There are many ways to work with couples. Here, John Turtz, Ph.D., outlines an integration of psychoanalytic treatment with systems theory, and the long and winding path that led him to this approach.

 

Life contains but two tragedies. One is not to get your heart’s desire; the other is to get it.

-George Bernard Shaw

 

Imagine an actor on a stage with a small spotlight shining only on him. Picture him moving his arms and legs wildly and unpredictably. We likely think this individual is acting rather strange. Now, as more stage lights turn on and the rest of the space is illuminated, you see other actors holding strings attached to the arms and legs of the actor in the spotlight. These actors are pulling the strings, generating those strange arm and leg movements that seemed so inexplicable moments before.

This image, given to me by an early supervisor, is a metaphor for broadening the site of pathology, a key concept from a systems perspective. Systems theory broadens the site of pathology from inside one human being to the complex interaction of the larger system in which that individual is embedded.

Working with couples inevitably involves thinking from a systems perspective. I believe that an integration of systems theory with a psychoanalytic perspective greatly enriches one’s work with couples – and individuals, too. In my early training, I struggled with how to integrate various theoretical orientations, as they appeared to carry conflicting underlying philosophical assumptions. Simultaneously steeped in existential therapy, family systems theory, and psychoanalytic psychotherapy, I had many questions: Is it more therapeutic to focus on the intrapsychic or the interpersonal? The past or the present? Should I be directive or non-directive? Is insight necessary for change? Clearly, I had more questions than answers. Today, I do not see these orientations in such stark contrast as I once did. What follows are some of my reflections on how these different perspectives can be integrated.

Erich Fromm (1947), one of the founders of interpersonal psychoanalysis who was very influenced by existentialism, believed that in order to understand human beings one needs to have a deep understanding of the human situation. Human beings are a part of nature, but because of reason, imagination, and self-awareness, we are also set apart from nature. This dichotomy, represented by the fall of Adam and Eve and their eviction from harmonious paradise, can never be fully resolved. This split leads to existential dichotomies innate to the human condition; life versus death, for example, or separation versus merger in that we are all simultaneously alone and related. This dichotomy plays out in all couples. There are no easy solutions to these existential problems, though Fromm (1956) writes, “Love is the only sane and satisfactory answer to the problem of human existence” (pp. 111-112). From Fromm’s perspective, finding a way to cultivate love is finding a way to live.

The emphasis in systems theory is upon wholeness and relationship. Wholeness refers to the whole being more than the sum of its parts, and relationship refers to how elements of a system interact with one another. With couples, content may change, but the underlying structure and the form which the patterns of interaction take persist. Consider the concept of first and second order change (Watzlawick, Weakland, and Fisch, 1974): While first order change makes no impact on the underlying structure of the system – think of the adage, “The more things change, the more they stay the same” – second order change qualitatively impacts the system’s fundamental structure.

Imagine the following scenario: A husband and wife enter your office. The wife begins the session complaining about her husband’s unavailability. The husband, appearing worn down and withdrawn, retaliates by claiming that his wife is always nagging and criticizing him. Both locate the pathology inside the other, and may even make some insightful interpretations about the other. Both, in fact, may be experts in the other’s emotional issues, but relatively blind to their own dynamics and role in the dance between them.

This is a prototypical example of the pursuer-distancer pattern, in which one member of a couple tends to pursue and the other tends to distance. From a first order change perspective, a lot of change can occur without in any way affecting the underlying structure of the system. For example, the husband could intensify his withdrawal behavior; this would lead to a change in intensity, but would not at all change the underlying structure of their relationship.

From within the system, second order change appears to be illogical. With this particular couple, each needs to do less of the same in order to induce a second order change, but from their individual perspectives, each needs to do more of the same because what each is doing thus far is not working. If the husband/distancer lessens his withdrawal, the wife/pursuer will not feel such an intense need to pursue. If the wife/pursuer lessens the intensity of the pursuit, the husband/distancer will feel less of a need to distance. But again, from within the system, doing less of the same feels illogical, thus the need for the therapist to make a dent in this very tight system. The therapist is the third figure in the now-expanded system; the therapist cannot not impact the system because he or she is now part of that system and the vehicle for change.

Where does psychoanalytic theory fit in? Irwin Hirsch, one of the founders of MIP, has written about unconscious processes from the perspective of contemporary interpersonal psychoanalysis. He highlights the dissociative model of the unconscious in contrast to the more traditional repression model which emphasizes the repression of unacceptable memories and their associated affects, experiences that were at one time able to be formulated but, as a result of their toxicity, were buried. Dissociated experience, on the other hand, was never formulated in the first place. It consists of internalized patterns of self-other configurations that develop implicitly through repeated interactions and never reach the level of conscious self-awareness. These internalized patterns that developed from past experience are then unwittingly reenacted in current relationships. Understanding unconscious process from a contemporary interpersonal perspective helps me to become aware of what is implicitly and unwittingly enacted between partners in a couples session. Seeing the couple through this lens helps me to deepen and enrich my work with them. I tend to address these issues in a very direct and straightforward manner, shying away from more strategic and paradoxical interventions.

From a two-person psychology with an emphasis on the dissociative model of unconscious processes, the giant chasm between psychoanalytic and systems theory diminishes greatly in size. As the preeminent interpersonal psychoanalyst Edgar Levenson (1982) stated, “I would prefer to see the therapeutic leverage as lying in the resolution of a redundant interaction with a great deal of homeostatic power” (p.11). Here is a psychoanalyst speaking in the same language as a systems therapist. Remember, any particular theory is only a worldview, not an absolute truth. I find that my work with couples is greatly enhanced by integrating psychoanalytic and systems thinking rather than rigidly adhering to either theory alone. The two theories together tend to intermingle and coalesce in a manner that is much more than the sum of their parts.

 

Interested in couples therapy? Join John Turtz for his upcoming seminar, “It Takes Two to Tango,” Thursdays, October 25 and November 1, 1-2:30 pm on the Upper West Side.

$90; $75 for candidates
3 CEUs for NYS social workers

Learn more and register HERE

 

John Turtz, Ph.D., is faculty, supervisor and former co-director at the Manhattan Institute for Psychoanalysis. He is teaching and supervisory faculty at the Westchester Center for the Study of Psychoanalysis and Psychotherapy, where he is currently director of the Couples Therapy Program and was former co-director of the Psychotherapy Training Program. He is in private practice in Manhattan and Larchmont.

 

References

Fromm, E. (1947). Man for Himself: An Inquiry into the Psychology of Ethics. New York: Harper & Row, Publishers.

Fromm, E. (1956). The Art of Loving. New York: Harper & Row, Publishers.

Levenson, E. (1982). Follow the Fox – An Inquiry Into the Vicissitudes of Psychoanalytic Supervision.  Contemporary Psychoanalysis, 18: 1-15.

Watzlawick, P., Weakland, J. H., and Fisch, R. (1974). Change: Principles of Problem Formation and Problem Resolution. New York: W. W. Norton & Company.

 

If you enjoyed this post, we recommend:
The Whole is Greater than the Sum of Its Parts: The Complexity of Couple Therapy by Wendy Greenspun, Ph.D.