NOTES DE LECTURE
Families in Transformation: A psychoanalytic approach, edited by Anna Maria Nicolò, Pierre Benghozi, Daniela Lucarelli.
London: Karnac Books, 2014.
Book Review[1] by David E. Scharff[2]
Reviews of books on family and couple psychoanalysis do not often grace the pages of JAPA, nor, with a few notable exceptions (Kernberg, 1998), do articles about its practice. That’s unfortunate. In these days of wide-spread attacks on psychoanalysis in general, this modality of practice, which in the minds of many of us represents a completely analytic approach, offers a way of working that is both effective and more readily understood by patients and the public than individual intensive psychoanalysis. It not only allows us to offer a different way of working that is more adapted to the needs of some (certainly not all) patients and their families, but it presents opportunities for therapeutic leverage not available in the practice of individual analysis.
By way of full disclosure, let me say that my interest in family and couple psychoanalysis dates back almost as far as my interest in psychoanalysis itself. Fortunately, then, back in the 1960s, there were no forms of family therapy other than ones derived from analytic centers, from the work of John Bowlby, Nathan Ackerman, and others who felt that psy- choanalysis was missing the boat by not understanding and working with families. Their work with families proceeded from an essentially analytic perspective. By the time family systems and strategic therapies diverged from and became antagonistic to psychoanalysis, I was thoroughly analytic and had little interest in working in those ways, which seemed to me to belie the fact that most of the originators of these schools – figures like Salvador Minuchin, Ivan Borzymeni-Nagy, Murray Bowen, James Framo, and Lyman Wynne – had undergone full or partial psychoanalytic training that informed and was central to how they understood families. But when they turned against analysis, that turning ensured that they could not effectively pass on that analytic understanding to their students. The result, to my mind, was the development of a shallow legacy, long on “technique” and short on soul, that in the end has withered on the vine and yielded to a never ending sequence of new therapy fads.
Family and couple psychoanalysis has never had a large following in North America, although it has maintained a tradition in a few pockets in Boston, New York, Washington, D.C., California, and a few other places. To our insular way of thinking, it might have almost disappeared, diminished from those days in the 1960s and 1970s when it seemed to be offering a new opening to analysis in theory and practice. So it is likely to come as a surprise to readers of this journal that it has been alive and hugely popular in other parts of the analytic world, most notably in Argentina, Brazil, France, Italy, and Great Britain. In South America, beginning with the work of Enrique Pichon-Rivière in the 1950s, family psychoanalysis offered a way of thinking that followed logically from his notion of the “link” (el vinculo), a construction in all intimate interactions that blends the intersubjective bond between people with their intrapsychic life. He thought that the interaction between people – conscious and unconscious – was mutually influential with regard to individual psychic structure, so the idea of family and group therapies followed naturally. He was already conducting family and group therapy by the end of the 1950s, based on his theories of forms of intersubjectivity, long before its “discovery” in the United States (Pichon-Rivière in press). This work has been followed by that of many others, including most prominently the work of Berenstein and Puget on the link (2008), and their many students continue to develop that work further in Europe and South America. In England, Enid Balint’s establishment in 1949 of the Family Discussion Bureau at the Tavistock Institute of Human Relations (now the Tavistock Centre for Couple Relationships) began a comparable trend, driven not only by theoretical developments by its staff, but by the landmark work of Henry Dicks, published in 1967 as Marital Tensions. In France, beginning with the work of André Ruffiot (1990), ideas of shared unconscious organization, and of the nonrepressed unconscious common to familes, spurred interest in family psychoanalysis. More recently, Rene Kaës (2007) has developed ideas about the link, at first in groups and later in families, contributing specific mechanisms through which unconscious links are constructed by families, spoken for, and dreamt about, and that in turn organize the internal psychic world of family or group members. Colleagues in France, Italy, Spain, and England have vibrant societies, conferences, and publications on the theory, practice, and ramifications of psychoanalytic work with families and couples.
There is work in English, the bulk of which has come from the Tavistock group and their colleagues, and from a few writers in the United States, more recently clustered around the International Psychotherapy Institute, my own affiliation (Scharff D.E. and Scharff J.S., 1987; 2014). But our anglophone productions pale beside those of the European Continent and South America, where contributors to the field outnumber us by orders of magnitude. However, their publications are in Spanish, French, and Italian, and very few have been translated to our deprivation.
It is with real pleasure, then, that I review the new volume Families in Transformation, edited by eminent Italian and French colleagues who have long been devoted to this field but have published little or not at all in English. Though this is indeed an edited collection, and therefore has less internal coherence than a book by a single author, it offers the reader three advantages: First, it turns out that there is a coherent theme to the volume, captured in the elegant and thorough introduction by two of the editors. Second, a diversity of applications is amply illustrated. And third, the various ways that family and couple psychoanalysis itself contributes to the core of individual analytic theory and practice soon becomes evident. After reading this book, it becomes virtually impossible to ignore the actual relationships of individual patients with wives, husbands, life partners, parents, and children even while focusing on the traditional intrapsychic world of the patient.
We all know that the inner world of each individual, and therefore of each patient, both interprets and organizes interactions with the external world. However, the central argument of this book is that the interactions of each individual continually reorganize the inner world. The argument, taking its direction from Pichon-Rivière’s discovery of the link, is that there is always a construction between interacting individuals, a pattern that is the result of their interaction (between couples, families, and groups) and that in turn contributes to the continual reorganization of the individuals who are members of these groups. That pattern, that link, is unique to the people in interaction and, as an analogue to each person’s internal mental links (between self and internal objects), is in continual and reciprocal interaction with them.
Turning now to the book itself, I have already said that the introduction, by Anna Nicolò and Daniela Lucarelli, is a brilliant essay covering both the history of the field’s central ideas and summarizing the most important themes of the chapters that follow. The book is organized, perhaps somewhat arbitrarily, into three sections: Family and Couples Today, Oedipus in the New Families, and Clinical Work with Couples and Families. I say arbitrarily because there is, of course, overlap in the presentation of theory and clinical work. For me the strongest chapters are ones with vivid, extensive clinical examples illustrating the ideas central to the chapter. In general, French and Argentinian writing is often short on clinical illustration, making it difficult to follow complex ideas. While some of the chapters here show this fault, it is not a general lack in the collection.
Rather than labor through each of the seventeen chapters, let me give highlights that I hope will entice readers to sample the book themselves. Right up front, chapter 1, by the eminent French analyst René Kaës, lays out the central tenets of his work: the way unconscious links operate in groups and families through the various spokespersons, dreamers, and actors, speaking for and illustrating the interaction of group and family links with the individuals who make them up. The centerpiece of this argument, which stems from Pichon-Rivière, is that these unconscious links are in continual interaction with the individuals’ psychic organization, helping to constitute and reconstitute them, and in turn are constituted by the unconscious communications and interactions of those individuals. This establishes, right at the beginning of the book, that this is an organizing principle for all that follows.
Many of the chapters have excellent clinical examples illustrating their main theme. A few of my favorites include Alberto Eiguer on identifications organized through intersubjective links in families, Stanley Ruszczynski (the sole native English speaker in the book) on perverse and frightened couples, Carles Pérez-Testor and his colleagues on the dynamics of infidelity, Ludovica Grassi on multiethnic relationships, and Giorgio Rigamonti and Simona Taccani on the secrets of couples. In all of these chapters, the writing emphasizes unconscious dynamics in a way that will be both familiar and reassuring to the analytic reader but often with the addition of an understanding of how interactional dynamics contribute to difficulty in families and couples, and therefore how these same dimensions of interaction in the therapeutic setting can contribute to individual growth, differentiation, and improvement in the relational sphere.
There are other fascinating essays: by Pierre Benghozi on myths of shame and treason in families, and on the sloughing off of old, maladaptive psychic skins during the maturational process of families of adolescents; by Diana Norsa on unconscious male and female representation in reconsti- tuted families; a chapter each by Rosa Jaitin and Massimiliano Sommantico on sibling dynamics and the displacement of oedipal patterns by sibling relationships and unconscious configurations; by Philipe Robert on new patterns of oedipal organization; and a particularly helpful, must-read paper by JeanGeorge Lemaire on the contributions of couple and family analysis to current psychoanalytic theory and practice.
I save my closing commendation for the contributions of Anna Maria Nicolò. In addition to her coauthored introduction to the volume, she has contributed three papers, each a gem. Chapter 4, “Where Is the Unconscious Located?” is a clear exposition of theory behind the “link,” illustrated vividly with two clinical examples. Chapter 10, “Couples and the Perverse Link,” redefines perversions in terms of the linking relationships involved. And the book closes with her presentation of a lovely clinical example illustrating how family myths express and maintain pathological family links. Nicolò has long been a major contributor to the literature of family and couple psychoanalysis, but is virtually unknown in the anglophone literature. Her work deserves wider recognition. To readers already familiar with the English-language literature of family and couple psychoanalysis, this book will come as a welcome addition, broadening their ways of thinking about analytic work from the traditions of Italian, French, and English colleagues. To those for whom this is a relatively new set of ideas, the volume will serve well as an introduction to a world of expanding application of conjoint work and conjoint theory in psychoanalysis. Finally, and perhaps most important, open-minded analysts can read here of ideas from family and couple practice that can enrich all of psychoanalysis.
References
Berenstein, I., Puget, J. (2008). Psychoanalyse du lien: Dans différents dispositifs thérapeutiques. Paris: Eres.
Kaës, R. (2007). Linking, Alliances, and Shared Space: Groups and the Analyst. London: Karnac Books.
Kernberg, O.F. (1998). Love Relations: Normality and Pathology. New Haven: Yale University Press.
Losso, R., Setton, L., Scharff, D.E. (Eds) (in press). Enrique Pichon-Rivière: A Psychoanalytic Pioneer. Lanham, MD: Rowman & Littlefield.
Ruffiot, A. (1990). Le groupe-famille en analyse: L’appareil psychique familial. In A. Ruffiot, A. Eiguer, D. Litovsky de Eiguer, M.C. Gear, E.C. Liendo, J. Perrot, B.A. Morel (Eds), La therapie familiale psychoanalytique. Paris: Dunod.
Scharff, D.E., Scharff, J.S. (Eds) (2014). Psychoanalytic Couple Therapy: Foundations of Theory and Practice. London: Karnac Books.
Scharff, J.S., Scharff, D.E. (1987). Object Relations Individual Therapy. Northvale, NJ: Aronson.
[1] Already published in Journal of the American Psychoanalytic Association, 63, 3: 582-587.
[2] Chair of the International Psychoanalytical Association’s Committee on Family and Couple Psychoanalysis, Chair of the board, founder and former director of the International Psychotherapy Institute, Washington, DC, and clinical professor of psychiatry at Georgetown University and the Uniformed Services University of the Health Sciences. davidscharff@theipi.org