The problem of interpretation in marital therapy

T h e l~roblem o f I n t e r p r e t a t i o n in Marita~ T b / 6 r a p y By JAxtl~ L. TITCHENEI{ E C E N T L Y A YOUNG ~rOMAN, speaking about a crisis ill her marriage, observed that in all the forms and ways of huma n- r e la ting sarcasm, intimidation and mean heartless criticism can never be sharper and more cutting than in h u s b a n d s and wives who are also bridge partfiers. This is evidence that m a r r i a g e is a' unique, highly charged and deeply m e a n i n g f u l relationship, though it m a y not always' appear to be on the surface. Because the interaction in a marriage focuses so m u c h from the past, from the present, and from expectations for the future, there can be major diaq%ulti'~s in working out an adjustment, but also this concentration of feeling and conflict offers opportmaities for the use of psychotherapy. Considering the intensity of feelings, the complex problems to be worked through, and the difficulty in perceiving psychic reality of a marriage, the marital interaction system is a strategic focus for accomplishing therapeutic aims for the benefit of both individuals or the children ~ind the whole family. W e need to think about the nature of the therapeutic action and the functions of the therapist in t h e process of marital treatment. This p a p e r is an effort to arrive at some preliminary, notions for the theory of interpretation in marital therapy. Although psychiatrists have been helpful in marital situations for m o s t of this century and there are some psychiatric pioneers who have long been seeing ma r r ie d couples in their offices, the idea of intensive and interpretive psychotherapy for a marital relationship has not caught hold until recently. W e are still stnlggling with somewhat competitive theories on the nature of marriage a nd on pathogenesis in mai~ital interaction. Papers on marital therapy have mostly been about its promises and its pitfalls rather than the details of interpretive technique. T h e subject for discussion is marital psychot!wrapy in which both h u s b a n d and wife participate in the treatment sessions with a psychiatrist. This m e t h o d must b e distinguished from marital counseling. Counseling is mostly offering advice to the m a r r i e d couple, but also they have their eyes opened to problems they did not know existed and it is often suggested from the counsellor's fund of experience that the}, try new ways of relating, of working, of having sex relations, and so on. Counseling that remains within its bounds requires a high degree of skill in selecting the topical area and timing for a suggestion to the couple. Skilled counseling m a y stay within its defined limits but still resemble psychothenapy when the advising serves as permissio)) for the couple to abandon primitive, ritualized ways of h a v i n g sex relations, for example. Counseling can be c o me most "difficult and uncontrolled in its effects when the advice encourages too

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JAMms L. TITCHrZXER. M.D.: Associate Pro[essor, Department o] P.~ychiatry, College o] ~tedicine, University oJ Cincinnati, Cincinnati, Ohio. 321

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m u c h catharsis or turns to n a m i n g unco~isci0us factors in tile relationship. T h e practice of r e f e r r i n g to unconscious drives a n d defenses in a n unsystematic a n d u n p l a n n e d w a y , s i m p l y b e c a u s e they seem to be there, has the effect of i n c o m p l e t e or i n a c c u r a t e i n t e r p r e t a t i o n a n d will tend to excite conflicts a n d pathological defenses r a t h e r t h a n leading t o w a r d a w o r k i n g - t l l r o u g h process. A l t h o u g h individual t r e a t m e n t of marital p a r t n e r s is not a subject of this p a p e r some of the ideas d e v e l o p e d h e r e m a y be a p p l i c a b l e to that a r r a n g e m e n t . Marital p s y c h o t h e r a p y is usually m o r e p r o l o n g e d t h a n counseling. It is nondirective a n d a d v i c e ix a v o i d e d . It is explorato D, in the context of a t h e r a p e u t i c alliance of the couple with the t h e r a p i s t . F r e e d o m of c o m m u n i c a t i o n b e t w e e n the spouses and w i t h the t h e r a p i s t is e n c o u r a g e d a n d exploited to .increase a w a r e n e s s of feelings, conflicts, a n d resistances to t r e a t m e n t . I n t e r a c t i n g defenses e n c u m b e r i n g t h e relationship a n d a p p e a r i n g as s y m p t o m s of a m a r i t a l neurosis are i n t e r p r e t e d . Tl~e goal of c o u n s e l i n g is to increase a couple's c a p a e it), to deal with exteraaal reality. M a r i t a l p s y c h o t h e r a p y is d e s i g n e d to i n c r e a s e a couple's c a p a c i t y to deal with psychic reality, including preconseions fet~lin.*~s fantasies, a n d conflicts within the individual spouses a n d as they a p p e a r in the m a r i t a l relationship. I n t e r p r e t a t i o n is the crucial activity of the marital therapist, a n d the aim of interpretation followed b y the. processes of w o r k i n g t h r o u g h ix t h e increasing neutralization a n d integration of aggressive a n d libidinous needs in the context of the marital r e l a t i o n s h i p a n d interaction of spouses. Such is the goal of marital t h e r a p y . N e u t r a l i z a t i o n m e a n s t h a t b e h a v i o r is less m o t i v a t e d b y d r i v e discharge, t h a t drives are m o r e in the, service o f the ego a n d with less conflict. Neutralization occurs t h r o u g h learning less defensive a n d m o r e a d a p t i v e means of drive control. This l e a r n i n g n e w w a y s of drive control in the comm u n i c a t i o n a n d interaction system of a m a r r i a g e m a y t)e s t i m u l a t e d by interpretation of resistances a n d interlocking d e f e n s e folh)wed l)y r e p e a t e d t u r n i n g over a n d r e s t u d y of these p r o b l e m s . T h r o u g h e d u c a t i v e processes, o p p o s i n g drives from the libidinous a n d aggressive aspects of t h e id " n e u t r a l i z e " e a c h o t h e r so that thest: nonconflietful fusions of id derivatives m a y 1)e e m p l o y e d in s u b l i m a t e d a n d c o n s t r u c t i v e a c t i v i t y - - t h a t is, in the service of the ego. W i t h o u t e n g a g e m e n t in f u r t h e r theorizing on this v e r y complex m a t t e r , w e must be content in this exposition to think of m a t u r i t y in m a r r i a g e as consisting of a relatice nerttralizatio~ of drives t a m e d from their primitive state of n e e d p r e s s u r e to a c q u i r e a m o r e suitable form for a marital relationship. H o p e f t d l y , the old p a t t e r n s of dt~fense and a d j u s t m e n t are seen as i n a p p r o p r i a t e in tile n e w context of an aflult marriage. "'Integration" in m a r r i a g e consists of rt, a s o n a b l e disposition of n e e d p r e s s u r e s so t|mt e a c h p a r t i c i p a n t in the relationship finds his feelings a n d needs fitting, m a t c h i n g a n d reciproeatillg with the other's in a m a i m e r that m a k e s possible a n d feasil~le a m e a s u r e of gratification for both. T h r o u g h interpretive w o r k the l r e a t m e l d ahns not at extinguishillg aggressive t~r hostile expression ( o r at e n c o u r a g i n g it as m a n y couples expect from t r e a t m e n t ) , but r a t h e r at exploration of the sourees of such feelings a n d at a s t u d y of their al~l~ropriateness a n d

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m e a n i n g .ira a h u s b a n d a n d w i f e p a i r w i t h t h e h o p e of a c h i e v i n g d e g r e e s of i n t e g r a t i o n a n d c o n t r o l w i t h a l l o w a n c e for s a f e t y d e v i c e s f o r p r e v e n t i n g h o p e less r a n c o r a n d d i s i n t e g r a t i o n . A g g r e s s i v e a n d l i b i d i n o u s d r i v e s w h i c h a r e i m p e l l e d f r o m p r i m i t i v e s o u r c e s in m u c h e a r l i e r r e l a t i o n s a r e l i k e l y t o p e r p l e x a n d o v e r w l a e l m t h e a d a p t i v e c a p a c i t y of tile m a r i t a l i n t e r a c t i o n s y s t e m . I n c r e a s i n g n e u t r a l i z a t i o n of t h e s e d r i v e s t h r o u g h t r e a t m e n t m a k e s t h e s a m e f e e l i n g s c o n t r o l l a b l e a n d a p p r o p r i a t e in t h e a d u l t m a r i t a l c o n t e x t so t h a t i n t e g r a tion is p o s s i b l e . T h e r e f o r e , t h e r e is a t t e n t i o n in m a r i t a l t h e r a p y to d e r i v a t i v e s of p r e g e n i t a l , p h a l l i c , a n d g e n i t a l n e e d s as t h e y a r e l i k e l y t o a p p e a r ill m a r i t a l i n t e r a c t i o n , w i t h s t u d y of t h e i r a p p r o p r i a t e n e s s in t h e a d u l t m a r i t a l c o n t e x t , a n d t h u s h o p e f u l l y a s y n t h e s i s o f n e w w a y s of i n t e g r a t i n g t h e s e n e e d s at a h i g h e r l e v e l of n e u t r a l i z a t i o n . T w o c a s e s in w h i c h m a r i t a l t h e r a p y w a s not s u c c e s s f u l m a y s e r v e to illust r a t e t h e i d e a of r e l a t i v e n e u t r a l i z a t i o n of n e e d s in m a r i t a l i n t e r a c t i o n b y s h o w i n g t h e e f f e c t s o f t h e l a c k o f it. A bitter and gloomy young woman with artistic talent was married to a salesman carried away by his optimistic view of the world and unable to comprehend his wife's nntrusting pessimism. Her anger over a deprived life and continuing frustratinn over her husband's frequent travels at:d happy insouciance when he was home could find no way of reasonable outlet and intc?gration in treatment. She could not reach him in his world of eheeD' illusions without increasing her anger to the point of degrading insults and teeth-grinding attacks. Then he. hurt terribly that his usually contagious humor had not lifted her, would leave her to avoid h;wing a severe depression himself. An amllitious young lawyer y-as an only child who nlarried at all early age in law school. l i e halt two children but demanded a divorce because he felt lie no longer loved his wife and found hilllself impotent with her in alleged contrast to his experience with other women, l t e had been an overproteeted, lavished boy who went with the prettiesl girl in his high sch~rtd, his wife-to-be. She was a confident, trusting girl with whom the boy was proud to be seen. l i e never dated another girl and therehy escaped the anxiety of chot,sing or having to be chosen, ite married early in life tel av,)id such conflicts. But his wife could not tolerate the fact that there were conflicts. When the marriage came to a crisis the lawyer was drivetl beyond the capacity of the treatment t(~ help him hy the force of feeiings with preoedipal origin which he had avoided by his precocious, initially childlike marriage. I n e a c h of t h e s e m a r r i a g e s r e a c t i v a t e d n e e d s r e g a i n e d t h e i r e a r l i e r i n t e n s i t y a n d f i x a t e d q u a l i t y s t r a i n i n g a d a p t a t i o n in t h e m a r r i a g e b e y o n d t h e c a p a c i t y o f t h e t r e a t m e n t to r e i n t e g r a t e t h e r e l a t i o n s h i l ) . I n t h e first m a r r i a g e t h e w i f e ' s r a g e f r o m h e r f r u s t r a t e d w i s h e s for s e c u r i t y w a s c o m b i n e d w i t h a h u s l m n d ' s d e n i a l o f a n g e r o r n e e d st, t h a t a r e c i p r o c a t i n g m e t h o d of d r i v e c o n t r o l c o u l d n o t b e d e v e l o p e d . Jn t h e s e c o n d m a r r i a g e t h e d e f e n s e s o f n o t h a v i n g to c h o o s e a n d b e d i o s e n in t h e h u s b a n d w a s a n a c h r o n i s t i c so t h a t h e h a d a c q u i r e d a s t r o n g a v e r s i o n f or t h e girl w h o h a d h e l p e d h i m c o m p r o m i s e w i t h a difficult problem. l n t e r p r e t a t i ~ m in m a r i t a l t h e r a p y is a s t a t e m e n t n a m i n g tlre p r e d o m i n a n t t m a c k n o t t ' l e d g e d b e | t a y l o r , f e e l i n g , o r t h i n k i , g c o r n , e y e d m t h e eOul~le as retest c u r r e n t l y a f f e c t i n g t h e d y n a m i c s of t h e i r i n t e r a c t i o t i w i t h t h e i n t e n t of i , -

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c r e a s i n g t h e i r ~ w a r e n e s s of t h e i r e x p e r i e n c e w i t h o n e a n o t h e r in m a r r i a g e . T h e c o m m u n i c a t i o n s a b o u t t h i s b e h a v i o r , t h i n k i n g , or f e e l i n g c o m e f r o m t h e prec o n s c i o u s a n d d e f e n s i v e p o r t i o n s of t h e e g o s of t h e i n t e r a c t i n g spouses. T h e a c t u a l p r o c e s s of i n t e r p r e t a t i o n u n f o l d s in t h e f o l l o w i n g m a n n e r , s i m i l a r to t h e p r o c e s s in i n d i v i d u a l t r e a t m e n t : First, w e h a v e a v a g u e h y p o t h e s i s of t h e t r o u b l e s a c o u p l e h a v e . W e see t h e m o v e r a f e w or m a r l y h o u r s . \~'e h e l p t h e m c o m m u n i c a t e so w e m a y l e a r n m o r e a b o u t t h e m . W e t r y o u t a f e w s p e c u l a t i v e c o n s t r u c t i o n s , s o m e t i m e s b e g i n n i n g w i t h t h e i r f a m i l i e s of o r i g i n a n d t a k i n g t h e m t h r o u g h t h e i r c o u r t s h i p a n d on u p to t h e i r c u r r e n t t r o u b l e s of v a r y i n g d u r a t i o n . W e refine t h e s e n o t i o n s f r o m t h e i r r e s p o n s e s to t h e s e i d e a s a n d f r o m o t h e r dat~l- W e h e l p t h e m t h r o u g h s o m e r e s i s t a n c e s . W e a d v i s e then) w h y the), w a n t to s t o p t r e a t m e n t . F i n a l l y , w e d e v e l o p a n appraisal of all u n a c k n o w l e d g e d d y n a m i c s e q u e n c e ( c o n f l i c t a n d d e f e n s e ) w i t h current and predominating effect u p o n t h e i n t e r a c t i o n of f e e l i n g , t h i n k i n g , a n d a c t i n g in t h e m a r r i a g e . O n l y t h e n , p e r h a p s a f e w m o n t h s a f t e r w e b e g a n to u n d e r s t a n d t h e m , d o w e u s u a l l y h a v e a n i n t e r p r e t a t i o n w i t h s o m e c h a n c e of i n f l u e n c e o v e r t h e i n t e r l o c k i n g d e f e n s e s w e h a v e l e a r n e d to i d e n t i f y in t h e m a r r i a g e . I n t e r p r e t a t i o n s in this f o r m of t r e a t m e n t a r e m o s t o f t e n d i r e c t e d at a v a r i e t y of v i c i o u s circles in m a r i t a l i n t e r a c t i o n . F o l l o w i n g is t h e w a y t h e s e vicious circles oDerate: D i s a p p r o v a l , d i s a p p o i n t m e n t , a n d a c c u s a t i o n a b o u t t h e self f l o w i n g from s u p e r e g o or e g o i d e a l s t r u c t u r e s a r e o f t e n p r o j e c t e d to t h e s p o u s e . T h e s e a t t i t u d e s a r e t h e n u n c o n s c i o u s l y p e r c e i v e d in t h e o t h e r . T h e y a r e not o n l y felt as u n p l e a s a n t or p a i n f u l in t h e i r r e f l e c t e d f o r m , b u t t h e y a r e also v e r y o f t e n r e i n t r o j e c t e d , t h e r e b y o n c e a g a i n i n c r e a s i n g t h e i n t e n s i t y of t h e o r i g i n a l conflict. 2 A husband in marital therapy with his wife for more than a year had often reported irritability and muscle tension when driving a car with his wife. They had talked over the usual problems of "back-seat" criticism and had largely done away with it without cnrin~ the problem. Then one day he noticed in the corner of his eve that his wife's calf extended toward the floor board when he came to an intersection, tte found that it happened regularly anti guessed with probable correctness that it always had. This subliminal cue brought forth his own feelings of inadequacy about being an adult male of ",vhich automobile driving was a representative activity. The wife's floorboard action of which she was not aware had connection with her own past d~ving experience with her father. Thus a very slight movement of a leg brought forth projected doubts of masculine adequacy which were intensified in their reflection. He could think over the problem in its conscious lronn but when it was iutrojected from the wife it caused irritability and tension, lte had literally introjected her muscle tension. T h u s . p r i m i t i v e s u p e r e g o p r e s s u r e s c a u s i n g guilt, s h a m e , a n x i e t y , a n d d e i)ression c i r c u l a t e in m a r i t a l i n t e r a c t i o n b y tilt." m e c h a n i s m s of projec.tion a n d i n t r o j e c t i o n . T h e o r i g i n a n d real n a t u r e of t h e s e p u n i t i v e s u p e r e g o a t t i t u d e s f r o m v e r y e a r l y life e x p e r i e n c e a r e t o t a l l y m i s u n d e r s t o o d b y t h e s p o u s e s a n d a r e c o v e r e d b y s e v e r a l l a y e r s of d e f e n s e w o r k e d i n t o c o m p l i c a t e d m a r i t a l g a m e s . I n t e r p r e t a t i o n is d i r e c t e d at t h e s e v i c i o u s circles, n e v e r l e a v i n g o n e p a r t of t h e c i r c l e out. C o m p l e t e n e s s of a n i n t e r p r e t a t i o n i n c l u d e s t h e w i s h a n d (lef(,nse in e a c h p a r t i e i t ) a n t in t h e i n t e r a c t i o n .

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ill s u m m a r y , m a r i t a l t h e r a p y is d i f f e r e n t i a t e d from c o u n s e l i n g a n d o t h e r advisory a n d directive t e c h n i q u e s b y tile use of n o n d i r e c t e d exploration a n d i n t e r p r e t a t i o n of d e f e n s e a n d conflict in t h e former. I n t e r p r e t a t i o n a i m s at i n c r e a s i n g relative n e u t r a l i z a t i o n a n d i n t e g r a t i o n of n e e d p r e s s u r e s in m a r i t a l interaction, m a i n l y b y s t a t e m e n t s n a m i n g the p r e d o m i n a n t d y n a m i c s of thinking; feeling, a n d action in the c u r r e n t interaction a n d by b r i n g i n g to ligl.at the defensive-conflictive forces o p e r a t i n g in vicious circles in tile m a r i t a l interaction b y the m e c h a n i s m s of projection and introjeetion. T h e f o l l o w i n g discussion e x a m i n e s this sketch of the t h e r a p e u t i c process in greater detail. ~ ' I A R v I ' A L T H E R A P Y : T H E O P E N I N G .X'IOVES

T h e o p e n i n g moves, the s e t t i n g , the, basic rules, a n d tile contra~t for m a r i t a l t h e r a p y d e s e r v e one or several p a p e r s for really a d e q u a t e discuss:ion, b u t a n outline of these topics is n e e d e d as a basis for u n d e r s t a n d i n g i n t e r p r e t i v e techniques. E%X~h? the referral is u s u a l l y c o m p l i c a t e d . A psychiatrist or s o m e o n e else m a y c~'~ll a b o u t a c o u p l e w h o do not know x~,hat the), w a n t h e l p to get t h e m s ~ ' e s apaf~ or togetJler or s o m e t h i n g in between. T h e y u s u a l l y h a t e t h e i d e a ol~tmt~t'eatment a n d investigation of the p a i n f u l intricacies of t h e i r p r o b l e m a n d yet t h e y y e a r n for it, p e r h a p s as an escape f r o m d e c i s i o n a n d responsibility. Ill the m i d s t of all t h e s e c o m p l i c a t e d a n d crossed feelings the t h e r a p i s t suggests that one or the other of t h e m call for an a p p o i n t m e n t . Tile h u s b a n d a n d w i f e are seen i n d i v i d u a l l y for his and her version of the t r o u b l e a n d for the c u s t o m a D" d i a g n o s t i c e v a l u a t i o n p r e c e d i n g t r e a t m e n t . It is e s p e c i a l l y v a l u a b l e for the later work to h a v e well in m i n d the configuration of relations w i t h i n each spouse's f a m i l y of origin. Patterns c o n g r u e n t to these configurations will b e e m b e d d e d in tile miqita] interaction. An obvious e x a m p l e of the significance of such p a t t e r n s comes to m i n d from nay practice. mother of three sons came from a family of four daughters, l l~rr husband was one of 4

t h r e e s o n s . T h e i r o w n f a m i l y w a s m u c h diflrerent in o r g a n i z a t i o n a n t i in" t h e t y p e el r r e a s o n a b l y e x p e c t a b l e e n v i r o n m e n t f o r tl~e w i f e b u t v e r y s i m i l a r to t h e e x p e r i e n c e t h e

husband had. After these interviews, t h o u g h t is given to the possibilities of response to t r e a t m e n t a n d to tile sort of t r e a t m e n t whk.h m i g h t lye workable. O u r experience in marital p s y c h o t h e r a p y is not c o m p l e t e e n o u g h to 1)e w e l l - d e f i n e d ill stating its i n d i c a t i o n s a n d t h e r e is not room in this p a F e r for a t h o r o u g h investigation of this c o m p l i c a t e d matter. H o w e v e r , w h e n the marital relationship a n d p r o b l e m s in m a r i t a l interaetion a p p e a r to p r e d o m i n a t e in the neuroses of the h u s b a n d a n d wife, m a r i t a l t h e r a p y s h o u l d b e eonsidered. Also, w h e n the i n d i v i d u a l neuroses a n d n e u r o t i c (or p s y c h o t i c ) defensc.-s h a v e a m o r e t h a n u s u a l l y i n t e r l o c k i n g quality, m a r i t a l t r e a t m e n t m a y be preferre.d. I w o u l d r a t h e r h a v e the neurotic difficulties be s i m i l a r : l u a n t i t a t i v e l y ~ t h a t is, in d e g r e e of severity. It is like a s t e r e o p h o n i c system; if one of the speakers has to b e t u r n e d up or d o w n for there to b e some b a l a n c e in relative p a r t i c i p a t i o n

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a n d n e e d , t h e s y s t e m w i l l n o t w o r k p r o p e r l y , so if o n e s p o u s e ' s n e u r o s i s n e e d s too much attention marital therapy will not function well. An energetic bnsinessman sl:ddenlv left his wife. For a ),ear or so he was in and out of his marriage, severely upsetting her. T h e y decided at some point of extremity in feeEng about their situation to seek "marital eom~seling.'" But diagnostit: stndy revealed clearly that the wife-leavil~g was so much a s.vnaptom of depressive feelings in the husband ,,bout hi,nself and his work that individual treatmer, t seemed best for him and his wife. Vqhen a recommendation f o r m a r i t a l t h e r a p y is w a r r a n t e d a n d m a d e , it is n o t l i k e w r i t i n g at p r e s c r i p t i o n w i t h t h e u s u a l f a i t h that, t h e . pills w i l l b e . t a k e n . At t h i s p o i n t of t h e t h e r a p e u t i c p r o c e s s t h e t h e r a p i s t is m o s t l i k e l y v i e x y i n g t h e first o f t h e systemic r e a c t i o n s , a n d s y s t e m c o n s c i o u s ~ l e s s "' is o f g r e a t i m p o r t a n c e i n a t h e r a p e u t i c r e s p o n s e . " S y s t e m c o n s c i o u s n e s s ' " r e f e r s to t h e d o c t o r ' s awareness that spouses present through their communications a unit with s y s t e m p r o p e r t i e s . A s t i m u l u s c a u s i n g c h a n g e in o n e p a r t o f t h e s y s t e m w i l l result in change throughout the system through compensato~' mechanisms which operate to maintain equilibrium of the system, T h e h u s b a n d a n d w i f e s e l d o m a c c e p t t h e i d e a in t h e s a m e m a n n e r . F o r e x a m p l e , o n e is e a g e r , t h e o t h e r g r u d g h a g , " o n e is s a c r i f i c i a l , t h e o t h e r c o m p l i a n t ; a n d so o n a n d o n . T h e t h e r a p i s t is o b s e r v i n g a t t h i s p o i n t in t i m e t h e r e s p o n s e of at s y s t e m , t h e m a r i t a l i n t e r a c t i o n s y s t e m a n d its s y m p t o m s , its c o m m u n i c a t i o n c h a n n e l s , its d e f e n s i v e a n d i n t e g r a t i v e ' o p e r a t i o n s , a n d so o n . In many cases the maintenance of e q u i l i b r i u m of t h e i n t e r a c t i o n system requires t h a t if o n e s p o u s e is c o m p l i a n t , . t h e o t h e r b e g r u d g i n g . T h e r e f o r e , argmments with or interpretations of these responses are usually premature b e f o r e t h e s y s t e m p r o p e r t i e s h a v e b e e n a p p r a i s e d . I t is b e s t to a c c e p t t h e system's total response and note the behavior for later interpretive work. An engineer came for consultation beeanse his marriage of 20 years was on the verge of dissolution. However, he claimed he was not at all disp!eased or unhappy witli the turn of events. H e was in love with another. Jtis wife had been a shrew [or )'ears he said. l i e married her from pity and she had beer~ pitiless toward him. llis only request was that the doctor see his wife in consultation and arrange individual treatment for her to prevent the shattering impact of separation and divorce. From an interview with his wife it appeared she had been some of the things he said, but not all of them. A t the en(I of this first hour he informed me that he. intended taking his wife with him to South America for a morlth's business trip. l i e couldn't hurt her by denying her this trip, he said. I;a spite eL his logical explanation this seemed curious behavior for o~le fed up with a marriage, in love with another, and demanding divoi'ce. It also seemed notable that a wife, al)out to be abandoned could cheerftllly take such a trip widl her husband. Upon their return I r e c o m m e n d e d marital therapy, even though they were', sttpposed to l)e ending their marriage, and later used observations ()n the strange w a y the~" had first sought help hy making believe they were close to divorce. It is possible their "'make helieve'" woMd ha~'e ftu)le(! them too. The idea of exploring together their feelings; thinking, and actions and the d y n a m i c f a c t o r s n n d e r l y i n g t h e i r i n t e r a c t i o n is s t a t e d i1~ s e v e r a l i n f o r m a l w a y s t o t h e c o u p l e as t h e r e a s o n a n d m o t i v a t i o n f o r t h e i r u n d e r t a k i n g m a r i t a l t h e r a p y . T h e r e a r e t w o r e a s o n s f o r t h i s sort o f t : m p h a s i s . S i n c e o n e o r ' b o t h i n d i v i d u a l s

IN'I"lr;|iF'IIETA"rlON

IN

.-XIAII.ErAL "rttERAPY

327

m a y secretly or o p e n l y h o p e for release f r o m the m a r r i a g e , the usual, autom a t i c p r e j u d i c e that a t h e r a p i s t is an antagonist of divorce is under-cut. This part o f the t r e a t m e n t c o n t r a c t i m p l i e s that the exploratory w o r k h a s the adv a n t a g e for b o t h p a r t n e r s of m o r e explicit u n d e r s t a n d i n g of f~ietors i n f l u e n c i n g their m a r r i a g e w h e t h e r or not it is to b e dissolved. U n a c k n o w l e d g e d a n x i e t y a h o u t separation a n d fai.lure is then a m a t t e r for i n t e r p r e t a t i o n a n d at least partial w o r k i n g through. Secondly,, this b e g i l m i n g a t t i t u d e is a d v i s a b l e to distinguish the t r e a t m e n t from c o u n s e l i n g a n d m o r e direct relief from d e c i s i o n - m a k i n g t h e y p r o b a b l y have in m i n d . This w i s h for direct assistance in conflict with the actual for~n of t r e a t m e n t is a m a n a g e a b l e tension w h i c h actually provides a m o t o r for interaction a n d i n c r e a s i n g f r e e d o m of c o m m u n i c a t i o n in the early hours of t h e r a p y . It is sirnilar to the tension p r o v i d e d b y the silence oF the g r o u p t~crapist a n d the silence of the p s y c h o a n a l y s t . ]n the first h o u r of the marital t h e r a p y I e m p l o y a device to i n i t i a t e t h e t h e r a p e u t i c work. It seems to work, so I h a v e not tested the d e v i c e m o r e caret'ullv by o m i t t i n g it in the t r e a t m e n t of an e q u a l series of couples. T h e d e v i c e is s i m p l e a n d goes s o m e t h i n g like this: "As you know, I h a v e t a l k e d ~v'ith each of ),ou a b o u t the troubles in y o u r m a r r i a g e and l h a v e in m i n d y o u r i n d i v i d u a l views as well a s s o m e other things. N o w p e r h a p s you w o u l d like to put these views together here, to e x c h a n g e ideas and feelings on w h a t has h a p p e n e d , a n d see w h e r e you agree a n d differ on the problems.'" T h i s o p e n e r is a little h y p o c r i t i c a l since t h e y cannot r e a l l y follow the instruction, b u t they know m y intent a n d w i l l i n g l y e m b a r k on the task. If a n y o n e c h a l l e n g e d m e on the speech, w h i c h s e l d o m n e e d s to b e as l e n g t h y as the quelled one, I w o u l d s m i l i n g l y agree but suggest t h e y try a n y w a y . F r o m that first llour on, the c o u p l e chooses the topic, following t h e original instruction to try to increase their f r e e d o m to express thoughts, feelings, a n d p e r c e p t i o n s of t h e m . e l x e s , each other, the t h e r a p e u t i c process, a n d the therapist, a n d to increase s p o n t a n e i t y in r e s p o n d i n g to each other, the interventions of the therapist, a n d a n y t h i n g o c c u r r i n g in the interaction in the offlee as well as outside. J

INITIAl. ~q'A(;E OF ]NTEliPIII~'I'IVE W O R K L'~ ~IAP, ITAL TItERAi'Y

A l t h o u g h I b e l i e v e we are c a p a b l e of d o i n g t h e r a p e u t i c work w i t h m a r r i e d couples, t h a t w e can treat the interaction s y s t e m a n d can construct a coherent theory of i n t e r p r e t a t i o n from our present state of knowledge] we h a v e m u c h to learn a b o u t the l m t u r e of m a r i t a l interaction a n d ;~bout i t s relation to pathogenesis of neuroses in either the m a r r i a g e itself or the i n d i v i d u a l s e x p o s e d to the relationship. F o r e x a m p l e , the first task ill marital therapy is to a c h i e v e some clarification of the c o m m u n i c a t i o n s y s t e m for the benefit of the c o u p l e a n d for the progress of the m a r i t a l therapy. Some theories of marital t h e r a p y see :clarification of the c o m m u n i c a t i o n system as the p r i n c i p a l goal of the work. "t I feel that this a i m of i m p r o v i n g c o m m u n i c a t i o n is jiot n e c e s s a r i l y th(.ra[~eutic and that it is not a l w a y s e n o u g h for a t h e r a p e u t i c result, b e c a u s e c l l t r i f i c a t i o l l d o e s i | o t aim tow:lr(l relative l l e l l l r : t l i × i l t i o n all(l intt'gration basic

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to i m p r o v e m e n t of a neurotic m a i v i a g e . I w o u l d ho]d that this c l a r i f y i n g and b r e a k i n g d o w n of distortions or b r i n g i n g h i d d e n c h a n n e l s to light is nec~-,;:,~',ryto t h o r o u g h t r e a t m e n t a s a s t a g e is~ a t h e r a p e u t i c p r o c e s s . It is a stage prior to i n t e r p r e t a t i o n of d e f e n s e a n d conflict, b u t it will c o n t i n u e as long as the work goes on. \.Ve need to know more a b o u t these c o m m u n i c a t i v e processes a n d h o w they are built into m a r i t a l interaction systems t o ' m a k e our t r e a t m e n t m o r e e f f e c t i v e ~ t h a t is, to m a k e i n t e r p r e t i v e work m o r e effective. T h e m a n y i m p o r t a n t researches on the mysteries a n d intricacies of interaction in m a r r i e d couples a.a,4.7 h a v e b e a r i n g on marital Omrapy 'because t h e y s h o w us the r e s i s t a n c e s w e shall e n c o u n t e r in the early phases o f treatment. " M e t a - c o m p l e m e n t a r y " interactions (\,Vatzlowick; d a m n e d if you do, d a m n e d if you don't), n o n s c h i z o p h r e n i c doul~le-binds, disqualifications, pseud'o-mutual interactions, a v a r i e t y of g a m e s patterns and a great n u m b e r of other unk-'l)eled a n d unclassified interaction patterns serve as the first line of resistance in m a r i t a l t h e r a p y . T h e s e patterns of interaction have b e c o m e i n g r a i n e d traits of the marital r e l a t i o n s , such as e h a r a c t e r r i g i d i t y a n d a r m o r in the i n d i v i d u a l Patient. T h e y h a v e t o lye appraised, d e l i n e a t e d , a n d c o m p r e h e n d e d in d e p t h b y tim therapist, a n d t h e n they h a v e to be p o i n t e d out, usually repetitively, as they shift in form as a result of i n t e r p r e t a t i o n to e l u d e f u r t h e r investigation. In this initiaiTstage of i n t e r p r e t i v e work the t h e r a p i s t notes some patterns of interaction w h i c h e v a d e or distort or c o m p r o m i s e with eonflietual m a t e r i a l in order to keep it from a w a r e n e s s of both h u s b a n d a n d wife. T h e s e patterns should b e d e s c r i b e d i n detailed, operational, e v m T d a y terms the couple will u n d e r s t a n d mad w i t h d a t a on how each spouse participates. Also, patterns w h i c h constitute resistance to t h e r a p y should b e d e s c r i b e d for the couple, b e c a u s e such patterns are actually interferring w i t h the couple's a d j u s t m e n t outside of t r e a t m e n t . T h e dose a n d t i m i n g of explanato D, s t a t e m e n t s w i t h their p e r t i n e n c e to p a t h o g e n i c d e f e n s e structures m u s t lye c a r e f u l l y considered. As tlmrapists, we are not m e r e l y critics of c o m m u n i c a t i o n or j u d g e s of style. W e n e e d not describe a style or w a y of c o m m u n i c a t i o n just b e c a u s e it exists. T h e inteq~retation of a patten~ of c o m m u n i c a t i o n or style of interaction s h o u l d fit into a t h e r a p e u t i c p l a n in w h i c h the content of p r o b l e m s a n d conflicts is most signifieant. V~'e m u s t h a v e in m i n d that we are seeking the couple's a w a r e n e s s of potentially destructive a n d disintegrative conflict for the purposes of relative n e u t r a l i z a t i o n or i m p r o v e d drive control in the interaction system a n d increasing integration. These resistive patterns, repetitive in f a m i l y interaction a n d occasionally a c q u i r i n g an a u t o n o m y of f u n c t i o n ~ t h a t is, f u n c t i o n i n g in the interaction of the couple even w h e n the conflict is not p r c p o t e n t ~ h a v e a preconscious quality. T h e y are a v a i l a b l e to consciousness in both spouses if attention is specifically directed to them. T h e y are like preconscious defenses w h i c h prevent free association a n d h i n d e r f r e e d o m of c o m m u n i c a t i o n in l ) s y c h o t h e r a p y or psychoanalysis, a l t h o u g h some part of each pattern has roots in the unconscious ego of each participant.

INTI~HPIIlTFA'I'ION

Lt\r 3 f A H I T A L

"I"ItERAI"i"

329

O n e e x a m p l e o f s u c h a p a t t e r n is t h e u s e of c e r t a i n w o r d s o r t o p i c s to g e n e r a t e f e e l i n g in a d i s c u s s i o n . B u t this s p i r i t e d d i s c u s s i o n m a k e s p o s s i b l e a m a s s i v e d i s p l a c e m e n t a w a y f r o m a t o p i c w i t h w h i c h tlm c o u p l e f i n d s v e r b a l i n t e r a c t i o n c a u s e s a n x i e t y . Money al]d .money problems a r e a m o n g t h e m o s t f r e q u e n t and best of these. A ctmpte whose marriage was burdened by severe self-doubt and projections of doubt upon each other were frequently bringing urgent nmney problems and money disagreements to the .treatment sessions. These were'tQ,ing hours, getting nowhere; if a money problenl was solved or some agreement managed, it seemed to only spawn more of the same. The therapist was caught in "'helping" or refereeing, just as many marital counselors must often tind themselves bogged down w i t h this sort of material. Then one day the ,therapist heard the wife talking about a semi-secret fund she was reserving to save herself from even greater troubles forecast for t h e future. S h e repeated over ,'rfi'd over with increasing force the following phrases: "I know y o u want it, but you'll not get it." "How you'd like to put your hands on it," but I won't let you touch it.'.... I won't let you near it though I k~Jow you want it,'" The husband denied any interest in the fund and said she could keep it, but he was taunted into an impotent kind of pursuit as the interaction continued. Then, through some questions and observations it ,,va~ possible-to clarify the meaning of the interaction, that the money was the wife's body which the husbar~d was supposed to seek guiltily. ,XI~mev matters were more easily settled outside of the hour beeat~se they hnd lost the sexual connotation after that. S o m e o t h e r t o p i c s u s e d in a s i m i l a r m a n n e r are h o u s e c l e a n i n g , o r h o u s e h o ] d d u t i e s a n d t h e i r s h a r i n g , or c h d d r e n s p r o b l e m s . D i s c u s s i o n o f t h e s e p r o b l e m s a n d a c t i n g o u t in t h e s e a r e a s a r e h i d d e n b y p r e c o n s c i o u s m e c h a n i s m s f o r c o n d u c t i n g a t h e r a p e u t i c session while s h u t t i n g the therapist out of the intera c t i o n a n d c o v e r i n g o v e r the r e a l e m o t i o n a l conflict. T h e s e i n t e r a c t i o n m e c h a n i s m s , t h e xqrst line of d e f e n s e in a m a r i t a l n e u r o s i s a n d t h e u p p e r l e v e l of r e s i s t a n c e in m a r i t a l t h e r a p y , f u n c t i o n i n - t h e t r e a t m e n t in t h e s e w a y s : Firs4, t h e y e x c l u d e t h e t h e r a p i s t f r o m a real p a r t i c i p a t i o n in t h e interaction process b e c a u s e h e does n o t k n o w the code and the c o d e w o r d s (e.g., t h a t m o n t ~ m a y b e a w i f e ' s b o d y ) , of h e d o e s n o t t m o w h o w to p l a y t h e g a m e , or h e d o e s n o t r e a l i z e t h a t affect a n d h a r m o n y are p s e u d o - n m t u a l , or h e d o e s not u n d e r s t a n d w h a t all t h e f i g h t a n d e x c i t e m e n t is a b o u t . T h e l a t t e r , f i g h t i n g , is a m o s t p o w e r f { l l e x c l u d i n g m e c h a n i s m . T h e c o u p l e fights o v e r trivial or u n l m o w n m a t t e r s w h i l e t h e t h e r a p i s t feels h e is a t t e n d i n g a p r i m a l s c e n e m~d d o e s n o t n o t i c e t h a t h e is also b e w i l d e r e d a n d h a d b e t t e r l o o k f o r t h e u n c o n s c i o u s d e t e r m i n a n t s of t h e b e h a v i o r . O f t e n at thi~ p o i n t t h e r a p i s t s will t W to offer c o m m e n t s on " m i s u n d e r s t a n d i n g " or " p o o r c o m m u n i c a t i o n " as a basis f o r t h e fight, b u t t h e s e i n t e r v e n t i o n s fail b e c a u s e t h e y d o n o t d e a l w i t h d e f e n s i v e m e c h a n i s m s in t h e spouses" e g o s a n d t h e y d o n o t s e a r c h o u t affect. S u c h i n t e r v e n t i o n s m a y s t o p f i g h t i n g b e c a u s e t h e c o u p l e w o u l d like to lye p o l i t e a n d c o m p l i a n t , b u t talk a b o u t " n o t c o m m u n i c a t i n g ' " as a c a u s e o f fighti n g a n d o t h e r u n p l e a s a n t n e s s is a c t u a l l y a f o r m o f r e a s s u r a n c e a n d it is also illusory, T h e c o u p l e feels b e t t e r b e c a u s e t h e y a r e p e r m i t t e d to h o p e t h a t s o m e w i r e s for b e t t e r c o m m u n i c a t i n g will s o o n lye p r o v i d e d b y t h e t h e r a p i s t , l'mt it is

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illuso~, b e c a u s e one f i n d s . u s u a l l y that the c o u p l e is i'eally c o m m u n i c a t i n g only too w e l l on an unconscious level a b o u t feelings a n d thoughts w h i c h are not comforting. Second, these p a t t e r n s of interaction, g a i n e s , pseudo-mt, tual feelings, and the other m e c h a n i s m s . m a y be used to block aw,.areness .dr a n d emotional participation in the t r e a t m e n t b y one or b o t h m e m b e r s of t h e pair, F o r example, it f r e q u e n t l y h a p p e n s that one of the i n d i v i d u a l s will offer h i m s e l f or h e r s e l f as the person to b e "'corrected" a n d cured b y the observations of t h e other member," or c o n v e r s e l y that o n e . o f the two will elect to treat the other with interpretations a n d comments, asking for assistanee in this work from the therapist. In b o t h eases this k i n d of resistance can b e differentiated, from a working-through process occurring later i n ' t l i e t~eatment b y a theoretical, onesided, n o n i n t e r a e t i v e q u a l i t y of the statements. T h i s - k i n d of v e r b a l i z a t i o n differs from w o r k i n g through" in b e i n g o v e r g e n e r a l i z e d a n d not p e r t ! n e n t to the real ongoing interaction. Very often these d~fensive statements on the self or the other in a s e e m i n g effort to c o m p l y with the t h e r a p e u i i e effort a n d its aims are a c c o m p a n i e d b y a look' or g l a n c e at the therapist, mad this is almost a p a t h o g n o m o n i e sign. XVith r e f e r e n c e to "'looks" il) marital therapy, w h e r e , d o e s t h e therapist keep his gaze w h e n h e is talking or listening in m a r i t a l ther0py? T h e r e . i s no e a s y solution. His gaze on the one who is s p e a k i n g m a y work t o ' k e e p the other from b r e a k i n g in or i n t r u d i n g . Staring in b e t w e e n the ° two is, artificial, as is a tennis spectator's kited of eye,. h e a d ~fnd b o d y .action w h e n t h e r e is r a p i d interc h a n g e b y the c o u p l e . I ' t r T to maifitain a" fi'ee-floating attention visually as 3yell as aurally. My, gaze will rest with the s p e a k e r but. will take in the rest of the scene freely as 1 listen Io the v e r b a l c o m m u h i e a t i o n a n d w a t c h the kinesthetic c o m m u n i c a t i o n of b0tft persons jnvotx, ed with the s a m e floating attentiveness. In the m a n n e r that h o v e r i n g attention" is given to v e r b a l eommun,:,: :;~tion in i n d i v i d u a l t h e r a p y , *he s a m e k i n d of s c a n n i n g of other c o m m u n i c a t i o n systems is v a l u a b l e in m a r i t a l *herapy; it also prevents an artificial m a n e u v e r i n g b y the eyes. H o w e v e r , glances b y a n d betx t e n spouses." a n d t o w a r d the therapist will b e e l o q u e n t m o d e s of c o m m u n i c a t i o n in this k i n d of t h e r a p y . O n e or the o t h e r will a p p e a l to his or h e r spouse or e s p e e i a l l y to the therapist for d e f e n s i v e assistance, or h e - m a y level" a s e a r c h i n g lgok for anotl:aer's a t t i t u d e t o w a r d a c u r r e n t or recent .ex"pression. Alliances are swiftly sought, m a d e , a n d broken lLv s h i f t i n g glar~ces in marital t h e r a p y . O b s e r v a t i o n of this i n t e r p l a y aids in d e c i p h e r i n g v e r b a l interchanges. In summaQ,, m a n y of the. a u t o m a t i c i~teraetion patterns iJ,stituiionalized a n d s y s t e m a t i z e d b y couples a.nd d e s c r i b e d b y f a m i l y researchers are m o d e s of initial resistance in m a r i t a l therapy. T h e initial task of the t h e r a p i s t is clarification of these transactions, games, disqualifications, .double-Yoinds, a n d the like. I n t e r p r e t i v e work will not take h o l d until the therapist is no l o n g e r e x c l u d e d from real p a r t i c i p a t i o n in the interaction" b y rules tie does not u n d e r s t a n d . Clarification is for the benefit of the eot q)Je,.tlie therapist, a n d the t h e r a p e u t i c process, but it is only a.first step, not an end-goal, t o w a r d s the aim of r e l a t i v e neutralization of marital'eontlict and i n c r e a s i n g integration of the maritnl

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relationship. T h e s e resistances are a n a l o g o u s to the reticence, s h a m e , selfr e p u g n a n c e , a n d d o u b t s of t h e a n a l y s a n d or individual p a t i e n t in p s y c h o t h e r apy. T h e y arise from the "second censorship" in the preconscious, the first b e h l g the repressive b a r r i e r b e t w e e n unconscious and conscious system in the ego.

T h e w o r k of c l a r i f y i n g ' c o m m u n i c a t i v e processes in the m a r i t a l interaction system m u s t be c o n c e n t r a t e d in the early phases of t r e a t m e n t b e c a u s e a therapeutic: action e a n n o t have, effect until at least some of it has b e e n done, b u t this sort of w o r k will continue to the last hero" of the t r e a t m e n t too. B e c a u s e s o m e of the m a j o r defensive structures built into the interaction s y s t e m are a p p r o a c h e d t h r o u g h i n t e r p r e t i v e work, the type of resistances w e h a v e b e e n talking a b o u t will be e v o k e d a g a i n a n d r e i n t e r p r e t e d . IN'I'EI~i'I~L~I'ATION

IN =~'[ABITAL TI-IEI/AI'Y

Still to consider in this stud)" of the processes of marital t r e a t m e n t are the n a t u r e of the t h e r a p e u t i c alliance, the several stages a n d levels of i n t e r p r e t a tion, a n d s o m e t h o u g h t s on t r a n s f e r e n c e in marital therapy. T h e t h e r a p e u t i c alliance-is as necessary, though p e r h a p s m o r e c o m p l i c a t e d , to marital t h e r a p y as a n y o t h e r form of p s y c h o t h e r a p y . It cannot r e m a i n one-sided, t h o u g h it m a v start t h a t w a y or it m a y b e c o m e that w a y throug!l complications in t r e a t m e n t . T h e therapist is obliged to keep his e y e on t h e alliance, to find w a y s of m a i n t a i n i n g it in a r e a s o n a b l y b a l a n c e d form t h r o u g h out the course of tl~c t r e a t m e n t . A hypothesis of this study is that at a n y point of the t h e r a p e u t i c w o r k the therapist is allied with a relatively h e a l t h y a n d c o m p a r a t i v e l y conflict-free p a r t of the ego of one of the m , ~ t a l pair. This p r e d o m i n a t i n g alliance with a p a r t of the ego of one m e m b e r of t h e interaction system does not exclude the other. T h e therapist makes o b s e r v a t i o n s or interpretations t h r o u g h the conflict-free p e r c e p t i o n or behavior of one of the two p e o p l e involved d i r e c t e d t o w a r d pathologically defensive portions of the ego of the other. This h y p o t h e s i s m e a n s that the form a n d content of t h e alliance is c o n s t a n t l y sld[ting. W h e n an i n t e r p r e t i v e s t a t e m e n t has b e e n m a d e , using the alliance in the m a n n e r s u g g e s t e d here, it is time then to r e p a i r a n d r e i n s t a t e a n e w alliance w i t h t h e person w h o s e action, thinking, or feeling h a s b e e n i n t e r p r e t e ~ a n d to use this n e w l y o r d e r e d system h)r interpretation of t h e p a t h o l o g i c a l l y d e f e n s i v e portions of rite ego of the o t h e r m e m b e r of t h e marital pair. A clinical e x a m p l e of this process m a y help since a description of it m a y be m o r e c o m p l i c a t e d titan it is in pradtice. An e n g i n e e r felt justified in starting an extramarital affair and thinking of d i v o r c e after 1/~ years of marriage, b e c a u s e he said his wife had b e e n tms~anpathetie and shrewishlv d e m a n d i n g t h r o u g h o u t their )'ears together, lit, spent time in a treatment hour tleseribing the "'pain" of separating from his amour. At the end of this session time wife. w h o had 1)eel1 g r o w i n g more and more m o r o s e azJ(l glowering, thereb.v replicating the attitudes her h u s b a n d said justified him. stated that s h e w o u l d b e glad to e o n t i n n e with the w o r k but, "'If you ]rove to talk almut this "pain." yotl talk to him (therapist) alone." ""T~lat ~,'Oli't work." ] said. "This treatment o:dls G~r free t'~;prt..~sion antl (liscllssioll Of olllj of the feelings a n d p r o b l e m s b e t w e e n vet1.'"

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She replied that she just couldn't sit through this sort of talk, after all there were some things she could say that might be so explosive they. would send us all through the window. 1 said I d o u b t e d that and also w o n d e r e d w h e t h e r she really m e a n t w h a t she said. "'Do you want me to suggest that you take a t e n - m i n u t e walk while lae tells m e about his pa in..

A release of laughter demonstrated that the remark had broken t h r o u g h her morose defensiveness and sharply c h a n g e d her attitude. She was far mor~ attractive than before. For the time being there was a therapeutic alliance nseful for the purposes of dealing with the separation a n d grief reaction Of the h u s b a n d m o u r n i n g his lost youth, lost fmatasies, and lost y o u n g mother. Until that peal of l a u g h t e r occurred, I h a d d o u b t e d that I m i g h t gain some part of h e r ego, caught up with bitterness, as an all}" for analysis of her husband's source of anxiety and then for u n d e r s t a n d i n g of her own defensive severity and austerity in attitu~les to her husbm~d. I h a v e f e l t t h e t h e r a p e u t i c a l l i a n c e t h a t b o t h m e m b e r s o f a c o u p l e h a v e witla t h e t h e r a p i s t t o l~e a n e m o t i o n a l d e p o s i t t h e y h a v e m a d e w i t h t h e t h e r a p i s t as b a n k e r t o m a i n t a i n a n i n t e g r a t i o n f o r t h e t i m e t h a t t h e t h e r a p e u t i c w o r k is t o b e d o n e . A t t i m e s it s e e m s t h a t t h i s " ' d e p o s i t " is t h e i r o n l y j o i n t h o l d i n g , t h e r e s i d u a l o f t h e i r e g o s t r e n g t h i n v e s t e d in t h e m a r i t a l s i t u a t i o n . T h e t h e r a p i s t can use this alliance to draw one, then the other, and then both of the spouses into observing positions for views of the marital interaction. Interpretation in marital therapy must be a multifaeeted, somewhat detailed process traversing several stages or phases before completion. Yet once a therapist has derived a theme from observation of the marital pair interacting in t h e t h e r a p y s e s s i o n , i( is n o t o v e r l y d i f f i c u l t t o f o l l o w t h e t h r e a d t h r o u g h several forms of interaction, showing each spouse the ways he or she participated in compromising a need through defensive interaction with the other. The usual interpretation in marital therapy, prepared by considerable work on the communicative r e s i s t a n c e s in t h e i n t e r a c t i o n s y s t e m , h a s a d e f e n s e - t o d e f e n s e f o r m . T h e a i m is t o w o r k f r o m a d e f e n s e o r a s e t o f d e f e n s e s i n o n e participant to the matching or reciprocating defense or set of defenses in the other. An example at this point will show the layered structure and the defenseto-defense form of an interpretation in marital therapy. A business school g r a d u a t e a b a n d o n e d his junior executive's position to b e c o m e a fulltime artist, t i e m e t his wife-to-be in an artists' eafe w h e r e she worked part-time while in training as a social worker. Very soon after m a r r i a g e they b e g a n to have trouble. T h e h u s b a n d was cool and disinterested sexually, while the wife was distressed and highly eriticM. T h e i r family b a c k g r o u n d s contrasted. His parents were an older couple; his sisters were 216 a n d 17 years older. T h e y were evangelically religious and the family occupied a small trailer d u r i n g most of his childhood. This close b u t lonely childhood contrasted w i t h the.wife's c h i l d h o o d and adolescence as the oldest of three girls in an unstable and tempestuous m i d d l e class family whose parents were often more childish than their offspring. H e r parents w e r e divorced and remarried to e a c h other, then divorced a n d each m a r r i e d to others d u r i n g the wife's teenage years. She m a n a g e d the family and b e c a m e counselor to her parents until entering a marriage herself. From several week's appraisal and stud)" of their interaction, it a p p e a r e d that the wife, w h o had been her family's conscience and manager, unconsciously sought excitement and a d v e n t u r e in her unconventional husband, and he looked for m i d d l e class regularity and moderation just as unconsciously in her. a kindly, watchful, pregenital mother. The.. material p r o m p t i n g an interpretation was a discussion throllgh several hours of the

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husband's friends and professional associates. Their ways of living, opinions, and attitudes alarmed her, she said. l l e accented the ideas of freedo,~ ~md ucc.-uptance of others. "l'he underlying picture of this situation l~eg~lJ to crystallize as the argument continnecl. The husband had withdrawn to his little cult of artists, wavwanl students, and fringe intellectuals. This group was w a t c h e d over and disapproved of I)nt nurtured by the wife. who also felt excluded like mother.usually is by a son and his neighborhood gang. This was the piettlre of their unconscious interaction, ti~ough his friends and colleagues were professionally legitimate and a d u h in function too. The wife's masochistic fear of sexuality l~ecatne apparent. The husband and his way of life excited and frightened her and there were ways that he unwittingly capitalized on this. ;Lfter one of these verbal ventures by the husband, the therapist w o n d e r e d aloud if he knew the effect of such talk. t i e replied that he did not, that he was only being reasonable ,and not intending to provoke her. The therapist could then understand that in defense against her exeitel.~eut and fear the wife intimidated and overruled her ht~,sband in the treatment session and in their life outside. These defensive patterns were pointed out to them, not just the intimidating action by" the wife, but the husband's active way of being intimidated and overruled. This stage of the interpretive process required some work, as anxiety prompted the wife to feel like blaming all on herself and to want an escape from marriage and treatment, while the husband beeauae more directly ,ac, ore~six'eo~ . feeling instiffed now th;lt he found he had an "intimidating" wife, The next stage involved pointing out the repetition from the past in the wife's behavior; •her supervision of her husband was parallel to the necessary managing of her 6unilv's emotional affairs in childhood and adolescence. Now she externalized her conscience in the intimidating and overruling she performed on her husband. Then it was possible to use some spontaneous memories from the husband of his earlier family to demonstrate his wish to resolve a feeling o! loneliness 1)v-provoking regulatory attitudes from his mother and now from his x,, ire through ambiguous hints of loose m o r a l i t y The subversive excitement obtained by l,~s ,v:'. from a preoccupation with the husband's supposeslly evil ways and the fact l16,t! I,:-. lonorings were partially gratified through this specific m a n n e r of being p rovoen'..x.: was pointed out to them in several treatment sessions. Then tim therapist could show them how their adult marital aims were frustrated by modes of defenses from the past causing them to be unhappy. Gradually, as the defenses were worked upon, the emergent needs were renet,tralized, at least partially, without a gross disturbance in the family eqnilil~rium. This kind of dosage and phasing of interpretation, working from. defense to defense in the interaction situation, gradually per,nits a higher d e g r e e of integration. A s e l e c t f e w o f t h e w e l l - k n o w n m e n t a l m e c h a n i s m s g e t a lot o f p l a y i n marital interaction systems. Projective and introjective mechanisms and their a l l i e d p r o c e s s e s l e a d t h e list, ,,,,'hOe a f o r m o f t r a n s f e r e n c e a n d f o r m s o f d i s p l a c e m e n t a r e c l o s e b e h i n d . V~Zhy t h e s e m e c h a n i s m s p r e d o m i n a t e s o m u c h in m a r i t a l n e u r o s e s is w o r t h c o n s i d e r a b l y m o r e t h o u g l a t a n d i n v e s t i g a t i o n . A b r i e f s t u d y in t h i s p a p e r o f t h e s e p r o c e s s e s i n m a r i t a l t h e r a p y w i l l h e l p in further exploring the defense-to-defense technique and the phases and doses of i n t e r p r e t i v e w o r k in m a r i t a l t h e r a p y . We shall deal with the problem of these particular defense mechanisms t h r o u g h a c a s e i l l u s t r a t i o n , b u t first a b i t m o r e d i s c u s s i o n o n t h e d i r e c t i o n a n d f o r m o f i h t e r p r e t a t i o n is in o r d e r s i n c e t h e c a s e w i l l d e m o n s t r n t e l~olh p o i n t s . W h i l e a p p r a i s i n g t h e f l o w o f t h o u g h t a n d f e e l i n g in m a r i t a l t h e r a p y , t h e communicative a c t s , t h e l o o k s a n d g l a n c e s , a n d t h e c h a n g e s in t o n e a n d e m p h a s i s , it m a y b e c o m e a p p a r e n t t h a t a n i n t e r p r e t i v e m o v e c a n a n d s h o u h t b e m a d e t o w a r d o n e o f t h e s p o u s e s w h o is s h o w i n g a d e f e n s e ~md its c o n f l i c t

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w i t h i n c r e a s i n g c l a r i t y , W i t h d u e r e , : ~ e c t to t i m i n g a n d t h e u s u a l c o n c e r n a b o u t g a u g i n g t h e p r o p e r l e v e l a n d w o r d i n g of the' i n t e r p r e t a t i o n , it is th'e t h e s i s o f this s t u d y t h a t t h e t h e r a p i s t s h o u l d p r o c e e d t o m a k e his i n t e q ~ r e t a tion. H e n e e d n o t a n d s h o u l d n o t w a i t u n til t h e i n t e r p r e t a t i o n c a n b e d i r e c t e d t o w a r d b o t h partieipant-s. I t is a m i s t m d e r s t a n d i n g o f . m a r i t a l d y n a m i c s a n d 'the i n t e r p r e t i v e p r o c e s s to i n s i s t t h a t all i n t e r v e n t i o n s b y t h e t h e r a p i s t s h o u l d b e d i r e c t e d t o w a r d t h e m aritid p a i r r a t l l e r t h a n i n d i v i d u a l s . C o n t r a r y t o s u c h m i s l e a d i n g d i c t a , I b e l i e v e t h a t t h e majority of e f f e c t i v e o r " m u t a t i v e ''~ i n t e r p r e t a t i o n s b e g i n w i t h r e c o g n i t i o n of a d e f e n s i v e p r o c e s s in o n e or t h e o t h e r o f t h e h l d i v i d u a i s . T h e f a c t is t h a t a n i n t e r p r e t i v e m o v e t o w a r d o n e p a r t of t h e s y s t e m w i l l s t i m u l a t e a r e s p o n s e f r o m t h e whole s y s t e m , a n d t h e t h e r a p i s t is o b l i g e d t o e v a l u a t e t h e r e s p o n s e f r o m b o t h p a r t s of t h e i n t e r a c t i o n s y s t e m . H i s s e c o n d a r y ~fnd t e r t i a r y i n t e r p r e t a t i o n s w i l l c o n s i s t of o b s e r v a t i o n s on t h e r e a c Oon o f both s p o u s e s . So as in i n d i v i d u a l p s y c h o t h e r a p y o r p s y c h o a n a l y s i s , t h e t h e r a p i s t n e e d n o t r e s t o n hi s l a u r e l s a f t e r h e h a s s p o k e n . Ffe m u s t b e e v e n m o r e a l e r t to o b s e r v e t h e effects u p o n t h e i n t e r a c t i o n a n d t o s e e h o w d e f e n s i v e s y s t e m s a n d p r o cesses r e a r r a n g e to d e a l w i t h t h e s t i m u l u s h e h a s b r o u g h t to b e a r . O n e o f t h e signs t h a t t h e i n t e r p r e t a t i o n h a s bee~a a c c u r a t e is s o m e p a r t i c i p a t i o n ~?rom t h e other S p o u s e w h i c h m a k e s a complernentary i n t e r p r e t i v e s t a t e m e n t on h i s o r h e r b e h a v i o r p o s s i b l e . I n t h e f o l l o w i n g c a s e a n i l l u s t r a t i o n of p r o j e c t i v e a n d i n t r o j e c t i v e p r o c e s s e s in m a r i t a l i n t e r a c t i o n w i l l also d e m o n s t r a t e t h e w o r k f r o m a d e f e n s i v e s t r u c t u r e o f o n e s p o u s e i n t o t h e c o m p l e m e n t a r y s e t of m e c h a n i s m s in t h e o t h e r , A college professor sought marital therapy for himself and his wife, who had also beel~ a college teacher, ill their fifth year of marriage, Each of them had completed a psychoanalytic treatment prior to marriage, hut he felt this was the first time he was seeking treatment for a real need. Tile), wanted marital therapy because of hrimn~ing anger toward each other. mutual feelings of great inadequacy about their behavior in marriage, and deep concern abollt their responses to their four-wear-old l)ov, In a session occurring after a year of treatment lt~e husband brought in his objections to his wife attending a panel discussion on a topic in which he was deeply involved and participating. From a number of other references to his feelings about this event, his selfoonsciousness was interpreted as a projection of his own self-critical attitude to his wife, hut then followed an identificqtiou with this same critical attitude making him feel greatly lacking in confidence, This pasmtge of self-criticism from himself through the wife and back to the self had the effect of greatly increaMng the pressure of these feelings since they were then allied and associated with so many other ideas and feelings in the relationship. H e reported the following sequence in the next session: The wife attended the panel. As he stood up to speak, his eye found his wife's face in the crowd. He became very ang U" for a moment but then he mastered the self-consciousness more than he had ever been able before and participated effectively in the panel, l t e then laughed and remembered that he had dreamed that his wife was kicking him in lhe testicles prior to the pane]. As he continued, it was apparent he had completely repre.~sed the interpretation in the preview,s ]lent.

~,Vhen reminded of the interpretation, he replied that it had not helped, l i e had still been self-conscious until, motivated by anger, he ha~l mastered it. It was possible to show him that the dream had started a process of the-C~go's gaining control of conflict. The self-

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eonsei0usness was not so powerful when it no longer passed through the wife and was no longer felt as her attitude. The anger was a sign of the breakdown of the projeetionintrojection defense system and the use of ego mastery. The previous interpretation and ~he dream had started this process. Meanwhile, as though in response and interlaced with the husband's conflicts and dreaming, the wife reported dreams of her mother, indicating criticism of her eapaeites in child-rearing. She felt stigmati-zed as a bad and angry daughter, now a bad mother, finding her husband to be her chief critic in reality. She felt his distance from her, and his tendency to depression was equal to blaming her for faulty treatment of her son. These feelings were seen ,as aspects of superego and ego-ideal structure reprojeeted to husband. She hated these attitudes in her husbaild and she felt him to be angry toward her. Her son's behavior was her failure as a woman in her husband's eyes. although these feelings actually came from ideas introlected from her relationship with mother and later projected to husband. "lqae appropriately worded interpretations were nmde to her in conjunction with complementary statements to her husband. T h i s c o u p l e ' s use of t h e s e m e c h a n i s m s c o n s t i t u t e d a " m i r r o r - w a l l p h e n o m e n o n " in w h i c h e a c h .of t h e m e v a l u a t e d h i m s e l f or h e r s e l f so m u c h f r o m r e f l e c t e d i m a g e s , as t h o u g h t h e y w e r e a t t i t u d e s of t h e o t h e r , t h a t a b a r r i e r or wall grew between them. F o r m s of d i s p l a c e m e n t or s u b s t i t u t i o n p l a y m a j o r roles also in t h e e o m n m n i c a t i o n of m a r i t a l c o u p l e s . F o r e x a m p l e , t h e young artist r e f e r r e d to in a p r i o r i l l u s t r a t i o n i n t e l l e c t a m l l i z e d h i s d e t a c h e d n o n e o m m i t m e n t wifla a n i d e a of " ' f r e e d o m " ha w h i c h t o l e r a n c e , d i s t a n t m u t u a l r e s p e c t a n d l a i s s e z - f a i r e v a l u e s w e r e e x t o l l e d . H e w a s n o t a r t i c u l a t e a b o u t this. I n s t e a d , his w i f e i n t e r p r e t e d t h e s e a t t i t u d e s for h i m , a n d s h e h a m m e r e d on t h e w a l l of t h o u g h t a n d f e e l i n g s t h e s e a t t i t u d e s s e e m e d to b e to h e r . O n c e ha a t r e a t m e n t session s h e m o v e d v i g o r o u s l y f r o m h e r u s u a l s t a t u e s q u e p o s i t i o n in a d i r e c t i o n t o w a r d h e r h u s b a n d a n d c o n f e s s e d h e r d e m a n d i n g n e s s a n d p o s s e s s i v e n e s s s a y i n g , "'But h e c a n ' t p u t his h a n d s on a n y t h i n g n o t his.'" T h i s p r o v e d to b e ~ r e f e r e n c e in a d i s p l a c e d a n d s u b s t i t u t i v e f a s h i o n to t h e s e x u a l d i s t a n c i n g in t h e i r m a r r i a g e a n d at a n o t h e r l e v e l to his ot~dipal g u i l t o p e r a t i n g as an i n h i b i t o r in t h e m a r i t a l r e l a t i o n s h i p a n d p e r c e i v e d u n c o n s c i o u s l y b y his wife. T r a n s f e r e n c e - l i k e m e c h a n i s m s m a y b e f r e q u e n t l y o b s e r v e d in m a r i t a l i n t e r a c t i o n . T h e s e m e c h a n i s m s are d i f f e r e n t f r o m t r a n s f e r e n c e s d e v e l o p i n g t o w a r d t h e ~ h e r a p i s t in a t r e a t m e n t p r o c e s s . T h e t r a n s f e r e n c e m e c h a n i s m in t h e r e l a t i o n s h i p o f s p o u s e s is o b s e r v a b l e f r o m t h e i n i t i a l e v a l u a t i o n of a m a r i t a l c o u p l e a n d will a p p e a r a n d r e a p p e a r in d e f e n s i v e l a y e r s of t h e i n t e x a c t i o n s y s t e m as t h e t h e r a p e u t i c p r o c e s s u n f o l d s . T h i s t-ype of t r a n s f e r e n c e m e c h a n i s m m u s t b e d i s t i n g u i s h e d f r o m t h e n a t u r a l l y O c c u r r i n g s e a r c h for p e r s o n s r e s e m b l i n g o b j e c t s f r o m t h e p a s t in b e n e f i c i a l w a y s . T h e n a t u r a l l y o c c m w i n g s e a r c h f o r a m a t e w i t h c h a r a c t e r i s t i c s c o m b i n i n g s o m e of t h o s e p e r c e i v e d in p a r e n t s a n d s i b l i n g s m a y b e u n c o n s c i o u s b u t it also m a y b e a d a p t i v e a n d u n r e a l i s t i c . T r a n s f e r e n c e in a m a r i t a l i n t e r a c t i o n s y s t e m is a n u n r e a l , d e f e n s i v e , r e g r e s s i v e m a n e u v e r of p r o j e c t i n g w i s h e s a n d p a r t i a l o b j e c t s f r o m m e m o r y f a n t a s i e s to t h e s p o u s e . I n this ease, a n u n g r a t i f i e d or o v e r i n d u l g e d w i s h or f a n t a s y f r o m t h e p a s t is u n c o n s c i o u s l y p r o j e c t e d to t h e s p o u s e a n d loved, h a t e d , or f e a r e d

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there. This t r a n s f e r r e d trait m a y or m a y not really exist in the objeet; the o t h e r m e m b e r of the m a r r i a g e , b u t if it does it will be e x a g g e r a t e d unconsciously a~ld there will be fiuatasy wishes a n d fears excited by it. .' I n t e r t w i n e d with this ph6nomeiion of transference-like mechani.sms in the marital relationship is the wholly intriguing p r o b l e m of t r a n s f e r e n c e in the process of marital t h e r a p y . T r a n s f e r e n c e in marital the-rapy is a defense or resLstanee system w i t h o u t t h e ei3.,stallization or the completeness a n d d e p t h of a t r a n s f e r e n c e neurosis. Transference in marital t h e r a p y serves one or the o t h e r 0 r both of the marital p a i r as a t e m p o r a r y resting place,: a repository of defenses r e v e a l e d or u n f o l d e d b y the flaerapeutic work. F o r example, a vel T transitory a n d p r e l i m i n a r y sign of a t r a n s f e r e n c e consists of the a p p e a l i n g or resigned or o t h e r kind of glance fi'om one spouse w h e n the other is injecting conflict into the t h e r a p e u t i c .interaction. T h e r e are. h o w e v e r , m o r e stable and substantial indications of this p h e n o m e n o n which, w h e n t h e y exert resistive pressure, h a d best be i n t e r p r e t e d at s o m e stage if s u c h interventions will be u n d e r s t o o d a n d assimilated. T h e college faculty couple alluded to in a previous illustration presented a transference resistance late in the course of their treatment. T h e wife began a questioning of some o f the therapisCs intentions. After some discnssioh she was able to describe the feeling that the therapist was p u s h i n g her off and expecting too m u c h o f her. T h e doctor's activity in the treatment a p p e a r e d to her to be self-serving a n d for t h e doctor's convenience more than her's; therefore, it was hypocritical and egocentric disapproval o f her behavior. This a t t i t u d e ascribed to the therapist was related to " t a l k s " with her f a t h e r early a n d late in d l i l d h o o d w h e n he advised, cajoled, a n d l e c t u r e d her more for his o w n a n d his wife.'s peace of m i n d than f o r her well-being. H e r sensitivity to this kind of p e r s u a d i n g was based on tones of voice s h e h e a r d from the therapist and w a s related also to expressions of a t t i t u d e f r o m her h u s b a n d . I n both case.s the sensitivity came fr,om the , t a l k s " with her filther. This i n t e r c h a n g e a b o u t a defensive transference in the wife bro~lght from the h u s b a n d his feeling t h a t the therapist's voice often caused him to feel an unrealistic" inadectuaey related to the c h i l d h o o d experience of his parents p u t t i n g h i m d o w n . This recognition of the defensive transference in the relationship w i t h the therapist b r o u g h t into the open the fi.~'ling he h a d upon h e a r i n g his w i f e ' s sometimes loud and strident voice in anger to their son. His anxiety a n d a n g e l on h e a r i n g her voice was great because it was a wished and feared reeIJactment of a previous f a m i l y situation, l i e felt an i n d i g n a n t a n g e r over the t r e a t m e n t of the son but e n d u r e d it as t h o u g h h e were personally sift)jetted to it. Partly he e n d u r e d it r a t h e r t h a n tr3"ing lo c h a n g e it b e c a u s e he could b u i l d up a f u n d of righteous feeling for later use. In this case t h e s p o n t a n e o u s l y emerging, complementary.' transferences could be seen as resistance to the flow of interaction in the t r e a t m e n t process. W h e n t h e t r a n s f e r e n c e reactions w e r e discussed and used for u n d e r s t a n d i n g , t h e e n e r g y a n d observing processes were released to p e n e t r a t e f u r t h e r into the defenses a n d conflicts of the m a r | / a ! neurosis_ SU~I~IA~RY I. N'[arital p s y c h o t h e r a p y is a t r e a t m e n t s i t u a t i o n i n w h i c h h u s b a n d a n d w i f e w o r k c o n j o i n t l y w i t h a p s y c h i a t r i s t . T h e m o d e o f t r e a t m e n t is n o n d i r e e t i v e a n d exploratory, seeking defenses and conflicts in the interaction system through interpretation. The aims of treatment are relative neutralization of need pressures and increasing integration.

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2. Interaction patterns built into the communication system used by the couple appear as resistances to the treatment process and require clarification before mutative interpretation of defense and conflict can have effect. These problems tend to exclude the therapist or one or both spouses from participation in the t r e a t m e n t interaction. 3. I n t e r p r e t a t i o n s in m'arital t h e r a p y work from the defenses of one spouse to c o m p l e m e n t a r y "defenses in the o t h e r in a continuously r e v e r b e r a t i n g fashion s p a n n i n g the interaction system of the marriage, 4. Proiection a n d introiection, the "mirror-wall" phenomenoa~, a n d the issues of t h e r a p e u t i c alliance and transference have been considered. REFERENCES

1. Berne, E.: (,ames People l'lav. New York. Grove Press. 1965. 2. Crotiahn, M.: Clinical illustrations from psychoanalytic family thentpy. In: The Psychotherapies of Marital Dislmrnmnv (B. Greene, Ed.). New York, 1965. pp. 169-I87. •3. llalev, J.: Strategies of l~sychotheral~y. New York. Grune & Stratton, t963. 4. Jackson. D.: The marital quid pro quo. In: Family Therap)' for Disturbed Families (G. Zuk anti I. Boszonnenyi-

Nag), Eds.). l'alo Alto, Calif. Science and Behavior Books, Inc., 1966. 5. Lennard, 1t.: The Anatomy of Psvclmtherapy. New York. Columbia University Press, 1965. 6. Strachev. J.: The nature of the thenlpeutic action of psychoanalysis. Int. J. Psvchi:,t. 15:127-159. 193~t. 7. Watzlawick, P.: An Anthology. of Human Communication. Text and Two Hour Tape. Paio Alto, Calif., Science and Behavior Books, Inc., 196,1.