Focus on Families, Couples and Groups

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.