Response to MacIntosh’s Review and Discussion of the Psychoanalytic Couple Therapy Journal Literature: A Self Psychological, Intersubjective Perspective

ABSTRACT

After expressing my appreciation to Heather MacIntosh and highlighting her article’s significant contributions to the field, I comment briefly on some of the implications of her methodology and findings. I then elaborate on her summary of the history of the application of self psychology (Kohut, 1971) and intersubjective systems theory (Stolorow, Brandshaft, and Atwood, 1987) to couple therapy, highlighting the key contributions of both theories and describing the current state of the field.

Notes

¹ In fact, I would have welcomed a little more information about the approach—perhaps in a footnote.

² To me, couple psychoanalysis and psychoanalytic couple therapy are interchangeable, except that couple psychoanalysis indicates that the treating provider is a psychoanalyst, and the provider of psychoanalytic couple therapy might or might not be an analyst (I am not.). Many years ago, I was told that the term psychoanalytic should only be used to refer to work conducted by a psychoanalyst, and nonpsychoanalysts should always refer to their work or thinking as psychoanalytically-oriented or informed—even if they were extremely immersed in and knowledgeable about psychoanalysis. I tried to follow that guideline for a while, not wanting to offend, but never heard it again and it does not seem to be a convention currently being followed by many … I appreciate this, because as the years have gone by, describing what I do as psychoanalytically oriented or informed doesn’t feel quite right or accurate to me. These terms, to me, imply something operating faintly in the background, which does not accurately capture the more fundamental, constant, or in my bones way I experience psychoanalytic theory operating in me and my work.

³ At least in the United States and Canada.

⁴ I counted journals as psychoanalytic if the words psychoanalytic or psychoanalysis appeared in their title or in the brief description of the journal’s mission on the journal’s web site. All others were considered nonpsychoanalytic. None were difficult to classify as one or the other. Journals classified as Nonpsychoanalytic journals include, for example, Family Process, Clinical Social Work Journal, Sexual and Marital Therapy, and the Journal of Marital and Family Therapy.

⁵ Of the 43 articles published in nonpsychoanalytic journals, four appeared in the 1960s, nine in the ‘70s, eight in the ‘80s, fifteen in the ‘90s, six in the 2000s, and one between 2010 and 2013.

⁶ This was especially surprising because the one article was mine (Leone, 2008). I submitted it to Psychoanalytic Psychology, having no idea that the journal had only published one previous paper on couple therapy since its inception in 1981. (That paper was Zeitner, 2003, which was not included in MacIntosh’s review, because it didn’t meet inclusion criteria.)

⁷ Nothing against special issues—I’m certainly happy to be included in this one and think they make an important contribution—but when comparing numbers of publications per journal as MacIntosh does in Table 1, it seems important to compare apples to apples. Publishing one (and now two) special issue(s) on couple therapy, although valuable, is still different than periodically, regularly including papers on the topic.

⁸ MacIntosh quotes this sentence at the beginning of her section of self psychology and intersubjectivity theory.

⁹ Although Solomon’s earlier work was very self psychology-based, beginning with her 1992 coauthored paper (Solomon and Weiss, 1992), her work has focused more on attachment theory, affect theory, and neuroscience.

¹⁰ We would now more commonly say function as a potential source of selfobject experience, using selfobject as an adjective describing a dimension of an experience, rather than as a noun or thing.

¹¹ I have always wondered why more people didn’t see the obvious applicability of Kohut’s work to conjoint work earlier. I can only guess that this was, at least in part, due to the unfortunate historical split between family systems theory and psychoanalytic theory.

¹² To me, MacIntosh’s statement that self psychology and intersubjectivity theory are “distinct models of treatment … born of similar ancestry” (MacIntosh, 2018, this issue, p. 341) is not quite accurate, because it implies that two distinct models derived separately from a third ancestor, which (other than both being influenced by Freud as all psychoanalytic models are) is not the case. Rather, much of Kohut’s work predated that of Stolorow and his colleagues, who both critiqued and built upon Kohut’s ideas, which he reportedly welcomed (Stolorow, 2010). However, other aspects of intersubjectivity theory emerged independently of self psychology and are broadly applicable to all psychoanalytic models, not just self psychology.

¹³ He recently revised this model to incorporate the influence of relational theory (Ringstrom, 2012), especially the concept of enactments—see Ringstrom, this issue.

¹⁴ I am not including Goldstein and Thau’s (2004) article on integrating attachment theory and neuroscience here, because although the article was listed in MacIntosh’s bibliography as part of the self psychology/intersubjectivity theory literature, I don’t consider it part of that literature and doubt the authors would.

¹⁵ See Doctors, 2007, for a discussion of the distinction between the two.

Additional information

Notes on contributors

Carla Leone

Carla Leone, Ph.D., is the director of North Suburban Family Psychologists, a group private practice in Lincolnwood, Illinois and is on the faculty of the Institute for Clinical Social Work in Chicago. She is an elected member of the governing council of the International Association of Psychoanalytic Self Psychology (IAPSP), and chair and co-founder of that organization’s Couples Therapy Interest Group. She is the author of several published papers on couples and family therapy and one on the “unseen spouse” of patients in individual therapy.