Commentary on David Scharff’s family session material and on the concept of link.

Commentary on David Scharff’s family  session material and on the concept of link

Timothy Keogh

It has been suggested that the suitability for treatment and the likelihood of successful treatment outcome with a couple or family are influenced by factors such as the level of bi-directionality (or, in attachment terms, the level of secure attachment) in the partners, the amount of interweaving of the unconscious phantasies of both partners (that is, the underpinning interphatasmic weft) and the level of motivation for treatment (de Forrster and Spivacow, 2006).  Making conscious the link between presenting problems in the couple/family and the underlying and unconscious object relations is the core of the work in object relations couple and family therapy.  When the family or couple is seen as the patient, then psychotherapy can be seen to create a multilayered, bi-personal field that allows for the emergence of the basic unconscious phantasies of the family/couple (Baranger & Baranger, 2009). In this [intersubjective] field, the therapeutic work does not only consist of the re-discovery of the internal world of the parties and its pathological interplay (often in the form of a projective deadlock), but also in the opening up possibilities of re-structuring, creating and inventing via projective and introjective mechanisms.  The ability to make use of links offered by interpretative work represents a development in the therapeutic process, which usually follows from a phase of containment resulting in less reliance on paranoid schizoid forms of relating and defence. This makes it more likely that the interpretations can be heard as helpful. It is at this point that the family/couple can begin to make links between their transference reactions to the therapist(s) and to each other.

In the current clinical material, the family has just retuned from a break (and a reduction) in sessions with their therapist (and the mother’s individual therapist). Difficulties are reported which  suggest that a regression has occurred during the break. Mother says, “I don’t think things are going very well sexually between Lars and me.” The focus is on the couple’s capacity for sexual intercourse. One becomes aware, however, that the family has experienced a failure to maintain a link with their absent object, which has caused them to lose their connection with each other.

Powerful unconscious forces have been at play. The neediness of the family and their inability to tolerate the feelings of separation and loss have resulted in their denial of the impact of the separation. The importance of the children’s play, as part of the family’s unconscious communication about this issue, helps to identify what has happened. The play scene reveals the underlying anger at being left and implicates this anger in unconscious attacks on the therapist.  The therapist also gains more evidence of this aggression in the form of self attack and the crash in self esteem that it caused.

At this point in the session the therapist begins to interpret the link between the collapse on self esteem (and indirectly the sexual difficulties) to his absence. The father has difficultly with this first foray of linkage. The therapist, presumably because he believes that the father is at a point of being able to hear such an interpretation, presses on and connects the internal attacks on linking with the inability to think about the concept put to him.

In terminology reminiscent of describing fearful attachment, the therapist interprets the withdrawal and bad feelings about self that seem to accompany a separation or loss.  He says, “You feel very hard hit by many things…. You feel it by feeling. You lose your sense of self worth.”

A type of transmutative interpretation (linking the transference phenomena with original trauma) is attempted when the therapist says, “And I know from what you have told me that it’s linked to the sense of losing your father. That is an area where you felt you didn’t get help and on the contrary that’s something that was painful.” Having opened up the link between the family’s/couple’s experience of the break and their recent difficulties, a further link is opened up by attempting to identify the needy (hungry) aspect of the family. Once again, the children’s play provides the unconscious material for this in the form of the puppet show and, in particular, the appearance of the hungry pig. This moves the session in the direction of a more direct transference interpretation about the family’s anger for leaving them alone in their hungry and needy state and how difficult it is to bear these feelings.  As such, it  has caused a slide to a more paranoid-schizoid level of functioning resulting in attacks on linking with the internal good object that has been building up during the psycho-therapeutic work.

The family’s tractability, however, and their return to more depressive anxieties during the session, seems to suggest they have made gains from the work they have done with the therapist, the evidence being the way in which the family are able to recover the good object and their willingness and strengthened ability to make the necessary links as they move more and more out of –K mode.

There is a sense of relief when their son announces, “The good guys won.” Ultimately, the therapist is able to make the important interpretation, “But if you don’t know you are angry or upset, then what we have is this sort of disintegration of things and that really costs you a lot!”