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Couple’s psychotherapy: learning to dance in synchrony

Interview with Dr Graziana D’Addabbo by Yuri Milaneschi

You’re a couple, ‘specially when your body’s doubled.

Massive Attack, Karmacoma

These cryptic lyrics from one of the most iconic Massive Attack’s tracks (I came of musical age in the ‘90s) often made me think about a specific aspect of my experience as a psychotherapist. In the (short) stretch of my career spent in clinic, before dedicating myself completely to research, I provided individual psychotherapy for anxiety and depression.

In this context, you sit together with a single client, but the clinical setting is inevitably inhabited by a multitude of others. The relational life of the subjects, especially with the closest partners, emerges in any part of the therapeutic work. Often, in exploring hidden thoughts fuelling discomforting emotions, the client sees images of the (allegedly accusatory, resentful, detached) gaze of the partner, producing painful feelings of shame, worthlessness, abandonment, anger or rage.

Relations disruptions may be signs of personality difficulties and almost invariably a detrimental consequence of unaddressed psychological distress. Here is the question triggered by the Massive Attack’s lyrics: what if the client in front of me doubles? What if I face the actual relationship rather than its internal representation in a single person? What would this change in the therapeutic work? I never had the occasion to experience this directly. Thus, I decided to ask Dr. Graziana D’Addabbo, an experienced clinical psychologist, who made the transition from individual to couple’s psychotherapist.

Could you describe your professional background and history?

I am a clinical psychologist and board-certified psychotherapist coming from Italy, where I worked for 10 years in different settings: hospital, schools and private practice. After moving to Amsterdam, I earned a research master’s in Clinical and Developmental Psychopathology and I had specific training in Emotionally Focused Couples Therapy (EFT), an evidence-based approach developed by Sue Johnson that was revealing for me.

Why did you decide to delve into couple’s therapy?

After years of delivering only individual psychotherapy, I felt the need to expand my area of expertise with specific training in couple’s therapy. Two reasons drove my motivation at that time.

The first one was clinical: more and more often I was facing some kind of limitations. Clients were hardly trying to solve their relational difficulties, talking with me over and over about a third person who was absent but at the same time so present in our room. Since most of the time the problems in a couple are negative patterns in which both partners play a role, the impact of individual therapy was limited.

The second reason was more personal. After struggling in my most important relationship and undergoing a couple’s therapy, I have realised how important it is to repair the bond. How important is to deeply understand our interactions and to change them.

What are the main differences you found moving from individual to couple’s psychotherapy?

Of course, the change in the setting is significant.

You deal at the same time and in the same space with two persons, two internal worlds. This can sometimes be intense, almost overwhelming. In particular, when partners fight, you may find yourself in a really dangerous territory where it is extremely important to validate what happens to both of them, without taking sides with one of the two and leaving the other one desperate and alone.

It is extremely important to remember that your client is their relationship and that everything that happens has to be read as a relational problem or resource. This has some practical implications. First of all, it changes how you evaluate and assess problems. Although as a clinician I recognise individual limitations or even potential psychological disorders (referring clients to individual therapies and psychiatric evaluation), the main focus is how those persons are connected or disconnected, what they do when they are triggered, how they feel and “how they dance” (S. Johnson) in their attachment bond.

The real “enemy” is the dysfunctional relational pattern and the different roles of the partners in their disharmonic dance. For example, one can play the role of a pursuer protesting and asking for connection, while the other one may withdraw. Remaining focused on this aspect helps to avoid the risk of being absorbed by the specific content of a fight. Instead, the core issue is the way the partners found to ask each other important questions (“Are you there for me if I need you?” “Can I trust you?”), beyond the obvious topics of conflict that are triggering distress.

What would you consider the core of couple’s psychotherapy?

The core is attachment, an innate survival instinct present from the beginning of our lives that shapes the way in which we structure relational bonds. Adult love is an attachment process and couple distress may be read as an insecure attachment, which can be described as the lack of availability, responsiveness and emotional engagement of the partner in moments in which the other one needs comfort and support. EFT is based on the evidence that adult lovers need a secure base and move in the same way as parents and children do in situations of distress.

When a partner tries to connect and the other doesn’t respond, we can observe the same behavioural strategies we see in children: protest and desperation (anxious strategy), distancing and shutting down (avoidant strategy) or both (fearful avoidant strategy).

What's interesting to underline is the universality of these behaviours, which allows me to work with couples from all over the world with extremely different cultural backgrounds but showing the same problematic patterns. The contents of the fights may be very different, but the emotions are the same.

How can the understanding of the attachment theory guide you in better helping your couples?

Using the lens of attachment allows me to understand and explore experiences, reactions, behaviours of the partners, without ever losing focus on why they need to move in certain ways that are causing them a lot of pain. Most of the time, a partner has their own way of interpreting what the other does or says, confirming preconceptions about the other (“He does that because he doesn’t care, he doesn't love me”).

It can be extremely revealing to discover that there may be other reasons behind certain behaviours, even positive and unexpected (“He is angry with me not because he hates me but because he feels guilty” or “She is withdrawing not because she doesn’t care but because she is scared of ruining the relationship”). Knowing what is happening when triggered, what the other one is saying to himself, and why one may feel threatened and become defensive or aggressive, combined with the awareness of our own reactions and emotions, is the first step for the de-escalation of the negative pattern and for creating safety.

A final suggestion for all the couples out there. When should they search for the kind of professional support you provide? What should they expect?

Our physical and mental health depends on how secure or insecure our intimate relationships are. That’s why it is so important to help couples to repair and to create secure interactions.

A professional support may be helpful when partners struggle to connect when the volume of their fights is higher and higher and the possibility of repairing is more and more difficult, when anger or silence are the only way to communicate, and when the partners are feeling lonely, even if they are together (that is worse than being alone).

When it’s not too late and the possibility to repair - although small - is still there after all the pain and the partners are willing to work together, the couple’s psychotherapy can help them reach a common goal: to learn how to dance together in synchrony, trusting and following the partner, knowing that if one stumbles, he will not fall but will be supported by the arms of his beloved.


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