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The Effectiveness of Couple Therapy
Our study shows improvments in relationships and mental health

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An extract released from our book, Engaging Couples, talking about our approach to couples therapy

by Andrew Balfour and Mary Morgan

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You can read here an exclusive excerpt from our 70th Anniversary book Engaging Couples: New Directions in Therapeutic work with Families that lays out how we approach the technique of helping couples with our therapy.

Being a couple: psychoanalytic perspectives

At first sight this may seem an extravagant claim, but we hope that, as you read on, you too will come to feel that a psychoanalytically-informed approach to working with couples offers a way of understanding some of the core mysteries of our lives.

What draws us together to form couples? Why do we choose this person, rather than that person as a partner? Why do we get stuck in familiar, unhappy patterns of experience in our closest relationships? How may these patterns replay early conflicts in our lives? How might we unconsciously repeat core emotional problems, passing them on, unwittingly, to the next generation? These questions, and others, will be explored in this chapter, which is divided into two parts. The first will outline what we know about couple relationships, taking the reader through the key ideas about how couple relationships work. The second describes how these ideas are translated into the model of couple psychotherapy that has been developed and is currently practised at Tavistock Relationships.

The questions we have raised are ones that we all might wonder about. They have been around since the inception of Tavistock Relationships 70 years ago and they continue to preoccupy the minds of clinicians and writers to this day. In post-war Britain it was recognised that families needed support, both material and psychological. It became clear, and has been further established since, that the couple relationship is at the centre of family life; what today we might call a ‘creative couple relationship’ provides the conditions in which children thrive (see Chapter 2). The early work of Tavistock Relationships also showed that an enduring intimate couple relationship could provide the conditions in which each partner can continue to grow psychologically.

An attitude of curiosity or research mindedness has always been central in the clinicians at Tavistock Relationships. In order to help couples, it is necessary to understand the couple relationship, and the early therapists, while offering ‘family casework’ to the couples they saw, also learnt from them, drawing on psychoanalysis and developing a model of theory and practice that today has a national and international influence (see Morgan, in press).

So, what have we discovered over the last 70 years about the couple relationship? And do we have a model of psychotherapy that is effective in helping couples?

What have we learnt about the couple?

  • We are drawn together for unconscious as well as conscious reasons, and the relationship we establish can be developmental and defensive.
  • We need intimacy, but what this means to each couple can be very varied.
  • For a relationship to develop there needs to be a capacity to tolerate separateness and difference, as well as closeness and intimacy.
  • Love, hate and curiosity are all intrinsic to a relationship.
  • We need to relinquish an idealised ‘in love’ state and move to a more reality-based relationship to enable a deeper, enduring love.
  • Couple relationships can provide the conditions in which individual partners, separately and together, continue to grow and develop.

Couples are drawn together for unconscious as well as conscious reasons

This was one of the early discoveries of Tavistock Relationships clinicians. They observed that each partner, disowning parts of the self with which they were not comfortable, could ‘find’ and recognise these disavowed aspects of themselves in the other. This is like an unconscious version of the idea that opposites attract – whereby one partner, at an unconscious level, selects another who has a capacity for feelings that they find difficult to know about in themselves. Why would this be an attraction? The early pioneers in this field realised that one of the opportunities that the adult intimate relationship provided was that, within the safety of the relationship, it was possible to make contact again with these lost (‘split off’) parts of the self. Someone ill at ease or even frightened of their more aggressive or assertive self, for example, might be attracted to this denied part of themselves in the partner they chose. Over time, it may be possible to ‘get to know’ this part of the self, lived with in the other, and eventually, as it becomes experienced as less threatening, to ‘take it back’ into the personality. In this way, the individual develops and becomes more whole by virtue of this opportunity provided by the relationship. Importantly, there is an idea of complementarity to such unconscious partner choice, such that there is a ‘fit’ between the partners whereby each recognises in the other their capacity to hold and express feelings that they find difficult to encompass, or know about, in themselves. In the example just given the other partner may be afraid of vulnerability and over time, as it is expressed in the relationship by their partner, find this less frightening so that gradually it can be brought back into the self.

The early clinicians also encountered many relationships that were not working positively in this way. The partners were drawn together for similar reasons but, instead of the other partner containing the troubling part of the self, the other who was carrying a ‘double dose’ (both their own feelings as well as the extra ‘dose’ of their partner’s feelings too) exaggerated that part of the self, making it more, not less frightening. The couple then present in a polarised way, one partner carrying, for example, an excess of aggression, the other an excess of vulnerable feelings. Each partner remains frightened of this troubling part of the self and cannot take it back, so the need for the other to carry it is further intensified. Understanding this kind of defensive arrangement threw light on why some couples were very unhappy together but could not separate. In a situation such as this, where each partner is holding aspects of the other’s self, the couple are ‘joined together’ in a psychological system. Whilst this may be experienced as unhappy, any movement towards separation threatens the emotional equilibrium on which each individual has relied. Often, this is the presenting situation of couples seeking help for relationships in which they and their children are suffering, where greater closeness and intimacy cannot be tolerated nor can the partners separate and move on in their lives.

A couple’s need for intimacy

Being part of a couple requires intimacy, and for most a sexual relationship; for some it involves discovering and expressing their sexuality. Couple relationships provide the conditions for intimacy that are different from a mother–baby intimacy or intimacy between friends, but this can be hard for a couple to negotiate and maintain.

Sex, we are discovering, is a complex thing. Many couples have a good, exciting sexual relationship at the beginning but it changes over time. Others have problems from the outset, with painful sex, loss of erections, premature ejaculation or different levels of sexual desire. Having children usually means less time and energy for sex, and often when the children are older and making fewer demands and there is more time for sex, desire has diminished or even disappeared. Recent ideas suggest that part of sexual excitement is to do with having our own sexuality discovered and elaborated by another (Target, 2007), but with the familiarity of a long-term partnership it can be difficult for desire to be maintained, and there is a significant body of literature on this important area (see Benioff 2017; Clulow, 2009, 2017). Ageing also brings challenges for the couple’s sexual and emotional life together, with changing bodies and health requiring adjustments that can be difficult to make. For some, the capacity to adjust to losses and functional limitations enables them to sustain intimacy into old age (Balfour, 2009). They are more accepting of such changes and maintain a satisfactory sexual relationship, even if it may not be felt to be as exciting as it once was. For others, these changes are threatening to the relationship and to the sense of self: the need to feel desired and to be sexually potent feels central to who they are. If these changes cannot be managed in the relationship, either partner may seek sexual validation outside it.

We know sexualities to be complex too. While the most common sexual orientations are heterosexual, bi-sexual, gay and lesbian and transsexual, there are other ways people experience their sexuality, for example pansexual or polyamorous. Others reject the idea of gender as binary, choosing not to be identified as masculine or feminine. Sexuality is also fluid, someone may feel themselves to be heterosexual yet after several years of married life meet someone of the same gender and discover or develop their same sex orientation, or move between more than one sexual orientation. It is easy to draw distinctions between couples with different sexualities, such as heterosexual or same sex couples, but within any couple the way they express and live out their sexuality is not only unique but also can be challenging for the couple.

Interested in finding out more?

The book can be purchased at Karnac Books

How do I take a training in couple work? To find out more vist our training page.

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