Interpretation in Couple and Family Psychoanalysis: Cross-cultural perspectives. (2019)

This book, edited by Timothy Keogh and Elizabeth Palacios, is in the Library of Couple and Family Psychoanalysis series. It is a collection of conference proceedings from the IPA Couple and Family Psychoanalysis Committee Conference hosted by the Madrid Psychoanalytic Association in 2017.

I recently referred a couple living in Greece for analytic couple psychotherapy. *Emma, the wife, was English born, and Stavros, the husband, was Greek. There were noticeable cultural differences between them. Emma keenly felt the impact of the Covid-related lockdowns and missed her family in England terribly, whilst the couple frequently saw Stavros’ family in Ithica. This referral raised potential issues in working with couples from cultures other than white Anglo-Saxon cultures. These differences might play out in how we use interpretation in analytic couple work, so I was eager to read and review a book on cross-cultural perspectives in interpretation with couples and families. The impact of culture on a person’s internal world interests me greatly.

Let me put my cards on the table from the outset. The book’s title suggests two important lenses to view couple and family analytic work, interpretation and cross-cultural perspectives. So, I expected this book to be about interpretation in couple and family analytic work and I was not disappointed with this lens. I also expected the book to convey something of the effect of history and culture on the internal worlds of the clients and how this impacts the analytic work. I wanted to review this book because I believe culture and its impact on a person’s internal world are very important. I was disappointed because this was not adequately addressed in any of the papers or responses. Perhaps my wish for a cultural lens may have been my misguided interpretation of the title.

Only one of the papers went anywhere near touching on the importance of the client’s culture. This paper by Monica Vorcheimer was about her work with a family with two warring Argentinian brothers: Vorcheimer uses the metaphor that this family supports the current government but at the same time wants it to change.

So now let us turn to what this book does look at in some depth – Interpretation. Bolognini, writes in the IJPA:

The interpretive function in psychoanalysis cannot really be carried out without a partial experiential immersion in the patient’s inner world. Bolognini (2002).

As I read on I was keen to observe how the authors immerse themselves in their clients’ internal worlds and how this relates to the interpretations made.

To adequately represent all chapters in this book is impossible, so I shall give the reader a brief overview and mention a few of the papers that I enjoyed. The book is in three parts.

Part I explores the concept of interpretation from the perspectives of therapists from Australia, South America, North America, Britain, and Europe.

Part II examines how we can employ interpretation in working psychoanalytically with couples.

Part III focuses on how we apply interpretation in analytic work with families. Discussants provide a productive commentary following each paper, allowing the reader to engage with each author and discussant’s perspectives more deeply.

Christopher Clulow, the book series editor, writes a thoughtful foreword. He reminds us that interpretations can be mutative for all participants when partners and family members listen to and hear each other as “other” in the presence of a containing therapist. Interpretations can also be mutative by creating insight. That is, by formulating new ways of seeing things to ameliorate unhelpful dynamics. Misrepresentations of circumstances can shift by shedding light on and challenging unconsciously prescribed rules, roles and beliefs. These misunderstandings are fuelled by the couple or family’s unprocessed, highly anxiety-provoking archetypal internal world representations of themselves in relationship with the other(s).

The two theoretical threads throughout the chapters are first Object Relations Kleinian and post Kleinian theory which connects the intrapsychic and the interpersonal.The second thread is Link Theory. This theory allows us to observe the impact of the intersubjective and socio-cultural influences on a person’s psyche in relation to others.

In their introduction to Part I, Palacio and Keogh point out that interpretation in couple and family work is far more complex than with individuals because it shines a light on the unconscious internal object-relational dynamic that we call the unconscious couple relationship. They remind us that children’s play often reflects the dysfunctional family dynamics in family analytic work.

The different chapters evocatively and poignantly described the struggles of the couple, families and their therapists.

In the chapter “Approaches to Interpretation with Couples and Families” the authors look at several different approaches to interpretation in individual, couple, and family work. Elizabeth Palacios represents the European perspective towards interpretation and compares the British and American approaches to the French and Latin American approaches. Mary Morgan represents the British perspective, David Scharff and Jill Savege Scharff represent the North American perspective, Janine Puget the South American perspective, and Timothy Keogh the Australasian perspective. Apart from mentioning the importance of language in making interpretations in the South American context, there did not appear to be that much difference in the authors’ approaches to making interpretations in analytic couple and family work. What is present is a discussion about psychoanalytic culture and how this shapes theory, however, what is disappointingly absent is the cultural background of the clients and its influence on the client’s internal world and how this impacts and informs the analytic work.

Mary Morgan’s chapter entitled “Complex and Creative” is a well written paper about the complexities involved in interpretation in couple work and the importance of modelling and developing a “couple state of mind” with the couple. The author elaborates on what can go wrong in making an interpretation to a couple.

I found the chapter by Pedro Gil Corbacho and Carmen Monedero Mateo “Demand Analysis” very interesting. The authors have devised a novel way of working with couples who bring very primitive and challenging dynamics. They see the couple for a 90-minute session with a series of breaks. During the breaks, the co-therapists take time out to discuss and process the couple’s primitive projections and the projective system between the therapists and the couple and then return and share this with the couple.

In “Links to the Past and to Wider Social Issues in a Family Assessment”. Jill Savege Scharff and David Scharff work as co-therapists and show elegantly how they use link theory in the family assessment.

Monica Vorcheimer chapter “Interpretation and Family Psychoanalysis” was the only paper that made any use of the cultural milieu in the analytic work. Vorcheimer explores some family work with two warring Argentinian brothers: a 17-year-old son named Lorenzo and his 19-year-old brother Sergio. Vorcheimer uses the metaphor that this family supports the current government but at the same time wants it to change. In Attention and Interpretation, Bion states that interpretations are neither right nor wrong but must be significant and true for the people involved. The author ends by saying that interpretation is a privileged tool that not only helps patients understand themselves but at the same time allows the analyst to place himself at the best point in terms of therapeutic temperature and distance,

This positioning is a helpful way of thinking about how the therapist can use her own interpretations.

In the introduction, Christopher Clulow states that:

As therapists, we must engage our patients with different socio-cultural lenses than our own and to this end we must be open to learning from our patients.

This book is about how therapists from different countries use interpretation in couple and family work according to where they trained and worked. I would have liked to learn more about the impact of the therapist’s cultural background and the family and couple’s cultural background on the therapist’s interpretations. I was particularly interested in hearing more from the authors about how they shaped interpretations according to the language and culture of the couples and families they saw. Unfortunately, there is no comment on how interpretation changes with

different socio-cultural sensitivities. As a result, while we hear about slightly different psychoanalytic cultural traditions and family-of-origin factors, the conference papers did not sufficiently address different socio-cultural lenses. I would have also liked to learn more about the impact of timely and resonant interpretations on the bodies as well as the psyches of the clients. The French-Swiss psychoanalyst Danielle Quinodoz writes:

I define a language that touches as one that does not confine itself to imparting thoughts verbally…..If the words I pronounce as an analyst awaken, or re-awakens, bodily fantasies in the patient, these words may enable him to find an emotional meaning in forgotten sensory or bodily experiences, which may then become a starting point for his work of thinking and of symbolisation. Quinodoz (2003)

Overall, I found this book to be a valuable collection of papers describing deep and rich clinical work and exploring the theories underlying different types of interpretation and the clinical implementation of these ideas in couple and family work. The book provides the analytic couple and family clinician with plenty of ideas to think about and explore further in their own work. However, for this reviewer’s part, I look forward to reading a book on how the client’s cultural background impacts their internal worlds and how to work with this analytically; but this is for another time.

References:
Bolognini, S. (2002) The Analyst at Work. Two Sessions with Alba. 83, 753-759 The International Journal of Psychoanalysis Freud, S. (1899) The Interpretation of Dreams SE Vol. … p.534

Quinodoz (2003) Words that Touch. A Psychoanalyst Learns to Speak. Translated P. Slotkin. Karnac Books London.

Reviewer: Dr Susan Oliver PPAA, ANZSJA.
Please note: The names and details about the couple described in the introduction of the book review have been changed to protect their confidentiality.