Table Of Content‘This book focuses on the impact of loss in couples and families where persis-
tent grief leads to a chronic form of melancholic depression and sense of
hopelessness, referred to diagnostically as complicated grief. Drawing on clin-
icaland theoreticaldevelopments incouple and family psychoanalysisoverthe
last several decades, this text, the first of its kind, provides the reader with a
range of contemporary and innovative contributions concerning this clinical
presentation, one hundred years after Freud’s original text Mourning and
Melancholia (1917). The extensive clinical experience of the internationally
known authors has allowed them to develop and illustrate an integrated object
relations and link theory framework, which opens new perspectives in the
understandingofcomplicatedgriefasit,manifestsincouplesand families.The
editors propose an original approach to the assessment of this problem and a
short-term intervention model for its treatment, underpinned by this frame-
work. Their clinical approach allows a questioning of the method, the metap-
sychology and the epistemological pedestal of contemporary psychoanalysis
and indoing so, opens upa new field of research. This new wayof listening to
psychic suffering, which focuses on the inter-subjectivity of the couple rela-
tionship,alsohighlightsthepotentialpreventivementalhealthvalueofsuchan
approach to diagnosis and treatment. From this vertex the book also examines
the effects of the intergenerational transmission of un-mourned loss, which not
only affects the couple (family) as a whole, but also has consequences for the
broader social and cultural contexts in which they live. Moreover, the book
addresses a clinical issue of immense contemporary relevance considering the
suffering and adverse implication un-mourned loss can cause in individuals,
couples and families and thus our world. The book, whose authors are recog-
nisedbytheIPAand theIACFP,therefore representsasignificantcontribution
to the field of couple and family psychoanalysis.’
Rosa Jaitin President,
International Association of Couple and Family Psychoanalysis
‘Loss, grief and mourning are universal human experiences. Over the cen-
turies, tradition, culture, religion, philosophy, direct interpersonal sensitivity,
generosity and intergenerational wisdom have provided human beings help
and support in facing these painful experiences. This book demonstrates,
however, that when complicated grief occurs, such supports are often not
enough and darkness and despair can dominate the internal psychic land-
scape. In these circumstances medication is often seen as the solution. The
authors show how psychoanalysis can go deeper. In particular, they demon-
strate how couple and family psychoanalytic interventions can help in facing
and working through the immense loss of a family member and avoid the
temptation of denial, disavowal, withdrawal or fixation to an impossible,
omnipotent recovery, as in the myth of Orpheus and Euridices.
I highly recommend this seminal text on complicated grief, not only
becauseit isscientificallyvaluable,butalsobecauseit isfull ofhumanity.The
book is both fascinating and touching, wide and deep and profoundly rooted
in psychoanalytic theory and culture. It contains the best psychoanalysis can
offer today about this crucial subject, thanks to the contributions of some of
the most experienced and qualified clinicians from around the world, who
represent cutting-edge thinking about couple and family psychoanalysis.’
Stefano Bolognini, Immediate Past-President,
International Psychoanalytical Association
‘Howtimely,followingthepublicationjustover100yearsagoofFreud’sseminal
paper, Mourning & Melancholia, that such a rich collection of perspectives on
loss are explored in relation to the important field of couple and family rela-
tionships.TimothyKeoghandCynthiaGregoryRobertshavebroughttogether
theirowncreative thinking onworking withlossincouples and familieswitha
collection of astute clinical papers from highly acclaimed couple and family
psychoanalytic therapists from around the world. All affirm that it is the
unconscious meaningof lossthat determinesthe capacity tomournor fallinto
seriousdepression.
Theeditorsare,bothexperiencedcliniciansinthisarea,havealsoproduced
abookthatinterweavesObjectRelationstheorywiththeconceptofthelink(el
vinculo)creatinganenrichedunderstandingoftheimpactofunmournedlosson
relationships, including intergenerationally on those in the present. The other
contributorstothebook highlight throughcloselyobservedclinicalmaterialor
film,boththeshockinglytangiblelossesthatarenonethelessavoidedandtheless
tangiblelossessuchasthelossofanidealisedrelationship,thatarehardertoget
hold off. They show that without being addressed, these have a destructive
influence on relationships. We know that loss is an intrinsic part of human
experience and the failure to mourn is detrimental to mental health. What this
impressivebookachieves,istoshowhowunrecognisedandunmournedlossgets
deeply embedded in the couple and family psyche, how, without being addres-
sed,thisimpedescreativedevelopment.Thisexcellentbookwillbeofenormous
valuetoallthoseworkingwithcouplesandfamilies,whethercoupletherapists,
analystsormentalhealthpractitioners,particularlyforthosewishingtoexpand
their understanding of the more deeply unconscious aspects of loss and the
impactonrelationships.’
Mary Morgan, Reader in Couple Psychoanalysis,
Tavistock Relationships
Psychoanalytic Approaches to Loss
PsychoanalyticApproachestoLoss:Mourning,MelancholiaandCouplesapplies
psychoanalyticideastotheclinicallycomplexissueoflossincouplesandfamilies
and outlines a new model for the assessment and treatment of associated
unresolvedgrief.Inlinewithcontemporaryapproachestocoupleandfamily
psychoanalysis, this integrated object relations and link theory model pro-
vides a clear framework and approach for assessing and treating this clinical
presentation.
The book brings together contributions from internationally known and
respected clinicians and authors who focus on loss, including repeated preg-
nancy loss, the loss of a child or parent and the loss of a relationship itself.
These psychoanalytic couple therapists take the reader inside their consulting
rooms, enabling observation of their approaches to the treatment of couples
experiencing loss and associated unresolved grief.
Psychoanalytic Approaches to Loss: Mourning, Melancholia and Couples
will make an important contribution to the literature on grief and mourning
and the application of psychoanalytic thinking to couples presenting with
difficulties linked to unresolved grief, following loss. It represents an essential
resource to psychotherapists, counsellors, family therapists, mental health
professionals and manyothers supporting those experiencing loss.
Timothy Keogh is a training and supervising analyst and full member of the
Australian Psychoanalytical Society. He is Honorary Senior Lecturer, Medi-
cal School, University of Sydney and a research fellow of the International
Psychoanalytical Society.
Cynthia Gregory-Roberts is an individual, couple and family psychoanalytic
psychotherapist in private practice in Sydney, Australia. She is a member of
theAustralianAssociation ofSocial Workers andCollegeofSocialWork and
an accredited Mental Health Social Worker.
This page intentionally left blank
Psychoanalytic Approaches to
Loss
Mourning, Melancholia and Couples
Edited by
Timothy Keogh and Cynthia Gregory-
Roberts
Firstpublished2019
byRoutledge
2ParkSquare,MiltonPark,Abingdon,OxonOX144RN
andbyRoutledge
711ThirdAvenue,NewYork,NY10017
RoutledgeisanimprintoftheTaylor&FrancisGroup,aninformabusiness
©2019selectionandeditorialmatter,TimothyKeoghandCynthia
Gregory-Roberts;individualchapters,thecontributors
TherightofTimothyKeoghandCynthiaGregory-Robertstobeidentifiedas
theauthorsoftheeditorialmaterial,andoftheauthorsfortheirindividual
chapters,hasbeenassertedinaccordancewithsections77and78ofthe
Copyright,DesignsandPatentsAct1988.
Allrightsreserved.Nopartofthisbookmaybereprintedorreproducedor
utilisedinanyformorbyanyelectronic,mechanical,orothermeans,now
knownorhereafterinvented,includingphotocopyingandrecording,orinany
informationstorageorretrievalsystem,withoutpermissioninwritingfromthe
publishers.
Trademarknotice:Productorcorporatenamesmaybetrademarksorregistered
trademarks,andareusedonlyforidentificationandexplanationwithoutintent
toinfringe.
BritishLibraryCataloguinginPublicationData
AcataloguerecordforthisbookisavailablefromtheBritishLibrary
LibraryofCongressCataloginginPublicationData
Acatalogrecordhasbeenrequestedforthisbook
ISBN:978-1-138-31243-2(hbk)
ISBN:978-1-78220-548-7(pbk)
ISBN:978-0-429-45823-1(ebk)
TypesetinTimesNewRoman
byTaylor&FrancisBooks
Contents
List of illustrations ix
Acknowledgements x
Editors xii
List of contributors xiii
Series Co-Editor’s Foreword xv
Preface xviii
Introduction 1
TIMOTHYKEOGH
PARTI
Theoretical understandings and clinical approaches to loss 13
1 Psychoanalytic understandings of loss and their relevance to
couples and families 15
TIMOTHYKEOGH
2 Link theory and object relations theory: an enriched approach to
working with melancholic couples 34
ELIZABETHPALACIOS
3 Assessing and formulating issues of unresolved loss in couple
functioning 45
CYNTHIAGREGORY-ROBERTSANDTIMOTHYKEOGH
4 A proposed theoretical framework and model for intervention 60
TIMOTHYKEOGHANDCYNTHIAGREGORY-ROBERTS
viii Contents
PARTII
Loss in couples and families: theory and practice 75
5 The family’s use of regressive defences as an avoidance of
mourning 77
ANNAMARIANICOLÒANDSTEFANIATAMBONE
6 The lamp of tragedy past: traumatic intergenerational loss and
the couple 87
JUDITHPICKERING
7 Some considerations regarding the impact of early parental loss
on adult couple functioning 102
CATRIONAWROTTESLEY
8 Mourning and melancholia and the couple experience of a
miscarriage 118
CARLBAGNINI
9 Loss in the everyday life of couples 129
MONICAVORCHHEIMER
Epilogue 140
TIMOTHYKEOGHANDCYNTHIAGREGORY-ROBERTS
Author Index 143
Subject Index 145
Illustrations
Figures
4.1 Dynamic developmental anxieties/link theory model of couple
functioning 65
4.2 The Unresolved Grief Triad (UGT) 67
Table
4.1 A grid depicting developmental anxiety, link and therapeutic
focus 70
