Clarity, harmony, truth and unfailing courtesy for the reader are the major desirable ingredients Nobelist writer Ved Mehta learned from his editor, William Shawn of the New Yorker. These, you will find, characterize Arthur Nielsen's remarkable book on couple therapy.
Grounded in an in-depth review of the clinical and research literature, and drawing on his many years of experience, Nielsen's book describes the three main approaches to conceptualizing couple distress and treatment—systemic, psychodynamic, and behavioral. Then, he shows how they can be integrated into a user-friendly model that draws on the best of each. Covering both fundamentals and advanced techniques, this book—described by the current editor of Family Process (the lead journal in the field) as “one of the best books ever written about couple therapy”—should be valuable to both beginning and advanced couple therapists, as well as to psychoanalysts simply wishing to understand more deeply the problems of intimate relationships.
Nielsen, an analyst in Chicago, has spent four decades listening to, working with, and healing couples. He has also taught a wildly successful undergraduate course at Northwestern University, “Marriage 101: Building Loving and Lasting Relationships.”
Analysts, like other individual therapists, often struggle when they try to see partners conjointly. We find it hard enough to manage two psyches in the consulting room, the patient's and our own. How much harder to grasp three psyches, particularly when two are, as Nielsen notes, “often at war with each other.” Nielsen addresses this problem throughout the book, eschewing adherence to specific schools of technique, in favor of hewing to the needs of our patients. Like a fine sailor, he senses the crosswinds and the current in order to navigate to a peaceful shore.
The book is divided into modules of technique, each building on the others depending on the needs of the couple. It begins with the basic format of “Couple Therapy 1.0,” the Model T of couple therapy, where the therapist attempts to help the couple talk to each other in the here-and-now of the consulting room. This section offers immediate survival skills and fundamentals for working with more than one person simultaneously.
When Couple Therapy 1.0 proves insufficient, Nielsen adds therapeutic interventions he terms “upgrades.” The first of these focuses on the couple as system and describes maladaptive interpersonal dances, including common patterns (e.g., adversarial, pursuer-distancer, conflict avoiding, or identified patient couples) and interventions specific to each. The next section covers psychodynamic upgrades that allow us to examine dysfunctional process from the perspectives of hidden issues, divergent subjective experiences, transferences, and projective identification. We then shift to interventions that teach empathic listening, emotion regulation, problem solving, and communication skills. Nielsen concludes with a detailed chapter on how to sequence these therapeutic options. Detailed case examples throughout the book bring the concepts to life.
Buy and read this book. It will inform you about couple work, it will help you with your individual patients…and, it might even help your marriage.
Nathan Szajnberg, MD, is former Freud Professor (Hebrew University). His books include: Reluctant Warriors; Sheba and Solomon's Return; Jacob and Joseph; Judaism's Architects; and Lives Across Time, co-authored with Henry Massie. Szajnberg's two novellas are Jerusaland and Breathless.