Focus on Families, Couples and Groups: Archive

COLUMN TWO

Hello couple, family and group therapists, and welcome to the second eForum column devoted to our specialties! For anyone who missed the first one, "Focus on Families, Couples and Groups" is a new recurring column addressing the application of self psychology to family, couple and group therapy. The goal of the column is to help members of IAPSP who work in these modalities to share news and ideas and connect with each other between conferences.

As I indicated last time, my plan at this point is for the column to include the following:

1. Member news or announcements relevant to self psychologically-oriented couple, family and group therapy, such as upcoming workshops, publications, book suggestions, etc.
2. Brief articles, essays or case studies related to the application of self psychology to these modalities - approximately 500 - 800 words
3. Reviews of relevant books or other publications of interest - about 500 words

Any other ideas for what might be included are most welcome and encouraged, as are submissions of any of the above. Please send them to me at: .

Member News and Announcements

Allan Gelber, Ph.D., Chair of the Arizona Psychoanalytic Self Psychology Association, presented at the annual conference of the American Group Psychotherapy Association in San Diego in February of 2010. He discussed principles of complexity theory as represented in abstract impressionism and expressionism and their relationship to self psychology and intersubjectivity theory. The workshop included clinical examples and a 40 minute process group, followed by a discussion of the group's process from various perspectives. (Editor's note: Allan's description made me wish we could do something similar at one of our conferences: a process group followed by a discussion of the group's process from various perspectives. Anyone interested in chairing, participating as a member of the process group or attending such a workshop? - Carla)

Former member Marty Livingston, Ph.D., who has written and presented extensively on the application of self psychology to couple and group therapy, has just published his first novel! Marty describes the book, entitled "Searching," as " a tale of early family trauma and the ensuing struggle in search of self. It involves family dynamics, healing and a key experience in a group that deals with mourning of early loss, but is not as heavy as all that sounds. It's simply a coming of age drama with the excitement and struggle of a youngster." For more information see Marty's website, martylivingston.com.

Film recommendation

A film that may be of particular interest to readers of this column is Nancy Oliver's Lars and the Real Girl, which was reviewed by Joye Weisel-Barth in a recent issue of the IJPSP (Weisel-Barth, 2009). I would like to thank Joye for drawing my attention to this delightful, powerful and moving film and highly recommend it to those of you who haven't seen it. While Joye focused on ideas about loneliness that the film prompted for her, I was most struck by the ways the film illustrates a number of contemporary self psychological and relational psychoanalytic concepts, including some relevant to family and group therapy.

In the film, a depressed, frozen young man's dramatic transformation is facilitated by both his individual therapy with a gifted therapist and by what I would call community-wide milieu therapy by his family and community members. Rather than challenge or argue with Lars's bizarre beliefs, they immerse themselves in his (delusional) inner world, accepting and joining him in it before gradually introducing an alternative subjectivity. Joye sees this as the family and community engaging in "illusory play therapy" with Lars, and I agree, but I would emphasize more the curative impact of their empathic immersion in Lars' internal world and their attuned responsiveness - which on two occasions included confrontation - to his changing selfobject needs.

I recommend the film for your own enjoyment but also for its usefulness as a teaching tool and a launching point for discussions of the curative process. The medium of film moves us "from the realm of clumsy language to a place of immediate visceral experience," as Joye notes, and thus is much better than a paper - or a newsletter column! - at conveying ideas. I have used the film in teaching and found it was one assignment all the students loved. Feel free to let us know what you think.

Weisel-Barth, J. (2009). Loneliness and the Creation of Realness in Lars and the Real Girl, International Journal of Psychoanalytic Self Psychology, 4 (1) 111 - 118.

In the future this column will include short essays or articles by people other than me, but since those haven't started pouring in yet, I am including an excerpt from a paper I am currently working on. Please contact me if you would like to contribute so we can hear from someone besides me!

Working with Difficult Parents: Applying What We Already Know

Carla Leone, Ph.D.

Working with parents is often the most difficult aspect of treating children and adolescents, and yet is the area in which most child therapists and analysts have the least training. "Difficult parents" - meaning those the child's therapist experiences as resistant, hostile, disruptive, intrusive, defensive, and so forth - can make a hard job even more challenging, not to mention interfere with the effectiveness of the child's treatment. Ironically, although self psychology and intersubjective systems theory offer a wealth of ideas about understanding and treating the so-called "difficult patient," these concepts are often applied beautifully in the treatment of difficult children or teens, but not so readily when it comes to their misattuned, neglectful or even abusive parents.

I have often heard therapists treating children or teens present cases in which the child or teen's misbehavior is formulated in self psychological terms, but the misbehavior of the parent is not. I certainly do not mean to imply that the two are equally problematic, just that the underlying causes of problematic behavior are the same in children or adults.

For example, while the child's problems may be seen as stemming from a lack of adequate selfobject responsiveness by caretakers, the parent's poor parenting is rarely seen in terms of the lack of responsiveness of the parent's current selfobject milieu. Similarly, the child's difficulties may be framed as deficits in the child's capacities for self-esteem, self cohesion and affect regulation; his defensiveness or resistance as efforts to protect a fragile self; intrusive, needy, demanding behavior as efforts to elicit desperately needed selfobject responses; and aggressive behavior as a by-product of narcissistic injury, a desperate effort to restore a sense of power and agency, and/or a protest against perceived injury. However, when that child's parent has difficulty parenting well, cancels parent guidance sessions, blames the child and refuses to see his or her contribution to the child's problems, calls the child's therapist constantly, demands to be included in the child's sessions, or behaves in an aggressive, hostile manner toward the child or the therapist, these formulations tend to be much slower in coming. Finally, I have frequently heard therapists note the "forward edge" tendrils of health in a child's protests against the parent, but have rarely heard the same formulation when it comes to the parent's protests against the child. This discrepancy is certainly understandable given the cuteness and vulnerability of our child patients, but very unfortunate for the vulnerable child part of the parent.

"Pretend the parent is your individual patient and you've never met their child," I often suggest to students and consultees who are angry with a child patient's difficult parent. "How would we understand this behavior if your child patient had done something similar?" I might ask. These ideas can hopefully help us apply to work with difficult parents the same theoretical understandings that are so helpful with individual child or adult patients - and thereby help both parent and child.

That's it for this column. Again, please send your comments, suggestions, ideas, feedback or submissions to me at .

COLUMN ONE

I am very pleased to announce a new feature of eForum: a recurring column devoted to the application of self psychology to family, couple and group therapy. I appreciate the invitation to edit and coordinate this column and hope it will be a great way for members of IAPSP who conduct these modalities to share news and ideas and connect with each other between conferences. As we know, work in these modalities is not for the faint of heart! Individual work is difficult enough, but trying to understand, hold and respond to the needs of more than one patient at a time - all while trying to increase connections and reduce narcissistic injury between them - can be an even more daunting task. Clinicians who work in these modalities can use all the help we can get - and hopefully this column will provide some. To help make that happen, please send any ideas, reactions, comments or suggestions to me at . Thus far I am envisioning the column as having three main components:

• Member news or announcements relevant to self psychologically-oriented couple, family and group therapy, such as upcoming workshops, publications, book suggestions, etc.
• Brief articles, essays or case studies related to the application of self psychology to these modalities - approximately 500 - 800 words
• Reviews of relevant books or other publications of interest - about 500 words

I would also like to eventually compile an annotated bibliography of references on the application of self psychology to these forms of treatment.

Announcements and Resources

Since this is the first column, the only announcement I have is that I will be doing a day-long workshop on couple therapy at the Hamm Clinic in St. Paul MN on Monday, October 11th. Please send me some others! A resource I would like to recommend is the list-serve of the Couple and Family Section (Section VIII) of the Psychoanalysis division (Division 39) of the American Psychological Association. You have to be a member of Division 39 in order to join the section and have access to the list-serve, but you do not have to be a psychologist or an APA member to join the division. Each month there is a clinical question related to couple or family work and occasionally a clinical paper is distributed to members and discussed on the list-serve. Most members are not very influenced by self psychology but there are a few of us, and I have found it useful to hear different perspectives. If there is enough interest maybe IAPSP will be able to have a similar list-serve at some point - please let me know if you would be interested.

Self Psychology and "Emotionally-Focused Couple Therapy": More Overlap Than You Might Expect

One of my interests these days is the similarities and differences between self psychologically-oriented couple therapy and the approach known as Emotion-Focused Couple Therapy (EFT), advocated by Susan Johnson. I have read her book The Practice of Emotionally Focused Couple Therapy: Creating Connection (Johnson, 2004) and recently attended a day-long workshop she led. Overall, I have found a surprising degree of overlap between the two models and believe there are aspects of Johnson's approach that can add to our self psychological model and (not too surprisingly!) much that self psyEmotionally focused couple therapy is a short-term (8-20 session), structured, manualized approach originally developed in the 80's by Johnson and her colleague Les Greenberg, in an effort to design a non-behavioral, humanistic, experiential approach that could be manualized and empirically validated. It appears to have fairly significant empirical support, with higher reported success rates than any other form of couple therapy that has been empirically studied. It is primarily influenced by the work of Carl Rogers, research on the neuroscience of emotion, systems theory and Bowlby's attachment theory.chology has to offer to the approach she describes.

As my title suggests, I was surprised by the many similarities between EFT and a self psychological, intersubjective approach. First, there is a major emphasis on empathy and the therapeutic alliance in both models. Although Johnson draws on and cites the work of Carl Rogers, not Heinz Kohut, both approaches emphasize the need for both partners to feel deeply understood and accepted.

Second, Johnson's focus on emotional experience, particularly on the importance of getting to the more vulnerable affects of sadness and fear under the anger and blaming is very consistent with the self psychological focus on subjective affective experience, especially the work of Marty Livingston on cultivating vulnerable moments in couple therapy (Livingston, 2001).

Last, the overlap between attachment theory and self psychology has been noted by others and is evident here. In EFT model, the relationship between partners is seen as "an emotional bond rather than a bargain to be renegotiated" (Johnson, 2004, p.7). The focus is on partners' needs for safety, protection, connection and help "regulating negative affect and constructing a positive and potent sense of self." Sound familiar? Oh, and the term "corrective emotional experience" is used quite a bit in both approaches as well. There are a number of other similarities (including a focus on health) that space does not allow me to go into here, but I hope to detail them further in a future paper.

The differences between the two models were less surprising. Most obvious is that "insight" is almost derided at times by Johnson, although there is still some focus on drawing connections between partners' childhood experiences and interactional patterns and their current ones. EFT is certainly more focused on here-and-now interactions, but since self psychologists also focus quite a bit on current interactions between partners, in an effort to facilitate selfobject experience between them, the difference is probably just a matter of degree.

Then there is the short term nature of EFT vs. the longer term nature of most psychoanalytically-oriented couples work. Watching a tape of Johnson working with a couple, I felt she was rushing at times; her push to focus on the vulnerable affect and the negative interactional cycles made me feel that the therapist had too much of an agenda at times. Certainly the therapist did not approach the session "without memory or desire" a la Bion! Yet I was also impressed with the positive aspects of such a singular focus (which has helped structure me when I am feeling overwhelmed) and by the success rates she claims in 8-20 sessions. I found myself wondering if some of my couples might change faster if the focus was narrower - and they knew they had only 10-20 sessions.

Third, in EFT there is a greater focus than in most psychoanalytic models on the therapist as "choreographer" - scripting or orchestrating healthier interactions such as prompting partners to turn to each other and express a vulnerable feeling. This to me is one of the things EFT can add to a traditional psychoanalytic model. I have previously written about more directive or choreographing-type interventions as consistent with a self psychological framework because the therapist is providing a structuring or idealizing function and facilitating selfobject experience between the partners (Leone, 2008) - so I liked this difference.

Finally, on the other hand, in EFT there is almost no mention of transference - the term does not appear in the index of the book, and it is clear that the relationship with the therapist is not considered part of the cure or a vehicle for understanding and hopefully transforming partners' interactional patterns. This is one of the areas, along with the concepts of narcissistic injury, unconscious organizing principles and implicit relational knowledge, that I think could enhance or add to the EFT approach.

Overall, although there were certainly things I disagreed with - and although I thought the book was quite repetitive at times - I am glad I learned more about this approach and have found it helpful. To be continued!

References

Johnson, S. (2004) The practice of emotionally focused couple therapy: Creating connection. New York: Brunner-Routledge.

Leone, C. (2008). Couple psychotherapy from the perspective of self psychology and intersubjectivity theory. Psychoanalytic Psychology, 25 (2) 79-98.

Livingston, M. (2001). Vulnerable moments: Deepening the therapeutic process. Jason Aronson.

Carla Leone, Ph,D. is on the faculty of the Institute of Clinical Social Work in Chicago and the director of a group private practice in Lincolnwood, Illinois which specializes in the treatment of children, adolescents, adults, couples and families.