Table Of ContentWhat This Thing Called Love?
IS
What is This Thing Called Love? provides a clear how-to guide on the
art of psychotherapy with couples from a psychoanalytic perspective.
The book draws on both early and contemporary psychoanalytic
knowledge, explaining how each theory described is useful in formu
lating couple dynamics and in working with them. The result is an
extremely practical approach, with detailed step-by-step instructions
on technique, illuminated throughout by vivid case studies.
The book focuses on several key areas including:
• An initial discussion about theories of love.
• Progression of therapy from beginning to termination.
• Transference and countertransference and their unique manifesta
tions in couples therapy.
• Comparisons between couples therapy and individual therapy.
• Step-by-step instruction on technique.
What is This Thing Called Love? is enlivened with humour and human
ness. It is crucial reading for psychoanalytic therapists, psychologists,
psychiatrists, couples therapists and students who want to learn about -
or augment their skills in - this challenging modality.
Sarah Fels Usher is a psychoanalyst in private practice in Toronto. She
is the President of the Toronto Psychoanalytic Society, founding
Director of the Fundamentals Psychoanalytic Psychotherapy Program,
and a faculty member of the Toronto Institute of Psychoanalysis. Her
first book, Introduction to Psychoanalytic Psychotherapy Technique, is a
psychotherapy guide for students and beginning therapists. Dr Usher is
also Book Editor of the Canadian Journal of Psychoanalysis.
This book is an important contribution that will help these
clinicians develop the skills necessary to work with troubled
marriages. Numerous clinical case presentations bring this
work to life, clearly illustrating each phase of treatment.
Lewis Aron, Ph.D., Director, New York University
Postdoctoral Program in Psychotherapy & Psychoanalysis
The book is filled with rich clinical material and written with
great lucidity. Sarah Usher offers to the reader her clinical
wisdom distilled after many years of experience, and what is
offered is considerable and valuable. The important insights
contained in this book will benefit all therapists, including
those working with individual patients as well as couples.
Morris Eagle, Professor Emeritus, Derner Institute of
Advanced Psychological Studies, Adelphi University
What is This Thing
Called Love?
A Guide to Psychoanalytic
Psychotherapy with Couples
Sarah Fels Usher
First published 2008 by Routledge
27 Church Road, Hove, East Sussex BN3 2FA
Simultaneously published in the USA and Canada
by Routledge
270 Madison Avenue, New York, NY 10016
Routledge is an imprint of the Taylor & Francis Group, an Informa
business
Copyright © 2008 Sarah Fels Usher
Typeset in Times by Garfield Morgan, Swansea, West Glamorgan
Printed and bound in Great Britain by TJ International Ltd,
Padstow, Cornwall
Cover design by Sandra Heath
Cover illustration by Graphic Design, Southsea, Hants
All rights reserved. No part of this book may be reprinted or
reproduced or utilised in any form or by any electronic,
mechanical, or other means, now known or hereafter invented,
including photocopying and recording, or in any information
storage or retrieval system, without permission in writing from
the publishers.
This publication has been produced with paper manufactured to
strict environmental standards and with pulp derived from
sustainable forests.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British
Library
Library of Congress Cataloging-in-Publication Data
Usher, Sarah Fels.
What is this thing called love? : a guide to psychoanalytic
psychotherapy with couples / Sarah Fels Usher.
p. ; cm.
Includes bibliographical references.
ISBN 978-0-415-43383-9 (hbk) - ISBN 978-0-415-43384-6 (pbk.)
1. Marital psychotherapy. 2. Psychoanalysis. I. Title.
[DNLM: 1. Marital Therapy-methods. 2. Couples
Therapy-methods. 3. Psychoanalytic Therapy-methods.
WM 430.5.M3 U85w 2007]
RC488.5.U82 2007
616.89'1562-dc22
2007024975
ISBN: 978-0-415-43383-9 (hbk)
ISBN: 978-0-415-43384-6 (pbk)
FOR GARY
This page intentionally left blank
Contents
Preface Vlll
Acknowledgements XIV
1 The psychoanalytic perspective 1
2 Getting started: the first three sessions 29
3 Interlude: on love 49
4 The ongoing therapy: technique 72
5 Transference(s) 101
6 Countertransference 116
7 Denouement: working through and termination 135
Bibliography 152
Index 158
Preface
Many psychotherapists and psychoanalysts are aware that a
large proportion of their patients spend a significant amount
of their time in treatment talking about their experience of
intimate relationships. It seems natural, then, that therapists
may develop an interest in treating those relationships, in vivo
as it were, but alas, they may have had no training to do so. It
is my hope that this book will provide a guide to experienced,
psychoanalytically-oriented individual therapists who want to
treat couples, and, as well, will function as a source of super
vision for them. I hope those therapists already working in
this arena will find the book provides some calm in what can
be turbulent waters, as they connect with the stories, feelings,
and ideas shared here.
It is somewhat surprising that psychiatry, psychology, and
psychoanalysis have not given much attention to treating
people in their committed relationships, considering that so
much therapy time is spent in analysing the therapeutic dyad.
Psychoanalytic theory has evolved significantly over the past
half-century: classical Freudian "one-person" theory explored
the intrapsychic life of individuals, their drives and defences -
drive reduction was the prime motivator; object relations
theory focused on our current modes of relating to others,
which stem from internal representations of our early attach
ments - relatedness is the prime motivator; more recently,
relational theory moves the emphasis completely to issues of
relationship, viewing all psychoanalytic concepts through this
lens. (These theories, and others, will be elaborated in the first
Preface ix
chapter.) I have omitted several important intervening and
contemporary theories here for the sake of making a point:
that is, that we are highlighting more and more, in both our
theory and practice, the significance of self in relation to other.
That psychoanalytic theory could be applied to work with
couples seems almost self-evident; in fact, a psychodynamic
theory of behaviour is especially appropriate for relationship
problems. What a simmering stew of unconscious ingredients
there is here, bubbling up at times to the surprise of most, if
not all, of the participants in this triadic therapeutic inter
action. Our early and later concepts apply in spades: trans
ferences, which occur in relation to the therapist, and for the
couple, in relation to each other, and countertransference,
which can become intense and highly complex. Our old
friends, the concepts of resistance and defence, make an
interesting appearance here in relation to the therapy as a
whole, as well as to the way in which the couple interact with
each other. Even thinking of the myriad opportunities for
projective identification can be overwhelming. As a bonus,
because people often consciously and unconsciously see part
nership as a means of healing psychic wounds, working with a
couple together may provide an opportunity to treat
individual symptoms and their aetiology as well as treating
the relationship dysharmony. The recognition by the couples
psychotherapist of the repetition of unconscious patterns of
relating, described in analytic theory, is as important as a
detailed knowledge of the facts of the couple's relationship
and of each partner's life (Ruszczynski, 1993). Thus, even
though at first glance psychoanalysis and marital therapy
seem to focus on the observation of different data - psycho
analysis on the intrapsychic, and marital therapy on the
interactional - the data observed by both methods overlap
considerably (Finkelstein, 1988).
When we see couples in psychotherapy, we find that each
partner in the relationship brings a set of conscious and
unconscious expectations, and each may feel that in exchange
for what they give to the other, they will receive what they
want. Sager (1994) refers to these as contracts, and states that
