Supportive psychoanalytic couple psychotherapy

עודכן ב: 14 מרץ 2021

Supportive psychoanalytic couple psychotherapy

Ziva Levite, Idit Honigman, Hana Cohen, Liora Rehes, and Gidi Shavit

Abstract

This paper aims to deepen understanding of the application of supportive psychoanalytic psychotherapy in work with couples and to anchor it in psychoanalytic theory and practice. It is based on the experience of collaboration between experienced couple therapists and supervisors, who face the frustration intrinsic to supportive psychoanalytic couple psychotherapy (SPCP). The article defines the principles of supportive psychoanalytic psychotherapy and discusses its application to couple psychotherapy, highlighting the therapist’s role. A case example employing supportive couple psychotherapy is discussed for the purpose of clarifying and illustrating the essence of this therapeutic approach.




Keywords: Supportive psychotherapy, psychoanalytic couple psychotherapy, supportive psychoanalytic couple psychotherapy, splitting, projection, holding environment, countertransference.

Even when patients do not get cured they are grateful to us for seeing them as they are

(Winnicott, 1971, p. 117-118).

INTRODUCTION

Psychoanalytic psychotherapy concentrates on insights that enable development and change, while challenging defences and encouraging integration. Yet, not all individuals are helped by working with deeper unconscious material. There are some who have difficulty in containing the anxiety involved in insight-directed psychotherapy. They require holding and containment rather than interpretive work (Kernberg, 2000; Rockland, 1989). Joseph, writing about patients who are “difficult to reach” says, " It is very difficult to reach them with interpretations and therefore to give them real emotional understanding" (Joseph, 1975, p.75).

We propose therefore that, for couples, who might in psychological terms be similarly categorised, supportive psychoanalytic psychotherapy offers a more appropriate approach. Change using this type of psychotherapy is characteristically infrequent and slow. Therapy sessions are typically filled by partners’ attacks on each other and on the therapist that are so emotionally intense that there is space for neither change nor development (Bollas, 1987; Ruszczynski, 1995). In order to survive this demanding and challenging process, both partners, the couple's relationship, and the therapist, all need to be held and contained. This article is an attempt to deepen understanding of supportive psychoanalytic couple psychotherapy (SPCP) and to anchor it in psychoanalytic theory and practice.

SUPPORTIVE PSYCHOANALYTIC PSYCHOTHERAPY

Kernberg (1999) makes a distinction between psychoanalysis, psychoanalytic psychother