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Fam Proc 25:35-42 , 1986
A Systemic Approach to Couple Therapy MONY ELKAÏM, M.D.a aDirector of the Institute for the Study of Family and Human Systems, Square des Nations 5, 1050 Brussels, Belgium; and Editor of the
journal Cahiers Critiqu Critiques es de Thérapie Thérapie Familia Familiale le et de de Pratiques Pratiques de Réseaux. Réseaux. This article presents a model of couple therapy based on the reciprocal double bind. Two cases are presented to illustrate the model, and different modes of intervention are described. This paper stresses that therapy has more to do with the intersection of the maps of the world of members of a system than it has with a search for some individual or systemic truth.
My purpose in this article is to provide couple therapists with a simple set of tools for analysis and intervention. The model I propose stresses the reciprocal double binds that develop between the members of a couple and the use made of them by the therapist, both in analysis and intervention. This helps to reframe as "protective" precisely the behavior that each member of the couple reproaches his or her partner for and to create paradoxical tasks, which may include the couple's families of origin. This model may be aligned with others that also deal with reciprocity in some specific behaviors of the members of a couple (see 1, 2, 3, 6, 9, 10).
An Example Anna is Dutch. Benedetto is Italian. She complains about his suspicious attitude and says that he constantly follows her and spies on her. There is no affection between them, she says, as they are overly susceptible to falling into "aggressions." He describes himself as isolated, lacking tenderness in his relationship with her. He is convinced that she is always creating coalitions with his friends against him. He complains that she speaks Dutch, a language he does not understand, to their child and to her friends in long telephone conversations. In the course of the third session, however, she voices another complaint: "He has changed a lot and in the direction I have always wanted. But now, I feel unable to cope with this wave of affection. That makes me feel sad and guilty." This type of reaction highlights the nature of the multiple cycles in which this couple is imprisoned. A Model I will offer this example as the basis for a model that provides a means of structuring a line of interventions in couple therapy. We use the term "official program" to describe the explicit request of each member of the couple for a change in the behavior behavior of the other other member. member. In addition, addition, we term "map "map of the world" world" the the blueprint blueprint that that each member of of the couple has drawn up in the course of his or her past and then attempts to use in the present situation. This notion derives from Alfred Korzybski's work pointing out the importance of the difference between map and territory (7). Our assumption in this particular case is that Anna's map of the world is in contradiction with the official program. The hypothesis we start from is that this woman is enmeshed in a double bind she she wants her husband to stop behaving in a way that leaves her no choice other than to reject him, and neither can she accept his being closer to her. In order to test this hypothesis, we explore her history and discover that she was extremely close to her father, who favored her over his other offspring. She wept at great length when talking about an evening just before Christmas when she was 4 years old and waited in vain for her father. He had been arrested, and her mother concealed this from her. During the session she said, "I felt terribly abandoned. I am convinced that it will always be that way, that friendship or love don't last." Benedetto added at that moment, "One day, she told me, you will not come back." This type of situation is often encountered in couple therapy. Members of a couple are torn by the contradiction between these two levels of expectation. If they live alone, they are both prisoners and jailers. If they meet someone else who, for his or her own reasons, is ready to develop a form of behavior corresponding to the member's map of the world, they are then only a prisoner and the other is the jailer. The couple's conflict offers a means of placing an internal contradiction at a distance from oneself by experiencing one level of the double bind as imposed from outside. At this stage of our analysis we begin to explore Benedetto's map of the world. We discover that he was placed with his grandparents when he was three weeks old and stayed with them until he was 12, at which time he returned to his parents. He said that "it was terrible to be torn away" from his grandfather and his friends and that during the first year after his return to his parents he would weep every night. His father called him "good-for-nothing" and was frequently brutal to him. Later on, he said that he was told by a psychiatrist that he was "suffering from a persecution complex." Finally, talking about the separation from his grandfather, he added, "I am afraid of being let down, I am afraid of becoming attached."
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Once again we find ourselves confronted with someone whose official program is at variance with his map of the world. He craves tenderness but fears attachment. He criticizes his wife for excluding him, but how could it be otherwise given his previous experience? In addition, if he could gain recognition despite all obstacles, he would then only contemplate being abandoned. Anna tells Benedetto, "I want you to be close to me." However, if Benedetto comes closer, he is following Anna's official program but not her map of the world. She can therefore only refuse that closeness. If Benedetto acts in a way that takes him away from her, he is following Anna's map of the world but not her official program. She can only suffer and urge him to come closer. In turn, Benedetto asks Anna, "I want to be recognized." However, if Anna stops excluding him, she is following Benedetto's official program but not his map of the world. He can therefore only refuse that relationship. If Anna recreates coalitions against him, she is following Benedetto's map of the world but not his official program. He can only suffer from this and urge her to recognize him. This reciprocal double bind in which the members of the system are locked explains the perpetual-movement aspect that is well known to couple therapists. These elements can be diagrammed, as in Figure 1. This diagram brings out two important aspects. It shows the double bind in which each member of the couple is locked; whatever the reply, it will fail to take into account the other level of demand. It also shows that, although the behavior of a member of the couple is connected to his or her own past, it is also bound up with the map of the world of the other member of the couple, thus helping each to sculpt his or her behavior in such a way as to protect the other's deep-seated beliefs.
Figure 1. Reciprocal Double Blind By the time the couple consulted me, they were no longer only two people unable to break away from a double bind, caught in a revolving door of mutual reproachment, each convinced the other was the cause of this movement that was making them dizzy. In fact, their behavior was governed by a rigid set of rules and cycles they helped set up by the perception they had of their situation. It does not take the therapist long to become engulfed by a therapeutic system in which the rules governing the couple tend to extend to the triadic system. Additionally, there is not only one cycle, as described in Figure 1, but several, and in the course of marital therapy the therapist comes up against one cycle after the other, whether the particular cycle is an old one or a new one arising as a result of a change. Finally, a couple does not live separately from their context. The most influential context is usually that of the members of the family of origin, and these relationships between the members of the couple and their own families constitute other loops of steady interactions connected to, and affecting, the couple's cycles described above.
Modes of Intervention Positive Reframing Accompanied by a Paradoxical Commentary
In couple therapies, one way of generating nonequilibrium in the system (4, 5) is to reframe positively those forms of 2
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behavior that both members of the couple reproach one another for and to accompany this reframing with paradoxical commentary. The therapist may introduce a reframe by commenting that the behavior of each member of the couple "protects" the deep-seated convictions of the other. This creates a therapeutic double bind preventing the maintenance of the cycle involved. Indeed, if the behavior one partner reproaches the other for is reframed as "protective" and explicitly elicits the map of the world that she or he was trying to place at a distance, then she or he can only attempt to interrupt the cycle leading to that form of behavior under pain of accepting that it is indeed needed. Moreover, if each partner can accept that it is possible that the other's behavior helps to avoid confrontation with one of her or his innermost convictions, it then becomes extremely difficult for either of them to consider as aggressive a form of behavior we then look upon as protective. Sometimes I present myself as so significantly touched by the extraordinary beauty and subtlety of the architectural edifice constructed by the couple that I cannot but admire the manner so painful and yet unique, so altruistic and original, by which they prove their love to one another. I then offer to limit myself to helping them to live out this gift so rare, this mutual sacrifice, this selfless love, without suffering too much but without changing it. The members of the couple then find themselves confronted with a therapist about whom they are unsure. They wonder if the therapist is speaking earnestly or whether she or he, despite all obstacles, is trying to bring about a change. I am no longer situated at the level of the official program or the map of the world of each member of the couple but at both levels at the same time. I find this all the easier, as it is not really an "artifice" that is involved and as I myself do not know whether, fascinated by the beauty of their common achievement, I do not prefer to respect their equilibrium and merely help them to remain as they are without too much suffering. This type of work, which others call "tongue-in-cheek," makes it possible to avoid the infernal yo-yo movement one is condemned to assume when responding to a single level of the double bind. Here, as elsewhere, humor and warmth permit the emergence of an entirely new relationship at the level of the therapeutic system. The couple are led to create other feedback loops that are neither "better" nor "worse" than the previous ones but different from them. If the therapist chooses to do so, she or he will need to make use of herself or himself once again to help the couple's system gradually achieve such a state of flexibility as to be able to exist independently of the therapist. Concerning this type of intervention I find it important to specify that, in my view, what happens in therapy has, above all, to do with the way in which the members of the therapeutic system construct reality. A successful intervention does not necessarily mean that the underlying hypothesis is bound up with the "truth." It merely means that the way in which the members of the couple and the therapist construct reality may have intersected. For this intervention to be possible, the psychotherapist must explore the couple's map of the world in sufficient depth as to be able to understand the rules of the mutual double bind that governs the system. It is also necessary that the paradoxical commentary proposed be sufficiently close to the way in which the members of the couple construct reality so as not to be rejected and sufficiently removed as to be able, through the surprising aspect of the paradox, to open up new prospects. From the Rules of the Couple's System to the Rules of the Therapeutic System
From the outset of the therapy the therapist finds himself in a situation in which the rules of the couple relationship seem to be continually expanding to the therapeutic system. Thus, in the case described above, the members of the couple systematically recreate with the therapist the relations existing between them. For example, Anna and Benedetto decided on a meeting place before coming to the session together. Anna waited for Benedetto in vain and then came alone and asked for a consultation insisting that she did not want to miss a session because of her husband. If the therapist falls in with such a request, he widens the rules of the couple to the therapeutic system by recreating with Anna a coalition that will place Benedetto at a distance from her and by confirming with Benedetto that he will always be rejected. What we have witnessed is a process in which Benedetto, by going to the wrong meeting place (as I was to learn later), and Anna, in demanding to see me without him present, act without realizing it, as if they were trying to disqualify the therapeutic context by applying to it their couple rules. By a process of trial and error, the couple's system evolves in such a way that certain cycles of the couple's behavior are linked to elements of the therapist's map of the world so that his reactions, although different from those of the members of the couple, can maintain the preexisting cycle or create a cycle of the same type. What we then get is a therapeutic system that is apparently different from the couple's system but in which "plus ça change" at one level "plus c'est la même chose" at another. In this context, the fact that the therapist is careful to avoid being governed by the rules of the couple and that the cycles he creates remain flexible, allows the therapeutic system to make new relationships possible and open up new alternatives. Paradoxical Tasks
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To illustrate another situation of mutual double bind, a couple whose members are closely linked to their families will be briefly described. Nathalie reproaches Marco for placing restrictions on her freedom even in the smallest matters. She spoke of a birthday present she gave to Marco that he made her take back because he considered it too expensive. Marco criticizes his wife for behaving irresponsibly. The children are never ready on time for him to take to school, which is constantly creating problems for him with his employer. The household budget is badly managed, and he has to keep a constant eye on the expenditure of money, and so on. After their rows the one who feels attacked by the other's behavior goes back to his or her parents. After speaking to both members of the couple about their backgrounds, their therapist constructed a diagram during his period of supervision (see Figure 2). The dilemma of each member of the couple is bound up with the contradiction between the official program and his or her map of the world. The behavior one reproaches the other for is precisely what helps him or her not to be confronted with this contradiction. The task to be proposed at particular times during the week should enable the members of the couple no longer to undergo their mutual double bind in the same way. For that to be possible, the task will need to be addressed to both levels of the double bind at the same time.
Figure 2. Reciprocal Double Blind For example, one task could be the following: Marco and Nathalie will decide what Nathalie could do so that Marco would look upon her as responsible. For example, she could carry out the chores allocated to her in the morning so that everyone is ready on time. Marco should then do his utmost to prevent her from succeeding. Nathalie and Marco will decide what Marco could do so that Nathalie feels a greater sense of freedom. For instance, he could accompany Nathalie to buy something for herself that she doesn't absolutely need. Nathalie could then try and convince Marco not to let her carry out the purchase. These tasks make it possible to ask the other to respond at the same time to the two levels of the double bind of the partner, for each is asked to respond to the official program and to respect the map of the world of the other. In addition, the latter request is not even made by the partner but by the therapist, which also frees each partner from his or her own double bind. Thus, Nathalie can behave responsibly, which is what Marco is explicitly asking for, and she can also respect his map of the world because she has been requested not to succeed. This frees Nathalie from the restraint she imposed upon herself by responding to Marco's map of the world. It is now he who explicitly requests her to behave irresponsibly. Marco may all the more easily ask Nathalie not to call in question his own map of the world because it is the therapist who has proposed that he make such a request of his partner. Marco is now free to live the two levels of his double bind without feeling in contradiction with himself. Similarly, Marco will be able to behave in such a way as to leave Nathalie free to make the purchase she wishes, in accordance with her explicit request; also, he can respect her map of the world because he has been requested to prevent her from making the purchase. This frees Marco from the constraint he imposed upon himself by responding to Nathalle's map of the world. It is now she who specifically requests him not to let her make the purchase. Nathalie may now all the more easily ask Marco not to call in question her own map of the world, as it is the therapist who proposes to her to make 4
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such a request. In this way, Nathalie may live the two levels of her double bind without feeling in contradiction with herself. The fact that I refer to Marco and Nathalie does not mean that I believe that their behavior is rooted in the intrapersonal attributes of either of them. The situation is one that is bound up with the two partners of the couple but is not reducible to them. The paradoxical tasks are addressed neither to Marco nor to Nathalie but to the situation in which they find themselves. When the repetitive cycle is reproduced, the rules of the couple, bound up with each partner's perception of them, will be experienced differently. Alternative cycles can thus come into being. As mentioned above, any couple, far from living in a vacuum, is inseparable from their various contexts. With few exceptions, the most indissoluble context is that made up of their most immediate family. However, we choose to intervene in the more extended family only in those cases in which the extended family is directly linked to the conflicts of the couple. In the specific situation of Nathalie and Marco, one of the functions of conflict seems to be to help the two partners not to separate themselves from their families of origin. Here again, a series of tasks might be proposed: Nathalie could choose a specific moment to behave "irresponsibly" in order to help Marco return to his parents. When Marco finds that Nathalie needs to return to the warmth of the family home, he should behave in such a way as to create a conflict that helps her return to her parents with peace of mind. Other variations are possible: for example, when Nathalie behaves responsibly, Marco will accompany her to her parents. When Marco lets Nathalie do what she wishes, she could accompany him to his parents' home. One of the advantages of this task is that it may remove the need for their conflict to persist in order to allow each of them to remain attached to his and her families of origin.
The Therapist and His or Her Map It has been customary to stress the importance of establishing a correct map that corresponds to the territory (7). In this context, the family therapy movement tried to look for maps that would help us to better understand the territory in which we were acting as family therapists. Following this path, we took an interest in the analogies between open systems at equilibrium or far from equilibrium (5) and human systems. For this reason we had to try to get rid of the paradox in which is represented a person drawing a map of a territory in which this person is finding himself or herself drawing that map. The theory of logical types of Russell has helped us try to maintain this problem at a distance by stressing the difference between logical levels. It seems that today we are beginning to accept the notion that our work as therapists will be hampered if we continue to separate both the observing system from the observed system and the "outside" from the "inside." We now realize that we cannot avoid being caught in the paradox in which we apparently describe a reality that we are constructing at the same time. It then becomes important, in working with human systems, to place oneself at the core of the paradox rather than avoid it. From that point on, what counts most is not so much the relationship between a map and a territory but the relationship between the maps of the members of the same system. What makes psychotherapy possible is first and foremost the congruence of the maps of the members of the therapeutic system. I should emphasize that the model I have proposed, as well as the modes of intervention I have described, are bound up with one of my particular ways of constructing reality. I make no claim to describe reality, but if the way the reader constructs reality coincides with mine, this model may prove useful, providing that a specific alliance with the couple undergoing therapy makes this type of intervention possible. To conclude, I wish to express my appreciation to those colleagues whose works have helped me to construct reality in this specific area, especially Paul Watzlawick, Janet Beavin Bavelas, Don D. Jackson (15, Mara Selvini-Palazzoli, Luigi Boscolo, Gianfranco Cecchin, Giuliana Prata (11), Carlos Sluzki (12), Philippe Caillé (2, 3), Humberto Maturana (8), Heinz von Foerster (14), and Francisco Varela (13).
REFERENCES 1. 2. 3. 4. 5. 6. 7.
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Bowen, M., Family Therapy in Clinical Practice, New York, Jason Aronson, 1978. Caille, P., "Couples in Difficulties, or the Cruel Face of Janus," J. Strat. Syst. Ther., 3, 1-11, 1984. Caillé, P. and Haartveit, H., "Scenes from a Couple Group," Fam. Ther. Networker, 8(1), 30-65, 1984. Elkaïm, M., (1981) "Non-equilibrium, Chance, and Change in Family Therapy," J. Mar. Fam. Ther. July 1981. Elkaïm, M., "From General Laws to Singularities," Fam. Proc., 24, 151-164, 1985. Framo, J., Explorations in Marital and Family Therapy, New York, Springer, 1982. Korzybski, A., Science and Sanity, Lakeville, Conn., The International Non-Aristotelian Library Publishing Company, 1933.
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8. 9. 10. 11. 12. 13. 14. 15.
Maturana, H., "What Is It to See?", Arch. Biol. Med. Exp., 16, 255-269, 1983. Papp, P., "Staging Reciprocal Metaphors in a Couple Group," Fam. Proc., 21, 453-468, 1982. Sager, C., Marriage Contracts and Couple Ther apy, New York, Brunner/Mazel, 1976. Selvini-Palazzoli, M., Boscolo, L., Cecchin, G. and Prata, G., Paradox and Counterparadox, Jason Aronson, New York, 1978. Sluzki, C., "Marital Therapy from a Systems Theory Perspective," in T. J. Paolino and B. S. McCrady (eds.), New York, Brunner/Mazel, 1978. Varela, F. J., Principles of Biological Autonomy, New York, Elsevier North Holland, 1979. Von Foerster, H., Observing Systems, Seaside, Calif., Intersystems Publications, 1981. Watzlawick, P., Beavin, J. and Jackson, D. D., Pragmatics of Human Communication, Norton, New York, 1967.
Manuscript received August 8, 1984; Revisions submitted November 30, 1984; Accepted September 5, 1985.
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