A special issue focused entirely on psychoanalytic couple therapy is particularly fitting for a journal dedicated to the psychoanalytic study of people and their contexts. Contemporary psychoanalytic theories view the psyche as inextricably embedded in relational contexts, including our intimate relationships. As the eleven papers in this issue convincingly demonstrate, couple therapy offers opportunities for deep psychological change and healing in both partners as well as in the relationship between them. We believe that psychoanalysis has too long been seen as occurring only between one therapist and one patient, with insufficient recognition of couple therapy as a primary, powerful form of analytic treatment in its own right. We hope this special issue contributes to continued change in this perception and enhanced recognition of the curative power of psychoanalytic conjoint work.
The project of couple therapy is complex and often daunting. Paying attention to each partner’s subjective experience, their personal histories and the moment-to-moment process in the room, including our own countertransference, is a lot to juggle. We hope the papers in this issue will offer practical help in this endeavor, particularly with regard to work with couples who present with difficult or traumatic personal histories. The papers blend intersubjective, empathic and systemic perspectives with behavioral, psychoeducational, and attachment-based interventions to yield exciting and, we think, forward-looking examples of psychoanalytic thinking.
We are pleased that the authors include a range of voices, from those who have previously written extensively on couple therapy (Leone, MacIntosh, Nielsen, and Shaddock), to those whose paper here is their first or one of their first publications (Dehganpour, Edwards, Isaacson, Prowe and Winitsky), to one who has published extensively on individual therapy and psychoanalysis but here contributes his first paper applying his ideas to couple therapy (Stern). One of our goals in agreeing to this project was to encourage newer writers—people we knew were out there doing excellent, powerful clinical work Footnote1, often with very difficult couples, but who had not yet written about it—to take the plunge into sharing their ideas and their work in writing. We are delighted with the results and look forward to hearing more from all of our authors in the future. We also hope that other as yet unpublished couple therapists will be inspired to share their work in writing as well, as couple therapists need all the help we can get.
In the opening paper of the issue, Stern applies his recent contribution to individual treatment—the vivid image of children growing up in an “airless world” (Stern, Citation2019) and his ideas on how to help adults with that history—to couple therapy. He suggests that adult partners can co-create mutually negating airless worlds between them and proposes a treatment approach to bring “psychic air” back into these relationships, including the use of “dialogue breakdown analysis” and the concept of “empathy with the needs of the system.”
Couples who put their intimate relationship lives in our hands require a particular ethical and clinical commitment, Mark Winitsky asserts in the next paper. Drawing on Donna Orange’s “hermeneutics of trust” (Orange, Citation2011), Winitsky details an attitude of interest in and acceptance of what each partner actually tells us, a salutary argument against the “experience-distant” quality of many psychoanalytic couple theories.
In the third of the theory-oriented papers that open this issue, Shaddock applies the developmental systems perspective of infant research to reveal the potential for adult development in couple therapy. A brief discussion of his paper by Beatrice Beebe details specific ways her infant research findings can illuminate couples’ process.
Next, Edwards focuses our attention on how early experiences of shame and the subsequent reestablishment of connection with caregivers impact later adult couple relationships. Integrating concepts from psychoanalytic theory and neurobiology, and using a detailed case example, she illustrates how she helps couples see that their conflicts reactivate and reenact childhood experiences related to shame and its aftermath.
Leone then takes up the long standing debate in couple therapy circles regarding the advisability of including occasional individual sessions with each partner as part of couple therapy in some cases. The paper advocates strongly that couple therapists make decisions about including individual sessions on a case-by-case basis, using their empathic sense of each partner’s needs and the needs of the couple.
Extending the idea of combining couple and individual work even further, Prowe argues that couple therapy is defined by therapeutic intention, rather than by who is present for sessions. This intention guides his intuitive and pragmatic treatment of a couple in which both partners suffered extreme childhood trauma.
These two papers are followed by one by Dehganpour and Leone in which Dehganpour chose to alter the traditional psychoanalytic frame in a different way—by briefly seeing the parents of one member of a couple he was treating, and planning to meet with all four family members. The paper focuses on in-law related conflict in general, a very common area of conflict for many couples but one that has rarely been addressed in the psychoanalytic couple therapy literature.
Next come two papers in which the authors integrate psychoeducation into a fundamentally psychoanalytic treatment model. First, Nielsen focuses on what he sees as the two most difficult things successful couples need to be able to do—ask for what they need and listen constructively to criticism. He details the multiple reasons why people may have difficulty with one or both of these and offers practical advice on how to help couples improve their skills in both arenas.
His paper is followed by MacIntosh’s summary and detailed illustration of her research-based treatment model for couples in which one or both partners are survivors of childhood trauma, known as Developmental Couple Therapy for Complex Trauma (DCTCT). She developed this approach, which includes an initial stage of psychoeducation about the impact of trauma, after finding that many traumatized couples did not do well in traditional attachment and emotion-focused couple therapy because they became too overwhelmed or dysregulated.
Next, Isaacson presents her work with a very different but also multiply traumatized and stressed couple with whom she worked with for a much longer time. Grounded in the concepts of empathic connection and emotional dwelling, and integrating concepts from several related theories, the paper beautifully illustrates that, as Isaacson tells us, “where there is emotional dwelling, there is hope.”
Lastly, Shaddock’s second paper returns to the idea that the type of couple treatment detailed in this issue holds great promise for individual growth and development. He details two vital areas of adult development—overcoming our tendency to repeat the past and learning to recognize and tolerate alterity—that can be addressed in couple treatment.
In closing, we would like to thank all the authors of the papers in the issue, many of whom wrote and/or revised their papers under considerable time pressure. We also thank the peer reviewers who reviewed the papers on tight deadlines, as well as co-editor in chief Annette Richard and Taylor and Francis editorial assistant Marissa Nania, for their unflinching assistance. We hope readers will find these papers as helpful, moving and inspiring as we have.
Disclosure statement
No potential conflict of interest was reported by the authors.
Notes
1 In several cases we learned of their work through their posts on the listserv of IAPSP’s Couple Therapy Interest Group.