Psychotherapy With Couples

Theory and Practice at the Tavistock Institute of Marital Studies

Stanley Ruszczynski

• Publisher: Routledge
• Year: 2018
• ISBN:
  9780429918292
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

A thought provoking, persuasive, challenging, and above all practical guide for beginners and more experienced therapists alike. It shows the demands and complexity of marital work and is an important reminder of the interdependence of theory and practice.

Part One
The Institutional Context

There is no such thing, outside the realms of imagination, as a marriage free from conflict. Such a relationship is not in the nature of human beings. In the depths of our minds we never, throughout our lives, succeed in freeing ourselves fully from the hates and resentments that first arose in infancy.… These emotional forces are part of the essential dynamics of our personalities, and they operate intensely in marriage. …

Geoffrey Thompson

Chapter One
The theory and practice of the Tavistock Institute of Marital Studies

Stanley Ruszczynski

In this introductory chapter I outline the development of the thinking and practice of the Tavistock Institute of Marital Studies as it has developed since its establishment in 1948. It is, of course, not possible in one chapter to trace the entire organizational, intellectual, and clinical life of an Institute spreading over 45 years. I will therefore limit myself to a sketch of the theory and practice of working with couples as it has emerged in the Institute’s research, publications, and clinical work. Those who may want to have an overview of the Institute’s organizational development can refer to Bannister et al. (1955), Woodhouse (1990), and, more briefly. Dicks (1970).

The Family Discussion Bureau

The Tavistock Institute of Marital Studies (TIMS) came into being after World War Two as a result of the growing political concern for the state of marriage and the family. It is somewhat sobering to read that the particular areas of concern were increase in divorce, separation, marital disharmony, and family tensions” (Astbury, 1955). A contemporary list would, with the addition of child abuse, read rather similarly.

In 1947, against the background of this concern, the Family Welfare Association (FWA), a family casework agency originally established in 1869, initiated what was to become a seminal project. Some of the staff of the FWA were becoming increasingly aware that requests for material help frequently exposed needs of a more personal and emotional kind. The Association therefore decided to offer specific technical help to some of its practitioners in developing their skills to deal with these specific difficulties, focussing in particular on problems of marital relationships (Menzies, 1949). Enid Elchholz (who became Enid Balint in 1953), a senior member of the staff of the FWA, approached the Tavistock Institute of Human Relations CTIHR) for consultative help and advice. TIHR allocated Isabel Menzies (now Menzies Lyth) and Dr A. T. M. Wilson, together with Elizabeth Bott (now Spillius) to work with the FWA on their experimental project (Menzies, 1949; Menzies Lyth, personal communication 1992). This collaboration led to the formation, In 1948, of the Family Discussion Bureau (Bott, 1957). Initially, the group planned to use the title “Marriage Welfare”, but decided that this might be seen to be associated with social failure. The hope was that the name eventually chosen—the Family Discussion Bureau (FDB)—could be seen to apply equally to preventative and therapeutic work, and to emphasize the joint client-worker nature of the task (Bannister et al., 1955).

In the Tavistock family: psychoanalytic roots

With the establishment of the FDB and the beginning of the new focus on marital relationships, the caseworkers felt that they needed a deeper understanding of emotional forces and the functioning of relationships to enable them to understand the underlying factors in a marriage. Help, too, was needed to develop the degree of awareness of their own and their clients’reactions to each other, so as to enable them to use the therapeutic relationship as a means of help. Psychoanalysis was seen to offer a substantial theory of relationships, and also a therapeutic goal for effective help. The therapeutic goal was seen to be a need to increase the clients’ insight into the unconscious motives that influence the nature of their personal relationships.

Soon after the setting up the FDB, therefore, Isabel Menzies Lyth agreed to explore the possibility of recruiting a psychoanalyst to the group. She approached Dr Michael Balint, who expressed great enthusiasm for the project and became its first psychoanalytic consultant (Menzies Lyth, personal communication 1992). This subsequently developed into a more formal connection with the Tavistock Clinic, and Dr Balint was followed in 1953 by Dr J. D. (Jock) Sutherland and Dr Geoffrey Thompson. Taken together, the psychoanalytic and socio-dynamic orientations of the Tavistock Clinic and of the Tavistock Institute of Human Relations proved to be of enormous value to the FDB, in relation to both staff training and organizational development.

Although the FDB did not formally join the Tavistock Institute of Human Relations until 1956, and then transferred in 1979 to the Tavistock Institute of Medical Psychology (the original body that had set up the Tavistock Clinic in 1920), it has been from its very beginning part of the “Tavistock family” and shared the Tavistock philosophy of applying psychoanalytic principles in its theoretical and clinical approach. In 1968 the FDB changed its name to the Institute of Marital Studies and in 1988 formally appended the name of the Tavistock, to become the Tavistock Institute of Marital Studies. Throughout the history of TIMS, some members of staff, as well as being trained to work with couples, have also undertaken individual psychoanalytic or psychotherapeutic training, at the Institute of Psychoanalysis, the Society of Analytical Psychology, the British Association of Psychotherapists, and the Lincoln Centre and Institute for Psychotherapy. This additional training has never been a requirement nor an expectation, but it has further underpinned the conceptual base of the Institute, which has always been “catholic” in its theoretical and technical development. It has been influenced by Jungian thinking, by the work of the British object relations school (especially Balint, Sutherland, and Winnicott), and by the work of Klein and Bion.

The interrelated functions

When the FDB was established in 1948 it defined its tasks as threefold:

To provide a service for people seeking help with marriage problems; to devise techniques appropriate to such a service, and evolve a method of training caseworkers; and, to find out something about problems of inter-personal relationships as they reveal themselves in marital difficulties.

[Astbury, 1955]

This stemmed directly from the Tavistock focus, which had been, since its establishment, that of understanding and treatment, research, prevention, and teaching to specialists and non-specialists (Dicks, 1970).

The present-day TIMS retains precisely these same aspirations and has the same functions as in its beginnings: psychotherapy with couples, training and consultation, and research and clinical studies. These tasks are, of course, interrelated and each informs the others in a mutually nourishing interaction. The many publications that have emerged from the Institute have recently been critically appraised in an essay-review (Haldane, 1991).

To outline the theory and practice of the TIMS would require a constant interweaving between the three functions: clinical observation may lead to a research project; the research produces new concepts and frames of reference, which may be written up in papers and books; publication of these may lead to training and teaching events; teaching may Inform supervisory and clinical practice, and so on. Within the psychoanalytic tradition there has always been Interconnectedness between theory and clinical practice. As Kurt Lewin asserted, “there is nothing so practical as a good theory” (quoted In Woodhouse, 1990). The historical picture I give, therefore, tends to be more disjointed than the reality of the Interconnectedness between the three functions. The chapters that follow and make up this book then discuss In greater detail some of the clinical thinking and practice of couple psychotherapy at the TIMS.

Theoretical underpinnings

In the first two publications to emerge from the TIMS (Bannister et al., 1955; Pincus, 1960), the two sets of authors outline the psychoanalytic view of human growth and development that shapes the internal world of the child and continues to influence adult relationships.

The dynamic theory of behaviour offered by psychoanalysts seemed especially appropriate for marital problems. In recognizing the importance of unconscious forces in mental life, it gave a basis for understanding and dealing with the Irrational and emotional elements in personality which often prove so intractable in family tangles. (Bannister et al., 1955)

In the course of infancy and childhood, the developing human being builds up an unconscious inner world made up of the images corresponding with the earliest experiences of significant others and how these satisfied or frustrated his needs and wishes. Because the infant’s emotional and intellectual capacity is very limited, he is unable to apprehend the “reality” of those around him and tends to experience emotions in extreme form. “Good” experiences become idealized and raise the phantasy of omnipotence, and “bad” experiences become terrifying and persecutory. This inner world has a compelling reality, and external situations are interpreted in accordance with it. The ways in which the human being relates to his environment and to others in it are characterized by his earliest experiences. In the course of normal growth, the testing out of phantasies against normally favourable reality slowly bridges the gap between the two, and a more realistically ambivalent sense of internal and external relations emerges. However, residues of the more primitive images remain and may be reactivated by certain situations, relationships, or life events. Each new relationship throughout life is experienced against the background of these Internal images, the more “mature” as well as the more primitive.

This concept of personality offers a framework for understanding the unconscious meaning of many of the disharmonies of an individual’s relationships. It also offers a framework within which to understand the way a couple relates to the psychotherapist. Transference attitudes can often be observed and used even without detailed factual knowledge which would enable the (psychotherapist) to ‘account for’ them” (Bannister et al., 1955). The recognition by the psychotherapist of these repeated unconscious patterns of relating is as Important as a precise and detailed knowledge of the facts of the couple’s relationship and of each partner’s life. “The history of the patient’s object relations comes alive in the transference” (Joseph, 1988).

Choice of partner

As well as offering a way of thinking about the nature of couple interaction, and how this will be re-enacted in the transference relationship to the psychotherapist, psychoanalytic theory also suggests ways of understanding partner choice.

Partner choice always Involves conscious and unconscious parts of the personality. The strongest bond between a couple may well be the harmony of their unconscious Images and patterns of relationships. “Sometimes the partner may seem to characterize a repressed or split off part of the other’s personality; often very dissimilar partners seem to find in each other what they have most sternly repressed in themselves” (Bannister et al., 1955).

By mutually receiving one another’s unconscious projections, each partner gives the other an initial feeling of acceptance and attachment. This extemalization of the internal conflict into someone who has to be contended with each day may enable that part of the personality to become gradually more tolerable within the self; however, it may alternatively produce a fierce effort to control or punish it in the partner. Tensions within a couple relationship can therefore be thought of as internal conflicts externalized and acted out in the partnership. In this sense the couple relationship can be thought of as a mutual transference relationship.

Shared phantasies and shared defences

These processes of projection and projective identification (as well as the resulting introjection and introjective identification) are part of normal average human development, and continue to be employed in all relationships. The mutual acceptance of the other’s projections constitutes the unconscious attachment that the couple will have to each other and will consist of shared internal phantasies and shared defences. If too much of the personality is projected or if too little is found to be acceptable and so slowly taken back, these mechanisms can impoverish the personality, which has in effect disowned parts of itself. It will also result in weak boundaries—the sense of self and sense of other is confused by the projective system. If this defensive posture is held too rigidly, the partners’ shared phantasies and illusions and their shared defences will become defining and restricting characteristics of their relationship.

This, then, becomes the focus for the couple psychotherapist’s therapeutic intervention. In this sense the patient for the couple psychotherapist is the couple’s relationship—the interaction between the two partners—rather than either or both of the individuals. The dynamic nature of the interaction is, as it were, between the two partners’ split-off and projected parts of themselves, as located in the other, the force with which these are projected, and how they are recovered and dealt with by the other. At the extreme, each partner is In effect not relating to a separate other but to the disowned self, projected into and identified with in the other. The exploration of shared phantasies in couple psychotherapy may allow the projected attributes to be found less terrifying and eventually felt to be capable of being taken back. The psychological boundaries between the two partners become more clearly established, and so internal and external object relationships are subsequently modified.

* * *

Alongside the development In the 1960s of the theory of couple interaction and its implications for couple psychotherapy, the TIMS was also teaching what it was learning itself to various other practitioners from many disciplines who may in the course of their own professional practice deal with couples and families and who will therefore benefit from an understanding of couple interaction.

Much of this teaching was conducted in groups, which became “training laboratories”: the Institute staff would test out their theories and develop methods of application for those practitioners in other agencies and institutions.

It is no accident that practitioners concerned with marital work, and therefore with manifestations of intrapsychic processes in inter-personal relationships, should find themselves paying attention to the group as a vehicle for containing and working-through the emotional impact of learning and working in this field. They could not be unaware, in themselves as in their clients, of resistance to personal change. … Bion (1961) observed and documented processes by which members of a group can unconsciously co-operate in avoiding the struggle with its real task. The parallel with ways in which couples can unconsciously co-operate to maintain illusions about themselves and each other is striking. [Woodhouse, 1990]

One of the most important developments in the work of the TIMS emerged out of a series of teaching seminars run for social work supervisors in South-West England between 1965 and 1974.

The refaction process

Following Heimann’s seminal paper on countertransference (Heimann, 1950), in which she argued that the psychotherapist’s feelings towards the patient need to be conceptually separated from the psychotherapist’s transference to him, the hypothesis was offered that the psychotherapist’s feelings and attitude to his patient may be understood as more than simply his personal reaction, his transference, to the patient. A growing interest therefore developed in the use the psychotherapist may be able to make of his affective responses. This development challenged the idea of the psychotherapist’s “neutral” stance and obliged a review of Freud’s perhaps confusing suggestion that psychotherapeutic treatment “may be compared with a surgical operation” (Freud, 1916–17). In simple terms, it is hardly possible to be working with a patient without, to some degree, consciously and unconsciously, becoming involved in the relationship and therefore affected by the patient.

Heimann initiated the process whereby psychotherapists began to think more about the nature of their emotional involvement with and response to their patients. Rather than seeing it simply as a personal response that had to be avoided, it began to be recognized as something necessarily being unconsciously stirred up by the patient and therefore needing to be understood. “The issue is not between detachment and involvement, but between objectivity in the presence of involvement” (Dicks, 1967). This theoretical and clinical development was substantially aided by Klein’s discovery of schizoid defence mechanisms, particularly projective identification (Klein, 1946), which was subsequently developed, primarily by Bion (1952, 1955), to be understood not only as a mechanism of defence, but also as an unconscious means of communication from the patient. Countertransference, the feelings and reactions stirred up in the psychotherapist, came to be seen as a major source of information and therefore a psychotherapeutic tool, though it remains a controversial and much discussed issue In psychoanalysis.

The basic understanding is that some of the feelings stirred up in the psychotherapist have been projected into him by the patient, both for defensive, evacuative purposes but also as a means of unconsciously communicating certain aspects of his Internal world. The task for the psychotherapist Is to become consciously aware of what is being stirred up In him, make some sense of it, and offer some understanding to the patient through an interpretation or comment. It also came to be understoo...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• ACKNOWLEDGEMENTS
• CONTENTS
• CONTRIBUTORS
• FOREWORD
• PREFACE
• PART ONE The institutional context
• PART TWO The unconscious contract in the couple relationship
• PART THREE The couple and the individual
• PART FOUR A therapeutic approach to the couple relationship
• REFERENCES
• INDEX