Trust theory and working with couples

ABSTRACT

In this paper, the author discusses ways in which certain theoretical ideas found in relational self psychology theory, and particularly the concept of “a hermeneutics of trust,” support working empathically with couples in difficult situations. Three case vignettes are provided to illustrate the author’s application of these ideas in complex and confusing situations.

KEYWORDS:

• Complexity
• couples
• hermeneutics
• relational self psychology
• trust

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

¹ One might say that shaking his hand was the first intervention, which, according to Wikipedia, is a tradition older than history demonstrating peaceful intent and the absence of weapons.

² D. M. Orange (2011) called Ferenczi the “(g)randfather or grandmother … to most strains of relational psychoanalysis” (p. 74). She also describes Kohut’s work as “heavily indebted to the Ferenczian legacy” (p. 74 footnote). Bacal and Carlton (2010) recount the following: “(Kohut) told Bacal (personal communication) that ‘Ferenczi had the right idea.’ That is, Kohut, like Ferenczi, believed that there was a good deal to be said for responding to a patient in the ways that the patient experienced as therapeutic, even if these ways would not be endorsed by the prevailing tenets of psychoanalytic practice” (p. 133–134) (italics in original).

³ In this letter, Ferenczi was urging Freud, who had inspired him to be unremittingly honest, to open up. He signed the letter, “Yours, thirsty for honesty, Ferenczi.”.

⁴ Novack (2018) discusses the importance of the analyst trusting the patient in the context of individual therapy.

⁵ See Leone (2021) for an example of how psychoeducation can be experienced as an attuned selfobject response.

⁶ Even Freud (1910), who was generally suspicious of what patients told him, described the technical importance of not pushing: “Psycho-analytic intervention … absolutely requires a fairly long period of contact with the patient. Attempts to ‘rush’ him at first consultation, by brusquely telling him the secrets which have been discovered by the physician, are technically objectionable. And they mostly bring their own punishment by inspiring a hearty enmity towards the physician on the patient’s part and cutting him off from having any further influence” p. 225.

⁷ Of course, when working with couples, we must add the words “or partner” to the word “analyst” in Brandchaft’s statement, and consider how the partners might be threatening each other’s “essential selfhood.”.

⁸ As Ghent’s (1990) puts it, “(r)esignation accompanies submission; it is heavy and lugubrious. Acceptance can only happen with surrender … It is joyous in spirit … ” (p. 111).

⁹ Johnson recommends doing this rather directly, “by reframing interactional positions to create new perceptions and responses, or by interrupting interactional patterns with tasks, such as sharing fears, that create a new kind of dialogue” (p. 48).

¹⁰ I am proposing that we trust not only our patients, but also the process in which empathy will develop over time. Kohut (2010) spoke of a developmental line of empathy. “There is always the question of how to treat people with very serious self disturbances, who cannot possibly benefit from interpretations, I believe. It’s too soon, and for many years, they do need an empathic understanding on the closest level that we can muster. And it does not mean that one cannot move naturally, slowly, and gradually into higher forms of empathy and explaining, much, much, much later on” (p. 129). Perhaps my idea of “trust” implies an early, relatively non-interpretive empathic stance, similar to what D. M. Orange (1995) called “fallibilism, the commitment to hold theory lightly, to live with uncertainty and ambiguity, and to be always prepared to revise our views” (p. 3).

Additional information

Notes on contributors

Mark Winitsky

Mark Winitsky, Psy.D., is a faculty member and training and supervising analyst at the Institute of Contemporary Psychoanalysis Los Angeles, part-time faculty member at Cal State Long Beach, clinical supervisor at the Southern California Counseling Center, and former president of the Gestalt Therapy Institute of Los Angeles. He is a clinical supervisor in the AACAST program for couple and sex therapy and a clinical consultant in the Integrative Psychoanalytic Couple Therapy program in Chicago (CPI and ICSW), and a former co-chair of the IAPSP Couple Therapy Interest Group. He is in private practice in Los Angeles.