COUPLES THERAPY

COLLABORATIVE PSYCHOANALYTIC COUPLES THERAPY

(THE DOUBLE CONJOINT SESSION)

Victor Bloom MD

Shirley I. Dobie-Bloom PhD

After many years of working with couples, individually and in groups, including conjoint sessions, the authors created a method which has proved quite efficaceous. We have felt for a long time that the best way to treat people in marital difficulty is individually, in analytic therapy. That is the best way to get at the underlying conflicts, transferences and defense mechanisms of the individual, which stand in the way of adaptive communication and intimacy. The individual therapy for each member of the marital pair includes one or more face to face sessions a week, plus participation in a weekly analytic group, including other patients in psychoanalytic psychotherapy.

The combination of individual and group therapy exposes repressed conflictual neurotic material which is worked through in individual and group sessions. The group sessions are particularly useful for the individual to compare his or her marital relationship with those of others. In this way, troublesome transferences are exposed and highlighted and the endless array of distancing mechanisms are detected and examined as to their adverse consequences for the relationship. The interpretations to the group as a whole include the ubiquitous fear of vulnerability in intimacy and the comfort obtained by the achievement of distance. At the same time, paradoxically, this defensive distance leads to feelings of rejection, deprivation, abandonment and frustration, and recreates the childhood feelings of aloneness and separation-anxiety. These feelings in turn lead to feelings of depression, loss of self-esteem, anger and insecurity. Also in turn, these painful emotions lead to further distancing and a vicious cycle of distancing, which can destroy a marriage.

It is common for couples to initially blame the other for the trouble in the marriage. Our experience leads us to say without fear of contradiction that for the most part the blame or attribution is pretty much 50-50. However, it is therapeutic to point out that each person is responsible for 100% of their 50%. Each member of the marital pair must assume responsibility for his or her role in the difficulty. Each member participates in 'the dance of intimacy' and obtains unconscious gratification thereby. There is also a feeling of safety in distance.

We are psychotherapists with separate practices, but sometimes it works out that one of us has the husband in treatment and the other the wife, and vice-versa. In cases where the married couple is committed to try to preserve and improve the relationship, they give us permission to communicate with each other about the marital (interpersonal) dynamics. In this way we are able to discover the intrapsychic dynamics and behavioral mechanisms which are evident in the one person and omitted or avoided in the reports of the other. This provides each therapist with comprehensive information not immediately accessible to the other. This information must be used judiciously and tactfully, tentatively and empathically. This exchange of information increases the rate at which insight is obtained, assimilated and utilized. When one therapist can communicate with the other about the interpersonal dynamics of each patient of the marital pair, it is quickly determined whether the insights are being utilized in a productive manner, and thereby, avoidance of communication and intimacy can be readily explored as it comes up.

Furthermore, this newly-created mini-group of four, the two therapists and the two patients, creates a unique modality for empathic interpretation. Each patient in individual therapy learned to free-associate in an atmosphere of safety and security. At the same time, each patient gets to see his or her spouse empathically understood and sensitively treated. This observation of the therapeutic working-alliance of the other, can be internalized into the self, and made a basis for further empathic understanding of the other at home, instead of the bickering, blaming and fighting which was the manifest content of the troubled marriage. Each patient gets a better perspective of the other's resistance to change, and thereby one's own resistance to change.

It is well known that due to characterological resistance, progress for some couples is quite slow, despite the fact that incremental change over years is quite steady. As Freud described many years ago in "Turnings in the Ways of Psychoanalytic-Therapy", with each gain, new resistance sets in, making further work on a deeper level more and more difficult. For those couples seeking ultimate psychoanalytic benefit, these characterological resistances, leading to renewed interpersonal distance after each exposure to intimacy, can readily be analyzed by periodic conjoint sessions with both analysts in attendance. I call these, for lack of a better name, "double conjoint sessions".

One couple asked for a 'retreat' of two three-hour sessions in a day, and another scheduled ten three hour sessions in a year. These mini-marathons allowed us to share observations and insights in a concentrated way and also enabled both therapists to observe the couple in action. We could thereby observe the gains in openness of communication and intimacy, and also the points where distancing occured, and in this modality, each member of the couple had the opportunity to be empathically interpretive to the other, not relying solely on the therapists for interpretation. The therapists, in their relating to each other in the double-conjoint session, were models for good communication, which is reality-based and maturational, as well as empathic.

The many years of free-associating individually and in groups enable each member of the couple to free-associate to each other, and as in therapy sessions, this openness must be dealt with tactfully and sensitively. Such communication between members of the marital pair is encouraged by the therapists, with advice on how best to go about it.

In these sessions it is possible to explore conflictual difficulties in the sexual relationship, and we have an opportunity to see how episodes of sexual intimacy may lead to fear, guilt and further distancing. It is usual that interpretations to one apply to the other as well, and so each sees how the other is vulnerable and fearful from too much closeness, how it is a mutual problem and no one can or should be blamed.

We have observed over time, employing these techniques in an otherwise traditional psychoanalytic conceptual framework, a deepening of the marital relationship and a strengthening of the commitment toward each other which comes from self-insight and insight into the other on a deep level. The improved marital relationship usually is accompanied by an enhanced quality of parenting and success in respective careers, whether it be in the business world or the domestic world.

The double conjoint session of two members of a marital pair and their therapists, who communicate and know each other's individual and interpersonal dynamics from longterm individual and group work provides the ultimate opportunity for couples to find fulfillment in both love and work, to grow separately and together in marital happiness and fulfillment.

Dr. Bloom is Clinical Associate Professor, Department of Psychiatry, Wayne State University School of Medicine and in private practice in Grosse Pointe Park.

Dr. Dobie is Adjunct Clinical Associate Professor, Department of Psychology, Wayne State University and in private practice in Grosse Pointe Park.

1007 Three Mile Drive

Grosse Pointe Park MI 48230

(313) 882-8640

vbloom@comcast.net