Insight-Oriented Couple Therapy

Historical and Theoretical Underpinnings

Insight-oriented approaches to couple therapy vary in the extent to which they emphasize the unconscious nature of relational patterns, the developmental period during which these maladaptive patterns are acquired, and the extent to which interpersonal anxieties derive from frustration of innate drives. However, a shared focus of insight-oriented strategies are previous relationship injuries resulting in sustained interpersonal vulnerabilities and related defensive strategies interfering with emotional intimacy, many of which operate beyond partners' conscious awareness. Consequently, insight-oriented approaches to couple therapy emphasize that partners' maladaptive relationship patterns are likely to continue until they are understood in a developmental context. This new understanding serves to reduce partners' exaggerated emotional and behavioral reactivity and permits them to develop alternative, healthier relationship patterns.

Couple interventions emphasizing the interpretation of maladaptive relationship themes derive from diverse theoretical approaches that can be placed on a continuum from traditional psychoanalytic techniques rooted primarily in object relations theory to schema-based interventions derived from more traditional cognitive theory. In its most orthodox formulation, IOCT derives from object relations theory (developed by Melanie Klein, Ronald Fairbairn, and others) and its central tenet that the primary drive in infants is to secure attachment to the mother. From interactions primarily with the mother, infants develop internalized images (or “introjects”) of the self, significant others, and transactions connecting these images. From an object relations perspective, maladaptive relationship patterns of adults reflect enduring, unhealthy introjects that give rise to inevitable frustration when these are projected onto [Page 860]relationships with significant others. In a distressed marriage, partners' dysfunctional mental representations of significant others interact in an unconscious, complementary manner, resulting in repeated disappointments and persistent conflict. Consequently, the goal of psychoanalytically oriented couple therapy is helping partners to modify each other's projections, distinguish these from objective aspects of their own self, and assume ownership of their own projections.

Evolving from object relations theory, attachment theory (developed by John Bowlby) emphasizes the importance of emotional closeness to others as an innate survival function from which infants develop information-processing capabilities and emotional responses intended to foster secure emotional bonds. From an attachment perspective, difficulties in intimate adult relationships stem from underlying insecure or anxious models of attachment. Susan Johnson and Leslie Greenberg developed emotionally focused couple therapy (EFT) from an attachment theory perspective. EFT is different; EFT is how this is known by the field.

Interpersonal role theory (developed by Jack Anchin and Donald Kiesler) regards the persistence of maladaptive interpersonal patterns as resulting from their reinforcement by the responses of significant others. Rather than stressing dysfunctional mental representations, interpersonal theory emphasizes the unconscious assignment of specific roles to oneself and others in which feared relational events are elicited and enacted by the individual in his or her interactions with others.

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