Psychoanalytic couple therapy

Domain I · Psychodynamic & depth psychology · Mary Morgan, Jürg Willi, Fred Sander · 1975 · London

What it is

Psychoanalytic couple therapy treats the relationship itself as the patient. It works mainly through interpretation, inside a stable joint setting. The core idea of change is as follows. Partners choose each other partly unconsciously. Through a shared unconscious phantasy and shared defence, they…

Format

• Format (Tavistock). One therapist, or historically a co-therapy pair, sees both partners together. Sessions are weekly and about 50 minutes. The work is usually open-ended, with a fixed time, room and fee. A brief, time-limited Tavistock variant exists: Couple Therapy for Depression, about 20…
• Format (Willi). Joint sessions with a focus on the collusion. He held that the concept could also guide individual therapy with one partner. Session counts not found.

Who practises it, and how they are trained or regulated

• Format (Sander). Flexible combination or sequencing of individual and conjoint sessions within one psychoanalytic frame.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Overly individual interpretations that lose the couple frame.
• Any new violence or fear. That means stopping conjoint work and returning to D2.
• Pseudo-acceptance ("Yes, we both do it, but..."). It is working when spontaneous "my part" statements appear between sessions.
• Your own siding, blaming or rescue fantasies. Over time the couple starts to say "we" and to wonder about "what happens between us".
• Flight into health and sudden dropout. It is working when the couple can reflect on a relapse in the session without full re-enactment.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.