Module 4
Psychodynamic Models
a. The Place of Theory
The theoretical foundation of the field of family therapy must be strong, lest it
become merely a set of clever, empirically derived intervention techniques. Important
and seemingly effective as some of these techniques may be, they require the kind of
rationale or justification that only a coherent, unified theory can provide. Patterson
(1997) argues that a clear theoretical position provides the structural underpinnings
for assessment and treatment planning to occur. He maintains that a therapist must
accurately identify the major theoretical orientation from which he or she operates
before utilizing congruent intervention methods within it. There is considerable
controversy over whether an integrated supertheory is ever likely to emerge.
The task of integrating the central theoretical constructs of major
psychological theories poses significant challenges due to the inherent complexities
and divergences across different theoretical frameworks. While the pursuit of
conceptual integration is admirable in its aspiration to create a unified understanding
of human behavior, the reality is that many theoretical constructs are characterized by
inherent incompatibilities that hinder seamless integration.
One of the primary obstacles to conceptual integration lies in the divergent
assumptions and premises that underpin various psychological theories. For example,
psychodynamic theories emphasize the role of unconscious drives and conflicts in
shaping behavior, while cognitive theories focus on conscious thought processes and
information processing mechanisms. These differing conceptual foundations can lead
to fundamental discrepancies in how phenomena are conceptualized and explained,
making it difficult to reconcile the central tenets of these theories within a single
integrated framework.
Furthermore, the methodologies and epistemological orientations associated
with different theoretical traditions may further complicate efforts at integration. For
instance, behaviorist theories emphasize observable behavior and experimental
manipulation, while humanistic theories prioritize subjective experience and
qualitative inquiry. The methodological diversity inherent in psychology reflects
differing ontological and epistemological commitments, posing challenges for
integrating disparate theoretical perspectives into a coherent whole.
Additionally, the historical and cultural contexts in which psychological
theories emerge shape their conceptual frameworks and explanatory mechanisms. For
example, psychoanalytic theory emerged within the context of early 20th-century
Vienna and reflected the cultural zeitgeist of its time, while cognitive theories were
influenced by developments in computer science and information processing theory.
These contextual factors contribute to the unique conceptual landscapes of different
theories, making it difficult to bridge the conceptual divides that separate them.
Moreover, the diversity of domains and levels of analysis within psychology—
from biological processes to sociocultural influences—further complicates efforts at
conceptual integration. The complexity of human behavior and cognition defies
reductionism, necessitating an interdisciplinary approach that integrates insights from
multiple theoretical perspectives and levels of analysis. However, achieving such
integration requires navigating the inherent tensions and incompatibilities that exist
between different theoretical constructs and explanatory frameworks.
Despite these challenges, efforts to promote interdisciplinary dialogue and
collaboration hold promise for advancing towards a more integrated understanding of
human behavior. By fostering mutual respect and open-mindedness among
researchers from diverse theoretical traditions, psychologists can cultivate a culture of
synthesis and innovation that transcends theoretical boundaries. Moreover, advances
in technology and computational modeling offer new opportunities for integrating
diverse theoretical perspectives through the development of formal models and
simulation techniques.
In conclusion, while the task of integrating the central theoretical constructs of
major psychological theories is fraught with challenges, it remains an important and
worthwhile endeavor. By acknowledging the inherent complexities and
incompatibilities that exist between different theoretical frameworks, psychologists
can work towards fostering a more inclusive and integrative approach to
understanding human behavior that reflects the rich diversity of theoretical
perspectives within the field.
Different schools of family therapy make different assumptions about human -
nature, have different goals, and use different criteria for evaluating what constitutes a
successful outcome (Liddle, 1982). Brown (2010) draws a useful distinction relevant
to the debate between integration versus eclecticism when he suggests that teaching
family therapy from a meta-theoretical perspective avoids inadvertently advocating a
specific eclectic approach based on the particular sequence of theories presented.
Keep this caution in mind as you read about each approach. You might find it helpful
to consider each with an open mind. All theories, of course, are hypotheses offered in
the hope of shedding light or providing fresh perspectives on the causes of family
dysfunction. They are never, in and of themselves, true or false; rather, some are more
useful than others, particularly in generating research hypotheses that can be verified
through testing.
Indeed, the field of psychology is characterized by a dynamic interplay of
theories and hypotheses, each offering unique perspectives on human behavior and
cognition. While theories serve as invaluable frameworks for understanding and
interpreting phenomena, it is essential to recognize their provisional nature and
openness to revision and refinement in light of new evidence and insights.
The tentative nature of theories reflects the iterative process of scientific
inquiry, wherein hypotheses are subject to continuous testing, evaluation, and
modification in response to empirical findings and theoretical advancements. As our
understanding of human behavior evolves and new methodologies emerge, theories
must adapt to accommodate new data and perspectives, leading to the emergence of
novel theoretical proposals and paradigms.
Moreover, the expendability of theories underscores the dynamic nature of
scientific knowledge, wherein theories that once held sway may be supplanted by
more comprehensive or parsimonious explanations. This process of theoretical
turnover is integral to the advancement of knowledge, as outdated or inadequate
theories are gradually replaced by more robust and empirically supported frameworks
that better capture the complexity and nuance of human behavior.
At the same time, it is important to recognize that theories, even if provisional,
play a crucial role in guiding research, shaping clinical practice, and informing public
policy. They provide a conceptual roadmap for organizing and interpreting empirical
findings, generating testable hypotheses, and guiding interventions aimed at
addressing psychological phenomena and promoting well-being.
Furthermore, theories do not operate in isolation but rather exist within a
broader ecosystem of scientific discourse, where they are subject to scrutiny, debate,
and synthesis with other theoretical perspectives. Interdisciplinary collaboration and
dialogue facilitate the cross-fertilization of ideas, leading to the integration of diverse
theoretical frameworks and the emergence of novel syntheses that transcend
disciplinary boundaries.
In this sense, the evolution of theories in psychology is not linear but rather
dialectical, characterized by a continuous interplay of synthesis and critique that
drives scientific progress and innovation. As theories evolve and adapt in response to
new evidence and theoretical developments, they contribute to the cumulative growth
of knowledge and the refinement of our understanding of human behavior and
cognition.
In conclusion, while theories in psychology are tentative and expendable in the
sense that they are subject to revision and replacement, they also serve as
indispensable tools for advancing scientific inquiry and understanding human
behavior. By embracing the provisional nature of theories and fostering a spirit of
open inquiry and collaboration, psychologists can continue to push the boundaries of
knowledge and generate new insights into the complexities of the human mind and
behavior.
At this stage in the development of family therapy, we need to examine the
usefulness of the contributions that have already been made to our understanding of
family development and functioning. Some models came from the research
laboratory, others from the consultation room of a clinician working with families.
With contemporary advances in neuroscience, some clinically derived theories, such
as psychodynamic therapy, are gaining support from controlled scientific
experimentation.
b. Psychodynamic Models: Some Historical Considerations
Psychoanalysis, both as a collection of theories and a form of practice,
deserves recognition for playing the central role in establishing and defining the
nature of psychotherapy (Sander, 1998). Traditionally, psychoanalysis focused on
treating neurotic individuals by examining and reconstructing childhood conflicts
generated by the colliding forces of inner drives and external experiences. Shortly
before World War II, a large number of European psychoanalytic clinicians and
theorists (including Erik Erikson, Heinz Kohut, and Erich Fromm), came to the
United States to escape the Nazi regime. With their arrival, psychoanalysis began to
gain greater acceptance. Many of family therapy’s pioneers—Ackerman, Bowen,
Lidz, Jackson, Minuchin, Wynne, Boszormenyi-Nagy—(all men, incidentally), were
psychoanalytically trained. Some, such as Jackson and Minuchin, moved far from
their psychoanalytic roots toward systems thinking, while others (Bowen, Lidz, and
Wynne) produced theories that reflected some of their original training.
Sigmund Freud, founder of psychoanalysis at the turn of the 20th century, was
aware of the impact of family relationships on the individual’s character formation,
particularly in the development of symptomatic behavior. For example, in his famous
case of Little Hans, a 5-year-old boy who refused to go out into the street for fear that
a horse might bite him, Freud hypothesized that Hans was displacing anxiety
associated with his Oedipus complex. That is, Freud believed Hans unconsciously
desired his mother sexually but felt competitive with and hostile toward his father, as
well as fearful of his father’s reaction to his hostility. Hans had witnessed a horse
falling down in the street, and Freud speculated that he unconsciously associated the
scene with his father, since he wanted his father hurt, too. According to Freud, Hans
unconsciously changed his intense fear of castration by his father into a phobic
symptom about being bitten by the horse, which Hans had previously seen as
innocuous. Substituting the horse for his father, Hans was able to turn an internal
danger into an external one by displacing it onto a substitute object.
Historically, the case of Little Hans has conceptual as well as technical
significance. Conceptually, it enabled Freud to elaborate on his earlier formulations
regarding psychosexual development in children and the use of defense mechanisms
(such as displacement) as ego functions that people unconsciously use to protect
themselves from overwhelming anxiety. Note, however, that Freud chose not to work
with either the child or the family but encouraged Hans’s father, a physician, to treat
his own son under Freud’s supervision. Ultimately, Hans was relieved of his phobic
symptom.
From this and similar examples from among Freud’s published papers, it is
clear that Freud recognized that the family provided the early environment—or
context—in which neurotic fears and anxieties developed. Freud argued that
psychoanalysts were “obliged to pay as much attention. . . to purely human and social
circumstances of our patients as to the somatic data and the symptoms of the disorder.
Above all, our interest will be directed toward their family circumstances”. However,
his therapeutic efforts concentrated on the family of origin as the client unconsciously
internalized it and later remembered it during analysis and not how his current family
functioned.
Freud’s theories and techniques stress intrapsychic restructuring rather than
restructuring interpersonal or transactional phenomena within a family. Freud’s
opposition to working with more than one family member at a time became virtually
an unquestioned doctrine among psychoanalysts (Broderick & Schrader, 1991). In
fact, as Bowen (1975) notes, psychoanalytic isolation of the therapist–patient
relationship and the related concern that contact with the patient’s relatives would
“contaminate” the therapist may have retarded earlier growth of the family therapy
movement. Bowen reported that some hospitals had one therapist deal with the
patient’s intrapsychic processes while another handled practical matters and
administrative procedures, and a social worker talked to relatives; failure to respect
these boundaries was considered “inept psychotherapy.” Later, this principle began to
be questioned—more often for research than for clinical purposes—and family
members began to be seen therapeutically as a group.
Early psychoanalytic theory was significant in the subsequent development of
family therapy. While the parameters of the clinical experience were later expanded
by many family therapy practitioners to include family members, clinicians from
various theoretical perspectives to this day still consider important Freud’s emphasis
on unconscious conflict, resistance, and transference and countertransference.
Another psychoanalytic influence on family therapy is the work of Alfred
Adler, an early associate of Freud’s in Vienna. Adler helped found the child guidance
movement in the early 1900s. As a physician, Adler began to specialize in neurology
and psychiatry, especially in treating childhood disorders. Adler was one of the first
invited by Freud to join the Vienna Psychoanalytic Society, which he did in 1902.
Although initially he published psychoanalytically oriented articles, Adler eventually
diverged from psychoanalytic theory, emphasizing the importance of social (including
family) factors as opposed to Freud’s drive theory (Sharf, 2012). Adler particularly
challenged Freud’s lack of attention to social elements in personality formation.
Instead, he insisted that an individual’s conscious personal and social goals as well as
subsequent goal-directed behavior could be fully understood only by comprehending
the environment or social context, especially the family, in which that behavior
originated and was displayed. Adlerian concepts such as sibling rivalry, family
constellation, birth order, and style of life attest to Adler’s awareness of the key role
of family experiences in influencing adult behavior. His holistic view of the person as
unpartitionable is applicable to the systems outlook of family therapists.
The goal of Adlerian family therapy is to promote changes in both individuals
and the family as a whole (Carlson, Sperry, & Lewis, 2005). While specific goals will
differ from family to family, basic principles include the promotion of a new
understanding and insight about purposes, goals, and behaviors; the enhancement of
skills and knowledge in such areas as communication, problem solving, and conflict
resolution; the increase of social interests and positive connections with others; and
the encouragement of commitment to ongoing growth and change. This last concept
—encouragement—is particularly important in working with families as a means to
“promote changes in both individuals and the family as a whole.” Encouragement as a
technique used by the therapist helps family members in therapy together challenge
misdirected goals while focusing on realistic possibilities.
Adler’s direct family therapy connection can be seen today in such
psychoeducational efforts as marriage enrichment programs and parent education and
the integration of Adlerian concepts with some of the major approaches in family
therapy by scholar-practitioners. Some critics maintain that Adlerian therapy still
places too great an emphasis on the self rather than on the self in relation to the larger
culture.
Another important theorist, American psychiatrist Harry Stack Sullivan, was
psychoanalytically trained but was also influenced by sociology and social
psychology. Beginning in the late 1920s, he stressed the role of interpersonal
relationships, within the family and with outsiders, in personality development.
Sullivan (1953) argued that people are essentially products of their social interactions;
to understand how people function, he urged the study of their “relatively enduring
patterns of recurrent interpersonal situations”. These patterns of interaction within a
family significantly influenced a person’s personality as well as relationships both
within and beyond the family. Sullivan emphasized the crucial nature of the early
mother–child dyad, arguing that these formative experiences lead to viewing parts of
oneself as “good me,” “bad me,” and “not me”—concepts that, as we shall later see,
are consistent with object relations theory.
Sullivan (1940) described his way of engaging patients as acting as a
participant observer, anticipating by several decades the second-order cybernetic idea
of the therapist as part of the ongoing therapeutic system. This is a significant
departure from Freudian psychoanalysis in that it replaces
transference/countertransference analysis with attention to what a person is doing with
others in the here and now. The participant observer is not objective (i.e., a blank
screen onto which clients transfer their inner psychic dynamics); instead, the therapist/
participant observer recognizes the impact of her or his own subjective experience
during therapy. This recognition aligns with most contemporary approaches to
psychodynamic theory that view the meeting and understanding of multiple
subjectivities as foundational to the therapeutic experience.
The influence of Harry Stack Sullivan, a pioneering figure in psychiatry and
psychoanalysis, extends far beyond his own theoretical contributions, shaping the
development of family therapy and relational psychoanalysis through the work of his
students and colleagues.
Don Jackson and Murray Bowen, both renowned figures in the field of family
therapy, were deeply influenced by Sullivan's ideas and approach to understanding
human relationships. Trained under Sullivan and his colleague Frieda Fromm-
Reichmann, Jackson and Bowen absorbed Sullivan's insights into the dynamics of
interpersonal relationships and the interconnectedness of individual and family
functioning.
Jackson, in particular, drew heavily from Sullivan's notion of redundant family
interactive patterns in his development of family therapy approaches. Building on
Sullivan's emphasis on the reciprocal nature of interpersonal interactions, Jackson
pioneered the concept of family systems theory, which views families as dynamic
systems characterized by interrelated patterns of communication, behavior, and
relationships. By identifying and intervening in dysfunctional patterns of interaction
within families, Jackson sought to promote healthier relational dynamics and improve
individual and family well-being.
Similarly, Bowen's theories regarding individual pathology emerging from a
faulty multigenerational family system can be traced back to Sullivan's influence.
Bowen expanded upon Sullivan's ideas by exploring the ways in which family
dynamics and intergenerational patterns of interaction shape individual psychological
functioning and emotional well-being. Bowen's concept of differentiation of self,
which emphasizes the development of autonomy and emotional maturity within the
context of family relationships, reflects Sullivan's emphasis on the importance of
interpersonal relationships in shaping identity and psychological development.
In addition to their contributions to family therapy, Sullivan's influence can
also be seen in contemporary relational psychoanalysis, a school of thought that
emphasizes the importance of interpersonal relationships and relational dynamics in
psychoanalytic theory and practice. Sullivan's focus on the interpersonal nature of
psychological distress and his emphasis on the role of social context in shaping
individual experience laid the groundwork for the relational turn in psychoanalysis,
which prioritizes the therapeutic relationship and the exploration of relational patterns
in the therapeutic process.
Overall, Sullivan's influence on Jackson, Bowen, and the development of
family therapy and relational psychoanalysis underscores the enduring relevance of
his ideas and the far-reaching impact of his work on the understanding of human
relationships and psychological functioning. By integrating Sullivan's insights into
their own theoretical frameworks and clinical practices, Jackson, Bowen, and their
contemporaries have expanded our understanding of the complexities of interpersonal
dynamics and the role of social context in shaping individual and family well-being.
c. The Psychodynamic Outlook
Freud’s psychoanalytic theories focus on what he believed were biologically
determined forces, or drives, within a person as the basis for understanding
motivation, conflicts, and symptomatology. That is, drives motivate behavior by
means of bodily demands that take the form of unconscious wishes and impulses
seeking satisfaction. Freud contended that each drive has four components: an aim
(say, the release of sexual or aggressive tension), a source (in the case of hunger, for
example, the bodily need for nourishment), an impetus (the pressure or urgency of the
drive), and an object (the person or thing or condition that will satisfy the drive: food,
sexual intercourse, etc.). An object choice, then, as first articulated by Freud, might be
a significant person or anything that is a target of another person’s feelings or drives
(St. Clair & Wigren, 2004). It is important here to note that it is not the real object or
person, per se, nor how that object or person behaves in real life, that is at issue, but
rather the fantasies about the object the perceiver experiences. So falling in love with
another person, according to Freud, primarily involves investing energy in one’s inner
thoughts or mental representations of that special person.
While classical psychoanalysis is less frequently practiced today, attention by
some analysts working with couples or families is still given to core concepts of
classical analysis. Sander (2004), for example, points out how infantile sexuality and
aggressiveness powerfully influence the interpersonal lives of family members. He
argues for adding to the Oedipal myth the myth of Pygmalion and Galatea as a
powerful expression of an individual’s desire to change the psychic dynamics of
others—that is, to use unconscious fantasy to create others in one’s own image.
Relationships are affected by the compliant or resistant response of others to these
wishes. A trio of Freudian concepts remains important to any psychodynamic
approach to individual or family therapy: transference, countertransference, and
resistance. In short, transference refers to a client’s unconscious “transfer” of feelings,
wishes, and reactions related to important people from childhood (usually the parents)
onto the therapist. Countertransference refers to the therapist’s unconscious
experiences that emerge during the analytic process; these may interfere with the
therapist’s ability to positively interact with the client (although once understood by
the analyst, countertransference experiences offer important clues about either the
patient’s inner world or the heretofore unconscious dynamics between analyst and
patient).
And resistance refers to any unconscious impediment experienced by the
client (or, countertransferentially, the analyst) to the unfolding of the therapy. For
Freud, the analysis of the transference after lifting resistances to understanding it or
overcoming countertransference obstacles was a primary goal of psychoanalysis.
Psychoanalytically oriented family therapists also incorporate these concepts into
their work (Scharff, 2003). For them, interpretation of the resistances and
transferences of individual family members or the family as a whole—that is, making
them conscious through language—will lead to psychic healing.
Most of the family therapy pioneers were psychoanalytically trained, and in
their initial zeal to adopt systems thinking, they seemed to dismiss individually
focused psychoanalytic ideas as antiquated and, in the linking of adult pathology to
childhood developmental conflicts, hopelessly linear. Later, however, many family
therapists advocated a more integrated view, urging that systems thinkers not neglect
the individual family member’s personal conflicts and motivation (Nichols, 1987).
Mary-Joan Gerson (2010), a relational psychoanalyst and systems family therapist,
argues for a foreground–background dialectic between psychoanalysis and systems
theory. Sometimes during a session, one theory and practice takes precedence over the
other and vice versa. Today, many Freudian ideas about the needs and conflicts of
individual family members are being revisited alongside family relationship patterns
and community life.
As family therapy moved beyond early mechanistic cybernetic formulations,
and as there were renewed attempts to include individual experiences and outlooks in
a comprehensive understanding of family functioning, there has been a revival of
interest in psychodynamic postulations. The new look, however, is relationship based
and seeks not only to discover how the inner lives and conflicts of family members
interlock but also how the binding together affects disturbances in family members.
Bentovim (1998) and Slipp (1984) attempted to integrate psychodynamic and family
systems concepts. Bentovim, a British family therapist, presents a model called focal
family therapy.
This approach is developmentally oriented and looks for family disturbances,
especially traumatic events to family members that have led to intrapsychic and
interpersonal disturbance within the family. Samuel Slipp (1984) sees psychoanalysis
and family therapy as potentially complementary and both involved in the genesis and
maintenance of psychopathology. He attends to any significant childhood
development of the participants while addressing ongoing family interaction using the
framework of object relations theory. Both individual and family diagnoses are part of
Slipp’s treatment plan in his effort to integrate psychoanalytic and systems concepts
and therapeutic methods.
Nichols (1987) argues for the restoration of individual dynamics into
psychodynamic family therapy, because individual family members remain separate
flesh-and-blood persons with unique experiences, private hopes, outlooks,
expectations, and potentials. At times, people may react as individuals.
Psychoanalytically oriented therapists who accept Nichols’s holistic view—what he
calls interactional psychodynamics—are urged to remain attentive to the circular
nature of personal and family dynamics. As we present various family approaches that
reflect a psychodynamic perspective, keep in mind that each one simultaneously
addresses two levels of understanding and intervention: the motives, fantasies,
unconscious conflicts, and repressed memories of each family member and the
complex world of family interaction and family dynamics.
Nathan Ackerman, a psychoanalytically trained child psychiatrist in the child
guidance movement, is generally credited with adapting psychoanalytic formulations
to the study of the family. In what may have been the first paper specifically to deal
with family therapy, Ackerman emphasized the influence of the family as a dynamic
psychosocial unit. The constant interaction between the biologically driven, inner-
conflicted person (a psychoanalytic concept), the family, and the social environment
(a person-systems concept) preoccupied him for more than three decades, as he
applied an intrapsychic vocabulary to family diagnosis and treatment.
In contrast to the approach practiced by most child guidance clinics, in which
parent (usually mother) and child were seen by separate but collaborating therapists,
Ackerman, head of the Child Guidance Clinic at the Menninger Clinic in Kansas,
experimented with seeing whole families together for both diagnostic and therapeutic
purposes. As part of his effort to obtain a complete picture of family functioning,
Ackerman had members of his staff make home visits with client families (Guerin,
1976). By the 1950s, Ackerman had moved explicitly into family therapy. In New
York City in 1960, he opened the Family Institute, soon to become the leading family
therapy training and treatment center on the East Coast. Ackerman remained
throughout his long career a boldly direct, provocative, confrontational therapist, who,
true to his psychoanalytic background, never lost sight of the individual family
member’s needs and longings.
Ackerman (1970), regarded by some as the “grandfather of family therapy,”
saw the family as a system of interacting personalities; each individual is an important
subsystem within the family, just as the family is a subsystem within the community.
Family functioning receives input from several sources: the unique personality of
each member, the dynamics of family role adaptations, the family’s commitment to a
set of human values, and the behavior of the family as a social unit. At the individual
level, the process of symptom formation may be understood in terms of intrapsychic
conflict, an unconscious defense against anxiety aroused by the conflict, and the
resulting development of a neurotic symptom (a classical psychoanalytic explanation).
At the family level, the symptom is viewed as part of a recurring, predictable
interactional pattern intended to assure equilibrium for the individual but actually
impairing family functioning by producing distortions in family role relationships. In
family terms, an individual’s symptom becomes a unit of interpersonal behavior
reflected within a context of shared family conflict, anxiety, and defenses.
Conceptualizing behavior in this way, Ackerman was beginning to build a bridge
between psychoanalytic theory and the then-emerging systems theories.
A “failure of complementarity,” to use Ackerman’s terms, occurs when change
and growth within the system become constricted. Roles become rigid, narrowly
defined, or stereotyped—or shift rapidly, causing confusion. According to Ackerman
(1966), the family in which this occurs must be helped to “accommodate to new
experiences, to cultivate new levels of complementarity in family role relationships”
(p. 90). Flexibility and adaptability of roles are essential, allowing for maturing
children to gain appropriate autonomy.
Should the conflict between members become chronic, the family is at risk of
reorganization into competing factions. The process begins when one individual—
often noticeably different from the others—becomes the family scapegoat. As that
individual is singled out and punished for causing family disunity, various
realignments of roles follow within the family. One member becomes “persecutor,”
while another may take the role of “healer” or “rescuer” of the “victim” of such
“prejudicial scapegoating.” Families are thus split into factions, and different
members may even play different roles at different times, depending upon what
Ackerman considers the shared unconscious processes going on within the family at
any particular time. Typically, observed Ackerman, such family alliances and
interpersonal conflicts begin with a failure of complementarity within the marital
dyad; the family is precluded from functioning as a cooperative, supportive,
integrated whole. In such cases, Ackerman shifted a family’s concern from the
scapegoated person’s behavior to the basic disorder of the marital relationship.
Ackerman remained staunchly psychodynamic in outlook; his death in 1971
removed one of the major proponents of this viewpoint in family therapy. A collection
of his published papers with commentary by the editors (Bloch & Simon, 1982),
called The Strength of Family Therapy, attests to his trailblazing efforts as well as his
broad range of interests (child psychoanalysis, group therapy, social and cultural
issues, marriage, and more). He was among the first to demonstrate his work with
families before a professional audience, breaking the traditional psychoanalytic code
of secrecy about what really went on during therapeutic sessions. Despite Ackerman’s
importance in the early years of family therapy, few therapists today would say their
approach follows Ackerman’s style. He did not leave behind any defined theory of
family processes or guidelines for clinical interventions. The Family Institute
(renamed the Ackerman Institute in his memory), while acknowledging his pioneering
efforts, does not operate from a psychodynamic perspective today. While many
therapists continue to be interested in the “psychodynamics of family life” and use
classical psychoanalytic concepts, the psychodynamic view is currently best
expressed by the psychoanalytic theory termed object relations, to which we now turn.
d. Object Relations Theory
Object relations’ combined attention to individual drives (motives), the
development of a sense of self (wishes, fears, internal conflicts), and unconscious
relationship seeking helps explain the revived interest in psychoanalytic formulations
by some family therapists. They are rediscovering the value of basic psychodynamic
concepts that draw attention to the inner lives and conflicts of individual family
members. Object relations theory views the infant’s experiences in relationship to the
mother or primary caregiver as the main determinant of adult personality formation.
According to this theory, the infant’s need for attachment to the mother is the
foundation for the development of the self—the unique psychic organization that
creates a person’s sense of identity considers issues of attachment and loss to be
central to functioning in humans and all higher mammals; he argues that how people
resolve these issues determines personality development and possible
psychopathology. Most contemporary psychoanalysts place great emphasis on early
attachment experience and its impact on subsequent development.
While Freud used the term object in relation to instinctual drives, other
theorists have expanded it to refer to internal, largely unconscious views a person has
of an individual (or a part or aspect of an individual) from past experiences in
childhood that shaped his or her current relationships with others (St. Clair & Wigren,
2004). So an individual interacts not only with the actual other person but also with
this subjective, internalized representation of the other, likely a distorted version of
some actual person from the past. The theoretical work of Melanie Klein, a British
psychoanalyst who emigrated from Vienna in 1926, provided much of the foundation
of object relations theory. Her insights into the preverbal, inner world of the child’s
object relations are often considered the start of the movement.
Klein focused on the infant’s innate or instinctual makeup as containing
elements of love as well as hate. Because the infant’s inner life, beginning at birth,
involves a world of fantasy, he or she first experiences objects, such as the mother,
through fantasies. The infant filters real-life experiences through such prior fantasies.
Working directly with children—in contrast to Freud, whose theories about childhood
came from the recollections of neurotic adult patients—Klein was able to delve into
the fantasies of young clients and to expand previous psychoanalytic formulations to
cover the earliest phases of life. Freud saw drives as originally objectless; Klein
argued that drives (urges, instincts) are relational and inherently directed at objects.
Following Klein’s lead, object relations theory was developed further by
members of the British Middle School (Michael Balint, Ronald Fairbairn, Harry
Guntrip, and Donald Winnicott), so named because it attempted to maintain a balance
between classical psychoanalysts and the followers of Klein, in order that the British
Psychoanalytic Society avoid splitting into rival factions (Slipp, 1988). In general
they hold that an infant’s primary need is attachment to a caring, nurturing caregiver,
in contrast to Freud’s idea that the infant’s basic struggle is in coming to terms with
sexual and aggressive impulses aimed at acquiring gratification from a, a psychiatrist
in Edinburgh, Scotland, who worked therapeutically with schizoid adults, followed
Klein’s work but rejected her acceptance of Freud’s drive motivation in favor of
purely psychological explanations. His innovative theory of personality development
was based strictly on the consideration of object relations, and those objects inevitably
are people.
Fairbairn maintained that because the infant experiences different sets of
encounters with a mother—sometimes nurturing, sometimes frustrating—and cannot
control the circumstances or leave the relationship, she or he creates a fantasy world
to help reconcile the discrepant experiences. In this mediating process, called splitting
by Fairbairn, the child within the first year of life internalizes an image of the mother
into a good object (the satisfying and loving mother) and a bad object (the
inaccessible and frustrating mother). The former becomes an idealized object and
allows the child to feel loved, the latter a rejecting object that leads to anger, a feeling
of being unloved, and a longing to regain that love. Part of mother is loved, another
part hated; because she is not seen yet as a whole person, one or the other part
dominates at different times. Most children are able to integrate the two images by the
second year of life. However, the degree to which a person resolves this conflict
provides the basis for how well he or she develops satisfying human relationships
later in life. If unresolved, the splitting is likely to lead to labile feelings as an adult as
a result of a tendency to view people (or the same person at different times) as “all
good” or “all bad.” Note that object relations psychoanalysts are concerned with the
internalized representations of distorted external object relationships. This is
important because it argues for keeping the therapeutic focus on the patient’s inner
world rather than on her or his relationships with actual people, an important
difference from some family therapy theories and more contemporary psychoanalytic
theories.
To Fairbairn, these internalized split objects become part of one’s personality
structure: good-object introjects (imprints of parents or other significant figures)
remain as pleasing unconscious memories, bad-object introjects cause intrapsychic
distress. Psychological representations of these introjects unconsciously influence
future relationships, since current experiences are interpreted through the filter of
one’s inner object world of good-bad images. As a result, the person may grow up
with distorted expectations of others, unconsciously forcing intimates into fitting the
internal role models. These distortions are an inevitable feature of everyone’s life; the
capacity to challenge reality in well-enough versus poor terms distinguishes
normative from dysfunctional experience. The earlier the split (e.g., from an early loss
of a parent), the more likely it is that the person will yearn to merge with loved ones
so that they become a part of him or her. Or he or she may also yearn for
independence and separation, a normal part of growing up, although too much
distance may lead to feelings of loneliness and depression.
e. Object Relations Therapy
Braverman (1993) notes how an individual’s therapy can be enhanced by
exploring the objects projected by the client onto more people than just the person of
the therapist. A psychoanalytically oriented systems therapist, she argues, would want
to help the client understand how members of one’s family of procreation hold each
other’s unexamined projections as part of the family’s self-corrective feedback
system. Slipp (1988) suggests that the object relations perspective also reminds family
therapists that individuals may bring serious personal emotional problems into a
relationship and that pathology need not exist mysteriously only in the transactions
between people.
We present two approaches using object relations theory in family therapy.
First, however, we note an important concept used by object relations therapists when
working with individuals or families: the holding environment. Holding environment,
a phrase attributed to D. W. Winnicott, refers to the safe and nurturing environment
provided by the mother to her infant that supports good-enough psychological
development. The term also refers to a comparable environment that the therapist
seeks to create for the patient. In this “shared holding” space, the child (or individual
or family) may interact with the therapist for the sake of growth and/or healing.
Although the concept originated in object relations theory, it is accepted by most other
contemporary psychoanalytic perspectives.
James Framo (1981) stressed the relationship between the intrapsychic and the
interpersonal, offering an amalgam of psychodynamic and systems concepts. One of
the few psychologists in the early family therapy movement, he was affiliated first
with the Eastern Pennsylvania Psychiatric Institute (EPPI) in Philadelphia then had an
academic career at Temple University. For the last 20 years of his long career, ending
in his death in 2001, Framo was a teacher and practitioner in San Diego.
Among the founders of the family therapy movement, Framo is particularly
celebrated for his advocacy of couples groups. Maintaining an understanding of an
individual’s intrapsychic world, Framo nevertheless believed psychoanalytic theory
had not paid sufficient attention to the social context of a person’s life, particularly the
early crucial role played by family relationships in shaping individual behavior.
Framo refused to polarize the intrapsychic and the interactional, maintaining that both
are essential to understanding the dynamic aspects of family life. As he pointed out in
the introduction to a collection of his papers (Framo, 1982), his orientation to marital
and family theory and therapy emphasized “the psychology of intimate relationships,
the interlocking of multi-person motivational systems, the relationship between the
intrapsychic and the transactional, and the hidden transgenerational and historical
forces that exercise their powerful influences on current intimate relationships”.
Framo developed a set of intervention techniques that helped couples in
marital therapy deal with unresolved issues each partner brings to the marriage from
his or her family of origin. Framo believed that these intrapsychic conflicts continue
to be acted out or replicated with current intimates, such as a spouse or children.
Indeed, Framo (1981) contended that efforts at the interpersonal resolution of inner
conflict (e.g., harshly criticizing a spouse for failing to live up to one’s wildly
inappropriate expectations) are at the very heart of the kinds of distress found in
troubled couples and families.
Extrapolating from Fairbairn’s proposals regarding splitting, Framo (1976)
theorized that a young child who interprets parental behavior as rejection, desertion,
or persecution is in a dilemma; the child cannot give up or change the sought-after
object (the parents). Typically, the ensuing frustration is dealt with by internalizing
aspects of the “loved-hated” parents in order to control the objects in the child’s inner
world. According to Framo, the most powerful obstacle to change is people’s
attachments to their parental introjects. The more psychologically painful the early
life experience, the greater the investment in internal objects, the more an adult will
engage in an unconscious effort to make all close relationships fit the internal role
models. Framo drew from Fairbairn and Dicks to posit that people usually do not
select the partner they want; they get the one that they need. Each is drawn to
someone who recreates the childhood dream of unconditional love, but also is enough
like the bad inner object to allow old hatreds to be projected. According to Framo
“one’s current intimates, one’s spouse and children, are, in part, stand-ins for old
images, the embodiments of long-buried introjects.”
Framo’s unique contribution to family therapy technique was his process of
guiding a couple through several treatment stages: conjoint therapy; couples group
therapy; and, finally, family-of-origin (intergenerational) conferences. The couples
group, added soon after beginning treatment, allowed Framo to use many of the
positive aspects of group therapy, especially therapeutic feedback from other couples,
to assist his therapeutic efforts. It may be more enlightening and potent for a couple to
see its own interaction patterns acted out by another couple than to hear a therapist
merely comment on the same behavior. To Framo, the group experience also reduced
the individual’s resistance to the next stage of treatment, which involved bringing
family-of-origin members together. In a daring therapeutic maneuver, Framo (1992)
involved each individual (without the partner present) in sessions with his or her
family of origin (parents, brothers, and sisters). Here, Framo provided an opportunity
to clear up past misunderstandings or sources of chronic dissatisfaction directly with
family members. In some cases, misinterpretations based upon childhood
misperceptions could be straightened out. Clients were encouraged to present their
views, perhaps not aired before, but the session was not intended to be an opportunity
for indictment, blame, recrimination, or condemnation.
Often conducted with a co-therapist, family-of-origin sessions were usually
divided into two 2-hour sessions with a break in between (varying from several hours
to an overnight interruption). There were two major goals—to discover what issues or
agendas from the family of origin might be projected onto the current family and to
have a corrective experience with parents and siblings. Framo cogently reasoned that
if adults were able to go back and deal directly with both past and present issues with
their original families—in a sense, to come to terms with parents before they die—
then they would be liberated to make reconstructive changes in their present marriage
or family life. Usually held toward the end of therapy, family-of-origin conferences
enabled individuals to gain insight into the inappropriateness of old attachments, rid
themselves of “ghosts,” and respond to spouses and children as individuals in their
own right—not as figures on whom they project unresolved issues and introjects from
the past. As Framo (1992) warned, family-of-origin therapy may not change people’s
lives drastically, nor is it likely to fulfill all fantasies of what clients might get from
parents and siblings. However, it often has a restorative function, reconnecting family
members to one another, allowing participants to see one another as real people and
not simply in their family-assigned roles. Old rifts may be healed by more accurate
readings of one another’s intentions, or perhaps as past events are reinterpreted from
an adult perspective. The encounter provides a forum for forgiveness, compromise,
acceptance, and resolution.
According to the Scharffs, interpretation by the therapist in order to provide
insight is essential. While they oppose the blank-screen stance of classical
psychoanalysts, they do adopt a neutral stance of involved impartiality, helping
provide a shared holding environment,1 thus creating a therapeutic climate allowing
each family member to project onto the therapist his or her own unfinished problems
from the past. In contrast to the view that the therapist inevitably becomes a part of
the family system—the Scharffs believe they are able to remain outside the family
system, and in a position to offer comments on what is happening to them as well as
on what they observe taking place within the family. That is, the Scharffs make use of
the transference, which they view broadly as occurring between family members,
between each family member and the therapist, and between the family as a group and
the therapist.
This is an essential part of treatment, since the therapist’s neutrality evokes in
the therapeutic sessions an “object hunger”—a replay of infantile relating with
caretakers in the family of origin. At the same time, the therapist experiences
countertransference in responding to the family struggles, unconsciously evoking his
or her own internal struggles from the past. If sufficiently worked through in previous
personal analysis and training, and with supervision, this shared venture of object
relations may evoke greater empathy from the therapist with family vulnerabilities
and struggles. As David Scharff (1989) points out, in this way, object relations
therapists allow themselves to “be the substrate for a newly emerging understanding,
which they then feed back to the family in the form of interpretation”.
f. Kohut and Self Psychology
Heinz Kohut (1971, 1977), an American psychiatrist born and educated in
Vienna, was responsible for another major development in psychoanalysis. Kohut’s
disavowal of drive theory represents a more radical departure from Freudian theory
than the original object relations theorists, many of whom retained it in their
reformulations. Based on his work in analyzing patients with narcissistic personality
disorders—patients Freud considered unanalyzable because they were unable to
engage in a relationship (or establish a transference) with the analyst—Kohut
developed what he termed selfpsychology, a theory of psychoanalysis that emphasizes
the relationship between the self (the person’s personality core or center of initiatives)
and outside objects as the defining organizational principle of human life. Kohut
believed that changing family lifestyles and new family forms required reexamination
of Freudian theory. From his viewpoint, conflict within the person (and between
people) arises early in life from a compromised sense of self rather than from
instinctual conflict. Kohut focused specifically on how early relationships, especially
with the caretaker mother, are crucial in forming the child’s later sense of self and in
affecting how well that person can make and sustain relationships later in life.
Kohut contends that initially the infant does not experience its parents as
separate persons or objects but instead experiences them narcissistically as
selfobjects. Selfobject refers to a sense of oneself in relation to another that is needed
for the sustenance or enhancement of the self (Skelton et al., 2006, p. 423). A
selfobject is neither self nor object but the self-sustaining psychic function that takes
place within a self in its relationship to others (objects) who by their presence help
sustain and support the self’s sense of itself. The concept can be clarified by example.
An infant experiences her mother’s breast as something simultaneously part of herself
and as something alien depending on her needs at any given moment. Perhaps when
very hungry and feeding, the available breast is experienced as something
undifferentiated from the self, whereas when the infant is full, the breast might be
experienced as somehow other than self—at least until hunger returns. Kohut insisted
that throughout life, our self needs require a selfobject, and so from birth on we
unconsciously seek and form selfobject relationships.
In therapy, the selfobject is analyzed by exploring the selfobject transference,
which is co-created by both the client and the analyst. In Kohutian terms, the
selfobject transference is the transference formed by patient within which current
narcissistic needs are experienced and explored vis-a-vis the therapist. Unlike the
Freudian transference, which is intended to be “worked through,” the selfobject
transference is to be understood so that developmental needs can be met and goals
achieved. Developmentally, Kohut maintains that the infant does not yet have a self,
even if the parents think otherwise. That core self begins to emerge from interactions
with and responses from selfobjects. Ideally, young children start to develop a core
cohesive self when they experience two qualities from their attentive parents—
empathy (validating how they feel) and idealization of parents (being proud to have
good parents and to be part of them). As a result of internalizing parental appreciation,
the child forms an autonomous self, characterized by self-acceptance and self-esteem.
Such children are said by Kohut to have their needs mirrored by their parents and the
idealization met by satisfying interaction with parents who themselves feel self-
esteem. Children whose parents fail to demonstrate sufficient appreciation or
themselves have little self-esteem continue to crave admiring attention throughout
life.
Narcissism, then, is ever present, especially among infants and young children,
and represents a stage of development. It is not a pathological condition of self-
absorption but a necessary motivating organizer of development in which love of
selfprecedes love for others. All adults continue to have narcissistic needs they wish to
fulfill and continue to need the mirroring of the self by selfobjects throughout life (St.
Clair & Wigren, 2004). As Kohut (1971) notes, even as adults, seeking a connection
with someone who is unresponsive or indifferent often makes us feel empty, unloved,
with lowered self-esteem, and filled with narcissistic rage. By exploring “self needs”
by analyzing the selfobject transference, the therapist helps the client mitigate these
unpalatable “selfstates.”
Kohut (1971) contended that patients with narcissistic personality disorders
are experiencing a defect in the structure of the self, not having successfully
completed the integration of the grandiose self (what the child wants or believes he or
she deserves) and idealized object (what the idealized parents want him or her to do)
into a reality-oriented self. It is the job of the selfpsychologist to help the client
complete this integration. Kohut found that those who grow up feeling insufficiently
admired or attended to will seek such acceptance in exaggerated narcissistic cravings.
To the narcissistic adult, then, a selfobject is a person relatively more undifferentiated
from oneself who serves the needs of the self. He or she sees everyone as an extension
of self and as existing to serve the self. Within a marriage, he or she may continue to
search for the idealized partner—determined to be in control, rageful if not—forever
seeking merger with the unconditional availability of the mirroring selfobject or
idealized object.
The therapist often finds the necessary empathy to help narcissistic clients by
remembering the great pain and deprivation that led to this self state. A person whose
selfobject has helped her or him successfully bridge inner self states and the object
world can be said to have integrated narcissistic and object needs. In this instance,
narcissism is mitigated by an appreciation of others. Such a person, with healthy
narcissism with which to take care of inner needs, also appreciates the existence and
needs of others. For analysis to be effective, according to Kohut, the reactivation of
the original developmental tendencies must take place with the therapist. Persons with
disorders of the self must be both mirrored and permitted to idealize the authentic,
empathetic therapist so that both self and other may be appreciated. The term
mirroring denotes the acceptance (even celebration) by one person (parent or
therapist) of another person’s narcissistic self such that the person being mirrored may
experience self-acceptance. In therapy, the therapist can begin to develop within the
patient mirroring or idealizing transference. In the former, the client’s self is affirmed,
and through the latter, the client can reinforce that affirmation by appreciating via
idealization the specialness of the other. Once transference is established, therapist
interpretations provide the patient with insights into how to negotiate self needs with
the needs of others within the mutuality of a maturing relationship.
g. Intersubjective Psychoanalysis
Intersubjective theory originated in the United States during the 1990s and is
associated with the work of Robert D. Stolorow, Bernard Brandchaft, and George E.
Atwood. Intersubjectivity is sometimes considered synonymous with selfpsychology,
but while the two theories share some key ideas, there are important differences
between them. Both reject the concept of drives in favor of an emphasis on
relationships; both feature the analyst’s use of empathy and introspection as a guiding
principle of the therapy (Trop, 1994), as well as the co-construction of the client–
therapist relationship. Intersubjectivity departs from the self-psychological
assumption that analyst and patient are separate psychic entities even while
appreciating the importance and inevitability of the patient’s selfobject and selfobject
transferences.
Whereas the traditional selfpsychologist will eventually interpret the patient’s
selfobject transferences with the goal of helping him gain an enhanced sense of an
independent self that can relate to others, the intersubjective analyst appreciates that
every interaction, whether between child and parent or client and therapist, takes form
within an intersubjective field. The intersubjective field (or matrix) represents a
dynamic psychological system made up of the reciprocally interacting and differently
organized subjective worlds of parent and child (or client and therapist).
Within the intersubjective field, two subjectivities meet and engage with each
other. The recurrent patterns of intersubjective transaction between the two (say the
child and the mother or the client and the analyst) result in the establishment of
organizing principles that unconsciously pattern subsequent experiences.
Intersubjective psychoanalytic therapy seeks to investigate and illuminate these
previously established organizing patterns and establish the possibility of new ones.
Leone (2008) integrates these basic intersubjective concepts within couple therapy.
She illustrates how selfobject needs, unconscious organizing principles, and learned
relational patterns can be used to conceptualize couples’ difficulties. She elaborates a
treatment approach that involves (a) listening from within each partner’s subjective
perspective; (b) establishing a therapeutic dialogue through which each partner’s
selfobject needs, ways of organizing experience, and patterns of relating can be
empathically illuminated and transformed; and (c) facilitating new relational
experiences with the therapist and eventually between the partners themselves.
Livingston (2004) adds that the intersubjective model, with its emphasis on a
person’s subjective/affective experiences and on the experience of increasing
vulnerability during therapy, invites the processing of previously unexpressed painful
affect for couples. As one partner speaks about a painful concern, for example, the
other may react with a selfprotective response. The therapist continually strives to be
attuned to each partner’s shifting self/affective states as they emerge during a session.
The therapist legitimizes each partner’s fears and desires and at the same time reminds
each that their respective responses triggered protective or impatient reactions in the
other. With the support of the therapist’s sustained empathy, each partner may develop
an increased capacity for affect regulation and a strengthened psychic structure.
Healing is seen as the outcome of processing intersubjective differences and ruptures
that occur during therapy and the resulting deepening of intimacy of both partners.
h. Relational Psychoanalysis
From its inception, psychoanalysis has been concerned with human
relatedness (Mitchell, 2000), although the focus during analysis or therapy remained
on the patient and his or her inner world. However, some theorists and practitioners
took a divergent path, most notably in Europe the Hungarian psychoanalyst and one-
time confident of Freud, Sandor Ferenczi, and in the United States, Harry Stack
Sullivan. Ferenczi thought differently than Freud and even went so far as to
experiment in mutual analyses, whereby the patient and the analyst analyzed each
other. This approach to the analytic experience was so renegade that it contributed to
the end of Ferenczi’s friendship with Freud.
As a result, his idea of the mutuality of the psychoanalytic relationship went
underground for decades. In the United States, Harry Stack Sullivan and others wrote
about the impact of the external world on a developing psyche. Without entirely
abandoning drive theory, these early “interpersonalists” tended to address the
relationship between outside events and personal relationships and a patient’s inner
world. But again, traditionalists of the time rejected this shift in emphasis, and these
ideas remained marginalized for years.
Today some theorists who appreciate the mutual relationship of therapist and
patient in the therapeutic encounter refer to this as two-person psychology (Wachtel,
2010). Greenberg and Mitchell first coined the term relational in their efforts to
synthesize British object relations with the interpersonalists (Greenberg & Mitchell,
1983). This two-person psychology takes place within the largely unconscious
intersubjective field noted by the intersubjectivists. Relational psychoanalysis
involves the mutual impact of external, interpersonal, or social relations, internal
relations among persons, varied self-states, and object relations (Skelton, 2006).
Within this intersubjective field, the older concept of analyst as outside authority
gives way to one in which both analyst and patient are equals whoLparticipate equally.
They experience a “meeting of the minds,” resulting in a unique “co-constructed”
psychic experience that can lead to healing (Aron, 1996) for both. An analysis, then,
becomes not the analyst’s encounter of the patient’s theoretically separate psyche so
much as the occasion for two minds to meet and mutually influence each other in
unique and manifold conscious and unconscious ways. Whereas most analysts today
do not go as far as Ferenczi in engaging in mutual analysis, relational analysts do
include selective self-disclosure in their approach to technique.
Presumably, the analyst, having already been analyzed, is more likely than the
patient to become aware of the resulting unconscious constructions that emerge during
the therapeutic work and can help make those constructions available to both parties
by giving them language. Very often these mutual interactions require that the analyst
divulge personal information to the patient. For most of the history of psychoanalytic
technique, the analyst was advised to remain neutral—to be a blank screen—so as to
allow the patient’s transference to unfold with relative freedom. To divulge personal
information was regarded as a countertransference error that unconsciously and
unhelpfully gratified the patient’s infantile wishes.
Relational psychoanalysis rejects the blank screen metaphor as reflecting a
naive assumption that the analyst could ever be truly separate. Under the right
circumstances, for example, an experienced relational therapist might say to a
narcissistic client something like, “You know when you go on and on about yourself, I
feel left out and unimportant to you. I wonder if that is how your wife feels when she
tells you how lonely she feels.” As in every therapeutic intervention, there is always
some risk (in this case, the therapist should be aware that the statement is in the
service of the therapy rather than a sadistic impulse of her own). In this example, a
client who does value his therapist might benefit from learning that he has had an
impact on her and that something within him needs to be examined. The relationship
between the two in the here and now in which both parties are sharing how they feel
would be seen as central to the client’s growth.
According to Perlman and Frankel (2009, p. 108), a “cornerstone of all
relational theory is the premise that human beings are born with a primary need for
relatedness and communication with other human beings.” The self is shaped through
our interactions with others. This is an important point of contact with systems theory.
Gerson (2010) takes this understanding of analysis into her work as a family therapist.
Although she acknowledges the transference-countertransference dimensions of
couple or family work, she leaves behind the traditional dyadic nature of these forces
and posits a more circular one. Rather than exploring individual histories and opening
hidden fantasies, as she might when working with an individual, in couples work she
strives to disrupt circular—that is, repetitive—dynamically constituted problems by
taking a more playful and less interpretive position.
Whereas the Scharffs argue for a more traditional separation of therapist from
clients, Gerson uses herself to hold the couple’s dynamic processes and “plays” with
them in ways that may be tolerably disruptive to old patterns. From a relational
perspective, she appreciates that her work with couples is indeed co-created, but she
doesn’t use this awareness to enhance individual introspection. Rather, by placing her
analytic knowledge in the background and moving her systems knowledge to the
foreground, she interacts more directly and playfully (through the use of metaphor,
visual imagery, dramatic enactments, and so on).
For more than 100 years, psychoanalytic theory and practice have changed in
far-reaching ways. No longer just concerned with the inner life of the patient as the
sole target of inquiry, psychoanalytic theory embraces the patient, the world in which
the patient was born and developed, the patient’s current family and significant
relationships, as well as the patient’s relationship with the therapist. Although
conceptualized in many ways, relationships now stand at the center of the work for
most psychoanalysts. This increased emphasis opens new ways of applying analysis
to couple and family therapy.
Indeed, despite the evolution of psychoanalytic theory and practice over time,
certain core principles and techniques remain foundational to the psychoanalytic
approach. These enduring elements serve as the bedrock of psychoanalytic therapy,
providing a framework for understanding the intricacies of human experience and
promoting therapeutic growth and insight.
At the heart of psychoanalytic practice lies a steadfast commitment to
exploring unconscious processes, which are believed to exert a powerful influence on
thoughts, feelings, and behavior. Through careful and patient listening to the client's
associations and free associations, therapists aim to uncover hidden conflicts, desires,
and fears that may be operating outside of conscious awareness. By bringing these
unconscious dynamics into conscious awareness, psychoanalytic therapy seeks to
promote self-understanding and facilitate meaningful change.
Moreover, psychoanalytic therapy places a strong emphasis on the dialectic
between fantasy and reality, recognizing the interplay between internal psychic
structures and external reality in shaping individual experience. Clients are
encouraged to explore their fantasies, dreams, and unconscious desires within the
context of their lived experiences, allowing for a deeper understanding of how
internal and external realities intersect and influence one another.
Central to the psychoanalytic process is the concept of transference, which
refers to the client's feelings, attitudes, and perceptions toward the therapist that are
unconsciously transferred from past relationships onto the therapeutic relationship. By
examining and working through transference reactions, clients can gain insight into
their interpersonal patterns and relational dynamics, fostering greater self-awareness
and emotional growth.
Additionally, psychoanalytic therapy addresses the psychological resistances
that clients may encounter when confronting uncomfortable thoughts or feelings.
These resistances, which manifest as defense mechanisms and avoidance strategies,
serve to protect the individual from experiencing distressing emotions or confronting
painful truths. Through the therapeutic process, clients are supported in exploring and
overcoming these resistances, allowing for deeper exploration and resolution of
underlying conflicts and issues.
Despite the evolving landscape of mental health care and the proliferation of
diverse therapeutic approaches, psychoanalysis retains its relevance and appeal for
many individuals seeking a deeper understanding of themselves and their
relationships. Its emphasis on unconscious processes, careful listening, attention to
transference, and exploration of psychological resistances continues to offer a unique
and valuable perspective on the complexities of human experience and the journey
toward self-discovery and healing.
In conclusion, while psychoanalysis has undergone significant changes and
adaptations over time, certain core principles and techniques endure as essential
components of psychoanalytic therapy. By honoring these foundational elements and
integrating them with contemporary insights and innovations, psychoanalytic
therapists can continue to offer clients a rich and transformative therapeutic
experience grounded in deep exploration, insight, and self-awareness.
