Couples Therapy: An Investigation of Theoretical Underpinnings

couples therapyA talk presented as part of ICP+P’s couples therapy training program’s experiential conference on February 27, 2016.

By Barbara Shapard

Edited by Mary O’Farrell and Jen Sermoneta

DESCRIPTION AND SUMMARY OF THE COUPLE’S HISTORY

On February 27, 2016, the Couples Therapy Training Program of ICP+P presented an experiential conference on working with couples embroiled in the aftermath of an affair. First, the audience watched two prepared but unscripted vignettes representing segments from an ongoing couples treatment. The therapist demonstrated containing intense affect, addressing underlying dynamics in the couple, and resolving an impasse.

Following the vignettes Barbara Shapard used the case to illustrate her discussion of how the therapist used self psychology, object relations, and relational theory both to conceptualize the trauma to the couple and to make strategic interventions. In the paper that follows this recap, Shapard explores examples of work aimed at stabilizing the couple, developing therapeutic alliances with both partners, and reestablishing the couple’s hope.

To help readers understand the theoretical paper, we offer a brief summary of the couple’s history and current situation, by clicking here.

PRESENTATION

Couples therapy is most difficult because the therapist is dealing with two people who have primary intense attachments to loving, but also to hating, each other. So their two simultaneous powerful perspectives and voices, like in a good opera, sing on top of each other in harmony and discord with each other. The therapist must also simultaneously resonate with, contain, profoundly understand, and intervene upon the process. It is a difficult task that many therapists are especially challenged by.

Livingston (1995) proposes that the goal of couples therapy is to negotiate the tension between two disparate self experiences. This couple is in a polarized power struggle as to who gets to be contained and who ends up being the container. Benjamin (1998) explores the dialectical tension between the spouses as to who has a voice, is recognized, is cared for and resonated with, be it perfectionist Amy or aversive Joe (both in the case example). Or who is to be parent, protector and container, and whose self is somewhat subjugated to serve the other? Additionally, Benjamin (1998) suggests a positive goal of a couple is to constantly negotiate dominance and submissive tendencies toward mutual recognition. Kohut speaks to the goal of couples therapy, describing a “good marriage as one in which one partner or the other rises to the challenge of providing the selfobject function that the other’s temporarily impaired sense of self needs at a particular moment.” (1984, p. 22)

HISTORY OF COUPLE

Joe and Amy come to therapy despairing and hopeless. In crisis, they cannot imagine re-creating the erotic, romantic love they had originally found in each other. That love in the beginning was blissfully self-regulating, providing a trusting attachment, and a soothing stability that motivated them to experience expansive excitement, sexuality and curiosity (Lichtenberg, 1999). Amy sought out Joe as a stable, consistent, quiet man she could count on, and Joe sought out Amy as a woman who would love, organize, and value him. Bacal (1990) talks about Object Relations theorist Fairbairn who postulated an interesting projective dynamic: the spouses search for the libidinal good and safe exciting object, but in time the couple regresses to treating themselves and each other as the bad, antilibidinal, unsafe object that they experienced with their parents.

Using Wallin’s (2007) description of attachment models, Amy sought out stability from Joe to regulate her ambivalent, preoccupied attachment to a labile, suicidal, alcoholic mother, two needy sisters and an unavailable father. Joe sought out Amy, who would be warm and caring to neutralize his avoidant, dismissive attachment to a critical, cold mother and passive father. In time, the return of the repressed finds Amy’s disappointment in discovering that Joe could not always be counted on and so, to protect herself, Amy withdrew from Joe with a complaining and shaming posture. Amy re-instituted her developmentally familiar accommodating strategy by over-functioning to stabilize her family. Amy’s stance expresses the containing tendency of many women who work outside the home in addition to taking care of children and domestic responsibilities. Within that pervasive containing role, Amy and other women compromise their assertive and curiosity motivations. Benjamin (1998) would suggest that women’s containing tendency needs to be integrated with their assertion motivations and with men’s ability to contain in order for relational mutual negotiation to take place within a couple. Joe’s reaction to Amy’s criticism and hyper-efficiency was to protect himself with a frozen, passive aversion as he had with his mother. Thus, dynamically, the couple recreated the relationship with the original parental object: Joe became Amy’s inadequate disorganized mother and Amy became Joe’s critical mother. The original ideal romantic love they had blissfully created was lost to each other, leaving Joe to experience the tip of his shame of inadequacy and Amy to experience the tip of her indigestible trauma and vulnerability.

DYNAMICS OF AFFAIRS

It is most difficult working with couples dealing with affairs because of the overwhelmingly intense trauma to the couple experiencing feelings of betrayal, abandonment, guilt and shame. An affair produces a polarized threatening emotional impasse, which does not allow space for the couple to build up a safe trusting relationship with the therapist or the therapeutic work.

What do affairs represent in the life of a couple? Brown (1999) discusses several underlying dynamics of affairs. Some affairs are initiated to avoid conflict and anger, or out of fear that needs cannot be negotiated. Some affairs are due to longstanding desire to leave the marriage and to avoid longing and intimacy. Affairs may also be initiated to avoid feelings of loss and fears of death (often brought on by the death of a parent, child or sibling). In any of these situations, affairs may be an expression of early developmental vulnerabilities due to trauma.

Perel (2006), in Mating in Captivity, would say that Joe and Amy are so enmeshed in their developmental attachment that there is no air for sharing what is interesting in themselves and life, and no air for the exciting erotic play motive to take hold. Lichtenberg (1999) would agree that this couple is favoring affiliation and attachment over curiosity and intellectual motivational systems. For Joe it has become too risky to know he sexually needs Amy because his erotic longing gets swallowed by his fear of Amy being like his mother, controlling him and flaunting his failures. He feels unable to live up to her standards. Feeling whipped and shamed, Joe seeks out another erotic source to meet his sexual intimate longings.

Mitchell, in Can Love Last?, suggests that it is cheap to trust falling in love with a stranger as there is no deep risk yet. Involvement with the object of the affair is much less frightening than completely investing one’s sexuality, vulnerability and excitement in one person. He adds (2002, p. 207), “It is not that romance necessarily fades over time, but it becomes riskier.” For Joe, the affair is an expression of his desire to be loved wholly, neutralizing his unconscious shame and failures. He feels too afraid of Amy to know that he desires most to be loved wholly by her.

In turn, for a long time it has been too dangerous for Amy to know that she needs Joe’s care to soothe her anxiety. Rarely can Amy let herself know or risk erotic motivation and longings toward Joe when she feels his abandoning aversion and his “irresponsibility.” Joe has been turned into her irresponsible mother and she repeatedly now experiences early abandonment trauma. How can the therapist neutralize the couple’s strong aversion, betrayal, anger and hurt on both of their parts? How do Joe and Amy affect the therapist?

EXPLORING THE COUNTERTRANSFERENCE AND THE DYNAMICS OF TRANSFERENCE

Solomon (1997, p. 23) stated,

Even more than individual treatment, marital therapy is influenced by countertransference reactions…. No matter how hard a therapist tries to preclude it, the transference process with couples invariably engenders countertransference reactions, love or hate or some mixture of intense feelings.

Amy’s intense, anxious staccato anger, and readiness to pounce and attack, might impact the therapist, who could be feeling helpless, de-skilled and frozen. Unable to think, Catherine may temporarily withdraw from Amy’s anger in a way similar to Joe’s withdrawal. Amy’s ongoing expression of anger and latent suffering makes it difficult for Catherine to tolerate not being the ideal good containing mother. However, in her reverie, Catherine keeps in mind that Amy is anxiously vigilant that the therapist not betray her or parentify her as Joe and her mother and father have. Catherine also continually empathizes with Amy’s attempt to survive the onslaught of the trauma of Joe’s affair, which gets fused with her early trauma of living with her mother and family of origin. Catherine is aware that Amy will try to push Catherine to side with her in viewing Joe as abhorrent. Catherine negotiates a tricky balance with Amy: attuning to Amy’s suffering while still being interested in Joe’s experience. This therapeutic stance helps Amy tolerate Catherine’s interest in Joe’s perspective.

Catherine experiences difficulty relating to Joe’s striking aversion, staring off into distance, and tuning out. Catherine might feel frustrated, inadequate and awkward regarding Joe’s disdain — similar to Amy’s experience of Joe. Yet, in Catherine’s reverie, she also can see Joe’s anxiety and, according to Tatkin (2009), understand the necessity of Joe’s efforts at self-preservation and neurological self-regulation as tactics he employs to hold off his internal mother, Amy, and possibly even the therapist from shaming him. Joe assumes any thought or question the therapist poses is a trap to cast him in the worst light. He is well aware that he has betrayed his wife and family and has been an inept husband. Besides Joe’s own guilt and shame, Amy never fails to remind him of his betrayal. Joe’s apparent disinterest can be understood as his frozen, hyper-aroused, physiological fight and flight tension, where he is not thinking but just trying to survive.

Lichtenberg (2015) describes this traumatized focus as just “seeking escape and relief.” The only hope Joe has is that the condemnation will last only one hour. Catherine slowly earns Joe’s trust by positive attunement to, affirmation of, and curiosity about what he feels. Her attunement encourages enough safety for Joe to think and speak up. Many times Catherine will feel swooped-up by the intensity of Amy’s and Joe’s negative transference to each other and Catherine may lose her thinking and her voice. As she struggles for continued reflective understanding, Catherine will slowly be able to intervene on the chaotic experience.

DYNAMICS OF TRAUMA AND SAFE HARBOR

Lichtenberg (2015) distinguishes between trauma and trauma stress as the repetitive experience of parental empathic failures. Joe learned to emotionally shut down in response to his mother’s cold and critical demeanor. Amy’s trauma states are more severe and chronic as a result of her ambivalent and distracted attachment to her disturbing mother, which evoked in Amy a rigid constricted adaptation of relating to others as the containing mother. Amy now is faced with the recent acute trauma regarding the affair that evokes the experience of the original trauma. Several authors (Herman, 1992; Lichtenberg, 2015; McCormack, 2000; Ogden, 2015; Shaddock, 2000; and Solomon & Tatkin, 2011) concur that clients experience a neurological freezing, an inability to think, due to overwhelming and intrusive anxiety and dread that makes self experience feel shattered and fragmented. Amy expresses her acute trauma by dissociated, hyper-aroused states and externalization that is often in the form of anger. Herman (1992) and McCormack (2000) suggest the anger is her attempt to ward off, and at the same time express, her destabilizing self experience. Her anger helps her survive such chaotic internal feelings.

Mitchell (2000) and Bromberg (2006) say that new growth of longing and desire is embedded in old neurotic hope. Amy’s powerful neurotic wish is that Joe could stabilize her and if she just shakes him up enough he will then accurately contain her. Amy also harbors the wish that Catherine would shore Joe up so that he would then stabilize her. Kertesz (2004), in his novel Liquidation, explores what therapists know: that by attending to the person’s trauma and naming the loss, the trauma can be transformed into a new digestible experience.

The therapist acting as Winnicott’s (1967) good enough containing mother implicitly alters the threshold for the experience of safety and trust in the couple. Feld (2004), Lichtenberg (1989), Livingston (2002), and Shaddock (2000) built upon Kohut’s (1984) premise that the therapist’s major emphasis is on empathic immersion in the client’s subjective experience. The therapist takes an affirming protective position, serving as the provisional maternal figure to meet the clients’ developmental needs for affirmation and validation of their perspective. Catherine’s willingness to be a mirroring witness to the spouses’ trauma is the beginning phase of the spouses’ finding ways to feel and understand their trauma. Catherine holds a continuous containing space to experience Amy’s sense of shattered self, ruptured life, abandonment and radical loss of trust. Catherine simultaneously holds a continuous space to contain Joe’s anxiety-ridden confused state and fear of losing Amy and his children. Authors such as Fosha, Siegel & Solomon (2009), Johnson (2004), Ringstrom (2014), Scharff & Scharff (1991), and Solomon & Tatkin (2011), explain the therapist’s role in stabilizing the spouses when working with emotionally reactive couples. Bringing their ideas together, the therapist…

  • Recognizes the feelings of emotional distress,
  • Attunes to the emotional experience,
  • Promotes safety (by interrupting escalation),
  • Defines the emotional experience with words,
  • Reframes or restructures the entrenched distorted perspective to a less paranoid, more realistic perspective,
  • Identifies the trigger,
  • Locates the memory, and
  • Distinguishes the past from the present (reframing experience).

For instance, in the first vignette, Catherine works with Amy on recognizing that she was “blindsided by the affair”, and then labels the affair as trauma. Resonating with Amy’s distress, Catherine uses feeling words to describe Amy’s experience, further validate her emotional experience, and stretch her understanding. Later, Catherine respectfully asks Amy’s permission to talk to Joe, demonstrating her attunement to Amy’s feeling threatened by Joe’s perspective. Upon Amy’s angry interruptions, Catherine says, “I know it is difficult to hear Joe. I need to hear his perspective.” Here, Catherine is interrupting Amy’s escalation by resonating with Amy and stretching her to tolerate listening to and considering the validity of Joe’s experience. Catherine’s curiosity about Amy feeling “alone and burdened” helps Amy locate the model scene, from age 6, of trying to protect her younger sisters from her alcoholic, suicidal and depressed mother. Catherine’s empathic response, “you were alone and responsible”, joins Amy’s emotional experience and promotes affect and words for Amy to consciously record a representation of her child self.

In the first vignette, Catherine also internally joins and resonates with Joe’s dissociation, confusion and pain. Brown’s (2005) formulation of “the split world” explains Joe’s experience of a disconnection between his realities — homelife with his wife and children clashing with the other reality — an erotic woman who values him. Joe keeps the two realities going side by side through compartmentalization and dissociation, and the consequence for him is self-alienation.

Catherine asks if he is in the room and where he is. Here, Catherine is providing attunement and recognizing Joe’s emotional distress while asking him to join her. Catherine shows empathic interest in Joe’s experience of the affair, by using the word “special” to underline that someone showing interest in him was important. Putting words to affect, Catherine hopes Joe might be able to think and talk out from under his feelings of failure and shame.

Catherine’s exploration of Joe’s history allows him to first share a memory of being a rebellious adolescent wanting “to get drunk to piss off [his] mother.” Joe feels Catherine’s attention and then risks showing his hurt and vulnerability regarding another childhood memory. Joe had proudly displayed his artwork portfolio on the mantelpiece for his mother’s admiration, but instead she was furious about the “inappropriate location.” Catherine offers him an empathic space and assures him that his thinking and feelings are important and valid.

COUPLES THERAPIST ASSESSING AND INTERVENING ON THEIR STYLE OF RELATING

In the previous example, Catherine interrupts the escalation as well as sets limits on Amy to hear Joe. The therapist’s action is the beginning of restructuring the couple to a more mutual relating by teaching Amy to tolerate and self-regulate her feelings while listening to Joe. Amy’s ambivalent, preoccupied attachment and Joe’s dismissive, aversive organization produces an entrenched self-defeating pattern of communicating and relating. Amy desperately and angrily approaches and grabs at Joe to be understood and contained. Unfortunately, she repeatedly experiences Joe’s withdrawal. Then Amy steps it up from complaints to attacks, and Joe freezes. Overwhelmed and helpless, Joe is disappointing Amy, just as he disappointed his mother, and he then avoids Amy. Amy withdraws to a depressed and “containing-others position” and Joe settles into his chronic withdrawn state. Now both live in parallel universes in a dissociated, lonely, depressed state.

Catherine starts to intervene on this relating style by quieting Amy in the session, “let me hear from him, I know this is hard.” Joe feels emboldened to think and talk more. Amy must tolerate and contain her anxiety. In future sessions, Catherine will share the self-defeating patterns of their relating, lending some awareness and understanding to their destructive relational creation.

DEVELOPMENTAL STAGE OF THE COUPLE

Coleman (1993) and Sharpe (1992) state that the therapist is up against the repetitive couple’s airtight (or, in Sharpe’s terms, oppositional) unit, which has been effectively keeping at bay their original longing for and fear of intimacy. Shaddock (2002) describes couples like Amy and Joe as a closed system, reflecting an arrested developmental stage short of separation and individuation. The couple has not differentiated themselves and their experience from their parents or each other. Ringstrom (2014) talks about how couples use aversive and denigrating postures, such as Joe’s avoidance and Amy’s attack, to express punishing disappointment in the other’s failure to join in a twinship experience. The loss of the fused romantic ideal feels like life’s biggest betrayal. Ringstrom (2014) adds that the therapist is up against the couple’s collusion that the couple can heal each other by continued enmeshment. In the couples therapy, Catherine, the therapist, temporarily becomes the stand-in for the wished-for idealizing parents and idealized spouse.

Thus, hopefully, Amy and Joe can do the tough internal work of letting go of their enmeshed transference to their parents and each other. Only then will Amy and Joe be able to deal with the threatening reality that they have different vulnerabilities, motivational needs, and agendas from their parents and from each other. The couple will join in seeking comfort from each other in their awareness of their disappointment in, and loss of, the original parents, and loss of their idealized fused relationship.

THE THERAPIST EDUCATES THE COUPLE TO DEVELOP CONTAINMENT

Catherine models curiosity, interest, and empathy that the couple will (hopefully) unconsciously internalize and use in their relationship. At the closing of the first vignette, Catherine says, “Not to minimize the trauma of the affair, but the histories are important also and helpful to my understanding.” Communicating to them that it is good to relate spouses’ histories to their present life and marriage, Catherine begins a process of understanding the present as influenced by the past family of origin experience. At the close of the second vignette, Catherine summarizes Joe’s longing to please Amy and Amy’s fear of trusting and needing. Catherine emphasizes the importance of owning their feelings and their internal dynamics and couple dynamics.

Catherine also educates the couple that “therapy is a slow process and painful feelings will arise, but we will keep working and talking.” This reassures Amy and Joe that there is hope even with the ongoing fears and tensions they are experiencing over the course of the work. Catherine clearly tells Joe that Amy will persistently bring up her upset about the affair and the couple will need to attend to and process the trauma. Catherine suggests an exercise of awareness around listening, as a way to slow down the escalating conflict. In the future, the couple might be able to utilize this strategy to better regulate their rupture and repair process.

TRACKING AND INTERVENING ON THE OSCILLATION OF AFFECT

It is an important but difficult task for the therapist to track and intervene on the oscillation of tension between the spouses, between different affect states within the individual spouses, and between progression and regression of the couple. Both Joe and Amy oscillate between fear and threatened states, expressed by Joe’s avoidance and Amy’s rage. The therapist verbally resonates with, and then works to interrupt, their hyper-aroused conflictual states. Initially Amy and Joe frequently provoke this regressive dynamic that Catherine attempts to contain. Livingston (2002, p.428) comments,

The therapist, after painstakingly thoughtful and empathic responses, finally succeeds in engaging the needs of the husband, or patiently provides the safety the wife needs in order to drop her contempt for one vulnerable moment and to express the shame and hurt underneath it. Inevitably, at just that moment, the partner’s terror of a crack in his or her self-esteem regulation system triggers an outburst.

In the first vignette, Catherine’s resonating with Joe’s feeling “special” with the other woman threatens Amy. Feeling betrayed, Amy demands that her hurt is witnessed immediately. She blurts out “I am busy working and taking care of everything while you feel special and I carry all the burden.” Catherine quickly attends to and stabilizes Amy with affirming her experience “of course you are angry… it is hard to hear his perspective.” Then Catherine asks about Amy feeling “alone and burdened” and Amy shares a memory of being age 6 and protecting her younger sisters from her mother’s drunken meanness. Feeling heard and resonated with, Amy is able to self regulate.

Ringstrom (2014), in A Relational Psychoanalytic Approach to Couples Therapy, cautions therapists, and Bromberg (1998), Mitchell (1993) and Stern (1997) would agree, to be aware that successful insight can threaten the spouses’ sense of perspective and identity, evoking a vulnerability that will recycle back into projecting danger into each other. Amy repetitively recycles back to Stalfa and Hasting’s (2005) term “accusatory suffering” and focuses on the affair when she is threatened by Joe’s different perspective as well as when she feels abandoned, inadequate or uncomfortable with the idea of being vulnerable with Joe.

In the second vignette, 6 months into couples therapy, Catherine intervenes on their recycling back to their threatened and attacking positions by legitimizing both of their emotional experiences. Catherine’s interventions help the couple to feel safe enough to consider their own reverie and self experience and speak from that position. The session begins with the couple repeating their regressive theme fight. However, Joe speaks to the positive transference they both have toward Catherine, saying, “We need to move in with you.” This moment speaks to the middle phase of the couples therapy work, where the couple has developed an ability to trust resolving their impasse within reach of the good mother therapist. However, the couple is not able to find the ego strength to intervene on their conflicts by themselves. So Amy is angry at Joe’s “lack of responsibility”; he did not pack their daughter’s homework in her backpack, but instead focused on fixing the garage. Joe feels angry and responds that he cannot get Amy to listen that he just didn’t have the time.

Catherine decides to break the regressive escalating hyper-aroused conflict by suggesting a listening exercise, which serves to point out how difficult it is for Amy to intervene on her hyper-aroused state and listen to Joe. Amy, flaunting her usual argument, sarcastically says, “Oh, my list to you is not detailed enough: get the children ready for school!” and the, “Fine, I will do everything myself.” However, Amy’s failing to listen in the exercise emboldens Joe to find his voice. With intense anger, he protests “F…ing listen to the psychologist for once!” Joe is not able to risk shouting “F…ing listen to me.” Bromberg (2006) and Mitchell (1993) would suggest that Joe’s anger may be his only way of asserting himself at this point, and yet this protest can transform his usual passivity into the leading edge of proactively asserting himself toward her. Shocked, Amy says, “I do not know what to say to that.” She then remembers the flyer from the hotel where Joe and the other woman had stayed overnight. Perhaps Amy is almost recycling back to accusatory suffering in response to Joe’s anger at her. Joe asks Catherine “How can I please her when she is so upset like this?” Catherine interrupts the regression into escalation, joins with Joe and Amy and refers to the difficult week for the couple, including stressors and fights about chores and the hotel flyer being a trigger memory of the affair. Amy, prompted by Catherine’s empathically joining them about the difficult week, then remembers another disappointing event: Joe’s inability to maintain his erection.

Catherine then gently prods Joe about the erectile dysfunction, and Joe replies that he “gets distracted.” He rambles and stammers for a while but, as he resonates with Catherine’s interest in him, he eventually works up the courage to express his desire and concludes, “I want to make her happy.” Joe has momentarily overcome his fear and reticence of critical Amy, his internalized mother, and become able to assert himself. Unfortunately, Amy responds internally to her developmental and present fears of being unlovable to Joe, and recycles back to “I do not believe it.”

Joe and Amy could become deflated here, but Catherine stretches Amy’s perspective by gently reminding Amy that “Joe wants to be perfect for you.” Catherine is reframing Amy’s distrustful developmental perspective, distinguishing the betraying Joe and her mother from the present Joe that wants to please her. Catherine is asking “can you let him in?” Joe again takes a risk, saying almost as a question, “I didn’t even know if you wanted sex.” Amy responds “I said we can have sex if you want to,” although she is not able to own her desire, which is too threatening. Amy shares her anxiety, “I cannot imagine you looking at me when you have been with a 27 year old woman” and “I don’t know if I should try anymore.” Amy seems to respond by emotionally recycling back to a threatened position. Since Catherine empowered Joe by repeating his statement to Amy, “He wants to be perfect for you,” Joe asserts himself again, stating, “I want you” and “She (the other woman) does not cross my mind” (symbolic erection). Amy volunteers, “That is hard to believe. I do want to hear it.” Remembering Catherine saying “he wants to be perfect for you,” Amy is working up the courage to finally express her desire to hear Joe’s reassurance. Amy is on the edge of understanding she does not trust Joe, not just because of the affair or his “irresponsibility,” but because she feels unsafe being that vulnerable to him.

Catherine continues to expand Amy’s awareness, repeating, “You do want to hear his wanting you.” Amy then, feeling safe enough with Joe and Catherine’s reassurance, takes a big internal risk by observing herself and says, “I feel bad that you find me demanding of you in bed… I do not like that you think you have to be perfect.” Here, Amy is taking back her projection that Joe has to live up to her “perfection” defensive strategy. Perhaps Amy is pre-consciously understanding that her perfectionistic expectations are affecting Joe’s assertion and erection? Amy, at this point, announces that the session is over, perhaps overwhelmed by the new insight and self-awareness. Catherine summarizes, “Amy, when you get scared, that kid in you wants to control again. And Joe, when you feel threatened, your fear of shame leads you to withdraw.” Catherine is reframing their relational dynamics and stretching Amy and Joe’s awareness at the end of the session. Catherine reassures them, “that we are going to just keep on listening and talking… and working through this.” Amy says “Thank you” with an authentic tone of appreciation, realizing something new and powerful has happened inside of her and Joe and the couple. Joe also expresses appreciation.

As a result of Catherine’s responses to both Amy’s and Joe’s developmental sensitivities, the threatening negative cycle is intervened upon. Lichtenberg (2015) explains that therapeutic progress in working with trauma is when the unregulated affect gradually presents itself to be reframed, which allows a new self oriented perspective. Here the couple learns to tolerate the separateness from each other and from their original internal parental objects. The therapist’s attunement to, and witnessing and processing of, Amy and Joe’s plight allows them to create a higher platform of relating. In the vulnerable moment in session, for the couple, there is a new shared memory on top of their conflict and their original trauma. There is also a neutralizing effect on their original trauma. Siegel (1999) says it takes seven minutes for this neurological shift to take place. Now, both of them will repetitively oscillate between these two themes; the theme of Joe asserting and Amy trusting, and that of Amy regressing to attacking and complaining, and Joe withdrawing and avoiding. Ringstrom (2014) describes using the concept of “past thinking emotional experience.“ In this couple, the Amy attacking and Joe avoiding theme marks the old entrenched, threatened state delineated from the linking, thinking, and trusting state. The therapist’s repetitive naming of their self defeating thinking and relating is helpful for the couple to be aware of and intervene on during their cycle of hyper-aroused regressive relating.

TOWARD TERMINATION

Mitchell (1993) stated that the vision therapists have for their clients will unconsciously affect their progress. Clients read therapists’ motives and desires for them, internalizing them as permission to grow. For this couple, hopefully Joe will find his assertiveness and Amy will grow to experience an integrated fuller self as the couple works toward termination. Joe needs to continue to genuinely apologize and understand the meaning of the affair, and Amy needs to continue to offer genuine forgiveness and to also understand the role she played in the affair. Both of them need to continue to share their understanding and regret as to how they have hurt each other and reaffirm themselves as a couple with a future.

Shaddock (2002) emphasized the importance of developmental factors. Accordingly, whether in a couples modality or in individual therapy, Joe would need to consciously take responsibility for, and work-through. his fear of assertion by identifying and understanding the triggers, fear and shame that cause him to withdraw. Joe would also need to continue to delineate Amy from his internalized mother and continue to separate from his parents.
In either the couples modality or individual therapy, Amy needs to become familiar with her post traumatic stress, which means learning to acknowledge and feel the destabilizing fears and internal horrible chaos, become aware of what triggers her trauma response, and develop strategies to intervene on her anxiety by self-soothing and self-regulation practices. Amy would learn to trust her feelings of needing and relying on Joe, delineating him from her mother and family of origin.

Termination is indicated when the couple can own and express their perspectives, desires, and empathy for their partner. A couple ready for termination will display confidence in being able to negotiate future conflicts and share a vision for their future.

In conclusion, McCormack (2000), Mitchell (2000), Ogden (1989), and Ringstrom (2014) discuss the conceptualization that the therapist holds the vision of “the third.” For the couple, this “third” perspective is the dialogue, the negotiation, that neutralizes the threatening binary power-or-victim system by transforming it into a perspective of two people surrendering to the couples system (the third). Thus, the couple in the opera is now aware that they create the harmony or useful discord toward resolution that enriches both partners.

I want to acknowledge Mary O’Farrell for her dedication and excellent editing that moved the presentation to this written form.

REFERENCES

Bacal, H.A. and Newman, K.M. (1990). Theories of object relations: Bridges to self psychology. New York, NY: Columbia University Press.
Benjamin, J. (1998). Shadow of the other: Intersubjectivity and gender in psychoanalysis. New York, NY: Routledge.
Bromberg, P.M. (2006). Awakening the dreamer: Clinical journeys. Hillsdale, New Jersey: The Analytic Press.
Brown, E. M. (1999). Affairs: A guide to working through the repercussions of infidelity. San Francisco, CA: Jossey–Bass, Inc.
Brown, E.M. (2005). Split self affairs and their treatment. In F.P. Piercy, K.M. Hertlein & J.L. Wetchler (Eds.), In Handbook of the clinical treatment of infidelity (pp. 55-70). Binghamton, NY: The Haworth Press. Inc.
Coleman, W. (1993). Marriage as a psychological container. In S. Ruszczynski (Ed.), Psychotherapy with couples (pp.70-96). London: Karnac Books.
Feld, B. (2004). Holding and facilitating interactive regulation in couples with trauma histories. In Psychoanalytic Inquiry, 24 (3), 421-437.
Fosha, D., Siegel, D.J., & Solomon, M.F. (Eds.), (2009). The healing power of emotion: Affective, neuroscience, development, and clinical practice. New York, NY: W.W. Norton & Company.
Herman, J.L. (1992). Trauma and recovery. New York, NY: Basic Books.
Johnson, S.M. (2004). The practice of emotionally focused couple therapy. In N.H. Gilman (Ed.), Basic principles practice series. New York, NY: Brunner-Routledge.
Kertesz, I. (2004). Liquidation. New York, NY: Knopf Doubleday Publishing Group.
Kohut, H. (1984). How does analysis cure? Chicago: University of Chicago Press.
Lichtenberg, J.D. (1989). Psychoanalysis and motivational systems. New Jersey: Lawrence Erlbaum Associates, Inc.
Lichtenberg, J. D. (2015). A developmentalist’s approach to research, theory and therapy: The selected works of Joseph Lichtenberg. New York, NY: Taylor & Francis.
Livingston, M.S. (1995). A self psychologist in couplesland: Multisubjective approach to transference and countertransference-like phenomena in marital relationships. Family Process Institute, 34, pp. 427-439.
McCormack, C. (2000). Treating borderline states in marriage: Dealing with oppositionalism, ruthless aggression, and severe resistance. Northvale, New Jersey: Jason Aronson.
Mitchell, S. A. (1993). Hope and dread in psychoanalysis. New York, NY: Basic Books.
Mitchell, S. A. (2000). Relationality: From attachment to intersubjectivity. Hillsdale, New Jersey: The Analytic Press.
Mitchell, S. A. (2002). Can love last?: The fate of romance over time. New York: W.W. Norton and Company.
Ogden, P. (2015). Sensorimotor psychotherapy: Interventions for trauma and attachment. New York: W.W. Norton & Company.
Ogden, T. H. (1989). The primitive edge of experience. Northvale, New Jersey: Jason Aronson, Inc.
Ringstrom, P. A. (2014). A relational psychoanalytic approach to couples therapy. New York, NY: Routledge.
Scharff, D. E. & Scharff, J. S. (1991). Object relations couple therapy. Northvale, New Jersey: Jason Aronson, Inc.
Sharpe, S.A. (1992). The oppositional couple: A developmental object relations to diagnosis and treatment. In R.A. Nemiroff & C.A. Colarusso (Eds.), New dimensions in adult development (pp. 386-415). New York, NY: Basic Books.
Shaddock, D. (2000). Context and connections: An intersubjective systems approach to couples therapy. New York, NY: Perseus Books Group.
Shaddock, D. (2002). Fostering individual growth in conjoint contexts. Presented at the May 25th International Conference on the Psychology of Self.
Siegel, D.J. (1999). The developing mind: Toward a neurobiology of interpersonal experience. New York, NY: Guilford Press.
Solomon, M. (1997). Countertransference and empathy in couples therapy. In J.P. Siegel & M. Solomon (Eds.), Countertransference in couples therapy (pp. 23-38). New York, NY: WW. Norton & Company.
Solomon, M. & Tatkin, S. (2011). Love and war in intimate relationships. New York, NY: W.W. Norton & Company.
Stalfa, F.S., & Hastings, C.A. (2005.) Accusatory suffering in the offended spouse. In F.P. Percy, K.M. Hortlein & J.L. Wetchler (Eds.). Handbook of the Clinical Treatment of Infidelity,(pp. 83-90). Binghamton, NY: The Haworth Press. Inc.
Stern, D.B. (1997). Dissociation to imagination in psychoanalysis. Hillsdale, New Jersey: The Analytic Press.
Tatkin, S. (2009). I want you in the house, just not in my room… unless I ask you: The plight of the avoidantly attached partner in couples therapy. The Re-attachment Edition. In New Therapist Magazine, 62, pp. 11-16.
Wallin, D. J. (2007). Attachment in psychotherapy. New York, NY: Guilford Publications, Inc.
Winnicott, D. W. (1967). Mirror role of mother and family in child development. In Playing and Reality (pp. 111-118). London: Tavistock, 1971.