Enactments at the edge: Transformational moments in psychoanalytically influenced couple therapy
Enactments in psychoanalytic theory and practice have been well described as a dynamic that is co-created between analyst and patient. This article explores this concept in analytic couple therapy, focusing particularly on how it is played out in the context of the three-person dynamics of the couple–therapist system. The author considers that only couple interactions that involve mutually coercive projective identification can be truly described as enactments. By invoking dialectical theory and the notion of the dialectical edge, the author attempts to provide an understanding of the psychic mechanisms involved in the transforma- tional moments relating to enactments that occur at times of heightened tension and ambiguity.
Key words: enactment in couples, transformation, dialectics of change, dialecti- cal edge, belief systems, coercive projective identification, repetition compulsion, containment.
“When two characters or personalities meet, an emotional storm is created. If they make a sufficient contact to be aware of each other, or even to be unaware of each other, an emotional state is produced by the conjunction of these two individuals . . .”
(Bion, 1979, pp. 1–2)
When Bion spoke of an “emotional storm” and the state that is produced by the conjunction of two individuals, he could, I believe, in today’s con- text, be talking of the stormy enactments that we frequently encounter in our daily analytic work. The emotional storm involving two “characters”, that I wish to address, is that of the couple relationship. I would like, in particular, to attempt to illustrate how the dynamic of enactment is played out in the context of the three-person dynamics of the couple–therapist system, and how the therapist becomes intricately involved in the dynamics of the “bad weather”, as a participant observer, or what is commonly described as the analytic third (Ogden, 2004).
To quote Bion further:
What that emotional storm is, one does not immediately know, but the prob- lem is, how to make the best of it; this means a capacity to turn the circum- stance, as I choose to call it for the moment, to good account.
(Bion, 1979, pp. 1–2)
I propose, further, to illustrate the transformational value of heightened storms that ensue with couples, and the therapist’s role in helping to turn, as Bion puts it, the circumstance (the couple’s storm) “to good account”.
The notion of enactment emerged long before it was formally described in 1986 by Jacobs (Jacobs, 1986). Ferenczi wrote,
“I have finally come to realise . . . the time will come when the therapist will have to repeat with his own hands, the act of murder previously perpetrated against the patient”
(Ferenczi, 1932, p. 52).
Sandler (1976) anticipated the notion of enactment in his paper on role responsiveness. He described how, through the mechanism of projective identification, patients can influence the analyst to play out a painful object relationship.
Bohleber and colleagues (2013), in their study involving the conceptual- isation of enactment, conclude that each practitioner arrives at their own personal understanding. Mine is best summed up as follows:
In my view, enactments, in common with other psychoanalytically understood dynamics, occur not only between therapies and patient, but between all individuals. To qualify as an enactment, an action would need to involve several important, related dynamics; namely, one person would need, unconsciously through projective identification, to set out to influence the other to take on the “transference role” pertaining to their painful, internalised object relationship. In order that the enactment can be perceived, however, the recipient would need to be open to receiving these projections, in accordance with their own internal representations and subjectivity. Enactments may be anticipated, just prior to being evident, but, as usually happens, they are often only identified after the fact.
It is important at the outset to be able to distinguish between what are commonly observed and understood in couple work as patterns of inter- locking vulnerabilities and the notion of enactment. These interlocking dynamics are similar to, but sufficiently different from enactments, to warrant closer examination. Enactments, as noted above, require one partner to be unconsciously motivated to influence the other to enact their past painful traumatic relationship scenarios, whereas in less complex inter- locking vulnerabilities, these escalating vicious cycles depend more on simple projection and “fit”, than as a result of unconsciously intended influence and provocation.
Enactments that arise in couple therapy (as opposed to individual ther- apy), are particularly complex, because not only do partners provoke enactments in one another, but, as I hope to demonstrate, therapists also find themselves drawn in to them.
In order to be able to distinguish between a more simple interactional dynamic and one fuelled by projective identification, therapists need to rely heavily on their countertransference. After an enactment, the therapist is often left with uncomfortable feelings of having gone too far, or acting with insufficient reflection, or at times of shame at having provoked the patient. In the case of simple projections the therapist does not fear having been provocative. Making such a distinction in work with couples is more complex. Again, the therapist must refer to his/her countertransference response to the couple’s interaction, in order to notice what they may be stirring up in one another. In a general sense interactions involving projective coercion and enactments tend to feel more intense, provocative, evocative, and more experience near, than when overt provocation is absent. It is my belief, that it this very increased intensity that makes for a greater potential for therapeutic change.
It goes without saying that it is just as important for couple therapists to be able to identify, not only the coercive dynamics that occur between partners, but as crucially, their own influential participation in the therapy process.
For an enactment to be co-created by two people, and then be constructively managed, requires, as I understand it, the dynamic interaction of three well known psychic mechanisms; projective identification, repetition compulsion, and containment. In individual psychotherapy the process runs as follows: the patient remembers their past pain in the present; projective identification is activated in order to influence the therapist to repeat this; the therapist is drawn in to re-enact this painful scenario. Finally, through containment the therapist attempts to transform unmentalised emotional pain into language and understanding.
I shall briefly describe these three important dynamics:
In Klein’s initial description of projective identification, the infant splits off and projects good and bad aspects of self into mother. In Klein’s percep- tion, the effect on the mother remained an internal phantasy in the infant (1946, 1955). Later theorists (Bion, 1959, 1962; Rosenfeld, 1987) under- stood projective identification as a dynamic of influence, whereby the projector is capable of inducing various emotional states in the recipient, such as empathy, understanding, and disruption. It is in this form of influence and coercion, that projective identification is understood, to function as a crucial dynamic in enactment.
When Freud observed his patients compulsively repeating painful experi- ences in their lives and in the transference, he became aware that this behaviour conflicted with his ideas relating to the pleasure principle. He made sense of this contradiction, by postulating that repetition could be a way of remembering, a manifestation of the death instinct, and a path to the mastery of previously insurmountable painful experiences (1914g, 1920g). Betty Joseph (1959), drawing on Freud, described two modes of repetition, a passive and an active mode. In the passive mode, repetition is based on a homeostatic need; that is, to maintain an attachment to what is known and familiar. In the active mode there is a drive towards change and mastery.
Although containment does not have a direct role in the dynamic of enact- ment, it is vital in its understanding, processing, and management. Bion (1962), in describing containment, notes how beta elements—the unman- ageable, incomprehensible, emotional elements that relate to the patient’s mental pain and disturbance, are projected via projective identification, into the analyst. The analyst, being open to receiving these projections, attempts then to hold, process, and make sense of these inchoate mental elements, before returning them to the patient in a more digestible and understandable form. He names this the alpha function.
The process of containment when moving from dyadic to the triadic work of couple therapy becomes more complex. The couple therapist needs to “absorb” each partner’s projections, in order to understand and identify with both their inner, unprocessed, subjective states. The therapist then must hold and tolerate the ambiguity and tension aroused within him/herself through these projections, while at the same time, understand- ing the impact that each of the partner’s projective identifications has on one another. In this mode, the therapist functions as a reflective containing third (Ogden, 2004). As described above, the extent to which the work tilts towards passive or active repetition, will depend a great deal on the con- taining capacity of the therapist. This is further explored below.
Although it is generally accepted that enactments are potentially trans- formative, in my reading of the literature there is surprisingly little that explains how this change takes place. I will attempt, by invoking dialecti- cal theory and the notion of the dialectical edge, to share my understand- ing of the psychic mechanisms involved in the transformational processes associated with enactments, especially in those occurring at times of heightened tension and ambiguity. After giving some theoretical back- ground to this issue, I shall illustrate it further with a clinical example.
Dialectical phenomena and the dialectical edge
Although Winnicott made no direct reference to the idea of dialectical ten- sions and “edge” in his work, this understanding was clearly implicit in his writing about potential space (Winnicott, 1971). Ogden (1992) has noted that, Winnicott drew on a multitude of dialectical phenomena, such as “me–not me”, “subject–object”, “illusion–reality”, for his understanding of transitional phenomena and their potential for creativity. Ogden (1992) can be credited with having brought a clear understanding of dialectical phenomena into the realms of psychoanalysis, as has Hoffmann (1998), in his work on dialectical constructivism, and Pizer (1996), in his work on the dialectics relating to potential space.
Ogden defined a dialectic in the following way:
“A dialectic is a process in which each of two opposing concepts creates, informs, preserves, and negates the other, each standing in a dynamic (ever- changing) relationship with the other . . . The dialectical process moves toward integration, but integration is never complete. Each integration creates a new dialectical opposition and a new dynamic tension.”
(Ogden, 1992, p. 208)
Since, as Ogden notes, in dialectical situations “integration is never com- plete”, the potential for the irresolvable tension arising out of doubt and incompleteness, to act as a rich resource for creative thinking, has been shared by many psychoanalytic thinkers. When discussing the nature of transitional phenomena, Winnicott observes, “The searching can come only from desultory formless functioning . . . It is only here, in this un-integrated state of the personality, that which we can describe as creative can appear” (1971, p. 64). Bion (1962) similarly emphasises that tolerance of frustration is essential for thought development. He notes that it is the absent breast that gives the child his first opportunity to know reality through thought. Bion also encouraged analysts to approach their work without memory and desire (Bion, 1962, 1970), and to develop a capacity for negative capabil- ity, that is, in the words of John Keats (1817) to be “. . . capable of being in uncertainties, mysteries and doubts (quoted by Bion, 1970, p. 125). In essence, they endorse the idea that creative thought and change is spurred on by a healthy “dose” of frustration, doubt, and incompleteness.
I have previously written (Israelstam, 2007, 2009) that when irresolvable dialectical tensions begin to escalate, what was previously stable and “known” (albeit non-productive), begins to become less integrated, less predictable, and more chaotic. Eventually if unabated, tensions reach a cli- mactic point or “edge”. This heightened tension at the “edge” has, under conditions of optimal containment, the potential to develop into a reflec- tive, transformational, transitional space. It is to be hoped that this space could facilitate the capacity for new thought, and more constructive relational interactions. On the other hand, failed containment might lead to the collapse of this space.
I hope to show in the clinical example below, how the particular dialec- tic related to change vs. homeostasis in the couple’s interactional dynam- ics, reached a critical “edge”. The change vs. homeostasis dialectic seems most relevant in this case, and it is one that could be considered a core dialectic that presents in many troubled couple relationships. Notwithstanding this there are many other dialectical entities of relevance to our work, such as dependence vs. independence; ritual vs. spontaneity (Hoffman, 1998) and illusion vs. reality (Pizer, 1996). The potential for positive transformations are created, under optimal conditions of contain- ment of frustration, doubt and ambiguity, at this “edge”.
The inner world has been conceptualised in many ways, notable exam- ples being that of object relationships (Fairbairn, 1958), or relationship schemas (Bowlby, 1973). I find the idea of a belief system to be very help- ful in describing an inner mental–emotional state. Beliefs might be seen as a form of object relating, in that they are determined by our experiences arising out of our interactions with significant others (Britton, 1988). In the case history below, the couple, Jack and Sue, both dominated by maladap- tive belief systems, were unfortunately “programmed” to expect, and indeed prioritise, evidence that only served to confirm their destructive belief systems (Israelstam, 1989a,b; Weiss 1997). These belief systems become the subjective lenses through which our beliefs are selectively constructed, and are self-fulfilling (Israelstam, 1989a,b; 2007). I aim to show in this case example, how patients tend to repeat early painful expe- riences, by invoking others to participate in this maladaptive “old shoe that fits” (Sandler, 1976). These enactments often have very mixed unconscious motives. On the one hand, there may be as with Joseph’s passive repetition (Joseph, 1959), a longing to repeat in order to master and revise maladap- tive believing systems (Weiss, 1998). On the other hand, there may well be as with Joseph’s active repetition, an equally strong pull to repeat in order to maintain the “old order”.
This duality is often manifest with patients who come to us in pain, with two apparently dialectically, yet related, opposing needs, such as the need to change and the need to stay the same. Jack and Sue, who had reached a critical edge fuelled by their coercively fuelled enactments, could either move forward towards positive change, or fall back to “more of the same”.
This presentation begins with two assessment sessions, followed by a ses- sion fourteen weeks into the therapy. My reflections and associations as the therapist are given in parenthesis.
First assessment session
Jack is forty-four and manages a software company. Sue is forty-two and works part-time as an occupational therapist. They have two children, Adam, aged six and Becky, aged four.
Jack, looking uneasy, places his heavy, bulging briefcase by his side, sits down, then stretches back with his hands behind his head.
Sue looks anxious and tense. “I’m so sorry we’re late. We had to drop the kids off, the traffic was so congested. There was a small accident, but it doesn’t take much to cause mayhem. Our roads can’t handle this increasing traffic!”
Jack: “She gets really worked up when we’re late. I kept trying to tell her that five minutes wouldn’t make a difference. She still gets stirred up.”
That it “doesn’t take much to cause mayhem”, speaks to me symbolically of how it does not take much to spark off tensions in this couple. The traffic congestion, and bulging bag speak of their built-up tensions, and that they have little capacity for emotional containment.
Sue: “I’ve been trying for years to get Jack to agree to come for help. Things have had to reach a crisis point.”
Jack: “It’s true. I have always felt that we should be able to sort these things out ourselves.”
Sue (speaking in a cutting tone): “Well we haven’t, have we?!”
Jack sits back, hands behind his head, looking up and away, and is silent.
Sue: “I’ve just had enough. I can’t go on like this anymore. We are living such separate lives. He’s more intimate with his laptop and surfboard than with me!”
Jack, still looking up, sits further back in his chair.
Sue, looking directly at me, shakes her head, as if she assumes that I naturally would agree with her as to how difficult Jack is: “He’s impossible. It doesn’t matter how much I ask him to please help me with Adam who has an attention deficit disorder. His ritual of reading the paper over breakfast carries on, while I’m killing myself getting Adam dressed! I’ve just had it! I asked him to move out of the bedroom last week. He did that without protest. I think it suits him, he can continue his love affair with his laptop in peace, and get up every day at 5.30 a.m. to surf!”
Jack, shrugs his shoulders, and glances at me, as if to assume that I knew well what he was having to put up with. In a frustrated tone, he says, “I can never please her. I kill myself working to try and give her and the kids a good life. As for my surfing every day, it’s for my peace of mind. To be honest, I do welcome being downstairs. If she’s not on at me about how I let her down, then she goes on about Adam and how he doesn’t listen. I try to explain to her that if she didn’t shout so much, he might listen!”
I was not only aware of how they both needed me to take their side, but that I myself felt pulled in all directions to do this! When I encountered Jack’s defensive style, I was aware of feeling irritated and drawn to side with Sue. Sue’s sharp and critical tone, jarred with me, and left me pulled to side with Jack. Although it was very early in the assessment, I found that I had to work hard at processing these strong countertransference feelings and I had a sense that I was being pulled into enactments.
Sue: “So you are admitting that you are pleased to sleep downstairs!” At this Sue’s voice quietens, she looks sad and dejected, and a little tearful.
Jack looks uneasily away, and is silent.
Sue: “I wish he would put as much time into our home to fix things, as he does his surfing. We have a leak in the kitchen and the ceiling is bulging. I’m waiting for it to burst through!”
Jack: “She’s exaggerating. It’s just a drip from the shower above. I need to reseal the tiles. The ceiling is hardly bulging, it’s just a little stained!”
Sue: “He refuses to get a handyman, always wants to do things himself. Jack: “I tell her that it’s not only to save money, I also get a lot of satisfaction out of fixing things.”
Early in my assessment of the couple, I am struck not only by how they are already provoking one another, but also by how they arouse my anxiety and doubts about my capacity to help them. I decided to offer an interpretation of my understanding, although I was aware of how constrained I felt in intervening.
Therapist: “I’m beginning to see how you press each other’s buttons. Sue, I see how anxious and agitated you get when you experience Jack’s withdrawal. Jack, I notice how you go into avoidance mode when Sue’s distress intensifies. So for you Sue, it’s a bursting ceiling and for you Jack, a mere drip. I am getting a sense of how the two of you can clash!”
Jack: “I just want peace, I can’t stand this tension. She says I’m happy being downstairs. It’s true that it’s peaceful, but I hate sleeping on my own.”
Sue: “Do you think I enjoy a cold bed!”
At the end of the session, we made arrangement to meet for a second assessment meeting.
It was only after the couple had left, that I began to understand something of my reluctance to make an interpretation. On reflection, I could see how concerned I was not to add to the “bulging” tension, and how inclined I was to want to minimise the intensity of the situation, as Jack was doing, symbolised by his remark, “It’s only a small leak.” I wondered if I had already become somewhat influenced to re-enact a hesitating and un-containing parental figure. I was aware, as indicated above that I was also being drawn in to enact a scenario that related to their need to be the special one. I wondered how these countertransference deductions that I had made, corresponded to Jack and Sue’s early experiences with their significant others.
Second Assessment Session
The air in the room chilled as the couple sat down ignoring each other’s gaze.
Sue (her face reddening and clearly angry): “On Sunday morning Jack said that he was going over to his mother for a while, to help her with her computer. He arrived back well after our lunchtime! I had made his favourite roast. It was dry and cold by the time he arrived.” Looking imploringly at me, she exclaimed, “Do you blame me for complaining?”
Jack, in his characteristic style, silently leaned back and looked away.
Sue: “His mother’s so controlling! He’s never acknowledged his child- hood and how it’s affected him!”
Jack (sounding defensive): “I hate the way she goes on about my mother. Anyway I don’t normally think much about my past. I try to live in the present.”
I could sense the tension and how this could quickly turn into further escalation and coercions witnessed in the first session. I felt it important to begin to explore the couple’s past relationships to their significant others, to provide the opportunity for myself and the couple to get to understand the important role that their internalised belief systems plays in their current interactional difficulties.
After sitting for a moment in the tense atmosphere, I suggested that this might be a good time for me to get to know something of their past.
Jack: “I’ll try. Yes it’s true, my mother is very demanding, but means well. She’s had a hard life. When I was five, my father ran off with a friend of my mother’s! She never stopped telling me, how betrayed she felt by my father and how selfish and nasty he was. He moved to another state. After that, I only saw him in the school holidays.” Jack looked down as he said this, his voice softened and sounded sad.
Therapist: “That must have been hard for you, to miss out on so much time with your father.”
Jack: “Yes I was always sad to leave him after the holidays. That’s where I learned to love surfing. Mom never re-married. She said that her main concern was to try and make a good life for us. She was always so sad and used to lean on me a lot. She would say that I was the only one who understood her pain. I was pretty lonely as a kid. I seldom brought friends home to our house; it always felt so dark and gloomy.”
I believe we all felt taken over by this dark and gloomy atmosphere.
Jack exclaims, “Wow!” Taking a deep breath, his voice quavers as he struggles to hold back tears. “What a sad story I have! I’ve hardly spoken about my early life.”
Jack sits still, while tears come to his eyes.
Therapist: “It must have been so hard for such a little boy to have to carry such a sad and embittered mother’s pain.”
Jack: “Yes nothing I did seemed to make her happy. I so loved being with my father. I used to miss him so much. It’s hard to admit to myself, but I often wondered how much he could have loved me, given that he was able to move so far away when they split up!” Jack’s face was wet with tears.
Sue: “I hardly ever see him cry.” She leans over towards him, as if to touch him, but does not. “He never gives me a chance to see this softer side. I wish he would talk more. He’s always so closed.”
Jack: “I’ve always kept my feelings close to my chest.”
Therapist: “It sounds like you’ve never had much chance to be heard. It seems that there was not enough space for your mother’s pain and your own, and no father nearby to support you.”
Jack: “No, I didn’t want to give her more trouble.
Therapist (turning to Sue, who was looking softer and less angry): “Sue, perhaps you can tell me about your background?”
Sue: “Well mine’s not too good either. My parents are from Eastern Europe. I don’t think that they ever settled here. My mother is very criti- cal and controlling. It feels like she has never known me. My Dad worked hard to create a life for us. He was rather quiet and withdrawn. I never felt important to him; he and my mother showed much more interest in my younger sister. She knew how to dance to their tune.”
Her voice softens and her eyes well up with tears. Jack passes her a tissue, and then moves back into his chair.
Therapist: “You have both been letting me know of the pain and loss that you have experienced in your early days, and how you again find yourselves alone and unfulfilled in your relationship. I’m wondering how long this situation has existed, and if there have been better times.”
They explained that they had met in their late twenties, and that the attraction was mutual and intense. They both agreed that things began to deteriorate after the children were born.
Sue: “Jack just wasn’t there for me when I most needed him. That’s when he started to become more obsessed with his surfing.”
Jack: “I felt that I had lost her to the kids. She’s so caught up with their every need”!
At the end of the session, Jack and Sue expressed their wish to continue with therapy. We agreed to meet weekly.
I was struck by how quickly mutually created enactments could occur between Sue and Jack. They typically evolved in a circular and escalating manner. Sue expresses her anger and hurt, which activates Jack’s anxiety and guilt about hurting, as well as his feelings of helplessness in being unable to please her. He then passively and aggressively withdraws. This arouses Sue’s separation anxiety to which she responds with overt anger and hurt.
I also reflected on my potential to be drawn into enactments reflecting painful relationship scenarios of their past. In one I might take on the role of an uncontaining, emotionally unavailable/absent parent—I had to struggle with feelings doubt and helplessness. In another, I might take sides to gratify unmet oedipal longings. I had to work hard at maintaining an even- handed stance.
The following account illustrates the emergence and management of an enactment of condensed and heightened tension (Bass, 2003), and the potential for transformation at this point of crisis in the session.
Fourteen weeks later
They sit in their usual seats, both looking somewhat sad and dejected.
Jack: “I took her away for the weekend without the kids. I felt things went well, but it looks like I’ve messed up again!”
Sue (her eyes welling up with tears): “Yes we were able to get a bit closer, but now we’re back to square one!”
I note how quickly Sue’s tears prompt Jack’s vulnerability. He looks down, like a naughty boy who has disappointed his mother.
Sue: “I came home to one of my mother’s toxic guilt-tripping e-mails. She still manages to bring me to tears in spite of all my therapy. I tried to share this with Jack who was busy on his iPad. He muttered something, but never even looked up. I simply lost it. Surely you know the effect my mother’s e-mails have on me!”
Jack, still not looking up, remains silent.
I note the growing intensity building. Sue, red in her face, is enraged by Jack’s misattunement. Jack responds angrily and passively. A storm has brewed. I feel edgy and need to work hard at containing the stormy feelings evoked in me.
Sue: “Well say something. Don’t just sit there”!
Jack shakes his head looking away, leaning back, almost out of his chair.
Sue: “Look at me when I speak! Do you see what I mean”! She looks directly at me, seeking my affirmation. “This is what he does, it drives me crazy! It’s as if I don’t exist”!
Jack: “Yes, I did see your tears, but I figured that you would be seeing your therapist tomorrow, and that she would help you.” He looks at me imploringly. “I just can’t win, can I?”
Sue: “I’m not married to my therapist. I’m married to you! You are never there when I need you most”!
Jack, quietly smouldering, does not respond or look up.
Their storm has upgraded to a higher category! I sense that Sue’s comment about just “sitting there”, could well have been meant for me. Jack’s remark about the therapist helping, I believe might well reflect his need for me to help him with Sue. I can again feel coercion to take sides and to respond to the provocation to repeat the emotional absence of their inner parental figures.
I make the following interpretation based on my countertransference: “I can see how helpless you both feel about trying to work things out together, perhaps hoping that I will be able to save the situation. But you are, I believe, as yet unsure of my capacity to do this.”
Sue (looking red in the face and about to explode): “I am feeling desperate. I don’t believe you or anyone can help. I’m beginning to feel that it’s time to split.”
Jack (head hanging low): “I wish you could help, but I don’t see how you can. I know I can’t, I have failed.”
I sense that we have reached a critical moment in our work. There has been a collision of their subjectivities. Each has influenced the other, via projective identification, to respond to their expected role. Jack activates her belief that she is unimportant and unlovable, and that closeness results in pain and abandonment. Sue activates Jack’s belief that he is unable to please women, is destined to hurt them, and that closeness only brings pain. The more he withdraws from her, the more abandoned she feels. The more she berates him, the more attacked he feels, and the more he withdraws! The more their conflict escalates, the more anxious I become, and the more helpless I feel in being able to calm the storm.
My formulation is and my emotional responses inform me that the intense interactions occurring at this critical stage are not based on simple projection, but a potent mix of provocation and projection. Here are the makings of a mutually created triadic enactment, a co-created storm; one that is imminent, but as yet, not fully erupted. This highly charged space has, as described above, the potential to collapse or to be resuscitated. At this moment, the triadic system is in a state of near collapse. Neither Jack nor Sue has any semblance of a capacity for containment and reflection. They are each trying to survive the mutually created storm, with little to hold on to. They want me to be their life raft, yet are not confident in my capacity to save them. I conclude that Jack and Sue are precariously positioned at the heightened “dialectical edge” between the possibility for change and that of homeostasis. It is the edge between active and passive repetition, an enactment to master vs. one that repeats their pain (Joseph, 1959).
My hard work to process this allows me to regain my reflective and containing capacities, and I feel again on reasonably firm ground, although Jack and Sue remain preoccupied with their survival. This enables me to function as a reflective third, and not to prematurely shut down this potentially productive tense and fluid state.
After sitting in silence for a while, I reach out to them, becoming some- thing of a translator of their subjectivities. “Jack, you’re shaking your head and looking very perplexed and despondent. I think you are con- cerned that I may not be able to help you, that you are left to cope on your own, as you felt when your father left you to cope with your des- perately unhappy mother, when you needed the caring yourself.”
Jack slowly begins to lift his head from his hands, eyes wet with tears. He self-consciously attempts to wipe them away with his hands.
Jack: “Yes, I haven’t thought much about these things, I’m realising now how much these things have affected me. I used to have terrible night- mares. I wet my bed till I was ten. I always felt so ashamed and terrible about giving my mother the extra work of washing my sheets.”
Therapist: “I’m wondering Jack, if you are feeling anxious about giving me ‘extra work’ in managing your ‘wetting’ tears”?
Jack: “I’m always self-conscious about crying.”
Sue (looking a little softer, turns towards Jack): “I keep telling him that I don’t want him to fix things. I just need some acknowledgement that you have heard, otherwise it’s like I don’t matter, like I don’t exist.” Sue is silent for a while and then continues. “Well I’m not sure if it’s a coinci- dence, but just the other day I was telling my therapist about how my anger towards her has been growing over the last months. I was feeling that she wasn’t really interested in me. Yet I get it that she is a caring person. I’m beginning to understand that it’s to do with my own parents, this mistrust that I have about being important to anyone.”
Therapist: “It’s these painful feelings that Jack, as your rejecting parent, manages to trigger in you.”
Sue (bursting into tears, covers her face with her hands): “No one really knows how terrible it was for me growing up. I felt so alone, so unloved, like I didn’t belong!”
I am anxiously wondering how Jack will respond to Sue’s outpouring. Will he be able to rise to the occasion, or will there be yet another repeated enactment; more of the same?
Jack reaches for the tissues, but almost in mid-air, changes direction and instead moves his chair closer to hers, putting his hand, albeit tentatively, on her lap. She puts her head on his shoulder; they sit quietly for a few minutes.
I feel very touched, and relieved, knowing that it was important not to interrupt this important moment of a growing mutual understanding. I note that the coercive storm has been downgraded, and that the couple has responded to my containment. A space has become more available for thought and reflection.
Sue slowly lifts her head from Jack’s neck, wipes her tears, and says quietly, “I think I’m getting it now. I’m doing to Jack what I’ve been doing to my therapist. She has commented on how I provoke and test her. I can be so mean to you Jack! I can see today how vulnerable you can be, and how you try too hard to please and fix things, and that you are struggling. For me though, when you are tentative, it’s like you are dropping me”!
Jack: “The last thing I want to do is hurt you, yet I can see how I keep stirring and provoking these feelings up in you.
Therapist: “Yes it seems Jack, when you withdraw, you provoke Sue’s sense of being emotionally abandoned. You Sue, then respond with anger and hurt, I believe in those moments you become Jack’s wounded and hurt mother. This serves to provoke in Jack his helplessness, anxiety and withdrawal. A real vicious cycle! It seems that the two of you have spent a lot of painful time locked in together, triggering and fuelling each other’s most vulnerable wounds.”
Sue (tearfully): “Yes, we have, for far too long. It’s painful to think of how much time we have wasted.”
Jack: “I never realised how frustrated and helpless I could feel when I can’t do things right for Sue. I think I’m beginning to see what you mean by seeing my mother in Sue.”
When the session ended, Jack placed his hand on Sue’s shoulder as they left the room. They both turned to me, looking somewhat relieved, and thanked me for the session.
I note that both have also “tilted” away from me as a disappointing object to a potentially helpful one. Each has begun to withdraw their projections from the other, Sue’s projections onto Jack as the rejecting parent, and Jack’s projections onto Sue, as his disappointed and angry mother. They have also downgraded their coercion and provocation of one another. In dialectical terms it might be said that they have been tilting away from homeostasis to change.
I continued to see the couple twice a month for the next year. Their compulsion to enact continued. Sometimes this was constructively con- tained, as illustrated above. At others the storms exploded beyond my and their containment capacity. These painful episodes often resulted, how- ever, in our being able to sit back and reflect on what had happened. In effect, they were opportunities for the couple to learn from experience.
The couple ended therapy, feeling confident that they would manage well on their own. They do return to see me briefly on occasions, when they are feeling stuck in old patterns.
I have wondered at the function that enactments have for Jack, Sue, and me, as therapist. I am impressed by the notion that our unconscious has the capacity to identify difficulties and obstacles that generate discomfort and pain, and is then capable of thinking, planning, and activating behaviours to reduce the distress (Weiss, 1997, 1998).
What might then be the possible unconscious motives and “planning”, that drove the three of us to participate in the enactments or near-enact- ments described above? Some motives were shared, some belonged to the couple, and the others to me and the couple.
The shared motive, I believe, relates to the need to “shake” the process out of its stuckness. We had, for weeks, reached a plateau, with little change. In my view this was a shared and co-created experience, brought about by multiple, coercive, projective identifications, arising from grow- ing pessimism in each of us about our ability to improve things. The enact- ments certainly had the function of bringing things to life by precipitating and bringing into the present moment, an experience-near re-enactment of early, painful relationship experiences.
The motive more specifically relating to the couple concerned their quest to master what was unmanageable at the time of their original trauma. To put it another way, this was Jack and Sue’s quest to have their strongly held, pathogenic beliefs disconfirmed. The quest for mastery, although desired, is often hard won. Although as human beings we value and seek out novelty and change, we are, to some degree, drawn to the need to remain the same, to have our negative beliefs confirmed. The “old shoe”, although outdated and badly worn, is sometimes preferred, as it is at least familiar. When Jack and Sue influenced one another to enact their past painful hurts, they did so with two dialectically opposed needs, that is, the need to change and the need to remain the same, to confirm or to dis- confirm their respective strongly held belief systems.
In their mutually created enactments, both were driven toward homeostatic repetition.
As for my participation, I have detailed above the conflicted feelings aroused in me to respond to the couple’s projective identifications coerc- ing me both into taking sides or to letting them down. Fortunately, although I often came close to the “edge” of these enactments, unlike the couple, I had as their therapist, the luxury of distance that allowed my reflective and containing capacities to come alive and to facilitate the transformation from a destabilised edge to a potentially creative transitional space. This more balanced and flexible state allowed new understanding and the freedom to be able to know and imagine the other for who they were, uncontaminated by painful figures of the past.
I have attempted to illustrate how the dynamics relating to enactments that arise out of the interactions between therapist and couple partners, have much in common with the therapist-patient dyad. However in dyadic work, it is the therapist that is drawn into the enactment (co-created), whereas in couple therapy, the situation is more complex (tri-created). I described how Jack and Sue drew one another into enactments, and how they both, and as a couple, would attempt to influence me to participate in enactments with them. I have also attempted to illustrate how as therapist, I could at sometimes contribute to and participate in an enactment, but at other crucial times was able to step back to observe and reflect.
Change is of course a multifaceted, and a multi-determined phenome- non. Here I have highlighted the potential for change brought about when a crisis is generated by the clashing of irresolvable, dialectically related entities. I have chosen a case example that particularly demonstrates that the outcome of an enactment, notably when it has reached the edge within the dialectic of change vs. homeostasis (or a new belief vs. an old patho- genic belief), is largely determined by the containing capacity of the thera- pist. The compulsion to repeat can be so compelling, especially when fuelled by real provocation. Where transference projection collides with reality without adequate containment, enactments are destined to result in a passive repetition of earlier pain and disruption. If the containment is effective, however, there is a greater likelihood that the repetition will tilt towards being active and constructive. It is proposed that the states of con- trolled/contained chaos, as have been illustrated in the case of Sue and Jack, facilitated the couple’s capacity to transform their old maladaptive belief systems into healthier ones. It might also be said that this couple’s ability to improve could be attributed, through identification with me, to their growing capacities to act as participant observers and to foster mutu- ally containing capacities. It is these capacities, if securely internalised, that could provide them with continuing potential to know and imagine the subjective experience of the other.
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