Couple Psychotherapy – New Directions How fresh and innovative approaches to many human conditions can challenge ‘silo’ thinking and practice. After more than 70 years of the ‘Tavistock approach’ to psychotherapeutic work with couples, what does it mean to claim to offer ‘new directions’? Over this time, the organisation has contributed to the conceptual, clinical, and technical development of couple psychoanalytic psychotherapy, advancing the evolution of the field. What, though, makes this our approach any different from the scores of others on psychotherapy that you might invest your time in exploring? Why be interested in ‘engaging couples’? Alongside the development of couple psychotherapy, Tavistock Relationships has established a plurality of new approaches, reaching people who, historically, have not had access to such psychological help. Consider, for a moment, how much our systems of health and social care are focussed on the individual in isolation. If you think about it, this holds true right across the lifespan: from maternity services that rarely include the parental couple as the locus of care, to services for people with long term conditions, such as dementia, that focus on the individual patient alone, without considering their partner or family who are living with the realities of chronic illness alongside them. Our approach is to challenge the silos in our human services that this ‘atomized’ focus gives rise to. These are evident in the chasm that exists between child and adult mental health care, they contribute to the neglect of our relationships in treating illness and depression, and they limit opportunities to strengthen the relational environment of the older couple at one end of the lifespan and of children at the other. We have explored new ways of approaching some of the key issues of contemporary family life, including depression, living with long-term conditions, inter-parental conflict and domestic abuse to name but a few, refracting them through a lens that sees our relationships as fundamental to the fabric of our lives – the most important social capital of all. Such ‘new’ approaches are about developing established therapeutic models to fit different circumstances, tackling some of the problems of our modern world from fresh angles. Previous generations of colleagues did radical things, and close study of the innovative thinking of our analytic forbears can be humbling. In advocating a wide ‘family’ of approaches, we need to recognise that some ‘children’ will resemble their ‘parents’ more obviously than others; that the next generation, whilst sharing the same genes, will also be different. To pursue this metaphor, it is true that, after all, offspring are their own people, responding and adapting to the circumstances of their generation. That said, their capacity to make use of what is of value from parental figures will strengthen and enable them to adapt to the unique features of their lives. At the heart of the psychoanalytic model is the recognition that we are not free agents, making conscious choices about what we will do and how we shall be; rather, we are driven by unconscious forces. Modern neuroscience confirms just how much of our minds remain outside conscious awareness: brain changes can be detected that show the movement of the body towards a particular goal before we have any conscious awareness of having ‘decided’ to perform that action. This is a picture of our minds as driven by a significant degree of unconscious determinism, challenging popular beliefs around conscious free-will. In his book A Children’s History of the World, EH Gombrich uses the image of a lighted taper falling down the well of human history, illuminating as it falls different layers of the past, plunging downwards into deeper strata, until finally going out, consumed by darkness as by an infinite regress of time. This image could be extended to the human mind, whose area of depth is in the layers of our minds that we are consciously unaware of but which nevertheless exert their influence on our everyday lives. These influences can be discerned, perhaps most of all, in the ways in which we find ourselves repeating familiar, sometimes destructive, patterns of behaviour with others, and especially with those who are closest to us. Curiosity about ourselves, and the wish to understand and find meaning in our lives, may represent a fundamental human need that drives our potential for growth and emotional development and our striving to find ways of living better, more meaningful lives. This is not the exclusive preserve of psychotherapy or therapists. However, because so much is outside our conscious awareness, our attempts to make sense of our feelings and behaviour are at times defeated and we may be in need of help to extend our understanding of ourselves and others. It can be painful, sometimes threatening, to seek such understanding, to think about our motivations, the sources of our actions and behaviour. Such curiosity or thinking can be defended against and denied. Yet, the psychotherapeutic approach suggests that the act of seeking to understand and of feeling ourselves understood can itself be therapeutic and lead to change, offering an enlargement of the area in our minds where we have some choice or freewill in terms of what we think, do and feel in our closest relationships, and so to be less driven by unconscious enactments and defeating patterns of behaviour. In a world of competing models of psychological therapy, where the success of one can threaten the extinction of others, it can be difficult to make space for a plurality of approaches. Under such conditions of competition it can be difficult to retain a mind that is open to seeing similarities and recognising differences where they exist. Such struggles are familiar to all of us in our relationships, as couple therapists know from their daily work. Such conflicts are also played out within services, where competition over resources is the order of the day. At the risk of joining the clamour of competing voices for the merits of one therapeutic modality over another, we notice, using examples from diverse settings, how the couple relationship offers a uniquely important locus of intervention. It is the site for the inter-generational transmission of mental health and should be at the forefront of our therapeutic efforts, at the centre of thinking in health and social care, throughout the lifespan, from cradle to grave. ‘Our latest book, Engaging Couples: New Directions in Therapeutic work with Families, (ed. Andrew Balfour, Christopher Clulow and Kate Thompson) explores new innovative treatments, developed and trialled at Tavistock Relationships, such as using Mentalization-based techniques with severely conflicted couples; short term models for those couples struggling with the pressures associated with adoption; brief interventions for couples wanting to separate, alongside treatments that integrate behavioural and cognitive therapies with more psychodynamic approaches when working with depression, to name but a few. The book’s message is that research and clinical evidence is now clear - intervening to help couples offers a chance to free the adults involved from damaging, repetitive cycles and the possibility of transforming the psychological inheritance of future generations. Kate Thompson, www.TavistockRelationships.org Contains extracts from Engaging Couples: New Directions in Therapeutic work with Families, (ed. Andrew Balfour, Christopher Clulow and Kate Thompson), Routledge 2018.