3
Couples, Imagined
J. P. Cheuvront
This chapter discusses the clinical treatment of same-gender couples. The purpose, in the simplest sense, is to contribute material about same-gender couples in treatment, but it also addresses the notion of a couple. One cannot begin to think about treating couples without bringing into focus an understanding of what a couple is. This is true regardless of how the couple is gendered. Couples come for treatment with their individual and shared understandings (although not necessarily articulated) of coupled relationships, and these understandings contextualize their immediate concerns. As clinicians, we have our own ideas and experiences of what being a couple means. Clinical facilitation of difficulties occur only when some understanding of the couple's individual and conjoint hopes, fears, and resignations has been made and may require the therapist to question his or her own assumptions of what a couple should look like.
Previous authors have typically focused on specific issues that they feel characterize or are likely to influence same-gender couples, such as coping with HIV (Forstein, 1994; Cabaj and Klinger, 1996), difficulties with autonomy and intimacy (Gray and Isensee, 1996), homophobia (Fisher, 1993; Brown, 1995; Freedman, 1996), and partner abuse (Walsh, 1996). Others have questioned presumptions about differences between same- and discrepant-gender couples (Singer, 1994; MacDonald, 1998) and focused on difficulties imposed by dominant societal ideas of intimate relationships with emphases on a broader understanding of what constitutes a couple (Simon, 1996). In my own experience, same- and discrepant-gender couples do not look particularly different in treatment. Specific concerns, whether they are struggles with an illness (such as HIV or cancer) or social intrusions (such as racism, sexism, or homophobia), must (and can only) be understood from within the perspective of the couple under treatment.
Although an increasingly significant portion of psychoanalytically informed clinical treatment is being conducted with couples, with few notable exceptions (i.e., Trop, 1994; Gerson, 1996; Sander, 1998) surprisingly little of the clinical and theoretical literature is devoted to case examples, clinical technique, and theoretical understandings of couples work. Much of the writings on couples treatment is found in or influenced by the family therapy literature. My own theoretical disposition focuses on the intersubjective (e.g., Stolorow, Brandchaft, and Atwood, 1987; Stolorow and Atwood, 1992; Orange, Atwood, and Stolorow, 1997) nature of interpersonal relations. Intersubjective refers to the relational contexts in which experience emerges (Stolorow, Orange, and Atwood, 1999) — in which personal experience is seen as fluid, multidimensional, context-sensitive, and historically influenced — to my mind a distinct and much broader meta-theoretical conceptualization than that of mutual recognition, as it is used elsewhere in the literature (e.g., Stern, 1985; Benjamin, 1995).
Intersubjective approaches to couples therapy have been outlined previously. Trop (1994, 1997) has discussed the importance of understanding disjunctive interactions within couples by illuminating the principles unconsciously organizing the participants' inner experiences. Ringstrom (1994) suggests that partner's tendency to reenact conflictual past events in the service of maintaining self organization is important in couple's understanding each other and their relational difficulties. The idea that conflicts arise from the negotiation of hoped-for and feared responses rooted in early experiences and that articulation of these dynamics is important in couples treatment has been recognized and elaborated on by Alexander and Van Der Heide (1997) and McMahon (1997).
Each of these authors has used intersubjectivity to explain conflicts that arise within relationships and how the understandings of these conflicts can be used clinically to more closely approximate a truth for the couple that effects change in the quality of their interactions and understanding of their partnership. Implicit in each of these articles, and indeed in much of the couples therapy literature, is the notion that the couple, as the entity under treatment and as a treatment goal, is a shared, understood concept between the individuals in treatment and between therapist and patients. Often unsaid are presumptions about coupled relationships as particularly gendered, structurally and temporally stable, and context-insensitive. Left unquestioned and unarticulated, these discrepancies can cause distance, misunderstandings, and disruptions within the couple, as well as between the couple and therapist. What has not been discussed, to my knowledge, is how intersubjectivity, a meta-theory that specifically looks at the subjective experiences that influence psychological theorists' understandings and development of their own theories, can help us understand how our own beliefs about couples might facilitate, hinder, or otherwise influence and guide treatment of couples.
Using case material, this chapter illustrates how clinical dialogue can facilitate articulation of the patient's lived experiences, and how expansion of each of the partner's capacity to understand and empathize with both their own and their spouse's experiences can usher in change. Of particular importance in the clinical exchange are the individuals' understandings of what it means to be a couple. This includes hoped-for and feared experiences, disappointments, negotiation and experiences of social support (or disapproval), and the perceived (wished-for or dreaded) degree to which the notion of being coupled limits or expands the domain of shared and personal experiences. The chapter also demonstrates how viewing the notion of a couple as constructed by the participants provides a context from which a wide breadth of solutions and ways of understanding difficulties can be articulated. If one is going to “treat” a construct, if a construct is seeking assistance, then it is vitally important that the construction, the troubled interpersonal field, this virtual patient, be understood. And it is here, in our willingness and capacity to meet our patient's struggles and creative approaches to sharing their lives with others that notions of gender configuration quickly recede and more salient dynamics of lived experiences emerge.
Christopher and Stuart
There was a lot of catching-up to do: Christopher and Stuart, 49 and 50 years old, respectively, had been together for 18 years when they first came to seek treatment. By profession, they were writer and publisher. Stuart met Christopher when the small publishing company where he was working published one of Christopher's books in the early 1980s. This marked the beginning of a personal and professional relationship which had, despite setbacks, endured to the present time. Treatment commenced on the heels of a whirlwind 18 months in which they had busied themselves producing one of Christopher's short novels for television, the first joint venture for the company they had established together. Besides a rigorous production schedule and frequent trips to shoot locations, Christopher and Stuart had managed to see Stuart through a major medical crisis related to his diet-controlled diabetes that required a week's stay in the hospital and substantial rehabilitation on discharge. All of this was achieved without modification or setback in the production schedule. In fact, they recounted, their sponsoring agency and crew only became aware of the personal crisis after the production was completed.
Crisis, in the form of extreme productivity, was not what brought this couple to treatment. As a team, Christopher and Stuart were particularly skilled at tackling adversity. Earlier in their relationship, a time characterized by frequent parties, lavish spending, and frequent drug and alcohol use, Christopher and Stuart had helped each other confront their substance abuse problems. They established a sobriety that both had sustained for more than 10 years. Much more difficult for both of them was down time — periods that were outside of crisis and when the pressures of productivity were reduced, which by design, should have been times when they could enjoy the fruit of their labors. Instead, they reported fighting and bickering of a sort they never experienced while busy and complained that they had difficulty finding leisure activities they both enjoyed. This surprised and worried them both because they had spent countless hours anticipating the end of the most recent project as a time to relax with each other, spend time with friends, and attend to their neglected personal lives.
The first two months of treatment were spent warming to one another. They depicted themselves as the “model couple” in their circle of friends, an impression that did not surprise me given their seeming ease with one another, clever banter, and complementary charm. In our initial sessions, little of the conflict they were describing in the content of their narratives was apparent in their interpersonal interactions. Christopher and Stuart would describe bickering escalating to verbal fighting and profoundly hurt feelings, although their behavior betrayed little to none of this within the treatment process.
After this period, they began a series of disagreements in treatment. The session began as usual, with a recounting of the previous week's events. To meet financial obligations, Stuart had taken a consulting position for a publisher that afforded them a steady income in the interim between their own projects. They had agreed that Christopher would attend to their business, which at this point consisted of the relatively mundane tasks of producing financial reports and sorting out expenses for the recently completed project. As of late, Stuart had been busier than usual, preoccupied with a publishing deadline that was fast approaching. Shared time had been reduced to the few hours before sleep, which often took the form of an exhausted Stuart planting himself in front of the television. The television had long been a source of disagreement, with Stuart finding the passive entertainment relaxing and Christopher experiencing the drone of the tube as intrusive and extremely irritating in a small apartment that afforded no means of escape.
As Stuart and Christopher recounted their disagreement, Christopher became increasingly withdrawn, more careful than usual about his word choices, and seemingly preoccupied with an internal struggle that communicated a sense of hopelessness and isolation. Stuart responded by appearing exasperated and angry at Christopher's distance. Whereas I had previously seen Stuart reach out to Christopher when struggling with depressive affect, here he made no such effort. As the discussion continued, interpersonal distance widened, and the content turned toward Christopher's concerns about Stuart's health and his worry that he was not taking proper care of himself. Stuart responded with irritation, noting feelings of intrusiveness and vulnerability. He described feeling that in these moments Christopher was “hitting below the belt.” Christopher understood this as confirmation that his concerns about Stuart's health, including his fear that he alone was worried about Stuart's physical condition, were justified. He also took this as indication that their partnership was severely troubled.
This, they would confirm later, was the typical resting place of their “downward spiral.” Arguments would invariably shift to usher in and heighten feelings of distance, hopelessness, intrusiveness, and a sense of unresolve. Our session ended on this note, a silence lingering between the three of us as, I imagined, they reflected on their frustration and difficult feelings evoked by this too-often repeated discourse pattern. I reflected on the hopefulness of having been allowed to witness the interpersonal knots they had previously only described.
The following session showed none of the difficulty or interpersonal distance of the prior session. Both Stuart and Christopher were able to reflect on their experience of the session, including the experience of my presence. They agreed that they had both been conscious of my presence during their exchange and had alternately wondered when I was going to “step up and fix things” and whether their difficulties were too overwhelming for me. I told them that I could understand how they could have these experiences given the clear distress that they both had experienced. I then summarized as best I could what I experienced as their individual emotional states and concerns during their interchange.
Over the course of the next four months, weekly treatment continued to move forward. Sessions regularly repeated the same degenerative, dead-end form displayed previously, and other sessions consisted of reflecting and articulating their dynamics as a couple and as individuals. During these times, my interest often focused on dimensions of their individual life experiences, particularly experiences in relationships outside their partnership. I also took opportunities to become more familiar with their understandings of intimate relationships in their families of origin.
My inquiries into Christopher's and Stuart's individual familial experiences stemmed from material they provided. For example, the death of Stuart's brother and their visit with the family ushered in a host of memories and reflections about his family life as a child. In our dialogue, I learned of the intrusive nature of Stuart's father, the struggle of his mother to feel some semblance of control, and the potential explosive (literally) nature of family discussions. Broken windows, physical altercations, and banishments from the home were not uncommon. Relationships, as displayed by Stuart's parents, were coercive, undermining, and volatile. Concern for others was always viewed with skepticism and suspicion, subject to scrutiny for ulterior motives. Concurrently, a love between parents, siblings, and other family members was often displayed. They were fiercely protective of their own and had, in very specific ways, demonstrated profound devotion to one another. The net result was that feelings of love comingled with the potential for harm. Members of the family were protected from outside dangers, but internal destruction was often tolerated or overlooked.
Inquiry into Christopher's feelings of hopelessness and fear of isolation from Stuart recalled a period in his late teens when he was hospitalized for nine months for a treatable, but severe, medical condition that required the attention of experts in a town miles from his childhood home. During this time difficulties arose elsewhere in his family that compounded the physical distance with emotional unavailability. Initially, relatives who lived close to the hospital provided support. This support faded, however, as in Christopher's recollection, he increasingly expressed his distress at the little attention and emotional support he was receiving from his family. As such, Christopher dreads feelings of abandonment and his own expression of needs. Experience has told him that this is met with further isolation and increasing despair.
As Stuart's and Christopher's individual histories became elaborated, I began to weave these understandings into the treatment. I became better able to articulate the felt difficulties encountered at the depths of their arguments as old feelings and fears rooted in early family interactions. Christopher's feelings of profound hopelessness and emotional abandonment were tied to his early feelings from the actual withdrawal of familial support during the crisis of his late adolescence. His desperation in the face of these feelings understandably caused him to become excited and express his concerns, needs, and fears to Stuart. In turn, Stuart experienced Christopher as argumentative and found the intensity of his experiences frightening. It was, for Stuart, the sort of intense emotional milieu that led to physical violence and emotional destructiveness within his family. Stuart's response was to withdraw protectively, dodging the literal blows he imagined would inevitably follow. Of course these sorts of dynamics are cyclic — Stuart's withdrawal in the face of Christopher's expressed emotional experience only induced increased panic in Christopher and furthered Stuart's withdrawal. This was the heart of the downward spiral.
Over the course of three or four sessions, Christopher, Stuart, and I worked to understand and articulate these dynamics. Although the initial introduction of my understandings occurred during sessions in which the dynamics were in action, subsequent sessions inevitably led to reviewing the session with more emotional distance. During these sessions, both patients made modifications and refinements, and both attempted to articulate their partner's position, or as we came to describe it, their dilemma. Eventually, my interpretations became their dialogue. It was clear that the elaboration of these ideas had taken on a life of its own outside of treatment — to the point that it became common for me to ask them to help me catch up. Concurrently, the frequency and intensity of their arguments tended to diminish. Arguments became disagreements and, at times, opportunities to understand one another better.
Within treatment, the degenerative, dead-end, affect-laden arguments were replaced by discussions of fears, dilemmas, dissatisfactions, and pleasures of their intimate and business partnership. Whereas difficulties in conducting their business had been a major motivating factor in bringing Christopher and Stuart into treatment, early attempts at discussing these issues had quickly led to misunderstandings, misattunements, and, ultimately (once they felt comfortable enough to do this in front of me), degenerative argumentation. At this point in treatment, they were able to articulate their concerns more productively. Nonetheless, the presenting dilemma — that they were unable to settle on down-time activities that they enjoyed doing together — continued to bother them. For a period of time, we discussed possible solutions to this problem, including activities that they might both find enjoyable. For example, we discussed how a short trip to a location that both Christopher and Stuart enjoyed might provide some mutual enjoyment and feeling of togetherness. In my treatment experience, it is unusual for these sorts of suggestions to, unto themselves, address the underlying feelings of dissatisfaction. Couples are rarely so naïve or uncreative as to be unable to problem solve, on their own, pragmatic difficulties. In the context of treatment, however, couples often expect this sort of problem solving with the therapist and perceive it as an engagement in process that they can easily recognize as “working on the relationship.” From my perspective, problem solving is useful because it can help facilitate and strengthen working relational ties between the therapist and patients. When this works, I believe it is because we have optimally responded (Bacal, 1998) to the couple's needs, not that we have provided such a brilliant pragmatic solution.
As we struggled in treatment with the frustration Stuart and Christopher felt at having what looked like discrepant (and, at times, opposing) ways of spending free time, it occurred to me that what had been left unquestioned were the sources and reasons for their frustration. Why, I wondered, was it so important for Stuart and Christopher to spend their free time with each other, particularly when a large percentage of their time was spent together negotiating their business? The idea that free time should or must be spent with one's spouse and that somehow the camaraderie, mutuality, and team effort that occurs in the context of “work” is different than or inferior to shared experiences in free time is often a misconception. This presumption about the use of free time is related, I think, to an idea that our culture seems to hold in which it is presumed that all of an individual's interpersonal needs to be provided by his or her spouse (S. Kiersky, 1999, personal communication). It is, I believe, often stronger than the tradition of sexual fidelity in that feelings of betrayal are clearly worsened when a cheating spouse is revealed to have, in addition to being sexually unfaithful, spent free time (for example, vacations) with the lover, with the implication being that these moments were robbed from the rightful recipient. More realistically, individual needs are varied and change over time. What is certain about the reification of the spouse as the sole provider of companionship, friendship, and other interpersonal needs is that eventually needs will go unmet. This is not to say that for some couples the inability to engage in mutually enjoyable activities is not problematic. But for Christopher and Stuart, whom I had often heard speak about their work together with excitement, I genuinely felt that the quality of their work time together was experienced as quite profound, sustaining, and rewarding for them both.
The opportunity to introduce the kernel of this idea was presented in a session in which they again expressed their concern about competing wishes as to ways to spend nonwork time:
JPC: You know, despite our efforts to come up with some ways you might enjoy each other's company during less busy times, there continues to be some dissatisfaction with the quality of the time you spend with each other, and today you both sound a little hopeless about it. [Stuart and Christopher both nod in agreement.] I wonder if it might help for us to think a little differently about the dilemma. I guess I'm trying to understand why, for both of you, you feel that this is an important dilemma to solve.
CHRISTOPHER: [Lightheartedly] Well, it would be nice if we could just have a regular relationship and enjoy each other when we're not overloaded with the insanity of work.
STUART: [Agreeing] It would just be nice if we didn't have the arguments and bickering during off time.
JPC: [Roused by Stuart's idea of “regular relationship”] Yeah, and we've seen how it really affects the quality of your time together. But I guess I'm interested in something Christopher said. I'm not sure you realized it, but you said you wanted to have a “regular relationship.” [Smiles all around as everyone seems to understand, in the context of a same-gender relationship, this is a humorous notion.] What do you think you mean by this?
CHRISTOPHER: Well, I guess I don't really mean “regular.”
JPC: But I think you were getting at something quite specific that is not so easy to articulate. I know you don't mean that you want a woman partner, but it seems like there might be some other idea there.
CHRISTOPHER: Well, I guess I look at other couples and they like to do things together. They have mutual interests, like they like to go to the movies together, or do sports together, or go dancing, or something. We seem to have such trouble in that sense. It makes me feel that we must be such a poor match, and that when we are working we are just too busy to notice.
JPC: So, your different ways of wanting to enjoy free time sort of stokes a fear that you are not, in fact, a good match?
CHRISTOPHER: Yeah, and it makes me sort of sad, because I would love to share these things with Stuart.
JPC: So there is a kind of loneliness that is part of this as well. Stuart, what are your thoughts?
STUART: I understand what Chris is talking about, for him, I think this really bothers him. I guess that I'm just mostly bothered by his dissatisfaction. I'm caught sometimes wondering whether I agree but don't want to think about us being a bad match, or whether it's just not true and he's making something of nothing. I mean, [to Christopher] I'm not saying you are making it up, I know you feel this way, and I understand that, it's just that I don't think I feel the same pressure. I guess there is so much that we do share that it doesn't have the same feeling to me.
JPC: How do you mean, Stuart?
STUART: Well, look what we've been through. We got sober together, we published together, we went broke together, we made a television show, we have lectured together, we got through my hospitalization. I just think that whether we agree on a movie to see or whether to go to a museum together isn't that important.
JPC: So for you the work you do together sort of sustains the feelings of closeness, but Christopher seems to have other expectations.
CHRISTOPHER: Well, I agree with Stuart. I don't know, it just seems like we should enjoy doing things together that aren't work related. [Pause] Also, if I don't do them with Stuart, I don't do these things at all. Like I never saw [my friend's] exhibit at the [museum].
JPC: So it feels like, if you don't do something with Stuart you can't do it at all, like with someone else?
CHRISTOPHER: I guess I could. I mean, that's the way it seems to play out.
JPC: Maybe what we should be talking about and trying to understand, then, is not so much about finding ways that the two of you can be comfortable and enjoy free time together, but how you can be comfortable and enjoy free time apart.
Subsequently, Christopher and Stuart have been able to articulate a broader range of experiences within these interactions. For example, Christopher has linked his fear that Stuart might become emotionally distant as a factor that motivates the desire for shared down time. He has noticed that this is connected to feelings of being controlled by Stuart in that his unavailability for a particular experience has the impact of essentially preventing Christopher from engaging in the event. Rather than simply experience this as Stuart's wielding of control, Christopher has begun to understand how his own fears contribute to a context in which his options become limited. Similarly, Stuart has been better able to understand Christopher's frustration and how, at times, his unwillingness to alleviate Christopher's fears about their relationship plays an important part in Christopher's unwillingness to seek out friends with shared interests.
In general, our discourse has changed focus. We have moved from feelings of general dissatisfaction and unease to a dialogue in which specific affective experiences and ideas about historical sources can be connected. This historical awareness helps to explain and make understandable the emotional intensity of interpersonal difficulties. This is, I think, at the heart of what is meant by a deepening of the treatment — an idea often invoked when discussing individual treatment but less commonly used to describe the process of couples treatment. The intersubjectivity literature describes these clinically facilitating conditions as a broadening of experience in individual treatment: “closer and closer approximations of such truths are gradually achieved through an analytic dialogue in which the domain of reflective self-awareness is enlarged for both participants” (Stolorow, Atwood, and Orange, 1999, p. 387). Replace the words both participants with the words all participants and you have, from my perspective, a fairly accurate description of an important process active in all meaningful couples work. A process that expands the domain of possibility, limited only by the participants' abilities to stretch beyond social convention and preciously held fantasies about the structure of hoped-for relationships. As Stuart and Christopher's case suggests, in couples therapy with same-gender couples, treatment can move quite quickly beyond the couple's gender configuration. Rather, as in struggles within any intimate relationship, articulation of closer and closer approximations of mutual and individual lived experiences helps create a context in which feelings of difficulty, confusion, hopelessness, and anxiety can be reduced — made to feel understandable, tenable, and ultimately assuaged.
Simone and Deborah
Many couples come to treatment when they realize that channels of communication are failing and emotional experiences or situational factors (or both) overwhelm their capacities to cope. This was the case with Simone and Deborah, aged 42 and 37, respectively, who came for treatment five years into their relationship. Some details of their treatment show the ways in which hoped-for or expected life experiences, bolstered by the pressures of social norms, can be a focal point of friction within a couple. This may limit their capacity for intimacy and mutuality. Their case illustrates how couples treatment can illuminate the couple's ever-shifting meanings of these struggles to help articulate, broaden, and demystify their individual and shared lived experiences.
Simone met Deborah two years after her divorce from a marriage that had produced two children, Shawn and Mark. They have lived primarily with Simone, but spend significant time with their father, who shares joint custody and lives in the same neighborhood. At present Shawn and Mark are aged 14 and 12, respectively. One year into their relationship, Deborah moved in with Simone and her family, effectively becoming a stepparent to the boys. This was a welcomed role for Deborah who, having envisioned starting her own family someday, jumped at the opportunity to parent. In couples sessions, Deborah confirmed that this opportunity was an important factor that attracted her to Simone. Unfortunately, in important ways the role of stepparent was more difficult than Deborah had expected. Although she had forged a strong bond with Simone's youngest son Mark early in their relationship, relations with his older brother Shawn proved to be much more difficult. Shawn, aged 10 when Deborah moved in with the family, had proven to be a dispositionally difficult child. Precocious to a fault, Shawn was prone to mood swings and to lashing out verbally at others unexpectedly. His strong capacity to articulate his thoughts and feelings made him capable of being hurtful while at the same time radiating a charm that attracted peers and adults alike. This was not lost on Deborah, who felt unwelcome and rejected by Shawn while hoping for acceptance and the sort of close bond she had forged with his younger brother.
From Deborah's perspective, the first four years of the relationship were spent deepening her relationship with Mark while attempting to forge a relationship with Shawn. Difficulties increased between Deborah and Shawn as the boy entered adolescence. Shawn's behavior began to feel more provocative and mean-spirited, often targeting Deborah or Simone. Whereas Simone tended toward tolerance, understanding, and nonconfrontation, Deborah was dispositionally more structured, suggesting to Deborah that greater limits, rules, and more frequent discussions with Shawn about his misbehavior were crucial. Deborah's distance from Shawn and the difficulties living in the same home with him added fire to her wish for direct action in the form of rules and punishments. Simone, who had the advantage of confidence in her connection to her son, disagreed, suggesting that Deborah needed to be more understanding of Shawn and his moody nature.
Four months prior to the start of treatment, Deborah had had enough. Weary of her ability to forge a relationship with Shawn, aggravated by her feeling of being relegated to second-tier parent, and increasingly experiencing herself as a visitor in her own home, Deborah suggested that she and Simone separate. Simone was not entirely sure this was a bad idea. For her part, she had found Deborah to be increasingly withdrawn, spending much of the time and energies previously devoted to the family on activities and interests away from the home. Simone understood this as evidence of Deborah's selfishness and unwillingness to compromise for the family and had experienced her lack of engagement and distance as worrisome. Attempts at discussing the precariousness of their situation quickly degenerated into hurtful arguments and furthered mutual withdrawal. Despite their disagreements, both Simone and Deborah were fearful of losing the other. In the spirit of working out a way to be together, they agreed that including a mediator in the form of a couples therapist might help them better understand their difficulties and maintain their relationship.
Throughout treatment Deborah's feelings of disappointment with her parental role coupled with Simone's feeling that Deborah was unwilling to give up her own needs for the family emerged as central points of contention. The meaning of parenting and the negotiation of parental roles in the family, however, shifted for the couple through the course of treatment. To trace these themes as they developed through the treatment, I will show how the parenting disagreement emerged in the course of three successive periods in treatment and how it served as a venue within which different kinds of relational difficulties could be illuminated and understood.
Our attempts at discussing the couple's dissatisfactions echoed the stalemate that brought them into treatment. No sooner did Deborah touch on her feelings of frustration in her role as parent, particularly with Shawn, than Simone responded by seemingly tuning out Deborah's concerns and by shifting the conversation to her own feeling that Deborah was selfish and “wants things both ways.” The disagreement was clearly stale, both participants having approached the topic from any number of ways over the past years. I was most impressed with how the interaction showed the degree to which Deborah and Simone had difficulty hearing each other's concerns without becoming defensive. Although absent from the actual content of their discussion, the notion of a responsible party and blame seemed to be ever present and implicit in the process of their discourse. As with Christopher and Stuart, moving treatment further relied on helping the couple find a way to discuss matters such that they could actually listen to each other without the distraction of raising defenses. It is difficult to be empathic when one is feeling threatened.
To this end, our conversation moved to better understanding the feelings that emerged when they attempted to discuss parenting disagreements, rather than resolving the matter itself. Inquiry inevitably led to individual histories and emotional experiences, hopes, and fears with caretakers. Treatment illuminated an underlying lack of trust, rooted in early experiences, for both Simone and Deborah. Distrust emerged from a proclivity to stoke one another's fears based on self-protective measures that inadvertently fueled a complementary, and equally provoking, reaction from the other partner. We identified these interactions as rooted in their individual and discrepant experiences with early caregivers and their attempts to head off similar dreaded experiences in their current relationship. As in the prior case material, our discourse seemed to provide a way in which Simone and Deborah could better empathize with each other, allowing them to feel less provoked or attacked by their partner, and sympathize with the other's internal struggles. Only with this established could they to actually begin to hear and entertain each other's concerns about their relationship, family, and individual lives.
This period in treatment, although brief in the telling, unfolded over three to four months of weekly sessions. There is no substitute for time, particularly with integrating new understandings of their partner's lives, couples require continued work out of sessions. Simone and Deborah were active in this respect, often reporting how they had disentangled themselves during disagreements at home. For Simone and Deborah (as with many couples in therapy), the relief felt at this point in treatment had a direct impact on improving the quality of their daily lives. It is at this point that couples report that the “tools” therapy provided have made the sort of arguments that brought them into treatment a thing of the past. Unfortunately, for some couples this relief reduces their motivation for treatment just as their ability to engage one another's emotional experiences becomes available. Particularly for couples in which both individuals are petrified of life without their relationship, the removal of these polarizing arguments can be experienced as threatening.
However frightened they may have felt about losing a future together, Simone and Deborah continued treatment. Deborah reintroduced complaints of dissatisfaction with the parenting role following an incident between her and Shawn, witnessed by Simone, in which she felt hurt by Shawn's verbal lashing out and unsupported by Simone's reluctance to intervene:
DEBORAH: … I feel like my hands are tied, and you [Simone] don't do anything to make it easier.
JPC: What sort of things from Simone would help?
DEBORAH: If we could come from a unified front. She should have stepped in and said, “Shawn, it's inappropriate to talk to someone like that.”
Simone: But I didn't hear him as attacking you: it felt like he was angry at both of us.
DEBORAH: NO, it was definitely pointed at me. When he said [something directly relevant to Deborah's actions that day in their house], he clearly was singling me out. And it's hurtful to hear it from him and frustrating to not be able to do anything about it.
JPC: What would you like to do?
DEBORAH: Well, I would like to say, “Shawn, that's inappropriate to say to someone, you're being rude, nasty, and hurtful.” But I can't do it, or at least I'm not supposed to do it according to [Shawn's therapist].
Simone: I thought that we agreed with [Shawn's therapist] that the discipline shouldn't come from you.
DEBORAH: Yeah, we did. But it's hard.
JPC: It can't be easy having someone who lives in your house verbally attacking you without having any recourse.
DEBORAH: Yes. It would help if Simone could step in at those times, so it wouldn't have to be me but it would be handled anyway.
JPC: It might also communicate to you that Simone understood the awkwardness of your position and is trying to help.
SIMONE: I don't have a problem with that. It's just that sometimes, like this, I don't really have a sense that Deborah has been hurt. Until she told me now, I didn't know that she felt more targeted any more than me.
JPC: That is something you need to work on. See, I sense that the reason Simone is less likely to be ruffled by Shawn has to do with the strength of their relationship — when Shawn isn't in one of his “moods,” Simone and Shawn can be buddies, she is his confidant. I think that creates a willingness to forgive or ignore some of the difficult parts of Shawn. [They both nod in agreement.] I think it is much more difficult for Deborah, who imagines her parental relationship as more like the one she has with Mark, and given how distant Shawn keeps from her, Shawn and Deborah's relationship is more like roommates who don't really like each other than like parent and child.
SIMONE: IS that how if feels to you?
DEBORAH: Yeah, it's like a bad college roommate, but you don't have to take your college roommate to soccer practice.
This excerpt represents an important turn in Simone and Deborah's relationship. Not only is Simone able to begin to understand Deborah's difficulty with Shawn, but they both begin to see that Simone's seeming unwillingness to intervene may, in fact, not suggest lack of caring for her spouse (as Deborah fears) but a different subjective experience that has limited her capacity to attune herself to Deborah's struggle. Specifically, Simone is able to hear and understand through the roommate metaphor the discomfort Deborah is experiencing in her daily life. The discrepancy in their capacities to tolerate Shawn's difficult moments is understood through the parental affirmation Shawn bestows on Simone but denies to Deborah. Through conversations like these in subsequent sessions, Simone and Deborah clarified other points of contention. Simone's feeling that Deborah was selfish and unwilling to give up certain aspects of her life for the family began to be understood as ways that Simone had begun to compensate for needs not provided within the family, and how these outside activities actually helped her cope with her mixed feelings about her parental role.
For both Deborah and Simone, these new understandings competed with their individual fantasized versions of their relationship. For Deborah, the hoped for relationship with Simone was one in which she felt fully engaged as an equal parent, beloved by both her spouse and her adopted children. The actual complexities and contingencies of her lived experience ran counter to this, partially by not accounting for the common awkwardness of being a stepparent, and partially by the perceived threat and concomitant provocative protective measures made by Shawn. Feeling increasingly anxious and hopeless about the widening gulf between her hoped for and lived experience, Deborah had sought an explanation. Attempts at discussing this with Simone raised Simone's anxiety, preventing her from helping Deborah understand the situational factors that precluded the hoped-for experience. Unable to see this and faced with Simone's defensiveness, Deborah experienced Simone as unresponsive, uncaring, and ultimately responsible for her unsatisfactory parenting experience. Only when Simone and Deborah felt safe enough to listen to one another were they able to see the broader context influencing their difficulties.
Simone's ideal of an untroubled spousal relationship required similar attention to the broader impact of their circumstances. Simone experienced Deborah's dissatisfactions as childish and as reflecting an unrealistic wish to both be involved in the family and have a life outside of the family as well. Simone experienced Deborah's outside interests as contrary to her professed hopes for their family and, in this respect, often felt that she had to negotiate Deborah as a third demanding child. She did not understand that Deborah needed to use outside activities as a way of counterbalancing her experience of parenting as disappointing and that Deborah's experience as a stepparent was different from her own as a birth parent. As such, Deborah's complaints and absences stood contrary to Simone's imagined relationship for her and her family. As with Deborah, increased capacity for listening to one another shifted this understanding, providing her access to the complexities of her partner and broadening the domain of her own experience.
Both of these themes, Deborah's feelings about parenting and Simone's idea about her spouse's relationship within the family, continued to be discussed in treatment. Once they began to understand and articulate one another's experiences, both Deborah and Simone were faced with the decision as to whether they were willing to give up their hoped-for experiences and engage in the present circumstance, or whether they wished to part ways and pursue other partners with whom they might find the desired conditions. Either decision requires giving up something, either the lived relationship or the hoped-for relational configuration. This sort of dilemma can be overwhelming for couples. Often individuals require access to their own treatment to understand what they are giving up. This was the case for Deborah, who on extensive reflection announced the following near the end of the couples treatment:
DEBORAH: [to Simone] You know that I still want to feel like an equal parent, but I guess I understand the sort of things that stand in the way of it. It's not that I'm not hoping for more, but I think somehow I hadn't really considered everything.
JPC: What do you mean?
DEBORAH: Well, like my relationship with Mark.
JPC: You mean, that you feel like that is a good relationship?
DEBORAH: Yeah. Especially after [an event the previous week in which the importance of Deborah to Mark was quite apparent].
JPC: Are there other things?
DEBORAH: Well, my relationship with Simone. [To Simone] I think that we've sort of overlooked us. The kids are such a big part of things now, but as I think about it, in less than six years Shawn will probably be out of the house, and then in a few more Mark will be gone, and that ultimately it's you and me.
SIMONE: That's hard to imagine, but you're right.
JPC: So, how does that impact on you now?
DEBORAH: Well, I was talking to [my therapist] and I asked myself, am I happy? Not in general, just today, am I happy today? And the answer was yes. Things are great with Mark, Simone and I are arguing less and less and getting better at discussing things. And even with Shawn, with his therapy, I feel like there are some changes that are occurring. And like we've talked about, who knows what sort of relationship we might have in the future. So I guess that means I am here for now, and it feels okay making that day-to-day decision, it helps me appreciate what I do have and takes me away from focusing on some idea of how things should be.
This segment illustrates the beginning of Deborah's capacity to integrate expected feelings with her actual experiences. Similarly, Simone has been able to see how Deborah cannot provide hopes for her spousal relationship. Through treatment, Simone has struggled to integrate her idea of how an intimate relationship should appear with the actual lived experience with Deborah. She has started to understand how Deborah's absence is less a reflection of her feelings for Simone, but an attempt to provide meaningful experiences for herself that are not fulfilled by her parenting role. Faced with this fuller view of their shared experience, Deborah and Simone are left to weigh the benefits and pitfalls of remaining together and separating.
In general, Deborah and Simone entered treatment clutching ideas about their relationship that, given their circumstances, could not possibly be met by one another. Their discourse surrounding difficulties in parenting provided the context through which they were able to negotiate and better understand their struggles. Early attempts at understanding these difficulties pointed to their inability to listen to or empathize with one another's experiences. Treatment at this point focused on helping the couple better communicate through identifying fears and feelings that seemed to get in the way when attempting to discuss emotionally laden topics. Once they became better able to listen to one another, discussions about their parenting difficulties focused on articulating and understanding the contexts that gave rise to their circumstance and questioning their fears and assumptions about their partner's intentions. These discussions pointed out the inevitable clash between their hoped-for relationship and actual lived experience. Later in treatment, discussions about parenting and their relationship changed focus to expressions of mourning about lost aspects of the hoped-for relationship and recognition of pleasures and satisfactions in their lived experiences.
Discussion
We all hold preconceived ideas about intimate relationships, including how they are gendered. Hopes and concerns about interactions with others are formed starting with our earliest experiences. The idea of a couple emerges in our experiences with caregivers and is elaborated by social and cultural influences as we increasingly have contact with the outside world in childhood. These interactions are complex. Wished-for experiences from caregivers originating in childhood can remain a central influence on people's adult assessment of intimate relationships long after the wished-for experiences have lost their importance. Similarly, feared experiences of intimate relationships, rooted in childhood, can narrow the adult's capacity to take risks, feel comfortable with commitment, or be available for closeness and mutuality. These organizing influences, both from caregivers and our culture, can go unnoticed while exerting tremendous impact on the course of our lives. This is often the material of individual therapy. That this is also important material for couples therapy should not be surprising. An additional complexity is introduced in couples therapy, however, in that precisely that which we are supposed to treat — namely, the couple — is elusive. We are assisted in individual treatment, I suspect, by our physical boundaries that render agreement as to the meaning of individual in all but the most unusual, and often severe, cases. Differences in subjective experiences between the members of the couple and the therapist introduce at least three sets of mutually influenced understandings about couples. As I hope the two cases presented here have shown, an important aspect of couples therapy is the articulation, understanding, and, if possible, integration of these experiences.
Resolution in couples therapy can occur when competing unfulfilled hopes and concerns have been identified. The clinical dialogue, when focused on articulating the participants' felt experiences, evokes closer and closer approximations of subjective truths about their lived experiences together. Unfortunately, integration of opposing desires and fears is a process marked by access to new experiences, and thus, a function of time. As a result, predictions about the outcome of an individual's or couple's struggle are difficult to make. My own experience suggests that although couples therapy can diminish the time spent approaching a resolution to these struggles, it has less impact on the desired outcome. This is to say that couples therapy can hope to illuminate the struggles faced by the couple, but cannot take the couple's or therapist's ideals about successful partnering as criteria for success. Couples therapy can only serve to clarify certain aspects of the patients' lived experiences, leaving full integration or disposal of certain aspects for the future.
Couples, however they are imagined, however they are gendered, come to therapy because there is unhappiness, there is anxiety, there is conflict. The vantage point of the couples therapist is only as expansive as our capacity to listen to patients' experience and imagine equally fulfilling ways of living that differ from our own. We cannot protect or do away with influences from society or our own lives in the clinical situation. Yet through our own awareness of these influences, inspection of our own and our patient's presumptions about couples, and willingness to be educated by our patients, we can maximize our capacity for identifying and entertaining new ways for people to conceptualize, assess, and potentially feel satisfied with their chosen relationships, however they might be configured, however they might be gendered.
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