A therapist in search of the couple: A brief therapeutic intervention with a gay male adoptive couple

Introduction

This paper will offer an outline of a time-limited psychotherapeutic intervention with a gay male couple that were seen within a specialist adoption service. The presentation is loosely based on my work with the couple and, to protect their confidentiality, all identifiable features have been altered. In keeping with the focus of this particular edition of the journal concerning aspects of technique in contemporary couple and family psychoanalysis, I will highlight, through the case material, the application of transference, countertransference and interpretation in my work with them. I will introduce the reader to the couple through the referral process and initial assessment before moving on to a discussion of the actual work I undertook with the two men. Given the importance of finding a central focus in time-limited psychotherapy, I have chosen three particular themes to illustrate the progress of the therapy from beginning to end and will incorporate aspects of my particular use of transference, countertransference and interpretation as the work unfolds. Towards the end of the paper I will offer some specific considerations in working with same-sex couples that, in my view, warrants integration with the therapeutic task.

The referral

Adam and Martin, a gay male couple in their late twenties, were advised by their social worker to seek an initial consultation from a couples based specialist adoption service. At the time of the referral, the couple in question had been caring for Max, a ten-month old boy who had been placed with them with a view to adopt. The reason Max was placed for adoption was that his sixteen-year old mother who conceived him during a one-night stand was unable to offer him long-term care. However at the point of adoption it seems that Max’s mother had a change of heart, indicating that she was not comfortable having her son raised by two men. The couple were profoundly affected by this turn of events and Adam in particular experienced the rejection as a deep narcissistic wound. Despite the court approving the adoption, Adam remained unsure as to whether he could continue parenting Max and he was also threatening to leave the relationship as he longed for his freedom.

The service

 The specialist adoption service, funded by a grant, was made available to adoptive parents wishing to consider the impact of the adoption on their own couple relationship. The service offered, free of charge, an evaluated intervention of twenty sessions for adoptive couples. Nyberg (2011) suggests that there is increasing demand for timelimited couple psychotherapy within the public sector and that a model that offers twenty sessions is a well-recognised treatment approach suitable for an evaluated intervention. Although limited research exists on the efficacy of time-limited psychotherapy with couples, some of the studies that do exist (Gill and Temperley, 1974; Clulow et al., 1986; Pengelly, 1997; Lanman and Grier, 2003) speak of the importance of finding a “central issue” or “focus” for treatment, since, as Mann (1973) points out, goals have to be specific rather than global. Nevertheless, practitioners using time-limited psychotherapy are believed to assume a more active stance in their work, thought to be the result of a limit imposed on the treatment (Mann, 1973). As will be seen, the pressures of working within a time-limited approach became a particular concern of mine, since the twists and turns in holding Adam and Martin together in therapy within the limits of a twentysession model proved something of a challenge. Indeed, this touches on a core consideration concerning the extent to which the presenting concerns can be properly understood or addressed during the course of time-limited psychotherapy (Lanman and Grier, 2003), and raises further questions concerning the development of transference and countertransference phenomena in the work, as well as the use of interpretation. In an attempt to answer these questions, I will focus on three specific aspects of my work with Adam and Martin; the first concerns the transition to parenthood, the second is related to the nature of the couple fit and the third addresses the impact of gender and sexual orientation on the couple’s evolving dynamic.

The initial assessment

The initial assessment was conducted by one of the female therapists attached to the service. During the assessment, she heard that Adam and Martin had met online some four years earlier and, that after a few months, it was agreed that Adam would move into Martin’s flat. Adam is from the north of England and at the age of fifteen, when his father left the family home, it was he who assumed responsibility for his mother and younger sister following his mother taking to her bed with depression. Although Adam struggled to leave home he did eventually come to London in his late teens in order to complete his studies although, he continues to have regular contact with his mother and sister and they are both said to be accepting of his sexuality. Martin, on the other hand, is from farming stock and grew up in Ireland where he suffered badly at the hands of a father who drank heavily and had aggressive outbursts towards him. It seems that Martin’s mother was either too afraid to intervene or too frightened to leave and Martin therefore assumes that she was complicit in allowing his father’s abuse towards him to continue. Martin managed the situation at home by throwing himself into his studies whilst staying under the radar of his father’s gaze. Martin did well in his exams and at university studied economics. He currently has a well-paid job as a property developer, which involves some international travel. Martin’s parents are completely rejecting of his sexuality and although he has no contact whatever with them he does occasionally see one of his sisters who is married and lives in London. Adam and Martin, prior to the adoption, talk of a strong bond between them with many shared interests and a good network of friends. Influenced by the increasing number of gay men within their circle having children, the couple decided to adopt. Goldberg (2010) suggest that the decision concerning the route to parenthood is often related to the importance of having a biogenetic relationship to one’s child, i.e. passing on one’s genes or physically resembling one’s child. She suggests, that where this is not a consideration, couples are often more likely to adopt. However the decision for Adam to give up his job to care for their adopted child, Max, was not one he found easy to accept, as it was based solely on Martin’s earning potential. Moreover, both men were taken by surprise with the speed of the adoption and from their point of view felt that it had been premature.

At the initial assessment it became apparent that the couple relationship was under particular strain and the assessor felt that it was in danger of breaking apart. Despite assurances to the contrary, Martin was convinced that Adam had found another man and believed that this accounted for his wish to be free. Adam denied any interests in other men and instead complained that Martin was trying to control him. He was clearly resentful of the position he found himself in as the primary caregiver for Max and felt that this suited Martin more than him. In addition, both partners felt judged by their social worker, who, in the light of Adam’s wish to return to work, questioned his commitment to Max. In response to this, both men spoke of their trauma in managing contact visits between Max and his mother until the adoption was finalised. During this time, Adam felt that he had to defend his care of Max, especially when Max’s health visitor voiced concerns about a nappy rash. At the point that they came for help the men spoke of trust between them breaking down and they were also worried about what would happen to Max if they were to separate.

The therapy

My introduction to the couple came when Adam turned up on his own for the first session explaining that Martin had a stomach bug and was confined to his bed. He told me that he had considered cancelling the session but Martin felt that he should attend and Adam himself believed that he could make good use of the time. I felt that my space to think had quickly disappeared and, like Martin’s mother, I was being asked to collude with something that didn’t feel quite right. Adam then began to speak about his difficulty with Martin, who Adam believes, pressured him into adopting. Adam explains, that because Martin earns a big salary, it was assumed that Adam would be the one to give up his job to care for Max. Adam did not feel that he had the option other than to go along with Martin’s wishes, much as I felt in regard to seeing Adam on his own. Although at some level Adam accepts that he was excited about the prospect of becoming a father, he had no idea that it would happen so quickly and he was therefore resentful of having to forfeit a much-anticipated foreign holiday. Since caring for Max, Adam believed that he was cast in the role of housewife, an identity that he completely eschewed. By contrast, Adam saw Martin as the man of the house and the provider. Most importantly, he spoke of his struggle to get Martin to understand or really accept his concerns and the tensions inherent in their situation frequently resulted in emotional outbursts from Adam that caused Martin to withdraw. Adam was clearly at his wits end and felt that he could not continue if things did not improve. My initial reading of situation was that the transition to parenthood for this couple had resulted in a split within their relationship that was now threatening to destroy their union.

The transition to parenthood

 Generally speaking, the transition to parenthood for many couples is experienced as stressful (Cowan and Cowan, 2000). This is due mainly to changes that the couple relationship itself has to go through in order to accommodate a third. One obvious example of this is the loss of a partner’s attention but, in my view, the real or symbolic meaning of assuming responsibility for a needy and dependent baby, cuts deep into the residues of unresolved or un-relinquished freedoms associated with adolescent development and, once activated, can create particular challenges for a couple – as it seemed to be doing in the case of Adam and Martin’s transition. Given the paucity of research relating to the transition to parenthood among couples who adopt, and more specifically for same-sex couples who adopt, Goldberg and colleagues (2014) conducted a qualitative study of heterosexual, lesbian and gay couples adopting through the child welfare systems. The aim of this study was to better understand how the transition to parenthood had affected these couples’ relationships. What they found was that many parents indicated some decline at least in relationship satisfaction during the transition and for same-sex couples additional stressors relating to their sexual minority status were highlighted. According to Goldberg et al. (2012), gay men «become parents amidst institutions and discourses that privilege heternormativity and thus present challenges to their parenting pursuits» (p. 158), whilst Mallon (2004) draws particular attention to the supposed deficiency of gay male households due to the absence of a female parental figure. Taken as a whole, the body of research relating to all adoptive couples, emphasises particular strains related to:

1. the unpredictability of the timing of the transition to parenthood;
2. the interface with social care agencies who ultimately determine if the couple is “fit” to parent;
3. unique challenges for foster-to-adopt couples, as in the case of Adam and Martin when Max’s mother had a change of heart (Goldberg et al., 2010; 2012). Not surprisingly, at the point that I met with Adam, these forces were threatening to overwhelm the couple.

Adam was acutely in touch with a longing to be free of the constraints and responsibilities of childcare, and although this could be viewed as a hedonistic wish to return to what Smith (2017) refers to as a “gay lifestyle” it seemed to me that this feeling was powerfully rooted in the role he was forced to assume when his father left the family home. By the same token, Martin was also responding to Adam’s outbursts in much the same way he did when his own father exploded and I wondered if his failure to attend the initial appointment was linked to a fear that Adam would use the session to attack him.

Thankfully, both men arrived together for their second session and immediately entered into an argument over Adam’s bid for freedom. Martin accused Adam of seeing other men and believed that Adam wanted out. Adam responded by accusing Martin of trying to control him and was particularly bitter towards him for having to give up his much-loved job and lifestyle. Adam also reminded Martin that he is completely reliant on him to look after Max when, as he put it, Martin “swans off abroad”. Martin pointed out that his trips abroad are always work related. I interpreted into the rivalry suggesting that the two men seemed unable to combine their resources and instead where locked into something quite competitive. Budman and Gurman (1983; 1988) hold with the belief that early transference interpretations can strengthen the alliance and intensify the therapeutic endeavour. Adam completely agreed with what I was saying, adding that he felt that he needed to assert himself otherwise Martin would take over. Martin acknowledged that things needed to change and, although challenging for him, he assured Adam that he was in the process of changing his work schedule so as to enable Adam to have a phased return to employment. Once it became apparent that at least part of these arrangements involved outsourcing aspects of Max’s care, I wondered if this was in Max’s best interests. My remarks provoked an immediate reaction from both men and they began arguing that straight couples often return to work several months after the birth of a child and, so, why was I objecting to their plans. Their challenge suggested something of a critical superego presence on my part, and, as a consequence, they were at pains to assure me that Max is doing really well. I explained that I was not meaning to be critical but more that I wanted to ensure that they were taking enough account of Max’s own early traumatic history when he was taken from his mother and in the context of this, I wondered how Max might respond when looked after by a number of different carers. Putting these concerns into words allowed the men to talk about the plans they had in mind to ensure continuity of Max’s care. They also spoke of their own trauma in securing the adoption, involving months of uncomfortable contact visits between Max and his mother. They wanted me to know just how devastating it had been for them when, at the point of the adoption, objections were raised about them becoming Max’s parents. From their account I sensed that they were trying to reassure me of their commitment to Max but, in common with many couples that become parents, I also felt that they were struggling to balance the host of conflicting needs in the face of the pressures related to the reality of parenting.

Despite the ups and downs of the couple session, I felt that I had begun to make contact with them, so I was therefore surprised when only Martin arrived for the next session. He explained that Adam had a job interview, and also announced that they would not be able to attend the following session, as they would be abroad. In addition, I heard that Martin’s firm were setting up a new branch in the West Country and his boss was keen for him to take charge of the new office as soon as possible. I suggested to Martin that they as a couple seemed to be struggling to find a secure base for their relationship and wondered how this would happen if they were to continue attending separately or disrupting the regularity of the therapy.

In terms of the transference and countertransference aspects of this early work, I felt that I was being used as yet another critical authority figure in danger of taking over and telling them what to do. On the other hand, I also felt that by invoking my helplessness, much as they felt at the hands of their respective fathers, they were now presenting me with something quite triumphal in their attempts to put me in my place and take charge of the agenda. Interestingly, when I took the couple to group supervision, members of the supervision group also felt provoked and began to express concern at the way the men were misusing the therapy. Also, in the context of forthcoming changes to Max’s routine and the possibility of a major move to another part of the country, the group raised concerns for Max and felt that I needed to be tougher in my approach with the couple. I immediately felt provoked by the comments and found myself attempting to defend the men, much as they attempted to defend themselves against my concern, a case of my countertransference identification complementing that of the couple (Racker, 1968). At the same time, it has also been suggested that in working with the transference it is necessary to recognise the central place of enactment that is often at play in the service of preserving a couple’s equilibrium (Balfour, 2016) and, in that regard, it is conceivable that the strength of the couple’s projection was now being enacted between myself and the other members of the supervision group. This notwithstanding, the group persisted in questioned me as to whether Adam and Martin were really committed to the therapy and I was therefore left in no doubt that I needed to think with them about whether the service we were offering was appropriate to their needs.  At my next meeting with the couple they talked positively about their trip abroad and felt free of the judgment of others. I wondered if they felt I was being judgmental towards them and they agreed that I was feeling like all the others. I explained that I was struggling to get to grips with their situation as they seemed to be constantly on the move and I was finding this unsettling. Adam could not understand why I was saying this now as he felt that my input had made such a difference in helping him become less competitive with Martin and from his point of view they as a couple were working well together. Moreover, they both felt that the proposed move away from London offered them the possibility of a new start with Max. In exploring the implications of the proposed move in regard to the therapy, I learned that the timing of the move meant that it would be possible for them to attend the full twenty sessions.

The couple fit

Seigel (1997) suggests that when working with couples, the psychotherapist is faced with the transference relationship between the partners, their individual and joint transferences to the therapist, as well as the therapist’s countertransference to the individuals and to the couple. In many respects the inter-subjective field was very much alive in my early work with Adam and Martin and indeed between them and me. From their early histories it was possible to see how Martin had chosen a man who was not frightened to speak out when angry and upset, since Martin growing up with a tyrannical and abusive father struggled to put his own outrage into words. Adam, on the other hand, longed for a father to take care of him but was also resentful of the control his father exerted on him by leaving the family home and forcing Adam into a caregiving role to his mother and younger sister at a particularly sensitive time in Adam’s own development when he might have been expected to be pursuing his own interests. Balfour (2016) suggests that through our lives we replay particular patterns of relationships with ourselves and with others. He believes that these are shaped developmentally through a series of projections, identifications and introjections «as the lived atmospheres of our early lives become part of our internal worlds» (p. 60). He goes on to suggest that we are recruited by our partners where «respective projections and configurations of object relating fit together, as elements of the inner world of one individual converge with their partners» (p. 60). My task, according to Balfour (2016), was to notice how the couple «shape the transactions in the room in ways that avoid a contact with difficult or disturbing anxieties, relationships or states of mind» (p. 62) in the service of preserving emotional equilibrium. I believe that Adam and Martin were enacting with me their internal defensive scripts whilst also being desperate for a new beginning, unconsciously embedded in the couple’s decision to adopt and their associations relating to the proposed move to the country. Perhaps, Max was the external representation of each of each of the men’s own internal needy child. However, my job had only just begun and I was now faced with the on going struggle of getting the two men into the consulting room together and keeping them there long enough to help them address their more deep-rooted issues.

 

The men arrived for their next session still imbued with hope. Given that things were feeling so good I wondered how they wished to use the session. Martin said that he had been thinking a lot about his parent’s rejection of him and wished that they could accept him as gay man; the hope being that one day they would welcome him, Adam and Max into their home. Martin knew that this would never happen but the forthcoming visit to Adam’s mother had clearly stimulated a desire in him to have the same possibility. Adam, on the other hand, was not looking forward to the forthcoming visit to his mother, feeling on guard against her apparent dependence on him and her critical approach to his parenting of Max. I commented on how the couple always seemed to be bracing themselves against the presence of some critical outside force. This clearly resonated with Adam, who then spoke of “the searching eyes” on them returning from holiday as they cleared border control with Max. They both spoke of their sense of being outsiders having to defend what they were trying to build for themselves and Max. Paradoxically, I felt, for the first time that I was actually being allowed into their struggle. It therefore came as something of a surprise when, towards the end of the session, they told me that they would once again have problems attending the next two sessions together. They were now actively seeking my permission for each of them to attend separately. Although I felt under pressure and wanted to stand firm, I also took their request as an unconscious attempt to avoid further conflict, fearing it would destroy the progress they had made. I therefore acknowledged the difficulty of them coming together whilst also commenting on their need for distance. I did add that I would leave it up to them to decide how best to proceed but pointed to the time-limited nature of the work and hoped that it would be possible for them to continue attending together in order to move the work forward.

Unsurprisingly, only Martin turned up for the next session and his presentation confirmed my belief as he voiced his struggle to speak openly in the couple sessions fearing further outbursts from Adam. Given the fear associated with Martin’s father, I wondered if Adam might be expressing some of Martin’s own unexpressed anger. Martin admitted to his reluctance in arguing with Adam fearing that it would only make matters worse and he did not want to expose Max to conflict within the home. I suggested that although I understood and, to some extent, accepted his reluctance to fight, I could also see that he was still being organised by a belief that it would not be possible to resolve conflict. When Adam arrived for his session, he told me that he was furious with Martin, “I am sick of being blamed whilst Martin takes no responsibility when things go wrong”. In my countertransference I began to feel frustrated and angry at the couple’s use of me as a conduit for their complaints with each other. I reacted to this by suggesting to Adam (reinforced with an email to Martin) that as long as they continued to meet separately rather than together, they would not find any meaningful resolution to the difficulties that beset their relationship. Essentially, I was drawing attention to the projective system that kept the difficult feelings alive whilst also keeping them at bay. It is also possible, of course, that I was feeling the pressure of working within a time-limited framework with a highly avoidant couple, as well as the sentiments of my supervisory colleagues.

By permitting Martin and Adam to see me separately whilst taking up and naming the couple’s shared resistances, I believe that the two men did feel understood and, as a consequence, were then able to commit to attending the remaining sessions together. In fact, during this stage of the therapy they did bring their shared conflicts without feeling that it would all end in disaster. For instance, when Max was going through a phase of crying through the night, Martin was adamant that Adam needed to read a particular book on controlled crying believing that this would offer them as parents a joined-up response. Adam, on the other hand, refused Martin’s remedy and instead sought advice from his own mother. Martin continued to object and I ventured a suggestion that it might be hard for him to trust the advice of Adam’s mother, since his own mother had failed him so miserably. Adam, however, believed that Martin’s refusal to accept and value his contribution was at the heart of Adam’s unhappiness within their relationship. Martin was furious with Adam for always accusing him of being unsupportive when he felt that he was trying his best to work alongside him. I wondered if Adam’s strength of feeling about his contribution never being acknowledged was also linked to his own father’s failure to thank him for the care he had offered his mother and sister when he had left the family home. Through this endeavour, I sensed that the work with Adam and Martin was finally deepening and that the men were beginning to feel more of their emotional connection.

Although these developments in the work were encouraging, it is still the case, when working within a time-limited model of psychotherapy, particularly with a highly defended couple, such as Adam and Martin, that certain constraints operate within the model that prevent the possibility of working at a deeper level in regard to the individual and shared unconscious phantasies. For instance, their shared fury and destructive rage towards their respective fathers, and, perhaps, to a lesser extent, their mothers, is something that may have been more available to comment on and work with during an open-ended therapy; where the emerging transference could have afforded greater opportunity for making links to early childhood experiences that seemed to be enacted within the couple relationship and to some extent within the therapy itself. However, the struggle to get the two men into the consulting room together seemed to dominate the therapy and, in my view, limited the scope of the work. Yet, the couple’s tendency to split, together with the ensuing feelings of helplessness that each felt at the hands of the other, referenced a longing in both for acceptance and recognition that seemed missing in their families of origin and within society generally. Unfortunately, it is often the case that with same-sex couples, this rejection is played out within the couple relationship and it is not hard to see that the rivalry and conflict between Adam and Martin came to dominate their couple dynamic.

The impact of gender and sexuality

According to Connolly (2004), it is believed that same-sex couples present quite distinct clinical concerns arising out of the impact of homophobia, heterosexism and the internalization of both. Because of this, it is believed that therapists must take account of these important influences in their work with same-sex couples, otherwise they will be in danger of reinforcing the couple’s sense of otherness and may leave them struggling to validate their own relationship. Research consistently shows a cross section of the population of most countries holding negative attitudes towards sexual and gender minority lifestyles and relationships. Howard (2017), writing about transference and countertransference as well as interpretation, suggests that it is our job as therapists to help deconstruct and co-create shared meaning that allows for growth and development but not, at the expense of shaming, re-traumatizing or losing our patients on the way. As someone who understands and actively attends to the importance of gender and sexuality in my work with couples, I was curious as to why these particular aspects were so absent from my work with Adam and Martin. Moreover, the particular challenges facing samesex couples who adopt, i.e. lack of positive role models and mirroring, the impact of prolonged and extensive scrutiny and, in many cases the absence of family support, are influences that I would normally speak to directly in my work as a way of supporting and empowering couples in the face of outright rejection or the micro-aggressions that occur when same-sex couples are subtly invalidated. However, the focus of my work with Adam and Martin seemed to centre entirely on the enactment of past histories in their current relational dynamics as well as the struggle of helping and holding them in the therapeutic space. Yet, Adam had likened his primary caregiving role of Max to that of a housewife and Martin had spoken of his longing for acceptance from his homophobic parents, both of which warranted further exploration. This seems especially important given the fusing of gender and sexual orientation in ways that create discomfort, as evidenced in Adam’s perception of himself as a man in the role of a woman, and, the shared experiences as gay men raising a child against a backdrop of suspicion and concern. I believe that these powerful contextual forces infiltrate the interior of the couple relationship in ways that may account for disturbance between same-sex partners and that ultimately pull them apart.

As the couple began to settle into the work and their trust in me increased, Adam spoke openly of his discomfort in being a gay dad. He said that he couldn’t bear the judgemental eyes on him and when they as a couple were out together in public with Max, he was anxious that Max would not play up, as it would draw attention to them. He went on to explain that it felt very different being out with Max on his own since he could pass as a straight dad, an identity for which he could feel proud and comfortable. Martin, although sympathetic, was angry with Adam for not fighting back. I, wondered, however, if Martin was in touch with his own wish to fight back at his parent’s rejection of him as a gay man and father. At the same time, I could see that although Martin’s fight was located externally, Adam’s seemed to be more of an internal struggle related to the conflict within him concerning the integration of his masculine self with his gay identity. For both men, Max had come too soon, but I came to see that this was an unconscious reference to Adam and Martin’s prolonged struggling to settle things for themselves and of finding a more comfortable home within their couple relationship into which Max would be welcomed. Perhaps the decision to adopt was a shared unconscious attempt to force a resolution rather than allowing a careful “working through” of the couple’s complex issues relating to being gay. By speaking directly to these issues, regarding the internal and external conflicts associated with their separate and shared gay identities, it was noticeable how they began to reclaim their couple relationship from the grip of external forces that were felt to be threatening their connection. Despite the timelimited nature of the work, Adam and Martin seemed able to make good use of the sessions and they also thought about how the move to the country might be for them. I have since heard that they feel very settled in their new life together and that Max is thriving.

Conclusion

This paper has attempted to illustrate the complex workings of therapy with a gay male adoptive couple seen within a specialist adoption service using a time-limited model of couple psychotherapy. Working with same-sex couples through an adoption process, requires a specific understanding of the ways in which heternormativity impacts the couple’s relationship. At the same time, the transition to parenthood, a key developmental stage for most couples having children, powerfully impacts the couple’s relationship, as baby makes three. Working with the twists and turns of this, together with the enactment of past histories in current relational dynamics, became a major focus for my work with Adam and Martin. In addition, understanding the nature and impact transference and countertransference on the evolving dynamic in the work between the couple and myself, provided an important reference point for the therapy, although time-limited therapy inevitability limits the scope of this work. That said, making use of interpretation as a way of speaking to unconscious processes proved invaluable for communicating and furthering understanding of the individual and couple dynamics. However, only by engaging with and confronting the individual defences of both men, was it really possible for their couple relationship to emerge.

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