F. & Fosshage , J. (1992), Self and Motivational Systems. Hillsdale, NJ: The Analytic Press .
16
Main , M. (1991), Metacognitive knowledge, metacognitive monitoring, and singular vs. multiple models of attachment. In:
Attachment Across the Life Cycle, ed.C.M. Parkes et al. London: Routledge .
2/6/2018 EBSCOhost
17
Maroda , K. (1994), The Power of Countertransference. Northvale, NJ: Aronson .
18
Maroda , K. (1999), Seduction, Surrender, and Transformation. Northvale, NJ: The Analytic Press .
19
Mitchell , S. (1997), Influence and Autonomy in Psychoanalysis. Hillsdale, NJ: The Analytic Press .
20
Odgen , J. (1997), Reverie and Interpretation. Northvale, NJ: Aronson . (PAQ.066.0567A)
21 Orange , D. , Atwood , G. & Stolorow , R. (1997), Working Intersubjectively. Hillsdale, NJ: The Analytic Press .
22
Renick , O. (1996), The perils of neutrality. Psychoanal. Q., 65 : 495-517. (PAQ.065.0495A)
23
Schermer , V. (2000), On the future of group therapy theory. Group, 24 : 13-20.
24
Segalla , R. (1995), The evolution of the self psychological perspective of group psychotherapy. Presented at the National
Group Psychotherapy Institute, Washington School of Psychiatry, Washington, DC.
25
Segalla , R. (1996), “The unbearable embeddedness of being”: Self psychology, intersubjectivity and large group experiences.
Group, 20 : 237-271.
26
Segalla , R. Silvers , D. , Wine , B. & Pillsbury , S. (1988), Multiple selfobjects: Experiences in group and couples treatment.
Presented at annual Conference on the Psychology of the Self, Washington, DC.
27
Stolorow , R. & Atwood , G. (1992), Contexts of Being. Hillsdale, NJ: The Analytic Press .
28
Stolorow , R. Brandchaft , B. & Atwood , G. (1987), Psychoanalytic Treatment: An Intersubjective Approach. Hillsdale, NJ: The
Analytic Press . (IJP.072.0363A)
29
Teicholz , J. (1999), Kohut, Loewald and the Postmoderns. Hillsdale, NJ: The Analytic Press . (PSP.014.0267A)
30
Wolf , E. (1988), Treating the Self. New York: Guilford Press .
Psychoanalytic Inquiry, 2004; v.24 (3), p453 (15pp.)
PI.024.0453A
Record: 16
Title: Holding and Facilitating Interactive Regulation in Couples with Trauma Histories
Authors: Feld, Barbara
Source: Psychoanalytic Inquiry, 2004; v. 24 (3), p420, 18p
ISSN: 07351690
Language: English
Abstract: I discuss theoretical models of individual development in a dyadic system and their
importance for couple therapy. These models are based on early infant research about the
dyadic system created between caregiver and child and include ideas about self-regulation
and mutual regulation. These related and overlapping theories are also relevant to the use
of couple therapy with partners who have histories of early trauma. Traumatized
individuals tend to use avoidant, disorganized, or ambivalent strategies of stress
regulation, as opposed to secure and responsive ones. These strategies cocreate
problematic interactive patterns in their couple relationships. It is therefore important to
establish a therapeutic atmosphere of empathy, responsiveness, and trust that facilitates
the partners' capacity to change their interactive patterns. This therapeutic atmosphere
serves as a model for the partners that aims to promote more secure attachment,
understanding, and growth.
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Accession Number: PI.024.0420A

(Permalink): direct=true&db=pph&AN=PI.024.0420A&site=ehost-live&scope=site
direct=true&db=pph&AN=PI.024.0420A&site=ehost-live&scope=site">Holding and
Facilitating Interactive Regulation in Couples with Trauma Histories</A>
Holding and Facilitating Interactive Regulation in Couples with Trauma Histories

Barbara Feld, MSW, author, is Head, Family Therapy, Mt. Sinai Hospital Department of Psychiatry. She also is in private
practice.; 1150 Fifth Avenue, #1C New York, NY 10128 barfeld30@hotmail.com
I discuss theoretical models of individual development in a dyadic system and their importance for couple therapy. These models
are based on early infant research about the dyadic system created between caregiver and child and include ideas about self-
regulation and mutual regulation. These related and overlapping theories are also relevant to the use of couple therapy with
partners who have histories of early trauma. Traumatized individuals tend to use avoidant, disorganized, or ambivalent strategies
of stress regulation, as opposed to secure and responsive ones. These strategies cocreate problematic interactive patterns in
their couple relationships. It is therefore important to establish a therapeutic atmosphere of empathy, responsiveness, and trust
that facilitates the partners' capacity to change their interactive patterns. This therapeutic atmosphere serves as a model for the
partners that aims to promote more secure attachment, understanding, and growth.
Psychoanalytic thinking has been evolving to include new models of individual development in a dyadic system. In the past,
individual therapy and couple therapy moved on parallel tracks. Drawing more on relational and systems models in
understanding the individual, some aspects of psychoanalytic thinking and the systems models used in couple and family work
are moving closer to one another. These attachment and dyadic systems approaches focus on self-regulation and interactive
regulation of affect—a bidirectional view. Therefore, they have considerable relevance to work with couples and their interactive
difficulties.
In this paper, I illustrate the therapeutic and conceptual advantage of integrating attachment theory and dyadic systems theory in
viewing the intergenerational transmission of trauma (van der Kolk, McFarlane, and Weisaeth, 1996; Lyons-Ruth, 2001; Tronick,
2002). I specifically discuss these related and overlapping theories and their importance for couple therapy, especially as they
apply to couples with family histories of early trauma. In addition, I discuss the concepts of vulnerability and rupture-repair as they
relate to therapeutic work with these couples.
The results of family trauma often appear in unexpected and discontinuous ways within an individual's relationships. Traumatized
individuals tend to use avoidant, disorganized, or ambivalent strategies of stress regulation (Lyons-Ruth, 2001). Because of each
of their disorganized, less coherent patterns of relating, they are often either embroiled in combat or disengaged, blaming, and
distrustful (van der Kolk, 2002). Each partner with a family traumahistory did not feel safe in his or her family of origin. Each has
no context in which to assume that he or she will be safe in his or her current nuclear family. Because each often associated love
with trauma, it is possible he or she will continue to do so. As a result, an individual most in need of holding would be unable to
ask for or elicit it.
I propose that an aim of couple therapy is to help the partners to become aware of and better regulate the cocreated, interactive
aspects of their relationship, which includes the aspect of listening to each other. To do this, it is helpful for the therapist to foster
the development of understanding, accessibility, and responsiveness in both partners. However, each partner first has to be
understanding and accepting of himself or herself. Helping each partner to develop self-understanding is particularly difficult with
couples whose early trauma histories are implicit and hidden disrupters in their psychic equilibrium. Couple therapy can provide a
holding and facilitating environment that promotes the expression and exploration of each partner's relational patterns and the
couple's relational processes—keeping in mind each partner's needs for safety.
My theoretical framework and method of working are derived from key concepts in attachment theory(Ainsworth et al., 1978;
Bowlby, 1969; Main, Kaplan, and Cassidy, 1985) and dyadic systems theory (Tronick et al., 1998; Lachmann and Beebe, 2002;
Sander,2002). I find two linked concepts derived from attachment theory useful: The individual develops internal working models
that persist over time, and the individual grows up with implicit relational knowledge(Lyons-Ruth, 1998). Another useful concept is
derived from empirical face-to-face mother-infant interaction (Tronick et al., 1998; Lachmann and Beebe, 2002; Sander, 2002):
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The individual grows up within a dyadic systems matrix. Winnicott (1965) also developed a similar systems approach with his
concept that there is no such thing as a baby—but rather a mother-baby unit.
When the security of a bond is threatened, a person responds with typical attachment-seeking behaviors, which were designed in
childhood to maintain attachments in the face of loss. Bowlby (1969) called these internal working models. Bowlby (1980) thought
that these reciprocal interactions between mother and child during the first five years of life form the template for later
relationships. It follows that a person makes connections and forms attachments according to the model he or she derived from
patterns of interaction in his or her family of origin. These working models can be observed in patterns that partners establish with
each other. They interact in a reciprocal influencing system. The patterns embedded in the system can cause problems for the
couple. Although these behaviors may seem disruptive in the present relationship, the partner unconsciously feels they are
needed to maintain the attachment. Problematic behaviors(e.g., angry outbursts, hypervigilance, withdrawal) may be part of the
pattern. Unfortunately, these responses confirm the person's negative perception and further evoke the attachmentbehavior. The
partners are then caught in an ongoing cycle.
These patterns, however, are not writ in stone and can change as the partners are exposed to new relational experiences.
Therefore, the building blocks of secure attachment need to become available in the therapeutic setting (Johnson, 1996). This
can provide the partners with an experience of different models of relatedness as well as a model for greater flexibility in their
own responsiveness.
This attachment model is extremely helpful in understanding each person's patterns of attachment and his or her internal working
models. It seems to me that a related concept, implicit relational knowing(Lyons-Ruth, 1998), adds to this theory by focusing on
the implicit, nonsymbolic way a person learned the process by which he or she cocreates a relationship. This concept focuses on
the interactive relational patterns that affect ways of being with others learned in the context of a child's relationship with others
and communicated by way of highly practiced sequences of actions. Mutual regulation then cocreates a dyadic system (Beebe
and Lachmann, 1998, 2002; Tronick et al., 1998; Sander, 2002; Tronick, 2002). For example, a child learns early in life what
forms of affectionate approaches a parent welcomes or rejects. These implicit modes become models for the child's affectionate
approaches to others thereafter. The modes may not be symbolically encoded and therefore are not accessible to
consciousattention (Tronick et al., 1998; Tronick, 2002). Because they are not conscious but are cocreated in an interactive
system, they can be very difficult to access and change without the intervention of another, outside the dyadic system—creating a
new, triadic system.
Another related and overlapping theory, a dyadic systems perspective, as applied to psychotherapy from research on face-to-
face infant-caregiver interaction, emphasizes the process and systems aspects of dyadic interactions (Sander, 1975, 2002;
Beebe and Lachmann, 1996, 2002; Tronick et al., 1998). Infant research illustrates that the basic processes of interaction at the
nonverbal level remain similar across the life span. This perspective is a significant contribution to understanding dyadic patterns
of interaction and their effect on self-regulation and interactive regulation. This reciprocal relational process shapes each
partner's individual state of consciousness and is shaped by it. Co-construction of interactive patterns, mutual regulation, and
self-regulation, unique to each dyad, is central to this approach (Beebe and Lachmann, 2002). This focus endorses a totally
bidirectional view of each partner's contribution to the organization of the dyad. In the bidirectional view, each person's behavior
is predictable from that of the other, not caused by it (Tronick et al., 1998; Lachmann and Beebe, 2002; Tronick, 2002). Although
this view relates to infant-caregiver or patient-analyst interaction, it applies as fully to couple interaction. It is interesting to note
that a pattern such as “chase and dodge” (Beebe), in which the mother looms toward her baby's face and the baby moves his
head and body away, seems very similar to the pursuer-distancer marital pattern described by family therapists. In this scenario,
one partner insists on intense interaction, and the other distances and separates himself with television, computer games, work,
and so forth. It is therefore important to access the system thus created in order to be helpful to the couple.
To summarize, I find the related and overlapping attachment and systems theories I mentioned useful in my work in the following
way. Attachment theory and the idea of internal working models are very helpful in understanding each partner, his or her
attachment style, and their internal working models created through interactions in the family of origin. The idea of implicit
relational knowing adds a more nonconscious, dyadic, cocreated, and interactive dimension to my understanding of the couple.
Addition of a dyadic systems focus gives the therapist a process idea of the partners' ongoing, interactive impact on each other.
In this continuing cycle, each partner shapes and is shaped by the other. As I discuss later, the systems perspective gives an
added dimension to understanding the therapeutic relationship (Lachmann and Beebe, 2002).
These theories have evolved with a different vocabulary, and each focuses on different aspects of related phenomena. I find
these different aspects useful in my expanded thinking about couple work. I think it is important to note that a change in the
theory results in listening and intervening differently. For instance, transference-countertransference is now seen as a complex
system involving multiple matrixes. The therapist is always watching for a pattern and for the unconscious assumptions and
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implicit relational knowing each partner brings to the interaction. These ideas are particularly helpful in dealing with early trauma
because trauma is carried in a nonverbal, somatic, and implicit fashion. They help me tune in to the possibility of unknown
reactions that resurface at unexpected moments.
I find it particularly important to establish the therapeutic situation as an area of safety, a holdingenvironment(Winnicott, 1965),
that the couple can use as a secure base from which each can explore his or her wishes to be understood by the other (Clulow,
2001). The therapist's ability to accept all of the partners' affects, especially the unexpected, disorganized ones, contributes to
this containment and holding. The holdingenvironment is not just part of an overall relationship but is one element in the
therapeutic action. It is a change agent in its own right because it provides an ambiance different from what existed in each
partner's family of origin and can serve as a model for the emotional tone that the partners might be able to create. It is important
to recognize, however, that a dynamic system also exists in the interactive relationship of therapist and couple, with the therapist
working to self-regulate and calm herself in an atmosphere of extreme tension and disorganization. The holdingenvironment is an
ideal in the therapist's mind. It is helpful in creating a safe haven but is not always attainable because patients and therapists
react differently from within their own subjectivity.
Because of each partner's vulnerability, disruption in the couple and therapeutic relationship is quite likely. The principle of
disruption and repair of interactions comes from the principle of ongoing regulation (Tronick et al., 1998). It organizes violations of
expectations and subsequent attempts to resolve these breaks. Infant research indicates a wide range of interactions
encompassing the term disruption—from mild, easily rectified disruptions to severe ruptures (Tronick et al., 1998; Beebe and
Lachmann, 2002). The capacity to repair a disruption is learned implicitly in patterns of regulation in the family of origin. The
couples I am discussing have not had the experience of repair.
When I start to work with a couple, especially one in which each partner has a family history of trauma, I try to establish a
listening stance that aims to facilitate a sense for each partner of being attended to and understood. This process requires a
modeling of the direct communication and cooperative, coherent discourse that are so necessary in the repair cycle between
people. I try to tune in to each partner's deeply felt and expressed emotions, the partners' communications, and the patterns they
have established and continue to maintain. Hopefully, the therapist's attempts to contain and bear these feelings begin to help
each partner bear his or her own emotions and that of the other. Each partner then can feel that his or her emotions of fear, hurt,
shame, anger, and longing, for example, can be expressed without either feeling that his or her emotions are being negated or
are too intense to manage (Johnson, 1996). This work can help each partner to regulate his or her distress in a new way. This
scenario is an ideal, of course, and subject to disruption, as I describe later.
Ideally, focusing on the system of interaction that has been established between the partners helps me to stay out of the pull to
side with one or the other partner. The triangular therapeutic system, including the therapist's subjectivity, gives the partners an
opportunity to broaden their range of responses and relate more flexibly. Introduction of the therapist's subjectivity can provide a
new element in the partners' interaction, which gives them a space in which to think instead of react. As each person relates to
different people from separate aspects of themselves, each partner's broader capacities are enacted with the therapist, often to
the surprise of the other partner, thus providing an opportunity to change the system.
It is helpful to see how events in a person's environment can stimulate or resurrect a particular vulnerability in his or her psychic
structure. Because attachment needs arise with special intensity during times of vulnerability, when each partner is again
subjected to trauma, a fight-flight reaction is more likely to occur (van der Kolk, 2002). The events in New York City on September
11, 2001, shockingly and dramatically changed the felt level of safety for everyone. New York became a war zone, a place of
death and destruction, in which few people felt contained and held. This situation was illuminating for clinicians because we
became aware that previously traumatized people reacted to these events in idiosyncratic ways. In particular, it intensely
decreased feelings of safety within each traumatized individual—feelings that might have helped sustain some balance within the
traumatized couple system. As a result of their early relational experience, these people often had a difficult time being
compassionate with one another's painful experiences.
To illustrate my ideas about the usefulness of attachment and dyadic systems theory in facilitating interactive regulation in
couples with early family trauma histories, I discuss a couple I had seen for several months before September 11 and continued
to see afterward.
Rachel, 39, was from a Southern patrician family. Matt, 40, grew up in a small business family in a rural town in Maine. They had
been married for eight years. Rachel and Matt had multiple levels of trauma beginning in early childhood. Both came from
alcoholic families with abusive fathers who were either remote or irrational depending on their alcohol consumption. Rachel's
father was verbally and physically abusive. Her mother did not protect her children from the father's rage but finally left him when
Rachel was 13. In addition, Rachel was raped at age 16 as she left a school dance, in a place of presumed safety. When she told
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her parents about the rape, they did not acknowledge her experience. She felt alone and abandoned in their presence. This is the
type of phenomena attachment theory thinks of as creating internal working models.
Matt's father was physically abusive as well, especially when feeling threatened or anxious. His mother did not attempt to protect
her children during those rages. At other times, the father was affectionate and loving. When Matt was nine, male friends of the
family sexually abused him. He says he remembers when as a child he was thinking, “Forget love. When you let someone love
you, you get hurt.” This created a working model that colored Matt's experience of himself and his interaction with others.
Their parents' erratic behavior left Rachel and Matt feeling that they had no control over safety factors in their environment. The
effect of their parents' erratic behavior lives on in their implicit relational knowing and emerged in their behavior toward each
other. Rachel found solace in painting, which helped her maintain some sense of order and control over her world. When she
graduated from college, she went to Florence, Italy, to study for three years. Matt immersed himself in playing the violin. His
mother had great hopes that he would become a concert violinist. Her expectation had an aversive, controlling influence over him
as well as a positive bonding aspect. Matt became aversive to being controlled. This reaction was exacerbated by his severe
juvenile diabetes, which caused him to black out unpredictably, even when performing. Eventually it contributed to his decision to
seek another career.
Confrontations and attempts to discuss difficult issues were impossible in both of their families. Statements such as “That
[physically or emotionally] hurt me” were disallowed. Although Matt's father's rages clearly frightened the entire family, there were
implicit and explicit prohibitions against discussing that fear, and no one ever did. For both Rachel and Matt, these experiences
created internal working models of avoidance of communication for fear of criticism, retaliation, or disengagement. It became a
pattern for them to be dissociated. As neither Rachel nor Matt could expect others to be protective, for Matt survival depended on
withdrawal and for Rachel it depended on selective inattention to perceived hurt and loss.
Before they were married, Matt and Rachel had formed a rescuer relationship. Rachel was called to come and get Matt whenever
he had a blackout, and Matt listened to her fears whenever she felt threatened in a given situation. They shared a romantic vision
of providing each other with total safety and of having a child who would further affirm this bond. Their marriage, however, altered
the context of their relationship. As a result, there was a system shift within the marital context, and experiences such as the
rape, which had been kept out of the relationship, were drawn in. To Rachel, marriage meant men controlling women, including
sexually, which reminded her of her rape. To Matt, marriage proved his masculinity but created the possibility of being controlled
by someone he loved. For each partner, marriage also reevoked internal working models of family relational patterns. The context
of marriage, therefore, changed the experience of the relationship from one that provided safety and rescue to one of possible
trauma and a defensive battle for control. Although premarital sex had been good, Rachel now responded with panic to sexual
encounters, and Matt responded with rage, or with disengagement, to what he perceived as her control. His anger, though not
physical, further reminded her of lack of safety, and his disengagement, of total abandonment. Her panic, rage, and subsequent
withdrawal, as protective mechanisms, escalated the situation. Matt's response was to feel hurt, frustrated, and angry. The
security of their bond was threatened, and they reacted by their typical attachment behaviors of hypervigilance and withdrawal.
Here we can see how the residues of early patterns hook into each other in a very toxic way.
Before September 11, we were working on the marital system I just described—Rachel's wish for a child and her anger at Matt for
what she perceived as his denial of this wish (Matt had been impotent the preceding year). September 11 changed the context of
their lives from one of relative physical safety to one of disaster. They live near Ground Zero and saw the disaster site almost
daily. Their physical world now confirmed their psychological dread. Both of their trauma histories were evoked, and Rachel
became symptomatic (see van der Kolk, 2002). After September 11, Rachel became almost phobic with the idea that she would
be stuck in a slow-moving train in a tunnel, and it would be bombed. When they arrived separately in my office, Rachel often
recounted, with pressured speech, her experience of the train, the bodies pressed against her, her wish to kick and push the
people next to her to create space around her, and her rage and panic at being in that situation. Matt's response to her distress
was to try to calm her or to use humor as a way of self-regulation. Rachel could not trust Matt and took his reaction as not
compassionate, which further escalated both of their feelings of fear and isolation.
Initially, my reaction was a mildly guilty feeling that Rachel was coming uptown to see me in my relatively safe situation. Although
we had all experienced this trauma, we each experienced it within our own subjectivity, which must have affected the system we
had created. I wondered whether I could soothe them and maintain the holdingenvironment while I was anxious and Rachel's
anxiety was affecting my own. I needed to self-soothe before I could help them to regulate their interaction. However, my
understanding that she was expecting not to be understood, as part of her internal working model, informed my attempts to help
her to continue to express her feelings and to calm them. My comments were aimed at calmly containing the anxiety she felt with
a soft, soothing voice. I attempted to enlist Matt in an understanding mode of responding to her. However, she reacted with anger
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to his use of humor, and he became frustrated at her lack of empathy toward him. I tried to help them both to become aware of
each of their vulnerable feelings and need for comfort.
We came to understand more fully what was involved in Rachel's panic when taking trains. Closely packed trains had always
evoked bodily memories of her rape, but under ordinary circumstances she had these responses under control. The
retraumatization of September 11 stimulated these memories and made them more difficult to contain. Matt's reaction at that time
made him unavailable to help with her responses. His (perceived) lack of support caused her further distress and reactivated
memories of her parent's lack of responsiveness. Her reaction angered him because he consciously wished to be supportive.
This aspect of their relationship was a constant source of strain for them and proved to be a difficult transference-
countertransference dilemma as well. At times, I thought I was being responsive to Rachel, but she did not experienced it as
such. This pattern was frustrating for me and evoked my feelings of not being understood. At such times, I found it helpful to
observe and comment on their relational system from a reflective position outside their interaction, while recognizing that the
therapist is always part of the system. (Using the therapist's reflective stance as a model, it is often useful to suggest that the
partner's emotions be expressed from a subjective rather than blaming position. This approach is a powerful way of helping the
partners in a stressed relationship to think about their feelings and to rephrase each of their responses. The therapist can
facilitate this by translating the partner's statements so that communication is used to inform rather than manipulate and to
encourage understanding and connection rather than mistrust and disconnection.)
Rachel and Matt exhibited an oscillating pattern of angry attack and withdrawal at times of emotional stress. To be helpful, I had
to be able to elucidate each of their attempts to manage their feelings of vulnerability and shame. One way I did this, for example,
was to translate Matt's humor, withdrawal, angry faces, and so forth as his way of regulating his feelings of vulnerability and need
and to translate Rachel's panic and anger as her way of regulating those feelings. As in the example I just discussed, when
Rachel and Matt each understands the other's needs, each of their patterns of responding with anger diminishes. Knowing that
the negative affect they perceive in one another is a result of each of their reactions to a threat to the relationship helps in further
deciphering their process. The angry response she has is her attempt to insist that he change his humorous or withdrawn
behavior and help her feel less isolated and alone. His avoidant, angry withdrawal is his attempt to protect himself from her
criticism, which he responds to as a validation of his feelings of being unlovable. My approach here is to focus first on each
partner's insecurity, longings, and fear of loss of connection. I then focus on the ways in which these result in patterns of
interaction that maintain and organize the other's responses in a cycle of reciprocal influence. My description of their observable
interactions and the system they maintain often helps them to see how each of their behaviors reinforces the other's responses in
a continual “feedback loop.”
I try to attend to each partner's nonverbal communication based on his or her implicit relational knowing. Nonverbal experience
draws on deep patterns that are out of awareness and created from early attachment experiences. Nonverbal communication is
therefore an important aspect of each person's emotional expression and the partner's emotional interaction. This includes their
physical orientation toward or away from each other and the congruence of their affect with their verbal and facial expressions.
Well-functioning couples usually are coordinated in taking turns and cuing in a mutually regulated dance. Partners with interactive
difficulties are mutually regulated as well, but in a more chaotic, interrupting system. Facial expression transmits emotional states
to both partners and is associated with patterns of psychological arousal (Beebe and Lachmann, 1998). Partners are sensitive to
the gaze of the other and respond to matching and mirroring. Some partners are avoidant of each other's gaze in a mutually
regulated fashion, with resulting feelings of abandonment. In other couples, one or both partners are highly vigilant regarding the
affects expressed by the other.
Matt has a very expressive face and is unaware of the emotion it expresses or its impact on Rachel, who vigilantly observes
emotion in others. At times during a session, Rachel reacted to what she perceived as his anger at her. On these occasions, I
also noticed his facial expressions, and it was helpful at those times for me to ask him whether he was aware of the expression
on his face. He usually wasn't. I wondered about his experience of his own expression at that time. This helped him to get in
touch with his own inner reaction and then to talk about it. This way of working with affect is helpful only after the therapeutic
relationship is experienced as safe. It is possible that this intervention could be taken as critical or shaming and could undermine
the person's sense of safety. Therefore, it is important to be aware of the ongoing need for safety in the therapeutic relationship.
Family-of-origin work is especially important with traumatized couples because it helps each partner to understand his or her
response to the other from the perspective of his relational past and the implicit patterns and internal working models each had
established. During this exploration, it becomes clear that the episodes that occurred in each of their families of origin were
usually much more severe than they are in the couple relationship but are responded to as though they are the same. The
partners' implicit reaction then causes their negative interaction to escalate and, at times, results in duplicating the scenes from
each of their families of origin. I actively draw the parallels between the partners' patterns and the patterns from their families of
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origin. The partners can then increase their understanding of their interactions and begin to de-escalate them. I talk about the
contexts and environments in which they lived, like the air they breathed, and that it is understandable that they are reacting as
they are. Here the use of dyadic systems thinking informs and changes technique by contributing an understanding of the
patterns and processes of interaction and their intergenerational transmission. This understanding helps the therapist to create
an atmosphere in which the partners can think about these patterns and begin to interrupt them in their own relationship.
In one session, Matt and Rachel were arguing about his lack of attentiveness to her and her feeling that he tuned her out. In the
middle of her accusation, almost as a throwaway, she also stated that she knew that she wasn't interesting, and he became
furious. I stopped the interaction to disentangle the threads of the argument. In her family of origin, Rachel's role was that of an
artistic but uninteresting person who had to take a back seat to her mother. She accepted this about herself on one level but
resented it and was enraged by any context in which that aspersion might be possible. As stated earlier, Matt came from a family
that was so bellicose that he learned to tune people out. Unfortunately, he disconnected and tuned Rachel out even when she
didn't seem to be attacking, but when he felt threatened for some reason that was not readily apparent to her. When he withdrew,
she then felt uninteresting—one of her internal working models. Disentangling these threads and then exploring them with the
couple seemed to help them to begin to better understand each other and de-escalate their reciprocal patterns of interaction. This
example illustrates how attachment theory and the concepts of internal working models and implicit relational knowing are so
helpful in deepening a therapist's understanding of partners' repetitive interactions.
The transference-countertransference relationship is mutually created and regulated and is based on relational patterns that are
often implicit. Some partners are able to collaborate with me in creating a safe place in which they can expose their vulnerability
in the hope of being understood and contained. My capacity to be attuned becomes part of this cocreation. Partners with
traumatic histories have a more difficult time establishing this type of therapeutic alliance, as part of each of their implicit
relational knowing is to anticipate danger. The therapist's office, therefore, may also be experienced as a dangerous place. What
a therapist might offer as a presumed helpful and understanding comment might be reacted to as its opposite. In addition, what is
taken as helpful by one partner may not be taken as such by the other.
One of the implications of systems thinking is that the therapist has to pay attention to multiple systems—the couple system, the
therapeutic systems (therapist with couple, therapist with each partner), and the conscious and unconscious of each person in
each dyad. Although it is impossible to be consciously attuned to all these systems at the same time, the therapist can usually be
peripherally attuned to them. If attention to one aspect is given up, as in the example to be described, the therapy could be in
trouble. As I stated earlier, each partner can experience the therapist's responses in his or her own fashion. At times, the
therapist's empathic stance toward one partner might hurt the feelings of the other, causing a disruption in the therapeutic
relationship. A very frustrating example of this occurred early in my treatment with Rachel and Matt and has occasionally returned
to haunt the treatment since then. Rachel was discussing her fear of having infertility problems because of Matt's impotence the
preceding year. In his perception, her insistent, compulsive attempts to become pregnant had elicited Matt's avoidance of sex and
subsequent impotence. Her way of organizing her world stimulated feelings of humiliation and only allowed her to think that she
was uninteresting or unattractive. It was difficult for him to dislodge her assumptions with reassurance, because her conviction
was intransigent. Discussion of their reciprocal interaction was not helpful in this situation. I tried to work with each of their
attempts at self-regulation. Rachel's position, however, was fraught with intense anxiety and had become controlling and
inflexible. I tried to work with Matt's response of anger and withdrawal, as control was a problematic issue for him. However, his
impotence persisted.
I felt pressured to come up with some solution that would allow Rachel to become pregnant while working on the problems in
their relationship. As a result of the pressure I was feeling, I became misattuned to them and lost my usual system-centered
focus. I explored other ways that they might try to become pregnant. (I had been seeing them in couple sessions with an
occasional individual session for each to help establish and then strengthen a secure base for the therapeutic relationship.) In a
scheduled individual session, Matt talked about his guilt at his impotence and his growing understanding of the pain Rachel was
feeling at not becoming pregnant. I raised the idea of individual sex therapy with him, but he was not ready at that time. In
addition, in my need to be helpful, I discussed with him how he might feel about artificial insemination. (He did not respond as
though he felt singled out, but of course this was a possibility.) That evening, Matt discussed artificial insemination with Rachel in
an attempt, he said, to show her some understanding of the pressure she was feeling for her to become pregnant. She became
angry at Matt but did not show any anger toward me at the time. She continued to come to sessions, but often she was late and
arrived with many excuses about train schedules. Her avoiding her anger was reflected in my avoidance and in Matt's as well.
Months later, during an angry outburst about another of Matt's actions that she perceived as insensitive, Rachel revealed her
rage at him and anger at me. She felt that we both should have understood that she would feel totally invaded by artificial
insemination. However, she had continued to come because she had felt that I had been attuned to her in the past. Any attempt
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to investigate the possibility of her having a conflict over pregnancy would have failed at that time. However, sharing my
understanding that someone who had been raped might feel raped again by artificial insemination helped repair my breach of
empathy to some extent and allowed her to feel responded to by me. This incident did not go away; it continued to be resurrected
whenever she became angry with Matt for some perceived misunderstanding. The experience further enlightened me about
Rachel's vulnerable and distrustful reactions and about Matt's reactive tendency to fearfully avoid her anticipated anger. I also
became aware, once more, of my own tendency to avoid some very vulnerable patients' angry feelings. The therapist's own
acknowledgment of frustrations and empathic failures may help each partner to be able to accept his or her own failures and
missteps. In addition, by example and through the therapist's empathic stance, each partner can process his or her own
experience and construct new meaning.
Change in therapy occurs through an event, interaction, or intervention that alters the system. Each event alters subsequent
events, and a system is never exactly the same again. As applied in couple therapy, a couple's interactions can change as a
result of the processing of a difficult treatment experience with the therapist. When the session focuses on one partner's
experience, and things go well, the other is able to observe and experience the work for himself or herself. Each partner can then
be encouraged to respond in a new fashion. The idea is that encouraging one partner to be an observer within the interactive
field allows him or her to think rather than be pressured to react. This enables that person to understand the other and to react
differently when encouraged by the therapist.
For example, Rachel related an incident in which she had felt violated by her gynecologist's intrusive questions and his
revelations of his own sexual encounters. She was annoyed that Matt hadn't respond as she had hoped. He said he hadn't tuned
in to what felt to her like a reenactment of her rape because she hadn't been physically threatened. When she became upset
again, in the session, he became confused that their discussion of the incident had turned into a discussion about his response
instead. I intervened here to help refocus on Rachel's need for a response and Matt's wish to give one. I suggested she talk
about what she would have wanted from him when she told him about the incident. As she talked, she became reflective about
her own responses and said that she didn't feel that Matt was “there for her” and she didn't know why. He had been listening and
said that he realized she hadn't had a man who had been responsive to her in her childhood, and he really wanted to be
supportive of her. I said that both of them felt that they had not had the experience in their families of anyone being responsive to
them, and they continued to demand responsiveness but expected nonresponsive behavior from others. It was difficult for them
to sense how to be responsive and to respond to others. They left the session feeling more compassionate toward each other's
feelings and experiences. However, this ability to be compassionate toward each other continues to be transitory and needs the
help of a responsive other to make it happen. This type of experience will accumulate in the sessions so as to begin to alter the
couple system and the partners' perceptions of each other.
In conclusion, the actuality of the clinical work occurring in the midst of catastrophe allowed me to think about the impact of
trauma as an organizer of experience. As a result of the difficulty in working with past trauma amid further trauma, I had to reflect
on the helpfulness of key elements of new psychoanalytic theories in understanding my therapeutic work. In addition, the
commonality between these attachment and dyadic systems theories along with the concepts of implicit relational knowing and a
holdingenvironment allowed me to integrate a view of the systemic intergenerational transmission of trauma and a therapeutic
approach to these phenomena.
Establishing a therapeutic atmosphere of safety facilitates the partners' capacity to change their patterns of interaction. To create
this atmosphere, the therapist attempts to establish a holdingenvironment that promotes self-understanding and mutual
understanding through examination of implicit patterns of interaction established early in life. This understanding is then applied
to the system that has been cocreated between the partners. The therapeutic atmosphere of empathy and responsiveness
serves as a model that aims to promote more secure attachment, understanding, and growth.
References
1
Ainsworth , M. D. S. , Blehar , M. C. , Waters , E. & Wall , S. (1978), Patterns of Attachment: A Psychological Study of the
Strange Situation. Hillsdale, NJ: Lawrence Erlbaum Associates .
2
Beebe , B. & Lachmann , F. (1996), Three principles of salience in the organization of the patient-analyst interaction.
Psychoanal. Psychol., 13 : 1-22. (PPSY.013.0001A)
3 Beebe , B. & Lachmann , F. (1998), Co-constructing inner and relational processes—Self and mutual regulation in infant
research and adult treatment. Psychoanal. Psychol., 15 : 480-516. (PPSY.015.0480A)
4
Beebe , B. & Lachmann , F. (2002), Infant Research and Adult Treatment. Hillsdale, NJ: The Analytic Press .
(JICAP.002D.0061A)
2/6/2018 EBSCOhost
5
Bowlby , J. (1969), Attachment and Loss: Vol. 1 . New York: Basic Books . (IPL.079.0001A)
6 Bowlby , J. (1980), Attachment and Loss: Vol. 3 . London: Hogarth Press . (IPL.109.0001A)
7
Clulow , C. (2001), Attachment theory and the therapeutic frame. In: Adult Attachment and Couple Therapy, ed. C. Clulow.
London: Brunner-Routledge , pp. 85-104.
8
Johnson , S. (1996), Basic Principles into Practice Series: Vol. 11 . The Practice of Emotionally Focused Marital Therapy. New
York: Brunner/Mazel .
9
Lyons-Ruth , K. (1998), Implicit relational knowing: Its role in development and psychoanalytic treatment. Infant Ment. Health J.,
19 : 282-291.
10 Lyons-Ruth , K. (2001), Relational contexts of trauma. Presented at Freudian Society Trauma Conference, New York City.
11
Main , M. , Kaplan , N. & Cassidy , J. (1985), Security in infancy, childhood, and adulthood: A move to the level of
representation. Monogr. Soc. Res. Child Dev., 50 (1-2, Serial No. 209).
12
Sander , L. (1975), Infant and caretaking environment: Investigation and conceptualization of adoptive behavior in a system of
increasing complexity. In: Explorations in Child Psychology, ed. E. J. Anthony. New York: Plenum Press .
13 Sander , L. (2002), Thinking differently: Principles of process in living systems and the specificity of the unknown. Psychoanal.
Dial., 12 : 11-42. (PD.012.0011A)
14
Tronick , E. Z. (2002), A model of infant mood states and Sanderian affective waves. Psychoanal. Dial., 12 : 73-99.
(PD.012.0073A)
15
Tronick , E. Z. Bruschweiler-Stern , N. , Harrison , A. M. , Lyons-Ruth , K. , Morgan , A. C. , Nahum , J. P. , Sander , L. & Stern
, D. N. (1998), Dyadically expanded states of consciousness and the process of therapeutic change. Infant Ment. Health J., 19 :
290-299.
16
van der Kolk , B. A. (2002), Posttraumatic therapy in the age of neuroscience. Psychoanal. Dial., 12 : 381-392.
(PD.012.0381A)
17
van der Kolk , B. A. McFarlane , A. A. & Weisaeth , L. (1996), Traumatic Stress. New York: Guilford Press .
18
Winnicott , D. (1965), The Maturational Processes and the Facilitating Environment. New York: International Universities Press
. (IPL.064.0001A)
Psychoanalytic Inquiry, 2004; v.24 (3), p420 (18pp.)
PI.024.0420A
Record: 17
Title: The Significant Other and the Psychoanalytic Relationship: Reflections on Couples
Therapy
Authors: Gerson, Mary-Joan
Source: Psychoanalysis & Contemporary Thought, 1998; v. 21 (1), p61, 24p
ISSN: 01615289
Language: English
Abstract: Working with couples and families offers the analyst a fresh perspective on our working
assumptions regarding “real” relationships, that is how interaction with significant others is
heard and absorbed within the psychoanalytic relationship. In this paper, Edward Albee's
Who's Afraid of Virginia Woolf(1962) provides a springboard for investigating how extra-
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analytic attachments can shed light on: (1) our implicit psychoanalytic value system; (2)
current perspectives on the nature of the self; (3) the structure of narrative in
psychoanalytic treatment; and (4) the basic framework of the analyst-patient relationship.
Accession Number: PCT.021.0061A
(Permalink): direct=true&db=pph&AN=PCT.021.0061A&site=ehost-live&scope=site
direct=true&db=pph&AN=PCT.021.0061A&site=ehost-live&scope=site">The Significant
Other and the Psychoanalytic Relationship: Reflections on Couples Therapy</A>
The Significant Other and the Psychoanalytic Relationship: Reflections on Couples Therapy
Mary-Joan Gerson, PHD, author; 80 Central Park West, Suite C New York, New York 10023
Working with couples and families offers the analyst a fresh perspective on our working assumptions regarding “real”
relationships, that is how interaction with significant others is heard and absorbed within the psychoanalytic relationship. In this
paper, Edward Albee's Who's Afraid of Virginia Woolf(1962) provides a springboard for investigating how extra-analytic
attachments can shed light on: (1) our implicit psychoanalytic value system; (2) current perspectives on the nature of the self; (3)
the structure of narrative in psychoanalytic treatment; and (4) the basic framework of the analyst-patient relationship.
Introduction
This is the setting: It's 3 o'clock in the morning at the home of Martha and George, protagonists in Edward Albee's (1962)Who's
Afraid of Virginia Woolf?
Martha: (armed again): Well, maybe you're right baby, SNAP! It went snap tonight at Daddy's party. I sat there at Daddy's party,
… and I watched the younger men around you, the men who were going to go somewhere … and you weren't there! And it
snapped! It finally snapped! And I'm going to howl it out, and I'm not going to give a damn what I do, and I'm going to make the
damned biggest explosion you ever heard.
George: You try it and I'll beat you at your own game.
Martha: (Hopefully) Is that a threat, George, Huh?
George: That's a threat, Martha.
Martha: (Fake-spits at him) You're going to get it, baby.
George: Be careful, Martha … I'll rip you to pieces [p. 75].
Martha and George might appear at your office on Monday morning. In response to your routine opening inquiry, “How might I
help?” Martha might gaze fondly at George and demurely state, “We don't communicate well.” Where would you begin? What
inquiry would unlock this vise of sadomasochistic behavior? Alternatively, Martha might appear alone and describe a debilitating
experience of marital entropy, of rage and isolation. Would psychoanalytic treatment adequately engage her demons, one of
whom is George?
One could consider this therapeutic challenge from the perspective of modality choice. More and more psychoanalysts today are
working with couples1 with varying positions on integration (Wachtel and Wachtel, 1986; Scharff and Scharff, 1987; Luepnitz,
1988; Solomon, 1989; Gerson, 1996). There are inviting issues concerning the combination, sequencing, and compatibility of
individual and couples therapy. However, I think that what is particularly challenging from a theoretical perspective is to
reexamine exactly how our psychoanalytic frame accounts for the structure and press of “real” relationships, whose centripetal
force does not fully penetrate psychoanalytic engagement.
As psychoanalysts we essentially view the significant other as a palimpsest of past imprinting. Sullivan (1964) described the
relationship of self and other as crowded by “illusory meyous,” personifications of self and other that allow for the maintenance of
security systems and the suppression of information that would destabilize them. For Fairbairn (1952), the significant other
evoked an eruption of incompatible responses—to a simultaneously persecutory, enticing, and neutral “other.” Our psychoanalytic
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task is to enter, with the patient, into the boarded up and frightening chambers that house ghosts from the past and to name and
recognize them. However, we are sometimes stymied as analysts, as we stand in effigy for shadowy figures from the past or
present. What causes the impasse is that the relationship between people who share lives together has its own obdurate and at
times seemingly impenetrable internal coding. To account for this intractability, the systemic view is that intimate relationships are
so multifaceted and complex that they become organized in redundant loops of communication, verbal and nonverbal. Though
Martha's and George's reciprocity, circularity, and complementarity (systemic terms for describing relationship systems) are
particularly invariant and particularly grisly in content, the form of it (an interlocking and endlessly redundant process) is
regrettably what much of what we call intimacy is made of.
Where does an awareness of tangled extratransferential bonding lead us as psychoanalysts? For me, it leads to a nest of
extremely interesting questions, to wit: How does a focus on the relationship with the significant other reveal our implicit
psychoanalytic values regarding “real” relationships? What are the implications for our epistemology, particularly our constructs of
transference and countertransference? How does a focus on extratransferential relationships inform our current discourse on the
nature of the self? On the function of narrative? On the essence of what is mutative in psychoanalysis?
We will enlist George and Martha to serve as our significant other relationship exemplar in this discussion, and to that end, let me
provide a brief synopsis of the play:
The entire play takes place past midnight on a Saturday night in George and Martha's home on a New England college campus.
They are a childless couple in their fifties, Martha's father is the college president; George is an associate professor of history.
During a party at Daddy's house (as he's called), Martha has invited Nick, a recently arrived thirtysomething biologist, and his
wife, Honey, to follow them home. The visit results in a failed sexual liaison between Martha and young Nick. Over the next four
hours secrets are revealed and used as weapons: Nick married Honey because of a false pregnancy, and perhaps because her
father was wealthy. George and Martha share a twenty-one-year-old fantasy of having a son together. In his adolescence,
George accidentally shot both his parents. At the climax of the play, George murders their fantasied son.
The Psychoanalytic Frame: Significant Other as Protagonist

The potential integration of psychoanalysis and systemic couples therapy can be viewed from many perspectives. Like an
archipelago of islands floating between the mainlands of these two therapeutic orientations, each integrative formulation offers an
interesting visit or resting place. For the Scharffs (1987), whose perspective is largely informed by a Fairbairnian schema,
individual transferential experiences can be subsumed in a collective “contextual” transference which derives from a range of
personal experiences including “the mother's holding of the baby” and “the previous generation and its holding of the current
family” (p. 68). Paul and Ellen Wachtel (1986) frame their position on integration in terms of cyclical psychodynamics in which
“Life circumstances … maintain inner structures, which in turn contribute to maintaining the same basic life circumstances” (p. 6).
For me (1988, 1996), the psychoanalytic and systemic perspectives function most heuristically as figure and ground: One
organizes the treatment relationship and the other informs it. I think that work with couples and families widens our
psychoanalytic frame of inquiry and makes it more supple, but in what fashion?
First, our psychoanalytic tendency to organize transference data exclusively in terms of parental influence seems parochial after
categorizing family data within sibling and parental subsystems; sibling transferences have been neglected in our literature
(Lesser, 1978). Second, one begins to contextualize developmental attributions. If the subject is mother, one wonders about the
influence of father; for example, a denigrating mother is readily viewed as potentially reacting to spousal denigration. One begins
to experience an almost serendipitously enhanced neutrality, not of the cold abstinent variety, but rather a kind of kaleidoscopic
curiosity, a “what if” or an “at-the-ready” or an “on the other hand,” which evolves from honed practice in empathizing
simultaneously with multiple perspectives.
However, I strongly believe that the therapeutics of psychoanalysis and systemic couples therapy have an internal consistency
and integrity, each built from a different set of constructs. One can't simply mix and match these constructs. For example, when I
became interested in what I would call transference in working with families, I arrived at the same conundrum presented by all
psychoanalytic concepts including resistance and countertransference, ergo, what is transference to a couple? It is shared, but
how? It is certainly not averaged or summed. Martha and George are ferociously aggressive, but their aggression has sprouted
from different seed: Martha was narcissistically appropriated by her solipsistic, devaluing father; George has committed the
unspeakable sin of patricide, testimony to a curse of aggression which he failingly and flailingly attempts to undo. How do you
combine individual meaning systems without being facile or heavy-handed? The sculptor Henry Moore said, “There's a right size
for every idea.” It's like recognizing the obvious: Psychoanalytic concepts serve as explanatory constructions of dyadic
relationships systems. In fact I think that preserving a figure-ground relationship heightens our appreciation for the unique power
of both psychoanalysis and systemic couples therapy. As Schimek (1983) has pointed out, transference involves infinitely more
than the visitation of the past on the present. Rather, it is a state of consciousness, a worldview in which the discontinuity
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between fantasy and reality, and past and present is deconstructed, a radical renovation of subjectivity. In contrast, participation
in couples therapy offers individuals a highly focused and dense experience of their impact on another'ssubjectivity.
The Psychoanalytic Frame: The Significant Other as “Other”

There is a stunning moment in the play. Martha is regaling Nick and Honey with an account of a humiliating boxing match
organized by her father twenty years ago, in which she was able to tumble George into a huckleberry bush. George slinks off to
the garage and reenters the room, ominously carrying a long pointed object. Hearing him stalk back into the room, Honey and
Martha turn and scream in terror as he cocks the trigger of a hunting rifle. He fires and an umbrella flushes out of the barrel.
“Pow, you're dead!” George wryly announces. This is the essence of internally calibrated redundancy. Working with George and
Martha from either a systemic or psychoanalytic perspective presents a dilemma: Would a transferenceinterpretation of either's
behavior provide anything more than gladiator fare? Would a transferenceenactment represent anything more than one of their
playful interludes of triangulation, perhaps more neutralized than “hump the hostess”?
Family systems therapy, drawing on the work of von Bertalanffy (1968) in general systems theory, and the cybernetic
epistemology of Gregory Bateson (1972), addresses redundancy under the general rubric of patterning, the central template of
systems theory. We can look at patterning most accessibly through language, through its report (what we're saying to each other
in content) and command (how we're maneuvering each other through that content).
Early in Act I, Martha says: “C'mon over here and give your Mommy a big sloppy kiss,” and when George refuses, rather
poignantly asks, “Why don't you want to kiss me?” (p. 10). George reads this content as a gambit for domination rather than a
need for tenderness. (Is he incorrect? Could Martha even say?) What we observe here is their failure to decode mystifying
experience by means of stepping out of redundant loops of interaction and commenting on them. Their use of language has been
vitiated and corrupted, since over time the report of Martha's communication has been swamped by its command aspects. This is
true for all couples episodically, or in problematic domains, but for Martha and George, the inbalance between report and
command is extreme. The problem is not a matter of Martha's “castrating” behavior or George's own insecurities and defenses. In
fact Watzlawick, Beavin, and Jackson (1967) note viewers often glossed the drama with a gender biased reading, seeing George
as the victim because “he accuses her of strength while she accuses him of weakness” (p. 157). Martha and George's problem is
actually bigger than both of them, a systemic twilight zone of attack and defense. No linguistic statement can remove them from
the loop, nor, in Bateson's terms, can there be news of a difference.
Psychoanalysts are no strangers to befuddling report and command discrepancy. The heart of transference deconstruction is
figuring out just what the metamessage is to us as analysts, as we listen to the patient's recollections of experience. Sometimes
the metamessage seems radically at odds with the content of the data, and we feel dismissed or disoriented when the data
should call for sympathy. However, in psychoanalytic treatment, we keep faith in the verbal, interpretive decoding of discrepancy,
in “negotiating meanings” as Bruner (1990) would have it. We're able to keep faith, because we are subject to the disorienting,
maddening dual-channel communications by any given patient at most for four hours a week. For Martha and George, the
confusion exists twenty-four hours a day, and in fact the sadism and the masochism—the “Fun and Games” as the first act is
called—is probably as much a solution, a source of constancy, as a perversion. Martha and George probably surrender to
experiencing all communication in terms of the command message of attack, to avoid being flattened out by what Sullivan (1953)
proverbially called “a blow to the head” of sudden anxiety. George wants to believe that he evokes Martha's statement, “I swear
… if you existed I'd divorce you …” (p. 11), not that it catches him from behind.
The Backlighting of the Psychoanalytic Frame: Self and Selves

How can the pragmatics of communication—particularly the gap between report and command—inform our psychoanalytic work?
It can help us understand our difficulty in shifting dynamics and becoming a “new object” to the patient.
One of the reasons our patients resist seeing us as offering a new and nonreplicative relationship experience is because there is
a significant other who redundantly reinforces a familiar dynamic with the patient. Moreover, the dynamic is generally experienced
as central to the person's self construction. Couples work gives us a healthy respect for the way significant others organize the
self beyond past templates of internalization. It matters what the characterandpersonality of the partner is (Levenson, 1991a). In
fact, it is a limited, unilateral transference version of this data which is available to us in psychoanalytic treatment. Thus Martha
appears poorly differentiated and frozen in idealization of her father. It was probably inevitable that she would marry a man whom
she considered inferior to Daddy, but this inferior spouse could have been less hypervigilant, less acerbic, and more
accommodating than George. George is a key protagonist in his own right, not a reissue of Daddy or of a projected rendering of
Martha. Martha feels terrorized by her own aggression because she is married to George, not because she idealized her father.
And she may have to undo her redundant interactions with him, not with a figure in effigy, if she is to liberate herself.
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The implications for treatment are unsettling. It would mean that patients could assume very different gestalts of selfhood each
time they enter into a new relationship, right before our psychoanalytic eyes, and worse still, before they have acquired (in our
presumably stereoscopic vision) adequate insight! Moreover, it would mean reshaping the concept of countertransference in the
way it is being considered in more radical quarters of relational and interpersonal theory today. Namely, the person we “treat” is
someone responding to our personality and our characterological needs, and that no amount of supervision or personal
psychoanalysis in the world can prevent the vagaries of psychoanalytic coupling. We are in the territory of Spezzano's (1995)
recently proposed definition of consciousness as “the creation of minds in interaction” (p. 24) and a continent away from the
transference neurosis.
Today we are much more keenly aware of the real analyst. Almost all of psychoanalysis has become, in Mitchell's terms
“interactive” (1993), in Hoffman's constructivist (1991), or in Aron's “intersubjective” (1991). It's hard to find a corner of
psychoanalytic practice today where the real relationship isn't a backdrop to the transferenceenactment. However, as
psychoanalysts treating Martha or George, we might wonder about the scope of our savagery and whether it were adequate for
participation in Martha and George's psychic arena. Ellen and Paul Wachtel (1986) warn that, “Despite prevailing myths, all
therapists are not equivalent. Each of us has characteristics that inevitably enter into shaping which aspects of the patient's
personality and the patient's conflicts are most powerfully engaged in relation to us” (p. 295). This position urges a new and more
comprehensive self-reflection.
We are clearly in the area of self theory here. Today the self is under siege, challenged by an aggregate class action suit on the
part of feminists, postmodernists, cross-cultural psychologists, and cognitive scientists. Bruner (1990), in a recent text, notes:
Self has a peculiarly tortured history. Some of the theoretical trouble it has generated, I suspect, can be attributed to the
“essentialism” that has marked the quest for its elucidation.… Psychoanalysis, of course, was a principal essentialist sinner: Its
topography of ego, superego, and id was the real thing, and the method of psychoanalysis was the electron microscope that laid
it bare [pp. 99-100].
Bruner (1990) characterizes the contemporary self as “distributive,” a product of the situations in which it operates (p. 109).
Clearly psychoanalytic theory has emphasized the self as encapsulated, in Winnicottian terms as true or false, in Kohutian terms
as structurally coherent, in Atwood and Stolorow's (1984) view as cohesive, temporally stable, and positively affectively colored.
The swirl of reconstruction around the concept of the self largely arises from its conceptual location at the divide of a modernist
and postmodernist perspective, For Gergen (1991), “the final stage in [the] transition to the postmodern is reached when the self
vanishes fully into a stage of relatedness. One ceases to believe in a self independent of the relations in which he or she is
embedded” (p. 17). Analysts today are absorbing the rather shocking possibility that we are multiple selves. Mitchell (1993) has
begun to map this territory, delineating aspects of self which are multiple and discontinuous, as well as those which are integral
and continuous. He culls from this dialectic a therapeutic precept, that each of us is weighted along one end of this scale and
states, “Meaningful hope is generated in analysis precisely when a sense of continuity begins to emerge from within
disconnected fragments of experience or when a compulsive, rigid character armor melts into a new freedom to discover itself in
different forms” (p. 116). Radical questions arise. If the search for a true self means focusing on what is essential and context-
free, might this search be injurious to one's interpersonal relationships?
Psychoanalysis and Family Values

There is another issue, relevant to viewing the self as decentered, and this issue takes us into the disreputable realm of family
values. What really are our beliefs, our presuppositions about couple and family relationships? Isn't psychoanalysis actually the
history of an evolving set of family values? We wonder today whether Freud didn't underestimate the effects of real parental
abuse in turn of the century Vienna, emphasizing a modernist concern with inner rather than outer experience. We can
reconsider Winnicott's emphasis on the nonimpinging mother in a culture where parents have little time for their children who
preoccupy themselves with excessively regulated computer games. Levenson (1991b) concludes that “the history of
psychoanalytic ideas is a veritable palimpsest of cultural change and circularity” (p. 5). At the very least, observing the patterned
interactions of couples and families can sometimes invite psychoanalysts to refigure their presumptive assumptions about family
relationships, including gender constructions (Goldner, 1991). One even contemplates defiling our own most sacred cow, the
importance of an articulated subjectivity. In couples therapy, an unreflective and literal person, who would be extremely frustrating
in analytic treatment, can seem endearing in contrast to a psychologically minded but dismissive partner.
Actually I think there is a crucial value embedded in family therapy, which is an important one to add to the tapestry of
psychoanalytic work: This value is a belief in the capacity of people as patients to heal themselves through their significant
relationships. It is an article of faith that our personal redemption depends on the action of others.
Thus Willi (1987), a family theorist, notes:

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I depend on my partners for my self-realization.… This revolutionary aspect of applied systems theory has not been given
much attention so far; possibly, it has even been repressed.… It conflicts, too, with the different paradigms of the personality and
the goal of psychotherapy used by some individually oriented therapists [pp. 434-435].
As Perl (1992) notes, in T. S. Eliot's The Cocktail Party(1950), Edward Chamberlain asks “What is Hell? Hell is alone, Hell is
oneself … the other figures in it—merely projections,” a dramatic rendering of an early psychoanalytic perspective. In No
Exit(1949) by Sartre, Garcin declares “Hell is other people.” Garcin's statement is closer to the position offered here, namely that
we are all our own dybbuks and saviors. The genre shifts from tragedy to naturalism. Thus it is not Cordelia's blind commitment
to honesty, nor Lear's vanity that wreaks dramatic havoc. It is, rather, Cordelia's monocular vision of her relationship context. She
underestimates the envy she arouses in her insecure sisters; if she attended to it, she might naturally withdraw from her
privileged position with her father and he would consequently be less invested in her responsiveness. They are permutations of
each other.
If she were sitting alone in an analyst's office, Martha would likely face the terror of her aggression, the fact that her aggression
acts to deny her own desperateness and leads her to degradation. Nevertheless, it is possible that the harridan voice in her is so
multiply cued and so available that she may never be able to restrain it until George becomes someone who will not call it forth in
her. Similarly, no one more than Martha can deliver George from his hurtfulness and attendant self-hatred, since no one but
Martha has the same arsenal of reflected appraisals. In her gaze, he faces his murderous past wedded to his sadistic present; his
professional failure and denigration as a man by her own father; his substitutive power to humiliate and deprive her. Needless to
say the shift would not be easy. There are family therapy techniques developed to deal with expansion in rigid couples:
prescribing the symptom or heightening absurdity, for example. These interventions are often criticized by analysts as superficial,
mechanistic, and authoritarian. But they posit a value that is perhaps subversive, that a therapist can focus on disequilibrating
people to release healing functions, which they can provide for each other.
As psychoanalysts we generally more readily look at how relationship choice reiterates early developmental trauma; we are more
taken with the repetition compulsion in object choice than with an opportunity for expansion. And here I would like to propose an
observation that has emerged in my clinical work with families that weds the concept of repetition of trauma with the possibility of
healing. I have become convinced that the opportunity to help the significant other lies in precisely the same domain of character
as the propensity to hurt, that is we look for significant others who have a molecular personalitystructure of a certain sort: the
tendency to repeat and the possibility to redeem.
Martha fell in love with George. She tells Nick so:
There is only one man in my life who has ever … made me happy.
Nick: The … the what-do-you-call-it? … uh … the lawn mower, or something?
Martha. No; I'd forgotten him … George; my husband.
Nick: (Disbelieving) You're kidding.
Martha: You always deal in appearances? … George who is good to me, and whom I revile; … who can hold me, at night, so that
it's warm, and whom I will bite so there's blood; who keeps learning the games we play as quickly as I can change the rules; who
can make me happy and I do not wish to be happy, and yes I do wish to be happy. George and Martha: sad, sad, sad [pp. 88-89].
It is clear that Martha fell in love with a man who had the capacity to turn love into hate in an instant but who could also remain in
this “game” tenaciously and loyally. It's as if the radar in her security system operated both protectively and prophylactically. Now,
if she could prevail upon George to desist from ridiculing her, she would have the experience of mastering her own
developmental trauma, and of reconstructing her own self-system. Barnett (1971), in describing the magnetized coupling of the
obsessional and hysteric characters, states that sometimes marriage offers a “desensitization of neurotic hypersensitivity” (p. 77).
I think it is as yet a riddle as to when this desensitization occurs, but I don't think it's correlated with severity of pathology, but
rather something more quixotic and idiosyncratic. Phillips (1994) advises that psychoanalysts become desensitized to
contingency:
It is one thing to recognize the object—another person—as separate and to make him or her available for use, and quite
another to live in time and make accidents available for use. If it has been useful in psychoanalysis to think that there is an
instinct-driven self, we may need to add to this a self immersed in its contingency [pp. 8-9].
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Implicit here is another value that is embedded in psychoanalytic practice and in theory, that is, the ideal of the autonomous
individual. Though this value has been challenged by feminist psychoanalysts, couples therapists argue for an even more radical
position on autonomy, inviting partners to change each other so that neglected needs are redressed. The lure of autonomy has
permeated the self-help and popular psychology literature leading to a prevailing belief that the apex of psychic health is reached
when self and other are accepted as given.
In contrast, Minuchin's favorite statement (Panel, 1997) to a couple is “Change her so that you can change.” Family systems
theory explicitly challenges our Western notions of encapsulation and autonomy in proposing that we are organized by external
others and not simply by internal versions of these “others.” By this reasoning, whom we spend our lives with shapes the very
essence of our psyches as much as any dynamicmotivation for mate selection.
In fact, one of the very interesting aspects of couples therapy is that people who change their working definitions of the “other”
feel substantially or radically different themselves. If my experiencing a new or alternative version of you makes me feel like a
different person—a not uncommon experiential aspect of couples treatment—this raises intriguing questions about the
assumptions of the psychoanalytic one-person (drive-based), and even two-person (internalization-based) psychologies. We
would assume that openness to new data would require a very careful and gradual release of security operations. However, if the
release is facilitated and supported therapeutically with the significant other present, what seems to happen is that a ricocheting
of reflected appraisals occurs in a cognitive-affective micromoment, that is, she, seeing him differently, evokes her expectation
that she will be seen differently, and makes her feel differently toward him. This is a Laingian knot untied.
Psychoanalytic Narrative
Roy Schafer(1976) shocked the classical psychoanalytic community in the 1970s by advocating “action” language as a
replacement for interior language. His position has now been absorbed into centrist psychoanalytic ideology, and there is
currently considerable sympathy for the view that helping a person create a coherent life narrative provides the key to psychic
restoration. The interesting question here is: How do people tell their stories differently in individual and couples therapy and how
might attention to a shift in genre recursively help us examine what we consider essential about psychoanalytic narrative? In
other words, what kinds of therapeutic stories do we tell about the life-stories told to us? Clearly psychoanalytic treatment is
organized around the autobiographical narrative. From an analytic perspective, as is the case in Western culture in general, we
have assumed that a personal, individual narrative is an essential aspect of identity. Moreover, when cases are presented and
described psychodynamically, history is presented with a weighting on what Donald Spence (1982) calls “archaeological truth,”
that is, what the patient reports about parents and past is assumed to have a kind of veridical truthfulness.
When in fact do people feel the need to return to talking about history? Our working assumption has been that this return occurs
at the time of nascent self-realization or insight. But this isn't clear. In Act II, George spontaneously begins to tell his traumatic
story to Nick, though disguising it as the story of an adolescent friend. Does the presence of Nick evoke tenderness in him, a
representation of a former self? From a systemic perspective one might imagine that the attempt at closeness is strategic, a way
to draw a male boundary in the sand, in order to withstand Martha's threatening invasion. It is ambiguous in the drama as it is in
therapy and in life.
In the family systems paradigm, autobiography is subsumed under a collective narrative of family development. One asks: What
attracted you to each other, rather than, what were your conflicts about attachment? As in all of family work, we attend more to
the relationship significance rather than the subjective implications of what is said. Since the emphasis is on a shared story, we
can note the strategic, or pragmatic function, of autobiographical narrative, and this purpose usually includes personal coherence
as well as personal defensiveness. There are spouses who reveal their narcissism and inability to connect by describing the most
seductively compelling developmental experience.
We realize in family therapy that what would be considered personal revelation of a painful sort can be used competitively by
couples we call symmetrical or competing couples. One hears patients vying for whose parents were sicker or more destructive!
We sometimes forget that representations of parents are extremely elusive. In some way we never really have an imprint of our
parents, precisely because they are so much a function of our evolving image of ourselves. Sometimes a redundant and
restrictive narrative statement represents the last hurrah of a long analysis. I think that one poorly chosen hedge against the
seemingly interminable nature of analytic exploration is to develop a kind of closure of one's history, to fixate on one narrative
version as “true” and compelling. It is wiser to close the analysis but keep the book open, and sometimes individuals after long
analyses are disoriented to discover in family or couples therapy a newly written life story. Every family therapist has had this
experience. I worked with a young couple both of whom demonized her mother as cruel, irrational, and destructive. The wife had
been in individual therapy for many years trying to “deal with her mother.” I couldn't loosen their obsession with her and invited
the mother and father to a session. What emerged in that session, previously absent from the wife's consciousness, was that her
father had subtly neglected her mother for years, and moreover that he enjoyed a very special—equally subtle—coziness with his
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daughter. The mother had grown increasingly enraged at everyone in the family; this expanded scenario didn't explain all her
behavior but it did broaden understanding of it considerably.
Analysts become aware that patients can use the essential form of psychoanalytic self-expression quite defensively. Too clear a
parental representation is probably the choicest correlate for an overly refined, personified self. “I am just like my mother, too
worried about everyone else,” can be the complaint of a person who, to others, may seem altogether too ready to exact a pound
of flesh for every good deed rendered. It becomes clearer in systemic work that a sense of historical continuity provides not only
a feeling of coherence, but also a defensive buttressing of the self, a kind of homeostatic equilibrator to the unexpected. An
individual patient of mine captured this well. Seemingly threatened by a new self-realization regarding a current relationship, she
quipped, as she shifted away from the subject, “Listen, I'm going to talk about my parents. What the hell, this is therapy.”
In psychoanalytic treatment, we try to listen to parental or familial relationship data but we attend to this material less frequently—
partly because it is difficult to absorb it, which is one of the fundamental reasons why family therapists offer videotaped and “live”
supervision. How exactly does a two- or three-person relationship system become encoded in one person's consciousness? The
drama of Martha and George is less illustrative of this phenomenon, because each is presented as essentially denuded of familial
connections, prompting just one of many permutations of what Sander (1979) points to as a portrayal of familial fragility and
barrenness in Virginia Woolf. However, for illustration we can turn to a family therapy instrument, the genogram, which is used to
chart family history in a spatial, generally three-dimensional diagram. Genograms are furnished with demographic data (i.e.,
births, deaths, and occupations), as well as relationship delineations, such as a continuum of closeness or distance, conflict or
harmony. It is quite astonishing how just-out-of-awareness experience bubbles up during certain genogram constructions in a
way that invites psychoanalytic explanation.
A few years ago a student, in a didactic, mock genogram exercise, proceeded to fill in the data for his parents' generational line,
and mentioned the funeral, fifteen years earlier, of his father's first wife, a woman he had barely known. His eyes welled up with
tears; he was shocked by his affective response since he had not considered the death important enough to discuss in his
individual treatment. Somehow, however, this loss and its meaning had permeated his transgenerational consciousness. There is
something about the spatiality of the genogram task that seems to evoke a response unpredicted in its resonance and depth.
Family data may be encoded in some inchoate form that we have not adequately deciphered—betwixt unconscious, dissociated,
and repressed—and its recall may be uniquely facilitated by a schematic, diagrammatic instrument. Thus comparing the life story
that one garners in individual versus a family therapy context is one of the clearest illustrations of Bruner's concept of the
distributed self; that is, what we learn as therapists is determined by where and how we are asking the question. Narrative thus
becomes the handmaiden of constructivism. From the constructive or distributed perspective, we are reassured that garnering all
the therapeutic sensitivity and empathy in the world does not in any way insure a comprehensive data set.
The Therapeutic System

Act I of Virginia Woolf is titled “Fun and Games.” Albee's designation is bitterly ironic, but the cultural parameters of game playing
are remarkably extensive. Games often constitute a sacred ritual, as they did for the Maya, for whom ballplaying provided a
vehicle for divining the inclination of the gods. Moreover several theorists have described psychoanalysis as a game, such as
Bach (1985), who notes that “Psychoanalysis can take place only within … [a] framework of a certain kind, with some ‘rules of the
game’ delineated clearly by the analyst, others by the patient, and still other ‘rules’ … acknowledged and analyzed eventually” (p.
220).
When we work with, as we call them “real relationships,” and move beyond psychoanalytic praxis, we soon start wondering the
rules of the psychoanalytic game. Of course one can wonder without shifting praxis or multiplying participants. Those writing
about the issue of asymmetry in the analytic relationship are so doing (Aron, 1991; Hoffman, 1991; Burke, 1992), focusing on the
analyst-patient relationship as a system in its own right, with implicit rules and procedures.
The sheer activity of couples therapy encourages analysts to rethink the rules of our game. One can reconsider the implicit rule
system and make it even more explicit. Thus if we value immediacy or authenticity, we have to be clear about what we mean by
these relationship stances. Unexamined systemic principles become prescriptive rather than liberating. Moment to moment, the
rules of authenticity are ambiguous and variegated in friendship, in marriage, in parenthood, and in psychoanalysis. Oscar Wilde
warns us that “Being natural is simply a pose.”
Work with families and couples who are organic units of society—rather more so than the psychoanalytic unit—tends to invite
even broader speculation about what is culturally unique about the psychoanalytic experience. Victor Turner, an anthropologist,
charts the process of social dramas, disruptions in identity or relationship, and their attendant ritualprocesses(1977). Such
disruptions are universal, occurring in daily life between neighbors, within communities, in the body politic. A social drama always
follows four phases: the first a breach, a sense of breaking a rule; the second an experience of crisis; the third, and most crucial,
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in which the group holds up to itself a “mirror” reflexively examining its meaning system; and, the fourth, redefinition, or less
favorably, irreparable schism. It is in the third phase of reexamination that a crucial experiential phenomenon occurs—that of
liminality. Turner (1977) describes liminality as:
“[B]eing-on-a-threshold” … betwixt-and-between the normal, day-to-day cultural and social states and processes of getting and
spending, preserving law and order, and registering structural status. Since liminal time is not controlled by the clock it is a time of
enchantment when anything might, even should, happen.… In it, play's the thing [p. 33]. registering structural status. Since liminal
time is not controlled by the clock it is a time of enchantment when anything might, even should, happen.… In it, play's the thing
[p. 33].
Turner links the concept of liminality to a broad spectrum of cultural life from religious ritual to science making and philosophizing,
but he conspicuously neglects the psychotherapeutic process, one of the most intense social dramas of both the modern and
postmodern eras. Psychotherapy clearly offers liminal experience—a space-time suspension, in which a social drama is evoked
within a ritualized form. But different psychotherapeutic approaches offer different experiences of liminality. For Hoffman (1994)
the essential axis of the psychoanalytic relationship lies between the dimensions of ritualistic authority and spontaneous
expressiveness. As Hoffman notes, some of the most powerful experiences in psychoanalysis occur when the dialectic between
analytic rigor and personal expressiveness is acutely exposed, when the psychoanalyst joins the patient in a deconstruction of
psychoanalytic ritual, bending and twisting the frame, testimony to the patient's personal, if unrecognized, power. In contrast,
family therapy interventions are choreographed by the therapist to accentuate and heighten liminal experience: to provide a
multiply coded metalanguage in which the social group—in this case the couple or family—can refigure itself. There is a
deliberate inclusion of theatrical form—as in all ritual—to encompass more than one individual consciousness.
To return to Martha and George: Intensive psychoanalytic treatment for either would likely center at a crucial point on the fantasy
of an unborn child, which in our terms, is often the fantasy of an unborn self, an unrealized self. For Martha the fantasy would
likely include a precious release from her compulsively flamboyant self-denigration and the pleasure in creating someone
unspoiled by her own destructiveness. In the transference-countertransference unfolding of this yearning would likely emerge, for
George, the unbearableguilt of having killed his parents, however inadvertently, and the restitutive myth of killing his own self and
life to repair it.
In contrast, if Martha and George were in couples therapy, with the focus on their selves as coconstructed and their story as
cowritten, the myth of an unborn child would be viewed differently. Any attempt to elicit the self-imaginings in the presence of the
other would be crushed by anxiety about humiliation and attack. Rich symbolicmaterial is transferential elixir but ineffectual
placebo in marriage. Rather the myth of the unborn child would be viewed as Watzlawick et al. (1977) points out, as a
homeostatic mechanism—a son-game with a “built-in limit … the necessity to share the fiction” (p. 174). Of course within the
action of the play, the rules of this game are revoked; George kills their son. What is most despairing about Virginia Woolf is that
what should be a major psychological occurrence will undoubtedly be immaterial in the couples' life. There will be no new story
told. The ying-yang composite self of George and Martha would have to be engaged. How? If George and Martha were in
couples therapy, the process might focus on a ritual, a metaphoric burial for their child. This metaphoric ritual could evoke a
sense of shared mourning and shared loss, a newly constructed interdependence.
In Act II George says, “once a month we get misunderstood. Martha, the good-hearted girl underneath the barnacles … And I've
believed it more times than I want to remember, because I don't want to think I'm that much of a sucker … I just don't believe you
… there is no moment any more when we could … come together” (pp. 74-75). But of course they will not come apart. The
question for George and Martha and for all of us as people and as therapists is to define what coming together actually means
today. I think we feel considerable anxiety about connection in postmodern culture; we are all players in this social drama. The
view presented here is that our psychoanalytic drama of connection and disconnection, as is often true of theatrical drama,
gathers focus and intensity from the energy of those waiting in the wings.
Footnotes
1
In April 1996, Division 39 (Psychoanalysis) of the American Psychological Association inaugurated Section VIII, Psychoanalysis
and Family Therapy.
References
1 Albee , E. (1962), Who's Afraid of Virginia Woolf? New York: Dramatists Play Service .
2
Aron , L. (1991), The patient's experience of the analyst's subjectivity. Psychoanal. Dial., 1 : 29-51. (PD.001.0029A)
3
Atwood , G. E. , & Stolorow , R. D. (1984), Structures of Subjectivity. New York: Erlbaum .
2/6/2018 EBSCOhost
4
Bach , S. C. (1985), Narcissistic States and the Therapeutic Process. New York: Jason Aronson .
5
Barnett , J. (1971), Narcissism and dependency in the obsessional-hysteric marriage. Fam. Proc., 10 : 75-84.
6
Bateson , G. (1972), Steps to an Ecology of Mind. New York: Ballantine .
7
Bertalanffy , L. Von (1968), General Systems Theory. New York: Braziller .
8
Bruner , J. (1990), Acts of Meaning. Cambridge, MA: Harvard University Press .
9
Burke , W. F. (1992), Countertransference disclosure and the asymmetry/mutuality dilemma. Psychoanal. Dial., 2 : 241-271.
(PD.002.0241A)
10
Eliot , T. S. (1950), The Cocktail Party. New York: Harcourt .
11 Fairbairn , W. R. D. (1952), Psychoanalytic Studies of the Personality. London: Routledge & Kegan Paul . (ZBK.007.0001A)
12
Gergen , K. J. (1991), The Saturated Self. New York: Basic Books .
13
Gerson , M. J. (1988), Sullivan and family therapy: An unconsummated affair. Contemp. Psychoanal., 24 : 669-724.
(CPS.024.0699A)
14
Gerson , M. J. (1996), The Embedded Self: A Psychoanalytic Guide to Family Therapy. Hillsdale, NJ: Analytic Press .
15 Goldner , V. (1991), Toward a critical relational theory of gender. Psychoanal. Dial., 1 : 249-272. (PD.001.0249A)
16
Hoffman , I. Z. (1991), Discussion: Toward a social-constructivist view of the psychoanalytic situation. Psychoanal. Dial., 1 :
74-105. (PD.001.0074A)
17
Hoffman , I. Z. (1994), Dialectical thinking and therapeutic action in the psychoanalytic process. Psychoanal. Q., 63 : 187-218.
(PAQ.063.0187A)
18 Lesser , R. (1978), Sibling transference and countertransference. J. Am. Acad. Psychoanal. Dyn. Psychiatr., 6 : 37-49.
(JAA.006.0037A)
19
Levenson , E. A. (1991a), The Purloined Self. New York: William Alanson White Institute .
20
Levenson , E. A. (1991b), Back to the future: The new psychoanalytic revisionism. Paper presented at the Institute for
Contemporary Psychoanalysis, New York City, April 19.
21
Luepnitz , D. (1988), The Family Interpreted: Feminist Theory in Clinical Practice. New York: Basic Books .
22
Mitchell , S. A. (1993), Hope and Dread in Psychoanalysis. New York: Basic Books .
23 Panel (1997), Dialogue for the millenium. Minuchin Center, New York, September 13.
24
Perl , J. A. (1992), Literary Modernism: The Struggle for Modem History. Springfield, VA: Teaching Company .
25
Phillips , A. (1994), On Flirtation. Cambridge, MA: Harvard University Press .
26
Sander , F. (1979), Individual and Family Therapy. New York: Jason Aronson .
27
Sartre , J. (1949), No Exit and Other Plays, tr. S. Gilbert. New York: Vintage .
28
Schafer , R. (1976), A New Language for Psychoanalysis. New Haven, CT: Yale University Press .
29
Scharff , D. , & Scharff , J. (1987), Object Relations Family Therapy. New York: Jason Aronson .
30
Schimek , J. G. (1983), The construction of the transference. Psychoanal. Contemp. Thought, 6 : 435-456. (PCT.006.0435A)
31
Solomon , M. F. (1989), Narcissism and Intimacy New York: W. W. Norton .
2/6/2018 EBSCOhost
32
Spence , D. P. (1982), Narrative Truth and Historical Truth. New York: W. W. Norton . (ZBK.015.0001A)
33
Spezzano , C. (1995), “Classical” versus “contemporary” theory: The differences that matter clinically. Contemp. Psychoanal.,
31 : 20-46. (CPS.031.0020A)
34
Sullivan , H. S. (1953), The Interpersonal Theory of Psychiatry. New York: W. W. Norton .
35
Sullivan , H. S. (1964), The data of psychiatry. In: The Fusion of Psychiatry and Social Science. New York: W. W. Norton , pp.
32-56.
36
Turner , V. (1977), Frame, flow and reflection: Ritual and drama as public liminality. In: Performance in Postmodern Culture,
Theories of Contemporary Culture, Vol. 1 , ed. M. Benamou. Madison, WI: The Center for Twentieth Century Studies , pp. 33-58.
37
Wachtel , E. F. , & Wachtel , P. L. (1986), Family Dynamics in Individual Psychotherapy: A Guide to Clinical Strategies. New
York: Guilford .
38
Watzlawick , P. , Beavin , J. H. , & Jackson , D. D. (1967), Pragmatics of Human Communication: A Study of Interactional
Patterns, Pathologies and Paradoxes. New York: W. W. Norton .
39
Willi , J. (1987), Some principles of an ecological model of the person as a consequence of the therapeutic experience with
systems. Fam. Proc., 26 : 429-435.
Psychoanalysis & Contemporary Thought, 1998; v.21 (1), p61 (24pp.)
PCT.021.0061A
Record: 18
Title: What is Happening With Bill and Jane?
Authors: Greenberg, Leslie
ISSN: 10481885
Language: English
Abstract: In this comment I applaud Goldner’s ability to capture couple experience and dynamics
while emphasizing that coupling involves more than attachment. In my view, couple conflict
and therapy involves attending not only to attachment, which involves closeness and the
threat of separation, but also to issues of identity, self-definition, and shame. I point out
how some of the interactions and dynamics in the case discussed involve a threat to
identity through invalidation more than to attachment by abandonment. As Goldner notes,
mutual recognition between people is the cornerstone of the relational ideal, and it is for
recognition through being seen, and validated for which Bill and Jane fight so hard, not
closeness. In my view not everything in couples is about regulating attachment; rather
everything is probably about regulating affect. Attachment is one, but only one, of the ways
couples regulate their affect.
direct=true&db=pph&AN=PD.024.0427A&site=ehost-live&scope=site">What is Happening
With Bill and Jane?</A>
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What is Happening With Bill and Jane?

Leslie Greenberg, PHD, author, Leslie Greenberg, Ph.D., is Distinguished Research Professor Emeritus of Psychology at York
University in Toronto, Ontario. He has authored many texts on emotion-focused approaches to treatment of individuals and
couples. These include the original texts Emotion in Psychotherapy (1986), Emotionally Focused Therapy for Couples (1988),
and Facilitating Emotional Change (1993), and more recently Emotion-Focused Couples Therapy: The Dynamics of Emotion,
Love and Power (2008), Emotion-Focused Therapy: Theory and Practice (2010), Working with Narrative in Emotion-Focused
Therapy: Changing Stories, Healing Lives (2011), and Therapeutic Presence (2012). He has published extensively on research
on the process of change. He has received the Distinguished Research Career award of the International Society for
Psychotherapy Research as well as the Carl Rogers and the Distinguished Professional Contribution to Applied Research of the
American Psychology Association. He also has received the Canadian Council of Professional Psychology Program Award for
Excellence in Professional Training and the Canadian Psychological Association Professional Award for distinguished
contributions to Psychology as a profession. He is on the editorial board of many psychotherapy journals. Dr. Greenberg is a past
President of the Society for Psychotherapy Research and an originating member of the Society of the Exploration of
Psychotherapy Integration. He conducts a private practice for individuals and couples and trains people in emotion-focused
approaches.Correspondence should be addressed to Leslie Greenberg, Ph.D., Department of Psychology, York University, North
York, Ontario M3J IP3, Canada. E-mail: lgrnberg@yorku.ca
In this comment I applaud Goldner’s ability to capture couple experience and dynamics while emphasizing that coupling involves
more than attachment. In my view, couple conflict and therapy involves attending not only to attachment, which involves
closeness and the threat of separation, but also to issues of identity, self-definition, and shame. I point out how some of the
interactions and dynamics in the case discussed involve a threat to identity through invalidation more than to attachment by
abandonment. As Goldner notes, mutual recognition between people is the cornerstone of the relational ideal, and it is for
recognition through being seen, and validated for which Bill and Jane fight so hard, not closeness. In my view not everything in
couples is about regulating attachment; rather everything is probably about regulating affect. Attachment is one, but only one, of
the ways couples regulate their affect.
Virginia Goldner in this richly descriptive paper vividly evokes some of the realities of couple therapy. She captures some
essential aspects of couple dynamics in wonderful phrases like
No one is immune from the contagion of reactivity, and few amongst us can resist the siren call of a fight (sometimes to the
death) over who gets to inhabit the victim position—the pleasure in that pain being that the other gets branded the perpetrator. (p.
402)
This reveals, with such accuracy, the important dynamic of positioning in couple conflict. She also captures the experience of
couple conflict so well in the phrase that, as she notes, is in every country and western song:
Your lover can torture you, make you desperate for air, reduce you to abject extremes of begging and collapse or drive you to
extremes of destructive aggression–and s/he can make it all go away in the blink of an eye. (p. 403)
She captures also the experience of the tantalizing object who is “there, but now, not there, for you—and unlike that toddler, no
appeal, no protest brings them back” (p. 404). It is sentences like these that display her talent as an astute observer of couple
conflict and a wonderful therapist and writer
In her opening theoretical proposals she emphasizes the importance of the attachment process, from “the cradle to the grave.”
Attachment certainly is central in work with couples. She observes there is now an interdisciplinary consensus that the same
mechanisms that regulate the mother–infant bond, which grow the brain and co-create the mind, also mediate attachment bonds
throughout the lifespan. She offers us the view that romantic love is an attachment process and writes that “attachment is
romantic, and romantic love is, in both the formal and evocative sense, an attachment process” (p. 404). It is here that our views,
to some degree, differ.
My argument is that the relational brain is more than an attachment process, that analogies between adult and infant attachment
run into problems when taken too literally and that love is not attachment. The stress-buffering effects of social relationships has
been one of the major findings in psychobiology in the last century (Hostinar, Sullivan, & Gunnar, 2014), and attachment certainly
reduces stress and we seek relationships for the comfort they provide, but the relational processes between two adults in an
intimate relationship are more complex than that between parent and child. We seek and bond with partners for more reasons
than attachment, and conflict in couples arise from causes in addition to threats to attachment as important as these are. In our
ongoing development of an emotion-focused approach to couples therapy (Greenberg & Goldman, 2008) we have expanded the
original theory of EFT-C (Greenberg & Johnson, 1986, 1988), which in its inception included attachment and dominance as two
major dimensions of intimate relationships, to view couples interaction as governed even more complexly. From an emotion
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theory perspective I now see affect regulation as a core motive that organizes three subsidiary major motivational systems
important in successful coupling—attachment, identity, and attraction. In addition given that affect is our primary meaning, action
and communication system (Greenberg, 2002, 2010) it needs to be given centrality in understanding human functioning in
general and more specifically couple functioning.
Goldner’s premise, in this paper, if I am reading her correctly, however, appears to be that love is based mainly on attachment
and that all problems stem from attachment ruptures. In my view this conflates the many different motivational systems involved
in love. One need only to look at Helen Fisher’s (2004) notions on the biology of love in which she sees love as being constituted
by (a) lust mating and the sex drive, (b) attachment and safety (deep feelings of union with a long-term partner), and (c) attraction
(romantic passion), or Hatfield’s Passionate and Compassionate Love, to see that love is more than attachment. In Hatfield’s
view, passionate love is characterized by intense emotions, sexual attraction, anxiety, and affection, while the compassionate
love of affection is characterized by mutual engagement, mutual respect, and care (Hatfield & Rapson, 2005). Ideally, love is thus
a relationship that combines comfort with respect and with passion. In addition when love is reciprocated people feel excited and
happy, but if love is unreciprocated people feel sad, discouraged, and even desperate. Further from a Buddhist perspective
(Geshe Kelsang Gyatso, 2012) attachment is more about me and what I can get from you, while love is more about what I can
give or do for you. Here three sentiments best describe love: affection, cherishing, and wishing good for the other. Affectionate
love is just liking a person, having a warm, fuzzy feeling. This is the way we feel when we see someone who we care about
whom we haven’t seen for a while. It is being unconditionally delighted to see the other without that needy “I want you to do
something for me.” On the basis of affection, we come to cherish the other—we find them special, we want to take care of them,
and their happiness matter to us, and we also wish for them to be happy and to have what they need and want.
In my view in our thinking about couples and couple conflicts we need to go beyond attachment to (a) include affection and
attraction, (b) to recognize that adult love differs significantly from mother–infant attachment, and (c) consider both attachment
and identity needs or phrased in more evocative terms love and power. Looking at love and power in couples in more
interactional terms we have suggested (Greenberg & Goldman, 2008) one needs to look at both affiliation and influence. In
addition in our current EFT couple theory we suggest that it is best to view affect regulation as a primarymotivation in couples
(and more generally in life). According to this view people are both consciously and unconsciously motivated to have the affects
they want and not have the affects they don’t want. The human affect system has evolved to aid survival and people seek
emotions because how they make them feel has aided survival. We seek relationships and achievement because they give us
certain feelings that aid goal attainment. This not a hedonistic view, that we simply seek pleasure and avoid pain. We are
referring to a system that has a variety of discrete emotions each with a different evolutionary function, not just pleasure and pain.
Each emotion is a response to the gratification or frustration of a particular need and/or goal attainment, such as safety from
danger, boundary protection, group belonging, comfort, and so on. Thus we attach, and maintain our identities to regulate our
affect because to be close and to be comforted makes us feel calm rather than anxious and joyful rather than sad, and to be
recognized and validated makes us feel pride rather than shame, while attraction and liking generate positive emotions like joy
and excitement, which act to bind us by being an antidote to the inevitable negative affects generated in coupling.
Witness what happens to Bill and Jane in the session transcript provided. Jane early on protests about the invalidation of her
identity in how Bill represents her. This protest is about representation not about closeness or abandonment. “He’s representing
himself as the victim—But he’s the one who fights me! And then he has the nerve to represent himself as the righteous one!” (p.
414). Goldner in the session responds with how afraid she is that she will be seen that way by her. Again this is about how she
will be seen. Jane responds, “I have loved you all these years, and I never shamed you around your issues” (p. 415). Here we
see love as shame as being embedded in shame more than as closeness or abandonment. I have seen many couples where the
partner says I know you love me you just don’t see me. The need for being seen is strong.
Later Goldner refers to Jane’s underlying fear. What is her fear? Is she afraid of being abandoned by him? I don’t think so. She
rather is fighting for her identity, for validation, for her legitimacy, for her sense of herself as a valid human being. Is it relational?
Yes highly. That is not a need for autonomy as some original couple theorists posit. Rather she needs recognition and validation
from another. She needs empathy, like she needs oxygen. This is not Harlows contact comfort or Bowlby’s (1989) separation
anxiety at work. It is about shame and identity. More like Rogers and Kohut’s theory operating at this instant. This is not to say
that Bill and Jane don’t have needs for attachment that are very important in regulating their affect, and their degree of arousal
and approach and withdrawal tendencies, but it is not the main system operating at this moment. As therapists, to be most
accurate in our understandings and interventions, we need to discriminate which system is operating when. We need to
understand that statements such as “I feel unloved” can be very ambiguous as to what underlies them. Often it is more of an
identity-related feeling, of feeling worthless or unlovable, than an attachment-related feeling of feeling alone or abandoned.
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Goldner’s interventions appear then to attend more to the influence or power dimension at this time in the session, than to the
affiliation or attachment love dimension. The paradox she engages in of declaring her weakness is an interactional intervention
related to power where she goes one down to take the powerless position and they respond by stopping their attack on each
other. This in some ways is more the stuff of Minuchin or Haley concerned with hierarchy than Bowlby concerned with attachment
security. Although she refers to herself as being left alone without support (the core theme of attachment aloneness), she also
states “I am at my limit” (p. 415), and this is not so much about her revealing her underlying attachment underlying needs for
closeness but more about weakness, and it is this that stops their identity attacks on each other.
Goldner believes it was effective because everyone understood that her “collapse,” had it occurred, would have been partial and
temporary but that the Kleinian specter of weakening her served to shock the couple into an awareness of their destructiveness
in a way that nothing else had done. As she says, neither Bill nor Jane came out to help her, but both of them helped her by not
saying anything more. This is an intervention to deal with issues of power and influence because the problem is in the domain of
power and influence not in the domain of comfort and closeness. Similarly the intervention pointing out dominance issues “You’ll
fight till you drop. You are like Gladiators—nothing but Death will stop you” was very helpful. She challenged them to take more
responsibility for their reactivity and dysregulation. The effect was a quieting of arousal. Here as Goldner says it was her
recognition, and acceptance, of the ferocity and drivenness of their process which produced that oddly calming effect. So as I see
it a lot of the interventions described targeted influence rather than affiliation.
Why do couples fight like this? Why if they are so driven to seek attachment do they fight to destroy? It is because it seems there
is a tipping point in some couple relationships where preservation of identity becomes more important to survival than the need to
be connected. This is where adult attachment differs markedly from toddler attachment. No longer is attachment crucial to adult
survival in the way it was as an infant. Now what seems crucial is identity preservation, through validation, being seen, confirmed,
recognized, and validated is crucial to maintain a sense of who one is in one’s own, and one’s partner’s, eyes. Identities at these
times are what seem to be most at risk, and partners fight to the death to preserve their identities. The threat here is to identity
through invalidation more than to attachment by abandonment. As Goldner notes mutual recognition between persons (I–thou
relations), is the cornerstone of the relational ideal (Benjamin, 1995). It is recognition that Bill and Jane fight so hard for, at this
juncture, not closeness. Not everything, mentalization included, is about regulating attachment. In fact it is the other way around.
Everything is probably about regulating affect, and attachment is one but only one of the ways human beings regulate their affect.
In an attempt to maintain attachment as the motivational royal road, one could argue but isn’t all this because we want to remain
attached, that we protect our identities because if we accept being bad then the other will abandon us. In fact if we accepted we
were bad as the other is claiming, they are more likely to accept us and the need to fight would subside. This is more like
sophistry, a plausible but fallacious argument where everything is explained by attachment ruptures. Life is not that simple or that
singular, or as Bettelheim proclaimed, love is not enough. In my view what has emerged in the field in the rush to attachment is,
given its usefulness and established scientific validity, it has become like the proverbial hammer and everything needs
hammering. But if one has a hammer, a screwdriver, and a wrench, one has more tools and will be a more effective craftsperson.
No doubtattachment is very important, and many couple conflicts are about closeness or lack of it—but not all, and not for Bill
and Jane in this instance.
Why is Goldner’s intervention of prescribing the symptom effective? As she notes it shifted the terms of the power struggle
between therapist and couple, leaving them with nothing to fightagainst Notice too how Goldner is concerned with their arousal
and dysregulation more than, let’s say, their insecure or disorganized attachment. Seeing affect regulation as the key mechanism
helps therapists work closer to the ground than either notions of insecure attachment or low self-esteem. The latter are higher
level concepts. More important for moment-by-moment therapeutic work are emotion variables such as degree of emotional
arousal, type of emotion, (anger, fear, shame sadness), and type of action tendency associated with the emotion, approach or
withdrawal, contact or avoidance.
CONCLUSION
I believe that Goldner in her writing at times recognizes that there is more than attachment security governing couple conflict. She
begins the description of Bill and Jane with the statement that she will “illustrate how disqualification can be driven by the need to
be understood on one’s own terms, and to have the other acknowledge the validity of one’s perceptions” (p. 413). This sentence
captures her attention to issues of identity and validation. In another example describing the paradox of couples conflict she
writes that if people trust the fairness of the process they experience something like “I will suffer your momentary negation of me
(in favor of your interiority), because you will be asked to recognize me, in all my extremes, before too long” (p. 411). Here as
Goldner shows it is recognition of otherness that is so important. My argument is that recognition of me—my identity is as central
in couple conflict as is the need for closeness and comfort through touch and caring. Threat is at the center of conflict, but not
only the threat of being left alone but also the threat to one’s identity, of not being recognized. Shame as well as anxiety is
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important in conflict. What is happening with Bill and Jane in this episode has a lot to do with identity threat and not with
abandonment threat.
Despite this different theoretical framing I appreciated much of what Goldner wrote and benefited from her insights and ability to
capture, so well, much of what goes on in couples and their fights for survival to preserve attachment and maintain identities. I
also think that ultimately it is important to integrate understandings of attachment and abandonment processes, and processes of
validation and disconfirmation of identities. This I believe can be done by the use of emotion theoretic understandings of human
functioning and recognition of affect regulation as a core human motive.
REFERENCES
1
Benjamin , J. (1995). Like subjects, love objects. New Haven, CT: Yale University Press .
2
Bettelheim , B. (1950). Love is not enough: The treatment of emotionally disturbed children. Glencoe, IL: Free Press .
3
Bowlby , J. (1989). A secure base. Clinical applications of attachment theory. London, UK: Routledge .
4
Fisher , H. (2004). Why we love: The nature and chemistry of romantic love. New York, NY: Holt .
5
2012). Universal compassion: Inspiring solutions for difficult times. Tharpa Publications Canada. Retrieved from
www.tharpa.comGeshe Kelsang Gyatso. (
6
Greenberg , L. (2002). Emotion-focused therapy: Coaching clients to work through feelings. Washington, DC: American
Psychological Association Press .
7
Greenberg , L. S. (2010). Emotion-focused therapy: Theory and practice. Washington, DC: American Psychological Association
.
8
Greenberg , L. , & Goldman , R. (2008). Emotion-focused therapy for couples: The dynamics of emotion love and power.
Washington, DC: American Psychological Association .
9 Greenberg , L. , & Johnson , S. (1986). Emotionally focused couples treatment: An integrated affective systemic approach. In
N. Jacobson & A. Gurman (Eds.), Clinical handbook of marital therapy. New York, NY: Guilford .
10
Greenberg , L. , & Johnson , S. M. (1988). Emotionally-focused couples therapy. New York, NY: Guilford .
11
Hatfield , E. , & Rapson , R. (2005). Love and sex: Cross-cultural perspectives. Needham Heights, MA: Allyn & Bacon .
12
Hostinar , C. , Sullivan , R. , & Gunnar , M. (2014). Psychobiological mechanisms underlying the social buffering of the
hypothalamic–pituitary–adrenocortical axis: A review of animal models and human studies across development. Psychological
Bulletin, 140 , 256 - 282–.
PD.024.0427A
Record: 19
Title: Sexual Desire Disorder: A Case Study from a Dynamic Perspective
Authors: Caruso, Norma, J.
Language: English
Abstract: This paper examines the dynamics of sexual desire by considering a couple with loss of
desire in one partner. It uses the language of attachment and object relations to
understand the couple's sexual dysfunction and illustrates the integration of behavioural
and psychoanalytic techniques to provide treatment. The treatment outcome supports the
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idea that compared with those with less secure attachment patterns, more securely
attached individuals are better able to integrate attachment and sexuality(Eagle, 2007).
This paper also upholds the attachment tenet that a secure base serves as the foundation
for exploration (Ainsworth, 1972), in this case, of the body (Holmes, 2007).
direct=true&db=pph&AN=CFP.004.0166A&site=ehost-live&scope=site">Sexual Desire
Disorder: A Case Study from a Dynamic Perspective</A>
Sexual Desire Disorder: A Case Study from a Dynamic Perspective

Norma J. Caruso, author, Clinical psychologist, treats couples and individuals in private practice in Richmond, Virginia. She is an
associate clinical professor in the Department of Psychiatry at the Medical College of Virginia, and is on the faculty at the
International Psychotherapy Institute, a British Object Relations training programme, where she trained. She has lectured
nationally and internationally on couple relationships and the evaluation and treatment of sexual difficulties. Her publications on
this topic have appeared in Couple and Family Psychoanalysis, Journal of Applied Psychoanalytic Studies, and New Paradigms
for Treating Relationships. Dr Caruso is certified as a sex therapist by the American Association of Sexuality Educators,
Counselors and Therapists. Her interest in attachment began in graduate school where she studied with Dr Beatrice Beebe who
advised her on her dissertation: Early Mother-Infant Interaction as a Predictor of Attachment at One Year.
This paper examines the dynamics of sexual desire by considering a couple with loss of desire in one partner. It uses the
language of attachment and object relations to understand the couple's sexual dysfunction and illustrates the integration of
behavioural and psychoanalytic techniques to provide treatment. The treatment outcome supports the idea that compared with
those with less secure attachment patterns, more securely attached individuals are better able to integrate attachment and
sexuality(Eagle, 2007). This paper also upholds the attachment tenet that a secure base serves as the foundation for exploration
(Ainsworth, 1972), in this case, of the body (Holmes, 2007).
Introduction
Helen Singer Kaplan (1974) introduced the idea of desire disorders and identified them as the most difficult sexual problems to
treat with the least favourable prognosis. One in three women, compared with one in seven men, identify desire disorders as a
problem, and women report them more often than any other sexual difficulty (Laumann et al., 1994). Lack of desire can result in
infrequent or absent sex in marriages. Without intervention, divorce can ensue if this difficulty arises in the first three years of
marriage (McCarthy & McCarthy, 2003).
The pervasiveness, detrimental impact, and treatment difficulties of sexual desire disorders suggest that they warrant further
exploration. Given their relationship nature, desire disorders should be studied in couples, rather than in individuals (Rix &
Shmueli, 2009). Most of the literature that considers relationship factors focuses on interpersonal dynamics and recommends a
cognitive-behavioural treatment approach (McCarthy & McCarthy, 2003). A psychoanalytic understanding and treatment
approach can fill a gap in the literature on sexual desire disorders. While Clulow and Boerma (2009) examine the dynamics of
desire disorders from a psychoanalytic perspective, Green and Seymour (2009) present a model for treating a couple that
integrates psychodynamic and behavioural techniques. This paper uses both attachment and object relations theories to
understand the psychodynamics of sexual desire disorder in one couple and applies an integrated model to treat it. It views
sexual dysfunction as a reflection of the couple's internal object relations that evolved from each partner's attachment and
psychosexual history. The treatment combines behavioural sex therapy techniques with psychoanalytic approaches to address
the marital and sexual issues (Kaplan, 1974; Scharff, 1982; Scharff & Scharff, 1991).
Case Illustration
Presenting Problem
Kelly, a twenty-nine-year-old woman, sought individual treatment because she lacked sexual desire for her husband, Hans, a
thirty-four-year-old man. The couple had intercourse, which Hans initiated, approximately three times a year; physical
expressions of affection were absent. Kelly initiated treatment to please Hans and to prevent him from leaving the marriage. At
my suggestion, Hans participated; believing he was helping Kelly.
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Both partners identified the other as a best friend with whom they had a conflict-free relationship. Kelly called Hans the “man of
her dreams”. Hans said that if treatment was unsuccessful, he would tolerate infrequent intercourse rather than jeopardise the
relationship. The couple presented as a fairy-tale couple, with the exception of infrequent intercourse.
Kelly dressed in neutral coloured, boxy clothes. Her clothing, short hair, and lack of make-up or jewellery did not conform to
traditional woman's standards of dress. In contrast to her drab appearance, Kelly's eyes sparkled and her smile was warm and
inviting. Her openness for self-discovery engaged me, while her thirst for what I offered often left me feeling idealised and
powerful.
Hans was bald, dressed conservatively, and looked older than his age. He was shy, reserved and, when he spoke, elaborated
minimally. His demeanour evoked discomfort in me and a desire to enliven the interaction.
Couple Relationship History

Prior to meeting in England, each partner had dated and experienced satisfying sexual relationships. Kelly and Hans were drawn
together by a sense of fun, physical attraction, and a shared disinterest in a committed relationship. Eventually, however, they
formed an exclusive relationship. Hans's even temper soothed Kelly. She was enticed by his ease with sexuality and playfully
referred to him as her “affair”. Hans loved Kelly's outgoing, social nature and wild streak, and acknowledged that it “jazzed [him]
up”.
Initially, Hans and Kelly had a mutually satisfying emotional and sexual life, but around the time they moved to the US, Kelly lost
interest in sex, and Hans became less expressive emotionally. Kelly was diagnosed with cervical cancer, which was successfully
treated with surgery. According to her gynaecologist, Kelly's loss of desire was not attributable to the physical effects of her
illness or surgery. The realisation that they lacked social supports propelled Kelly and Hans to marry. They consciously modelled
their marriage on Hans's even-tempered family.
Kelly and Hans were professionally successful. Kelly perceived herself as outgoing and attributed her good work relationships to
her efforts to curb her anger, an emotion that had caused past relationship problems. She described herself as dependent on
Hans, and had difficulty leaving him for business trips. Hans portrayed himself as introverted and quiet when angry.
Family History
Kelly was the youngest of five children. Her family was poor, and while her parents worked long hours, her oldest brother cared
for her. Kelly's mother alternated between being loving and volatile. She identified Kelly as her favourite child, a position Kelly
relished until the age of twelve. Kelly's idealisation of her mother shifted to scorn when she realised that her being favoured was
painful to her siblings, particularly her sister who was beaten regularly by her mother. Kelly sought nurturance and guidance from
her second oldest brother. They became rebellious teens who wore punk style clothes. Kelly's parents fought frequently and
divorced when Kelly was twenty-three years old. Subsequently, she became close to her father, who had been largely absent
during her childhood. Within her family, sexuality was never discussed.
Hans's family fostered independence. Although constricted in expressing affect, his parents openly talked about sexuality. Hans
was uncertain why his parents divorced when he was eighteen years old. He had a good relationship with them both, and
identified with his father's tendency to be a loner. Hans was idealised by his parents and, at times, protected his older brother by
concealing the brother's rebellious antics from their parents.
Attachment Perspective
Partners in loving, long-term, romantic relationships, in which the same individual serves as an attachment figure and a sexual
partner, face the challenge of integrating attachment and sexuality. According to Eagle (2007), compared with less secure
attachment patterns, more securely attached individuals can better overcome the biological and psychological factors that not
only separate the systems of attachment and sexuality, but also antagonise them. From this perspective, Kelly's and Hans's
sexual difficulties reflect an inability to integrate attachment and sexuality rooted in problematic, primaryattachment relationships.
Their couple relationship history reveals a failure to integrate these two systems. In the beginning, their sexual life was mutually
pleasurable, captured in Kelly's reference to Hans as her “affair” and Hans's view that Kelly “jazzed” him up. At the same time,
they shared a disinterest in being emotionally committed. Their decision to move to the US together suggests that they had
formed an emotional bond, but it coincided with Kelly's loss of sexual desire. Nevertheless, they formalised their connection
through marriage, driven by the hope of providing each other with emotional support. By the time Kelly and Hans began
treatment, their emotional bond had strengthened. Kelly's attachment to Hans was so strong that she had difficulty leaving him
when she travelled. Nevertheless, when their sexual connection eroded further, she sought treatment to address this problem.
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Mikulincer and Shaver (2007) examine the relationship between adult attachment patterns and sexual functioning, and conclude
that individuals with insecure attachment patterns use sex to meet attachment, rather than sexual, needs. For individuals with
anxious attachment, sex can satisfy unfulfilled emotional needs and lessen fears of separation and abandonment. For those with
avoidant attachment patterns, gratification of emotional and sexual distance is paramount and may be achieved by infrequent,
absent, mechanical, or casual encounters. Kelly prioritised an emotional connection over a sexual one, but restrained her
emotions to match Hans's affect, hoping he would not abandon her. Kelly anxiously clung to Hans in search of security, not sex.
Her dampened desire minimised the risk that a sexual liaison with Hans would become out of control with passion, as her
interactions with her mother became out of control with contempt. Hans cited his emotional connection to Kelly as the reason for
his tolerance of infrequent intercourse. However, his willingness to maintain the relationship if treatment resulted in no change
may have reflected an underlying conflict. Infrequent intercourse decreased the likelihood of Hans feeling the neediness and
longing that sexual encounters can trigger. These feelings, negated in his family, may have frightened him. Hans's avoidance
promoted security, but prevented a fulfilling sexual life.
Object Relations Perspective

In marriage, each partner contributes hidden aspects of themselves to form a “joint marital personality” (Dicks, 1967, p. 69). In so
doing, they locate split-off and repressed aspects of the self in one another through projective identification, and either treasure or
attack those aspects, depending on how those parts of the self were originally treated. The “joint personality” allows each
member of the marital dyad to re-experience aspects of their primaryobject relations in his or her partner through projective
identification. In the sexual relationship, the genitals can serve as the body screen for the projection of split-off conflicts with
attachment figures and intimate partners through the mechanism of conversion and, thereby, compromise the expression of
libidinal energy (Fairbairn, 1954; Scharff, 1982).
My hypothesis was that Kelly located her denied, split-off sexuality in Hans, but over time, felt overwhelmed by this aspect of him
and retreated. Her reprieve from sexual relations represented a re-awakening of anti-sexual tendencies rooted in her repressive
upbringing and activated by the bodily threat of her cervical cancer. Hans's penis represented an exciting and intruding,
dangerous object, and her vagina embodied the rejecting object that kept this perceived threat at bay through deadened sexual
desire.
I also speculated that Hans projected his emotional vitality into Kelly. He seemed to be terrified of her passion, and shut down
emotionally, presumably due to a lack of a model for dealing with strong feelings. For Hans, Kelly's vagina symbolised an exciting
object that evoked longing and neediness. By tolerating Kelly's lack of desire, he maintained the relationship and an elevated
view of himself without triggering feelings that were uncomfortable to him. Hans was unaware that he colluded with Kelly to avoid
sex. Kelly's and Hans's loss of vitality reflected their “psychosomatic partnership” (Winnicott, 1960, 1971) and their physical
interactions “resonate[d] with the depths of their individual psychology, and … their internal object relationships” (Scharff &
Scharff, 1991, p. 11).
Treatment
Assessment
The following is an excerpt from a session during the assessment phase:
After Kelly and Hans told me about their good week, they became silent. I felt deadened and imagined that the couple's
interactions in the session captured features of their transference to each other and, jointly, to me.
NJC: “Do you also have little to talk about at home as well?”
Kelly: “We have stopped talking because everything is so routine.”
NJC: “When you say routine, I hear you say boring. It makes me wonder if you stopped talking because things are boring or are
things boring because you stopped talking.”
Kelly: “Our conversations have become infrequent. I would rather be silent than struggle to find the right way to say something or
to deal with Hans correcting me.
Hans: “Kelly is not disciplined in her word usage. At work she is very precise.”
Kelly: “I have become disciplined at work so I'll be less reactive emotionally, but I want to relax at home.”
The couple's loss of vitality played out in the transference. Afraid that anger might emerge in the session, Kelly and Hans
withheld parts of themselves and became silent. Countertransferentially, I felt their deadness, conveyed through projective
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identification, and used my internal experience to explore the couple's relationship outside of the session. Anger, an affect that
had been strikingly absent from the couple's portrayal of themselves and from my experience of them, emerged. Their initial
presentation as conflict-free conveyed a core dynamic about how Kelly and Hans related. They failed to integrate their split-off
aggression into their relationship. I suspected this feature contributed to Kelly's loss of desire and to the couple's sexual
difficulties.
The couple's shared sexual anxieties were located in Kelly's body, but Hans contributed. Underlying his call for precision and
discipline in Kelly's use of words was his fear that she might use words to convey anger. Kelly responded by squashing her verbal
and emotional expressions of anger and opting for silence. Similarly, confined to a relationship that could only tolerate loving
feelings, Kelly lost her sexual passion.
Both psychoanalytic (Kernberg, 1995) and attachment theorists (Clulow & Boerma, 2009) note that along with longing, hatred
fuels sexual desire. Kernberg (1995) maintains that in the absence of aggression, boredom, and a lack of passion permeate
sexual life. The capacity to tolerate love and hate is also a hallmark of depressive position functioning (Klein, 1937), and
necessary to being a mature couple (Ruszczynski, 2005). Britton (1992) links this advanced development to resolution of oedipal
issues, which Eagle (2007) argues can only be attained by a secure attachment pattern. Accordingly, Kelly's and Hans's failure to
integrate aggression into their relationship was a feature of their impaired sexual and marital functioning. It also reflected the
absence of mature psychic development which, according to attachment theorists, was rooted in their insecure attachment
patterns.
Couple Therapy
The following is a segment from an early treatment session:
Kelly said that when she and Hans prepared to hike or bike, she frequently kept Hans waiting and he became “grumpy”. Then,
their plans deteriorated.
NJC: “Is this an example of how not dealing with annoyances kills off your vitality.”
Hans said, “No”, but Kelly agreed.
Kelly: “It is just that he is good at everything he does. I hold him back when we do activities.”
Hans: “I tell her I don't care.”
Kelly: “I don't believe you. I would feel angry, if it was reversed.”
NJC: “I heard in your comment, ‘Hans is good at everything,’ a feeling that you fall short.”
Kelly: “I can't identify one area in which I surpass Hans. He is my mentor, and I go to him with questions about how to handle
things. The first time we met, I thought this person will never want me. He does everything so well.”
Hans acknowledged his pleasure at hearing Kelly's perception of him. Subsequent sessions uncovered that he maintained his
elevated status through subtle criticism of Kelly, failure to validate her accomplishments, and a tendency to minimise his
struggles.
This segment illustrates an idealised-devalued split in the couple's relationship that captures a feature of their internalised objects
or mental representations of self and other. In the same way that Kelly and Hans were unable to integrate the affects of love and
hate, they did not view objects as whole. These failures reflect an intolerance of ambivalence and reveal the fragility of their
relationship. The unrealistic nature of this idealisation had a destructive impact (Kernberg, 1995), evident in the deterioration of
the couple's plans to spend time together based on Kelly's belief that she could not measure up to Hans.
This narrative also demonstrates the couple's shared state of not knowing, which contemporary attachment theorists consider a
failure to mentalize and link to insecure attachment(Fonagy, 2001). Although able to imagine Hans's anger, Kelly was unaware of
her own. Her difficulty tolerating this aspect of herself contributed to her inhibited sexual desire and was rooted in her family
dynamics in which aggression was used excessively and destructively. Likewise, Hans was unaware of his internal state. Having
grown up in a family that downplayed emotions, he tolerated Kelly's sexual inhibitions because he could not bear the longing and
neediness that sexual intimacy could trigger. Hans's submission desexualised the relationship. The couple failed to recognise
Hans's contribution to their sexual difficulties, and instead Kelly and Hans perceived Hans's tolerance solely as a loving act. This
viewpoint reinforced Hans's idealised position.
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Underlying Kelly's and Hans's use of part objects and their compromised ability to think was a shared anxiety that, in part, related
to their fear of the destructive potential of their aggression. I repeatedly named the couple's anxiety and interpreted how
seemingly minor annoyances, left unattended, accumulated and destroyed their sexual connection. Whereas Kelly agreed with
my interpretation, Hans disagreed. I imagined that Kelly perceived therapy as a home where she could relax and express herself,
while Hans viewed it as a place where he needed to monitor his words. Accordingly, Kelly expressed interest in individual
treatment, while Hans resisted it for himself, presumably anxious about the prospect of change. I decided to offer the individual
treatment to Kelly, believing that this combined approach would enhance my understanding of how Kelly enacted her dynamics in
both contexts. I also could interpret the organising nature of the transference as it manifested with me in the individual treatment,
and with Hans in the couple work. I recognised that this decision would affect each partner individually and the couple as a
whole.
Treatment proceeded with weekly couple sessions and weekly individual sessions for Kelly. The individual therapy provided a
forum for Kelly to become less dependent on Hans emotionally and to bolster her view of herself. As with Hans and her mother,
Kelly developed an idealised transference to me. Her hungry pursuit of self-discovery engaged me and propelled the treatment. It
also gave me an exaggerated sense of accomplishment and helped me understand Hans's feeling of superiority in relating to
Kelly. In contrast to the deadness that permeated her interactions with Hans, Kelly's interactions with me were lively. This
discrepancy, in part, was attributable to her once again feeling like the favourite child, a fantasy that she acknowledged. From an
attachment perspective, my increased contact with Kelly represented the possibility of obtaining the security she craved and,
thereby, of lowering her anxiety.
Hans supported Kelly's individual treatment, a reflection of his genuine concern, and his hope that I would fix his dysfunctional
wife and offer him relief. Consistent with his avoidant attachment style, Hans's fear of being overwhelmed by Kelly's emotionality
decreased, knowing that I provided a space for her to express herself. Just as he could not tolerate his neediness with Kelly,
Hans did not recognise either his longing for me as a maternal object, or his envy of what I offered Kelly. Additionally, by refusing
individual treatment, he avoided his anxiety and difficulty in accessing his internal life. In the couple therapy, Kelly's efforts to
supply Hans with words promoted my understanding of him and helped propel the treatment. Hans's refusal of individual
treatment implied that he did not need additional help. In not challenging this idea, Kelly colluded with Hans to maintain the
illusion of his superiority. I replicated the idealised-devalued split that operated in their marriage by working with Kelly, but not
Hans. Later in treatment, I explored this dynamic.
Kelly's Individual Therapy

The following segment illustrates how Kelly's individual sessions allowed more in-depth exploration of the intrapsychic dynamics
identified in the couple psychotherapy:
Kelly: “I've been thinking about what I'm good at. I've realised that I'm only been involved in activities that Hans is good at. I used
to be very social and loved to sing, dance, and play the piano.
NJC: “It sounds like those interests are dormant.”
Kelly: “Yes, I want to begin singing again and take up ballroom dancing.”
NJC: “I sensed sadness when you mentioned the piano. Is that a special loss?”
Kelly: “Not only did I give up playing the piano, I gave up my piano. It was a very old piano, not worth much.”
NJC: “Was it a Steinway to you?”
Kelly: “I had it since childhood.” Kelly identified musical pieces that she played to calm herself during stressful times.
NJC: “Did you turn to the piano, when your parents fought?”
Kelly: “All the time.”
NJC: “When you gave up singing, dancing and playing the piano, you gave up your aliveness. It is not just your sexuality that is
deadened.”
Kelly: “I can't believe it. I used to worry about becoming too close to Hans. Now, when I go on business trips, I can't bear to leave
him … This is so destructive.”
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Kelly had negated her identity and fused with Hans. Not only had she suppressed her affect and mirrored his more restrained
demeanour, she also pursued his interests and suppressed her own. Kelly relied on Hans to supply her with the resources she
believed she lacked internally. Having split off valuable parts of her self and deposited them into Hans, she was left with hated
aspects, and she felt inferior, psychically deadened, and envied Hans. Dynamically, this outcome is similar to the fate of the infant
who looks to the breast as the sole supplier of nourishment (Klein, 1957). From an attachment perspective, Kelly struggled to
negotiate connectedness and separateness throughout her relationship with Hans. Initially, she managed her anxiety that
closeness would result in fusion by avoiding relatedness. Over time, in her search for the security that was absent in her family,
she turned to Hans in the same way she had turned to her piano. She assigned him the role of saving her from psychic pain. In
excessively relying on him, Kelly blurred the boundary between herself and Hans.
Couple Therapy
Kelly purchased a piano, joined a singing group, and spent less time with Hans. Hans denied that he felt a loss or begrudged
Kelly her new found happiness, but Kelly reported that he had kept frantically busy. Hans's contentment struck me as similar to
his tolerance of Kelly's disinterest in sex. In both situations, he denied his neediness. I realised that I depended on Kelly to
provide information about Hans and that Kelly enlivened the couple's therapy, and without her, my ability to function as a therapist
felt compromised. Based on my countertransference, I wondered if Kelly served a similar function for Hans. Eventually, Kelly
reported that prior to meeting her, Hans experienced a depression so profound that he could not leave the house; and presently,
he did not drive for more than a half hour alone. Hans admitted that Kelly “is [his] everything” and that he feared losing her if he
expressed his sexual needs.
It was evident then that Hans projected his vitality into Kelly, and without her, he was deadened psychically. Typically, his superior
attitude disguised his neediness, and Kelly colluded with this defence. Its breakdown was now revealed together with Hans's
manic effort to cover his feelings of loss. He could now acknowledge his dependency and lack of separateness from Kelly. From
an attachment perspective, Hans feared that closeness would result in fusion, and to manage his anxiety of a loss of identity in
relating to Kelly, he used an avoidant attachment pattern that included denial of his neediness. His faulty sense of self- sufficiency
created the illusion of a boundary between himself and Kelly.
Like Kelly, Hans's separate identity was compromised. According to Kernberg (1995), such impairment inhibits the capacity to
experience passionate love that entails the crossing of boundaries between self and other. Without this psychic integrity, the
security of knowing that one will not destroy or be destroyed by merging with the other in a sexual encounter does not exist. Kelly
feared being invaded or intruded upon by a physical union with Hans and the aggression of penetration. Likewise, Hans could not
tolerate the risk that the aggression that accompanies penetration might destroy Kelly.
Attachment theorists (Mikulincer & Shaver, 2007) associate negative mental representations of self and other with insecure
attachment and link it to decreased satisfying sexual exploration. From this perspective, Kelly's and Hans's shared belief that they
must rely on the other for their vitality, rather than looking internally, reflected problematic attachment relationships and interfered
with their sexual functioning. Kelly's negation of her separateness and anxious clinging to Hans to obtain the emotional security
that was missing in her family interfered with desire for Hans. Similarly, to avoid experiencing the dependency that was not
tolerated in his family, Hans denied his sexual needs. His avoidance promoted security, but compromised his sexual life.

The following illustrates Kelly's reformulation of her perception of her mother:
Kelly: “I have been thinking about my inability to name anything positive about my mother. She loved music, was always singing,
and paid for me to take lessons. We look alike and are both social. I'm thinking of writing her a letter. I feel compassion for her
now.”
NJC: “This isn't the only time you had a change of heart about your mother. Up until you were twelve years old, you enjoyed a
special relationship with her.”
Kelly: “Yes, I was her favourite and she was everything to me.”
NJC: “She got dethroned and has had multiple successors.”
Kelly's appreciation that her mother nurtured her musical skills stemmed from a change in her perception of her mother's state of
mind and was accompanied by a shift in her own mental state, reflected in her compassion and desire for connection with her.
These changes indicated an improved capacity to mentalize and were linked to greater attachment security. Kelly recognised that
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her mother hurt her, but appreciated the good her mother had offered. Now, Kelly viewed her mother as a whole person, an
indication of depressive position functioning.
Kelly also examined her relationship with the brother, to whom she had turned when she renounced her allegiance to her mother.
In the following segment, with a sense of shame and horror, she revealed a “skeleton” from her past that she had never shared
with anyone. She had blocked it from her memory until three years ago, the same time that her sexual relationship with Hans
deteriorated.
Kelly: “When I was twelve years old and my brother was fifteen, he took out a spray, a gas of some sort. We took several sniffs
and eventually were strung out on the couch. Then, my brother put his hand down my pants. He stopped when we heard
someone coming. We never talked about it.”
Kelly had dissociated from the pain this aroused and masked it with rage throughout most of her life. In relating to Hans, however,
she had suppressed her powerful feelings to maintain a connection with him. Now, she wondered what other memories and
feelings she might have blocked, and, with a sense of horror, questioned if she had committed a murder. I suggested that there
had been a soul murder. To keep her brother as her saviour, she had killed off unsatisfactory aspects of him and of her childhood.
In the process, a part of her died, and her loss of sexual desire reflected this psychic deadness.
Kelly reported feelings of intense pain, sadness, and worry about who she would become. Her worry reflected reluctance to
relinquish ties to bad internal objects which, according to Fairbairn (1952), comprise the essence of identity and the workings of
internal life. Her mourning also suggested surrender of the fantasy that she could reclaim lost relationships, a goal that Eagle
(1999) identifies as essential for growth in individuals with enmeshed-preoccupied attachment styles. Kelly had the added
advantage of working towards this goal in individual therapy, a benefit that Hans remained unwilling to pursue.
Couple Therapy
I considered that the incident with her brother was linked to Kelly's loss of desire. This brief sexual encounter confronted her with
previously denied, split-off aspects of her brother and dangerously threatened to disrupt her idealised view of him. To maintain
her idealised perception of her brother, Kelly relied on repression. The pressure on her to form a committed sexual union with
Hans threatened to disrupt this defence. Desire for Hans carried the risk of the return of repressed feelings of danger and shame
about her brother, as well as of losing Hans as an idealised object.
Typically in hysterical organisation, through psychological conversion, genital body parts came to embody the functional
significance of Kelly's experiences. The use of projective identification allowed Kelly to locate her psychic experience of her
brother as an exciting and intruding object in Hans's penis. From an attachment viewpoint, Kelly's insecure attachment
compromised her ability to successfully shift her primary allegiance from her mother and/or brother to Hans as an attachment
figure. As a result, unconsciously, she equated Hans with parental figures and sexually responded to him as a “forbidden
incestuous object” (Eagle, 2007, p. 39) for whom she felt no desire.
Kelly now wanted to focus more directly on her sexual difficulty, a reflection of her psychic growth toward depressive position
functioning and more secure attachment. This shift supported the attachment tenet that a secure base serves as a foundation for
exploration (Ainsworth, 1972), in this case, of the body (Holmes, 2007). I introduced behavioural sex therapy involving a series of
graded home exercises that couples perform twice weekly. They begin with non-threatening, non-genital pleasuring of each other
and end with intercourse. The assignments recall the types of behaviours that Bowlby (1969) identified as attachment behaviours
and Ainsworth and her colleagues (Ainsworth et al., 1978) captured in the Strange Situation Test (Caruso, 2011). In prescribing
them, the therapist, in effect, calls upon the couple to engage in proximity-seeking behaviour that requires them to initiate contact
with each other and then to participate in a shared activity that involves the exploration of each other's body. With the completion
of each exercise, the couple is free to resume separate activities, but is expected to reunite for a second episode each week.
The exercises expose each partner to the physical and emotional presence of the other and to the self, experienced in relation to
another. As such, the exercises have the potential to trigger experiences of the self in relation to internalised attachment
relationships that, over time, become mentally represented and contribute to the formation of particular attachment styles. As the
couple narrate their experience in the session, they reveal their internalised images and attachment orientations, which the
therapist then uses to understand their execution of the exercises and their overall sexual functioning. Specific object relations
issues are associated with each behavioural exercise (Scharff & Scharff, 1991).
In the following segment, the Kelly and Hans reported their experience of completing the first exercise which prohibits breast and
genital contact:
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Hans: “We discovered that we enjoy the exercise more if the room is warm.”
Kelly: “Is that it?”
NJC: “Do you have something specific in mind.”
Kelly: “He knows what it is.”
Hans said they manually stimulated each other.
Kelly: “It seemed like you were the parent who said no sex, alcohol, and drugs, and we were the teenagers who violated the
rules.”
Hans: “My first inclination was to say ‘OK, let's get up and get dressed.’”
Kelly: “Oh, come on, you're not going to leave me out there.”
NJC: “You disagree?”
Kelly: “Yes. He's making me the devil. What he said was Dr Caruso would say, we should get up and get dressed.”
Hans: “That is what I said.”
Kelly: “He's acting like he wasn't aroused.”
Hans: “I was aroused, but I only went along with you.”
In not complying with the boundaries, the couple banded together and located the forbidding parental object in me, instead of
Hans. Hans's secrecy and the couple's mutual opposition are elements of sexual passion that organise human behaviour
(Kernberg, 1995, p. 54). Like Adam and Eve, who ate the forbidden fruit, derived from the tree of knowledge, they acted on their
desire to know each other in ways forbidden by parental figures. Possession of this knowledge required that they work through
the depressive position and oedipal complex (Britton, 1992; Ruszczynski, 2005) to reap the benefits of being a securely attached,
intimate couple whose mortality is insured by the creation of offspring (Clulow & Boerma, 2009).
Kelly's challenge of Hans's superior functioning signalled her growth toward more mature relatedness. She realised that the
idealised-devalued split between Hans and herself replicated the split between her mother and brother, and addressed this
dynamic with Hans. Eventually, Hans admitted feeling “lonely on the top”. I linked his present functioning to his former family role
of a golden child with a narrow range of emotions. Hans revealed that he stuttered during childhood and his speech therapist
attributed it to his constricted emotions. He said, “I literally became speechless, when I was angry.” I interpreted his emotional
withdrawal in the face of anger as serving a similar function. I observed that when Kelly expressed the anger that he could not
bear to reveal, he criticised her for her lack of discipline. In response, Hans said, “I'll have to think about that, before I comment.” I
wondered if my interpretation angered him and rendered him speechless.
Hans began to gain access to his affective experience, a goal that Eagle (1999) identifies as necessary for those with avoidant
attachment styles to achieve. I believed that adding individual therapy could have further promoted his maturation, a prerequisite
for developing a viable partnership. Hans remained uninterested in individual treatment.

Kelly explored her rebel role and the liveliness it engendered. To appeal to Hans, and less consciously to her mother, Kelly
dressed conservatively and restrained her demeanour. In doing so, she relinquished her aliveness, including sexual desire. Kelly
also discussed her fears that cervical cancer might prove fatal. She admitted that she never imagined being a mother and
recognised that her anxiety that she might emotionally damage a child contributed to her loss of sexual desire. Although capable
of bearing a child, she felt that her body lacked wholeness, an outcome of her psychically cutting off feminine, maternal, and
sexual aspects of herself to avoid identifying with her mother. Within the transference, Kelly viewed me as a woman who
integrated conformity and aliveness. She began to dress in feminine clothes and to feel sexual desire; she also consulted a
perinatologist with the hope of conceiving a child.
Couple Therapy
The couple began openly to express conflict, as is illustrated in the following segment:
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Kelly: “Every morning before we leave for work, we close all the windows and blinds. Several weeks ago, Hans shut the blinds as
I was looking out the window. When I said something, he said, ‘I'm not going to close the blinds anymore.’ This morning I said to
him, ‘Is this going to go on forever?’ He said, ‘I guess so.’”
With anger Kelly said, “He was defiant.”
Hans admitted his anger. Kelly said throughout their marriage they debated whether to close the blinds and lock the doors.
NJC: “You struggle with how open to be. You have a dilemma. If you openly show anger, you fear you'll lose control as in Kelly's
family. If you don't express it, close and lock the doors, so to speak, you fear that your relationship will die from a lack of light and
fresh air as in Hans's family.”
Consistent with the premise that hatred, along with longing, fuels sexual desire (Clulow & Boerma, 2009; Kernberg, 1995), the
couple's overt expression of anger coincided with a return of desire, revealed in the following segment:
Hans: “I told Kelly that I feel sexual desire again, but not for her. I had suppressed it after feeling so rejected by her. Therapy
helped me distinguish between my physical and emotional needs. I think about other women being available to me sexually, as
well as emotionally.”
Kelly: “The irony is that since we've been involved in separate activities, we have been able to talk more and I feel more
connected to him. Before Hans spoke of being aware of other women, I had wanted to tell him that I desire him now. When Hans
said that he doesn't desire me, I felt like he ripped something out of me.”
NJC: “It was painful to hear Hans's comments, but Hans saying he lacks desire for you, is not very different from what you have
been telling him.”
Kelly: “I never saw it that way.”
Hans: “Your rejections are painful to me.”
Through projective identification, Kelly gained a first-hand appreciation of how she hurt Hans and could no longer define herself
solely as a loving wife. This shift revealed her improved capacity to mentalize and view objects as whole, changes linked to
greater attachment security and depressive position functioning, respectively. These developments were accompanied by desire
for Hans.
Hans was no longer shielded by Kelly's symptoms and his difficulties emerged. Anger and pain fuelled his lack of desire, but he
had difficulty appreciating the magnitude of these feelings and threatened to end the marriage when Kelly expressed her anger.
Hans now used words to hurt Kelly, placing unrealistic demands on her, and no longer exercising restraint in verbal exchanges
with her.
Kelly's changes shattered the couple's unconscious marital contract that relied on an idealised-devalued split. Hans verbally
attacked Kelly to diminish her and related to her as a part object, inferior to him. His behaviour reflected paranoid-schizoid
position functioning and a failure to mourn his lost idealised position. Hans resisted knowing his pain, an indication of an impaired
capacity to mentalize, linked to insecure attachment.
Kelly now felt sexual desire for the person to whom she was attached, whereas Hans desired a woman outside of the
relationship. Kelly's ability to integrate attachment and sexualitysignified more secure attachment and greater resolution of issues
with primaryattachment figures. In turn, she was less prone to equate Hans unconsciously with parental objects and, therefore,
could feel sexual without fear of activating the incest taboo (Eagle, 2007).
With Hans's attraction to other women, treatment focused on this symptom and its link to his early attachment relationships. Hans
doubted the marriage's viability, if Kelly pursued separate interests. I understood his slip of the tongue: “The marriage can work if
Kelly has her interests and she has mine,” as revealing unconscious longing to merge with a maternal object. Whereas Kelly felt
more alive and connected to Hans when she pursued separate activities, Hans felt deadened, having lost the connection with a
maternal figure who idealised him. With other women, he could re-establish this oedipal triumph, originally derived from his
parents.
Hans also had difficulty relinquishing his idealised view of maternal figures. He resisted my interpretation that his mother's
unrealistic expectations for maturity had injured him. Hans needed to preserve his mother's goodness and restrict “his knowledge
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of her” (Britton, 1989, p. 90). Similarly, within the transference, Hans denied his anger at me for failing him and helping Kelly.
Through treatment, Hans was better able to identify and express his feelings, and acknowledge gains he had made.
Nevertheless, when the couple work focused on him, his difficulty thinking about himself became increasingly apparent. He
questioned whether to remain in treatment and in the marriage. Countertransferentially, I felt that I had failed Hans. Because of
his mental and emotional unavailability, alongside Kelly's quest for self-discovery, I had given him less attention than Kelly.
However, when I attended to Hans more intensively, he resisted my efforts, like the avoidant infant anxiously turns away when his
mother returns in the “Strange Situation Test” (Ainsworth et al., 1978). Dynamically, the analytic work represented the coupling of
two minds that was unbearable because it threatened to disrupt his link to the good maternal object (Britton, 1989; Morgan &
Freedman, 2005). By ending treatment, Hans would avoid “psychic intercourse” (Morgan & Freedman, 2005, p. 15) and a more
productive treatment outcome. Similarly, Hans was threatened by the prospect of a mature object relationship. His loss of desire
for Kelly coincided with the return of her desire and interest in conceiving a child; and it signalled his conflict about becoming a
parental couple, capable of creating a child. By ending the marriage, Hans would avoid this possibility and the accompanying
activation of oedipal issues.
During the next several months, Hans's vague interest in other women evolved into a focus on one woman outside of the
marriage. He resisted my interpretation that his behaviour represented an attack on internalised maternal expectations for
restraint and discipline. Kelly told Hans that he had hurt her and attempted to limit his behaviour in a way that she had failed to do
with her father. Hans ended the marriage and therapy after a few additional months. Deeply saddened, Kelly mourned the loss,
though she felt grateful for her personal growth and the return of sexual desire.
Discussion
This paper uses clinical material of a couple to examine the psychodynamics of loss of sexual desire, provide psychoanalytic
therapy, and illustrates the link between the attachment styles and sexual functioning. From an attachment perspective, the
couple's sexual difficulties represented a difficulty in integrating attachment and sexuality, rooted in problematic,
primaryattachment relationships. This paper also utilises object relations theory to understand unconscious, intrapsychic
variables that constructed the couple's relationship and interfered with their sexual functioning.
The couple's failure to integrate love and hate, view objects as whole, mentalize, and maintain the boundary between self and
other, were manifested in the transference, and encapsulated the underlying dynamics of their loss of sexual vitality. Analysing
countertransference reactions helped me find meaning in the couple's unconsciouscommunication that took place through
projective identification.
The treatment relied on both psychoanalytic and behavioural sex therapy techniques. The opposing goals and intervention
strategies of each method can confuse patients. A behavioural model implements directive interventions to relieve symptoms,
whereas a psychoanalytic approach fosters insight and uses non-directive strategies. To promote a sense of coherence for
patients, the therapist needs flexibility and the technical skills to employ the divergent treatment interventions and oscillate
between them (Caruso, 2011).
The partner who presented with loss of desire demonstrated an improved capacity to establish a separate identity, to mentalize,
to integrate love and hate, to view objects as whole, and to function within the depressive position, all reflections of greater
attachment security. Additionally, her sexual desire returned. By contrast, the partner who initially presented as asymptomatic,
showed difficulty tolerating separateness, viewing objects as whole, integrating love and hate, and moving toward depressive
position functioning, an outcome that is consistent with insecure attachment. Together these findings support the claim that
compared with those with less secure attachment patterns, more securely attached individuals can better integrate attachment
and sexuality(Eagle, 2007). Furthermore, the return of sexual desire in one partner, subsequent to an improved perception of
primary objects, supports the attachment tenet that a secure base serves as a foundation for exploration (Ainsworth, 1972), in
this case, of the body (Holmes, 2007).
Over the course of one and a half years, I provided weekly couple psychotherapy and weekly individual treatment sessions to the
partner who sought treatment for loss of sexual desire. The combined approach allowed observation and interpretation of the
organising aspect of the transference. It also complicated transference and countertransference dynamics and increased the
likelihood of my forming a stronger bond with one partner and of becoming unfairly biased. I discussed the pros and cons of
providing both modalities with the couple. I also sought professional consultation during the course of treatment that helped to
minimise the adverse effect of this approach. To promote cohesiveness, I also examined the impact of the couple work on the
individual treatment and vice versa. It is advisable to avoid this combined approach in couples who are experiencing high levels
of conflict or who rely on splitting as a major defence(Caruso, 2011).
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In applying attachment and object relations theory and practice to a couple's sexual difficulties, this paper demonstrates the
similarities and differences of these perspectives and offers clinicians alternatives to the more commonplace, interpersonal
framework and cognitive-behavioural approach. It is my hope that this broader framework will enrich the understanding of desire
disorders and result in treatment outcomes that will improve the sexual functioning of couples.
References
1
Ainsworth , M. D. S. (1972). Attachment and dependency: a comparison. In: J. L. Gewitz (Ed.), Attachment and Dependency
(pp. 97-137). Washington, DC: Winston .
2
Ainsworth , M. D. S. , Blehar , M. C. , Waters , E. , & Wall , S. (1978). Patterns of Attachment: A Psychological Study of the
3
Bowlby , J. (1969). Attachment and Loss. Vol. 1 Attachment. New York: Basic Books . (IPL.079.0001A)
4
Britton , R. (1989). The missing link: parental sexuality in the Oedipus complex. In: J. Steiner (Ed.), The Oedipus Complex
Today: Clinical Implications (pp. 83-101). London: Karnac . (ZBK.054.0083A)
5
Britton , R. (1992). The Oedipus situation and the depressive position. In: R. Anderson (Ed.), Clinical Lectures on Klein and
Bion (pp. 34-45). London & New York: Brunner-Routledge . (NLP.014.0034A)
6
Caruso , N. (2011). The entangled nature of attachment and sexuality in the couple relationship. Couple and Family
Psychoanalysis, 1 ( 1 ): 117. (CFP.001.0117A)
7 Clulow , C. , & Boerma , M. (2009). Dynamics and disorders of sexual desire. In: C. Clulow (Ed.), Sex, Attachment and Couple
Psychotherapy: Psychoanalytic Perspectives (pp. 75-101). London: Karnac .
8
Dicks , H. V. (1967). Marital Tensions. London: Karnac .
9
Eagle , M. (1999). Attachment research and theory and psychoanalysis. Presented at The Psychoanalytic Association of New
York, November, 1999.
10
Eagle , M. (2007). Attachment and sexuality. In: D. Diamond , S. J. Blatt , & J. D. Lichtenberg (Eds.), Attachment and Sexuality
(pp. 27-50). New York: Analytic Press .
11 Fairbairn , W. R. D. (1952). Psychoanalytic Studies of the Personality. London: Routledge & Kegan Paul . (ZBK.007.0001A)
12
Fairbairn , W. R. D. (1954). Observations on the nature of hysterical states. British Journal of Medical Psychology, 27 : 105-
125.
13
Fonagy , P. (2001). Attachment and Psychoanalysis. New York: Other Press .
14
Green , L. , & Seymour , J. (2009). Loss of desire: a psycho-sexual case study. In: C. Clulow (Ed.), Sex, Attachment and
Couple Psychotherapy: Psychoanalytic Perspectives (pp. 141-163). London: Karnac .
15
Holmes , J. (2007). Sense and sensuality: hedonic intersubjectivity and the erotic imagination. In: D. Diamond , S. J. Blatt , &
J. D. Lichtenberg (Eds.), Attachment and Sexuality (pp. 137-159). New York: Analytic Press .
16
Kaplan , H. S. (1974). The New Sex Therapy. New York: Brunner/Mazel .
17
Kernberg , O. (1995). Love Relations: Normality and Pathology. New Haven: Yale University Press .
18
Klein , M. (1937). Love, guilt and reparation. In: Love, Guilt and Reparation and Other Works: 1921-1945 (pp. 306-343).
London: Hogarth , 1975 .
19
Klein , M. (1957). Envy and gratitude. In: The Writings of Melanie Klein, Vol. 3 . London: Hogarth ( 1975 ).
20
Laumann , E. , Kolata , G. , Gagnon , J. , & Michael , R. (1994). Sex in America: A Definitive Survey. New York: Little Brown .
21
McCarthy , B. , & McCarthy , E. (2003). Rekindling Desire. New York: Brunner-Routledge .
2/6/2018 EBSCOhost
22 Mikulincer , M. , & Shaver , P. R. (2007). A behavioral systems perspective on the psychodynamics of attachment and
sexuality. In: D. Diamond , S. J. Blatt , & J. D. Lichtenberg (Eds.), Attachment and Sexuality (pp. 51-78). New York: Analytic Press
.
23
Morgan , M. , & Freedman , J. (2005). On being able to be a couple: the importance of a “creative couple” in psychic life. In: F.
Grier (Ed.), Oedipus and the Couple (pp. 9-30). London: Karnac .
24
Rix , S. , & Shmueli , A. (2009). Loss of desire and therapist dread. In: C. Clulow , (Ed.), Sex, Attachment and Couple
Psychotherapy (pp. 119-140). London: Karnac .
25
Ruszczynski , S. (2005). Reflective space in the intimate couple relationship: the “marital triangle”. In: F. Grier (Ed.), Oedipus
and the Couple (pp. 31-47). London: Karnac .
26
Scharff , D. E. (1982). The Sexual Relationship: An Object Relations View of Sex and the Family. Northvale, NJ: Jason
Aronson .
27
Scharff , D. E. , & Scharff , J. S. (1991). Object Relations Couple Therapy. Northvale, NJ: Jason Aronson .
28
Winnicott , D. W. (1960). The theory of the parent-infant relationship. In: The Maturational Processes and the Facilitating
Environment (pp. 37-55). London: Hogarth , 1965 . (IJP.041.0585A)
29 Winnicott , D. W. (1971). Playing and Reality. London: Tavistock . (ZBK.017.0001A)
CFP.004.0166A
Record: 20
Title: Relating Therapy
Authors: Birtchnell, John
Source: British Journal of Psychotherapy, 2014; v. 30 (1), p87, 14p
Language: English
Abstract: Relating therapy is a form of psychotherapy that is based upon relating theory. Relating
theory is briefly compared with attachment theory and certain aspects of psychoanalysis.
The interpersonal octagon (Birtchnell, 1994) represents a person's eight relating positions.
People need to acquire the capability to relate effectively in each one of these. Competent
relating is called positive and relating that falls short of this is called negative. Ways are
described by which patients are helped to shed their negative relating and become more
capable of relating positively. The Person's Relating to Others Questionnaire (Birtchnell et
al., in press) measures negative relating within the eight positions of the octagon. It
identifies a person's areas of negative relating and measures change in such relating over
the course of psychotherapy. Interrelating therapy is an extension of relating therapy that is
applicable to couples. The Couple's Relating to Each Other Questionnaires (Birtchnell et
al., 2006) is a set of four questionnaires by which each of two partners can rate how s/he
relates negatively to the other and how s/he considers that the other relates negatively to
her/him. It is used to measure change over the course of couple therapy.
Accession Number: BJP.030.0087A
(Permalink): direct=true&db=pph&AN=BJP.030.0087A&site=ehost-live&scope=site
direct=true&db=pph&AN=BJP.030.0087A&site=ehost-live&scope=site">Relating
Therapy</A>
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Relating Therapy
John Birtchnell, MD, FRCPsych, FBPsS, author; [mail@johnbirtchnell.co.uk]
Relating therapy is a form of psychotherapy that is based upon relating theory. Relating theory is briefly compared with
attachment theory and certain aspects of psychoanalysis. The interpersonal octagon (Birtchnell, 1994) represents a person's
eight relating positions. People need to acquire the capability to relate effectively in each one of these. Competent relating is
called positive and relating that falls short of this is called negative. Ways are described by which patients are helped to shed
their negative relating and become more capable of relating positively. The Person's Relating to Others Questionnaire (Birtchnell
et al., in press) measures negative relating within the eight positions of the octagon. It identifies a person's areas of negative
relating and measures change in such relating over the course of psychotherapy. Interrelating therapy is an extension of relating
therapy that is applicable to couples. The Couple's Relating to Each Other Questionnaires (Birtchnell et al., 2006) is a set of four
questionnaires by which each of two partners can rate how s/he relates negatively to the other and how s/he considers that the
other relates negatively to her/him. It is used to measure change over the course of couple therapy.
Introduction
Relating therapy is undoubtedly a form of psychotherapy and, although it is more pragmatic than psychoanalysis, issues such as
the transference are not necessarily ruled out. Just as attachment therapy draws upon attachment theory, relating therapy draws
upon relating theory (Birtchnell, 1996, 2002b) but the two theories are not incompatible. Relating theory proposes that relating
occurs across two principal axes, a horizontal one concerning getting close versus becoming separate and a vertical one
concerning relating from above downwards (upper), versus relating from below upwards (lower). During our early years, we strive
to acquire the skills that enable us to attain and function within each one of the four positions. The more competent and effective
ways of relating are called positive, and the ways that fall short of this ideal are called negative. Relating therapy has the clear-cut
objective of eliminating negative relating and replacing it with positive relating. The object of the present paper will be to focus
upon the kinds of strategy that may be adopted in order both to identify and correct a patient's negative relating. Relating therapy
has been briefly referred to in certain earlier publications (Birtchnell, 2001, 2002a, 2002b), but it has yet to be clearly defined and
described. The present paper aims to do this. There is a loose association between that which is here referred to as relating
theory and the longer-established attachment theory as defined by Bowlby (1977, 1988), Wallin (2007), Steele and Steele (2008)
and others. Whilst the term attachment might apply predominantly to the child-parent relationship and attachment-based
psychotherapy might focus upon both the therapeutic relationship and improving both the past and the present relationship
between the patient and a parent, relating theory would apply more to the entire range of relating towards and between people.
However, it has to be acknowledged that there must be some reason why a person does not currently relate positively to people
in one direction or another, and that her/his current relating deficiencies may be a consequence of her/his past relating
experiences. Therefore improving her/his current relating may also involve examining her/his earlier, and possibly also her/his
current relationships with one or both her/his parents.
The main objective of relating therapy is the identification and elimination of the more negative forms of relating and the
encouragement, reinforcement and enhancement of the more positive forms. That which is here referred to as relating therapy
did not exist before the establishment of the underlying relating theory, although the term has previously been used to define a
form of psychotherapy for patients who hear voices (Hayward et al., 2009). Before proceeding to an account of relating therapy it
will be necessary to briefly summarize the essential features of relating theory. Relating theory is sometimes called spatial theory
because relating is that which occurs across the space between two people. It is definable in terms of two principal axes: a
horizontal one that extends from being closely involved with others to being distinctly separate from others and a vertical one that
extends from relating to others from an upper position to relating to them from a lower position. An important principal of the
theory is that each one of these four positions, which have been called states of relatedness, can carry a clear-cut advantage for
the individual, so that no one of them should be considered superior or preferable to any other.
The understanding is that we are not born with the capabilities to relate from each of these four main positions, but that ideally,
over the course of our early interactions with others, we come, to acquire such capabilities. Whilst initially these various relating
behaviours may need to be consciously and deliberately thought out, by way of that which has been called the outer-me,
subsequently they come to happen quite unthinkingly, spontaneously and automatically, by way of that which has been called the
inner-me. In order that this should happen, the inner-me would need to be capable of learning, and subsequently comprehending,
the nature and advantages of each state of relatedness and of initiating those forms of relating that would enable the individual to
attain and maintain each and every one of them. For this to happen there would need to be a link between relating and emotion,
by means of which the attainment of a sought after state would give rise to pleasure, and the loss of one would give rise to
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displeasure. This applies even to fictional circumstances; which is why people like reading novels. This may be related to Freud's
pleasureprinciple.
Is there a difference between the conscious/unconscious distinction and the outer-me/ inner-me distinction? The two
comparisons overlap, but they are not identical. The conscious is the experience and expression of everyday thoughts and ideas.
The unconscious is a set of what would normally be considered to be disturbing or unacceptable motives and ideas which may
have become suppressed. The outer-me is the person's consciously and deliberately thought-out ideas and actions. The inner-
me is a set of ideas and actions that would previously have needed to be learned but which now have become automatic and
second nature, like speaking, reading, writing, driving a car or playing an instrument. The person now simply thinks and acts
spontaneously. The inner me also generates an appropriate emotional response to the gain or loss of a particular state of
relatedness.
Positive and Negative Relating

The most extreme form of negative relating is the total avoidance of a particular state, and functioning predominantly within the
confines of the opposite state. Less than this is insecure relating in which the person clings anxiously to a particular state of
relatedness and lives in fear of losing it. Another negative form of relating is the forcible imposition of a particular state of
relatedness upon another person. Negatively close people who constantly need to remain in the company of others, strive to get
close and stay close to them and to cling tenaciously to them. Negatively distant people, who constantly avoid getting close to
others, strive to keep a safe distance from them, keep themselves to themselves and try to dissuade others from getting too close
to them. It is unusual, though not entirely impossible, for a person to avoid both closeness and distance. Negatively upper people
strive to avoid adopting a lower position. They consistently need to be the one who takes control and attempt always to impose
their will upon others. Beyond this they may attempt to dominate, suppress, punish, intimidate or bully others. Negatively lower
people strive to avoid an upper position or accepting responsibility. They experience themselves as inferior. They are meek and
submissive and consistently look towards others for guidance, instruction, protection or reassurance. It would seem unlikely that
a person would avoid being both upper and lower.
Another form of negative relating is for a person to persistently attempt to persuade others to relate in a complementary way
towards her/him, like adopting a helpless attitude and giving the impression of needing to be looked after or told what to do; or
excessively offering to help, guide or look after others. It would seem unlikely that a person would seek to be treated for such
behaviour. Another relating problem is that the patient is the victim of someone who is persistently trying to impose a particular
form of relating upon her/him. Before attempting to modify a person's negative relating it is essential for the therapist to be in a
position to define for her/himself as accurately as possible the true nature, duration and severity of the patient's relating
tendencies and also to identify any significant others in the patient's life who may be contributing to the persistence of her/his
condition.
The Practice of Relating Therapy

The objectives of relating therapy are to identify the salient features of the patient's current negative relating tendencies and to
seek out those circumstances that may conceivably have caused the patient to adopt them, or that may be continuing to
sustaining her/him in them. It is likely that, by the time the patient has got to therapy, the pattern of negative relating will have
become so well established that it will not be easy to dispel. The first step in the therapy process will need to be to establish an
agreement with the patient that this is a form of relating that s/he might no longer wish to be associated with, to reach an
understanding that change will not come easily, and that the therapist and patient, and possibly others, will need to work closely
together in order to bring any change about. At this point it has to be acknowledged that the patient's negative relating will have
become second nature to her/him, and is therefore entirely under the control of the inner-me. It must be borne in mind that, in
order to modify such behaviour, the patient will, under the direction of the therapist, need to bring about a transfer from an
automatic, inner-me form of relating back to the more deliberate and conscious outer me form. That is that the psychotherapy has
got to take place within the more deliberate and consciously thought out, outer me mode of relating, and that hopefully, when in
this mode, the patient's negative relating has become unlearned, and consciously replaced by an equivalent form of positive
relating. Hopefully this newly acquired form of relating will eventually become the norm and therefore be automatic and second
nature to her/him, because, by then, it will have come under the control of the inner me. But this will take time.
It would seem likely that some forms of negative relating are more difficult to correct than others. Negatively upper people can be
pompous and self-opinionated. They do not like being told what to do. They may lose their tempers easily and even resort to
violence. Consequently they would not be inclined to offer themselves up to therapy. It is acknowledged that there may be rare
occasions when anger and rage may be appropriate. Negatively lower people may all too readily adopt the lower role of patient
but be reluctant to move into an upper position of authority. Negatively distant people may find the closeness of therapy
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disturbing while negatively close people would enjoy the intimacy of the therapeutic relationship and be disinclined give it up.
These issues would need to be tactfully raised over the course of therapy.
The therapy will involve attempting to enable the patient to try relating in a manner that s/he has to date been inclined to avoid. A
complication of the therapy could be that the patient has become involved in relationships that tend to maintain or reinforce
her/his in her/his present negative relating tendencies. In this process, it may be helpful to invite into the therapy sessions
someone with whom the patient has had a close and regular involvement, who may, though not necessarily intentionally, be
reinforcing the patient's negative relating. For example, an organizing and dominating person may reinforce the patient's
tendency to be compliant and obedient. It may be possible to explain to the invited person what would appear to be happening
here and even to persuade her/him to modify the way that s/he relates to the patient in order to make it easier for the patient to
change.
The Interpersonal Octagon

The interpersonal octagon is a diagram created by inserting intermediate positions between the four poles of the horizontal and
vertical axes described above. Each octant has been given a two-word name, the first word referring to the vertical axis and the
second word referring to the horizontal one. In the four principal positions of the octagon the word ‘neutral’ has been inserted in
the space where the word for the other axis would have been. Moving clockwise round the octagon from the top, the names of
the eight octants are upper neutral (UN), upper close (UC), neutral close (NC), lower close LC), lower neutral (LN), lower distant
(LD), neutral distant (ND) and upper distant (UD). In fact it has been possible to construct two octagons, one describing all the
positive forms of relating for each octant and one describing all the negative forms.
Whilst the interpersonal octagon shares certain features in common with the longer established interpersonal circle (Leary, 1957)
there are a number of differences between the two structures (Birtchnell, 1994; Birtchnell, in press). Like the interpersonal
octagon the interpersonal circle is constructed around a vertical axis and a horizontal axis, but in contrast with the terms of the
octagon those of the circle are all highly emotive; the vertical axis extending from dominate at the top to submit at the bottom and
the horizontal one extending from love to the left to hate to the right. Like the interpersonal octagon the interpersonal circle has
intermediate categories between the four main ones; but, unlike the octagon, it places the more adaptive forms of relating at the
centre of the circle and the more maladaptive forms at the periphery.
The Assessment of a Patient's Negative Relating

The Person's Relating to Others Questionnaire (PROQ3) (Birtchnell et al., 2013) is a self-administered questionnaire designed to
measure negative relating. It comprises a set of 48 randomly distributed I-statements concerning how the respondent considers
that s/he may relate negatively to others. There are six items for each of the eight octants of the octagon, only five of which refer
to negative relating and are scored. The remaining item refers to positive relating. It is not scored and is included only to reduce
the overall negative tone of the questionnaire. The allocation of items to each of the scales has been confirmed by a confirmatory
factor analysis. The alpha internal reliability scores for the scales in the sequence given above are 0.72, 0.85, 0.83, 0.79, 0.82,
0.70, 0.78 and 0.74. The questionnaire is scored by computer and the print-out includes both a set of scores and a graphic
representation of the scores, which are in the form of shaded areas of the octants (see Figure 1). The greater the shaded area is
the higher is the score.
bjp.030.0087a.fig001.jpg
Fig. 1: The pre-therapy graphic representation of PROQ3 scoresd
Ideally, before the start of therapy, the therapist should have access to the print-out of a recent PROQ3 which will provide her/him
with a clear indication of the patient's main areas of negative relating. It may also be advantageous, before the therapy begins, to
show the graphic representation of the scores to the patient, explain in simple language what the shaded areas of the octants
refer to, and enquire whether this might correspond with her/his own view of where her/his relating problems may lie. The therapy
should be directed towards the areas with the highest scores. This would be more clear-cut than in classical psychoanalysis, but
the correction of negative relating does not necessarily exclude the resolution of the transference. Patients often find the visual
representation of their relating appealing and feel motivated to try to improve upon it. It would be appropriate to repeat the
PROQ3 at stages over the course of therapy in order to provide an index of how well the therapy is progressing. If there remain
areas of the octagon that appear not to have been affected by the therapy the therapist should then direct her/his therapeutic
endeavours towards these more resistant areas. The PROQ3 should finally be administered at the end of therapy.
Psychotherapy patients have been shown to have significantly higher PROQ3 mean scores than non-patients on five of the eight
octants plus the total score. The scales on which there was no significant difference were the three upper scales. This may be
because negatively upper people are the least inclined to seek psychotherapy. A bossy person would be less likely to invite a
therapist to make her/him less bossy. The scale showing the most marked difference between patients and non-patients was
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lower close. Over the course of psychotherapy, the patients' scores have been shown to drop significantly on six scales plus the
total score. The scales on which there was no significant drop were upper neutral and upper distant (Birtchnell et al., 2013). This
study involved English (467 patients and 313 non-patients), Irish (403 non-patients), Dutch (204 non-patients) and Greek (994
students) samples. These findings would again be in accord with the idea that negatively upper people are less likely to seek
therapy than negatively lower people. This would support the view that negative relating is a characteristic of psychotherapy
patients in general, and that any form of psychotherapy is likely to have some effect of reducing it. An earlier version of the
PROQ was administered to two male forensic therapy samples, one in a medium secure unit and one in a prison therapeutic
community, before and after therapy. In both samples there were significant improvements in mean scores on a number of scales
(Birtchnell et al. 2009). It would seem likely that the therapy in these samples would have been administered largely to reduce the
prisoners' criminal inclinations rather than to eliminate their psychiatric symptoms or to modify their negative relating. It needs to
be stressed that the psychotherapy referred to in the above descriptions is not the same as that which will be described later in
the paper under the heading of relating therapy. One would anticipate, however, that the relating therapy that is yet to be
described, which is directed specifically at modes of negative relating, would have a more marked effect than most other forms of
psychotherapy upon the reduction of a patient's PROQ3 scores.
Some Relating Therapy Procedures

In relating therapy the focus is mainly upon the person's negative relating. It has yet to be determined whether improving a
patient's negative relating might also improve her/his psychiatric symptomatology. In relating therapy, as in most other forms of
psychotherapy, the patient would be encouraged to speak freely and openly about whatever would appear to be troubling
her/him, and the therapist would listen carefully and respond to those moments when the patient would appear to be showing
signs of disturbance or distress. The therapist need not tell the patient that any particular session, or part of a session was
intended to be focused upon the patient's relating difficulties, though, in a sense, this would probably become obvious to the
patient. Instead, the therapist would simply adopt certain strategies as and when issues of relating emerge during the course of
the session.
The patient may not tell the therapist that s/he has a particular relating problem, but such a problem may become apparent to the
therapist during the course of a normal psychotherapy session. A further area of concern may be the way the patient feels that
certain others relate to her/him or have related to her/him in the past. It would seem quite likely that the patient's negative relating
might be a consequence of the way that one or both of her/his parents have related to her/him. It would be appropriate therefore
to invite the patient to talk freely about each parent's style of relating to her/him and to observe how emotional this caused the
patient to become. In the past a patient's parent may have discouraged certain forms of relating. The parent may have preferred
to keep the patient excessively close and not allow her/him to spend time alone or explore new relationships. Or s/he may have
preferred to keep the patient in an obedient one-down position. Bowlby (1977) has argued that there is a strong causal
relationship between an individual's experiences with her/his parents and her/his later capacity to make affectional bonds. The
therapist may examine the extent to which the person's parents had been able to provide her/him with a secure base from which
to explore relationships with others. It may further be the case that the negative relating of close others towards the patient may
either be reinforcing the patient's own negative relating or be a response to the patient's negative relating towards them, and this
possibility would need to be cautiously explored. A further pointer to the patient's relating difficulties would be the way that the
patient relates to the therapist (i.e. the transference). S/he may be clinging, detached, controlling or submissive. The therapist
should, in a non-accusing manner, draw the patient's attention to this, try to ascertain whether this was something that s/he
tended to do with other people and explore why s/he might be inclined to do it.
The therapist would wish to encourage the patient to explain what it is that s/he fears most about those relating positions that
s/he tends to avoid, and endeavour to identify the origin of such fears. The therapist might also tactfully enquire whether they
might still be appropriate. S/he may suggest to the patient that s/he should now cautiously try to adopt those forms of relating that
s/he has always tended to avoid. Even this may arouse anxiety in the patient; so the therapy can only proceed as fast as the
patient can tolerate it.
The patient may show little concern about not being able to relate in a particular way. A persistently close person may prefer to
have lots of close involvements and see no point in becoming distant from people; or a distant person may see no advantage in
getting close to people. An upper person may always prefer to be the one who makes the decisions and may feel uncomfortable
about asking others to make decisions for her/him; a lower person may prefer not to be the one who makes the decisions. The
problem with these restricted forms of relating is that there are bound to be times when a close person may need to get distant or
an upper person may need to get lower. Versatility therefore can have its advantages and the therapist would be acting
appropriately if s/he were to encourage the patient to cautiously try to adopt a form of relating that s/he would normally tend to
avoid.
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A useful strategy for the therapist is to invite the patient to relate to her/him in a sequence of certain specified ways. Some of
these ways, like being upper or being distant, the patient may find inappropriate or embarrassing, but with the therapist's
permission and encouragement they should become a possibility. From an upper position the patient may be invited to tell the
therapist what to do or to give the therapist advice; and from a distant position s/he may try spending longer periods on her/his
own or doing things without the help of other people.
It may be that certain significant others relate negatively towards the patient. A parent, employer or marital partner may abuse
her/him in ways that s/he finds difficult to cope with. Such behaviour could be in response to the way the patient had behaved
towards them. On the other hand the patient's account of it could be correct. In situations such as this the therapist should not
take sides but simply acknowledge how upsetting this could be for the patient.
Seeking the Causes of Negative Relating

It is possible that a person who persistently relates negatively in one particular way has been subjected to experiences that have
interfered with her/his normal acquisition of the more positive forms of relating. It is appropriate for the therapist to enquire about
how her/his negative relating might have come about. The patient is unlikely to provide an immediate explanation for it, but
cautious prompting may help to uncover the origin. Negative closeness usually takes the form of clinging anxiously to an
important other person. This is equivalent to Bowlby's (1977) term ‘anxious attachment’. The negatively close person may have
experienced the disinterest or even the frank rejection of someone important to her/him or may consider that this other person
has revealed a preference for someone else or for others in general. S/he may conclude from this that s/he is unlikeable or
unloveable. Negative distance is a fear that others might come too close. The negatively distant person is afraid to allow other
people to become too involved with her/him, for fear perhaps that they will get to know too much about her/him. S/he will try to
create a barrier around her/himself and not reveal too much about her/himself to others. The negatively upper person might enjoy
the power to dominate and direct other people. S/he would always want everything to be done her/his way. S/he may perhaps be
sadistic. At an early stage in her/his life s/he may have concluded that you cannot trust people. Because of this s/he may even be
reluctant to seek the help of a psychotherapist. Negative lowerness is essentially a need to be cared for, protected or told what to
do. The patient does not trust her/his own judgements and may always need to seek the guidance, advice and direction of
another. For this reason the negatively lower person may find the prospect of psychotherapy appealing. However, somehow s/he
would need to be helped to acquire to ability to be upper sometimes.
Interrelating Therapy
Interrelating is the relating that takes place between two specified people or within a group of people. In interrelating each person
relates to the other and is related to by the other. Ideally the relating of both participants should be versatile, so that each can
relate positively towards the other and be related to positively by the other in any one of the eight positions of the octagon. Whilst
there are pairs of versatile people, there are many pairs of people who fall short of this ideal. In some relationships only one of
the two people relates negatively and the more positive relater attempts to accommodate the other's negative relating. It is
probable that the more common combination is that both partners relate negatively towards each other.
Interrelating therapy is the therapy that is directed by the therapist towards two or more people who do not get on well together. It
can be a component of couple or marital therapy or, in a broader context, of family therapy. It has also been applied to pairs of
workers (job-sharers) who are experiencing difficulties in working together (Lucy Daniels, personal communication). All of the
participants in interrelating therapy need to acknowledge that the relationship, of which they form a part, is not working
adequately and to accept that they each may be contributing to this. The next section will concern only the treatment of couples.
There is a set of four questionnaires called the Couple's Relating to Each Other Questionnaires (CREOQ) (Birtchnell et al., 2006).
They comprise two sets of self-rating questionnaires (one for each partner), concerning how each partner considers that s/he
relates to the other, and two partner-rating questionnaires concerning how each partner considers that the other relates to
him/her. The questionnaires cover exactly the same eight categories of negative relating as the PROQ3 and, just as with the
PROQ3, they include an un-scored positive item for each of the scales in order to reduce the overall negative tone. As with the
PROQ3, the four questionnaires of the CREOQ are scored by computer and the print-out comprises, for each one, both a set of
scores and a graphic representation of the scores (see Figure 2). The partners should be invited to complete the questionnaires
before the start of therapy and the therapist should have access to the scores and their graphic representation before the therapy
begins. The partners should be offered the opportunity to examine the print-out for themselves and to have the shaded areas of
the graphic representation explained to them. This creates a useful starting point for the therapy. As with individual therapy, the
CREOQ should be repeated some way into therapy in order to examine where improvements have been made and where
improvements still need to be made. It should also be repeated at the end of therapy when hopefully it will reveal in graphic form,
the changes have been made.
bjp.030.0087a.fig002.jpg
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Fig. 2: The pre-therapy graphic representation of CREOQ scores for a couple. M and W stand for man and woman. S and P
stand for the rating of self and the self's rating of partner
The CREOQ has been slightly modified by Lucy Daniels (see Figure 2) to make it applicable to job-sharers.
Some Interrelating Therapy Procedures

Some couple therapists work in pairs, but the present account will concern the practice of only a single therapist. There may be
times when each partner speaks separately to the therapist and times when the partners talk to each other whilst the therapist
watches and listens. Throughout the therapy, the therapist would need to adopt a totally neutral attitude towards the partners.
Sometimes one partner may recount to the therapist how s/he believes the other feels or behaves. At such times the other may
interrupt and dispute what s/he has said. Even then it is essential that the therapist should not take sides. Sometimes the
negative relating of one partner may provoke a negative response in the other. At other times, reducing the negative relating of
one partner may have the effect of reducing the negative relating of the other.
It helps the partners in a relationship if their interrelating can be broken down into its simple components such as close, distant,
upper and lower. Reducing the complex interactions between partners to such simple terms makes it easy for them to speak
freely about them. Although they are simple terms they really do represent what is actually happening between the partners. It
needs to be made clear to them that, for each of these positions, there are both desirable (positive) and undesirable (negative)
ways of relating and that the object of the therapy is to eliminate or reduce the negative forms and introduce or reinforce the
positive forms.
The print-out of the CREOQ may reveal to the therapist where the negative relating is likely to be located. It may be helpful for
the therapist to show the print-out to the partners and to explain briefly to them in simple terms what the eight positions of the
octagon represent. If one or both of the partners continues to relate negatively, it is almost certain that there will continue to be
difficulties in the relationship. Some combinations are likely to be more disruptive than others. On the horizontal axis, if both
partners are negatively close, each will be persistently needful of the other. If both are negatively distant, they may stay together
but there will be minimal involvement between them. If one is negatively close and the other is negatively distant, the relationship
is unlikely to survive since each will be forever frustrated by the negative relating of the other. On the vertical axis, if both partners
are negatively upper, there will be perpetual conflict over who should make the decisions. If both are negatively lower, then each
will be forever looking to the other to take the lead. If one is negatively upper and the other is negatively lower, they may stay
together but the relationship will be a very rigid one, with one partner becoming ever more dominating and the other becoming
ever more submissive.
Whilst the relationship would improve if each partner were made more aware of the relating limitations of the other, more would
be gained by both partners endeavouring to make good their own respective relating deficiencies. Progress in couple therapy will
be restricted if one or both partners continues to relate negatively. Therefore, before proceeding to correcting the relating
between the partners, it may be helpful for the therapist to take time out to examine and try to correct the negative relating of
each partner separately.
Sometimes it is clear that one partner is dominating the flow of talk and not giving the other the opportunity to put across her/his
point of view. In such a situation it is helpful for the therapist to invite the suppressed partner to talk freely for an extended period
of time whilst the other and the therapist remain silent. The other, of course, should be offered a similar opportunity. At the end of
such a period the therapist may refer back to one particular moment or phrase - or even just a word that seemed to be important.
If the therapist has been correct in her/his perception the patient may, at this point, become profoundly emotional. The partner
may, quite spontaneously, respond to this, or the therapist may need to invite the partner to respond.
The partners may seek to discover which one of them the therapist prefers. The therapist should make it clear that s/he has no
preferences and that her/his objective is to bring them closer together. This is invariably the case and, to this end, the therapist
should make a point of paying the same amount of attention and devoting the same amount of time to each one of them.
Interrelating therapy has been further extended to include the couple's child and even two of the couple's children. For this the
wording of the CREOQ has been modified in order to enable the parents to describe their relating to their child and their child's
relating to them and graphic representations of the interrelating between the parents and the child (FMCQ) and the parents and
the two children (FMCCQ) have been published (Birtchnell, 2001). The F, M and C stand for father, mother and child. Beyond two
children this procedure would become unmanageable.
Conclusion
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It seems likely that psychotherapy patients can be further helped by a form of therapy that is directed specifically towards their
problematic relating tendencies. The essence of this paper is the distinction that can be drawn between that which has been
defined as negative relating and that which has been defined as positive relating. Negative versions of each of the eight octants
of the interpersonal octagon have been defined and measured, and procedures for eliminating them and replacing them with
equivalent forms of positive relating have been suggested.
References
1
Birtchnell , J. (1994) The interpersonal octagon: An alternative to the interpersonal circle. Human Relations 47 : 511-29.
2
Birtchnell , J. (1996) How Humans Relate: A New Interpersonal Theory. Hove: Psychology Press .
3 Birtchnell , J. (2001) Relating therapy with individuals, couples and families. Journal of Family Therapy 23 : 63-84.
4
Birtchnell , J. (2002a) Psychotherapy and the interpersonal octagon. Psychology and Psychotherapy: Theory, Research and
Practice 75 : 349-63.
5
Birtchnell , J. (2002b) Relating in Psychotherapy: The Application of a New Theory. Hove: Brunner Routledge .
6
Birtchnell , J. (in press) The interpersonal circle and the interpersonal octagon: A confluence of ideas. Clinical Psychology and
Psychotherapy.
7
Birtchnell , J. , Hammond , S. , Horn , E. , De Jong , C. & Kalaitzaki , A. (2013) A cross-national comparison of a shorter
version of the Person's Relating to Others Questionnaire (PROQ3). Clinical Psychology and Psychotherapy 20 ( 1 ): 36-48.
8
Birtchnell , J. , Shuker , R. , Newberry , M. & Duggan , C. (2009) An assessment of change in negative relating in two male
forensic therapy departments using the Person's Relating to Others Questionnaire (PROQ). Journal of Forensic Psychiatry and
Psychology 20 ( 3 ): 387-407.
9
Birtchnell , J. , Voortman , S. , De Jong , C. & Gordon , D. (2006) Measuring interrelating within couples: The Couple's Relating
to Each Other Questionnaires (CREOQ). Psychology and Psychotherapy:Theory, Research and Practice 79 : 339-64.
10
Bowlby , J. (1977) The making and breaking of affectional bonds. 1. Aetiology and psychopathology in the light of attachment
theory. British Journal of Psychiatry 130 : 201-10.
11
Bowlby , J. (1988) A Secure Base: Parent-child Attachment and Healthy Human Development. New York, NY: Basic Books .
12
Hayward , M. , Overton , J. , Dorey , T. & Denney , J. (2009) Relating therapy for people who hear voices: A case series.
Clinical Psychology and Psychotherapy 16 : 216-27.
13
Leary , T. (1957) Interpersonal Diagnosis of Personality. New York, NY: Ronald Press .
14
Steele , H. & Steele , M. (2008) Early attachment predicts emotional recognition at 6 and 11 years. Attachment and Human
Development 10 : 379-93.
15
Wallin , D.J. (2007) Attachment in Psychotherapy. New York, NY: Guilford .
British Journal of Psychotherapy, 2014; v.30 (1), p87 (14pp.)
BJP.030.0087A
Record: 21
Title: Putting Back the Link between the Heart and the Head: Reflections on Some Kleinian
Theory from a Relational Perspective
Authors: Riddell, Jenny
(2), p129, 17p
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Language: English
Abstract: This paper looks at the relevance of key Kleinian theory when working in an attachment-
based relational manner. The key concepts are described briefly and then applied to
clinical work. The writer posits that Kleinian theory is helpful in working with the negative
transference, and that Kleinan theory can be applied in a relational manner in a clinical
setting. Two clinical vignettes are offered to explore this idea, one with an individual client
and one with a couple. The writer invites the reader to think about the ideas, rather than
seeking to present an argument to convince.
direct=true&db=pph&AN=AJRPP.004.0129A&site=ehost-live&scope=site">Putting Back
the Link between the Heart and the Head: Reflections on Some Kleinian Theory from a
Relational Perspective</A>
Putting Back the Link between the Heart and the Head: Reflections on Some Kleinian Theory from
a Relational Perspective
Jenny Riddell, author, Psychoanalytic psychotherapist, supervisor, and teacher. She works in private practice with couples and
individuals and teaches on a variety of clinical trainings and MA programmes. She has a particular interest in how couples grieve,
working with difference, and infertility. Email: riddells@onetel.com
This paper looks at the relevance of key Kleinian theory when working in an attachment-based relational manner. The key
concepts are described briefly and then applied to clinical work. The writer posits that Kleinian theory is helpful in working with the
negative transference, and that Kleinan theory can be applied in a relational manner in a clinical setting. Two clinical vignettes are
offered to explore this idea, one with an individual client and one with a couple. The writer invites the reader to think about the
ideas, rather than seeking to present an argument to convince.
The purpose of this paper is to explore whether Kleinian theory can be usefully employed in working from an attachment-based
relational style, and to attempt from this angle a re-connection of the head of theory with the heart of the emotional experience
that evolves between two people in relational psychotherapy.
GERTRUDE: O Hamlet, speak no more. Thou turn'st mine eyes into my very soul, And there I see such black and grained spots
As will not leave their tinct.
HAMLET: Nay, but to live In the rank sweat of an enseamed bed, Stewed in corruption, honeying and making love Over the nasty
sty… (Hamlet, 3, 4: 89-94)
GERTRUDE: O Hamlet, thou hast cleft my heart in twain.
HAMLET: O throw away the worser part of it, And live the purer with the other half. (Hamlet, 157-159)
I begin this section with Shakespeare's Hamlet, as I believe it illustrates some of the Kleinian concepts this paper will be dealing
with. The unconscious and the internal world were not ‘invented’ by psychoanalysis any more than Columbus ‘discovered’ North
America. Psychoanalysis has offered a framework, and a way of conceptualizing aspects of that same theme, the human
condition, that literature and art have expressed in abundance throughout time. In brief, the story of Hamlet is of a prince, a
young philosophical student who is deeply burdened and conflicted after receiving an intimation from his recently dead father's
ghost; it is the king's wish that Hamlet take revenge on his father's murderer. This happens to be, according to the ghost, the
king's own brother, who had just married his wife, Gertrude, Hamlet's mother. As Howard Dietz wrote in a song, it is ‘where a
ghost and a prince meet / and everyone ends as mincemeat’. However, the emotional, philosophical, religious, and moral torture
of Hamlet's dilemma, together with the destructive repercussions they have on the innocent as well as the guilty, are the focus of
the play.
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The exchange quoted above comes from ‘the bedroom scene’ (as it is known) in Hamlet, where young Hamlet confronts his
mother with the actual and symbolic images of her two husbands; Hamlet's father, ‘Old Hamlet’, killed and supplanted by his own
brother, Claudius. This Oedipal scene is one of the occasions in the play where Hamlet seeks a concrete certainty to help his
troubled mind into some kind of decisive set. He seeks to enforce on his mother's mind the good-bad father split, as represented
by these two potent male figures. Freud writes about Hamlet's dilemma in terms of the Oedipus complex, but comments on his
paralysis:
Hamlet is able to do anything - except take revenge on the man who did away with his father and took away that father's place
with his mother, the man who shows him the repressed wishes of his own childhood realised. Thus the loathing which should
drive him on to revenge is replaced in him by self-reproaches, by scruples of conscience, which remind him that he himself is
literally no better than the sinner whom he is to punish. (Freud, 1900, p. 367)
From a psychoanalytic perspective, a critique of the majority of the play may regard Hamlet as paralysed by being caught in a
depressive position (in Kleinian terminology) but an uncomfortable one of a horrific dilemma which renders him immobile, unable
to choose a decisive act and trapped in an ‘obsessional doubt’ (Sodres, 1994). We see him bent over the praying Claudius,
deciding not to enact the revengeful murder he is sworn to, as he holds in mind that the prayer being uttered may save Claudius's
soul. The fact that he is wrong, Claudius is still in mortal sin, is an irony, an irony that would have a double meaning to the no
longer Catholic audience of Shakespeare's time.
CLAUDIUS: My words fly up, my thoughts remain below
Words without thoughts never to heaven go (3, 3: 97-98)
However, the audience still holds in their collective mind the paralysing dilemma in which Hamlet is caught, he who is naturally a
fair man (as Fortinbras points out in his eulogy at the play's end) and a philosopher. To hold the two perspectives of a vista is a
difficult thing; it raises doubt and confusion, and this is painful. Hamlet has cleft his own heart in twain by killing Polonius (‘the
good old man’) and continues to erode himself with each debasing action he takes.
As the play unfolds, we see Hamlet having to force himself into a delusionary and simplistic place to act and fulfil what he sees as
his destiny (‘oh cursed spite, that ever I was born to set it right’ (1, 5: 210).
In this paper, I use the Kleinian terminology as it appears in her original writing and in more recent Kleinian writers. My purpose in
doing this is to demystify and perhaps detoxify some of the attitudes to the theory. I attempt to weave the language into a more
relational tone. Using two clinical vignettes, I invite the reader to explore the idea that there is room for these concepts in our
work, and that they are particularly helpful when working with what is sometimes called the ‘negative transference’. By ‘negative
transference’, I mean the experience enacted between client and therapist in the analytic process, whereby the therapist is seen
as holding a quality of, and relating with, negative (for example, hostile, withholding, cruel, absent) behaviour. However, this
experience, between client and psychotherapist actually belongs to a real relationship in the client's past, but it is now real, in the
room. This is a difficult, painful, and sometimes traumatic aspect of therapy for both concerned. We tend to stumble into it
together, client and therapist; working through it can be traumatic, but also creative. As therapists, it can push us to the edge of
our skills, but potentially costs the client far more; thus, negative transference requires extreme sensitivity at a time of assault on
the senses.
Much of Klein's theoretical exploration centres on the unconscious of the infant, on the infant's phantasies and how these, she
claims, are projectively identified into the mother(Klein, 1946). However, she writes far less about the impact on the mother, and
of what the mother does with this experience. This is taken up later by Winnicott as primary maternal preoccupation(Winnicott,
1958), Bion in containment, beta elements, and alpha functioning (Bion, 1962), Bowlby in the development of attachment
theory(Bowlby, 1988), Stern in terms of RIGS (Stern, 2004), Gerhardt on infant care (Gerhardt, 2004), and on to the more recent
relational school. Although we can chart such a clear developmental line from Freud to neuroscience and relational
psychotherapy, this family tree has in fact a number of roots and branches. All have their own truths and shape; however, this
paper concentrates on the root of Klein's concepts.
Has Klein's tendency to focus on the infant rather than on the mother's response been replicated in the consulting room? Do
Kleinian theorists offer or explore much of their relational experience in reaction to the projectively identified (mostly negative)
emotion they so often describe as receiving from their patients/clients? How much space is given to questioning what belongs to
whom and where is the therapist in this encounter? Does this get replicated in the supervisory relationship (Coleman, 2006)?
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In the modern Kleinians' style of work, is there a tendency to focus on destructiveness, hate, deathinstinct, and a reluctance to
look at love, reparation, life, and joy? Or is this a myth? If it is a myth, how and why has this perception come to be so rooted? I
have attended presentations where there seemed to be an overriding preoccupation with the destructive emotions of the client,
and an avoidance of the benign process. On these occasions, there can be an air of contempt towards the client in the
presenter's tone, and they appear a long way from engaging with an empathetic understanding of the trauma and pain so often
associated with the demonstration of aggression. Rarely is there much reflection on the therapist's own emotional process, or
much evidence of the role of supervision. The proud highlighting of the psychotherapist/analyst's ability to expose and tolerate the
client's level of destructive, envious, spoiling phantasies could, all too easily, feed into an enactment of sadomasochism.
The trouble comes when we lose sight of history and context, when the desire to preserve purity of tradition and thinking causes
us to sacrifice difference, evolution, and change on the altar of elitist excellence, uncontaminated by challenge. How Darwin's
findings suffered from such thinking was described in his biography by Desmond and Moore (1991). Klein's writing emerged from
its time, from within the social and historical conditions in which it was written, inside the context of her own life and experiences
and her own unconscious world. Can this have relevance to our work today? Certainly, just as Shakespeare's writing has. And
some of her concepts can be read and understood now as then, when the texts were written, while some will require re-
interpretation. Unless it is for a particular production, Shakespeare is not performed by an all male cast, in the pronunciation of
the time, or under the jurisdiction of the Lord Chamberlain. The blank screen of the psychotherapist was still a cornerstone of
practice in Klein's inherited theoretical world, but is held as less achievable, desirable, or realistic by many psychotherapists
today.
In order to explore the idea that some Kleinian theory is particularly useful in working with negative transference as it arises in the
therapeutic encounter, I take three key Kleinian concepts and speculate as to the manner in which they may present clinically.
This opens the question as to how the psychotherapist may respond, and how to use the interaction in a way that is informed by
attachment-based, relational sensitivity. My intent is not to give a theoretical critique of Kleinian thinking, or even to explore the
socio-historical context of her writing or her life. My intent is to play with some of her theoretical concepts as adapted to the
common domain of psychological theories. Of course, these concepts have been interpreted, or misinterpreted, or developed, or
honoured, or distorted (depending on how you may view it); but they do have a shared meaning for many who have studied
psychodynamic or psychoanalytic theory. It is this shared, fluid, and contradictory meaning, in the common domain, that I want to
work with. Kleinian language is extremely complex, difficult, and powerful. She wrote about pure and raw emotion and experience
in the baby and young infant. Much of what she wrote about belongs to the preverbal stage of development, and she appeared to
try to convey how powerful and visceral these experiences are for the infant through a language capable of reflecting them. It is
all too easy to be shocked and revolted by some of the terminology; much is made of this language, by both supporters and
critics of the theory and her writing. The definitions I choose do not highlight the more extreme language such as scooping out,
burning and spoiling with urine and faeces, controlling and tearing apart (Klein, 1946, pp. 1-24). However, other terminology will
be used. The three concepts to be explored are:
• the paranoid-schizoid and depressive positions;
• projective identification;
• reparation and love following the guilt: moving into the depressive position.
The Paranoid-Schizoid and Depressive Positions

The basic idea behind the ‘positions’ is that the newborn infant has experiences that are good (nurturing, feeding, warmth, love)
and bad (neglected, hungry, cold, hated), and these are kept as separate, the good/bad breast. Thus, the relationship is to
different experiences as if to different carers, ‘part objects’. There is no ‘whole object’, that is, the carer who both nurtures and, on
occasion, does not. The infant reacts emotionally with congruence to these experiences, loving the good and hating the bad. In
the depressive position, the infant realizes that the breast (prime carer) that provides the good is one and the same as the one
who withholds the good (thus, is experienced as the present bad experience). This realization brings the depression of
recognizing that both the hate and love the infant has expressed to these two aspects has landed on the same primary
carer/object. It is the realization of the power to hurt that which we love, as well as that which we hate, that causes a dilemma
leading to guilt, and then to reparation. Thus, through this process of psychic growth from paranoid-schizoid to depressive
positions, the infant moves from perceiving part objects (good/bad breast) into whole object (the mother/primary carer).
The positions constitute a
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psychic configuration … in which the individual deals with his innate destructive impulses by a) splitting both his ego and his
object representations into good and bad parts, and b) projecting his destructive impulses on to the bad object by whom he feels
persecuted … the paranoid schizoid position precedes the depressive position. (Rycroft, 1968, p. 125)
The depressive position
reached by the infant (or by the patient in analysis) when he realises that both his love and his hate are directed towards the
same object - the mother - becomes aware of his ambivalence and concerned to protect her from his hate and to make
reparation for what damage he imagines his hate has done. Since Klein's system includes the deathinstinct and innate hostility
and envy of the mother, this crisis is conceived as playing an essential part in every infant's development, regardless of the
quality of its mothering, and its outcome is held to determine all later development. (1968, p. 36)
These two descriptions, from Rycroft's Dictionary of Psychoanalysis, show a kind of two-dimensional process which negates the
primary carer's role, especially in the words ‘regardless of the quality of its mothering’. There is also an assumption of ‘innate
hostility and the deathinstinct’ from birth, which is refuted by later attachment and developmental theorists. An approach that
includes the recursive experience of the dyad seems to shift us from two- to three-dimensional perception, as we take the
thinking observational position.
For the purposes of this paper, I work with the attachment and relational model, which would refute the ‘deathinstinct’. Neither
would the attachment and relational model agree with innate envy and hostility in the newborn infant. Therefore, the infant's
capacity to hold hostile and destructive feelings from the start of life, in response to the quality of care they receive, is still an area
of contention between the different theoretical approaches. What is shared is that throughout life, at times of stress or distress,
we move back and forth between these emotional states in a regressive revisiting of our earliest developmental experiences. This
is normal, healthy living of life; problems arise according to the depth, length, and frequency of repression (Steiner, 1993, p. 28).
To link back to Hamlet for a moment, the adult demeanour of the paranoid-schizoid position is rigid, certain, and narcissistic; the
depressive position can hold balance and complexity but also uncertainty and dilemma in facing decisions. If the decision feels
too hard to make, the defence against the inevitable loss that any choice between things brings (which lover, which job) too
unbearable, perhaps we long for the simplicity of certainty and a return to a paranoid-schizoid world.
Projective Identification
Projective identification has a variety of interpretations, and can be confusing when we try to tease it out from the more commonly
used countertransference. In Kleinian terms, it is a normal function, a vehicle of unconsciouscommunication that is used
throughout life. On the simplest level, we could describe it as doing someone else's feelings for them: my client is telling me a sad
story in a deadpan way; I start to cry; has the pain been projectively identified into me? However, in order to work this out, we
need to think about sympathy, empathy, transference, and countertransference within ourselves, and carefully consider our
reaction before we attribute it to projective identification from the client. How can we work this out without a three-dimensional
model? Here is another definition:
Projective identification is not in itself a pathological mechanism and indeed forms the basis of all empathic communication.
We project into others to understand better what it feels like to be in their shoes, and an inability or reluctance to do this
profoundly affectsobject relations. However, it is essential to normal mental function to be able to use projective identification in a
flexible and reversible way and thus to be able to withdraw projections and to observe and to interact with others from a position
firmly based in our own identity. (Steiner, 1993, p. 6)
Steiner presents an idea suggestive of a process where something is put into someone and then taken back out, but he is
neglecting to take into account the contribution of the second party, and how their own affective state may influence the process.
Bion describes how the analyst, replicating what Winnicott called ‘the good enough mother’ and her reverie(Winnicott, 1958),
converts the beta elements of raw emotion into digested alpha functioning through emotional containment (Bion, 1962). Raw
material for this process is the emotion that is put inside the primary carer/psychotherapist via projective identification, to be
absorbed and transformed by them. However, the how and why and what of the psychotherapist's reaction to this process is
interpreted variously in the literature. Davies and Frawley address this in terms of ‘three levels of relational interaction
simultaneously in play’ (1994, p. 161). This paper, in line with a relational approach, will keep the focus on the psychotherapist's,
as well as the client's, process.
Reparation and Love following the Guilt: Moving into the Depressive Position
In the depressive position, the infant feels guilt for their attacks (in phantasy and reality) and seeks to repair this. A simplistic
example of how an observation may help us see this could be the exhausted mother whose milk is low, experiencing the
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frustrated, scratching hand of the hungry baby needing more milk. The baby may be experiencing the breast as withholding all
the good for itself, and responds with anger by scratching (in reality) and attacking (in phantasy). In contrast is the rested mother
with the blissful ‘letting down’ feeling, feeding the calm, deeply-sucking baby who strokes her, loving and rewarding the good
breast. In relational and attachment terms, we are interested in the questions as to how the mother responds to the scratch, to
the stroke? What does the baby take in with the feed?
We do not have to rely on Klein alone: here is an extract from a letter from Jenny Marx, written in 1850 during an eviction from
the family home due to poverty:
I was determined to feed my child myself, however frightful the pain in my breast and back. But the poor little angel absorbed
with my milk so many anxieties and unspoken sorrows that he was always ailing and in severe pain by day and night … in his
pain he sucked so hard that I got a sore on my breast - an open sore; often blood would burst into his little trembling mouth …
(Wheen, 1999, p. 158)
This is a beautiful description of a containing, non-retaliatory mother written half a century before Freud begins to publish his
thinking.
In contrast to this attachmentimage, again Rycroft gives us the two-dimensional model.
Reparation,
The process of reducing guilt by action designed to make good the harm imagined to have been done to an ambivalently
invested object; the process of re-creating an internal object which has in phantasy been destroyed. (Rycroft, 1968, p. 156)
On the other hand, Hinshelwood makes the important point that integration requires also loss of idealization, with the consequent
gain in terms of sense of reality and acceptance of what Winnicott calls ‘good enough’; this applies not only to the other, but
ourselves too.
Love in the depressive position is for the non-ideal object, the good object that is also blemished and flawed … There is here
the capacity for tolerance and forgiveness. Love in the depressive position is marked indelibly with concern and forgiveness.
(Hinshelwood, 1989, pp. 343-344)
And now let us proceed to think how all this may look in the clinical setting. In order to protect confidentiality of clinical work,
details and specifics are altered in the clinical examples, and events either changed or conflated. My intention is to illustrate the
beauty of close observation and detailed examination of moment-by-moment experience in psychotherapy. A crucial source of
learning was a two-year infant observation that facilitated my understanding of attachment theory, Kleinian ideas, and the
therapeutic relationship more than any other aspect of my training.
Clinical Example A
Damian is passing his mobile phone back and forth in his hands; it is on silent, he does not take calls in the sessions, but he
monitors them. He looks at the phone when it lights up, sometimes continues what he is saying, sometimes makes a passing
remark about the caller, sometimes is jolted out of what he is saying to me, and sometimes goes into quite a long reverie. His
phone has lit up three times so far in the session; we are fifteen minutes in. I make the calculation in my head. He finds his way
back to what we were talking about.
‘It's too much. I can't hold it all together. I feel so trodden on, no that's not right, it's my business, and how could I be trodden on?
What is it then? What do I feel?’
Long silence; he hates silence.
‘Well, what do you think?’
‘I think you've been describing feeling rather overwhelmed by what you are trying to manage.’ I reply.
‘Well, obviously!’ he replies, contemptuously. I wait, smarting a bit from his slap, as it feels. He continues. I know he may respond
in two ways: either he will re-engage with the anxiety he was exploring and we will think together about the material he is
bringing, or he will get angrier.
‘Why do you always just state the bleeding obvious? What do you know about how I think and feel? I don't know why I bother
coming here.’
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Now I know where we are and log in my mind that my anxiety has dropped slightly, though it is still raised. (It is more frightening
for me when I do not know where he is; is this how he feels when he does not know where I am?)
‘Damian you're right, I don't know how you think and feel. I am utterly dependent on you telling me and my ability to understand
what you are saying. But I do know that we have been in this place before, together, and have survived it.’
He looks at me hard, I stare back, and who is going to win? He smiles, and then visibly pulls back from the fight. His tone
changes.
‘Really, I do question whether I should continue. You've been very helpful, no, really. You really were, especially in the early
sessions’. There is a pause; I remain silent as I do not think he has finished, though he appears calmer. He resumes, ‘But it
seems we aren't getting any further, I wonder if it is time to end. I could always come back I suppose? Anyway, you can't stop me
from going if I want to. I could just walk out of here and never see you again. I don't even need to pay you! What will you do?
Come after me with solicitors? After all it's my therapy, as you're always saying. In fact, you do repeat yourself, you know?’ This
continues for a while, accusation and anger rising as he punches his fist into his open hand.
During this outburst he has avoided eye contact; now he looks to see the impact of all this on me.
I'm rattled and I show it, I say it. ‘Here we are again and this is difficult for us both. I think you help me to understand how you felt
as a small child by giving me a similar experience. However, when you were a small child you couldn't just walk away without
owing anything.’
Reflection on Vignette
Damian is six months into his therapy. Initially, he found the therapy helpful, as he clearly states. He was referred for anxiety
about managing his business decisions, having presented to his general practitioner with muscle pains; these had been found to
have no organic cause. The sessions provided a thinking space and containment, which helped his inherent competence to
reassert itself (my view), or to get help in making decisions (his view). When he arrived, he was functioning in a paranoid-schizoid
manner of certainty as to right-wrong, win-lose and good-bad. This had got into his management style and his way of handling
business. Initially, he saw me as helpful, facilitative and ‘pointing [him] in the right direction’. I saw myself as reflecting back to him
the denied and more balanced complexities of his dilemma as located in his narrative. For instance, he would be telling me of
‘that bastard who tried to screw me out of fulfilling his contract’ while mentioning in an aside that he had been unable to pay him
for two months, as someone else had not settled a bill of Damian's. It seemed to me that at that time the complexstructure of
economic, practical, and personal dynamics involved in his business could not be held in mind as a conflicting but mutually reliant
whole. In order to manage the considerable anxiety that this had stimulated in him, he had tried so split these components into
the good and bad, as in the nourishing or withholding breast (Klein, 1975b, p. 262).
Much of the work at this time was in the urgent and immediate conscious world. My reflections were not interpretations, but were
helping him back to a more ambivalentdepressive position. He was able to think through the complex ebb and flow of business
decisions without splitting people and their roles or demands into good/bad, friendly/hostile. So far, our relationship was untested
by the unconscious. This began to change as his present crisis settled down and there was more space in the sessions for the
unexpected to happen. From then on, we would periodically stumble into interchanges like the example offered above. As the
work continued, deeper connections could be made to the psychodynamics of how the past, his attachment experience, and
early object relations had led to this impact on his present life and behaviour.
However, let us look in detail at this vignette from earlier in the therapy and some of the choices I made as a clinician.
The extract starts with us in a familiar and comfortable state, though Damian is holding on to the world outside through his phone.
Have I commented on this before the example begins? Have I commented before in a previous session? Have I ever explored it?
Have I taken it to supervision, have I actively avoided taking it to supervision? I know that in supervision, defensiveness and
shame can be aroused in me, and this could lead me to hiding. I remember ‘should and ought’ hemming me in, so I felt I had
nowhere to move freely in my mind. I was roundly criticized once for turning on a heater when a client sat shivering, asking for
more heat. I had ‘prevented the client from experiencing the negative transference, and pandered to [my] need to be liked’; this
was a concrete interpretation of my action, not an idea to be explored. This supervisory interpretation may have been apposite,
may even have been ‘true’ in part. However, my long and traumatic struggle with the negative transference with this particular
client suggests to me that it was what Samuel Johnson called acts of kindness which are ‘the business of life’, which may have
been part of what enabled her to allow a benign experience of me alongside the malign.
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Damian and I had been through the meaning of his desire to keep hold of his phone, to ‘remain connected’; I had decided not to
interpret repeatedly or fight over this, but to see it as a communication, to find out what I could learn from observing what
happened, not only to him but to myself. He had engaged with the discussion, but thought my point ludicrous; after all, as he said,
he never answered the calls in the session. When I made the decision to let it be, there was an impact on how we went from
there. I am not, for a moment, suggesting this was the ‘right’ or only decision. Each time we choose what to pick up on, what to
let go, when to make an interpretation or remain silent, we are making a relational movement towards the other/s in the room,
and they make a relational movement in response to us. There is always another path the therapy could have taken, just as in
popular science fiction a change in events creates a parallel world. In going along with the distracting phone, I had to handle a
whole range of additional thoughts and feelings in myself, which, quite frankly, I would have rather done without.
One of the emotions I felt was exclusion, as I struggled with the Oedipal triangulation of this third in the room. This is a familiar
experience in couple therapy, when there are literally three in a room, but also familiar in individual therapy, when a third may be
present in thoughts and preoccupation during the session. What was the unconscious meaning of the phone; was it to get me to
feel this? Projective identification can be seen as essential unconsciouscommunication, as the last recourse when we have no
other way of communicating how we feel. ‘If I can't tell you how I feel I will show you by helping you to feel that too.’ So, part of
my internal supervisor (Casement, 1985) was working with this: what belongs to me and what belongs to Damian? Is he
struggling with his complex Oedipal drama, or am I, or are we both? If I had followed the ‘rules’ of classical psychoanalysis and
interpreted the use of the phone instead of managing this as I did, would I have lost something, and would I have gained
something else?
There is another factor at work here: the ‘rules’, as held by many classical psychotherapists, were developed in another era.
Among many socio-political differences is the fact that communication was managed far more slowly; we function in a world of
instant gratification, especially in terms of communication. There are clearly interesting repercussions in terms of the role of
verbal (and written, via email and text) communication, and how this relates to attachment style and attunement between client
and psychotherapist. How do we think about and accommodate these changes? Why am I flexible with the phone but not with the
fifty-minute frame? I do not confront the mobile in this vignette, yet I do impose on him that first silence, although I know he hates
it. What am I up to here? Am I unconsciously punishing him for my sense of exclusion, my Oedipal struggle about not being
special and chosen? Am I allowing him space to explore that discomfort in the knowledge (based on the six months we have
worked together) that I will eventually help him? Am I stuck and do not know what to say? These are only three possibilities. I
may well feel I have been wittingly or unwittingly cruel, as I respond to his request to say what I think with an interpretation.
‘Thinking’ is what we do together. I think I'm being helpful; his response suggests I have seriously jarred him. I have got it wrong.
I feel his reproof as contempt, but have I not been dealing with his contempt with regard to how I feel about his phone? I
remember how contempt was a chosen vehicle for his racist persecutors to throw at him in his school days. This thought, as I
wait to see how this intervention will develop, reminds me that we know each other better than we used to. This gives me
reassurance, while I register my anxiety rising; I am aware of that familiar combination of low grade panic alongside a capacity to
observe and think in a more ordered way. I believe this is containment at work (Bion, 1962), and it is a very difficult thing to do, I
remind myself. I regard this man, much younger than I am, from a different background, ethnicity, heritage, and gender. Am I
assuming too much when I think I know him, even a little? Do I realize this before or after I begin to speak: ‘Damian you're right, I
don't know how you think and feel. I am utterly dependent on you telling me, and on my ability to understand what you are saying.
But I do know that we have been in this place before, together, and have survived it.’
My immediate reaction on saying this, as I try to observe his reaction, is, ‘Sod it, there I go again, that irritating and potentially
confusing thing I do when I say two things, not one’. Have I added to the feeling of being overwhelmed he is already experiencing
in his life at the moment? Then there is the moment when we stand together on the precipice, and neither of us knows which way
it will go. It feels like win/lose, a stand-off in the room at that moment. On reflection, I see it more as an opportunity to take, or to
shy away from. Do we stick with the ‘good breast’, the benign and helpful psychotherapist, or does Damian make different use of
me and dare to explore the ‘bad breast’ through the negative transference? I think he hovers on the periphery for a moment,
leans towards the former, challenges this with sarcasm, then he courageously plunges into the latter.
I think his avoidant gaze is for fear as to whether I can bear his attack; can I see the wounded paw behind the growling defence?
Meanwhile, I am wondering the same thing. I know I am not a blank screen, and I do not want to be. I know Damian was, or
attempted to be, his mother's container after his father died when he was six. He vigilantly watched her and feared what he would
see, powerless to help her. He would come to a session having seen the film The Hours on television one night. The middle
scenario, of a child watching a severely depressed mother, had disturbed him profoundly; this had led to a breakthrough in linking
the past with the present.
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At that point, I make the projective identificationinterpretation, linking the feelings induced in me to his own experience as a child.
I think I am being experienced as the critical distant father, who then abandoned him through death, leaving no possible
opportunity for direct resolution. If I am to help him achieve that resolution, it is through enactment and reparation; this is what he
is offering me.
Now for another example, this time from couple work. Kleinian concepts can be helpful in understanding ‘the couple fit’, and how
unconscious phantasy works in the couple, building on projective ‘fit’ and, sometimes, excessive use of projective
identification(Ruszczynski, 1993).
Clinical Example B
Sven and Marsha are late, as this appointment has been moved to a different time, at their request; I check to see if there is a
message left, but there is not. I tidy up my consulting room, look at the clock, note it is ten minutes past the appointment time,
and wonder whether they have confused or forgotten the time, and will not come. At this point, they arrive. They come in, and
Marsha is apologizing in a blaming way. It is not her fault, she was ready on time, she was waiting for him to get back and he was
delayed at work, but it is also not entirely his fault either; the tube was delayed and the traffic terrible.
We begin the session. I ask how they are. He looks at me and shrugs, ‘OK, I guess. Same as usual, really. Nothing different.’ He
maintains eye contact with me. Silence for a moment. I look to her. She seems to take this as a request to speak. She says, ‘Yes,
OK. Busy, what do you expect? Children, family, lots to do. Same as usual.’ A short silence follows. Then she turns to him and
says, ‘We did have one row, didn't we?’ He seems to not know what she is speaking of. She prompts him. ‘You know, about the
restaurant.’ He shrugs his shoulders and says, in a familiar contemptuous voice, ‘That wouldn't have happened if you had just
answered the question, it was all because you behaved like a child. It's the same every time, if you just did what I asked you and
answered the question I asked you these rows wouldn't happen.’ She replies to this, ‘How dare you say that! I did reply to what
you asked, you didn't listen so I refused to tell you again. You're hopeless, it's always the same.’
They then replay, I suspect almost exactly as it happened, the argument blow by blow. As always, it escalates quickly. I listen to
the detail, make connections with themes in our work, what the manifest content may represent, triggers to underlying
vulnerabilities in each, the projective fit between them. They spiral in volume and anger until they are accusing and counter-
accusing, blaming and judging and sneering and snubbing. This is all very familiar to me.
Finally, I interject, somewhat out of weariness and despair, and make first an observation and then an interpretation as to what is
happening. I say, ‘I think this way of interacting is very familiar and repetitive. You describe three attempts to reconnect and make
up after the row, and each time the row just gets repeated. And now it's happening again here. I wonder if it feels like a game of
Snakes and Ladders, and you're down to square one again.’ There is hardly a second's silence before she turns on me and says,
‘No. Why do you say that? No it isn't! How can you say that? We aren't back to square one. We are just learning. We are allowed
to slip back a bit. We need to practice being different. It doesn't matter if we get thing wrong sometimes. Don't say that!’ He
watches her with a blank expression, no clue as to his thinking. Her eyes are fixed on mine, blazing.
Reflection on Vignette
Now, what is going on here? Let us start with my process. For me, the context is that this is the end of a long day. Their session is
an additional appointment I had put in to meet their real need for a change of time. The session I had before this one had been
extremely difficult. I had consciously spent the gap between the two setting the previous session's content aside. Part of me
would be grateful if they do not turn up, I realize, and I am just facing up to this when they arrive. I have been working with this
couple for a year, and gradually their constant rows have settled down a bit in the sessions. However, I still carry the
circumstances of their referral, how I had felt rather coerced into taking them on, but also empathetic as to the reasons for their
insistence, and believed this to be material for the therapy. Bullying, feeling bullied but not the bully, is a constant theme. Part of
what I need to work with is how easily responsibility is projected outside the self, leaving a momentary satisfaction of blaming the
other, hating the other, and then enviously attacking the other (rubbishing each other's feelings or any offer of meeting half way or
negotiation), but then leaving the self depleted and disempowered. If I did offer the session, it is my responsibility, and needs to
be freely given. However, I need to allow myself the emotion of relief that they may not turn up, to recognize how easily I can slip
into resentment, as if I had no agency, had been bullied into this.
In early sessions, the therapeutic alliance had evolved through my survival of, and non-retaliation to, the violent verbal discord. It
had also been necessary to hear and stay with their despair, negativity, and contempt. They presented as a warring couple who
may unconsciously invite rejection as well as repulsion (Mattinson & Sinclair, 1979), and I needed to gather up the underlying
vulnerability and tenderness in tiny clues, and evidence it before I could point it out to them. Initially, this would be rejected and
feared, perhaps experienced as exposing and humiliating. I then needed to take in and digest their spitting back out at me any
interpretations, or attempts to make sense, which is a hard meal to swallow and digest. This couple was locked into a Groucho
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Marx dilemma (‘I wouldn't want to belong to a club which would have me as a member’, or, in this case, a relationship) and
related on a projective system of mutual hatred (the ‘cat and dog’ typology), which functioned as a screen to hide the self-loathing
underneath. What unbearable rejection, trauma, neglect, or misattunement has led to this, as the only way of relating?
There is a repetition in their speech, voicing the repetition in their experience (‘same as usual, the same, the same …’); they are
demonstrating how stuck and cyclical this is, echoed by my experience of continuously going over the same ground. I think my
state of mind prior to the session led me to an, at best, insensitive, at worst, destructive, interpretation when I say, ‘I think this way
of interacting is very familiar and repetitive. You describe three attempts to reconnect and make up after the row and each time
the row just gets repeated. And now it's happening again here. I wonder if it feels like a game of Snakes and Ladders and you're
down to square one again.’ It is factually ‘true’, but is it helpful to offer it in this way?
This happens, we can get it wrong. What matters is how we reattune after such a derailing experience; how we help the therapy
to reregulate. In this case, the couple helped me. Her appropriately angry response to me, her rejection of my despair, was
couched in words I had said in a previous session when they had brought another furious row; they had both emotionally
collapsed and felt ‘back to square one’. I had needed to help them by containing, reassuring, and normalizing what they were
going through. I had used these phrases on that occasion, said these things. She had internalized them and drew on them when
she needed them. It is an irony that this should be when I, the good breast, had turned into the bad breast. But perhaps this was
the only way we three could manage this specific moment. My task was to attempt to hold the ability to know that we are all
fallible as well as reliable, to try to hold them as well as myself, as I stumble. This is the kind of struggle I wish I saw more
psychotherapists demonstrating in presentations.
His blank look is equally significant, I believe at this moment he is frozen. While in conflict, they are a fused couple. This state is
their distorted ‘secure base’, their known world (Bowlby, 1988); he clings on to it at this moment. Her hope is perhaps hiding
under her anger at me, but peeping out visibly, and this confuses him. He also can see her trying to fuse with me. But he is not
using his usual defences of contempt and concrete reason. Is he frozen and thinking? Can he see the fight for them as a couple
in her fight with me? Or does he just see the attempt to fuse with me? If so, is this potentially helpful as he has a chance to
‘triangulate’ his experience and become an observer of something he is usually dyadically enmeshed in?
They say that, as a psychoanalytic psychotherapist, you become your analyst and that ‘you can only go as far as you've been
taken in your own psychotherapy’. Without doubt, I internalized my analyst and my experience of being analysed, but alongside
other internalized relationships throughout my life. I draw on my internal working models both consciously and unconsciously.
However, I am also the unique blend of these internalized experiences and their internal dialogue which goes on within me and
creates more options and perspectives. I am also influenced by the different supervisors I have had the opportunity of working
with. I have chosen to work in a different style to several of these models, but believe all of the experiences, the ‘good and bad
breasts’, my part or whole object experiences of them, have added to my knowledge, experience, and professional skill.
Professionally, I am also made up of what I have internalized through the privilege of working with many individuals and couples
who have allowed me to see inside their most private and hidden selves. People who trust us to do that offer us the most
enormous faith and opportunity.
In conclusion, I have tried to illustrate the usefulness of certain Kleinian concepts when used in an attachment-based relational
way, when the negative transference appears in psychotherapy. I do believe that negative transference is, at times, unavoidable.
We may not want negative transference, but we may have to work with it. I do not believe it should be provoked, but neither can
or should it be avoided. This is because we, as psychotherapists as well as humans, get it wrong at times; also, sometimes it is
the only way of working through a fixed, traumatic relationship. On these occasions, I have found that the early object relations
theory weaves well into a relational perspective in helping to contain the anxieties of both/all in the consulting room. To be mindful
of never forgetting our own fallibility, avoiding certainty and remaining open to different perspectives, feels a crucial factor in
remaining a functional human being, and a safe and effective psychotherapist.
To end with returning to Hamlet and his split, part object fathers, could he have been freer to make his own decision in relation to
his revenge had his internalized father been less idealized? Had he been able to remember his father's fallibility, as his father's
ghost reminds him, could he have mourned him, left his mother ‘to heaven’, and sought open justice against Claudius? Could he
have gone back to Wittenberg and got on with his studies?
I leave you with these questions to reflect upon …
References
1
Bion , W. R. (1962). Learning from Experience. London: Heinemann Medical . (ZBK.003.0001A)
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2
Bowlby , J. (1988). A Secure Base: Clinical Applications of Attachment Theory. London: Routledge .
3
Casement , P. (1985). On Learning from the Patient. London: Routledge .
4
Coleman , W. (2006). The analytic superego. Journal of The British Association of Psychotherapists, 44 ( 2 ): 1-16.
5
Desmond , A. , & Moore , J. (1991). Darwin. London: Michael Joseph .
6
Davies , J. M. , & Frawley , M. G. (1994). Treating the Adult Survivor of Childhood Sexual Abuse: A Psychoanalytic
Perspective. New York: Basic Books . (PD.002.0005A)
7
Freud , S. (1900). The Interpretation of Dreams. London: Penguin , 1991 .
8
Gerhardt , S. (2004). Why Love Matters: How Affection Shapes a Baby's Brain. Hove, New York: Routledge .
9
Hinshelwood , R. D. (1989). A Dictionary of Kleinian Thought. London: Free Association Books , 1991 .
10 Klein , M. (1946). Notes on Some Schizoid Mechanisms. In: Envy and Gratitude. Reprinted London: Virago , 1988 .
(IJP.027.0099A)
11
Klein , M. (1975a). Envy and Gratitude. Reprinted London: Virago , 1988 (IPL.104.0001A)
12
Klein , M. (1975b). Love, Guilt and Reparation. Reprinted London: Virago , 1988 .
13
Mattinson , J. , & Sinclair , I. (1979). Mate and Stalemate. London: IMS/Tavistock .
14
Ruszczynski , S. (1993). Psychotherapy With Couples: Theory And Practice At The Tavistock Institute Of Marital Studies.
London: Karnac .
15
Rycroft , C. (1968). Dictionary of Psychoanalysis. Reprinted London: Penguin , 1995 .
16
Sodre , I. (1994). Obsessional certainty versus obsessional doubt: from two to three. Psychoanalytic Inquiry, 14 : 379-392.
(PI.014.0379A)
17
Steiner , J. (1993). Psychic Retreats. London: Routledge
18
Stern , D. N. (2004). The Present Moment in Psychotherapy and Everyday Life. New York: Norton .
19
Wheen , F. (1999) Karl Marx. London: Fourth Estate
20
Winnicott , D. W. (1958). Primary maternal preoccupation. In: Collected Papers: Through Paediatrics to Psycho-analysis.
London: Tavistock .
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2/6/2018 EBSCOhost

Couple Narratives and Adult Attachment - Using Conversation Analysis in Assessment

Attachment Status and Couple Functioning

AAI-Based Studies in Couple Psychotherapy

The Research Question

CA is based on the assumptions that:

Lepper & Riding, 2006Sacks, 1992a

Data Collection and Measures

CA ﬁndings - Openings Matching descriptors

77 had to discuss. It's just that

CA ﬁndings - Openings Matching descriptors

Empirical Measurements in Couple Psychotherapy

Implications for Clinical Practice

Implications for Teaching and Training

Limitations of the Study

11 Fonagy , P. (2003) Psychoanalysis today. World Psychiatry 2 ( 2 ): 73-80.

The Entangled Nature of Attachment and Sexuality in the Couple Relationship

Object Relations Perspective

I asked, ‘What was that about?’

This segment illustrates features of Joanie's and Bobbie's attachment style.

Joanie's Individual Therapy

Another individual session several months later follows.

Joanie said, ‘I didn't do the exercises because my stomach was upset.’

I asked, ‘Did you vomit?’ and she said, ‘Yes.’

I said, ‘You long for your father.’

Joanie's Individual Therapy

Joanie said, ‘Wow, how do you make these links?’

The following segment illustrates Joanie's struggle.

Bobbie's Individual Therapy

(pp. 97-137). Washington, DC: Winston .

5 Bion , W. R. (1970). Attention and Interpretation. London: Tavistock . (ZBK.002.0001A)

16 Dicks , H. V. (1967). Marital Tensions. London: Karnac .

35 Winnicott , D. W. (1971). Playing and Reality. London: Tavistock . (ZBK.017.0001A)

Sex, Couples, and Attachment: The Role of Hedonic Intersubjectivity

Sexual and Attachment Arousal - A Source of Confusion

Attachment versus Infantile Sexuality

From Drive Theory to Intersubjectivity

The Erotic Imagination

Coda and Conclusion

After you speak

After you speak

3 Bowlby , J. (1971). Attachment. London: Penguin .

Integrating Attachment Theory and Neuroscience in Couple Therapy

Anne: (Slumped into the sofa, crying)

Authors: Clulow, Christopher

An Attachment Perspective on Reunions in Couple Psychoanalytic Psychotherapy

Attachment Theory and Psychoanalysis

Observing Patterns of Behavior

Attending to Reunions in Psychotherapy with Couples

Attachment, Family Therapy, and Relational Psychoanalysis: Introduction to Virginia Goldner’s

An Attachment Systems Perspective Treatment of a Bicultural Couple

Ben said quietly, “I think that is right.”

9 Gadamer , H. G. (1976), Philosophical Hermeneutics. Los Angeles: University of California Press .

Attachment, Recognition, and Secondary Trauma: Reply to Commentaries

The Relationship between Attachment Patterns and Parenting Style

Attachment and Parenting

Gender Issues in Attachment Patterns and Parenting

The Present Study

Sample and Procedure

The Experiences in Close Relationships Scale (ECR)

The Parenting Style and Dimensions Questionnaire (PSDQ)

Results and Discussion

Appendix 1. Demographic Data

Appendix 2. Statistical Analysis