Psychoanalysis Needs Marital and Family Therapy

Psychoanalysis began 100 years ago as a revolutionary movement that challenged the two-dimensional pre-Freudian psychiatric world. In light of managed care and the psychopharmacologic revolution, it seems that we are returning full circle to that earlier era. In the first half of this century, psychoanalysis changed the very landscape of how the nature of man is viewed. While external historical factors play a significant role in the current decline of psychoanalysis, there are also internal reasons. I shall mention only one of them here.

The exclusive focus on the one-to-one analytic situation is a major factor. The shift to a “two person” psychology notwithstanding, analytic institutes, wary of alloying the pure gold of analysis, have failed to adapt to changing historical circumstances. How is it that the most comprehensive general theory of the mind is applicable to so few patients? The number of analyzable patients, realistically, is quite small. Yet, transference and unconscious conflicts are ubiquitous.

In 1917 Freud compared psychoanalysis to a surgical procedure and asked how such operations could succeed “in the presence of all the members of the patient’s family, who would stick their noses into the field of operation and exclaim aloud at every incision” (Standard. Edition of The Complete Psychological Works of Sigmund Freud 16: p. 459). Such boundary violations are part of the family’s transference-countertransference repetitive pattern of interaction usually involving shared unconscious fantasies. (See my chapter, “Marital Conflict and Psychoanalytic Therapy,” in R. Liebert and J. Oldham, eds., The Middle Years: New Psychoanalytic Perspectives, 1989.)

Such externalizing behavior can be interpreted in the context of conjoint treatment. Though Freud was skeptical about involving family members, a year later he observed that “unhappy marriage and physical infirmity are the two things that most often supersede a neurosis. They satisfy, in particular, the sense of guilt and the resultant need for punishment which makes so many patients cling so fast to their neuroses. By a foolish choice in marriage they punish themselves” (Standard Edition 17: p. 163). During the past half century our society has responded to the epidemic of marital instability through the emergence of tens of thousands of couple and marital therapists with no training in analytic theory. Meanwhile, psychoanalysts wonder where all the patients are!

Over 20 years ago I explored the potential of integrating psychoanalysis with family treatment through the study of five classical plays and a review of analytic contributions to understanding family dynamics (Individual and Family Therapy: Toward an Integration, 1979). Recently, I developed a fuller integration of theory and practice in my chapter, “Psychoanalytic Couple Theory,” in Frank M. Dattilio, ed., Case Studies in Couple and Family Therapy (1998).

Instead of building on our finely honed classical psychoanalytic technique by applying it more generally to marriage and the family, we have been as fixated on the past as our individual patients often are. We may need to apply our theory to our own group behavior to help deal adequately with current sociohistorical realities.

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