The central theme of this book is inclusion--in particular the inclusion of the therapist’s own subjectivity as a constituent part of the patient’s ongoing psychological life and the inclusion of the patient’s intimate relationships as part of the focus of psychotherapy. At a more general level, it is about the inclusion of ever-widening contexts, historical, relational, and societal in our understanding of personal experience.
Twentieth century science, in narrowing its gaze to isolated atoms and genes, brought us remarkable gifts. Psychoanalysis, by excluding “extraneous” details from the patient’s life and focusing on mental products that were unmediated by conscious control--dreams, fantasies, transference--was able to illuminate a heretofore unknown world of the unconscious. But this science has its liability: by excluding from our purvey the lived contexts of atoms, genes, and minds, we miss the actual effects of our cleverness and good intentions in the real world. As the poet William Carlos Williams writes:
the sign of knowledge in our time,
This “divorce” begins in what Robert Stolorow and George Atwood (1992) call “the myth of the isolated mind” in which “the individual exists separate from the world of physical nature and also from engagement with others” (p. 7), and ends with lives rent asunder by the continuing high rate of marital failures.
It has been my passion, both personally and professionally, to try to alter this climate of divorce in all of its meanings and manifestations. As a poet, I have tried to find language that connects vividly to the world, rather than isolates us behind walls of rhetoric and abstraction. As a therapist I have been drawn to work with couples and families, and to have my work informed by theories that value connection as the central organizing principle in our lives. I have also been drawn to the phenomenological, experience-near theories of self psychology and intersubjectivity theory, which seek to overcome the gap between theoretical abstraction and the understanding gained from empathic immersion in our patients’ lives.
In my last book, From Impasse to Intimacy, (Shaddock, 1998) I attempted to provide a context--informed by self psychology and family systems theory--for couples whose relationships had become stuck, chaotic, or unfulfilling, and for young couples that had seen so many of their parents’ relationships fail that they were either determined to have a perfect relationship or else were completely gun shy of commitment. Since so much of the initial stages of therapy is educational, I decided to write a book that would describe the nature of unconscious needs and fears, as well as the way relationships work as a system to protect partners from emotional pain. The response from both therapists and the general public was extremely gratifying, and led me to write a book more specifically about couples treatment.
The two words of the title of this book address the theme of inclusion. The word contexts speaks in particular of the epistomological stance that informs this book: against a view of personal experience that is grounded in a sense of determinism of, say early childhood experience, or an essentialist view of personality, my view is that our psyches are at every moment a product of multiple and overlapping contexts--historical, relational, societal. It is impossible to understand personal experience divorced from these contexts--including the context of a therapist observing and trying to understand a patient. This book argues for treatment contexts that are inclusive of the significant relationships in a patient’s life, in particular intimate partners. In the last 2 chapters I discuss treatment contexts that include the family of a troubled adolescent and the child of an individual therapy patient.
The word connection invokes the relational movement in psychoanalysis, evolving from Farenczi to the British Object Relations theorists through Heinz Kohut and self psychology to the modern relational schools, in particular the intersubjective schools of Robert Stolorow, George Atwood and their collaborators. All of these theorists emphasized the importance of relationship as the curative factor in psychotherapy.
This book is informed by several assumptions:
Couples therapy is an underutilized treatment modality, especially as the treatment of choice for individual problems and pathologies. In a useful comparison, Grotstein, (1999) describes Kleinian-informed therapies as informed by the metaphor of weaning, whereas Kohutian therapies tend to be informed by an emphasis on attachment or bonding. The couples therapy described in this book inherently supplies both types of experiences. The empathic exploration of each partner’s experience creates an attachment to the therapist, and the selfobject experiences created in the room foster renewed attachment experiences for the couple. At the same time, the presence of multiple subjectivities in the room inherently supplies “weaning” from the exclusive possession of the therapist’s support and empathy. The alternation of these attachment experiences with experiences that foster accommodation to other points of view makes couples therapy a uniquely development-enhancing modality.
Individual therapy can at times be alienating or even destructive to outside relationships. The idealizability of an individual therapist can provide an essential development-enhancing experience. At the same time, the patient’s spouse can pale by comparison. For some narcissistic individuals, the therapist’s empathy of their frustrations in relationship can be transformed into blame or anger.
Both partners benefit when one partner has a development-enhancing experience. In effect, a rising (selfobject) tide lifts all boats--providing empathy or selfobject experiences to one partner, and creates a context for openness and vulnerability.
Individual experience is inherently embedded in an intersubjective relationship system. This is what Stolorow, (1997) half-jokingly calls a “no person” psychology. The notion of a fixed self, a fixed representational world, or fixed pathology give way to a view of human experience that is at all times a product of the dynamic relationship between intrapsychic and interpsersonal experience.
Intersubjectivity theory, which developed from the study of caregiver/infant and patient/therapist dyads, can be usefully extended to the understanding of couples and families. Although there are many uses of the term intersubjective or intersubjectivity, this book is informed by the theories that have been formulated over four books and numerous articles by Robert Stolorow, George Atwood, and the collaborators. Three concepts in particular lie at the heart of this book: the centrality of empathic/introspection as a listening stance in couples therapy, the centrality of affect in human experience and the view of relationships as systems of mutual regulation, and the concept of the bipolar transference which views human experience in relationships as continually oscillating between the hope for new, development-enhancing experiences, and the fear that old traumatic, development inhibiting experiences will be repeated.