What Is This Thing Called Love?: A Guide to Psychoanalytic Psychotherapy with Couples PDF
Preview What Is This Thing Called Love?: A Guide to Psychoanalytic Psychotherapy with Couples
What This Thing Called Love? IS What is This Thing Called Love? provides a clear how-to guide on the art of psychotherapy with couples from a psychoanalytic perspective. The book draws on both early and contemporary psychoanalytic knowledge, explaining how each theory described is useful in formu lating couple dynamics and in working with them. The result is an extremely practical approach, with detailed step-by-step instructions on technique, illuminated throughout by vivid case studies. The book focuses on several key areas including: • An initial discussion about theories of love. • Progression of therapy from beginning to termination. • Transference and countertransference and their unique manifesta tions in couples therapy. • Comparisons between couples therapy and individual therapy. • Step-by-step instruction on technique. What is This Thing Called Love? is enlivened with humour and human ness. It is crucial reading for psychoanalytic therapists, psychologists, psychiatrists, couples therapists and students who want to learn about - or augment their skills in - this challenging modality. Sarah Fels Usher is a psychoanalyst in private practice in Toronto. She is the President of the Toronto Psychoanalytic Society, founding Director of the Fundamentals Psychoanalytic Psychotherapy Program, and a faculty member of the Toronto Institute of Psychoanalysis. Her first book, Introduction to Psychoanalytic Psychotherapy Technique, is a psychotherapy guide for students and beginning therapists. Dr Usher is also Book Editor of the Canadian Journal of Psychoanalysis. This book is an important contribution that will help these clinicians develop the skills necessary to work with troubled marriages. Numerous clinical case presentations bring this work to life, clearly illustrating each phase of treatment. Lewis Aron, Ph.D., Director, New York University Postdoctoral Program in Psychotherapy & Psychoanalysis The book is filled with rich clinical material and written with great lucidity. Sarah Usher offers to the reader her clinical wisdom distilled after many years of experience, and what is offered is considerable and valuable. The important insights contained in this book will benefit all therapists, including those working with individual patients as well as couples. Morris Eagle, Professor Emeritus, Derner Institute of Advanced Psychological Studies, Adelphi University What is This Thing Called Love? A Guide to Psychoanalytic Psychotherapy with Couples Sarah Fels Usher First published 2008 by Routledge 27 Church Road, Hove, East Sussex BN3 2FA Simultaneously published in the USA and Canada by Routledge 270 Madison Avenue, New York, NY 10016 Routledge is an imprint of the Taylor & Francis Group, an Informa business Copyright © 2008 Sarah Fels Usher Typeset in Times by Garfield Morgan, Swansea, West Glamorgan Printed and bound in Great Britain by TJ International Ltd, Padstow, Cornwall Cover design by Sandra Heath Cover illustration by Graphic Design, Southsea, Hants All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. This publication has been produced with paper manufactured to strict environmental standards and with pulp derived from sustainable forests. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data Usher, Sarah Fels. What is this thing called love? : a guide to psychoanalytic psychotherapy with couples / Sarah Fels Usher. p. ; cm. Includes bibliographical references. ISBN 978-0-415-43383-9 (hbk) - ISBN 978-0-415-43384-6 (pbk.) 1. Marital psychotherapy. 2. Psychoanalysis. I. Title. [DNLM: 1. Marital Therapy-methods. 2. Couples Therapy-methods. 3. Psychoanalytic Therapy-methods. WM 430.5.M3 U85w 2007] RC488.5.U82 2007 616.89'1562-dc22 2007024975 ISBN: 978-0-415-43383-9 (hbk) ISBN: 978-0-415-43384-6 (pbk) FOR GARY This page intentionally left blank Contents Preface Vlll Acknowledgements XIV 1 The psychoanalytic perspective 1 2 Getting started: the first three sessions 29 3 Interlude: on love 49 4 The ongoing therapy: technique 72 5 Transference(s) 101 6 Countertransference 116 7 Denouement: working through and termination 135 Bibliography 152 Index 158 Preface Many psychotherapists and psychoanalysts are aware that a large proportion of their patients spend a significant amount of their time in treatment talking about their experience of intimate relationships. It seems natural, then, that therapists may develop an interest in treating those relationships, in vivo as it were, but alas, they may have had no training to do so. It is my hope that this book will provide a guide to experienced, psychoanalytically-oriented individual therapists who want to treat couples, and, as well, will function as a source of super vision for them. I hope those therapists already working in this arena will find the book provides some calm in what can be turbulent waters, as they connect with the stories, feelings, and ideas shared here. It is somewhat surprising that psychiatry, psychology, and psychoanalysis have not given much attention to treating people in their committed relationships, considering that so much therapy time is spent in analysing the therapeutic dyad. Psychoanalytic theory has evolved significantly over the past half-century: classical Freudian "one-person" theory explored the intrapsychic life of individuals, their drives and defences - drive reduction was the prime motivator; object relations theory focused on our current modes of relating to others, which stem from internal representations of our early attach ments - relatedness is the prime motivator; more recently, relational theory moves the emphasis completely to issues of relationship, viewing all psychoanalytic concepts through this lens. (These theories, and others, will be elaborated in the first Preface ix chapter.) I have omitted several important intervening and contemporary theories here for the sake of making a point: that is, that we are highlighting more and more, in both our theory and practice, the significance of self in relation to other. That psychoanalytic theory could be applied to work with couples seems almost self-evident; in fact, a psychodynamic theory of behaviour is especially appropriate for relationship problems. What a simmering stew of unconscious ingredients there is here, bubbling up at times to the surprise of most, if not all, of the participants in this triadic therapeutic inter action. Our early and later concepts apply in spades: trans ferences, which occur in relation to the therapist, and for the couple, in relation to each other, and countertransference, which can become intense and highly complex. Our old friends, the concepts of resistance and defence, make an interesting appearance here in relation to the therapy as a whole, as well as to the way in which the couple interact with each other. Even thinking of the myriad opportunities for projective identification can be overwhelming. As a bonus, because people often consciously and unconsciously see part nership as a means of healing psychic wounds, working with a couple together may provide an opportunity to treat individual symptoms and their aetiology as well as treating the relationship dysharmony. The recognition by the couples psychotherapist of the repetition of unconscious patterns of relating, described in analytic theory, is as important as a detailed knowledge of the facts of the couple's relationship and of each partner's life (Ruszczynski, 1993). Thus, even though at first glance psychoanalysis and marital therapy seem to focus on the observation of different data - psycho analysis on the intrapsychic, and marital therapy on the interactional - the data observed by both methods overlap considerably (Finkelstein, 1988). When we see couples in psychotherapy, we find that each partner in the relationship brings a set of conscious and unconscious expectations, and each may feel that in exchange for what they give to the other, they will receive what they want. Sager (1994) refers to these as contracts, and states that
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