Meeting of the New York Psychoanalytic Society

April 26, 1988. SHARED UNCONSCIOUS CONFLICTS, MARITAL DISHARMONY AND PSYCHOANALYTIC THERAPY. Fred M. Sander, M.D.

After reviewing the very sparse analytic literature on marriage, Dr. Sander noted a rather casual aside of Freud's, made in 1919, in which he observed that an unhappy marriage can supersede a neurosis and can satisfy an unconscious need for punishment. Partners in such marriages use externalizing defenses and often do not seek individual treatment. Feeling victimized and blaming others can defend against depression and anxiety. Dr. Sander discussed the concept of shared unconscious conflicts, as the "unhappy marriage" requires a colluding and compliant "other." There must be shared internalized reciprocal or complementary identifications and fantasies, an idea which Dr. Harold P. Blum recently applied to Shakespeare's Macbeth.

Patients' choice of modality of treatment is often determined by defensive factors—e.g., the choice of conjoint therapy when separation conflicts are central. If psychopathology is viewed as a continuum from poor self-object differentiation, with primitive defenses, to higher levels of object relations, one can see that conjoint therapy is often initially necessary if the presenting and primary complaints deal with interpersonal conflict. After some individuation is achieved by the patients, individual treatment or analysis might then follow—or it might be indicated at the outset if the patient has the capacity to take responsibility for his/her internal conflicts. Dr. Sander presented two cases to illustrate the presence of shared unconscious conflicts. He concluded with the speculation that there may be fewer analytic patients these days because many neuroses are imbedded in marital disorders, which are increasingly being treated by therapists who are not analytically trained. Dr. Sander also discussed the usually polemical controversy over the relative weight of intrapsychic and environmental factors in neurosogenesis.