Inside out or outside in. Meeting with couples. Hugh Jenkins

Inside out, or outside in: meeting with couples

Hugh Jenkinsa

The complex difficulties often faced by couples require a range of modelsfor effective help. Relational intensity is heightened in therapy by the easewith which the therapist can be triangled into the couple’s relationshipand by the influence of the emotional triggers from their respectiveinternal worlds.

This article draws on systemic and psychodynamic models and atransgenerational perspective for gendered stories. Different time frame-works link interpersonal and intrapersonal themes. In this sense, thetherapist works ‘inside out’ and ‘outside in’. A framework of behaviours,emotions, feelings, meanings and beliefs is proposed to help link theseperspectives. ‘Invisible contracts’ and the sense of there often being anunconscious ‘pact to disappoint’ are described.

Clear models are not enough, for it is the intimate encounter betweenclient and therapist that is the bedrock of therapeutic change and growth.There is no short cut to this sense of intimacy in the unique encounterbetween therapist and each new couple. Brief examples from practicedescribe how the issues discussed may be addressed in couples work.

Introduction and background

[O]ne can get along for quite a time with an inadequate theory, but notwith inadequate therapeutic methods.

(Jung, 1931 [Chodorow, 1997, p. 85])

Much of what we do in the moment as therapists is to respond, toinitiate, or to ‘be’ in certain ways. Later we take stock and askourselves how and what this was, and either attempt to link it to aframework, or to develop one that somehow fits with events. This isfrequently a process of attempting to conceptualize the relationshipbetween our reciprocal roles, of making sense of ourselves in relationto others in their relationships to us. An exception to this is the

r The Association for Family Therapy 2006. Published by Blackwell Publishing, 9600 GarsingtonRoad, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA.Journal of Family Therapy (2006) 28: 113–1350163-4445 (print); 1467-6427 (online)

a Institute of Psychiatry, London, and independent practice. Address for correspon-dence: 83 Hurstbourne Road, Forest Hill, London SE23 2AQ, UK. E-mail: [email protected].

r 2006 The Author. Journal compilation r 2006 The Association for Family Therapy and Systemic Practice

original Milan Group (Palazzoli et al., 1978, 1980), who set aboutdeveloping a way to describe relationships, a model of change andtherapeutic intervention methods that were internally coherent. Inthe light of these opening comments and the above quotation fromJung, the following brief case description highlights something of themixing of theory, method and use of self. It occurs in the ninth sessionwith a couple in their late fifties.

The wife, Wyn, says that her husband, David, had told her that hewas not going to try any more. If they were to have a future, she had tochange. His history of depression during the second half of theirmarriage, his verbal and occasional physical outbursts had seemedintractable. When asked if that was ‘a fair view’, David agreed. Then,slowly, his expression changed, the colour of his face seemed to greyover, tears welled up in his eyes and flowed silently down his cheeks.Almost a minute passed in silence, during which I experienced apowerful urge, which I knew I would have to address in some way,emotionally, intellectually or cognitively. I knew that for me at least, itwould feel like a barrier about the unspoken if I did not trust myselfand said or did nothing. In a quiet voice, I said, ‘If I were your father,I would come over and hug you now’, to this six-foot, 59-year-oldman. Then came the story of his father, a factory worker, who Davidfelt had never really held him physically, who had died when Davidwas 19 years old, and to whom he still spoke in his mind and wishedhe could tell of his career successes. Many authors attempt to describethat moment of encounter, when one steps out of the ‘safety’ of theoryand ‘being professional’. I have described this elsewhere, when onecannot fall back on the security of the tried and tested, and from whichcan come a moment of liberation for both patient and therapist withan experience of relief as the unspoken, even the seemingly unspeak-able, is given voice (Jenkins, 2005, 2006).

We will return later to this particular moment in therapy and towhat followed. However, it is important to state that while my internalresponse was spontaneous, my articulation was considered, using ‘trialidentification’ (Casement, 1985) which encourages an approach tem-pered by carefulness. Goldbeter-Merinfeld (1999) speaks similarly ofthe importance of responding to resonances (resonances) and of thedanger of invasion (envahissement) of the client and how we must payattention to the dynamic of the therapist–client relationship, echoingthe theoretical approaches of psychodynamic theorists. While it isimportant that we have clear theoretical frameworks to guide us inour work, it is essential that we be true to our intuition, grounded in

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experience. It is often that intuited ‘right brain’ response whichcreates the truly therapeutic healing moment (Damasio, 2000a,2000b; Pally, 2000; Schore, 2003a, 2003b), and conceptually it is themoment when left (language) and right (emotional abstraction) brainmeet to form articulated meaning. Stern (2004) refers to the momentof kairos and the ‘now moment’ and the ‘moment of meeting’ (pp.165ff.). They are also moments of crisis, where the situation can neverbe quite the same again (Jenkins, 1989).

Marital and couple relationships tend to be long term, have ashared history and a high level of personal investment – both in therelationship and in defining the emotional, psychological and sexualidentity of both individuals. The voluntary nature of Western-stylemarriages means that there is often considerable emotional pressure‘to make it work’. Where marriages are arranged and viewed muchmore as the bringing together of families, the pressure may be of not‘losing face’ and of not bringing shame on the family. Two people whochoose to live together may later find themselves caught in the mostpainful and destructive of relational dances. Fear of the consequencesof change being worse than the current pain may add to theconfusion, and the therapist who is drawn into this emotional forcefield risks being disempowered and becoming part of a new triangle(Bowen, 1978a; Dicks, 1967). Added to the emotional vortex in thepresent are the differing stories, beliefs, scripts and mental maps thateach brings from previous early life experiences. Some of thesethemes in couples work are examined from the perspective ofvulnerability by Scheinkman and Fishbane (2004).

Two therapeutic traditions, (psychodynamic and systemic), a trans-generational perspective for men’s and women’s gendered stories,and the interrelated perspectives of present, past and future timeprovide some of the structures for my practice. These are just that –structures – within which the therapist engages intimately with herclients. Different levels of description can help the therapist avoidbecoming too focused on a single perspective (Goldner et al., 1990;Jenkins, 1985; Luepnitz, 1988), although understanding these theo-retical perspectives will not of itself ensure that there is a realtherapeutic encounter. Papp and Imber-Black (1996) elegantly re-concile some of the apparent contradictions of different therapeuticmodels by thinking in terms of themes, while safe practice comes fromself-questioning about the constantly evolving nature of the thera-peutic relationship (Sandler et al., 1992), influenced by gender, ages ofthe client, culture, ethnicity, (religious) beliefs, the nature of the

Inside/outside: couples 115


difficulties presented and how they resonate in different ways withsimilar personal considerations for the therapist. The basis of ourwork is the meeting of two or more flawed human beings, and we toobring our particular scripts and maps. It means that we should holdtheory lightly with a willingness to let go of formal models in thetherapeutic moment. In Lynn Hoffman’s terms, it is how to becomfortable with ‘not knowing’ (Hoffman, 1993), which is similar tothe analytic ideal of emptying oneself in order to be more open toexperience the client (Larner, 2000) and being in the present moment(Stern, 2004). From a personal viewpoint for each of us, it is to do withwho I have become in intimate encounters with my clients and myown life experiences.

Inside out and outside in

The therapist who works with couples solely from an interpersonal,systemic perspective pays attention to interactional and transactionalpatterns (Watzlawick and Weakland, 1977). She helps the couplebecome aware of their dance, the ways that they cue each other, andthe effects of this on themselves and their relationship. One mightdescribe this as ‘outside, outside’. Conversely, therapists with a strongintrapsychic model will relate what occurs between people to theirinternal world models, to the processes of projection and introjection.Box and her colleagues (Box et al., 1981) describe a model of workinganalytically with families, drawing on the powerful determinants ofearly experience to colour current struggles. In this sense, one mightthink of such a model as emphasizing ‘inside, inside’.

Attachment theory (Bowlby, 1998; Byng-Hall, 1991) provides animportant bridge between the inside and outside, and is part of aserious debate with the psychoanalytic world (Fonagy, 2001), while adultattachment is taken as the bedrock for psychodynamically informedcouples practice (Clulow, 2001). A recent issue of Family Process (2002,No. 3) addresses issues raised by attachment theory in terms of familysystems, and Akister and Reibstein (2004) and Mikulincer et al. (2002)discuss couple relationships in the context of attachment security and itsimplications for family dynamics. What I propose is a dynamic focus ofmoving between the ‘outside’ interpersonal systemic, to the ‘inside’internalized history, which is often not immediately available to theconscious, and of moving from those both public and intimate insidespaces out to those influences on the outside life of the couple. At this pointneither perspective is inherently more or less important. Rather, each

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contextualizes and informs the other, providing a richness thatneither can provide of itself.

A way of beginning to think about ‘outside in’ and ‘inside out’ maybe sensed in the different starting points for work with Tom andDoreen. They are a couple in their early fifties with long-standingsexual difficulties. When asked to talk to each other about their needs,each focused on their primary felt needs which are represented by thesolid arrows in Figure 1. The needs associated with the dotted linearrows feel they can be considered only after the individual’s primaryfelt needs have been met. For Doreen, the primary process is from theinside self, out. For Tom it is the reverse – from the outside self, in.There are important questions of gender, culture, family histories, aswell as previous (and early) experiences for each of them in relation totrust, intimacy and vulnerability that become their scripts (Byng-Hall,1995). Their respective internal world models are re-enacted indifferent ways in their married lives.

It may be argued that this represents a normal difference in whatwomen and men look for in intimate relationships. The implicationsfor the therapist are that she will need to hold the different internalmodels for Tom and Doreen, and simultaneously be able to under-stand and work with their repeating interpersonal relational patterns.If either begins to feel unheard or un-held for too long, the possibility

Tom

1

2

3

4

1. (Tom to Doreen) [Explicit] Meet my physical/sexual needs for love ( for my fulfilment)

2. (Doreen to Tom) [Explicit] Meet my emotional and psychological needs (for my ‘safety’)

3. (Tom to Doreen) [Implicit] How can I articulate oracknowledge my emotional side if I don’t feel loved?

4. (Doreen to Tom) [Implicit] How can I actualize my physical /sexualside if I don’t feel safe?

Doreen

Figure 1. Primary felt needs



of meeting both sets of needs will be jeopardized. Research consider-ing outcome in couples work found that shared couple agreement onratings of the alliance was predictive of good therapeutic outcome(Garfield, 2004).

Systemic thinking with couples

In systemic therapy, change is often believed to arise from particularstyles of questioning (Cecchin, 1987; Palazzoli et al., 1980; Penn, 1985;Tomm, 1987a, 1987b, 1988). The therapist attends primarily to therelational aspects of the couple’s experience as a way to their beliefsystems. She is attentive to the ‘spaces in between’, observing andworking with the couple’s patterns of interaction. This will frequentlybe connected to work with their communication patterns (Watzlawickand Weakland, 1977; Watzlawick et al., 1967). As couples begin to seehow they relate and the effects of their behaviours on each other, theygain the possibility of changing their patterns of behaviour. Thetherapist keeps herself out of the emotional force field by focusingon clients’ relational world, their beliefs about those relationships,how others may respond or what they may believe, as Jenkins andAsen (1992) have described in systemic work with individuals. How-ever, this does not take active account of the internal world(s) of theclient(s), the quality of the therapeutic relationship in the room or ofthe therapist’s own experiences. It is proposed here that to be whollysystemic, it is necessary to include the person’s ‘internal relationalsystem’, and to work with the interrelating intra- and interpersonallevels of experience.

The ‘archaeologist’: psychodynamic perspectives

Psychodynamic therapists attend to a different level of description.While systemic theories suggest a relational perspective, psycho-analytic theories offer ways to understand the mind, althoughFreud actually speaks of the ‘soul’ (die Seele). These two modelsprovide as many complementarities as opposites. Dare (1981,p. 288) suggests:

[The] family therapist intervenes on those external processes which arebeing internalised to become part of the crucial psychological make-upof the family members. The site of action of family therapy interventionsis thus the same as that of psychoanalytic psychotherapy but whereas

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psychoanalytic psychotherapy is directed towards the point at which theinternal world is being externalised, family therapy is directed towardsthe point at which the external world is becoming internalised.

Psychodynamic thinking lays special emphasis on early experiencesand the importance of past events in the individual’s life. ‘Even in theadult . . . the judgement of reality is never quite free from theinfluence of his internal world’ (Klein, 1959, p. 250). Klein goes onto say that ‘the relation to early figures keeps reappearing andproblems that remain unresolved in infancy or early childhood arerevived though in modified form’ (ibid., p. 258). We may speak of the‘emotional ledger’ (Boszormenyi-Nagy and Spark, 1973), or levels ofdifferentiation (Bowen, 1978b), or family myths (Ferreira, 1963), orfamily scripts (Byng-Hall, 1995). These unconscious realities haveimportant implications in the choice of life partner and the repetitivestruggles that may cause later pain and distress. They may alert thetherapist to problematic ways in which negative projective identifica-tion can interfere with the couple’s ability to relate openly to the realother. These same processes can affect their ability to engage intherapy. In this sense, psychodynamically oriented therapy empha-sizes the ‘spaces within’ the person and how that affects the subjectiveexperience of the therapist with the client (Casement, 1985; Malan,1979; Winnicott, 1949). The therapeutic relationship as an explicitvehicle for change is significantly different from systemic practice.Malan (1979) describes how a patient’s problematic relationship withsomeone in their current life may be linked to past circumstanceswhich are re-enacted – that is, are ‘transferred’ – in the therapy room.Therapy becomes the bridge between present and past relationshipsand may arouse similar processes in the therapist by particularities inthe client – that is, in the counter-transference – which is oftenpowerfully experienced by the therapist in couples therapy, and liableto become emotionally engulfed. Bowen (1978b, p. 468) consideredthis a serious issue in the training of family therapists:

I believe and teach that the family therapist usually has the verysame problems in his own family that are present in families hesees professionally, and that he has a responsibility to define himself inhis own family if he is to function adequately in his professional work. [Italicsadded]

The therapist working with couples thus needs to be aware of howeach person’s psychic structures function, how they develop and



resonate with the other over time outside the couple’s awareness, andthus become part of the relational dance. She must also be able to dealwith the possibility of her own material being activated, drawing herinto roles and responses which re-enact her own struggles and inhibitchange through her own counter-transference responses (Little,1951). Modifying slightly Dare’s observations, she needs to be com-fortable working at ‘the point [where] the internal world is beingexternalized . . . [and] . . . at the point [where] the external world isbecoming internalised’ (Dare, 1981, p. 288).

In couples work, the relational and intrapsychic spaces betweentherapist and client come to be imbued with powerful meaning. In hisseminal work, Dicks (1967) describes a model for encompassing theintra- and interpersonal worlds of the couple, further developed bythe work of the Tavistock Marital Studies Institute (Clulow, 2001). Thetherapist must contain the uncontainable, and create a safe holdingenvironment to explore the couple’s unconscious processes whiledrawing on her own experience and her intuitions of theirs, andmaintaining an appropriate differentiation of self (Bowen, 1978b) inrespect of the couple.

Schematically, psychodynamic and systemic perspectives are de-scribed in Figure 2. This diagram attempts to highlight some com-plementary differences between systemic and psychodynamicperspectives. The columns above and below the line indicate someof the difference of emphasis. Systemic perspectives are placed aboveand psychodynamic perspectives below the line. The therapist whowill embrace both perspectives needs to let theory sit lightly on hershoulders, both believing it enough, yet not too much. It becomes aquestion of doing therapy, not by the book, but by the patient(Casement, 1985).

Figure 2 represents the individual’s internal intrapsychic world,and his or her interpersonal relationships. In the couple, each personbrings his or her own internal world representations, attachments andways of dealing with others. Therapy with couples encompasses bothperspectives: their day-to-day experiences of each other, as well astheir belief systems, their inner worlds, their unique ways ofliving and reliving their early experiences and stories in their adultlives. The therapist must ‘hold’ the tensions of their intra- andinterpersonal realities as they interweave in their relationship witheach other and test the safety of the therapist (Clulow, 2001).At times, the testing is similar to an unspoken question: Can thetherapist be a good enough parent to contain in a safe way that which

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is experienced as uncontainable in the individual and at the level ofthe couple?

Gendered stories

One way to give meaning to what each person brings, having neverarticulated it as such before, is through gendered stories. These areboth in terms of how they are played out in the present, and aslegacies from the parents’ generation and before. Bowen would speakof differentiation of self: ‘people choose spouses . . . from those withequal levels of differentiation’ (Bowen, 1978b, p. 473). A way toaddress transgenerational patterns (Lieberman, 1979) is throughstories about men over generations in relation to men, and aboutwomen to women, as well as in relation to the opposite sex. This

Individual

Context defines meaning. Including culture, ethnicity, gender, family and individual life-cycle stages: intergenerational transmission processes.

Work directly with relationships

Work with hypothesizedinternalized relationships.

Object relationships, Attachment theory

Early experiences define meaning. Oral, anal, phallic phases; Primary/secondary process; Instinctual drives.

Interpersonal processes. Triangulation, coalitions, alliances, boundaries; communication [analogic, digital. symmetrical, complementary].

Individual whole as part of a larger system whole

Individual whole in terms of its [system] parts.

Intrapsychic mechanisms. Defences,resistances, sublimation, hidden impulses

Introjection/ projection denial, repression, splitting.

Causality. Relational, based on feedback,Circular.

Connections between: behaviours, feelings, meanings, beliefs.

Interpersonalrelationships

IntrapsychicstructuresSystems: Unconscious, Preconscious, Conscious. Id, ego, superego.

Causality. Early experiences played out in adult life relationships.Linear.

Figure 2. Psychodynamic and systemic perspectives



brings into focus how men relate intimately with women, ‘vertically’ asin child to parent, to grandparent, and ‘horizontally’ in peer, siblingand couple relationships, and similarly for women. This partlylinks to family-of-origin work (Framo, 1976, 1996), and I willoften suggest that each of the couple speaks to parent, grandparent,other relatives of the same sex, about their stories of beingmale/female, son/daughter, intimate or being valued, drawingimplicitly on a time-line perspective (Friedman et al., 1988). Onoccasion, this begins conversations between the individual and theparent (or grandparent or other important relative) of the samegender, opening up avenues of communication and relationshipthat are deeply moving to hear recounted, and healing in their effects.

Where earlier family members are dead, it is still possible towork with the internalized models, help discover new meaning andintroduce the possibility of developing new scripts. This was the casewith Joan. She was both seen with her husband and individually, andbegan to discover a new sense of self-worth, partly in response tocreating stories about different aspects of women’s survival overgenerations, each generation of women finding a different arena forsurviving in a hostile world. Importantly, this process linked herintolerable present to her past and projected her perspective into thenear future, bringing the possibility of new meaning and hope. This isshown in Figure 3. She confronted her husband’s refusal to takeresponsibility for his long-term denied infidelity and her previousfeelings of responsibility for the ‘functional death’ of her marriage.Drawing on her stories of women’s strength, she still mourned her‘lost years’, but celebrated her legacies to her adult daughters and thechanging stories about women’s survival. While remaining in themarriage, her story, or script, of being a victim with no voice (even herattempted suicide was not ‘heard’ by her husband) changed radically.Her pride in herself and her daughters is both impressive andmoving. Her husband’s scripts (Byng-Hall, 1988, 1995), not discussedhere, were of men disconnected from their emotions and feelings,with little sense of personal agency, nor of the lived experience ofwomen. His gendered stories included themes of emotionally dis-connected men and of confusing the denial of active hurt with being‘loyal and loving’ in the marriage.

While chronicling these different gendered stories over time,present, past and future, the connecting of this reflexive thread alsocollapses chronological time, chronos, into the present of new meaning,kairos.

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Time: present, past and future

Whether or not we pay it explicit attention, time in different guisesweaves its threads through therapy. Its meanings are an importantfactor in all approaches, however conceptualized (Boscolo and Ber-trando, 1993; Eisler, 2005; Jenkins, 2006; Palazzoli et al., 1978; Stern,2004). During therapy, as in couple relationships, time and times can beconfused and confusing. In the transference, the therapist is aware of

Nothing known

Youngest of fourteen children (one other girl). Welsh valleys. Remarkable girl; started smallholding to provide food to survive poverty.

To London at age 14 years. Could not read or write; in domestic service. Supported family in Wales. Made ‘dramatic strides from “shack” to owner-occupied house’.

Joan. Difficult marriage: did not feel strong enough to leave husband following long-term infidelity, for fear of jeopardizing daughters’ futures.

Daughters. Both daughters went to university and were successful in professional jobs.

Future generations of women?

Survival stories:

Physical survival

Material survival

Psychological survival

Professional survival

To survive ‘freedom’?

Figure 3. Gendered stories over generations



how the past becomes real in the present in the therapeutic hour; inmarriage, relationships are attributed elements that belong to otherpeople and to other times. In poetry, Dylan Thomas and T.S. Eliotaddress our relationships to time in quite different ways. Thomas(1963) rails: ‘Do not go gentle into that good night,/Old age should burnand rage at close of day;/Rage, rage against the dying of the light.’ Indifferent vein, Eliot (1935), writes: ‘Time present and time past/Are bothperhaps present in time future,/And time future contained in time past. . ./Time past and time future . . ./Point to one end, which is alwayspresent.’ Eliot plays with ways in which our present, past and futurebecome connected threads in one story. The interrelationships ofdifferent time dimensions are important in my practice. We think oftime that flies (tempus fugit), as the enemy, or that has to be filled, killedor found. This is chronos. The Greeks have two words for time: chronosand kairos. Chronos is time with beginning, middle and end. It is a linearconcept, is the origin of the word chronology, and is present in archives,museums, cemeteries, genograms and diaries. Dylan Thomas ragesagainst chronos, and ultimately it defeats him. Where chronos cannot beacknowledged, there is both denial of death and denial of growth withabdication of responsibility (Frankl, 1946/2004; Yalom, 1989). Kairosrelates to those instances of ‘flow’ where we are suspended almost ‘outof time’. It is not measurable; it is ontological, as in meeting aninteresting person, or the child at play, the musician lost in music, theperson at prayer. It is our ‘timeless time’ that we carry in ourselveswhere past and present touch and new meaning is created, always in thepresence of time future. Elements of this are captured by T.S. Eliot in‘Burnt Norton’, the first of The Four Quartets.

In her biographical and autobiographical account, Lynn Pan speaks‘of families proceeding to their destiny by walking in the direction oftheir origins; of a whole chain . . . . The present is only today’s version of thepast; You carry in you a history you may know little of ’ (Pan, 1992, pp.234–5, emphasis added). John Byng-Hall writes of ‘scripts’ and howthey can be played and replayed across generations, almost ‘time-lessly’ (Byng-Hall, 1988, 1995), while Bowen (1978a) would describehow levels of differentiation are replayed across generations. This isalso in a sense ‘psychoanalytic time’, where past connects with presentwithout reference to measurable chronos, and where in the analyticencounter the patient’s past is replayed in current relationships bothin and outside the therapeutic meeting. This is always against abackdrop of what might be the feared future, or one that could bedifferent.

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Whatever the issues, therapy begins in the present as the couple sitdown, yet they bring multiple gendered histories: individual, couple,those of parents and grandparents, their hopes or fears for the future,and in Lynn Pan’s words, ‘You carry in you a history you may knowlittle of.’ While each therapeutic encounter differs, I always hold inmind: ‘How does what is happening now for this couple relate to thevarious pasts here present?’ And: ‘how will these pasts need to beaddressed for them to envisage a different kind of future from the onethey most fear?’ This interrelationship and the process of enquiry arerepresented in Figure 4. The dynamic tension between present andpast then becomes part of the process of working towards a differentfuture than the one that is feared. The therapist moves between thecouple’s different interpersonal worlds and their respective families oforigin (the ‘outsides’), and the internalized, sometimes forgotten ornon-conscious worlds of each partner (the ‘insides’).

In the process of the session, ‘letting myself go’ with my ownreveries as part of touching what might be the couple’s reveries allowsme to imagine and experience their realities. At the start of this articleI described the powerful urge to hug David. I had first to let myself goenough to sense how he might be feeling to ‘know’ what he needed atthat moment, and then to articulate it in a way that resonated with hisunspoken timeless need. This emotional stance helps connect the T.S.Eliot timelessness of past and present as a step towards what may bedifferent now, and to envisage an alternative future to the one feared.

Present

Past

Future

Time

Figure 4. Times present, past and future



For David, the fear was of personal breakdown, and as a couple, theirretrievable ending of a marriage.

From behaviours or situations to beliefs

However useful these ideas may be, some kind of unifying theme isneeded to connect and hold them. We have noted something aboutthe ‘spaces between’ and the ‘spaces within’. Time and how we thinkabout and experience it are important, as are our stories, influencedby our gender, culture, race and many other elements of experience.Even the therapist’s ‘intuitive’ use of self with David has beenmentioned, and what followed next will be addressed in the finalsection of this article. But first, something is needed to hold thistogether, however lightly. The following is a framework that I bothbear in mind to work implicitly with it in therapy, and sometimes useexplicitly with couples, either in-session or as a homework task. This isrepresented in Figure 5.

The focus is, first, to choose an event, situation or behaviour thatboth agree as having occurred. Each person is then invited to identifyone or more emotions associated with this situation. By this is meant afeeling or feelings that are in ‘the public domain’ and are expressedopenly in relation to the other and to the event. These are shared and

Events, situation, behaviours

Emotions

Feelings

Meanings

Beliefs

G O V E R N

I N F L U E N C E

Figure 5. From events to beliefs: Levels of influence in human relationships

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their differences or similarities reflected upon. Then the same is donewith respect to feelings, feelings in the sense of being subjective,private, and often not expressed openly to the other and perhapsnot even to oneself (Damasio, 2000b). This is suggested in the contextthat expressed emotions often mask or protect feelings of vulner-ability, hurt, helplessness, fear, or other feelings that could not beshared safely within the relationship then. They may be at variancewith emotions expressed such as anger, aggression or depression. Inessence, emotions as I propose them often mask feelings of vulner-ability, fear, insecurity or fragility. This is discussed elsewhere byGoldner et al. (1990) in work with violence in couple relationships.Next, each of the couple is asked to say what are the meanings relatedto the above. As human beings we seek constantly to give meaning orto make sense of our experiences, and of what is happening aroundus. All this remains in the context of feelings and emotions about thesituation. Finally, both are asked to identify their belief(s) about thesituation, and more generalized beliefs about their relationship, trust,intimacy, how things should work out and so on. These are beliefs inthe sense of the operating system of a computer that one cannot see,but is there and determines what the computer can ‘make sense of ’.Beliefs and meanings are related, but different. As is shown in Figure5, repeated behaviours may influence another’s beliefs about them,and about the nature of their relationship, while beliefs will governbehaviour(s) that will affect emotions, feelings and the meaningsascribed. Beliefs, being often out of immediate awareness, reside ata non-conscious and unarticulated level much of the time.

One of the values of this schema is that it provides a model forbeginning to make sense of ‘not understanding’. What becomes clear ishow one spouse may be talking about how they feel inside (sad,vulnerable, not valued) while the other is pursuing a course of tryingto understand the meaning of all this – the ‘why’ and ‘how’. Or it may bethat while one is questioning the basis of their relationship – their beliefs,the other just wants to express how angry they are – their emotions.Neither is wrong, but each is pursuing their understanding, and theseunderstandings miss, thereby creating a true mis-understanding. All levelsneed to be addressed, but in a way that both parties are aware of whichone is being dealt with at the time. What this simple process addressesis: what is happening between the couple, the relational; their internalworlds of experience – ‘public’ and ‘private’ – and the meanings,followed by their beliefs. In this way they begin to address theirconstructions of realities based both on current time and internalized



time, that timeless time which is handed down from generation togeneration, influenced by their gendered, cultural stories.

The powerful experiencing of this simple outline in the session withthe therapist to guide and help contain can give confidence toexperiment (first of all with something non-contentious) as a home-based assignment. In a sense, whether with the therapist not actuallynaming the process as such, or as an explicit exercise, the couple havethe experience of socially (re)constructing the meaning(s) of theirrelationship (Gergen, 1999).

Invisible contracts: a pact to disappoint

The mix of unarticulated and confused emotions, feelings, meaningsand beliefs goes back frequently to the start of the relationship, andthe ‘unconscious’ mapping and matching that occurs as couples cometogether. Dicks describes this well: ‘Subjects may persecute in theirspouses tendencies which originally caused attraction, the partnerhaving been unconsciously perceived as a symbol of ‘‘lost’’ becauserepressed aspects of the subject’s own personality’ (Dicks, 1967, p. 63).Later in the relationship, whether soon or after decades, a sense ofdisappointment infuses the relationship as though there were someperverse form of talisman at work. ‘‘This is not how it was meant to be’’permeates their silent discourse. This may be acted out throughemotional or physical absence, abuse, affairs, misuse of alcohol,reckless spending, arguments – the ‘currency’ of the expression ofdisappointment is as varied as the ways in which two people cancommunicate with each other, but is often related to previous familyscripts and internal world models.

Couples often need something that feels tangible enough as aconcept that may be grasped to make sense of their relational pain.Sometimes in the session, and sometimes as a piece of homework (tobe carried out privately), I ask the couple each to imagine the invisiblecontract on the back of their marriage certificate, or their ‘virtualcertificate’ if it is a cohabitation. Of course, the reverse of a realmarriage certificate is blank, hence the invisibility of their ‘contract’. Iask them each to think along the following lines: ‘What was it that theother was meant to provide for you? How was the other going to‘‘heal’’ you? What was the other supposed to ‘‘be’’ that would help youfeel better about yourself? What did you not like about yourself thatthe other would carry, and that you could then criticize or be angryabout?’ The questions are both general in order to evoke freer

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thinking, and specific to their particular circumstances, to challengetheir personal beliefs. I always emphasize that the questions are thereto facilitate and not prescribe.

The rationale I give for asking this is that often the other person isnot aware of the ‘invisible contract’, and therefore of the expectationslaid upon them. I will add that we as individuals in our relationshipsare also not always aware of what are the questions we are asking ofthe other, and the roles that we have prepared for the other and forourselves. At this stage, I speak intentionally in terms of ‘we’ toemphasize the normality of these processes, and that this does notrelate to some kind of psychopathology. It is important to avoid, ifpossible, attributions of blame.

Sometimes the invisible contract is presented in a starkly simpleway, although with far-reaching implications. For one couple, Ben andKate, his contractual expectation was ‘To be first’. In and of itself thatneed not be a problem, providing his partner’s contract would fit.However, for Kate it was for him ‘To be a good father’, which with twodaughters now put him third in line. This is equally reasonable, butwith such varying expectations they were destined for mutual dis-appointment without any sense of why this should be so. The processof revealing the incompatible expectations relieved the pressure, andopened up possibilities for ways that both sets of needs could beacknowledged and possibly met. Family-of-origin deaths in the Ho-locaust for Ben contrasted with familial stability in Kate’s helped makesome sense of why each might choose those contractual needs fromtheir partner. For example, in a subsequent session, Ben tried toarticulate his needs, which Kate identified as his ‘neediness’. Ben saidthat Kate should always laugh at his jokes, even though she had heardthem before and did not find them funny. Painfully, the theme ofneeding to be affirmed and feel valued developed. Ben needed toknow that Kate would always affirm him, and to that end herepeatedly demanded her affirmation. His fragile sense of himselfand absolute need for certainty linked to his father’s family’s history ofextermination in the Nazi death camps in Poland, the most extremeopposite possible of affirmation. The more Ben demanded affirma-tion, the more Kate felt she could not give it, and felt herself losingcontrol and meaning. At the same time, the more he demanded, theless sure he was if the affirmation really was real, and so he demandedyet more. When asked: ‘What is the fear about not asking foraffirmation?’ it was that Kate might never give it to him. And whenasked: ‘What would happen if he did not ask and she did not give him



affirmation immediately or within a short time?’, he said it would bebetter to split up now than endure the intolerability of not knowing ifor when he would receive any. With careful probing, we began to seethe powerful explicit emotions, his hidden terror and fear (feelings),the meaning of not having constant reaffirmation of his sense of self,and his beliefs about ultimate inevitable catastrophe and emotionalannihilation.

If we return to David and Wyn who were introduced at the start ofthis article, we discover a different complex process. For David theinvisible contract was for Wyn always to be perfect in all things, makehim feel whole, and contain his bad feelings about himself. [But as partof his script, she could not be perfect because he was not good enough to deservesomeone who was perfect.] Wyn’s contracting was for David to accept herexactly as she is, and not see her sense of no self-worth, which was sostrong that she only told David of the abuse she had suffered in herfamily after thirty years of marriage. [But for Wyn, if he accepted her justas she was, there would be something wrong with him for not seeing that she wasunworthy.] The outcome of this invisible dynamic becomes that Wynwill always ‘fail’ David – no one is wholly perfect, and David will always‘fail’ Wyn, as he cannot ignore her failings or accept her as she is whenshe fails to be perfect for him. Both brought their internal worldmodels from their family-of-origin relationships where they do notfeel affirmed or valued for who they are. They try to ‘earn’ affirmationbut can never do enough within this set of belief systems. This, then,within their invisible contracts with each other, has become theirthirty-five-year pact to disappoint.

What this approach and task help address are the non-consciousprocesses that in part govern the living of relationships. It also helpsthe couple to become aware of the relationship of their ‘spaces inbetween’ with the worlds of their ‘spaces within’. It helps track theirstories over time, beginning to make sense of their struggles and senseof disappointment or despair. Importantly, it also helps them to seethe mutuality of disappointment, that both are in this together, andsometimes that expectations were unrealistically high, or part ofothers’ scripts.

Ending: self of the therapist in therapy

Central to my beliefs about therapy is the nature of the encounterbetween those who I see and myself. David’s response to me sayingthat were I his father I would want to hug him could scarcely have

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been more personal, and yet I could not be, or replace, or representhis father who had been dead for forty years. As well as being atherapist, I am also a son, husband, brother and father (but mentionnone). At another time it might have been useful to share some degreeof self-disclosure, but this must always be done with care (Roberts,2005; Yalom, 2002). I engaged in my private internal dialogue, my‘trial identification’ imagining the possible impact of personal sharing,but decided against it at that moment (Casement, 1985; Rober, 1999).What I do is support David to talk about his father as never before,and this allowed Wyn to say that this vulnerable, tearful man is a manwho she can love and respect. At the end of that session I said I wouldask him to do something very difficult if he agreed to come back,which he did. This was to write a letter to his father, telling him all thethings he had never been able to say or share; to ask him the questionsthat could never before be articulated; to share the loss he has alwaysavoided. In the next session, an individual one, he read the letteraloud to his long dead and lost father, and through this began aprocess of regaining his own lost self, but now, with a wife, he nolonger needed to terrify with his raging. Forty years was a long time towait for this. What also occurred was that David subsequently sharedthat in the reading aloud of the letter, and a subsequent privaterereading, he experienced the feel of his father’s unshaven cheek onhis at the end of the day when he would come home from work andkiss him, and the smell of the factory and tobacco on his coat. It seemsthat this re-creating of a sense of immediacy and intimacy hadtouched all his senses. In addition, through this he became awarefor the first time of the highly critical role his mother had played in hisparents’ marriage and in his own life, and how he attributed much ofthis to Wyn.

As we engage with our clients, we enter different worlds. We shouldnot make it appear that we only emphasize their interpersonalpatterns, the systemic elements, or that we follow the traditionalpsychodynamic route of early experience and a deficit or early traumamodel that has to be worked out directly in the therapeutic relation-ship. The title of this article proposes a false dichotomy: inside out oroutside in. It should rather be: inside out and outside in. The processneeds to weave from the internal world representations out to theinterpersonal realities, and from the outside of people and theirdealings with each other, back inside to those felt experiences andtheir maps or scripts. To be truly ‘systemic’ means to hold – sometimesin dynamic tension – these two broad perspectives, and be able to



move seamlessly between them. What this also means for us is that wecannot stand outside. In our minds we may, and must, be able to holdthat professional objectivity and neutrality, but in our encounteringthere will be personal and emotional risking. Yalom (1989, p. 14)summarizes this well:

We psychotherapists simply cannot cluck with sympathy and exhort pa-tients to struggle resolutely with their problems. We cannot say to them youand your problems. Instead, we must speak of us and our problems, becauseour life, our existence, will always be riveted to death, love to loss, freedomto fear, and growth to separation. We are, all of us, in this together.

I have attempted to reflect something of my methods in working withcouples. My practice includes couples seemingly at the end of their livestogether, of feeling that life cannot be faced any more, as well as those indifferent stages of uncertainty about their futures. The methodsdescribed are bedded in clear psychological frameworks for under-standing relationships and mind, in the belief that there is no all-encompassing model. I might like to think that change comes from therobustness of these therapeutic models, but I doubt it more and more.

I have attempted to address this dilemma, the personal self and theprofessional being, in an article entitled: ‘‘‘Je n’ai que moi’’: le temps etl’espace therapeutique dans le trajet personnel du therapeute’ (Jen-kins, 2006). But of course there is a certain hubris in the title: ‘I havebut myself ’, and it is more than that. It is somehow about holding thecentre of calm while remaining totally engaged, sensing my changingheartbeat in the emotional (and verbal) storms of anger and despair.The personal encounter is not enough. There needs to be a mix whichfor each therapist is their unique mix of theory, methods, and theintangibles of what we bring of ourselves to those encounters thatallows for the possibility of healing and change. This is the subject ofanother article in preparation. Others have already addressed theseissues from their perspectives (Kottler, 2003; McGoldrick, 1982;Roberts, 2005), and ultimately, it is always from our personal per-spective. To reprise and rephrase Jung, we need both adequatetherapeutic methods and an adequate, embracing theory that willhelp contain our flawed selves as healers for others.

Acknowledgements

With thanks to Joanne Warren for comments on earlier drafts of thisarticle, to the couples who allowed me to write about them with

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changed names and identifying information, and to Chris Dare for hishelp over the years in opening up my understanding of insides andoutsides. All responsibility for any confusion is my own.

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