Complex Love as Relational Nurturing: An

Integrating Ultramodern Concept

JUAN LUIS LINARES, M.D., PH.D.

This article is based on the description of therapy with a family in which three
members had been given a serious psychiatric diagnosis: a schizophrenic disorder, a
borderline personality disorder, and an antisocial personality disorder. The underly-
ing hypothesis was that these disorders were related to the specific ways in which the
obstruction of relational nurturing had influenced the turbulent history of the family.
The therapy aimed to reopen channels of nurturing behavior, promoting a reparative
attitude on the part of the father that could be extended and developed throughout the
relational network. This entailed working with concepts such as ‘‘reconfirmation’’ and
the ‘‘relational incubator.’’ The idea that the relational roots of psychopathology
(which do not deny the importance of biological bases) are to be found in the obstruction
of love by power is proposed as an ultramodern premise capable of integrating both
modernist and postmodern concepts and sensibilities.

Keywords: Love; Relational Nurturing; Psychopathology; Family Therapy

Fam Proc 45:101–115, 2006

INTRODUCTION
I have chosen to tell the story of my 2-year relationship with the Blasco family to
illustrate my ideas about how the obstruction of love generates psychological harm
and, subsequently, psychopathology; alongside this, a story will unfold about how
family therapy is a good tool for turning this process around, reopening channels
through which reparative love may once again flow (Figure 1).
During the 2 years of therapy, serious problems related to the psychiatric
diagnoses of three family members were addressed: a schizophrenic disorder
(Veronica), an antisocial personality disorder (Manolo), and a borderline personality
disorder (Jaime). I took on board these diagnoses, made by professionals unconnected
to the therapy, but with the aim of exploring their relational bases, thus enabling
them to be deconstructed. This focus on the relational aspects underlying the most
serious forms of psychopathology does not deny the importance of their biological
bases.

E-mail: juanlinares@telefonica.net

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Nuria Manuel Rosa

Marta Manolo Verónica Jaime

FIGURE 1 The Blasco Family

In a context defined by complexity, the various causal factors become superimposed

and mutually influence one another, yet this does not prevent them from being decon-
structed (Derrida, 1987) from the standpoint of one or more of them. As a psychiatrist
whose approach was shaped by the alternative movements that sprung up following May
1968 (I mean antipsychiatry and Basaglia’s [1968] anti-institutionalism) and as a sys-
temic therapist, it is inevitable that I should feel somewhat ambivalent about psychiatric
diagnosis. On the one hand, it represents an important body of knowledge that is able to
generate enormously useful metaphors for psychotherapeutic practice; however, it is also
a source of simplification and highly negative labeling. Family therapy, especially re-
cently, has focused almost exclusively on the latter aspect, and this has led it to abandon
almost totally the field of severe mental pathology. Thus, I propose a return to the former
(diagnosis as a source of relational metaphors), a version that is able to facilitate a fruitful
relationship with other mental health professionals.
Naturally, the therapeutic work described here also addressed problems and con-
flicts involving the other family members (Manuel and Marta), and even people close
to the family, such as Veronica’s boyfriend (Roberto). The common denominator was
my relationally sensitive and depathologizing view, which placed everybody on the
same human plane while according the symptoms an importance in keeping with their
severity.
I accompanied the family over a period of 2 years and adapted myself to their rhythms
rather than impose an external one. For example, I worked with those family members
who were able or wished to come to the sessions, allowing them to develop their natural
cycle in terms of changes of job or residence. In addition, I occasionally invited others, such
as Veronica’s boyfriend, who were regarded as playing important roles. Indeed, I believe
that one can never overemphasize the need to be flexible in proportion to the seriousness
of the case: Long gone are the days when the success of therapy was measured in terms of
the therapist’s ability to impose discipline on a family.
Given the seriousness and social repercussions associated with the pathology pre-
sented by the family, it is likely that the therapy would not have been possible in the
absence of psychiatric reputation and status. Such is the paradox of family therapy with
psychosis and other severe disorders: It requires a relational deconstruction of a diagnosis
that can only be made by professionals or centers with a recognized capacity in the field of
mental health. Yet this also means that responsibility can be taken for any medication
that may be needed during a certainFpotentially lengthyFperiod and also facilitates the

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writing of reports that will be accepted and taken seriously by judicial, employment-re-
lated, and health institutions. These are things that are done for clients, usually at their
request, and that are inspired by the practical intelligence of the therapist. In addition,
one must consider the possibility of complementary individual therapy being offered
alongside the family work. All of the above was indeed done with the Blasco family and
more than likely played a part in the therapy’s success.

THE FAMILYAND THE THERAPY: THE RELATIONAL INCUBATOR

1. Beginnings
Manuel Blasco, at the age of 45, was a man at the height of his career: a successful
executive of an important security firm. Coming from a modest family background and
having himself chosen to move to the big city, he carved out a path in life through
sheer determination and a strong and assertive character. He made up for his lack of
basic education with a well-developed common sense that was given full rein thanks to
his friendly nature and striking ability to relate to people.
His wife, Rosa, one year younger, was a shy and delicate woman whose fragility and
beauty found their perfect metaphorical reflection in her name (Rose in English), this
also being the name of one of the products sold in her small business, a florist.
With the arrival of children, the character traits and behavior of the parents be-
came more extreme, leaving Manuel ever more powerful and progressively more in
charge of all family responsibilities, both public and private. Meanwhile, Rosa, who
had always been more vulnerable and less able to make decisions, began to drink
secretly and neglect her work, both at home and in the florist. The couple’s rela-
tionship was slowly deteriorating, with few words being exchanged in an air of silent
confrontation; all this was built around mutual disqualifications, invariably more
explicit on Manuel’s part.
The crisis erupted when, after 12 years of marriage, Manuel discovered that Rosa
had been unfaithful to him. They separated without excessive animosity, and their
material possessions were shared out in a relatively civilized way. The decision over
custody of the children, however, was not so balanced: The three eldestFMarta, 10,
and 6-year-old twins, Manolo and VeronicaFstayed with their father, while the
youngest, Jaime, who was 4, went to live with his mother and her new partner. It
seems that this distribution was fairly in line with the wishes of the children because
the youngest was much closer to his mother, while the eldest three saw their father as
the safer option. It should be remembered that Rosa was a drinker and had taken a
lover, whereas Manuel bore most of the family responsibilities. The children, who
today can understand their mother’s suffering, were at the time very angry with her.
Yet the real drama had in fact barely begun.
A few months later, when the family seemed to have adapted to the new situation,
Rosa suffered a stroke that left her in an irreversible coma. Seeing her abandoned by
her partner, Manuel took responsibility for her, and, of course, of Jaime, who found
himself back alongside his siblings. Rosa lived for a further 6 years, reduced to a
vegetative state and a permanent in-patient in a basic care center; from time to time,
Manuel took the children to visit her there. Despite being briefly involved with several
women, he never sought to embark on a new relationship because, according to him,
he didn’t want to risk his children having to live through another failure. His heart,

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damaged and wizened, was clearly not the ideal ground on which to build lasting
stories of love. Thus, a new chapter began in the life of the Blasco family.
Manuel was working day and night and had to travel continually on business, so the
children were brought up by nannies and by themselves. With very little extended
family, despite having come from a rural environment where family networks tend to
be well established, this social isolation must have been a particularly heavy burden
for Manuel and his children. At the heart of all this was the following arrangement:
Manuel delegated to Marta the task of stand-in mother, which she did her best to
fulfill, trusting in the full backing of her father and her own natural strengths, which
suggested a solid and self-assured character like that of Manuel. The two boys, Manolo
and Jaime, were a source of conflict and competed to provoke and disqualify each
other. For Manolo, Jaime was the little brat who had had the privilege of hogging, and
maybe even the wickedness to provoke, their mother’s final moments, thus robbing
him of any such opportunity. For Jaime, Manolo was the crazy older brother who,
having bet on the winning horse out of sheer ambition and the desire for the easy life,
now had the nerve to accuse him of being a traitor and opportunist.
The fights between the two boys were more than a match for Marta’s authority and
were only brought under control during those sporadic occasions on which Manuel
was at home; however, exhausted and demoralized, he would simply order them to
shut up, resorting more to a ‘‘because I say so’’ rationale rather than more emotionally
coherent styles of child rearing. In this context of irate men, and with Marta taking
the first successful steps toward leaving that would soon see her become an inde-
pendent young woman (she finally left home at 17),VeronicaFkind, tranquil, and
quiet VeronicaFwas at risk of going unnoticed, and often this was indeed what
happened. On one occasion, when the family had to evacuate their house at night
because of the threat of fire, Manuel realized that Veronica was not with them and had
to go back and get her from her bed, where he found her crying in silence.
A few more years passed, and the family members continued their respective life
journeys.
Marta went off to live her own life, combining work with studies. There were some
difficult moments, but she made progress because she knew what she wanted. She
studied psychology and public relations, got offered increasingly better jobs, and
ended up living with a brilliant young man from a prestigious family. Despite her
success, she remained supportive of her family, proving influential but without
seeking to pull strings in a negative way. At times she despaired of her father or one of
her brothers and consequently revealed herself to be more fragile; although this led
her to assert her right to be looked after too, her relational availability was always
sincere.
Manolo and Jaime turned out to be intelligent and attractive young men, but both
had important weak points. Manolo did very poorly in school but showed a real eye for
business. At 18, he started running a fishmonger, a job that required him to get up at
4:00 a.m. to buy the produce, work all day making conversation with and offering
culinary advice to his customers, and clean the premises after closing. He lasted a year
and a half, made a good living, and then shut up shop without ever knowing
whyFperhaps because he couldn’t see himself as a real fishmonger in the future, or
maybe because he’d begun by then to suffer from agoraphobia and found it difficult to
go out alone. To combat his panic attacks, he took medication, which he himself
controlled very haphazardly, and drank alarming amounts of alcohol.

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Jaime took another path in this race for independence that appeared to be a shared
obsession among the Blasco children: As soon as he finished his basic education, he
enrolled in a vocational training program and rapidly qualified as an electrician. He
immediately found work in the trade and then, at age 22, he set up his own business.
Because he was very efficient, there was no shortage of work, but problems arose from
another quarter: He got in with an undesirable crowd and started to take cocaine on a
regular basis.
As for Veronica, little is known of her story except that she was a ‘‘very independent
girl.’’ How could she have been otherwise? More than independent, she was insig-
nificant or almost invisible; Veronica studied a bit, worked a bit, and went out with
boys a bit. And then, apparently as a result of her boyfriend leaving her, she suddenly
stepped over into madness. She did not go mad because she was left without a boy-
friend; indeed, much of this madness was already present in the disconfirming
treatment she received from her family. However, the way in which she experienced
the ending of the relationship, which was both brusque and unexplained, was no doubt
enough to push her over the edgeFat least this was the story that was agreed upon
with me during therapy. Whatever the case, Veronica’s psychosis marked the start of a
new stage in the story of the Blasco family.

2. Crisis
Suddenly it seemed that the forces of nature (and there were those who said forces
of hell) had been unleashed in this placid child. Veronica, who was 22 at the time,
began to hear voices that blasphemed and insulted her; encouraged by them and
amidst a terrible state of confusion, she declared herself to be the queen of the uni-
verse, with the authority to impose her will as she pleased. The most alarming con-
sequence for the family, and undoubtedly one of the most dangerous for Veronica, was
a period of sexual abandonment in which she slept with any ‘‘liege’’ within her grasp.
She was soon admitted to psychiatric hospital and found herself part of a harsh
therapeutic process characterized by high doses of medication, intense side effects,
long periods of isolation, and finally, a few sessions of Electro-Convulsive Therapy
(ECT). Her symptoms remained, and for many months, Veronica continued to chal-
lenge the world, the hospital staff, and her family. Then one day, for no apparent
reason, she began to get better.
If something had changed in the Blasco family, it was that a certain awareness of
collective crisis had taken the place of what had previously been a vague and undefined
sense of distress.
Manolo shut himself away indoors, obsessed with the Internet and given over to a
strange ritual every time he went out. He spent brief periods in bars, where he drank
to cope with his anxiety. In combination with high doses of tranquilizers, which he was
taking in an uncontrolled fashion, the alcohol had a clearly damaging effect on him. In
such a state, his provocative behavior became dangerous, causing altercations that
usually saw him end up at the police station.
Jaime bought himself a convertible car that he proceeded to drive dangerously
around the neighborhood under the effects of cocaine. His dangerous friendships
turned into organized crime, a world in which Jaime seemed to be wandering aim-
lessly and taking increasingly greater risks. His girlfriend became frightened and left
him, plunging him into a state of depressive rage governed by violent outbursts. He

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then hit his ex-girlfriend in public and crashed his car into her father’s car, an event
that led to him making a court appearance.
Their father, Manuel, remained disconcerted. One minute he was defending and
supporting his sons, the next he was flying into a rage and throwing them out of the
house amid scenes of loud shouting and violence. Retired and well off financially, he
met a woman, Nuria, who was very much in love with him; for the first time, he en-
tered into a stable couple relationship. He had reached the conclusion that he had to
do new things that offered his children a different family framework away from bad
company, and so he decided to move to the town where Nuria lived, over 120 miles
away. Manolo and Jaime agreed to go with him, but Veronica, both scared and excited,
was starting to get her life in order; she wanted to study and work, and moreover, she
was going out with Roberto, a Colombian boy with whom she declared herself to be
madly in love.
It was at this point that Marta thought that family therapy could help them, and
she soon convinced the rest of the family of this.
The five of them turned up at the first session. The atmosphere was tense because
the night before, an argument between Manolo and Jaime had ended with a bitter
intervention on the part of Manuel, one that was disqualifying and threatening for
both boys. Veronica, withdrawn and with a lost look about her, had witnessed yet
another performance of this show of male conflict, while with her appearance, she
seemed to be claiming the role of the real family problem. Marta, meanwhile, slipped
naturally and with a show of concern into the role of family communications manager.
In addition to gathering information and developing a relationship with each of
them, especially the father, I paid special attention to Veronica, and this revealed a
risk situation regarding her boyfriend. The three men in the family were strongly
opposed to Veronica’s relationship with ‘‘the Colombian,’’ as they disdainfully re-
ferred to him, and had already had violent run-ins with him, threatening him so that
he would ‘‘stop being a nuisance.’’ They assured me that their antagonism toward the
boyfriend was not because he was a foreigner but because he was involved in organized
crime and simply wished to take advantage of Veronica. In response to this, Veronica
seemed to come to life. With fire in her eyes, she said that this was not true, that he
treated her really well, and that they were in love, and no matter what people thought,
they were going to live together. Seeing that the family was at an important crossroads
in terms of its relationships and realizing that much was at stake for Veronica, I said
the following:

I can see that you are all concerned about Veronica’s welfare and safety, and this means that
the effort you’ll all have to make in holding back and letting her decide her future is espe-
cially worthy. But perhaps the effort will not feel so great if you can come to understand that
what would really drive Veronica mad is other people making important decisions on her
behalf.

This was enough for Marta to grasp the point and decide to support her sister; the
others followed suit, with varying degrees of willingness.
Having won the ‘‘fight over Roberto,’’ Veronica stayed in a hostel for young people
near Marta while Manuel, Manolo, and Jaime moved to the town where Nuria lived.
They all agreed to continue with therapy, although the availability of Manolo and

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Jaime was drastically reduced both as a result of distance and work commitments and
because the two of them entered the most acute phases of their own crises.
Manolo had moved into an apartment with his girlfriend and ventured out into the
world with the help of his particular resources. ‘‘My crutches’’ was his term for the
counterphobic company of his girlfriend, while he described the mixture of alcohol and
tranquilizers he took on the pretext of combating his agoraphobia as ‘‘filling the
tank.’’ His violent behavior increased until one day, during a brawl, he crashed his car
(in fact, it was his father’s car) into a car belonging to a gang of drug dealers, who got
out brandishing their guns. Miraculously, Manolo escaped with his life, although he
spent the night in police custody and the following day in a mental health center. The
outcome of all this was a court case and a diagnosis of antisocial personality disorder.
Jaime went to live with Manuel and Nuria, but his sadness and rage continued. It
appeared that he couldn’t stand his father’s girlfriend and made her life impossible,
while outside the home, he followed in his brother’s footsteps and came into contact
with both the police and psychiatric services. The diagnosis he received was slightly
more benign: borderline personality disorder.

3. Denouement
While the solution proposed by Manuel for his sons was failing, the therapy con-
tinued with a focus on Veronica, who made spectacular improvements. Against all
prognoses, she got a challenging job as a waitress in a very busy beach bar, carrying
out her tasks satisfactorily, and at the same time, she moved in with Roberto. The
young couple was invited to attend a session, and this confirmed the consolidated
status of their relationship. Roberto was sincere in his affection, and although he had
had some contact with small-time dealers when he was desperate and unemployed, he
was far from being a criminal.
Veronica’s progress was, with Marta’s help, readily transferred to the relational
dimension, and none of this escaped the ever-more-aware and convinced gaze of
Manuel: The girl was flourishing because her individual needs were being recognized
and she was receiving the full respect of others.
Meanwhile, Manuel had decided to return to the city. The scandals caused by his
sons had made it very difficult for him to stay in Nuria’s town, and so he opted to move
back to his old house and see his girlfriend on weekends.
It was at this point that a consensus was reached with Manuel, and subsequently
with the children, regarding a family story that would provide the framework for the
therapeutic intervention. In fact, this was done in an individual session, an ideal
framework in which to establish a therapeutic alliance based on responsibility and
parental love.
I expressed my admiration for the enormous investment that Manuel had put into
bringing up his children. I also praised his human qualities and showed my uncon-
ditional support with respect to his past and present suffering. These words evoked in
Manuel (to the extent that he began to cry) intense feelings of tenderness toward those
children who had lost a mother, a mother he had tried to stand in for despite being
unprepared for the task. I went on to make clear links, without assigning blame,
between what Manuel’s children had suffered and lacked in the past and their current
problems, such that these could not be put down to wickedness or idleness, as was
usually the case. Veronica’s psychosis, in addition to being a mystery from many

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points of viewFincluding, perhaps, that of biologyFwas a disproportionate reaction

to being an insignificant child. I said,

Manuel, you would arrive home late and tired, sometimes after having being away for several
days. Marta was your confidante and your right-hand woman, while Manolo and Jaime were
the adversary that you had to corner into submission. Veronica practically didn’t exist.

If madness was for Veronica a way of ensuring that she never again went unnoticed,
then the turbulence and impulsiveness of Manolo and Jaime also constituted a re-
bellion against this adult world, represented by their father, that had deprived them of
the affections associated with a peaceful childhood, leaving them to fight over the few
scraps of love that fell within reach. Our conversation continued:

I: Your children’s problems can be overcome, Manuel, but the solution lies with you.
Manuel: But from what you’re saying, I get the idea that I’ll have to do things differently with
Veronica and with Manolo and Jaime, is that right?
I: It certainly is . . . but with Veronica you’re already doing things right. You’re respecting her
and attending to her needs, you’re recognizing her as a person. This is the best antipsychotic
antidote you can give her. With respect to Manolo and Jaime, I suggest a complete change of
tack in your relationship with them. You have to take them under your wing unconditionally
and treat them in a new way, with the utmost gentleness. This means revealing all the love
you feel for them, the love that until now has been buried under this hard outer layer of male
roughness. You have to care for them as if they were disabled children, which underneath it
all they are; you have to forget their aggressiveness and ignore their attempts to provoke you.
Only you can do it, only you can build for them a genuine relational incubator.

Manuel understood the idea and put it into practice, helped by the fortunate co-
incidence that his sons did not return at the same time, Jaime coming home several
months before Manolo.
The first incubator session with Jaime reached epic proportions. The boy laid into
his father more aggressively than ever. Manuel had spoken of their inheritance,
suggesting that he wouldn’t leave them anything they didn’t deserve. Jaime reacted to
the provocation: ‘‘The only inheritance from you that would make me happy is that
you die as soon as possible. You can do what you want with the money.’’ He said all
this very seriously, staring coldly into his father’s eyes. Manuel appeared downtrod-
den because his efforts were not proving to be very productive, and the rest of the
session was marked by a sterile exchange of mutual reproaches.
It was thus necessary, in a further individual session, to reassert Manuel’s position,
pointing out that he hadn’t kept his side of the bargain, which under no circumstances
included threats or confrontation. Manuel needed to understand that it wasn’t simply
a matter of his moral duty as a father but also a practical issue. Unless he wanted to
have his children under his care for the rest of his life, he had no option but to make
the incubator work.
It was also necessary to temper Jaime’s behavior. In an individual session with him,
I said,

You know, this image you have of your father as a bad man does you so much harm. Yet he’s
not a bad man; he’s a sorry, unfortunate man. He loves you, but doesn’t know how to tell you

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this. You’ve all been very alone in your family, but now your father has recognized his
mistakes and blunders of the past and wants to help you.

There followed an emotive evocation of the sadness felt at his mother’s death and of
his permanent feeling of having been an intruder who had to keep out the way and not
bother others in order to be forgiven. Jaime cried, and by the end of the session, he
accepted the possibility that things could change.
And things did change, beginning with his attitude. The fits of impulsive violence
disappeared and, as his father showed himself to be more affectionate and flexible,
Jaime challenged him much less often. Jaime spent several months at home, going out
very little and sleeping a lot; the irony of this when compared with his uncontrolled
past was not lost on him. Later, he began to awake from this period of slumber, buying
himself a motorbike and getting a good job. By this time, Manolo had entered the
incubator.
It would be too protracted here to describe the details of a process that essentially
bore the same characteristics as that undergone by his brother. There were times
when he ferociously provoked his father, and it was necessary to reassure Manuel that
he was doing a good job and to temper Manolo’s behavior so that he could perceive the
spectacular change that had taken place in his father. The phobic symptoms improved
through a specific therapeutic program, which also included a reassessment of his
medication and control of his alcohol intake. Within a few months, Manolo began to
look for work and enrolled in the university to study economics. His life too had
changed.
The hypothesis that guided therapy with the Blasco family was that relational
nurturing within the family had been blocked initially by the conflict between the
parents, which led to their separation and the division of the family. Later, this
blocking continued through the mother’s long illness and death and as a result of the
father’s inadequate treatment of his children.
The eldest child, Marta, who was already grown up when the family lived through
its worse moments, benefited from being awarded the privileged status of her father’s
ally. As the stand-in mother, she could have suffered the consequences of an intense
parentalization, yet she escaped this fate thanks to her services being openly recog-
nized by her father and, undoubtedly, her siblings. Driven by a desire to free herself
from this pseudomaternal role, she ran the risk of leaving home too soon. However,
she successfully negotiated this stage, and the difficulties she faced made her mature,
enabling her to combine full personal autonomy with a nurturing relationship toward
her family.
Manolo and Jaime experienced the lack of relational nurturing in the form of de-
mands, rejection, and disqualification by their father. The requirement to be self-
sufficient, impossible to meet in a mature way, was accompanied by their father’s
relentlessly critical attitude, revealing an intense disappointment on his part. The
gleam of pride that appeared in Manuel’s eyes when looking at Marta became a look of
anger and disdain when he turned to the boys. Furthermore, these two had to compete
with each another: Manolo feared that the upstart Jaime would rob him of the little he
had, while Jaime that he was treated like a thief who deserved to be punished. As a
result of this relationally dysfunctional cocktail, both boys developed turbulent and
impulsive personalities, finding it difficult to establish stable social ties and revealing
depressive tendencies and violent behavior. Their respective interpretations of the

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compelling need to be independent led them to make spectacular gestures of auton-

omy that were nonetheless doomed to failure. All these traits were consistent with a
diagnosis of personality disorder, either antisocial or borderline, and sure enough, this
was not long in being assigned to them.
Veronica got the worst deal because seeing one’s own existence go unrecognized by
one’s most important attachment figures, an experience that constitutes the essence
of disconfirmation, is the most serious psychological aggression that a human being
can suffer. And this is what happened to Veronica when her father’s gaze, obsessively
caught up in the anger felt toward Manolo and Jaime or relaxed in proud contem-
plation of Marta, simply passed over her without any sign of recognition. Being herself
also became an urgent need in this young girl’s life, but she could not even take the
first steps toward personal autonomy; instead, she ran aground through the con-
struction of an alternative, delusional, and psychotic identity: ‘‘If I can’t be someone
who receives social recognition and approval, then I’ll be an unbearable mad woman;
at least her presence won’t go unnoticed.’’
The therapy was based on a solid alliance between me and Manuel, who at all times
felt that I understood and supported him. This was the only way to point out his re-
sponsibilities and mistakes from the past and to get him to accept the task of rectifying
them. This was what led to the metaphor of the relational incubator that would prove
to be so useful with the three symptomatic children.
With Veronica, a process of reconfirmation was embarked upon, and this, in our way
of working, is the backbone of family therapy with psychosis. The aim is to provide a
constant affirmation of recognitionFthe cognitive component of relational nurturing
that is blocked by disconfirmation. The therapy could not accept the slightest violation
of Veronica’s individual rights and, as its first cornerstone in this regard, chose to
focus on her relationship with Roberto, a relationship that had been rejected by the
family on the pretext that it wasn’t in her best interests. Of course, this was a false
protection that actually served to obscure the wounded pride of her supposed pro-
tectors, who didn’t like to mix with someone they felt disdain toward. When the
therapist managed to get Marta, followed by Manuel and, finally, Manolo and Jaime,
to accept Veronica’s right to choose her partner, the therapy took a giant step forward.
Eighteen months later, Veronica traveled alone to Bogotá, where Roberto was waiting
to introduce her to his family. They then returned to Spain and got married.
Jaime entered the incubator after a terribly violent confrontation with his father,
the latter finally realizing that he had to give in and show tenderness and under-
standing toward his wounded son. It was deeply moving to seeFand I made no at-
tempt to hide my emotionFhow Manuel, in what had until then been an emotionally
barren terrain governed by testosterone, would get up in the early hours to make
Jaime an herb tea and take it to him in bed, or how he would prepare food for him
every day and go for walks with him in the park. Only in this way, seeing him in
action, could Jaime change his view of his father and cease to regard him as a selfish
monster. And only in this way did he allow himself to change. Toward the end of
therapy, he got his motorbike license and bought himself a bike because, as Manuel
said when justifying his bank guarantee on the purchase, ‘‘he’s wanted one ever since
he was a kid.’’ In addition, Jaime got an excellent, highly qualified job and once again
began to go out with friends. As was mentioned before, Manolo followed in his
brother’s footsteps and received the same wonderfully caring and nurturing treat-
ment from his father.

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By now, nobody was surprised that the family could change. In our interpretation of
events, complex love had been restored, and this enabled relational nurturing to flow
freely among the various members of the family.
The key to success here was undoubtedly the work with Manuel, based on an al-
liance with me as ‘‘man to man, and father to father.’’ Through feeling that I accepted
him totally and that all his suffering was acknowledged, he was able to take on board
to a considerable extent criticisms that he had never heard before and that he would
have never taken from anybody. However foolish such male armor may be, peeling it
away without the man in question feeling insulted or attacked is a challenge that a
male therapist can face by showing himself to be both strong and vulnerable, without
hiding his emotions or even the tears that may well up during particularly intense
moments. It is a matter of showing, by example, that love and sensitivity are more
useful relational tools than are power and authoritarianism. This is what I didFand it
worked.

LOVE AND POWER

Love can be defined as a set of thoughts, emotions, and actions that overlap and
strengthen one another, where the other is both the object and the subject of binding
forces associated with happiness and pleasure.
It is understandable that the various psychotherapeutic models have avoided
treating love as the central phenomenon of the human condition or that they have
relativized its importance in numerous ways, simplifying it or reducing it to an in-
stinct. It is understandable because it is a difficult concept to deal with, one that is
replete with poetic, literary, philosophical, and religious connotationsFintense and
reductionist connotations, all of which imply important, at times sublime, simplifi-
cations.
But, despite the various meanings attached to love, it is universally agreed that it is
a highly important relational phenomenon. This alone should be reason enough to
follow the path set out by Maturana (1996), who defined us as loving beings who be-
come sick when love is obstructed. From this point of view, it makes sense to regard
family and couple therapy as a process of restoring the loving bonds that have been
partially or completely severed.
The condition of ‘‘loving being’’ is not an attribute exclusive to women, nor to
angels, but is one shared by both men and women, who also share the risk that love
becomes obstructed, leading to harmFand illness. We could say, therefore, that we
are primarily beings who love, and secondarily, beings who harm each other. And it is
this harm, the result of love being obstructed, that makes us sick.
In contrast to the obscurantist view of the origins of humanity, there are actually
sound reasons to regard the Paleolithic Age as a long period in which the prevailing
features of human relationships were loving bonds and solidarity. Data gathered from
Atapuerca, a wonderful site in northern Spain dating back to the origins of humanity,
reveal primitive humans to have been loving, capable of solidarity, and also scavengers
(Arsuaga & Martı́nez, 1998). What can be less violent than that! Indeed, it seems that
a long time passed before we decided to hunt live animals to obtain our necessary
protein intake.
However, soon after beginning to hunt animals, we decided to raise them as well.
The invention of stockbreeding and agriculture gave rise to the Neolithic Revolution

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and, in turn, the birth of civilization. For the first time in their history, human beings
found themselves with an economic surplus and were freed from the daily struggle for
survival. As material conditions enabled scientists, wise members of the community,
skilled craft workers, and artists to specialize, the first settlements became trans-
formed into towns and cities, ever richer and more beautiful.
However, economic surplus also led to a revolutionFor perhaps we should call it an
‘‘involution’’Fin human relationships by introducing and generalizing the trend
toward the appropriation of communal and other people’s property. Power relation-
ships took up a predominant position and were institutionalized in the form of pa-
triarchies, states, social classes, and wars of conquest. The phallus and the biceps
came to play a decisive metaphorical role, and force and dominance became key ele-
ments of the interaction between genders, generations, social classes, and ethnic
groups. In sum, power relationships became the main source of interference with and
obstruction of loving relationships.
Since that time, around 10,000 years ago, little has changed at the fundamental
level, although power relationships have become progressively more complex as hu-
man beings have consolidated their control of nature. However, neither the biceps nor
the phallus is the metaphor that it once was, now that brute force is readily replaced
by technique and DNA can be manipulated in the laboratory.
Perhaps this is whyFbecause it is easier to recognize the complexity of the power
relationships that obstruct loveFwe are also better placed to detect the complexity of
love itself, of complexly obstructed love. And perhaps the time has come, in order to
address these interwoven complexities that work both in favor of and against love, to
introduce the concept of relational nurturing, a concept that is more operative and less
susceptible to simplificationFeven if less susceptible to sublime simplificationFthan
that of love.

RELATIONAL NURTURING
Relational nurturing is a set of cognitive, emotional, and pragmatic elements that
combine to make human interaction a suitable substrate for growth, development,
well-being, and mental health. It should be apparent to all that, defined in this way,
relational nurturing is equivalent to the complex love that we have referred to time
and again, a love that ceases to be a purely affective phenomenon and one that em-
braces loving thought, feeling, and action (Linares, 2002).
These three levels are relatively independent, and each one may be obstructed by
power without the other two being significantly affected; however, the effect will
subsequently be generalized to all three levels. Thus, recognition and valuing the
other can be regarded as cognitive functions of relational nurturing, while their
blocking leads to disconfirmation and disqualification. Obstructing the emotional
functions of affection and warmth produces indifference and rejection. And the love
between parents and children may also be affected by the failure of pragmatic com-
ponents, principally protection and socialization.
All these ingredients of love, and surely many others not mentioned here, may be
combined and obstructed in a variety of ways. Thus, all parents believe that they love
their children, even those who abuse and cruelly mistreat them, or those whose dis-
confirmations drive their children toward psychosis or whose disqualifications lead
them into depression and suicide. This is why it is difficult for an observer ever to be

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totally convinced that such parents do not love their children, despite the sense of
astonishment that comes with witnessing the most obvious and harsh abuse, violence,
disconfirmation, or disqualification; the obstruction of complex love, which we are now
referring to as relational nurturing, is never homogeneous or total.
And let us not deceive ourselves; the consequences of these processes for children
can be terrible. Maturana (1996) has already spelled it out: We get sick when love is
obstructed. The postmodern mind of a social constructionist should not balk at the
suggestion that the obstruction of love by power is the main source of psychopathol-
ogy. In fact, this is a central idea in the work of the oft-cited Foucault (1966), one that
has been updated by White and Epston (1990) and taken on board by hundreds of
authors, mainly in the English-speaking world. Yet power is not an exclusively mac-
rosystemic phenomenon with respect to which the family acts solely as a transmitter.
On the contrary, the family is an active intermediary between society and the in-
dividual and is the space in which the power games that, in specific ways, come to have
a decisive influence on family members are played out. For what, if not a power game,
is the triangulation of children into transgenerational alliances in which they are
dragged toward rejection, loss, and disconfirmation? How else should we describe all
that children lack as a result of narcissistic parents who put their own needs before
those of their children? And what about the relational chaos of those families who are
wracked by disorganization and the powerlessness of the defeated?
In all these cases, we are faced with situations in which children participate, in a
circular fashion and with their symptoms, in dysfunctional relational games that are
ultimately the responsibility of parents, the latter being the local representatives of
power structures that extend far beyond the family unit. Thus, there is still a place for
linear causality, although now it comes to form part of the level of greater complexity
represented by circular causality. There is nothing new in that, of course, for it is
simply a further illustration of how one paradigm comes to substitute another by
assimilating rather than by displacing it. Something similar has happened in the al-
ternation between objectivism and subjectivism throughout the history of Western
thought (Linares, 2001). A new turn has never implied the outright rejection of what
went before, but rather, at most, its dialectic negation or its incorporation into the
latest proposals.

THERAPISTS AND THERAPIES

But what about postmodern family therapists? In my opinion, a relational psy-
chopathology based on the concept of relational nurturing meets the requirements
necessary for integrating both modernist and postmodern points of view. The ob-
struction of love by power is a postmodern, pathogenic principle incompatible with
naı̈ve modernist reductionisms, such as that offered by biological psychiatry under the
financial backing of the pharmaceutical industry. Yet at the same time, the principle
of parental responsibility contains an important element of linear causality, one that
is not alien to modernist sensibilities.
By playing a little with words and pending a better name, we could take the pro-
vocative step of calling the approach being proposed here ultramodern.
In terms of therapeutic intervention, the proposal, in keeping with the epistemo-
logical argument set out above, also integrates modernist and postmodern sensibili-
ties. The ultramodern therapist develops strategies and applies techniques but does

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not do so from a position of supposed objective neutrality; rather, he or she is com-

mitted to showing solidarity with, and responsibility toward, the client (Marina,
2003). Far from rejecting the medical model as authoritarian and noncollaborative,
the ultramodern therapist reformulates and places such a perspective within a tra-
dition of socially contextualized healing practices that are as old as humanity itself.
This conceptual integration of medical practices proves to be much more useful than
fighting against them. And besides, the stage is set for us to be merciless in our
criticism of authoritarian and largely noncollaborative therapists regardless of
whether they regard themselves as modernists or postmodernists.
Yet we should not confuse authoritarianism, which involves giving priority to our
own narcissistic interests and imposing them on others, with being an expert. The
expert negotiates and reaches an agreement with clients regarding what techniques to
apply, whether these be surgical, pharmacological, or communicational. And the true
expert finds it natural and easy to obtain the client’s participative and collaborative
acceptance. There are few relational processes as untarnished, honest, and gratifying
as this, and the ultramodern therapist accepts full responsibility for what is being
undertaken.
Of course, this responsibility is actually a coresponsibility. The therapist, as an
expert in persuasion and negotiation, shares responsibility for the unfolding of ther-
apy with other involved agents. Psychoanalysis was incredibly benevolent in its
treatment of therapists, attributing therapeutic difficulties to patient resistances. The
coresponsibility of ultramodern therapists in therapeutic work does not oblige them to
seek an impossible objectivity, but they must deal with their subjectivity in a mature
way, the first step toward which is an adequate training.
There are three main lines that therapists can follow in their practice:

1. In the cognitive line, therapists develop their ability to reformulate, which is

another way of describing the capacity to tell new stories from the material of-
fered by clients.
2. In the emotional line, therapists intervene intelligently, with an intelligence that
is either of the emotional kind or nonexistent. That is to say, far from denying or
hiding their emotions, they will recognize and use them properly.
3. In the pragmatic line, therapists show a practical spirit, one that enables them to
ask their clients to do things that they, the clients, are prepared to do without
feeling forced into doing so.

The key to good ultramodern training lies in helping therapists to move comfort-
ably along these three lines, a process that involves making use of their natural skills
and learning how to gain those which they lack. All of this should be done with a
flexible attitude, one that does not seek heroic therapeutic interventions and that
makes room for a wide variety of possible combinations between the cognitive, emo-
tional, and pragmatic elements. For at the end of the day, the objective of ultramodern
therapyFalthough more than likely of modernist and postmodern therapies, tooFis
the complete restoration of loving relationships. And this implies the construction of
new narratives that include perceiving and thinking about the other in a new way,
treating him or her differently than before and thus, in the process, coming to expe-
rience previously unknown emotions. Or, alternatively, it entails the rediscovery of

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thoughts, feelings, and behavior that are able to provide relational nurturing yet that
had, for whatever reason, been abandoned.
Restoring complex love, one that is as free as possible from the interference of
power, is the best way of counteracting all kinds of symptoms and dysfunctions and is
a process that requires technical skill and a sense of responsibility from therapists
who are also able to feel (complex) love toward their clients. Moreover, therapists
should then feel free to regard themselves as modernist, postmodern, or ultramodern.

REFERENCES
Arsuaga, J.L., & Martı́nez, I. (1998). La especie elegida. La larga marcha de la evolución
humana. Madrid, Spain: Temas de Hoy.
Basaglia, F. (1968). L’istituzione negata. (The denied institution). Torino: Einaudi.
Derrida, J. (1987). Le retrait de la me´taphore. Basaglia, F. (1968). L’istituziona negata (The
denied institution). Tonno: Einaudi. Paris: Galilée.
Foucault, M. (1966). Les mots et les choses: Une arche´ologie des sciences humaines. (The me-
taphor’s retirement). (Words and things: An archaeology of human sciences). Paris: Galli-
mard.
Linares, J.L. (2001). Does history end with postmodernism? Toward an ultramodern family
therapy. Family Process, 40, 401–412.
Linares, J.L. (2002). Del abuso y otros desmanes: El maltrato familiar entre la terapia y el
control. (After postmodernism . . . ultramodernism). Barcelona, Spain: Paidós.
Marina, J.A. (2003). Después del postmodernismo . . . el ultramodernismo. (On abuse and other
outrages: family mistreatment between therapy and control). Redes, 11, 9–29.
Maturana, H. (1996). Biologı´a del amor (Biology of love). Seminar presentation to the Catalan
Society of Family Therapy, Barcelona, Spain.
White, M., & Epston, D. (1990). Narrative means to therapeutic ends. New York: W.W. Norton.

Fam. Proc., Vol. 45, March, 2006