A Relational Psychoanalytic Approach to Couples Psychotherapy

Philip A. Ringstrom

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781136826078
• Edition: 1
• Topic: Psychology
• Subtopic: Psychoanalysis
• Index: Psychology

Winner of the 2014 Goethe Award for Psychoanalytic and Psychodynamic Scholarship!

A Relational Psychoanalytic Approach to Couples Psychotherapy presents an original model of couples treatment integrating ideas from a host of authors in relational psychoanalysis. It also includes other psychoanalytic traditions as well as ideas from other social sciences. This book addresses a vacuum in contemporary psychoanalysis devoid of a comprehensively relational way to think about the practice of psychoanalytically oriented couples treatment.

In this book, Philip Ringstrom sets out a theory of practice that is based on three broad themes:

The actualization of self experience in an intimate relationship

The partners' capacity for mutual recognition versus mutual negation

The relationship having a mind of its own

Based on these three themes, Ringstrom's model of treatment is articulated in six non-linear, non-hierarchical steps that wed theory with practice - each powerfully illustrated with case material. These steps initially address the therapist's attunement to the partners' disparate subjectivities including the critical importance of each one's perspective on the "reality" they co-habit.Their perspectives are fleshed out through the exploration of their developmental histories with focus on factors of gender and culture and more. Out of this arises the examination of how conflictual pasts manifest in dissociated self-states, the illumination of which lends to the enrichment of self-actualization, the facilitation of mutual recognition, and the capacity to more genuinely renegotiate their relationship. The book concludes with a chapter that illustrates one couple treated through all six steps and a chapter on frequently asked questions ("FAQ's") derived from over thirty years of practice, teaching, supervision and presentations during the course of this books development.

A Relational Psychoanalytic Approach to Couples Psychotherapy balances a great range of ways to work with couples, while also providing the means to authentically negotiate their differences in a way which is insightful and invaluable. This book is for practitioners of couples therapy and psychoanalytic practitioners. It is also aimed at undergraduate, graduates, and postgraduate students in the fields of psychiatry, psychology, marriage and family therapy, and social work.

1

THEORETICAL OVERVIEW

Beginning with the last half of the nineteenth century, and concurrent with the massive socio-cultural-economic changes coming out of the Industrial Revolution, a monumental change in the institution of marriage occurred, when it shifted from an arrangement agreed upon by the two families of the prospective bride and groom to a decision made on their own (Mitchell, 2002; Perel, 2007). Historically, the conscious needs of the family social system, often following the traditions of the community of which it was a part, determined the criteria for selection. By contrast, for the first time in human history, a new system introduced the potential for unconscious choice to be a primary factor in mate selection. Of course, for many years, this newer way of selecting a spouse was still likely occupied with conscious agendas, such as those reflecting the needs and interests of the intended’s social networks. But the very allowance of the personally intimate factors of love, passion, and desire as determining criteria opened the door for the unconscious mind to play a powerful role in the ultimate selection of a mate. I believe the ripple effect of this dramatic social change potentially insinuates itself into virtually every marital couple—or otherwise long-term committed relationship—entering conjoint therapy. As such, every system of couples therapy ultimately grapples with the ramifications of this choice.

Over many years of treating couples, providing consultations to other clinicians, and teaching seminars, I have stated that the goal of my approach is to enable two “‘real selves’ to intimately connect under that same roof.” I have added, however, that in so doing the partners will inevitably “stub one another’s toes,” and that central to my thesis is their developing the capacity to repair inevitable ruptures.

The conceptual basis for all of this begins with three themes, representative of qualities that are optimal for the functioning of long-term committed relationships. The three themes pertain to self-actualization in a committed intimate relationship, mutual recognition, and the relationship having a mind of its own.

The actualization of the self in the context of an intimate relationship

The distinguished neurologist Kurt Goldstein (1995) said, “There’s only one drive by which human activity is initiated: the drive for self-actualization” (p. 67). To actualize oneself means to express what is uniquely one’s own: actualization of the expression of agency.

(Modell, 2008, p. 351)

To capture something of what Modell is asserting, I begin with a story about our daughter, Lena, at the age of 5. One afternoon, my wife Marcia and I decided that we wanted to have some time alone, and decided to see if her grandparents would take Lena for a sleepover. We called them early in the afternoon and left our request on their answering machine. As evening approached, however, having not heard from them, we had all but given up hope, when they called and said they would be glad to accommodate our wish.

Elated, we went to Lena and announced with joy that she was going to get to have a sleepover with grandma and grandpa. Our elation stemmed from selfish motives for sure, but it also drew from the anticipation that Lena too would be thrilled, since she loved time with her grandparents. To our dismay, however, Lena burst into tears. Knowing implicitly that we would have normally discussed this matter earlier in the day, and that she might have had some input about it, she retorted to our gleeful solicitations with “You didn’t give me time to know my own mind!”

It was the first time she had uttered this expression, and it certainly was not one (at the tender age of 5) we could have imagined she would have. It was possible that she had overheard our conversations about what it means to have “a mind of one’s own,” as well as to “know one’s ‘mind,’” but it seemed unfathomable that she could grasp this meaning, though at least on some implicit level she surely did. Embedded in her assertion are several critical assumptions. First, in this particular space/time coordinate, she grasped that from the standpoint of her sense of self she was unprepared to react to what had confronted her. Furthermore, she implicitly knew that if her parents had given her the time to consider something related to her, as she would normally expect, she could better know what it is that she wanted to do, that she would be able to know “her own mind.” Hence, her statement implied some recognition that she had the capacity to make her choice vis-à-vis her desires, and that if she did not know what she wanted to do in a particular moment, she could, if allowed, know it soon enough. (Five minutes later, Lena decided that she did want a sleepover at her grandparents, and we, relieved of our guilt, scampered off to our film.)

The fulfillment of self-actualization in a long-term committed relationship to which each partner is drawn arises out of a longing to accomplish something incomplete in their upbringing—that is, to fulfill what has felt deficient, or to repair what has felt fundamentally broken. This involves the hope to become who they have not yet become, though it also entails, albeit unconsciously, the emancipation of a highly self-centered if not a seemingly selfish perspective. ¹ This latter point argues that their hopes for self-fulfillment are uniquely counterbalanced by their dreads that what they desire may very well be withheld or, even worse, that there will be a repetition of the profound disappointments about which their developmental narrative of hurt, pain, and vulnerability are “writ large.” This makes the hunger for actualization fraught with risk. Consequently, to control against being disappointed by the whims of the other, sometimes partners paradoxically act in manners so fraught with the anticipation of their not getting the thing they seek, they engage in an unconscious self-fulfilling prophecy, wherein they reject what might be offered even before it is. Given this vulnerability to self-fulfilling defeat, we might wonder why partners take any risks at all. And yet, it is the press of self-actualization that truly enlivens a marriage by “pushing” each partner to seek for something more. Actualization can therefore be a hotbed for passionate discord, though a powerful motivating force for being together at all.

In employing the term actualization, I am, of course, relating it to Maslow’s (1943) hierarchy of needs, wherein only after a basic foundation of physical needs has been cemented can one’s attention finally turn to the fullest realization of a sense of selfhood. While I believe that some of the work of self-actualization occurs in instances of solitude (Storr, 1988), I am focusing this book on how, in life and in therapy, each partner’s actualization is experienced as being both thwarted and fulfilled in the context of connections with intimate others.

The actualization of self is a theoretically complex notion. Chief among many of these ideas is our possessing a sense of agency, which is definitive in terms of capturing how each of us is unique. So what is agency? Fonagy (2003) notes:

Sometime during their second year, infants develop an understanding of agency that is already mentalistic: They start to understand that they are intentional agents whose actions are caused by prior states of mind, such as desires. At this point, they also understand that their actions can bring about change in minds as well as bodies: For example, they clearly understand that if they point at something, they can make another person change their focus of attention … this point marks when the two-year-old child comes to be able to distinguish his own desires from those of the other person.

(p. 421)

What Fonagy is positing is what Damasio (1994, 1999) and Bucci (2002) refer to as “core-consciousness.” That is, the state of consciousness that lends to experiences of having a core self and out of which “extended consciousness” develops, lending to one’s sense of an “autobiographical self.” All of this consolidates into our having a sense of identity, personhood, and personal narrative. And all of these elements operate on multiple levels of complexity, involving comparisons of the past with fantasies about the future, which become instrumental to our understanding of each marital partner’s wishes, longings, expectations, and of course disappointments.

Thus, agency suggests that, despite our biological determinism, we remain agents of “free will.” We can choose, and in so doing, at least in some manner define what it means to be ourselves. Still, fluidity of development over our lifetime dictates that many of those choices will likely change over time. Understanding this requires our capacity for self-reflection, which is a topic taken up in greater detail later, referring to the ability to “meta-cognize” and not simply react to our experience.

Meanwhile, though the description of these processes may seem terribly conscious, in fact much of what undergirds our sense of agency is unconscious. Thus, our intentions, our sense of purpose, derive from our unconscious self (i.e., extended and autobiographical memory). This complex memory system involves first declarative memory, which is typically accessed through verbal symbolization. A second memory system involves our implicit (nonverbal) and procedural memory (the “autopilot” of our personality organization). This system involves our more automatic ways of doing things, such as driving and riding a bike, as well as the routine, almost automatic ways in which we react to different relational contexts. Agency, however, also pertains to our capacity to reflect upon our experience, and in particular the meaning that such reflection conveys to us, as well as the choices such reflection avails to us. Still, we thrive upon and are enlivened by being spontaneous, while we also make agentic choices as outgrowths of being reflective. These principles relate to one another in an endless Möbius loop, wherein being spontaneous in very vitalizing ways folds seamlessly into processes of reflection that then add material for more spontaneous existence.

The Möbius loop model helps us understand one of the most profound evolutions in conceptualizing agency, arising from the neurosciences, which provocatively argues that agency is an illusion, albeit a necessary one. Modell (2008) writes:

We can accept the idea that the feeling of agency is a construction of our brain and in this sense is illusory, if we consider that all our mental constructions are in a certain sense illusory. If illusion is defined as a false appearance, a belief that does not have its correspondence in the physical world, the current view in neuroscience is that everything the brain constructs is an illusion. Selves do not exist in the physical world; our perception of the self is a construction of our brain. We essentially imagine ourselves. But we should not depreciate or disparage belief in illusions as false conceptions; if the self is an illusion and the feeling of agency is an illusion, these are illusions without which we cannot live.

(p. 362)

Despite agency being an illusion, it is one upon which we rely in determining our intentions and the intentions of others, for that matter. In this vein, neuroscientists also inform us that unconscious intentionality de facto precedes conscious intentionality.²

Now, if what I am positing so far seems too dry and too theoretical, consider that every disagreement, every argument, every discordant moment in the life of a couple is taking up dueling versions of reality. This can lead to mini-wars, the stakes of which are no less than the preservation of each party’s sense of sanity—that is, their sense of what constitutes their version of mind, and how that version makes sense of what they interpret constitutes reality. It is this that makes the principles of “perspectival realism” (discussed in Step Two) the lynchpin of this model of treatment, for it is perspectival realism that argues that everyone has their own unique, subjective perspective on reality, or what I refer to as “great-big-altogether-everything-else-both-beyond-and-including-me.” This is what we commonly refer to as “reality.”

The thing about our “illusions,” however, is that we can get stuck in them—that is, constrained in our capacity to choose and act, or to be relatively free of them (Weisel-Barth, 2009). Thus, our personal sense of agency functions in a most gratifying way when we feel less constrained in how we determine and pursue personal goals in work, love, and play. By contrast, it founders to the extent that our sense of agency functions more for defensive purposes, and in fact serves to “pervert” (Gentile, 2001) our pursuit of work, love, and play. This perversion of agency pertains to the degrees of freedom in our capacity to imagine and to make living choices.³

From all of this, we begin to see that agency, however individualistic it may seem philosophically, is psychologically a very relationally oriented phenomenon. Greenberg (1991) and elsewhere Aron (1996) argue that often our sense of agency is measured by our sense of being able to effect things in life (effectance). However, that feeling hinges upon the degree to which we feel safe doing so. Both authors argue that the crucible of agency is found in our conflicting needs as human beings to be effective—that is, to be impactful while also feeling safe and secure in our attempts to be agentic.⁴

In all these ways, agency is clearly not an isolated mind phenomenon, but one that can only be understood in terms of the reciprocal impact that one experiences in the relational field of others, of which one is a part (Stern, 2004). As Benjamin (1995) notes, agency requires, “the other’s confirming response, which tells us that we have created meaning, had an impact, have revealed an intention” (p. 33). Thus, while agency appears to arise intrasubjectively (from within), Benjamin (1999) asserts that it requires another’s confirming response regarding our meaning, the impact it has, and what it reveals about what we intended. This then places agency within the intersubjective field of mutual need, mutual responsibility, and mutual recognition.

The intersubjective field in which each partner’s sense of agency arises is therefore an additional factor in establishing the horizons of each partner’s self-actualization (Stern, 1997). It means that how one lives out one’s sense of agency in terms of self-actualization must be perpetually renegotiated in intimate relationships (Pizer, 1998). These points will be elaborated more in the second theme of this book, regarding mutual recognition of both partners’ subjectivity.

The mutual recognition of each partner’s subjectivity

This theme hinges to a large extent on Jessica Benjamin’s ideas about mutual recognition, which is a foundational concept to her theory of intersubjectivity. Benjamin presents a scholastically creative treatise involving, among important others, Hegel’s philosophy (1807), Winnicott’s developmental theory, and Beebe and Lachmann’s infancy research. Concurring with Daniel Stern (1985), Benjamin sees intersubjectivity as a developmental achievement,⁵ the first evidence of which arises around 8–9 months of life.

Intersubjectivity is a condition of our human nature. It is an innate, primary motivational system (Stern, 2004). The desire for intersubjectivity is one of the major motivations that drives psychotherapy forward. Patients want to be known and to share what it feels like to be them. Evolutionarily, this intersubjective tendency also strongly favors species survival. As Slavin and Kriegman (1992, 1998a, 1998b, 1998c) note: “Intersubjectivity makes three main contributions to assuring survival: 1) it promotes group formation, 2) it enhances group functioning, and 3) it assures group cohesion by giving rise to morality. The same impulse that contributes to species survival can also make psychic intimacy among friends possible” (p. 98).

Broadly speaking, the intersubjective motivational system concerns regulating psychological belonging versus psychological aloneness. The poles of the spectrum are, at one end, cosmic loneliness, and at the other, mental transparency, fusion, and the disappearance of the self. The intersubjective motivational system regulates our comfort, thriving somewhere between these two poles. The exact point of comfort depends on one’s role in any group with whom one has a personal history. The point on the continuum must be negotiated continually. Too much is at stake for it not to be.

Returning to Benjamin (1999), what is critical is that her ideas represent a bold departure from mainstream psychoanalytic theories such as ego psychology, object relations, self psychology, and Kleinian theory, insofar as Benjamin argues that an emerging sense of selfhood (i.e., subject) occurs not simply in relation to the regulatory supplies and provisions of the other (i.e., object), but also in discovering the subject in the other —that is, in discovering how the other is different from oneself. In fact, to my way of thinking, Benjamin’s (1992) argument represents a true evolutionary step in psychoanalytic theorizing. She boldly reshapes Freud’s dictum of “where id is, ego shall be,” as well as the object relationists’ dictum of “where ego is, objects must be,” to her own dictum, “where objects were, subjects must be.” Clearly, this last dictum is imperative to childhood development, but, to t...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Preface
• Acknowledgments
• Introduction
• 1 Theoretical overview
• 2 Step One
• 3 Step Two
• 4 Step Three
• 5 Step Four
• 6 Step Five
• 7 Step Six
• 8 Michael and Carmen: an illustration of the Six Steps
• 9 Frequently asked questions
• Appendix A: A brief summary of four models of family systems theory and their implications
• Appendix B: Practice questions
• References
• Index