Psychoanalysis, Psychotherapy and
Marital Therapy Centre

How does Couples Therapy work?

How does Couples Therapy work?

Melike Kayhan

What is Couples Therapy?  Why do couples stay in painful relationships?

One of the most striking things I have observed in my work as a couples therapist is how often human beings form painful romantic attachments. What's more, couples often stay in these harrowing relationships for years. It's a pattern that has always intrigued me. Are these individuals sadomasochists or simply perverse? How do these seemingly mismatched partners find each other in the first place? And why put themselves - and frequently, their children - through so much hardship by remaining in the relationship? I'd like to explore these questions in this article, and, at the same time, to give you some insight into the ways I work with these individuals in psychoanalytic couples therapy.  

According to Grotstein (1987), we stay in painful relationships because pain is preferable to emptiness, what he describes as the "black hole", the void. However compromised these relationships are, they still shield us from our greatest fear: nothingness. It is the "meaningless" life that embodies the unbearable terror, rather than the life of deprivation. Couples in these relationships may feel exasperated, but at least they feel a "sense of aliveness instead of deadness" (Kernberg, 1975, p.196). We see similar dynamics in suicide bombers on a mission; they wed themselves to the pain in order to to feel alive, to have purpose and meaning in their lives.

In order to appreciate our capacity to endure pain, we need to understand certain things about group psychology. For the members of a group, the preservation of 'the collective group self' can be more important than life itself. People in groups, as well as individuals who are part of a couple, will strive to protect 'the collective group/couple self' despite huge personal cost. The kamikaze suicide squads deployed by Japan during the Second World War are an extreme example of this behaviour. In order to protect national pride and a sense of identity - the integrity of the 'collective group self' - these men were prepared to die for their country (Lachkar, 2003, p. 77). Similarly, married couples will frequently sacrifice themselves, their families, and their children in an effort to preserve the union. 

Emotional pain in an intimate relationship is usually an indication of unresolved issues from both partners' past. These issues need to be worked through in couples therapy. Therapy gives both partners the opportunity to grow, develop and face new experiences. My clinical work with couples has revealed how often people fear these new experiences. Because they feel familiar, it's easier to revert to the old, painful and destructive ways of relating to each other. Change takes time. 

In psychoanalytic therapy, it is assumed that our choices of partner are based on unconscious processes: in order to repair a childhood wound an individual either chooses a very different partner to the parent who has inflicted the hurt, or a similar one in an attempt to repair the wound. To give you an example of the first scenario, somebody whose father had numerous affairs chooses a partner who adores them and appears very faithful. In the second scenario, an individual with an alcoholic parent chooses a series of alcoholic partners because of an unconscious wish to heal the parent and an internal fantasy that this is possible.

When an intimate relationship or a marriage is successful it meets very important psychological needs for each partner. Every individual needs love and intimacy. We all want to belong, to feel wanted, valued and validated. In a good relationship these needs are met. It is very important to share experiences and to not feel isolated in a relationship. 

In some cultures the mere fact of being married is an achievement and a source of pride and contributes to feelings of self-worth. When social, economical and psychological needs are met in marriage, both partners will feel fulfilled and the relationship can be viewed as successful. When these fundamental needs are not met the individuals concerned become unhappy and problems occur in the relationship. Thus, there may be a variety of reasons which compel couples to seek therapy.

Having observed many couples over the years, I think the reason two people lose the capacity to love one another, and themselves, is largely because they expect the other person to be able to heal past hurts. It's only when they become aware of having such unrealistic unconscious fantasies and expectations of each other that they can have a more fulfilling relationship. In couples therapy, this change can only occur when the insights gained through therapy are experienced within the relationship over and over again. 

In psychoanalytic couples therapy, we are looking at relationship dynamics rather than individual issues. In psychoanalytic therapy, not only are each individuals's hopes, disappointments, fears and wishes analysed but also both partners' inner worlds and the way these two worlds impact on each other. Just as no two homes are the same, nor are there two identical relationships. Every relationship has a unique character and all couples have a specific way of relating to each other. This is not something they are aware of but produced by their conscious and unconscious dynamics. In my experience, the most helpful thing for a couple to bring to therapy is the desire to heal their relationship, and each other. 

Melike Kayhan
Psychoanalyst, Psychotherapist, Couple and Family Therapist

Becker, B.J. (1978). Holistic, Analytic Approaches to Marital Therapy. American Journal of Psychoanalysis, 38:129-142.  
Grotstein, J. (1987). Meaning, meaninglessness, and the "black hole": Self and interactional regulation as a new paradigm for psychoanalysis and neuroscience: An introduction. Unpublished manuscript cited in Lachkar, 2003.  
Kernberg, O. (1975). Borderline conditions and pathological narcissism. New York: Jason Aranson.
Lachkar, J. (2003). The Narcissistic/Borderline Couple: New Approaches to Marital Therapy. Routledge: New York & Oxford.

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